Early Physiotherapy Intervention Research Articles

Physiotherapy for Simple Mastectomy Following Phyllodes Tumor

Phyllodes tumors are relatively rare breast tumors. Management of these tumors with surgical resection may cause postoperative complications. The purpose of this case study was to define the role of early postoperative physiotherapy in a patient with phyllodes tumor of the breast following simple mastectomy. A 50-year-old woman was brought to the outpatient department following a 1-year history of the lump in the right breast, worsening gradually in the preceding 2 months, and subsequently diagnosed to be a phyllodes tumor. She was treated with simple mastectomy followed by a drain insertion. Postoperatively, she presented with reduced chest expansion and functional mobility and postural impairments. Treatment protocol was set and follow-up was made on the 8th postoperative day. We conclude that early physiotherapy intervention can help in improving the functional mobility and preventing further postoperative complications.

Course of recovery in COVID-19 patients with pre-existing post Koch’s sequelae

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 predominantly causes respiratory disease in the form of viral pneumonia. Susceptibility to SARS-CoV-2, its progression and severity increases with presence of latent or active pulmonary tuberculosis (PTB). PTB is a highly prevalent respiratory disease in India. This case series explains the rehabilitation and course of recovery in ICU of two COVID-19 patients with post PTB sequelae. Both the cases showed safe and timely recovery due to appropriate and early physiotherapy intervention which needed modification in accordance with the medical management. However, their reduced functional capacity on pre-discharge assessment highlights the need for continuing pulmonary rehabilitation.

Early physical therapy intervention in adolescent athlete with L5 Spondylolysis and grade 1 L5-S1 Spondylolisthesis: a case study.

Early physical therapy intervention in adolescent athlete with L5 Spondylolysis and grade 1 L5-S1 Spondylolisthesis: a case study.

Effects of early intervention strategies using telehealth on an infant with Down syndrome: A case study

Purpose: To present the strategies used and the effects of early physiotherapy intervention using telehealth on a Down syndrome infant. Materials and methods: An infant diagnosed with Down syndrome performed the early intervention. Telehealth was performed synchronously according to the biopsychosocial model The assessments were carried out using the International Classification of Functioning, Disability and Health checklist. The Alberta Infant Motor Scale and the Brazilian version of the Affordances in the Home Environment for Motor Development - Infant scale were used to assess the activity component and environmental factors, respectively. Evaluations were performed at 5, 50, 79, and 105 days of corrected age. Results: The infant obtained progressive and constant gains during 100 days of early intervention. It is known that environmental and personal factors interfere with the performance of the infant's skills. Conclusion: Early intervention initiated in the first month of life using telehealth in an infant with Down syndrome proved an effective intervention method.

Hip arthroplasty: Effective rehabilitation protocols

Purpose: To identify the effectiveness of protocols in the functional rehabilitation process in the postoperative treatment of the hip. Methods: This is a systematic review study, composed of 4 blind and independent evaluators divided into three schematic phases. For the construction of this manuscript, the Recommendation Preferred Reporting Items for Systematic Reviews and Meta-Analyzes was applied. The descriptors used were: "rehabilitation", "physical therapy", "arthroplasty" and "hip" using the Boolean operator “AND” between each of them in the indexing bases. Results: Initially, 136 studies were found in LILACS, MEDLINE, MEDCARIB, PAHO-IRIS and WHOLIS, 99 studies in MEDLINE and 08 articles in PEDro. After reading the abstracts, 13 studies were selected, which were carefully analyzed. Discussion: Among the thirteen selected articles, the main clinical effects observed in the evaluated protocols were: improved functionality, quality of life, reduced pain, increased muscle strength. Conclusion: The functional rehabilitation of postoperative hip arthroplasty was significant in protocols that adopted early physical therapy intervention. These protocols resulted in rapid improvement in functionality, reduction of pain and quality of life. These improvements were also seen in protocols applied at home.

Early Physiotherapy Intervention of a Patient with Acute Intermittent Porphyria-A Single Case Study

Background: The Porphyrias are metabolic disorders, each resulting from the deficiency of a specific enzymein the heme biosynthetic pathway. Acute intermittent porphyria (AIP) is an autosomal dominant inbornerror characterized by decreased activity of porphobilinogen (PBG) deaminase leading to increased levelsof haem precursors, namely amino levulinic acid (ALA) and PBG. The major manifestations of theacutehepatic porphyrias are neurologic- neuropathic abdominal pain, peripheral motor neuropathy, and mentaldisturbanceswith attacks often precipitated by steroid, hormones, certain drugs, and nutrition influences.Purpose: Intensive care measures and a multidisciplinary therapeutic approach are essentialbut thereis lessdocumented evidence are available.If this aspect is incorporated early in the rehabilitation programme, thenthe functional recovery in such will be better.so the aim of the study is to find how Early Physiotherapyintervention using Comprehensive need based Approach to improve the functional status of porphyriapatient.Key Points of Case: A 17 years old male patient wasdiagnosed with acute intermittent Porphyria. Havingthe history of abdominal pain since last 3 months with family history of AIP which was diagnosed very late.A detailed Physical and Neurological examination of this patient was taken. Along with medical treatment,early physiotherapy intervention using comprehensive need base approach was being given to the patient.The Barthel Index was taken to assess the functional status of the patient and Berg Balance Scale was takento assess balance on admission and subsequent follow-ups. Post-intervention follow-ups were taken at 6weeks and 12 weeks period.Conclusion: A clinically significant improvement was found on Barthel Index and Berg Balance Scale.Early Physiotherapy intervention using a Comprehensive need based Approach is highly recommended toimprove the functional status of a patient with porphyria

Is physiotherapy an underused approach to prevent surgery in selective musculoskeletal disorders?

Objectives: The purpose of the literature review was to appraise the evidence that an early physiotherapy intervention helps to prevent the surgery in selective musculoskeletal disorders. A search of Google Scholar, Web of Science, Scopus, and PubMed was carried out utilizing the terms (“physiotherapy”, “surgery” OR “exercise, surgery” OR “rehabilitation”, “surgery”).
 Methods: The article titles and abstracts were screened for eligibility and included in the review. The recent literature evidently emphasized that physiotherapy has opted in selective musculoskeletal problems to avoid and delay surgeries.
 Results: Regardless of recommended conservative treatment option and effectiveness of physiotherapy, a massive gap can be observed between its evidence and practice. Conversely, overuse of diagnostic imaging, surgeries, and medications is present in clinical practice. In most of the clinical problems the long-term outcomes were reported the same with surgical and physiotherapy intervention. Likewise, patients can also get the advantage of better clinical outcome and cost-effectiveness with physiotherapy as compared to surgical intervention.
 Conclusion: The cost-effectiveness is an important factor in low-income countries where economic aspects of health care are highly considered. These advantages of physiotherapy should be considered by the clinicians, policymakers, patients, and included in the clinical guidelines.
 Bangladesh Journal of Medical Science Vol.20(2) 2021 p.409-413

Early Physical Therapy Intervention for Frail Patients Isolated with COVID-19

Early Physical Therapy Intervention for Frail Patients Isolated with COVID-19

Role of Early Rehabilitation in An Infant with Arthrogryposis Multiplex Congenita: A Case Report with 11 Months of Follow up

Background: Arthrogryposis multiplex congenital (AMC) is etiopathogenetically a heterogeneous disorderwhich is considered to be a neuromuscular syndrome present at birth. It is characterized by presence ofcontractures in more than two body areas at the prevalence rate of 1 in every 3000 to 5000 live births.Purpose: There are no reports in the literature which provides clear guidelines regarding physical therapyinterventions for children with AMC. The purpose of this case report is to document the infant’s recoverybased on the frequency and duration of physical therapy interventions during first 11 months of life.Key points of case: An infant with arthrogryposis multiplex congenital was followed from day 15 to 11months of early developmental period. Following continuous and integrated physical therapy, infant achievednormal developmental sequence with visible improvement in joint contractures. Without interveningsurgically, there is improvement in club foot of the baby. This article enlightens physiotherapeutic treatmentstrategies for child with AMC.Conclusion: Physical therapy of a child with AMC should be multi-centred, holistic and continuous.Early approach to physical therapist minimise the complications following AMC. Early physical therapyinterventions can help in prolonging the early need of surgical interventions during developmental age.

Feasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia

AimTo determine the feasibility of conducting a definitive randomised control trial (RCT) to answer the following questions: (1) Is early physiotherapy treatment acceptable and feasible for patients and direct healthcare providers? and (2) Is early physiotherapy intervention associated with better disability and psychosocial outcomes compared with the practice of routine MRIs?MethodsIn a feasibility RCT in Riyadh City from 01 March 2018 until 29 July 2018, chronic low back pain (CLBP) patients presenting to spine clinics were randomised to receive an MRI (intervention) plus physiotherapy rehabilitation or physiotherapy alone (control group). The acceptability of randomisation to the control group (non-MRI) was tested during the recruitment by qualitatively interviewing study participants and referring physicians. Moreover, interviews with study participants explored the broader social, political, economic, and environmental (context) aspects that may influence trial delivery and intervention implementation.ResultsThe recruitment target was not met: 16/24 (66%) participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified numerous factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, the lack of research infrastructure to support recruitment to trials, limited research capacity in terms of knowledge and skills of the healthcare team, and limited funding.ConclusionA definitive RCT to test the influence of MRI diagnosis on the psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia is feasible. However, the lack of research infrastructure, research capacity, the impact of MRI on patient outcomes, and a lack of clinical equipoise in the treatment and management of CLBP in Saudi Arabia pose major barriers to clinical trials.

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

BackgroundThe purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery.MethodsFifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months.ResultsAfter surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p < 0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively.ConclusionLimited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.

Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?

IntroductionChronic lower back pain is a leading cause of disability in US adults. Opioid use continues to be controversial despite the Centers for Disease Control and Prevention guidance on chronic pain management to use nonpharmacologic and nonopioid pharmacologic interventions. The objectives of the study were to assess the impact of early physical therapy (PT) intervention on improving functionality and reducing opioid burden in patients with chronic lower back pain.MethodsA single-center, retrospective chart review of patients receiving ≥6 PT visits and treated with either opioids first (OF) or PT first (PTF) therapy for chronic lower back pain were evaluated. Concomitant use of nonopioid and nonpharmacologic therapy was permitted. The Oswestry Disability Index (ODI), a survey measuring functionality, was recorded for PTF group. Pain scores and medication use including opioids were collected at treatment initiation and completion.ResultsOne hundred and eighty patients were included in three groups: OF group (n = 60), PTF group (n = 60), and PTF + ODI group (n = 60). The PTF + ODI group had mean ODI reduction of 11.9% (P < .001). More OF patients were lost to follow up (68.3%) or failed PT (60%) compared to the PTF group, 38.3% and 3.3% (P < .001). Reduction in both opioid and nonopioid medications as well as pain scores were observed but not statistically significant.DiscussionEarly PT resulted in improved functionality, decreased pain, and reduced medication use upon PT completion. These findings suggest PT, along with nonopioid modalities, are a viable first-line option for the management of chronic lower back pain.

Effectiveness of Early Physiotherapy Interventions for Weight Gain in Low Birth Weight Neonates

Background: Prematurity is a leading cause of death in Indian scenario. There are lack of studies done on early physiotherapy interventions in neonates. Early care interventions in premature newborns show positive effect. Growth retardation and demineralisation of bones in newborn are thought to be caused by prolong immobilisation or lack of physical activities. In this study we are going to give combination of massage, passive movements, facilitatory techniques, joint compression and kangaroo mother care, which has not been done before. Indeed this made us to study the effectiveness of early physiotherapy intervention on weight gain in low birth weight neonates. Objectives: To determine the effectiveness of early physiotherapy intervention on weight gain in moderate premature neonates (32–37 weeks), very premature (28–32 weeks) and extremely premature neonates (less than 28 weeks). Methods: Individuals fulfilling the inclusive criteria were selected. Written consent was taken from parents and care taker of neonates. Total 20 low birth weight neonates were taken. They were differentiated into moderate premature, very premature and extremely premature neonates. The weight was measured and breast feeding frequency was noted before treatment. Then the neonates were given massage, passive movements, proprioception stimulation by individual joint compression, oral stimulation and kangaroo mother care. This was given for 25-30 minutes each session for two times per day for 7 days. After that again weight and breast feeding frequency was checked to see progression. Later evaluation and interpretation was done using statistical analysis. Results: The early physiotherapy intervention is effective in low birth weight baby for improving weight in pre mature neonates. Conclusion: On the basis of result it can be concluded that the early physiotherapy is effective in improving weight, breast feeding frequency in low birth weight neonates. Hence, early physiotherapy interventions should be considered to decrease the morbidity and mortality rate of LBW neonates.

PreEMPT (Preterm Infant Early Intervention for Movement and Participation Trial): The Feasibility of a Novel, Participation-Focused Early Physiotherapy Intervention Supported by Telehealth in Regional Australia—A Protocol

Background: Early intervention is beneficial for improving preterm infant motor and cognitive outcomes in early childhood; however, little is known about whether early intervention can influence a preterm infant’s participation. Additionally, many studies investigating the impact of early intervention for preterm infants have been conducted in large metropolitan centres, leaving preterm infants who reside in regional areas underrepresented in the literature to date. Consequentially, it is not yet known whether there are service delivery models, such as using telehealth as an adjunct to face-to-face intervention, that might cater to the needs of preterm infants residing outside metropolitan centres. PreEMPT (Preterm infant Early intervention for Movement and Participation Trial) is a novel early physiotherapy intervention that has been designed to use a participation goal-directed intervention approach via a mixture of face-to-face clinic sessions and telehealth sessions to improve the motor and participation outcomes of preterm born infants. Methods: This study aims to evaluate the feasibility of PreEMPT using an assessor-blinded, randomised controlled trial to compare PreEMPT to Usual Physiotherapy Care (UPC) for preterm infants residing in a regional Australian hospital catchment area. Twenty-six preterm infants (≤34 + 6 weeks gestational age) will be recruited prior to term corrected age from the special care nursery of a regional hospital. Following informed consent and baseline assessments, infants will be randomly allocated to receive either PreEMPT, a novel participation-focused early physiotherapy intervention delivered weekly for 14 forty-five-minute sessions alternating face-to-face sessions with telehealth into the infant’s home, or UPC, two - three physiotherapy sessions in the 4-month intervention period. Outcome measures relating to infant neuromotor development, motor performance, general development, and parental mental health and well-being will be assessed at 4-, 6- and 8-months corrected age. Feasibility will be evaluated by acceptability (parental satisfaction), demand and practicality (recruitment rate and telehealth session implementation), implementation (attendance at assessment and treatment sessions), and limited efficacy testing (comparing outcomes listed above for infants in PreEMPT and UPC). Discussion: This study will be the first of its kind to use the participation of preterm infants in meaningful life situations as the foundation for intervention delivered via alternating face-to-face clinic sessions with telehealth into the home. The feasibility of this approach will be evaluated and used to inform future iterations of research about PreEMPT’s efficacy for improving preterm infant motor and participation outcomes.

Chemotherapy-induced peripheral neuropathy and its correlation with activities of daily living, psychological well-being, grip strength, and quality of life in cancer subjects: An observational study

Background and Objective: The incidence of cancer is rapidly rising, resulting in an increase in the number of patients opting for chemotherapy. Chemotherapy-induced peripheral neuropathy (CIPN) is one of the adverse and long-lasting side effects which evidently affects the activities of daily living (ADLs), quality of life, and psychological status. The objective of the present study was to assess for CIPN and find its correlation with grip strength, ADL, psychological variables, and quality of life. Settings and Design: This was an observational study undertaken in a tertiary care centre and cancer hospital for a period of 6 months. Materials and Methods: 102 subjects aged between 18 and 70 years were recruited. Subjects were evaluated using Modified Total Neuropathy Score (mTNS), Hand dynamometer, KLE University Institute of Physiotherapy (KLEU-IPT) Objective Functional Assessment Scale, Depression Anxiety Stress Scale (DASS-42), and functional assessment of cancer therapy-general (FACT-G). Results: CIPN seemed to be more evident in lower limbs than the upper limbs when assessed using mTNS scale. There was a statistical significance in reduction of grip strength (P = 0.00), KLEUIPT-OFS, DASS-42, and FACT-G with significant positive correlation (r = 0.05) with mTNS scores. Conclusion: CIPN demonstrated to be more pronounced in lower limbs than upper limbs. CIPN has shown to have significant correlation with the grip strength, quality of life, ADLs, depression, and anxiety, suggesting an early physical therapy intervention to avoid such complications.

Physical Therapy Management for Child with Generalized Joint Hypermobility

The purpose of this case report is to provide insight regarding the screening and early physical therapy interventions for a child with Generalized joint hypermobility (GJH). The increased mobility in joints than the normal range of movement in one joint is referred to as Hypermobility. The Hypermobility occurring in more than one joint is referred to as Generalized Joint Hypermobility (GJH). GJH is usually benign (asymptomatic) however, over time may lead to joint pain and developmental delay. Identifying the GJH at the school-age would facilitate to monitor early changes and to plan for early rehabilitative intervention. This case report describes the clinical findings of a 7-year-old primary school male student with GJH. This patient scored 9 points in the Beighton score. The preliminary physical therapy sessions were targeted to improve joint protection, joint control, and stability. The long-term goals were injury prevention and physical fitness.

A 3-Year Physiotherapy Management of a Case of Spinal Poliomyelitis Referred at Three Months Post Paralysis

Background: Poliomyelitis is known to bring about huge complications that foist debilitating disabilities on a patient with poliomyelitis. Most post-polio survivors live with disabilities throughout a lifetime with an attendant social and economic consequence.&#x0D; Objective: Based on the findings from subjective assessment and physical examination, the objective of the current study focused on early physiotherapy intervention measures for preventing complications such as contracture, joint stiffness, muscle wasting, severe gait abnormality, vertebral mal-alignment, and unusual pain.&#x0D; Case Description: A 4-month-old patient referred for physiotherapy evaluation following an inability to functionally move the two lower limbs and lifting of the left upper limb. There was no history of previous treatment before referral to physiotherapy management. The physical therapists reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use an approach combining the use of low intensity, short duration, and intermittent activity or exercise performed within patient’s limit of fatigue, weakness, and pain.&#x0D; Intervention: The child was on low-intensity exercises, electrical muscle stimulation and heat therapy 3 times per week for 12 months, 2 times per week for12 months, once a week, and once in two weeks for 6 months.&#x0D; Outcomes: Patient was able to achieve one-minute ambulation without walking aid in 33 months. Significantly, patient attained 5-minute ambulation in 36 months’ time. Also, ranges of motion were intact with no records of contracture in any tendon.&#x0D; Discussion: The outcome of this study demonstrated that early physiotherapy intervention and long-term follow-up are beneficial in preventing/reducing complications, thereby regaining of millstones and achieving functional independence in patients with acute flaccid paralysis such as polio.

Patient experience of physiotherapy input on a specialist heart failure unit

Purpose: Acute heart failure care is recommended to be delivered by a multidisciplinary team, incorporating education, and advocating self-management and patient centred care. With this in mind in 2016 a specialist 11 bedded heart failure unit (HFU) was opened to cohort patients with acute heart failure with the aim of improving outcomes in quality of life, 30 day readmission rates, and mortality. As heart failure is often associated with marked reductions in quality of life and high levels of debility, a full time specialist physiotherapist was funded to work as part of the multidisciplinary specialist team. The aim was to assess the impact of exercise education and early physiotherapy intervention on patient experience

When the Patient Is Not an “Ideal” Candidate. The Importance of Early Physical Therapy Intervention Pre- and Post–Lung Transplant: A Case Report

Purpose: Each year thousands of patients are placed on lung transplant waiting lists. Despite evidence of the importance of pulmonary rehabilitation programs for this population, minimal literature regarding physical therapy (PT) for the candidate that is admitted to the hospital to await surgery exists. This case report describes a successful rehabilitation approach for this patient population. Case Presentation: A 59-year-old male patient with a diagnosis of idiopathic pulmonary fibrosis was admitted to the intensive care unit to await lung transplant. The inability to manage the patient's high oxygen requirements in his home environment, as well as the progression of his disease, prompted the need for constant medical management in an intensive care setting. His presurgical comorbidities classified him as a less than “ideal” transplant candidate. He received early and frequent PT both pre- and posttransplant, with focus on strengthening and gait training activities to improve his functional capacity. Subjective improvements in quality of life and function after bilateral lung transplant were achieved despite potential for a complicated postoperative course related to his medical history. Conclusion: Early and frequent PT may be important for patients admitted to the intensive care unit while awaiting transplantation and can play an even greater role for the less than “ideal” transplant candidate. The PT interventions can be provided safely for this population in the hospital setting. A rehabilitation approach focused on maximizing a patient's functional capacity with strength and gait training activities may facilitate improved outcomes for lung transplant recipients deemed less than optimal candidates.

Coaching in early physical therapy intervention: the COPCA program as an example of translation of theory into practice

Background: Coaching is en vogue in pediatric physiotherapy, but often applied rather unspecific and undefined.Methods: This paper aims to describe coaching in early physiotherapy intervention, taking the specific coaching approach of the family-centered program “COPing with and CAring for infants with special needs” (COPCA) as a case in point.Results: The theoretical underpinnings of coaching in COPCA, including a meta-model, family-centered practice, the Neuronal Group Selection Theory and the goal-oriented coaching approach, are discussed. Next, the translation of theory into practical ingredients for coaching of families of a child with special needs is presented. The latter includes the appreciation of family autonomy and attitudes, and the creativity to ask specific questions to support the families in making their own decisions to promote their child’s development during daily care-giving routines.Conclusion: It is concluded that the approach of coaching is demanding for both families and pediatric physiotherapists. It requires an active role of the family members in the intervention process and for therapists that they incorporate the attitude of a coach that largely differs from the attitude of the traditional therapist. For families and pediatric physiotherapists appreciating these changes in attitude, COPCA’s coaching offers a promising form of early intervention.Implications for rehabilitationWe recommend the implementation of the promising approach of goal-oriented and solution-focused coaching in pediatric rehabilitation and/or early intervention.We recommend applying coaching methods that are based on explicit theoretical background and clinical knowledge.We recommend formal training in coaching before professionals apply coaching in pediatric rehabilitation and/or early intervention.