Benefits Of Physical Therapy Research Articles

Total Knee Arthroplasty Assessments Should Include Strength and Performance-Based Functional Tests to Complement Range-of-Motion and Patient-Reported Outcome Measures.

Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy.

Effect of stretching, strengthening exercises and walking on the management of restless legs syndrome: A cross sectional study

Background: Restless Leg Syndrome (RLS) is one of the most common causes of sleep disorders that cause functional disability in the lower limb. Due to it is self-limiting, it forces the person to seek treatment. Unfortunately, most of the times, it is misdiagnosed by the doctors and even if it is diagnosed, till date there is no guide program or treatment in the physical therapy. There is huge dearth of knowledge regarding benefits of physical therapy in RLS. Objective: The aim of the present study was to investigate the effect of stretching, strengthening exercises as well as walking on RLS symptoms. Also, to find out the impact of muscle strength and flexibility in relation to the severity of RLS symptoms. Methods: An inquiry of 418 questionnaires randomly distributed was done. A total of 20 participants diagnosed with Restless Leg Syndrome were included in the current study. Pre-post assessment was done for range of motion (by goniometer), functional testing of the foot and ankle, RLS rating scale and RLS ordinal scale. Six participants received physical therapy program for a total of 4 weeks. Twenty patients who had one visit to have the measurement were studied for the correlation study. Results: There was a significant correlation between leg muscles flexibility, strength and the severity of the symptoms. Also, there was a highly significant alleviation of symptoms in the other 6 patients. Conclusion: It can be concluded that physical therapy is effective in relieving symptoms of RLS.

Timed Up and Go as a predictor of mortality in older Indian patients with cancer: An observational study

Background: Therapeutic decision-making in older patients with cancer is challenging, and there is a need for a clinical parameter that can guide these decisions. The Timed Up and Go (TUG) test is an easy-to-administer tool that measures physical performance and may help to identify vulnerable patients.Objectives: We aimed to study the association between the TUG and overall survival in older Indian patients with cancer. We also aimed to evaluate the factors that were associated with a poor TUG score, to define the optimal cut-off score for older patients with cancer, along with the sensitivity and specificity.Materials and Methods: This prospective observational study was conducted in the geriatric oncology clinic at the Tata Memorial Hospital, a tertiary care center in Mumbai, India, between June 2018 and January 2022. We included adults aged 60 years and above, who had a diagnosis of malignancy, and had undergone a multidimensional geriatric assessment. Patients without a TUG score and for whom survival information was not available were excluded. Using the Short Physical Performance Battery (SPPB) as the gold standard, Receiver Operating Characteristic (ROC) curves with Area Under the Curve (AUC) were used, and the cut-off score with optimum sensitivity and specificity was derived. Mean values between two and more groups were compared using t test and analysis of variance, respectively. Categorical variables were compared using Fisher's exact and Pearson's Chi-squared test. The Kaplan–Meier survival estimate, and the unadjusted and adjusted Cox proportional-hazards model were used for survival analysis.Results: We enrolled 851 patients in the study. The median age was 69 (IQR, 65 to 73) years; 544 patients (76%) were men. We found that the TUG in women (median TUG, 11 seconds; IQR, 9.5 - 13.7) was longer than in men (median TUG, 9.6 seconds; IQR, 8.2 -11.6); P < 0.01. The TUG score increased significantly with increasing age in both sexes. Presence of comorbidities impaired cognition, poor nutritional status, depression, and anxiety were significantly associated with higher TUG scores. TUG was a significant predictor of mortality on both the univariate (HR, 1.056; 95% CI, 1.037–1.075) and multivariate models (HR, 1.058; 95% CI, 1.039–1.078). The median survival of patients with TUG <12 seconds was 13.9 months (95% CI, 11.2 to 16.5), compared to 8.5 months (95% CI, 6.6 to 10.3) in those with a TUG ≥ 12 seconds (P = 0.002). The TUG cut-off score of 10 seconds had an AUC-ROC, sensitivity of 62.32% and specificity of 80.58%.Conclusion: TUG can be a reliable tool in a busy outpatient setting to identify vulnerable patients who require a detailed geriatric assessment. A TUG score of ≥ 10 seconds is a good predictor of impaired mobility. Further 0.78 interventional studies are required to identify the benefits of physical therapy in older patients with cancer.

Benefits of physical therapy for people living with hemophilia.

This crossover study investigated effects of physical therapy (PT) on motor function in patients with hemophilia infected with human immunodeficiency virus (HIV) due to treatment with non-heat-treated blood products. Patients were randomly divided into a PT-first group (PT once monthly for 6 months, then only home exercise (HE) for 6 months) and an HE-first group (HE for 6 months, then PT once monthly for 6 months). Carryover, period, and treatment effects were examined. Carryover effect was observed for flexion muscle strength of the right hip joint and fast walking cadence. Period effect was observed for extension Range of motion (ROM) of the left hip joint, dorsiflexion of the right ankle joint, and fast walking cadence. PT tended to be effective for abduction of the left shoulder joint and fast walking cadence. Compared with HE, PT tended to contribute to improving ROM of the shoulder joints and fast walking.

PHYSICAL THERAPISTS’ PERCEPTIONS OF ADOLESCENT IDIOPATHIC SCOLIOSIS TREATMENT

Background:Few studies have demonstrated the benefit of physical therapy in the treatment of adolescent idiopathic scoliosis (AIS), alone or in conjunction with bracing or surgery. To our knowledge, there is no consensus in pediatric physical therapists who treat AIS patients.Purpose:To identify the optimal physical therapy practices for AIS including; weekly frequency, session length, treatment duration, clinical interventions, therapeutic goal-setting, and outcome measures from pediatric physical therapists’ perspectives.Methods:A 40-question validated survey, The Analysis of the Schroth Method in Adjunct to Physical Therapy Services for Treatment of AIS, was distributed to pediatric physical therapists across the country via the Academy of Pediatric Physical Therapy electronic newsletter and via dissemination by the Injury Prevention Research Interest Group from Pediatric Research in Sport Medicine. REDCap was used to collect and organize responses. The responses were analyzed by a descriptive statistics using percentages (%).Results:Sixty-five responses were obtained. The majority of physical therapists, 78.5%, were Doctors of Physical Therapy (DPT), treating 1-5 AIS patients a week (69.2%), and 18.8% had Schroth certification. Preferred treatment frequency was twice a week (41.5%) for a duration of 60 minutes (53.8%), over the course of 3-5 months (44.6%). The top three common clinical interventions were; core and trunk stability enhancement (90.8%), abdominal strengthening (83.1%) and postural correction (80.0%). The three most common therapeutic goal-setting parameters were activity based (78.5%), quality of life measure based (56.9%), and therapy participation based (50.8%). Additionally, for outcome measures, patient reported outcome was the most common objective measurement (78.5%), followed by pain (63.1%), manual muscle testing (46.2%), range of motion (44.6%), cobb angle (27.7%), scoliometer readings (26.2%) and Adam’s forward bend test (10.8%). Therapists often monitored progress with completed surveys by patients. However, patients’ ability to return to activity was the most common marker of improvement (72.3%). Patient’s scoliosis was often being treated in another manner aside from PT (46.2%), and many patients had medical conditions in addition to scoliosis (52.3%).Conclusion:According to our data, pediatric physical therapists believe that patients with AIS can benefit from physical therapy treatments addressing core and trunk stability, abdominal strengthening, and postural correction. Ideal treatment sessions would occur twice a week for 60 minutes over a period of 3-5 months. Objective measurements can be monitored to ensure improvements in quality of life, pain, strength, range of motion and curvature of the patient’s spine.AcknowledgementsThe Injury Prevention Research Interest Group from Pediatric Research in Sports Medicine and Suzanne M. McCahan, PhD

Evaluation of the efficacy of physical therapy on cognitive decline at 6-month follow-up in Parkinson disease patients with mild cognitive impairment: a randomized controlled trial.

In Parkinson's disease (PD), physical activity may represent a possible non-pharmacological intervention not only for improving motor symptoms but also for modulating cognitive impairment. To evaluate the efficacy of an intensive physical program on cognitive functions in mid-stage PD patients with mild cognitive impairment (PD-MCI) over a 6-month follow-up. This is a 6-month randomized controlled follow-up study. 40 PD-MCI patients were randomized to receive physical therapy (PT) or no specific intervention beside drug treatment (CT). Cognitive and motor assessments were performed at baseline (T0), 4weeks after baseline (T1) and 6months after T0. In a previous study, we reported a significant improvement in global cognitive functioning and attention/working-memory at T1. Here, we evaluated the residual effect of the training intervention at 6months on both cognitive and motor performances. Intra-group analysis showed that at T2 most of cognitive and motor performances remained stable in the PT when compared to T0, while a significant worsening was observed in the CT. Between-group comparison at T2 showed significantly better results in PT than CT as regards MoCA and motor scales. The percentage change of cognitive and motor performances between T1 and T2 confirmed the benefit of physical therapy on global cognitive functioning scores (MMSE and MoCA). In this follow-up extension of a longitudinal randomized controlled study, we demonstrated that physical therapy has a positive effect on cognitive functions, which extends beyond the duration of the treatment itself to, at least temporarily, reducing cognitive decline. Trial registration number (ClinicalTrials.gov): NCT04012086 (9th July 2019).

23. Functional Impact of Pelvic Floor Physical Therapy on Adolescents with Biopsy Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series

<h3>Background</h3> Chronic pelvic pain is a hallmark sign of endometriosis in adolescents and can persist in the form of musculoskeletal pain despite medical management. There is limited evidence to support that pelvic floor physical therapy (PT) is an effective intervention in treating chronic pelvic pain secondary to endometriosis in adolescents. The purpose of this case series is to describe the change in functional ability in adolescent females following pelvic floor PT management of chronic pelvic pain as part of a multidisciplinary approach. <h3>Case</h3> Participants included twenty adolescent females median age 16.5 years (IQR 3). Retrospectively, participants were included if they were referred to pelvic floor PT for chronic pelvic pain by Pediatric and Adolescent Gynecology between April 2018 and August 2019. All participants included had diagnostic laparoscopy performed with biopsy confirmed endometriosis. Fifteen participants had surgery before referral to PT and 5 participants had surgery after starting PT. The median duration of symptoms prior to referral to PT was 2 years (IQR 1.75). Pelvic floor PT included patient education, relaxation techniques to decrease pelvic floor muscle tone, manual therapy, breathing and postural retraining, and therapeutic exercise including pelvic floor muscle strengthening. Due to the adolescent age of the participants, all pelvic floor PT techniques were only performed externally. The Patient Specific Functional Scale (PSFS) assesses patient reported function and was utilized to determine functional improvements in participants referred to pelvic floor PT. The PSFS is a 0 to 10 point scale with 0 representing maximal disability and 10 representing no disability. Participants were able to self-report between one and three functional impairments with this outcome measure. In this case series, the PSFS score was represented as a percentage rather than a raw number to account for the variable number of impairments patients could report. Functional status was captured at initial evaluation and participants demonstrated a baseline score of 45.1% (IQR 16.66) on the PSFS. Functional status was captured throughout their course of PT care with the PSFS. Participants self-reported a clinically significant functional median improvement of 23.3% (IQR 41.66) over a median number of 12 visits (IQR 10.50) (p<0.001). <h3>Comments</h3> Participants in this case series reported significant functional improvement on the PSFS over the course of pelvic floor PT. This case series suggests that PT may be a helpful treatment option in the multidisciplinary approach to improve patient function in adolescents with endometriosis. Additional prospective controlled trials are warranted to assess the benefits of PT in this population.

Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease

Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.

Characterization of biopsychosocial factors of patients with chronic nonspecific low back pain

ABSTRACT BACKGROUND AND OBJECTIVES: Low back pain is considered a public health problem worldwide and has a personal, social, occupational and economic impact. Psychosocial signs such as inappropriate beliefs about pain, fear of movement, anxiety, stress, depression and low job satisfaction are characteristics of individuals with low back pain. These clinical signs are mediators of chronic pain and disability. The present study aimed to assess psychological comorbidities in patients with chronic non-specific low back pain who are undergoing physical therapy and patients awaiting physical therapy; in addition to characterizing the psychosocial profile of these individuals. METHODS: This research was carried out with 31 individuals recruited from physical therapy clinics in the region of greater Florianopolis. They were divided into two groups: Treatment (TG) and non-treatment (CG). The following self-report instruments were applied: Hospital Anxiety and Depression Scale (HADS), Health Status Questionnaire (SF-36V2), Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Index (OLBPDI), Fear-Avoidance Belief Questionnaire (FABQ) and Pain Castatrophizing Scale (PCS). RESULTS: Significant differences (p<0.05) were observed in the scores of the instruments applied between the groups. The CG had higher averages than the GT. CONCLUSION: The results obtained in this study support previous findings about the benefits of physical therapy for individuals with chronic nonspecific low back pain, suggesting that, in addition to reducing pain and disability, there are benefits related to psychosocial factors.

Associations Between Physical Therapy Visits and Pain and Physical Function After Knee Arthroplasty: A Cross-Lagged Panel Analysis of People Who Catastrophize About Pain Prior to Surgery.

Physical therapy visit number and timing following knee arthroplasty (KA) are variable in daily practice. The extent to which the number and timing of physical therapy visits are associated with current and future pain and function-and, alternatively, whether pain and function are associated with the number of future physical therapy visits following KA-are unknown. The purpose of this study was to determine temporal and reciprocal associations between the number of physical therapy visits and future pain and function in people with KA. A cross-lagged panel design was applied to a secondary analysis of data from a randomized clinical trial of patients with pain catastrophizing. The 326 participants underwent KA and completed at least 7 of 9 health care diaries over the year following surgery. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function subscales were completed preoperatively and multiple times during follow-up. Separate cross-lagged panel analyses were conducted for WOMAC pain and physical function. From surgery to 2months postsurgery, reciprocal associations were generally not found between physical therapy visit number and future pain or function. From 2 to 6months postsurgery, a greater number of physical therapy weekly visits were associated with higher (worse) 6-month pain and function. Higher (worse) WOMAC pain at 2 and 6months led to more visits from 2 to 6 and 6 to 12months, respectively. Higher pain scores 2months postsurgery were associated with higher physical therapy use in the 2 to 6months following surgery. However, patients with increased physical therapy use from 2 to 6months had significantly higher pain scores 6months postsurgery. Those patients with persistent pain 6months postsurgery were higher users of physical therapy 6 to 12months postsurgery. This reciprocal positive association between pain and physical therapy during this time period suggests minimal benefit of physical therapy despite an increased physical therapy use for patients with higher pain. This is the first study to determine the association between the number and timing of physical therapy visits and current and future pain and function. Based on the results, physical therapy might not be a cost-effective strategy to treat patients with persistent pain following KA.

Physical Therapy in Pediatric and Young Adult Patients With Sickle Cell Disease: Assessing Potential Benefits and Barriers.

Despite advances in the treatment of sickle cell disease (SCD) in pediatric and young adult patients, pain remains a significant cause of disease-related morbidity. Physical therapy has been shown to be useful for the treatment of pain in young patients with chronic illnesses, however, limited data exists regarding potential benefits of physical therapy in patients with SCD. We conducted a web-based survey of health care providers and support staff in the New England area to identify potential benefits of and barriers to outpatient physical therapy in this patient population. Nearly 92% of survey participants felt that physical therapy had the potential to be beneficial in pediatric and young adult patients with SCD. A majority of physicians reported having referred patients with SCD for physical therapy. Perceived potential benefits included improved functional mobility, improved chronic pain symptoms, decreased opiate use, improved mood symptoms, improved acute pain symptoms, and improved adherence with medications and clinic visits. Significant perceived barriers identified included lack of transportation, time constraints, patient lack of understanding, and difficulty with insurance coverage. Health care providers have a positive view of the use of physical therapy in the management of this patient population. Significant barriers exist which need to be addressed.

The role of physical therapists in oncology: the great unknown

Physical therapy is appropriate for patients with cancer. The literature supports treatment from diagnosis throughout the entire survival period. However, there is a lack of adherence to physical therapy interventions on the part of the patient, who is sometimes reluctant to undergo treatments that differ from surgery or medical treatments, or may be because these patients are unaware of the benefits of physical therapy. Additionally, physical therapists who take responsibility for the care of these patients, lack knowledge and training about current evidence of physical therapy in oncology. Physical therapy is so valuable for this population, but often overlooked and remains in the background or forgotten in oncology. Fortunately, patients' mindset are changing, training in this field is advancing for professionals so it is time for physical therapists to take action.

Effects and Benefits of Physical Therapy in the Mood, Quality of Life and Cognition Psychological and Cognitive Effects of Physical Therapy

The objective of this study is to quantify the effects of aerobic physical exercise program in the affective, quality of life and cognition aspects. This study included a sample of 40 participants with some physical pathology. All patients answered some questionnaires about clinical symptomatology (STAI, BDI, EUROqOL - 5D) and cognition (WAIS – IV). This battery test was performed before the intervention and after 10 weeks. The intervention was aerobic physical exercise consisting of an elliptical bicycle and walking on a static tape for a total of 45 minutes, three days a week. To evaluate the results, the statistical software IBM SPSS 23 was used. Values indicated a significant improvement in the affective and quality of life tests as well as higher scores in the cognitive tests once the physical exercise was performed. The results showed that aerobic physical activity improves cognitive qualities, affective status and perception of quality of life. The results show very positive possibilities for this field and for its more assiduous implementation as complementary therapy in some physical pathologies

APPRAISING OF KNOWLEDGE, ATTITUDE AND PRACTICE AMONG DENTAL PRACTITIONERS REGARDING ROLE OF PHYSIOTHERAPY IN TEMPOROMANDIBULAR JOINT DISORDERS

OBJECTIVES The aim is to assess the knowledge, attitude and practice of dental practitioners concerning physiotherapy management of Temporomandibular joint dysfunctions (TMDs.). METHOD 61 dentists were included from Tertiary, secondary and private dental clinics of Karachi, and the study design was cross sectional. RESULTS Prior to survey 45.9% of did not had knowledge about physical therapy management TMD. Maxillofacial surgeons and master’s degree holders had more knowledge about physical therapy (PT) management. 45.9% dentists reported that PT is non-effective treatment approach. Lack of knowledge on dentist’s behalf is the foremost cause of less referral to PT 88.5%. Jaw exercises were prescribed by 83.6% of dentists. In the end of the survey 52.5% dentists were reluctant to refer, 47.5% were maybe they will refer and 96.7% dentists were eager to gain more knowledge about the benefits of PT and collaborative treatment. CONCLUSIONS This study concluded that the dental practitioners of Karachi lack knowledge, attitude and practice regarding physiotherapy treatment of TMD. The benefits of multidisciplinary approach while treating TMDs were not very well known to dental practitioners and its benefits to patients. This study increased the knowledge of surveyed practitioners KEYWORDS Dentistry, Masticatory Muscles, Temporomandibular Joint Disorders, Orthodontics, Temporomandibular Joint, Manipulation

Does Respiratory Rehabilitation improve the outcome of pleural effusion in pulmonology department? Case report series and short literature review.

Introduction. Pulmonary rehabilitation is recognized as a complementary, non-pharmacological therapy for patients with COPD and pulmonary fibrosis. For pleural effusion, however there are not current recommendations in the existing literature. The aim of this study was to evaluate the beneficial role of respiratory rehabilitation (RR) in patients with pleural effusion and to review the main physiotherapy (kinetic therapeutic) techniques, as part of RR programs. Material and method. The article exemplifies three cases of acute pleural effusion or pachypleuritis, describing the diagnostic and treatment procedures as well as the pulmonary rehabilitation technique used. Results and discussions. Treatment goals, intervention, types of exercises were explained for each type of pleural disease. The diaphragmatic breathing, relaxation and/or antalgic postures, early mobilization, and a daily walking are recommended. Conclusions. Pulmonary rehabilitation should be applied in every patient with acute pleural effusion or pachypleuritis considering the potential benefits of physical therapy in the management of the patient`s illness. Key words: pleural effusion, respiratory rehabilitation, pachypleuritis,

Assessment of Pediatric Cardiology Referral Practices for Inpatient and Outpatient Post-Cardiac Surgery Physical Therapy

Purpose: Congenital heart disease (CHD) occurs in 4-12 per 1,000 live births with more than 30% of affected children requiring palliative or corrective surgery in early life. Studies on adult cardiac surgery patients clearly demonstrate the benefit of physical therapy (PT), a standard postoperative care step. However, it is unknown to what extent pediatric cardiac patients are referred for post-surgical PT in both inpatient and outpatient settings. The objective of this study is to assess pediatric cardiologist (PC) referral practices for both inpatient and outpatient post-cardiac surgery physical …

Benefits of physical therapy in the quality of life of mouth breathing children: Literature review

Introduction: The correct breathing process is through thenasal route, since it provides that the air during aspiration isfiltered, humidified and heated, thus conditioning the lungsfor gas exchange to occur. Allergic processes or other formsof affections can lead to the obstruction of the passage of airthrough the nose, leading the body to make an alternativeadaptation for the passage of air to occur through the mouth.A person who uses the mouth to breathe is called a mouthbreather. Once this adaptive process occurs, as a way tocompensate for this alternative airway, the body promotesa series of alterations in several segments of the body, such aschanges in the postural, respiratory, behavioral and stomatognathicsystems. Several techniques are used to treat themusculoskeletal dysfunctions presented by mouth breathers.Objective: to analyze how physiotherapy can contribute tothe improvement of the quality of life of mouth breathingchildren and to find out which are the most effective treatments.Methods: a search of data in the literature was carriedout by consulting the following electronic databases: Scielo,Bireme, Pub Med, Lilacs Google Scholar, as well as specializedbooks in the field. We excluded articles published before theyear 2000. Result: Among the analyzed articles, we perceivethat the treatment of mouth breathers occurs in a multidisciplinaryway, since it presents changes that encompassseveral body and systemic segments. Among the professionalsinvolved in the rehabilitation process, we highlight therole of physiotherapists. Conclusion: the physiotherapist isqualified to intervene in this pathology, with expertise inevaluation and establishment of the best treatment program,with physiotherapeutic conduits, allowing an improvementin respiratory patterns.Keywords: Mouth breathing children; Physiotherapy; Posturalevaluation; Treatment.

Impact of lower motor neurone facial palsy on oro-motor function and its remediation

Lower motor neurone facial paralysis (LMNFP) is often viewed by the general public and wider non-facial palsy fraternity as a cosmetic issue rather than a functional one. In this article, we sought to determine the severity and frequency of oro-motor dysfunction in LMNFP and assess the benefits of physical therapy and rehabilitation in this cohort. A prospective study at our institute was conducted for a one-year period (2015-2016), involving adult patients with LMNFP with significant oro-motor dysfunction. The exclusion criteria were (i) pre-existing oro-motor dysfunction, (ii) within six months of facial palsy onset. The assessment tools used were (i) The Facial Disability Index (FDI), (ii) IPREDD or Inventory of Patient-Reported Eating and Drinking Dysfunction for mastication and (iii) a bespoked Visual Analogue Scale (VAS) based on focus group discussions. Of the 183 new clinic referrals, FDI identified that 14% of patients with LMNFP had significant oro-motor dysfunction. IPREDD analysis showed that 74% of this cohort had masticatory problems, while the VAS indicated significant oro-motor dysfunction as well in those with LMNFP. Following speech and facial therapy, IPREDD-focused symptoms were reduced from 74% to 43% (shown to be significant), while VAS similarly showed a significant reduction in symptoms (two-tailed, paired Student's t-test p<0.01). Oro-motor function is a significant sequel of facial paralysis. Facial rehabilitation, both physical and psychological, can help reduce patients' distress and improve oro-motor function, without the need for surgical intervention in the first instance.

Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement

Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited. To compare the effectiveness of later-stage exercise programs after TKR and to explore heterogeneity of treatment effects. Three-arm single-blind randomized clinical trial (January 7, 2015, to November 9, 2017) using an intent-to-treat approach with follow-ups at 3 months and 6 months. The setting was Allegheny County, Pennsylvania (an outpatient physical therapy clinic and 4 community centers). Participants had primary TKR performed more than 2 months previously, were 60 years or older, experienced moderate functional limitations, and were medically cleared to exercise. Clinic-based physical therapy exercise (physical therapy arm), community-based group exercise (community arm), and usual care (control arm). The control arm continued their usual care, whereas the exercise arms participated in supervised exercise programs lasting 12 weeks. The primary outcome was arm differences in the Western Ontario and McMaster Universities Osteoarthritis Index-Physical Function (WOMAC-PF) at 3 months. The secondary outcomes included performance-based tests germane to knee replacement and additional surveys of physical function. Data were analyzed by linear mixed models and responder analysis. A total of 240 participants (mean [SD] age, 70 [7] years; 61.7% female) were allocated to physical therapy (n = 96), community exercise (n = 96), or control (n = 48). All 3 arms demonstrated clinically important improvement. At 3 months, between-arm analyses for the WOMAC-PF demonstrated no differences between physical therapy and community (-2.2; 98.3% CI, -4.5 to 0.1), physical therapy and control (-2.1; 98.3% CI, -4.9 to 0.7), and community and control (0.1; 98.3% CI, -2.7 to 2.9). Performance-based tests demonstrated greater improvement in the physical therapy arm compared with both the community (0.1 z score units; 98.3% CI, 0.0-0.2) and control (0.3 z score units; 98.3% CI, 0.1-0.4) arms and the community arm compared with the control arm (0.2 z score units; 98.3% CI, 0.0-0.3). The physical therapy arm had more than 17.7% responders than the community arm and more than 19.0% responders than the control arm. There was no difference in responder rates between the community and control arms. Based on the primary outcome, participation in late-stage exercise programs after TKR offered no benefit over usual care. The benefits of physical therapy identified by the secondary outcomes and responder analysis require confirmation. ClinicalTrials.gov Identifier: NCT02237911.

Access to Physical Therapy in a Medically Underserved, Urban Community.

Austin is Chicago's largest community and is 85% African American. The purpose of this study was to the examine facilitators and barriers to physical therapy (PT) access as described by Austin community residents and health care providers (HCPs). Community residents (n=47) participated in focus groups. Seven HCPs from Austin were interviewed by telephone or in person. All focus groups and interviews were recorded, transcribed, and analyzed using a constant comparative method. Austin residents and HCPs reported that having insurance and having a positive view of PT were facilitators to PT access. Barriers included poor proximity to PT clinics, cost, and incomplete knowledge of PT. Three barriers were identified by community residents and HCPs, all are modifiable factors. Future research should focus on increasing awareness about the benefits of PT and developing low-cost PT options. The PT desert identified in this study highlights the needs of underserved communities.