Proprioceptive Training and Conventional Physical Therapy on Balance and Quality of Life in Patients with Diabetic Peripheral Neuropathy: A randomized controlled trial

BackgroundThe upper extremity functional recovery remains a major challenge for specialists during post stroke rehabilitation, pertaining to adoption of various compensatory strategies by patients leading to motor redundancy and persistent functional limitations.ObjectivesThe study aimed to evaluate the effectiveness of Patient Tailored-Modified Constraint Induced Movement Therapy (mCIMT) combined with Trunk Restraint (TR) on Upper Extremity motor ability, balance, and health-related quality of life (HR-QOL) in chronic stroke survivors.MethodsIn this patient-blinded trial, 34 voluntary patients with chronic hemiplegia (>6 months post-stroke), aged 45-65 years, with Mini-Mental State Examination (MMSE) scores > 24 having and spasticity graded 1 or 1 + on Modified Ashworth Scale (MAS), were recruited and randomly allocated (1:1) to experimental or control groups. The experimental group received 60 min of Conventional Physical Therapy (CPT) plus 120 min of mCIMT with TR, while the control group received CPT treatment alone, three sessions per week for six consecutive weeks. Outcomes were assessed pre- and post-intervention using the Wolf Motor Function Test (WMFT), Berg Balance Scale (BBS), and Stroke Specific Quality of Life Scale (SS-QOL).ResultsBoth groups demonstrated significant improvements from baseline to post-intervention (p < 0.01) across all outcome measures. However, the experimental group exhibited significantly greater gains in functional ability, as reflected by SS-QOL scores (p < 0.005), compared to the control group.ConclusionEighteen sessions of mCIMT along with TR, delivered over six weeks in combination with CPT, demonstrated significant improvements in all outcomes (WMFT, BBS, and SS-QOL) among chronic stroke patients and is as beneficial to individual rehabilitation as conventional therapy alone.Trial registry name and URL: ClinicalTrails.gov (Registration ID: NCT06692569).

Boxing training including traditional stretching, muscular strength training, and duration training would be considered to be effective for improved functional stretching, dynamic balance, walking speed, and quality of life. We aimed to investigate upper limb function, balance, gait, and quality of life in stroke patients before and after a sitting boxing program. Twenty-six participants were randomly allocated to a boxing group (n = 13) and control group (n = 13) after the upper limb function, balance, gait, and quality of Life were recorded. The boxing group underwent a sitting boxing program (3 times/week) as well as conventional physical therapy (3 times/week) for 6 weeks. The control group only underwent conventional physical therapy (3 times/week) for 6 weeks. The Manual Functional Test (MFT), non-affected hand grip, Berg Balance Scale (BBS), velocity moment with eye opened, 10-m Walk Test (10 MWT), and Stroke-Specific Quality of Life questionnaire (SS-QOL) were significantly improved in the boxing group (p < 0.05) and showed significantly greater improvements in the boxing group compared to the control group (p < 0.05) after 6 weeks. The sitting boxing program group had positive effects on upper extremity function, balance, gait, and quality of life in stroke patients.

Background: Trigger points can cause severe and disabling pain in any skeletal muscle, however, upper trapezius trigger points tend to be more common. They frequently coexist with chronic musculoskeletal problems and cause pain both locally and regionally. The buildup of stress on muscle fibers and the development of trigger points may be caused by acute trauma or recurrent microtrauma. Objective: To determine the effectiveness of low-level laser therapy for the treatment of cervical pain in patients with trigger points of the upper trapezius muscle. Methods: A randomized controlled trial was conducted comprising 62 patients, randomly allocated into two groups, one received low-level laser therapy and conventional physical therapy while the other group received conventional physical therapy only. Outcome measures including pain intensity, cervical range of motion and neck disability index scores were assessed at baseline and after the 2nd and 4th weeks of treatment. While conducting the study, the rules and regulations set by the ethical committee of The University of Lahore were followed and the rights of the research participants were respected. The trial was completed in 9 months duration and data analysis was done using SPSS version 24. Repeated Measure ANOVA was applied with a 0.05 level of significance for the determination of changes in pain, neck disability index, and cervical range of motion parameters within the group. Independent sample t-test was used for the comparison of outcome measures between two treatment groups. Results: Most of the recruited patients were females in sample 50(80.65%). The mean age of participants was 27.81±7.7 years. Intra-group analysis showed significant improvement in all parameters (p&lt;0.05). There was a significant difference between the two groups for neck disability index and numerical pain rating scale (p&lt;0.05). Whereas, results manifest no significant improvement in cervical ranges at 4th week between both groups. Conclusion: Low-level laser therapy along with conventional physical therapy is proven to be more effective than conventional physical therapy treatment used in patients with trigger points of upper trapezius in terms of reducing pain and disability. However, it does not affect improving the range of motion of the neck.

Background: Trigger points can cause severe and disabling pain in any skeletal muscle, however, upper trapezius trigger points tend to be more common. They frequently coexist with chronic musculoskeletal problems and cause pain both locally and regionally. The buildup of stress on muscle fibers and the development of trigger points may be caused by acute trauma or recurrent microtrauma. Objective: To determine the effectiveness of low-level laser therapy for the treatment of cervical pain in patients with trigger points of the upper trapezius muscle. Methods: A randomized controlled trial was conducted comprising 62 patients, randomly allocated into two groups, one received low-level laser therapy and conventional physical therapy while the other group received conventional physical therapy only. Outcome measures including pain intensity, cervical range of motion and neck disability index scores were assessed at baseline and after the 2nd and 4th weeks of treatment. While conducting the study, the rules and regulations set by the ethical committee of The University of Lahore were followed and the rights of the research participants were respected. The trial was completed in 9 months duration and data analysis was done using SPSS version 24. Repeated Measure ANOVA was applied with a 0.05 level of significance for the determination of changes in pain, neck disability index, and cervical range of motion parameters within the group. Independent sample t-test was used for the comparison of outcome measures between two treatment groups. Results: Most of the recruited patients were females in sample 50(80.65%). The mean age of participants was 27.81±7.7 years. Intra-group analysis showed significant improvement in all parameters (p&lt;0.05). There was a significant difference between the two groups for neck disability index and numerical pain rating scale (p&lt;0.05). Whereas, results manifest no significant improvement in cervical ranges at 4th week between both groups. Conclusion: Low-level laser therapy along with conventional physical therapy is proven to be more effective than conventional physical therapy treatment used in patients with trigger points of upper trapezius in terms of reducing pain and disability. However, it does not affect improving the range of motion of the neck.

Background: Diabetic peripheral neuropathy, is a common manifestation of peripheral nervous system in diabetes due to elevated glucose level. Symptoms include painful lower limbs, altered sensation, reduce reflexes and weakness of lower limb resulting in impairment in balance and gait. As treatment various interventions are used such as balance training, strength training, aerobic exercise, sensory motor training. Aim of study: This study was to assess the effect of multisensory exercise training on sensation and balance in patients with diabetic neuropathy. Methodology: This study was conducted in various OPDs and diabetic center of Surat. 10 diabetic neuropathic patients were randomly assigned in to 2 groups; 5 patients were allocated in group A (conventional &amp; multisensory training) and 5 patients were allocated in group B (conventional therapy). Patients in both groups were treated for 3 days per week for 4 weeks. Conventional physiotherapy was given for 3 days in a week at home for 4 weeks. Sensation and balance were assessed by using Semmes-Weinstein Monofilaments and berg balance scale respectively. Data were recorded at baseline and after 4 weeks of training. Result: The result showed there was no significant difference in effect of multisensory exercise on sensation and there was significant improvement in balance in patients with diabetic neuropathy. Conclusion: The result of study indicate that 4 weeks of multisensory exercise program was improving balance in patients with diabetic neuropathy as compare to conventional therapy. Key words: Multisensory exercise, Sensation, Balance, Diabetic neuropathy

Background:Strengthening the hip muscles, particularly the abductors and rotators, has been reported beneficial for treating Patellofemoral pain syndrome (PFPS). Proprioceptive training (PT) is also shown to improve musculoskeletal pain and function in PFPS. The most appropriate treatment from these 2 is unclear. This study aimed to compare the effects of hip abductors and external rotator strengthening exercises along with conventional physical therapy (CPT) vs the proprioceptive training of the knee along with CPT in patients with PFPS.Methods:Forty-five participants were divided into 3 groups, experimental group 1 (EG 1), experimental group 2 (EG 2), and control group (CG), with fifteen participants in each group. EG 1 received hip abductor and external rotator strengthening exercises in addition to CPT. EG 2 received proprioceptive training and CPT. CG received CPT alone. Intervention programs lasted for 4 weeks. The pain was measured by Kujala Anterior Knee Pain Scale (AKPS). The study was registered retrospectively in the protocol registration and results system (clinicaltrials.gov, ID: NCT05698797 on 26/01/2023).Results:AKPS scores significantly (P < .001) improved in all 3 groups. A significant (P < .05) difference was also observed between all 3 groups. The greatest improvement was observed in EG 1, followed by EG 2 and CG.Conclusion:The addition of hip abductor and external rotator strengthening exercises to a 4-week CPT program showed a more significant improvement in AKPS scores than the addition of proprioceptive training in patients with PFPS.

We aimed to investigate the effects of aerobic exercise on pain perception, sensitivity, and health-related quality of life; to assess its effect on parasympathetic tonus by analysis of heart rate recovery; and to examine the effects of parasympathetic tone on pain sensitivity in patients with chronic musculoskeletal pain. Fifty patients with chronic musculoskeletal pain were randomized into two groups: control group (C group) and aerobic exercise group (AE group). Both groups received conventional physical therapy for 2 weeks; the AE group performed submaximal aerobic exercise on a treadmill for 30 min additionally. Exercise test, pressure-pain threshold measurement, short form-36, and visual analog scale were administered initially and finally for evaluation. Visual analog scale scores in both groups decreased significantly after treatment (P<0.001). Pressure-pain threshold sum increased significantly in the AE group, remaining unchanged in the C group. Increase in exercise test duration was significant in the AE group compared with the C group (P=0.0002). Heart rate recovery did not change with therapy in the groups. For short form-36, the AE group showed alterations in role limitations because of physical problems and general health perceptions; both groups showed a significant improvement in the physical function and bodily pain subscales, but mental health significantly improved only in C group. Short-term aerobic exercise along with conventional physical therapy decreased pain sensitivity and increased aerobic capacity, with significant improvements in health-related quality of life.

Stroke patients experience impaired sensory and motor functions, which impact their activities of daily living (ADL). The current study was designed to determine the best neurorehabilitation method to improve clinical outcomes, including the trunk-impairment scale (TIS), Berg balance scale (BBS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI), in stroke patients with impaired sensory function. Forty-four stroke survivors consistently underwent proprioceptive body vibration rehabilitation training (PBVT) or conventional physical therapy (CPT) for 30 min/session, 5 days a week for 8 weeks. Four clinical outcome variables-the FMA, TIS, BBS, and MBI-were examined pre- and post-intervention. We observed significant differences in the FMA, BBS, and MBI scores between the PBVT and CPT groups. PBVT and CPT showed significant improvements in FMA, BBS, TIS, and MBI scores. However, PVBT elicited more favorable results than CPT in patients with stroke and impaired sensory function. Collectively, this study provides the first clinical evidence of optimal neurorehabilitation in stroke patients with impaired sensory function.

Prospective, Longitudinal Evaluation of Health Related Quality of Life in the Pediatric Spina Bifida Population Undergoing Reconstructive Urological Surgery

Objective:To determine effectiveness of proprioceptive training and conventional physical therapy in managing patients with adhesive capsulitis.Methods:A pre-test post-test control group study was conducted at Rehman Medical Institute from June to December 2019. Thirty-eight patients, aged 30 to 60 years, with diagnosis of adhesive capsulitis for more than four months were divided into two groups. Subjects in Group-I (conventional group; n=19) received conventional physical therapy protocols for one month while subjects in Group-II (proprioceptive group; n=19) received proprioceptive training along with conventional physical therapy for one month. Disability of Arm Shoulder & Hand questionnaire, Shoulder Pain & Disability Index and goniometer were used at baseline and post-treatment to assess functional activity level, pain & disability and range of motion respectively. Data was analyzed using SPSS version 20.Results:The mean age of the participants was 53.13 ± 9.12 years. Baseline characteristics were balanced between the two groups. After the treatment, all measures (functional activity level, pain, disability, ROM) improved in both groups. Post treatment, between group analysis showed that functional activity (DASH) and pain (SPADI pain) significantly (P-value <0.05) improved in proprioceptive group as compared to conventional group. However, there were no significant differences (P-value≥ 0.05) in post treatment SPADI disability, SPADI total and ROM (flexion, abduction, external rotation) scores of both groups.Conclusion:Proprioceptive exercises along with conventional physical therapy are more effective in managing pain and improving functional activities in adhesive capsulitis patients as compared to conventional physical therapy alone.

Health Related Quality of Life for Stone Formers

Background: Loss of balance and Activity of daily living commonly compromised in stroke patients. Conventional physical therapy CPT) showed promising result in the rehabilitation of stroke, but these effects are very slow. Virtual reality (VR) technology is an adjunctive therapy that could be applied in neurorehabilitation in conjunction with conventional physical therapy. Objective: The aim of the study was to determine the effectiveness of virtual reality and conventional physical therapy (CPT) for stroke management in improving activities of daily living and balance. Methodology: A total of n=30 participants with sub-acute ischemic stroke, aged between 45-65 years, were divided into group A and group B. The group A received virtual reality training (VRT) with conventional physical therapy (CPT) for stroke management, while Group B received conventional physical therapy (CPT). The activities of daily living (ADLs) were assessed through Barthel index and balance was assessed through Balance Berg Scale (BBS). The data was collected at baseline, 2nd week, 4th week and after 6th week of intervention. The mixed ANOVA and One way MANCOVA was applied to see the interaction and main effects. The data was analyzed using SPSS 21. Results: The mean age of study participants of Group A was 51.533±4.82 years and Group B was 52.53±5.01 years. There is significant interaction effect between interventions and level of assessment in Balance score {F=11.705(1.683, 47.134), p&lt;.001, ηp2=.295} as well as activity of daily living {F=4.782(2.209, 61.841), p=.010, ηp2=.146} after 6 week intervention. Conclusion: Both groups were effective in improving ADLs and balance but VR was more effective as compared to traditional balance exercises. Keywords: activities of daily living, acute stroke, balance, physical therapy, virtual reality

Health Related Quality of Life Outcomes in Patients Treated for Metastatic Kidney Cancer: A Pilot Study

Aims/Background The evaluation of health-related quality of life in patients undergoing maintenance haemodialysis has garnered increasing attention. The modified creatinine index, a surrogate marker for muscle mass, has been linked to various clinical outcomes. However, the relationship between modified creatinine index and health-related quality of life in maintenance haemodialysis patients remains unclear. This study aims to elucidate the association between modified creatinine index and health-related quality of life in individuals receiving maintenance haemodialysis. Methods This cross-sectional study included 217 maintenance haemodialysis patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life Instrument. Collected data included general patient information, laboratory results, and haemodialysis-related parameters. The modified creatinine index was calculated based on gender, age, single-pool Kt/V (spKt/V), and pre-dialysis serum creatinine levels. Multiple linear regression models and smooth curve fitting were used to investigate the relationship between modified creatinine index and health-related quality of life. Subgroup analyses and interaction tests were performed to identify potential effect modifiers. Results The 217 maintenance haemodialysis patients had a mean age of 53.66±13.15 years and a median dialysis vintage of 39 (25-84) months; 120 (55.30%) were male. The mean health-related quality of life score was 55.76±10.33, and the mean modified creatinine index was 22.72±2.95 mg/kg/day. After adjusting for confounding factors, an increase in modified creatinine index was associated with an improvement in health-related quality of life (β=0.55, 95% CI: 0.04, 1.06, p = 0.033). No nonlinear relationship was identified between modified creatinine index and health-related quality of life by smooth curve fitting. Subgroup and interaction analyses indicated that the relationship between modified creatinine index and health-related quality of life was stable and not significantly influenced by age, gender, dialysis vintage, diabetes status, or body mass index (p > 0.05). Conclusion Modified creatinine index is positively correlated with health-related quality of life in maintenance haemodialysis patients, suggesting its potential utility in evaluating patient quality of life. Modified creatinine index could be clinically useful to improve the predictability of health-related quality of life in maintenance haemodialysis patients.

Determinants of Quality of Life for Patients With Kidney Stones