Efficacy Of Physiotherapy Research Articles

Maximizing Knee OA Treatment: A Comparative Look at Physiotherapy and Injections

Background: Knee osteoarthritis (OA) is a prevalent and disabling condition often managed with physiotherapy or intra-articular injections. However, the comparative effectiveness of these treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of physiotherapy and intra-articular injections in managing knee OA. Methods: A systematic search of PubMed, Scopus, Web of Science, PEDro, and Cochrane Library was conducted. Randomized controlled trials (RCTs) comparing physiotherapy and intra-articular injections in knee OA patients were included. Key outcomes included pain (VAS), function (WOMAC, KOOS), range of motion (ROM), and quality of life. Data from five studies with a total of 552 participants were analyzed. Results: Intra-articular injections, particularly botulinum toxin and hyaluronic acid, were found to provide rapid pain relief, outperforming physiotherapy in short-term pain management. However, physiotherapy contributed significantly to long-term functional improvements, particularly in early-stage OA. Combination therapy of injections and physiotherapy yielded the best short-term pain relief and functional outcomes. Heterogeneity in study designs and follow-up periods limited the generalizability of findings. Conclusions: Intra-articular injections are effective for immediate pain control, while physiotherapy plays a crucial role in maintaining joint function, especially for long-term management. Combining both interventions may offer the most comprehensive benefits. Further research is needed to determine the long-term efficacy of these treatments.

Experiences of digital physiotherapy during pregnancy and after childbirth: A qualitative study

BackgroundPelvic girdle pain, low back pain, and pelvic floor dysfunction can affect women's mobility, quality of life, and well-being during pregnancy and the postpartum period. Digital interventions for treating perinatal depression and lifestyle changes have been studied. Research on digital physiotherapy for musculoskeletal issues related to pregnancy and the postpartum period is sparse. MethodsThis qualitative study involved in-depth, semi-structured interviews with 19 participants, of whom six were pregnant and 13 had given birth. Participants were recruited from a private clinic in Sweden through convenience sampling and had received digital physiotherapy prior to the interviews. An interview guide with questions exploring participants' experiences of digital physiotherapy, including its impact on musculoskeletal issues and daily life, and their motivation for seeking digital healthcare was used. Data were analyzed using a qualitative content analysis with an inductive approach. ResultsThe analysis resulted in two main categories: Finding a new way into physiotherapy treatment and Personalized progress through tailored physiotherapy. These main categories encompassed four generic categories: Convenience and dissatisfaction motivators for digital physiotherapy, A dual experience – appreciated but not always comprehensive, Being involved in the rehabilitation process, and Perceived physical and mental improvements after digital physiotherapy. ConclusionDigital physiotherapy was well-accepted and perceived as beneficial for managing musculoskeletal symptoms during pregnancy and after childbirth. High accessibility and flexibility were considered advantages. However, inability to undergo a physical assessment was a challenge. Digital physiotherapy may be recommended as a complement to usual care, particularly for women with limited access to a physiotherapist specialized in women's health. Future studies exploring digital physiotherapy's efficacy for musculoskeletal issues during pregnancy and after childbirth are highly recommended.

Kinésithérapie effectivement basée sur le placebo : comment les recherches de ces deux champs s’alimentent

Beginning by exploring the historical links between physiotherapy and placebo, we examine how placebo research can help physiotherapy. Focusing on three original contributions, we look at how placebo treatments work and how placebo effects might be used in clinics by modulating contextual factors. The first study demonstrates that open placebos are non-inferior to deceptive placebos. The second examines the acceptability of placebo treatments and the third how physiotherapists use placebo effects in their daily work by manipulating contextual factors. We close by examining at the importance of placebo research in the design of relevant control groups in rehabilitation research. Taken together, these results reflect on the epistemological basis for determining the efficacy of physiotherapy, and motivate the practice of ethical physiotherapy rooted in an in-depth understanding of placebo effects and contextual factors.

The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort.

A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort. At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery. Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers' Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period. Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.

The Use of Physiotherapy in the Conservative Treatment of Cubital Tunnel Syndrome: A Critical Review of the Literature.

The lack of a clear answer regarding the efficacy of physiotherapy in the treatment of cubital tunnel syndrome (CuTS) has led to attempts to critically assess the scientific studies conducted to date. Two databases (MEDLINE via PubMed and PEDro) and Google Scholar were used to search for papers. The inclusion criteria were randomized controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of patients with CuTS. A total of 18 studies met the eligibility criteria, capturing a total of 425 participants. Seven papers were randomized controlled trials, three more described prospective studies without a control group, and eight papers contained case reports. An analysis of the literature evaluating the effectiveness of various forms of broadly defined physiotherapy indicates that their use can have a beneficial effect in reducing many subjective and objective symptoms and improving function. In the majority of papers included in this review, their authors indicated positive therapeutic effects. Only one randomized controlled trial reported no change following therapy. It can therefore be stated that the results of the research conducted so far are optimistic. However, only 7 of the 18 papers were randomized controlled trials, while 3 were prospective studies, and 8 papers were case studies, in which 23 people with CuTS were studied. The small number of randomized clinical trials and their considerable heterogeneity do not allow firm conclusions to be drawn about the effectiveness of physiotherapy in the conservative treatment of CuTS.

Efficacy of Physiotherapy in Plantaris Fasciitis for Inconclusive Results Demands Further Investigation

Plantar fasciitis patients often undergo physiotherapy interventions like gait training exercises with inner sole support to enhance functional ability. However, the efficacy of these additional interventions remains unclear. This quasi-experimental study aimed to assess the impact of such interventions on functional ability. Eight patients were divided into treatment and control groups. After a month of intervention, no significant difference was found in functional ability between the groups. While the study suggests some potential benefit, further research is needed to confirm the effectiveness of these interventions. Highlight: Evaluated physiotherapy on plantar fasciitis functional ability, with eight patients. No significant difference found after a month of intervention. Further research needed to confirm effectiveness of physiotherapy interventions. Keyword: Plantar fasciitis, physiotherapy, gait training, inner sole support, functional ability

Efficacy of Physical Activity Promoting Interventions in Physical Therapy and Exercise Therapy for Persons With Noncommunicable Diseases: An Overview of Systematic Reviews.

The objective of this study was to synthesize the evidence from systematic reviews on the efficacy of physical therapy and exercise therapy, including interventional elements explicitly aiming at physical activity promotion (PAP) in patients with noncommunicable diseases (NCDs). PubMed, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews were searched from inception to February 28, 2023. Two independent reviewers screened the literature to identify systematic reviews that evaluated the effects of physical therapy and exercise therapy, including PAP interventions. Patient-reported and device-based measures of physical activity (PA) outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of the included systematic reviews was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We assessed primary study overlap by calculating the corrected covered area and conducted the evidence synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Fourteen systematic reviews were included in the present overview, including patients with a variety of NCDs. Most included systematic reviews had critically low (n = 5) to low (n = 7) methodological quality. Most meta-analyses (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions, but not all pooled estimates were clinically relevant. Only three of the systematic reviews with meta-analysis included an assessment of the certainty of the evidence. The evidence from systematic reviews without meta-analysis was inconclusive. The results of the present overview suggest that PAP interventions in physical therapy or exercise therapy may be effective in improving PA for patients with NCDs in the short and long term. The results should be interpreted with caution due to the limited certainty of evidence and critically low-to-low methodological quality of the included systematic reviews. Both high-quality primary studies and systematic reviews are required to confirm these results. There is limited evidence that PAP interventions in physical therapy and exercise therapy may be effective in improving PA for patients with NCDs.

The impact of physiotherapy interventions on enhancing wound healing post knee osteoarthritis surgery: A meta-analysis.

In knee osteoarthritis surgery, managing postoperative wound healing and minimizing scar formation are pivotal for patient recovery and satisfaction. These aspects are particularly challenging due to the nature of the surgical procedure and patient demographics. Physiotherapy interventions are increasingly recognized for their role in improving these postoperative outcomes. This meta-analysis sought to evaluate the efficacy of physiotherapy in enhancing wound healing, as measured by REEDA scores, and reducing scar formation, as indicated by Manchester Scar Scale (MSS) scores, following knee osteoarthritis surgery. Analysing data from eight studies, we found that physiotherapy significantly improved wound healing, evidenced by lower REEDA scores (SMD = -19.58, 95% CI: [-22.49, -16.66], p < 0.01), and reduced scar formation, reflected in lower MSS scores (SMD = -24.79, 95% CI: [-30.03, -19.55], p < 0.01). These findings highlight the crucial role of physiotherapy in postoperative care for knee osteoarthritis patients, emphasizing its impact on enhancing recovery and improving surgical outcomes.

Physiotherapy Intervention for Cervical Radiculopathy: A Case Report

Introduction: The objective of this study is to determine the efficacy of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm shows (median nerve distribution). Patient was recruited on the basis of special test: Spurling Test, Distraction Test, and Upper Limb Tension Test. After 2 week of intervention significant improvement was shown by using- Numeric pain Rating scale for pain, Neck Disability Index for Disability, and SF_12 for quality of life, patient reported less symptomatic and symptoms reduction during work and exercise. This case report demonstrates an effective, evidence based approach to physical therapy treatment for patients in cervical radiculopathy.

Physiotherapeutic approaches for the erectile dysfunction management: basic principles and an efficacy evaluation of the current technologies

Physiotherapy is a treatment method for a wide range of diseases of various organs and systems. Its efficacy and practicability are of the great discussions during the past few decades. In urology, this method is used for treatment of erectile dysfunction (ED) caused by a violation of the trophism of genitalia due to radical prostatectomy, atherosclerosis, diabetes mellitus, Peyronie's disease. Shock wave therapy based on the remote action of a low-intensity focused acoustic wave is one of the widely used effective physiotherapeutic methods for the treatment of vasculogenic ED. The main effects of shock waves are neoangiogenesis, nerve fibers regeneration, deceleration of the cavernous fibrosis and reduction of the sympathetic outflow. Some technologies (e.g. radio waves) in addition to those effects also warm the tissues, what accelerates metabolism and improves regenerative processes. All shockwave and radiowave technologies have already demonstrated their efficacy compared with sham control. However, in the few comparative studies, no significant difference was found in efficacy between different technologies. Clinical guidelines consider physiotherapy only as an alternative treatment for patients with mild vasculogenic ED who are refractory or unresponsive to oral vasoactive therapy. Nevertheless, some studies make it possible to judge the efficacy of physiotherapy for treatment of patients with either etiology of the ED. The result of the ED treatment does not depend on the number of treatment courses, their duration, the number of pulses per course and the periodicity of therapy sessions. Also, the original studies have some major shortcomings (i.e. a large percentage of patients dropping out of follow-up). These factors cast doubt on the organotropism of physiotherapy. So, additional comparative studies are required to determine the optimal dosing regimen and to explore the influence of physiotherapy organotropic and psychological components on the results of the treatment. The study aimed to summarize the currently available data evaluating the efficacy of different physiotherapeutic technologies, to compare the efficacy of different technologies for ED treatment.

The Impact of Physiotherapy in the Management of Non-Operated Gonarthrosis in Mali

Introduction: According to the WHO, osteoarthritis is the result of mechanical and biological phenomena that destabilise the balance between the synthesis and degradation of cartilage and subchondral bone. Gonarthrosis is a genuine public health problem in developed countries due to its high frequency, the functional impotence it causes and its socio-economic impact [2, 3]. Its prevalence is estimated at between 7% and 17% in people aged over 45 [4]. This incidence has continued to increase over the last few decades due to the industrialisation of the world and the sedentary lifestyle of human beings. In the absence of any study on the role of physiotherapy in the management of gonarthrosis in Mali. We deemed it necessary to undertake a study whose aim was to evaluate the impact of physiotherapy in the management of non-operated gonarthrosis in the physiotherapy department of the Centre National d'Appareillage Orthopédique du Mali (C.N.A.O.M). Methods and Patients: This was a descriptive cross-sectional study over a period of one month. All patients seen in consultation with gonarthrosis and consenting were included. Results: In total, out of 561 patients seen in consultation at the C.N.A.O.M, we included 10 patients, i.e. 1.78%. Females accounted for 86%, with an average age of 55 years. Gonarthrosis was unilateral in 28.6% and bilateral in 71.4%. With the exception of one patient, all the other patients were overweight or obese. Apart from one patient, physiotherapy improved the symptoms in all our patients. Conclusion: Gonarthrosis is a very disabling condition. Our results are similar to those in the literature, i.e. it mainly affects obese adult women. Management is multidisciplinary. Physiotherapy plays a key role in the management of gonarthrosis. It significantly improves the clinical signs and quality of life of patients. A multicentre case-control study would be useful to assess the efficacy of physiotherapy alone in the management of gonarthrosis.

Patient Compliance With Physical Therapy Following Orthopedic Surgery and Its Outcomes.

Patient compliance is a major concern for the efficacy of physiotherapy amongst those that undergo orthopedic surgery. The substantial number of people who are non-compliant makes this an imperative issue to address. Our objectives were to quantify the percentage of patient compliance for physiotherapy after their surgery, to measure the association between compliance and the status of health, mobility, and pain, and to identify the causes of non-compliance. A cross-sectional study was conducted on post-orthopedic surgery patients attending physical therapy sessions at King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia, over a one-year period. The sample size of 359 was calculated and selected using simple random sampling. Our questionnaire was developed by adopting questions from two previously validated studies. The majority of the participants (n=194; 54%) were male. One hundred and ninety-three (53.8%) participants had a diploma or higher. The age group 18-35 was found to be significantly associated with skipping physiotherapy sessions when they started to feel well (P= 0.016) and skipping due to other responsibilities (P=0.002). Single people skip physiotherapy when they start to feel well (P=0.023), due to other responsibilities (P=0.028), and due to poor timing (P=0.049). Self-reported compliance to physical therapy after surgery was 231 (64.3%). Patient status showed overall improvement. There is a significant percentage of non-compliance and the patient's age, gender, marital status, and level of education play a role in the causes of non-compliance. In addition, the patient's status (health, pain, and mobility) is better in those who are compliant than in those who are not.

Efficacy of Physical Therapy after Intra-Articular Steroid Injection in Patients with Adhesive Capsulitis of the Hip Joint

Efficacy of Physical Therapy after Intra-Articular Steroid Injection in Patients with Adhesive Capsulitis of the Hip Joint

Physiotherapy Interventions versus Surgical Interventions for Patients with Prolapsed Lumbar Intervertebral Disc (PLID): A Critical Review

The most common predisposing factor for low back pain is a prolapsed lumber intervertebral disc. It is the most prevalent symptom in the modern population, albeit it was formerly the ancient curse of society, and it affects 80% of the population at some time in their lives. The goal of this study was to assess the efficacy of physiotherapy versus surgery for patients with prolapsed intervertebral disc. A thorough search of Medline, Embase, CINAHL, CENTRAL, and PEDro was done. Randomized control trial and prospective cohort study relevant to physiotherapy versus surgery, physiotherapy management alone, surgery among the lumbar disc herniation patients were included. Studies that were written in English and came out between 2006 and 2018 were enlisted using inclusion criteria. For screening, identified similar types of articles, avoid duplicate articles, and finally compare and contrast 5 articles. In the short-term, according to the majority of the articles, surgery was more beneficial than conservative treatment. However, there was no discernible difference between physiotherapy and surgery after a long period of observation, and the re-operation rate after surgery was 3%–20% within the first 1–2 years. Physiotherapy intervention had no adverse effects, whereas surgery had some adverse effects. In all circumstances, physiotherapy intervention is more effective than surgery. Physiotherapy interventions should be prescribed in a structured way.

Effectiveness of Physiotherapy Interventions in the Management Male Sexual Dysfunction: A Systematic Review

Background Male sexual dysfunction is a common disorder with consequential implications. Hitherto, treatment was based on pharmacological approach which has yielded little success in sustainability and produced attendant complications including overweight/obesity, and cardiovascular problems. Hence, the paradigm is toward non-pharmacological approach, but their efficacy is yet to be summarized for clinical practice. This study summarized efficacy of physiotherapy for male sexual dysfunction to inform clinical decision-making and practice. Methodology Electronic search of clinical trials on PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Central, Scopus, and Google Scholar was conducted covering from inception till July 2021 using words, such as male sexual dysfunction and physiotherapy and further refined to erectile dysfunction, premature ejaculation, exercises, electrical stimulation, biofeedback. Search strategy included expansion via medical subject headings (MeSH) and truncation of keywords. Boolean operators “AND” and “OR” were utilized. Results Out of 239 studies, 13 eligible ones were included in this study. Outcome measures used were full/abridged versions of International Index of Erectile Function (IIEF/IIEF-5), Manometric, or digital anal pressure measurement. Eleven studies were on erectile dysfunction/erectile dysfunction with climacturia and two on premature ejaculation. Physiotherapy was for 6–12 weeks covering 9–20 sessions. Physiotherapy used was standalone/combinations of pelvic floor muscle exercises, electrical stimulation, or biofeedback. PEDro scores of the studies were 4–9/10. Studies involved 912 participants (472/440 intervention/control) between 19 and 83 years with erectile dysfunction lasting 6–360 months. There was significant (0.0001 ≤ p ≤ .05) improvement in sexual function (interventions > controls). Nothing determines the efficacy of physiotherapy or choice of approach. Conclusion Physiotherapy is an effective non-pharmacological treatment approach for male sexual dysfunction.

Physiotherapy Efficacy of Mulligan Technique in Subacromial Conflict: Literature Review

General Information: The subacromial conflict is a disorder of gleno-humeral joint that results from compression of soft tissue.The Mulligan concept based on the biomechanical and anatomical concepts of the human body. Purpose: Evaluation of the effectiveness of the MulliGan technique in subacromial conflict. Methodology: The study is Review (Literature Review) and was conducted in 6 electronic databases. Randomized type studies were included in our study. The tests used to assess subacromial conflict were: Visual Analog Scale; Disabilities of the Arm, Shoulder and Hand; Short Form-36; Pressure pain threshold; Current pain severity; Numeric Rating Scale; Goniometer; Constant shoulder score. Results: From 65 studies found, only 6 include our study criteria. The study of Yanwu Wang, has the maximum scoring according to the Pedro scale, was evaluated with 10 points. Conclusions: The MulliGan technique resulted effective in treating subacromial conflict.&#x0D; &#x0D; Received: 23 September 2022 / Accepted: 28 November 2022 / Published: 20 December 2022

Evaluation of the effect of the drug on physiotherapy methods on cytokines and chemokines of Covid-19 patients

Previous investigations have demonstrated that interleukin-6 (IL-6), C reactive protein (CRP), tumor necrosis factoralpha (TNF-alpha), in Coronavirus disease 2019 (COVID-19) patients are considerably increased, and their progressive elevation are clinical threat indicators of disease severity. The purpose of this systematic review is to evaluate the efficacy of physiotherapy, specifically chest physiotherapy, on different cytokines in Covid-19 and non-covid-19 patients. The main complications and symptoms of this virus are as follows; a dry cough, fever, and progressive dyspnea. Quickly, the coronavirus, which is named SARS-CoV-21, has spread worldwide, causing severe lung inflammation, respiratory distress syndrome, cardiac and renal injury, especially in comorbidities patients. Approximately 96% of the cases experience mild respiratory symptoms; some progress to pneumonia, respiratory insufficiency, acute respiratory distress syndrome, and multiorgan failure. The overall mortality rate per number of diagnosed cases is 4.6%; it can range from 0.2% to 15% according to age and health problems. Combination MeSH and text terms were used to perform the search strategy. Interventions in RCTs and clinical trials with or without comparison were assessed. Six studies met the inclusion criteria. Studies demonstrated that physiotherapy could have an effect on TNF-alpha, IL-6, IL-10, IL-1β and CRP.

Efficacy of physiotherapy interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses.

To update and appraise the efficacy of physiotherapy for adults with cervicogenic headache. Bibliographic searches were conducted up to October 2021 for randomized controlled trials (RCTs), assessing the efficacy of physiotherapy interventions for adults with cervicogenic headache, in five databases: CINAHL, Physiotherapy Evidence Database (PEDro), PubMed, Sage Journals, and Wiley Online Library. Data extraction of included trials was conducted by two reviewers according to a standardized extraction form. The PEDro tool and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach were used for grading evidence. Results from trials with similar interventions and with similar outcome measures were pooled into separate meta-analyses. A qualitative synthesis was performed for studies that were not pooled into meta-analyses. Fourteen trials were included. Moderate-certainty evidence indicates that manual therapy significantly reduces headache frequency (mean difference [MD]: -0.93 episodes/week; 95% confidence interval [CI]: -1.40 to -0.46; 2 RCTs; n=265) compared to sham manual therapy, and headache frequency (MD: -1.23 episodes/week; 95% CI: -1.55 to -0.91; 3 RCTs; n=126) and intensity (MD: -1.63/10; 95% CI: -2.15 to -1.10; 4 RCTs; n=208) compared to no treatment in the short term. At 12-month follow-up, moderate-certainty evidence indicates that manual therapy did not lead to greater reduction in headache intensity (MD Visual Analog Scale 0-10: -0.12; 95% CI: -0.49 to 0.26; 2 RCTs; n=265) or frequency (MD: -0.32 episodes/week; 95% CI: -0.91 to 0.28; 2 RCTs; n=265) when compared to a sham manual therapy. In the long-term, in one high quality trial, neck exercise significantly reduced headache intensity compared to no treatment (MD: -1.51/10; 95% CI: -2.52 to -0.50; n=100) or to aerobic exercises in another trial of moderate quality (MD: -1.15/10; 95% CI: -2.1 to -0.20; n=180). Manual therapy in the short term and neck exercise in the long term may be efficacious to treat adults with cervicogenic headache. More high-quality evidence is needed and future results may change the current conclusions. Trial Registration Prospero: #CRD42019135858.

Comparison of the efficacy of physiotherapy, subacromial corticosteroid, and subacromial hyaluronic acid injection in the treatment of subacromial impingement syndrome: A retrospective study

Background: The optimal nonoperative management for subacromial impingement syndrome (SIS) is unclear. This study evaluated the efficacy of subacromial corticosteroid versus a hyaluronic acid injection and their effectiveness against physiotherapy in patients with SIS. Methods: SIS patients treated with either physiotherapy or subacromial injection of triamcinolone (40 mg), or subacromial hyaluronic acid injection were included in this retrospective study. The outcome measures were evaluated 3 and 6 mo after the intervention and included pain evaluated by a visual analog scale (VAS) and limb function assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Results: Eighty-eight patients with SIS were included. Treatment was done with corticosteroid injection in 31 patients, hyaluronic acid injection in 30 patients, and physiotherapy in 27 patients. The mean improvement of VAS, DASH, and ASES scores of the corticosteroid group was significantly higher when compared with the physiotherapy group at 3 mo (P=0.035, P&lt;0.001, and P&lt;0.001, respectively) and 6 mo (P=0.036, P&lt;0.001, and P&lt;0.001, respectively), also in comparison with the hyaluronic acid group at 3 mo (P=0.038, P&lt;0.001, and P=0.002, respectively) and 6 mo (P=0.044, P&lt;0.001, P&lt;0.001, respectively). The mean improvement of DASH and ASES scores, but not VAS, was significantly higher in the hyaluronic acid group compared to the physiotherapy group at 3 mo (P=0.022, P=0.034, and P=0.55, respectively) and 6 mo (P=0.46, P=0.039, and P=0.51, respectively). Conclusion: Subacromial corticosteroid injection is more effective than physiotherapy and hyaluronic acid injection in treating SIS symptoms. Level of Evidence: Level III.

Effectiveness of the multi-/interdisciplinary neurorehabilitati-on program in young patients with incomplete myeloradicualar injuries after spinal cord injury

Nowadays young persons may be frequent victims of traumatic cervical spinal cord injury (CSCI). Material and methods A retrospective study (January 2019-March 2021) we conducted with the approval of the Ethics Commission of THEBA, to assess the results of the complex me-dical rehabilitation program during the subacute period. A selected group of 23 young tetraple-gic patients with traumatic CSCI, were admitted to the THEBA Neuromuscular Rehabilitation Clinic with incomplete (AIS-B, -C, -D) myeloradicular injuries. All patients were males, aged between 19 and 57 years (with a mean of 44.35 years, SD 12.9). Patients came from urban areas 11 (48%) and the remaining 12 (52%) from rural areas. Results The spine lesion location was located at C2 vertebral level (4 men), C3 (4 men), C4 (3 men), C5 (6 men); C6 (in 2 patients); C7 (in 2 men); T6 and T7 in 1 patient each. The patients' neurological levels of injury were: C1 (in 2 pati-ents), C2 (in 2 patients), C3 (in 4 patients), C5 (in 7 patients), C6 (in 4 patients) and C7 (in 2 pati-ents). The AIS/ Frankel degree at admission was: incomplete lesion AIS-B 3 patients, AIS-C 11 pa-tients, AIS-D 9 men. The average muscle strength at admission was 60.72 (SD 25.74). In the study group 20 patients were operated: anterior osteosynthesis was performed in 16 patients and pos-terior vertebral approach in 4 patients. The neurological evolution was favorable: at discharge there were only patients with incomplete AIS-C (8 men), respectively AIS-D (15 men) grade type of lesions, and their average muscle strength at discharge was 71.97 (SD 22.30). The following comorbidities were associated: arterial hypertension (in 2 patients), traumatic brain injury (in 14 patients), alcoholism (in 9 patients), pneumonia (in 6 patients), neoplastic disorders (in 1 pati-ent), gastric ulcer (in 2 patients), depression (in 2 patients). Complications of the immobilization syndrome were: enterocolitis (in 3 men), bronchopneumonia (in 3 patients), urinary tract infec-tions (in 13 patients) and bedsores (in 2 patients). Discussion Effectiveness of the final therapeutic approach was assessed (in percentage) by evaluating the progress of the muscle strength (quanti-fied and compared at discharge vs. admission) reported to the number of days of treatment. The external-internal variations of the numeric scores of the quality of life, FIM, Ashworth and Penn were evaluated. Statistics was performed for small groups (Anova and Pearson) to establish the effectiveness of the rehabilitation program, evaluating the level of correlation between the sco-res quantified with the aforementioned the scales. An inversely proportional relationship was found between spasticity and efficacy of physical therapy (F 0.000, Pearson -0.35), between the scores of Penn scale and the effectiveness of physical therapy (F test 0.000, Pearson -0.18), respec-tively directly proportional relationship between the kinetic therapy and FIM (F test 0.000, Pear-son 0.74), similar to the relationship between physical therapy and the scores assessing the quali-ty of life (F test 0.01, Pearson 0.02). Conclusions These results underline the importance of a multi-interdisciplinary team approach in the management of the tetraplegic patients after CSCI during the subacute post-lesional/ post-operative stage. Keywords: neurorehabilitation program, incomplete myeloradicualar injuries, spinal cord injury