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Effectiveness of pulse electromagnetic field therapy in patients with subacromial impingement syndrome: A double-blind randomized sham controlled study.

To evaluate the three-month effects of pulsed electromagnetic field therapy (PEMF) in the treatment of subacromial impingement syndrome (SIS). Planned analysis of a randomized controlled trial with 4- and 12-week follow-ups. Physical medicine and rehabilitation clinic, treatment unit PARTICIPANTS: : Of the 250 individuals screened for eligibility, participants with a diagnosis of SIS (N=80) were randomized to intervention or control groups. The first group received PEMF + exercise and the second group received sham PEMF + exercise 5 days a week for a total of 20 sessions. Visual Analogue Scale (VAS), Constant Murley Score (CMS), Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) Quality of Life Questionnaire, and shoulder muscle strength measurement with an isokinetic dynamometer. Evaluations were performed before treatment (T0), after treatment (T1) and 12th week (T2). Evaluation at T1 and T2 showed improvement in most parameters in both groups compared to baseline. In the comparison between the two groups at T1 and T2, more improvement was found in the PEMF group in most parameters. In our study, PEMF was found to be superior to sham PEMF in terms of pain, ROM, functionality and quality of life at the first and third months.

Chronic pain in the lower extremities and low back is associated with recurrent falls in community-dwelling Japanese people aged 40-74 years.

To determine the longitudinal association between chronic pain in the lower extremities and low back and the odds of recurrent falls in middle-aged and older people. A cohort study. Communities in Japan. Participants were 7,540 community-dwelling volunteers aged 40-74 years. The baseline survey was a self-administered questionnaire conducted between 2011-2013. Predictors were presence of chronic pain in the knee, foot/ankle, and low back, with the degree of pain categorized as none, very mild/mild, moderate, or severe/very severe. Covariates in the multivariate model of chronic pain in a site were demographics, body mass index, physical activity level, disease history, and chronic pain in the other 2 sites. Logistic regression analysis was used to calculate odds ratios (ORs). None. Recurrent falls in the year before the 5-year follow-up survey. Mean participant age was 60.2 years. Higher degrees of chronic pain were associated with higher odds of recurrent falls for the knee (P=0.0002) with a higher OR of 1.48 (95% CI: 1.11-1.97), for the foot/ankle (P=0.0001) with a higher OR of 1.97 (95% CI: 1.36-2.86), and for the low back (P=0.0470) with a higher OR of 1.45 (95% CI: 1.09-1.91) in those with any degree of pain relative to those without pain. Higher degrees of chronic knee pain were associated with higher odds of recurrent falls in women (P=0.0005), but not in men (P=0.0813). Meanwhile, higher degrees of chronic low back pain were associated with the odds of recurrent falls in men (P=0.0065), but not in women (P=0.8735). Chronic pain in the knee, foot/ankle, and lower back was independently and dose-dependently associated with a higher risk of recurrent falls. A marked sex-dependent difference was also noted in the association.

Interrater Reliability of the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Functional Independence Measure Motor Domain in Individuals With Hereditary Cerebellar Ataxia.

To determine the interrater reliability of the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), and motor domain of the FIM (m-FIM) administered by physiotherapists in individuals with a hereditary cerebellar ataxia (HCA). Participants were assessed by 1 of 4 physiotherapists. Assessments were video-recorded and the remaining 3 physiotherapists scored the scales for each participant. Raters were blinded to each other's scores. Assessments were administered at 3 clinical locations in separate states in Australia. Twenty-one individuals (mean age=47.63 years; SD=18.42; 13 male and 8 female) living in the community with an HCA were recruited (N=21). Total and single-item scores of the SARA, BBS, and m-FIM were examined. The m-FIM was conducted by interview. Intraclass coefficients (2,1) for the total scores of the m-FIM (0.92; 95% confidence interval [CI], 0.85-0.96), SARA (0.92; 95% CI, 0.86-0.96), and BBS (0.99; 95% CI, 0.98-0.99) indicated excellent interrater reliability. However, there was inconsistent agreement with the individual items, with SARA item 5 (right side) and item 7 (both sides) demonstrating poor interrater reliability and items 1 and 2 demonstrating excellent reliability. The m-FIM (by interview), SARA, and BBS have excellent interrater reliability for use when assessing individuals with an HCA. Physiotherapists could be considered for administration of the SARA in clinical trials. However, further work is required to improve the agreement of the single-item scores and to examine the other psychometric properties of these scales.

Cerebral Small Vessel Disease Burden: An Independent Biomarker for Anomia Treatment Responsiveness in Chronic Stroke Patients With Aphasia.

To determine whether MRI-based cerebral small vessel disease (cSVD) burden predicts treatment-induced aphasia recovery in chronic stroke patients above and beyond initial aphasia severity and stroke-lesion volume. Retrospective. Four cSVD neuroimaging markers were rated using validated visual scales: white matter hyperintensities, enlarged perivascular spaces, lacunes, and global cortical atrophy. We also calculated a cSVD total score. We employed linear regression models to model treatment response as a function of cSVD burden. We also ran correlation analyses to determine the association among cSVD burden and pre-treatment linguistic and non-linguistic cognition. Research clinic. The study includes data from 30 chronic stroke patients with aphasia who received treatment for word finding difficulties and completed additional pre-treatment neuroimaging and behavioral assessments (N=30). 120-minute sessions of anomia treatment 2 times per week for up to 12 weeks. Change in accuracy on the treatment probes measured as a percentage (ie, change in accuracy percentage score=post-treatment accuracy percentage minus pre-treatment accuracy percentage). Baseline cSVD burden predicted response to anomia treatment independently from demographic and stroke-related factors. Patients with lower cSVD burden exhibited enhanced rehabilitation response compared with those with higher cSVD burden (β=-6.816e-02, P=.019). cSVD burden was highly associated with nonverbal executive function at baseline (r=-0.49, P=.005): patients with lower cSVD burden exhibited higher performance on nonverbal executive function tasks compared with participants with higher cSVD burden. No association was observed among cSVD burden and performance on language tasks at the baseline. cSVD, a marker of brain reserve and a robust risk factor for post-stroke dementia, may be used as a biomarker for distinguishing patients who are more likely to respond to anomia therapy from those who are less likely to do so and for individualizing treatment parameters (eg, targeting both linguistic and nonlinguistic cognition in severe cSVD).

Effectiveness of rehabilitation interventions on adults with COVID-19 and post COVID-19 condition. A systematic review with meta-analysis.

To evaluate the effectiveness of rehabilitation interventions for adults with COVID-19 and post COVID-19 condition (PCC) in all settings. PubMed, EMBASE, CINAHL, Scopus, Web of Science and Physiotherapy Evidence Database were searched from inception to 31st December 2021. PROSPERO registration number: CRD42021258553. We included randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) according to the University of Alberta Evidence-based Practice Center. One author extracted data using a predetermined Excel form. The meta-analysis indicates uncertain evidence about the effect of pulmonary rehabilitation and self-activities on exercise capacity (MD 65.06, 95% CI 42.87 to 87.25), respiratory function (FEV1: MD 0.16, 95% CI 0.05 to 0.28; FEV1/FVC: MD 0.05, 95% CI 0.01 to 0.09; FVC: MD 0.19, 95% CI -0.03 to 0.42) and anxiety (MD -12.03, 95% CI -21.16 to -2.90) in mild COVID-19 and PCC patients. According to the narrative synthesis, including RCTs and NRSI, prone positioning seems to show improvements in vital parameters in severe COVID-19 post ICU discharge, pulmonary rehabilitation in activities of daily living, and qigong exercise and acupressure rehabilitation program, and "twist and raise" walking technique in reducing dyspnea and weakness in any degree of severity of COVID-19 and PCC. FES-cycling or early rehabilitation programs seem to support a faster recovery in patients with moderate COVID-19 after ICU discharge. Yoga and naturopathy, Mandala coloring, and respiratory exercise seem to reduce anxiety and depression in patients with moderate and mild COVID-19. Cognitive motor training seems to improve cognitive function in PCC patients. There is very uncertain evidence about the effect of pulmonary rehabilitation on exercise capacity and respiratory function in patients with mild COVID-19 and PCC. Further high-quality research is required to improve the certainty of evidence available to support rehabilitation's crucial role in managing COVID-19.

The temporal relationship between moderate to vigorous physical activity and secondary conditions during the first year after moderate-severe TBI.

To determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist worn accelerometer and secondary conditions in the first year after moderate-severe traumatic brain injury (TBI). Prospective longitudinal cohort study. Four inpatient rehabilitation centers. Individuals (n = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study. Participants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6 and 12 months post injury. Minutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone). At baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point. Given the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the impact of physical activity in individuals with moderate-severe TBI.

Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis.

To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective. AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022. Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task). Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted. CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, -0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439). CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.

Overground Robotic Exoskeleton Training for Patients With Stroke on Walking-Related Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

This review aims to evaluate the effectiveness of solely overground robotic exoskeleton (RE) training or overground RE training with conventional rehabilitation in improving walking ability, speed, and endurance among patients with stroke. Nine databases, 5 trial registries, gray literature, specified journals, and reference lists from inception until December 27, 2021. Randomized controlled trials adopting overground robotic exoskeleton training for patients with any phases of stroke on walking-related outcomes were included. Two independent reviewers extracted items and performed risk of bias using the Cochrane Risk of Bias tool 1 and certainty of evidence using the Grades of Recommendation Assessment, Development, and Evaluation. Twenty trials involving 758 participants across 11 countries were included in this review. The overall effect of overground robotic exoskeletons on walking ability at postintervention (d=0.21; 95% confidence interval [CI], 0.01, 0.42; Z=2.02; P=.04) and follow-up (d=0.37; 95% CI, 0.03, 0.71; Z=2.12; P=.03) and walking speed at postintervention (d=0.23; 95% CI, 0.01, 0.46; Z=2.01; P=.04) showed significant improvement compared with conventional rehabilitation. Subgroup analyses suggested that RE training should combine with conventional rehabilitation. A preferable gait training regime is <4 times per week over ≥6 weeks for ≤30 minutes per session among patients with chronic stroke and ambulatory status of independent walkers before training. Meta-regression did not identify any effect of the covariates on the treatment effect. The majority of randomized controlled trials had small sample sizes, and the certainty of the evidence was very low. Overground RE training may have a beneficial effect on walking ability and walking speed to complement conventional rehabilitation. Further large-scale and long-term, high-quality trials are recommended to enhance the quality of overground RE training and confirm its sustainability.

One and Done? The effectiveness of a single session of physiotherapy compared to multiple sessions to reduce pain and improve function and quality of life in patients with a musculoskeletal disorder: a systematic review with meta-analyses.

To compare single and multiple physiotherapy sessions to improve pain, function and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs). AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, PEDro and reference lists. Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs. Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation. Six RCTs (n=2,090) were included (Conditions studied: osteoporotic vertebral fracture, neck, knee and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at six months in favor of multiple sessions compared to single session interventions (3 RCTs; n=1,035; SMD: 0.29; 95% CI: 0.05 to 0.53; p=0.02) but this significant difference in pain improvement was not observed at three months (4 RCTs; n=1,312; SMD: 0.39; 95% CI: -0.11 to 0.89; p=0.13) and at twelve months (4 RCTs; n=1,266; SMD: -0.05; 95% CI: -0.49 to 0.39; p=0.82). Meta-analyses with low-certainty evidence showed no significant differences in function at three (4 RCTs; n=1,583; SMD: 0.05; 95% CI: -0.11 to 0.21; p=0.56), six (4 RCTs; n=1,538; SMD: 0.06; 95% CI: -0.12 to 0.23; p=0.53) and twelve months (4 RCTs; n=1,528; SMD: 0.08; 95% CI: -0.08 to 0.25; p=0.30) and QoL at three (4 RCTs; n=1,779; SMD: 0.08; 95% CI: -0.02 to 0.17; p=0.12), six (3 RCTs; n=1,206; SMD: 0.03; 95% CI: -0.08 to 0.14; p=0.59) and twelve months (4 RCTs; n=1,729; SMD: -0.03; 95% CI: -0.12 to 0.07; p=0.58). Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care.

Open Access