Rehabilitation Exercises Research Articles

Integrating Motion Intention and Impedance Control in Teleoperated Robotic Rehabilitation for Upper Extremity Disorders

Abstract Due to the global pandemic in 2020, rehabilitation services had to adapt to virtual care to meet the needs of patients with a diversity of upper extremity disorders and injuries, from simple fingertip injuries to replanted extremities, while mitigating the spread of COVID-19. For patients who require occupational therapy in their rehabilitation, teleoperated robotic care can fulfill this need. Moreover, some clinical studies show that incorporating the active intention of patients into rehabilitation training enhances the effectiveness of therapies. This research aims to develop a bilateral impedance controller with a Franka Emika 7 DOF (degree-of-freedom) articulated robot using MATLAB, facilitating upper limb occupational therapy. Through this setup, the Franka robot will lead patients through various therapeutic exercises based on their motion intention, such as a pick-and-place exercise. The exercises’ efficacy is assessed through evaluations of torque, muscle strength, and jerking performance. During patients’ rehabilitation exercises with the Franka Robot, we anticipate observing decreased muscle activity alongside a smooth, assist-as-needed trajectory. This method will allow a patient to perform complex movements essential for daily activities quicker than traditional occupational therapy.

A quasi-experimental study on couple-based exercise program improving cardiac rehabilitation exercise compliance in post-PCI patients.

Percutaneous coronary intervention (PCI) helps treat coronary artery disease but only provides short-term relief and doesn't stop disease progression. Exercise rehabilitation can improve outcomes for patients after PCI and lower the risk of death and new heart problems, but many patients struggle to stick with their exercise routines. Spouses play a crucial role in supporting patients and helping them stay committed to their rehabilitation. This study aims to evaluate the effectiveness of a couple-based exercise program in improving exercise adherence among post-PCI patients. This study used a quasi-experimental design, 70 dyads were recruited for a 12-week investigation. Participants were divided into an intervention group to receive the Couple-Based exercise program and a control ensemble for conventional exercise-based cardiac rehabilitation. The primary parameter under examination was exercise adherence. Secondary endpoints encompass exercise self-efficacy, the 6-minute walk test, the 9-item Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Data were harvested at baseline and post-intervention (12 weeks). Following a three-month monitoring period, noticeable differences were observed in the Couples exercise group compared to the control group in the realms of exercise adherence, exercise self-efficacy, the 6-minute walk test, and anxiety-depression indices (P < 0.05). A couple-based exercise program developed based on a developmental-contextual framework improves exercise adherence and exercise self-efficacy, enhances cardiac function and exercise capacity, and improves anxiety and depression in post-coronary arteriography patients. This approach is likely to be an effective way to improve rehabilitation outcomes, leading to the broader goal of improving patient prognosis and reducing adverse cardiovascular events. The study's registration was recorded with the Chinese Clinical Trials Registry (12/04/2022, registration number ChiCTR2200058600).

Evaluation of V-type titanium cable internal fixation for the treatment of young adult fifth lumbar spondylolysis: technical notes and a retrospective clinical study.

Various strategies, each with its own set of limitations, are available for managing lumbar spondylolysis. In response, our department has developed an innovative solution: a V-shaped titanium cable integrated with a pedicle screw internal fixation system specifically designed for lumbar spondylolysis in young adults. The objective of this study was to thoroughly investigate the long-term efficacy of V-type titanium cable internal fixation for the management of spondylolysis, especially in young adults. Twenty-one patients with fifth lumbar spondylolysis were treated using V-shaped titanium cables and pedicle screw internal fixation at the General Hospital Xinjiang Military Command. The duration of low back pain before surgery was 6 ~ 48 (15.85 ± 11.57) months. The Medtronic (S7) navigation system was used during surgery to guide the placement of pedicle screws, aiming to avoid damaging the L4-5 facet joint by positioning the screws lower and further to the side. Intraoperative indices (operative time and intraoperative blood loss) were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), pelvic incidence (PI), and intraoperative imaging measurements of screw accuracy were meticulously recorded and assessed in a comprehensive manner. This thorough evaluation was conducted both intraoperatively and throughout the follow-up period, which lasted for at least one year.The Macnab efficacy criteria were used to assess postoperative outcomes during the final follow-up period. All patients successfully completed the 1-year follow-up on time. Two patients experienced postoperative wound liquefaction and successfully recovered after undergoing dressing changes. The average duration of the surgical procedure was 113.09 ± 6.97min, and an intraoperative blood loss of 50.47 ± 21.32 millilitres was observed. Significant differences were noted in visual analog scale (VAS) scores before and after surgery at various time intervals, indicating improvement with the progression of rehabilitation exercises. No significant changes were found in the pelvic incidence (PI), and there were no notable differences between the preoperative and postoperative periods. No loosening, breakage, or failure of the internal fixation was found during the long-term follow-up. Furthermore, there were no serious complications, such as infection or vascular or nerve injuries. occurred during the procedure. A patient who presented with a considerable cryptic fissure of sacrum 1 experienced dural injury during the surgical procedure. Intraoperatively, dural sutures were skillfully applied, and the adjacent muscles were fortified. Remarkably, the patient achieved successful healing in a single stage. On the first day postsurgery, a gradual improvement in mobility was noted. The use of a V-shaped titanium cable in conjunction with a pedicle screw internal fixation system for the management of fifth lumbar spondylolysis in young individuals is characterized by its ease of execution and ability to yield favorable outcomes. This approach relies on the prerequisite that patients with minimal intervertebral disc injury or mild lumbar spondylolisthesis demonstrate high overall success rates but experience low failure rates associated with internal fixation. Most significantly, this technique involves segmental internal fixation, which safeguards the functional spinal unit (FSU).

Abstract 4137180: Effectiveness of Exercise-based Interventions in the Prevention of Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis

Introduction: Breast cancer patients receiving anticancer therapy are at risk of developing cancer therapy-related cardiac dysfunction (CTRCD). While exercise has been shown to improve cardiorespiratory fitness in these patients, its effectiveness in preventing CTRCD remains unclear. Research Questions: How do exercise-based interventions affect CTRCD in breast cancer patients? Which exercise modality is most effective in preventing CTRCD? Goals: This network meta-analysis aimed to synthesize the available evidence on the effectiveness of exercise-based interventions based on cardiac function parameters and to identify the optimal exercise modality for preventing CTRCD. Methods: A comprehensive search was conducted in PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library from inception to March 4, 2024. Studies that used exercise interventions, either exercise alone or with other interventions, were included. Outcome measures included at least one cardiac function parameter such as left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS). Pairwise and network meta-analyses were performed using R software (v.4.3.3). Results: A total of 1149 participants from 14 RCTs were included. Compared to the usual care, exercise-based interventions significantly improved LVEF (MD=1.68; 95% CI=0.59-2.77; p＜0.05) and GLS (MD=1.40; 95% CI=0.59-2.21; p＜0.05). Based on the ranking probabilities, combined aerobic and resistance exercise was the most effective way to improve LVEF (4 studies, SUCRA: 96.46%), followed by cardiac rehabilitation (2 studies, SUCRA: 45.31%) and aerobic exercise (4 studies, SUCRA: 41.57%). In terms of improving GLS, combined aerobic and resistance exercise also ranked highest (3 studies, SUCRA: 87.77%). However, cardiac rehabilitation (2 studies, SUCRA: 46.70%) and aerobic exercise (1 study, SUCRA: 44.92%) were still less effective. Conclusion: This network meta-analysis provides low-certainty evidence for the potential efficacy of exercise-based interventions in preventing CTRCD, especially the combined aerobic and resistance training. Further rigorous studies are needed to confirm the effectiveness of exercise-based interventions in the prevention of CTRCD.

Personalised exercise rehabilitation in cancer survivorship: Findings from a triage and referral feasibility study.

Screening, triage and referral systems are proposed as efficient, needs-based models of cancer rehabilitation. This study aimed to evaluate the feasibility of the PERCS triage and referral system. Utilising a pre-post design, the feasibility of PERCS was evaluated quantitatively in the context of a physiotherapy-led clinic for patients diagnosed with cancer during COVID-19. Assessments at baseline and 12weeks (T1) included medical, social and physical activity history; patient-reported outcomes and performance-based measures. Following the assessment, the PERCS system allocated participants to one of three exercise pathways. Sixty-four participants were recruited over 5months (25.2% recruitment rate; female n = 39; mean age 61.4 (12.4) years). Almost all participants (90.6%) required support to become more physically active. The majority (n = 43, 66%) were referred to community exercise programmes, and n = 15 (23%) required physiotherapy rehabilitation. Five required medical pre-clearance, and one was re-triaged at 1week. The mean cost per participant for community exercise services was €107.70. At T1, adherence to physical activity guidelines increased for aerobic (44 to 83%) and resistance (13 to 67%) exercise. Improvements were observed in hand grip strength (x̄ 2.59kg, p = 0.001), 30-s sit-to-stand (x̄ + 3.7 stands, p < 0.001) and 6-min walk test (x̄ + 37.3m, p = 0.001). PERCS appropriately triaged patients to the right level of exercise and rehabilitation for individual needs. Participants experienced improvements in physical activity and physical functioning metrics. The PERCS triage and referral system is feasible to complete and may support the effective and patient-centred implementation of exercise into cancer care. ClinicalTrials.gov registration: NCT05615285.

Neuromuscular Regeneration of Volumetric Muscle Loss Injury in Response to Agrin-Functionalized Tissue Engineered Muscle Grafts and Rehabilitative Exercise.

Neuromuscular deficits compound the loss of contractile tissue in volumetric muscle loss (VML). Two avenues for promoting recovery are neuromuscular junction (NMJ)-promoting substrates (e.g., agrin) and endurance exercise. Although mechanical stimulation enhances agrin-induced NMJ formation, the two modalities have yet to be evaluated combinatorially. It is hypothesized that the implantation of human myogenic progenitor-seeded tissue-engineered muscle grafts (hTEMGs) in combination with agrin treatment and/or exercise will enhance neuromuscular recovery after VML. The hTEMGs alone transplant into VML defects promote significant regeneration with minimal scarring. A sex-appropriate, low-intensity continuous running exercise paradigm increases acetylcholine receptor (AChR) cluster density in male mice twofold relative to hTEMG alone after 7weeks of treadmill training (p<0.05). To further promote neuromuscular recovery, agrin is incorporated into the scaffolds via covalent tethering. In vitro, agrin increases the proliferation of hMPs, and trends toward greater myogenic maturity and AChR clustering. Upon transplantation, both hTEMGs+agrin and hTEMGs+exercise induce near 100% recovery of muscle mass and increase twitch and tetanic force output (p>0.05). However, agrin treatment in combination with exercise produces no additional benefit. These data highlight the unprecedented regenerative potential of using hTEMGs together with either agrin or exercise supplementation to treat VML injuries.

Knowledge, attitude, and perception of exercises among post-hematopoietic stem cell transplant patients: A cross-sectional study.

Exercise rehabilitation is crucial for the recovery after hematopoietic stem cell transplantation (HSCT). This study aimed to investigate knowledge, attitude, and perception (KAP) of exercise among post-HSCT patients. This cross-sectional study was conducted at Zhujiang Hospital, Southern Medical University between January 2020 and December 2022 among post-HSCT patients, using a self-designed questionnaire. A total of 192 patients were included, with the mean age of 37.90 ± 11.96 years; 116 (60.42%) reported to exercise before. The mean KAP scores were 9.22 ± 2.05 (possible range: 0-12), 43.51 ± 5.47 (possible range: 12-60) and 51.79 ± 7.45 (possible range: 15-75), respectively. Patients previously inactive in exercise exhibited significant differences in KAP scores from active patients: attitude total score, positive attitude, perception total score, willingness to exercise, aerobic exercise, breathing training (all P < .001), with a noteworthy distinction in resistance exercise (P = .018). According to structural equation modeling, perception was directly influenced by knowledge (β = 0.87, P < .001), attitude (β = 0.26, P = .007), and exercise habits (β = 3.36, P = .001), as well as indirectly by education (β = 0.44, P = .010) and knowledge (β = 0.18, P = .029). Post-HSCT patients had adequate knowledge, moderate attitude and perception of exercises, even 1 year after HSCT. Patients inactive in exercises exhibited significant differences in knowledge and exercise perception from active patients. Healthcare professionals should tailor education, target attitude, and personalize exercise plans to facilitate effective recovery post-HSCT.

Enhanced walking function and quality of life in unicondylar knee replacement patients through continuous nursing intervention: A clinical study.

The knee joint anatomical structure is susceptible to external forces, which can lead to functional break down, profoundly affecting the quality of life and daily functioning of individuals. To investigate the effects of continuous nursing intervention on walking function, quality of life, and treatment satisfaction in patients undergoing unicondylar knee replacement. This prospective study included 90patients who underwent unicondylar knee arthroplasty due to unicondylar osteoarthritis. Participants were divided into two groups based on their nursing methods: the control group (n= 45) and the observation group (n= 45). Three months post-intervention, the observation group demonstrated significant improvements in knee joint range of motion, Hospital for Special Surgery Knee Score score, and Lysholm knee joint score compared to the control group (P< 0.05). The observation group also had a shorter completion time for the Timed Up and Go test and significantly higher SF-36 scores (P< 0.05 for both). Additionally, Knee Injury and Osteoarthritis Outcome Score scores in the observation group were significantly higher after three months of intervention (P< 0.05). And the observation group reported higher satisfaction rates and lower dissatisfaction rates compared to the control group (P< 0.05). Early postoperative rehabilitation guidance, regular reviews, and rehabilitation exercise guidance result in better rehabilitation outcomes, enhanced knee joint function, improved walking ability, and overall quality of life for patients undergoing unicondylar knee replacement.

A Stretchable Conductive Material with High Fatigue Resistance for Strain Sensors.

Intrinsically stretchable conductive materials based on elastic substrates and conductive components play important roles in biomedical applications, such as exercise rehabilitation monitoring and disease prediction. A persistent challenge is to combine high fatigue resistance with excellent mechanical properties in stretchable conductive materials. Herein, we present a stretchable conductive material with both good fatigue resistance and high tensile properties (∼3170%) based on poly(acrylic acid)-phytic acid-trehalose-polypyrrole (denoted as PPTP). The as-prepared PPTP hydrogel electrode showed no obvious cracking or delamination after 400 loading and unloading cycles and maintained good electrical signal transmission function after 1000 cycles. We further collected stable signals for human motion and handwriting using the stretchable hydrogel electrode as a strain sensor, demonstrating the potential application of the PPTP stretchable hydrogel electrode in biomedicine.

Wearable device data-driven athlete injury detection and rehabilitation monitoring algorithm

In recent years, sports wearable technology has completely changed the way athletes prepare, compete, and recover. Wearable technology has a lot to offer in the rehabilitation process, which is essential to an athlete’s return to their best performance. Wearable devices for athlete injury detection pose potential challenges like data quality, security, and privacy, impacting accuracy, reliability, and effectiveness. To solve these problems, an innovative injury detection and rehabilitation monitoring (IDRM) system was proposed for athletes. By employing an adjustable recurrent neural network (ARNN) to detect anomalies in injury risks such as abnormal joint movements in athletes. In this study, biomechanics data was collected from sports athletes through wearable devices, and the wearable system provided feedback to the user. A redefined convolutional neural network (RCNN) was utilized to monitor the rehabilitation process. This system tracks athlete’s rehabilitation progress and ensures that progress monitors were performed correctly, and the system, feasibility was evaluated on 10 healthy subjects performing 4 different rehabilitation exercises. Each exercise was performed four times monitoring and validation. The data was preprocessed using a Gaussian filter to remove noise from the obtained data. Then the features are extracted using independent component analysis (ICA) for dimensionality reduction from preprocessed data. The proposed method is implemented using Python software. In comparative analysis, the performance of ARNN showed high performance, with an F1-measure of 91.6%, accuracy of 93.5%, recall of 92.8%, and precision of 91.4%. With a 95% accuracy rate, 98% F1 measure, 94% precision, and 93% recall, the RCNN model functioned effectively. The result showed the proposed method achieved better performance in athlete injury detection and accurately recognizing all rehabilitation monitoring. This study provides a complete approach to athlete health management by highlighting the integration of rehabilitation monitoring and injury detection into an overall structure.

The Effectiveness of Remote Exercise Rehabilitation Based on the "SCeiP" Model in Homebound Patients With Coronary Heart Disease: Randomized Controlled Trial.

While exercise rehabilitation is recognized as safe and effective, medium- to long-term compliance among patients with coronary heart disease (CHD) remains low. Therefore, promoting long-term adherence to exercise rehabilitation for these patients warrants significant attention. This study aims to investigate the impact of remote exercise rehabilitation on time investment and related cognitive levels in homebound patients with CHD. This study utilizes the SCeiP (Self-Evaluation/Condition of Exercise-Effect Perception-Internal Drive-Persistence Behavior) model, alongside WeChat and exercise bracelets. A total of 147 patients who underwent percutaneous coronary intervention in the cardiovascular department of a grade III hospital in Jiangsu Province from June 2022 to March 2023 were selected as study participants through convenience sampling. The patients were randomly divided into an experimental group and a control group. The experimental group received an exercise rehabilitation promotion strategy based on the "SCeiP" model through WeChat and exercise bracelets, while the control group followed rehabilitation training according to a standard exercise rehabilitation guide. The days and duration of exercise, levels of cardiac rehabilitation cognition, exercise planning, and exercise input were analyzed before the intervention and at 1 month and 3 months after the intervention. A total of 81 men (55.1%) and 66 women (44.9%) were recruited for the study. The completion rate of exercise days was significantly higher in the experimental group compared with the control group at both 1 month (t145=5.429, P<.001) and 3 months (t145=9.113, P<.001) after the intervention. Similarly, the completion rate of exercise duration was significantly greater in the experimental group (t145=3.471, P=.001) than in the control group (t145=5.574, P<.001). The levels of autonomy, exercise planning, and exercise input in the experimental group were significantly higher than those in the control group at both 1 month and 3 months after the intervention (P<.001). Additionally, the experimental group exhibited a significant reduction in both process anxiety and outcome anxiety scores (P<.001). Repeated measures ANOVA revealed significant differences in the trends of cognitive function related to cardiac rehabilitation between the 2 patient groups over time: autonomy, F1,145(time×group)=9.055 (P<.001); process anxiety, F1,145(time×group)=30.790 (P<.001); and outcome anxiety, F1,145(time×group)=28.186 (P<.001). As expected, the scores for exercise planning (t145=2.490, P=.01 and t145=3.379, P<.001, respectively) and exercise input (t145=2.255, P=.03 and t145=3.817, P<.001, respectively) consistently demonstrated superiority in the experimental group compared with the control group at both 1 and 3 months after the intervention. Interestingly, we observed that the levels of exercise planning and exercise input in both groups initially increased and then slightly decreased over time, although both remained higher than the preintervention levels (P<.001). The remote health intervention based on the "SCeiP" model effectively enhances exercise compliance, exercise planning, exercise input, and cognitive levels during cardiac rehabilitation in patients with CHD. Chinese Clinical Trial Registry ChiCTR2300069463; https://www.chictr.org.cn/showproj.html?proj=192461.

Effectiveness of Vibrapep (OPEP) on Pulmonary functions in phase one of cardiac rehabilitation-A Randomized controlled trial

Background and Aims: According to the WHO report 2022, coronary artery disease is the most prevalent cardiac disease worldwide. Impaired respiratory muscle function, increased secretions and reduced vital capacity are pulmonary complications commonly associated with CABG and Valve replacement surgeries. The purpose of this study was to compare the effect of Vibrapep and standard phase one of cardiac rehabilitation exercises on pulmonary functions. Methods: A Randomized Controlled Trial was conducted on 46 participants. Participants were randomly allocated into two groups, Vibrapep and phase one of cardiac exercises were given to Group A (n = 23), while Group B (n = 23) received only phase one cardiac rehabilitation exercises. The intervention was administered for twice a day for 5 days. Outcome measures such as Sputum volume, maximal inspiratory and expiratory pressure, thoracic expansion, SPO2 level, blood pressure and Peak expiratory flow rate were evaluated at baseline and on 5th day of the study. Results: Wilcoxon test of within-group analysis revealed statistically significant improvements in all parameters for both the interventional and control groups (p&lt;0.05*), except in diastolic blood pressure, whereas, between group analysis done using Mann Whitney U test also showed statistical improvement in both groups on all parameters with (p&lt;0.05*). Conclusion: Vibrapep exhibited to be an effective bronchial hygiene therapy in phase one of cardiac rehabilitation with respect to enhancing pulmonary functions such as sputum reduction, chest expansion, improved respiratory pressure’s, Peak Expiratory Flow Rate along with Cardiac rehabilitation.

Hip Flexor Muscle Activation During Common Rehabilitation and Strength Exercises.

Background/Objectives: The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) describe iliopsoas activation levels during common rehabilitation exercises and (2) provide an evidence-based exercise progression for strengthening the iliopsoas based on electromyography (EMG) studies. Methods: In total, 109 healthy adult participants ranging from ages 20 to 40 were included in nine studies. PubMed, CINAHL, and Embase databases were systematically searched for EMG studies of the psoas, iliacus, or combined iliopsoas during specific exercise. The Modified Downs and Black Checklist was used to perform a risk of bias assessment. PROSPERO guidelines were followed. Results: Nine studies were included. Findings suggest that the iliopsoas is increasingly activated in ranges of hip flexion of 30-60°, particularly with leg lowering/raising exercises. Briefly, >60% MVIC activity of the iliopsoas was reported in the active straight leg raise (ASLR) in ranges around 60° of hip flexion, as well as with supine hip flexion and leg lifts. In total, 40-60% MVIC was found in exercises including the mid-range of the ASLR around 45° of hip flexion and lifting a straight trunk while in a hip flexed position. Conclusions: The findings suggest that exercises in increased hip flexion provide greater activation of the iliopsoas compared to exercises where the trunk is moving on the lower extremity. Iliopsoas activation can be incrementally progressed from closed to open kinetic chain exercises, and eventually to the addition of external loads. The proposed exercise program interprets the results and offers immediate translation into clinical practice.

Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial

Study objectivesThis study aimed to assess the effect of perioperative rehabilitation exercise, initiated shortly after hospital admission, on postoperative outcomes in elderly patients. DesignA prospective, multicenter, randomized, controlled, open-label, and assessor-blinded clinical trial. SettingHospital wards. PatientsElderly patients (≥65 years, n = 160) scheduled for gastrointestinal surgery between June 2021 and November 2022 were enrolled and randomly assigned to the intervention or control group. InterventionsPatients were divided into two groups base on whether they had received a specific type of exercise program initiated after hospital admission and continued until 30 days after surgery. MeasurementsThe primary outcome was the Comprehensive Complications Index (CCI) measured at 30 days after surgery. Secondary outcomes were the rate of complications, number of complications, patient satisfaction, hospital readmission, postoperative length of stay, gastrointestinal function recovery, postoperative quality of life and psychological status. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted. Main resultsITT analysis showed a significantly lower 30-day CCI in the intervention group (β: -6.31; 95 % Confidence Interval [CI], −11.26 to −1.37, P = 0.013). Compared to controls, the intervention group had a decreased rate of hospital readmission (Odds Ratio: 0.00; 95 % CI, 0.00 to 0.32, P = 0.022), less number of complications (β: -0.57; 95 % CI, −1.03 to −0.11, P = 0.016), as well as lower rate of postoperative anxiety (β: -0.74; 95 % CI, −1.42 to −0.06, P = 0.033) and depression scores (β: -1.13; 95 % CI, −0.97 to −1.30, P = 0.008). Additionally, the intervention group reported higher satisfaction (β: 0.98; 95 % CI, 0.33 to 1.64, P = 0.004) and Euro quality of life-Visual Analogue Scale scores (β: 8.88; 95 % CI, 2.48 to 15.28, P = 0.007). Similar results were found in the PP analysis. ConclusionPerioperative rehabilitation exercise has a positive impact on postoperative complications, quality of life and psychological well-being in elderly patients undergoing gastrointestinal surgery, even when implemented after hospital admission.

Prehabilitative/rehabilitative exercise, nutrition, and psychological support for bladder cancer: A scoping review of randomized clinical trials.

The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost-effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. PLAIN LANGUAGE SUMMARY: In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.

Effectiveness and safety of exercise training and rehabilitation in elderly patients after heart valve intervention: A systematic review and meta-analysis of randomized controlled trials

ObjectiveTo investigate the effectiveness and safety of exercise rehabilitation in older adults undergoing intervention for heart valve disease. MethodPubMed, Embase, Cochrane Library, CINAHL, Ovid Medline, SPORTDiscus, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang were systematically searched until January 2024. Risk-of-bias assessments were performed using the Cochrane risk-of-bias tool. A meta-analysis of the following indexes was performed using RevMan 5.4 software. ResultsNine trials involving 631 patients were ultimately included. Exercise rehabilitation significantly reduced the risk of adverse events, increased the 6-minute walk distance, improved the physical component of quality of life, and shortened the length of postoperative hospitalization. However, exercise rehabilitation did not affect all-cause mortality, left heart ejection fraction, or peak oxygen uptake. ConclusionsExercise rehabilitation may enhance exercise capacity, reduce the incidence of adverse events, and shorten the length of postoperative hospitalization in older adults undergoing intervention for heart valve disease.

Effectiveness of vestibular therapy as an adjunct to cognitive therapy to improve cognition in elderly with mild cognitive impairment (MCI)

The rapid global increase in aging populations is leading to a rise in age-related conditions like mild cognitive impairment (MCI), necessitating new treatment strategies. This study will conduct a double-blinded, three-arm, randomized controlled trial to evaluate the effectiveness of adding vestibular therapy to cognitive therapy (VT+CT) compared to cognitive therapy (CT) alone and a control group. Participants will be assigned to one of three groups: VT+CT, CT only, or a control group. The VT+CT group will receive vestibular rehabilitation exercises along with a computerized brain program, while the CT group will get only the computerized brain program. Primary outcomes will include electroencephalography (EEG), the Digit Symbol Substitution Test (DSST), and event-related potential (ERP-P300). Secondary outcomes will be the Stroop Color Word Test (SCWT), Trail-Making Test (TMT), and European Quality 5 Dimensions (EQ-5D-5L). This research aims to determine if VT+CT improves cognitive function in elderly individuals with MCI.

Randomized trial of early exercise rehabilitation and its effects on patients with acute coronary syndrome

To assess the psychological and physiological benefits of early exercise rehabilitation in patients with acute coronary syndrome (ACS). Among 559 ACS-diagnosed patients at Fuzhou University Affiliated Provincial Hospital from January to December 2021, 200 eligible participants were assigned to two groups. The control group received standard care, while the experimental group received early exercise rehabilitation in addition to standard care. The outcomes measured included changes in depression levels (PHQ-9), fasting blood glucose, and troponin I (TnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Data were analyzed using SPSS, with t tests and chi-square tests for group comparisons. In comparison to the control group, the experimental group demonstrated significant improvements in PHQ-9 scores (P < 0.001) and lower fasting blood glucose levels before discharge (P = 0.046). Additionally, the experimental group had notably reduced TnI levels at 72 h after admission (P = 0.001), especially among non-diabetic NSTEMI patients over 60 years old, who showed decreased TnI levels at the 48-hour mark (P = 0.016). However, there were no significant differences in NT-ProBNP change values between the two groups (P > 0.05). Subgroup analysis revealed enhanced outcomes in the intervention group for ACS patients without smoking or drinking history and no heart failure (P = 0.025,P = 0.014,P = 0.018). Early exercise rehabilitation has notable benefits for ACS patients, including reduced depression, improved blood glucose control, and enhanced myocardial protection, especially in nondiabetic NSTEMI patients aged 60 and above.

Comparison of blood flow restriction training rehabilitation and general rehabilitation exercise after anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials.

Blood flow restriction training (BFRT) has been found to reduce quadriceps atrophy and weakness after anterior cruciate ligament (ACL) surgery. However, the clinical benefit of BFRT as compared to general rehabilitation exercise (GRE) alone remains uncertain. This study aimed to compare the effects of BFRT and GRE on ACL reconstruction rehabilitation through a meta-analysis of randomized controlled trials. PubMed, Web of Science, EMBASE, Elsevier and Biosis were searched for randomized controlled trials comparing BFRT and GRE following ACL reconstruction. Primary outcomes included muscle strength (extensor and flexor muscle general strength), Lysholm score, the International Knee Documentation Committee (IKDC) score, extensor muscle torque (peak torque and average torque) and muscle cross-sectional area (CSA). The secondary outcomes included a range of motion (ROM), pain, Y-balance and the Patient-Reported Outcomes Measurement Information System (PROMIS). Thirteen randomized controlled trials involving 376 participants were included. The change in muscle strength (Mean difference, MD: 12.96, 95% confidence interval, [95% CI]: 7.02-18.91, heterogeneity, I2 = 39%), Lysholm score (MD: 9.41, 95% CI: 8.93-9.88, I2 = 40%) and IKDC score (MD: 9.88, 95% CI: 0.57-19.19, I2 = 87%) of the BFRT group were superior to that of the GRE group at the time of last follow-up. However, no significant difference was found between the BFRT and the GRE groups regarding the change in muscle CSA, ROM, extensor muscle torque, pain score, Y-balance and PROMIS. BFRT seems to perform better than GRE in terms of functional improvement and muscle strength following ACL reconstruction, but there seems to be no significant difference between them in terms of joint mobility, pain relief, stability improvement and patient's perception of their disease and treatment. Level II.

A Preliminary Study on Kinetic Analysis of Ground Reaction Force and Impulse During Gait in Patients With Total Hip Replacement and Implication for Rehabilitation.

There is little research done on ground reaction forces (GRF) in terms of 3D impulses after total hip replacement (THR). This study aimed to investigate the GRFs and 3D impulses in four sub-phases of stance during gait in the patients undergoing THR. A total of 10 pain-free THR patients and 10 healthy people were recruited. This is an observational and retrospective study. The gait data was collected between 2008 and 2014 and analyzed between 2020 and 2024. All the participants were included in the three-dimensional gait analysis. Gait parameters, phase durations, GRFs and impulses' key values during gait were calculated in four sub-phases of stance. Statistical comparisons were performed with generalized linear models including age, gender, body mass index and walking speed as interactive factors. It is found that (1) cadence, walking speed, stride length and step width in THR group were significantly decreased in compared with control group; (2) the THR decreased loading response duration in operative side and pre-swing duration in non-operative side compared with the control group, but the THR's two sides have similar duration proportions in sub-stance phases; (3) the THR group had lower GRFs than the control group in vertical direction but higher in the medial-lateral direction; (4) in operative side, the THR's impulses in loading response phase were lower than the control group in anterior-posterior direction, and (5) in non-operative side, the THR's impulse in pre-swing phase in anterior-posterior direction was higher than the control side. The THR group showed slower walking speeds than the control group. The reasons could be from the decreased impulse in loading response phase, the decreased 2nd peak of GRF and the decreased pre-swing impulse in vertical direction in operative side. Clinicians are suggested to consider the information provided when designing relevant rehabilitation exercises on the related muscles and functions.