Introduction: En bloc turning highlights a lack of rotational intersegmental coordination, which commonly impacts turning ability in people with Parkinson's disease (PD). Whilst this turning deficit responds fairly well to medical treatment, it may be further mitigated by performing specific exercise training. Thus, the present study aimed to examine the effects of a 4-week exercise program, which focused on task-specific movements (TSM program) on turning ability and clinical outcomes in people with PD.
Methods: Twenty-two adults (67 ± 6 years) with early-to-mid-stage idiopathic PD were randomly assigned to an experimental group (EG; n = 11) or a control group (CG; n = 11). The exercise group (EG) group received a 60-min per session TSM program for 4 weeks (a total of 15 sessions), while the CG group performed their routine rehabilitation program (a total of 12 sessions). Inertial measurement units were used to measure turning kinematics including; onset latency of body segments and stepping characteristics. Clinical outcomes included the Unified Parkinson's Disease Rating Scale (UPDRS), functional reach test (FRT), and fall efficacy scale international (FES-I). Assessments were conducted at baseline and after 4 weeks.
Results: In the EG, turning kinematics, UPDRS scores, FRT, and FES-I scale, were improved at the end of the 4-week program compared with the CG (all p < 0.05).
Impact statement: A 4-week TSM program could be a promising alternative rehabilitation program for improving "en bloc" turns and clinical outcomes in PD patients.
Background and purpose: Sleep problems are common in individuals with chronic low back pain (CLBP). Central sensitization (CS) is present in a subgroup of individuals with CLBP. However, our knowledge about whether sleep quality varies between the subgroups of CLBP is limited. Therefore, we sought to examine whether the subgroup of CLBP with CS has poorer sleep quality than the subgroup without CS.
Methods: 2011 Fibromyalgia Survey (2011 FM survey) was used as a surrogate measure of CS to divide the CLBP participants into two subgroups: CLBP with CS and CLBP without CS. We also created a CS index comprising a set of quantitative sensory testing measures (i.e., pressure pain thresholds, conditioned pain modulation) to evaluate pain sensitivity. Sleep quality was assessed with Pittsburgh Sleep Quality Index (PSQI). Group differences about PSQI and CS index and associations between sleep quality and CS across the groups were analyzed.
Results: We included 60 participants with CLBP and 23 healthy controls (HCs). Overall, 80% of the participants with CLBP presented with poor sleep quality. Participants with CLBP with CS showed significantly higher PSQI scores (poorer sleep) than participants with CLBP without CS and HCs (p < 0.05). Both the 2011 FM survey and CS index were significantly correlated with sleep quality (r = 0.5870, p < 0.001 and r = -0.264, p = 0.04). Logistic regression models revealed that the FM status (odds ratio (OR) = 6.00, p = 0.02 [95% confidence interval: 1.31-42.1]), but not the CS index (OR = 1.11, p = 0.79 [95% CI: 0.48-2.71]) was associated with PSQI. After adjusting covariates, the results remained similar but became non-significant for the FM status.
Discussion: We found that sleep problems were more common and severe in those who exhibited signs of CS. Thus, clinicians may consider using 2011 FM survey to identify those with CS and co-existing sleep problems.
Objective: To determine how physically active individuals are following total knee replacement (TKR) and how accurately they self-report their step count adherence compared to objective measure following TKR.
Methods: Observational cohort study, nested within the PATHway randomised-clinical trial. Participants (n = 102) who had recently undergone TKR were recruited for the main trial. Only participant data from the intervention group were used for this study (n = 51). Participants in the intervention group received an activity tracker to monitor their physical activity and fortnightly health-coaching sessions for 3 months. Adherence was objectively measured as percentage of steps completed divided by the amount prescribed by the health coach. Participants were asked to self-report their adherence on a 1-10 numerical rating scale during health coaching sessions.
Results: Data from 44 participants were available, resulting in a total of 224 paired measurements. Participant step count increased over the first 8 weeks of follow-up, and plateaued from 8 weeks onwards at approximately 7500 steps/day. About two-thirds (65.8%) of participants accurately self-reported their step count adherence up until 12 weeks, the remaining one-third (34.2%) underestimated their adherence. Paired t-tests demonstrated statistically significant differences between the paired measurements from weeks 2 to 10.
Discussion: Participants were generally active and completed the step goal most occasions. Two-thirds accurately self-reported their step goal adherence. Self-reported measures should be combined with an objective measure of adherence for greater accuracy. A further understanding of how people engage with activity trackers can be used to promote behaviour change in physiotherapy-led interventions.
Background and purpose: The therapeutic benefits of prone positioning have been described over the last 50 years culminating in a systematic review supporting this management strategy for patients with severe hypoxaemic respiratory failure. Early work detailing treatment approaches for COVID-19 have advocated the use of prone positioning. Limited data exists regarding physiotherapy intervention in patients with COVID-19 owing to the recent emergence of this novel disease. Despite the acknowledged beneficial effects of physiotherapy on secretion clearance and lung recruitment in the general critical care population, there is a lack of evidence pertaining to physiotherapeutic intervention for acutely unwell intubated adults in prone lying.
Methods: This case study report follows the CARE case report guidelines. One patient with COVID-19 pneumonitis who underwent physiotherapy intervention in prone lying is discussed. Informed consent was gained from next of kin for data to be published.
Results: Treatment techniques including mechanical insufflation-exsufflation in prone were feasible and well tolerated by this patient with only transient adverse effects noted. Treatment techniques assisted with secretion clearance.
Discussion: Further work on safety, feasibility, and efficacy of physiotherapy intervention in patients with and without COVID-19 in prone will contribute to the evidence base on this subject.
Background and objectives: The neuromuscular system is responsible for performing adequate muscle activities to maintain postural balance. Since COVID-19 can cause damage to this system, long-term sequelae might alter control of postural stability. This study aimed to evaluate the postural balance of patients with post-acute COVID-19 syndrome (PCS) who were not hospitalized and to evaluate the correlations of changes in postural balance with general fatigue, muscle strength, and quality of life (QoL).
Methods: This was a cross-sectional study in which 40 patients with PCS and 40 controls underwent balance assessment through the Berg Balance Scale (BBS) and Tinetti Balance Scale (TBS). They were evaluated for general fatigue by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and quality of life (QoL) by the Short Form-36 (SF-36).
Results: When compared to controls, patients with PCS had lower BBS and TBS scores (p = 0.001 for both). The FACIT-F score was lower in PCS patients (p = 0.0001). HGS was slightly lower in the PCS patients, but not statistically significant (p = 0.09). Regarding QoL, PCS patients showed worse evaluations in five dimensions of the SF-36 (physical functioning, physical role limitations, bodily pain, general health perceptions, and mental health). Both the BBS and TBS scores had statistically significant positive correlations with the FACIT-F score, HGS, and two SF-36 dimensions (physical role limitations and emotional role limitations).
Conclusions: Patients with PCS show worse postural balance than controls, which is associated with general fatigue, lower HGS, and poor QoL. Postural balance assessment should be considered in the follow-up and rehabilitation of PCS.
Background and purpose: Most published clinical practice guidelines (CPGs) endorsed therapeutic exercises, education, and body weight management as the gold standard for managing knee osteoarthritis (OA). However, it is difficult to ascertain whether the physiotherapy practice pattern in Ghana uniformly conforms to the generally accepted standard. Our aim was to describe the patterns of physiotherapists' practice with respect to Knee OA in a low-resource setting.
Method: A web-based nationwide cross-sectional survey was performed among registered members of the Ghana Physiotherapy Association. Consented participants were sampled into the study through a purposive sampling method. A self-designed and validated questionnaire was administered to obtain the participants' awareness of CPGs, while the selection of modalities by the physiotherapists was based on a clinical vignette. Exploratory analysis of data was performed for the association of the age, sex, education, and the number of patients managed per week with the awareness of CPGs, using the Chi-square test at a significance level of p < 0.05.
Results: Of the total 165 participants, only 148 responded and were included for data analysis. Sixty-one (41.2%) of the 148 respondents were aware of specific CPGs for knee OA management, even though 98 (66.2%) utilized OA-specific outcome measures for management evaluation. Majority of the participants (90.5%) commonly selected therapeutic exercises, and 83.8% utilized education for weight management. Transcutaneous electrical nerve stimulation and ice therapy were selected by 68.2% and 66.2% of the respondents, respectively. The number of patients managed per week was not significantly associated (p > 0.05) with the awareness of CPGs.
Discussion: Our findings show high utilization of therapeutic exercises and patients' education in the management of knee OA despite the low awareness of OA-specific CPGs.
Implication for physiotherapy: The inclusion of passive modalities coupled with the physiotherapists' low awareness underpins the need for continuing education on condition-specific CPGs.
Background and purpose: Many patients experience post-COVID-19 functional limitations. This study aimed to monitor the functional improvement of patients over 3 months of follow-up and determine the risk factors.
Methods: This prospective cohort study evaluated 100 hospitalized patients who recovered from COVID-19 infection. The mean age was 53.2 ± 13.1 years. Fifty-nine had at least one comorbid condition. The mean lengths of the hospital and ICU stays were 7.8 ± 3.3 and 5.3 ± 2.5 days, respectively. The functional status of the patients was evaluated using functional independence measure (FIM) and post-COVID-19 functional status (PCFS) questionnaires at four time-points of discharge, 1 week, 1 month, and 3 months after discharge.
Results: Mean FIM score was 107.2 ± 17.4 at the time of discharge, 113.3 ± 14.9 at 1 week, 120.3 ± 10.2 at 1 month, and 124.3 ± 6.4 at 3 months after discharge (p < 0.001). The PCFS score was 2.71 ± 1.25 at discharge, 2.09 ± 1.3 at 1 week, 1.14 ± 1.1 at 1 month, and 0.64 ± 0.59 at 3 months after discharge (p < 0.001). Female sex, older age, and the lengths of hospital and ICU stays were negatively correlated with the functional status score.
Discussion: Post-COVID-19 functional limitations are observed in hospitalized patients and improve over 3 months after discharge. Female sex, older age, longer hospital, and ICU stays are risk factors that negatively impact functional status.
Objectives: To investigate the recovery of physical function, health related quality of life (HRQoL), and pain for people following hip fracture for the initial 12 months, and to examine whether postoperative outcome measures of physical function, HRQoL, and pain can predict physical function at 3 and 12 months.
Design: A prospective single-center observational study, as part of the HIPFRAC trial.
Settings: One hospital with two associated municipalities in Norway.
Subjects: 207 participants with hip fracture included in the study (140 participants transferred to a short-term nursing home placement and 67 transferred directly home at discharge from hospital).
Method: Outcome measures were Short Physical Performance Battery (SPPB), Timed Up & Go (TUG), Stair climbing test (SC), Numeric Rating Scale (NRS) for pain at rest and in activity, and EQ-5D-5L index and health score. Data were analysed by repeated measures of variance and multivariate regression analyses.
Results: There were statistically significant improvements in physical function (SPPB total score and TUG), NRS-pain in activity, and HRQoL (EQ-5D-5L) from hospital discharge to 3-month follow-up for the whole cohort and the two groups (p < 0.001). However, the largest improvements occurred within the first 3 months. Further statistically significant improvements occurred between 3 and 12 months (p < 0.05). The strongest predictors of physical function at 3 and 12 months post-fracture were physical function (SPPB) at hospital discharge and pre-fracture requirement of a walking aid.
Conclusion: The recovery of physical function, HRQoL, and pain in participants after hip fracture indicates gradual improvements during the initial 12-month follow-up, with the largest improvements within the first 3 months.
Background and purpose: There is an ongoing controversy in respect of the usage of continuous passive motion (CPM) following total knee arthroplasty (TKA). We analysed the impact of CPM on the early rehabilitation after TKA and the clinical outcome over the time.
Methods: Forty patients were prospectively randomized to postoperative protocols following TKA. Half of them (n = 20) received the standard manual therapy alone and the others (n = 20) were treated additionally with CPM. Identical implants were used in all patients. Passive range of movement (PROM) was noted. Patient satisfaction and knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the Knee Society Score (KSS) at time of discharge and 2 years postoperatively.
Results: The patients in the solitary manual therapy group (MT) showed preoperatively a 7.2° greater PROM (p = .03) with 5.4° higher flexion (p = .05). Analogously, the KSS presented with 42.7 points a higher score result compared to the CPM group with 35.9 points (p = .03). Although the preoperative ability with 105.2° for flexion and 97.2° for the PROM were in favour of the group without CPM (99.8° resp. 90.0°), at time of discharge the patients with CPM reached with 111.0° a significant higher flexion and with 109.0° a higher PROM (MT group: 107.0° resp. 103.5°) (p = .04/.02). At 2 years follow-up both scores (WOMAC/KSS) and function (extension, flexion and PROM) were balanced (p > .05). Patella resurfacing showed no impact on the clinical results at discharge or at time of last follow-up (p > .05).
Discussion: Although the addition of CPM did significantly improve knee flexion in the early postoperative stage, the difference might not represent a clinical relevance. Further, there were no notable effects on long-term clinical and functional results following TKA, so the routine application of CPM in the above stated setting might be ceased.
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