Individual Physiotherapy Research Articles

Does cognitive function affect functional capacity and perceived fatigue severity after exercise in patients with coronary artery disease?

Successful execution of exercise-based cardiac rehabilitation programs, an important branch of physiotherapy in individuals with coronary artery disease (CAD), depends on adequate cognitive abilities. It has been identified that coronary microvascular dysfunction, marked by reduced coronary flow reserve, is associated with impaired cerebral blood flow, affecting haemodynamic and cognitive performance. This study aimed to investigate how cognitive function influences functional capacity and differences in fatigue perception in CAD patients. Fifty CAD patients, with an average age of 59.40±6.58years, were evaluated for comorbidities (Charlson comorbidity index), number of CAD risk factors (hypertension, diabetes mellitus, dyslipidaemia, smoking, and physical inactivity), cognitive performance (Montreal cognitive assessment scale [MoCA]), functional capacity (incremental shuttle walk test [ISWT]), exercise-induced fatigue (Modified Bourg Scale), and physical activity (PA) levels (international physical activity questionnaire-short form). Analyses focused on the links between MoCA scores and CRF, ISWT outcomes, and differences in fatigue perception. Findings revealed a strong positive link between MoCA scores and ISWT performance (r=0.83, p<0.001), and a strong inverse relationship between CRF and MoCA scores (r=-0.95, p<0.001). In addition, MoCA score was positively correlated with differences in fatigue perception (r=0.88, p<0.001). These results highlight the critical role of cognitive function in determining functional capacity and managing fatigue in CAD patients. They also suggest that cognitive interventions may be a potential adjunctive approach in physiotherapy programmes.

Individual susceptibility analysis and physical therapy strategies for motion sickness

Individual susceptibility analysis and physical therapy strategies for motion sickness

Evidence-based physiotherapy interventions: evaluation of current practice in a palliative care service

Maintaining independence and quality of life are significant issues for patients with a life-limiting illness and physiotherapists play an essential role in the palliative care multidisciplinary team in maintaining, restoring, and improving physical function and quality of life (QOL). This study aims to describe current physiotherapy interventions utilized in a palliative care service and compare it to the evidence base of physiotherapy interventions in palliative care. An audit was conducted of all inpatient and community palliative care patients referred for physiotherapy review and intervention, over a 4-week period. A literature search was conducted and the level of evidence for individual physiotherapy interventions was assessed. The audit identified 35 patients referred to the Physiotherapist for the assessment and management of mobility, falls risk management and prevention, lymphoedema management and assessment of functional decline. The most frequently performed physiotherapy assessments and interventions were for mobility and transfer (94.3%), falls prevention and management (74.3%), reconditioning and strengthening (57.1%), and exercise prescription (48.6%). Physiotherapy in the palliative care setting is becoming more accepted to help benefit the function and QOL of patients with advanced progressive diseases. This audit highlights the importance of these interventions in assisting patients to manage their symptoms and function at home.

Correction of immune disorders under the influence of pharmacotherapy and extracorporal magnetic stimulation in patients after surgical treatment of prostate adenoma

Abstract. The literature analysis shows that benign prostatic hyperplasia is associated with chronic prostatitis in 50–70 % of cases. Moreover, the course of benign prostatic hyperplasia is associated with immunological disorders at the systemic and local levels. The presence of a chronic, sluggish process is accompanied by endogenous intoxication, which leads to a gradual decrease in the body’s immune reactivity. Purpose of the study. To study the role of the complex effects of pharmacotherapy and extracorporeal magnetic stimulation (EMS) in the correction of immune disorders in patients after surgical treatment of prostate adenoma. Material and methods. Observations were carried out on 88 patients after surgical treatment of pancreatic adenoma, who underwent medical rehabilitation at stages II and III. At stage II, in the comparison group (CG), 43 patients received standardized drug therapy and individual physical therapy; in the main group (MG), 45 patients additionally received immunomodulatory therapy with Tamerit. At stage III in the GS, patients continued pharmacotherapy, exercise therapy and transrectal magnetic therapy; in the OG, 45 patients were additionally prescribed EMS. To study the content of interleukins (IL), the enzyme-linked immunosorbent assay method was used; To assess the quality of life, the IPSS-QOL (International Prostate Symptom Score — Quality-of-Life) questionnaire and SF-36 (The Short Form-36) were used.Significance level — p &lt; 0.05. Results. After the II inpatient stage of rehabilitation in patients with OH after surgical treatment of pancreatic adenoma, the level of proinflammatory ILs decreased on average by 47.5 % (p &lt; 0.01) with an increase in the level of anti-inflammatory IL-10 by 36.2 % (p &lt; 0.01). After the third outpatient stage of rehabilitation, the positive dynamics increased significantly and amounted to 63.2 % (p &lt; 0.01) and 51.9 % (p &lt; 0.01), reaching normative values in the population. It should be noted that the achieved results are maintained in the long term. In the GS, in all cases after stages II and III of rehabilitation, the positive dynamics were significantly lower (p &lt; 0.05 — p &lt; 0.01). With the same reliability, in the group there was a decrease in the severity of urinary disorders (p &lt; 0.01), restoration of quality of life (p &lt; 0.05) according to the IPSS-QOL and SF-36 questionnaires with significant intergroup values (p &lt; 0.05). Conclusion. The integrated use of pharmacotherapy and EMS in patients after surgical treatment of pancreatic adenoma provides significant correction of immune disorders and restoration of physical and mental health.

Nutritional support in the complex of medical rehabilitation at the stage of adjuvant radiation therapy of breast cancer

BACKGROUND: Currently it is known that there exists the need for complex medical rehabilitation at the stage of adjuvant radiation treatment of breast cancer. However, data on the combined use of nutritional support and physical factors at this stage of oncological treatment are not available. AIM: Evaluation of the effectiveness of specialized therapeutic and preventive nutrition in patients with malignant breast diseases and a history of polychemotherapy at the stage of adjuvant radiation therapy in complex medical rehabilitation using low-temperature plasma and general magnetic therapy. MATERIALS AND METHODS: A prospective simple randomized study was conducted, which involved 60 patients at the stage of adjuvant radiation therapy for breast cancer. The main group (n=30) received a course of medical rehabilitation with the inclusion of nutritional support using specialized therapeutic and preventive nutrition LEOVIT ONCO®, as well as exposure to low-temperature plasma and general magnetotherapy. In the comparison group (n=30), the rehabilitation course included general magnetic therapy without therapeutic and preventive nutrition. All patients underwent individual physiotherapy exercises, and sessions with a medical psychologist. The results obtained were recorded using clinical and functional, laboratory, instrumental studies. RESULTS: It has been established that the use of specialized dietary products LEOVIT ONCO and physical factors is an effective method of rehabilitation. The use of nutritional support demonstrates the maintenance of the patient’s protein status, reduces intoxication, and reduces the negative impact of oxidative stress factors in the body at the stage of adjuvant radiation treatment. The inclusion of low-temperature plasma and general magnetic therapy in the rehabilitation program has a beneficial effect on hemomicrocirculation in the area of ionizing radiation exposure. CONCLUSION: The use of nutritional support and physical factors, as a component of complex medical rehabilitation, helps to maintain the optimal nutritional status of the patient, reduces the manifestations of skin radiation reactions, improves the psycho-emotional state of patients and the quality of life of patient.

Multiple birds with one stone: A new type of PPy/Fe3O4/rGO multifunctional composite fabric for wave absorption, UV resistance, anti-static and thermal insulation

To solve the problem of electromagnetic radiation pollution, it is especially important to develop electromagnetic wave-absorbing materials with excellent performance. The preparation of composite multifunctional textile materials with excellent wave-absorbing properties is one of the research hotspots for practical personal protection applications. In this work, PPy/Fe3O4/rGO polyester/cotton composite fabrics were prepared by impregnation, chemical reduction, chemical co-precipitation and in situ polymerization. When the thickness is 0.97 mm, the minimum reflection loss (RLmin) of PPy/Fe3O4/rGO polyester/cotton composite fabric is −12.12 dB, and the effective absorption bandwidth (EAB) is 4.7 GHz, which is excellent in wave absorption. Meanwhile, the PPy/Fe3O4/rGO polyester/cotton composite fabrics have excellent UV resistance (UV transmittance ratio of UVA and UVB bands as low as 0.02 %, UPF value of 100+), antistatic properties (static voltage half-life of 0.2 s), and excellent thermal management properties (thermal conductivity as low as 0.05796 W/(m·K)), and so on. The PPy/Fe3O4/rGO polyester/cotton composite fabrics prepared in this study are suitable for a variety of application scenarios, such as individual electromagnetic protection, individual protection in extremely cold environments, and individual heating physiotherapy, which is of great reference significance for the research of wearable individual protective textile materials.

The effect of movement system impairment-based classification treatment compared to routine physiotherapy on pain, disability, alignment, and movement impairments in individuals with tibiofemoral rotation syndrome: a randomized controlled trial

BackgroundKnee pain is a common musculoskeletal problem. Lower extremity movement impairments could alter stresses in different planes and contribute to knee pain. Classifying these impairments may be helpful in the diagnosis and treatment of knee problems. Movement system impairment (MSI)-based classification is a system to evaluate movement impairments. Trials that involve this classification are limited. Therefore, it will be of interest to examine the effect of movement system impairment-based classification treatment compared to routine physiotherapy in individuals with tibiofemoral rotation syndrome.MethodsTwenty-two individuals with knee pain aged 18–40 years (2 males, 20 females) diagnosed with tibiofemoral rotation (TFR) syndrome were included. After initial evaluation, individuals were randomly assigned into two treatment groups (MSI-based treatment and routine physiotherapy). Both treatment groups contained 8 treatment sessions over 4 weeks. Alignment and movement impairments data form, a numeric rating scale (NRS), and the Kujala Disability Questionnaire were assessed at baseline and after a four-week intervention. Independent samples t-test and Mann-Whitney U test were used for quantitative variables, and Fisher’s exact test was employed for qualitative variables to compare the groups. One-way Analysis of variance (ANOVA) and paired samples t-test were utilized to within-group changes of quantitative variables, and qualitative variables were analyzed with the McNemar test.ResultsThe results showed that pain intensity and disability significantly decreased within and between groups after intervention (P > 0.05). There were also statistically significant differences between treatment groups for 3 out of 6 alignment and movement impairments (PS-FAdd/IR, Step down-Add/Valgus, and STS-Add/Valgus) (P > 0.05). Within-group differences for alignment and movement impairments were significant only for the MSI-based treatment group (P > 0.05).ConclusionsThe findings suggest that a specific MSI-based treatment, considering a homogenous group of individuals with knee pain, may contribute to pain, disability, and alignment and movement impairments improvement. Therefore, it is important to notice the classification-based treatment for individuals with knee pain.Trial Registration Number (TRN) and date of registrationThe trial was registered at the (https://www.irct.ir), (IRCT20210505051181N3) on 17/7/2021.

People with newly diagnosed multiple sclerosis benefit from a complex preventative intervention-a single group prospective study with follow up.

Newly diagnosed people with multiple sclerosis frequently report fatigue, pain, depression and anxiety. Preventative programmes may be beneficial, but there is limited evidence of their effectiveness, especially long-term follow-up. The programme consisted of 6-month face to face intervention (an introductory workshop, psychology-led group sessions and individual physical therapy) followed by 6-month self-guided therapy. Outcome measures were taken at baseline, 6 and 12 months. Primary outcomes measures were self-report questionnaires for fatigue, satisfaction with life and disease acceptance. Secondary outcomes were spirometry, spiroergometric parameters and neuroactive steroid levels. From 22 participants enrolled, 17 completed the first 6 months and 13 the follow-up. Fatigue measured on the Fatigue scale for motor and cognitive functions decreased significantly at 6 months (p = 0.035) and at follow-up (p = 0.007). The Modified Fatigue Impact Scale (p = 0.035) and Satisfaction With Life Scale (p = 0.007) significantly increased at follow-up. Spirometry, spiroergometric parameters, steroid hormones and neuroactive steroids levels did not change significantly. This programme reduces fatigue and improves satisfaction with life in this patient group with improvements sustained at 12 months. People who participated more frequently showed greater benefit. The paper describes the effects of a complex preventative intervention for people with newly diagnosed Multiple Sclerosis. The study found that this programme reduces fatigue and improves satisfaction with life with long-term benefit (at 12-month follow up). The individuals who participated less frequently experienced fewer benefits.

Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease.

With longer life spans and medical advancements, the rising number of patients with advanced-stage Parkinson's disease (PD) warrants attention. Current literature predominantly addresses dementia and fall management in these patients. However, exploring the impact of swallowing function on patients with advanced PD is crucial. Previous research has demonstrated notable enhancements in the quality of life related to voice for participants following a group singing-intervention program. To further elucidate the effect of individual singing-induced swallowing exercises, our study aimed to investigate the quantitative and qualitative effects of therapeutic singing on swallowing function in patients with advanced PD in comparison to a matched usual care control group. The hypothesis of this study is that therapeutic singing-induced swallowing exercises can assist to maintain swallowing function in patients with advanced PD. This prospective matched control study compared the effects of a 6-week therapeutic singing-based swallowing intervention on swallowing function and quality of life in patients with advanced PD. The intervention group received individual sessions with a music therapist and conventional individual physical therapy. The control group received the same standard physical therapy for 6 weeks without music intervention. The primary outcome measure was Video Fluoroscopic Dysphagia Scale (VDS). The study revealed that the intervention group maintained swallowing function, whereas the control group experienced deterioration, indicating significant time-dependent changes in Penetration-Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and VDS. Analysis of PAS and NIH-SSS liquid food scores in both groups showed significant time effects. However, the intervention group exhibited no significant differences between the pre- and post-tests, indicating preservation of the swallowing function. VDS of liquid food indicated an interaction effect between time and group in the pharyngeal phase and total scores. The Swallowing-Quality of Life showed significant time-effect improvement in the intervention group. Therapeutic singing exercises may help maintain swallowing function in advanced PD patients, potentially enhancing quality of life related to swallowing in those with advanced-stage diseases. https://cris.nih.go.kr/cris/search/listDetail.do, identifier KCT0008644.

Interdisciplinary pain therapy in the elderly

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be amultimodal therapy based on abio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.

Підготовка майбутніх фізичних терапевтів до складання програми фізичної терапії для дітей середнього шкільного віку з хворобою Літтла

The article revealed the issue of professional training of future physical therapists for the preparation of a physical therapy program for middle school children with Little's disease, where it was taken into account that each patient had an individual physical therapy program according to the patient's categorical profile of the ICF, selected research methods and determined physical therapy methods. The purpose of the study was to analyze the preparation for the development of a program of physical therapy for children of secondary school age with Little's disease, which future physical therapists will be able to use in their professional activities. The physical therapy program was developed for a boy, 11 years old, who has the main diagnosis: Little's disease, concomitant diseases: mild mental retardation, valgus deformity of the lower limbs, congenital. A categorical profile was determined according to the short basic set of ICF DP for a child of middle school age (11 years) with Little's disease (spastic diplegia). The physical therapy program included the following methods: therapeutic exercises, mobility training and walking with aids, massage, training on an exercise bike and a home program (fitball exercises to relax muscles, improve balance, gymnastic exercises to increase muscle strength of the upper limbs, improving posture, exercises to improve the mobility of the joints of the lower extremities, strengthening the skills of standing and walking with a walker, games and gymnastics for the fingers (development of the manipulative function of the hands), treatment of position). The study showed that in order to draw up a physical therapy program for patients with Little's disease, it is necessary to determine the research methods, obtain the initial data based on them, compile a categorical profile of the patient according to the ICF, and choose physical therapy methods and their dosage according to the obtained results.

Physiotherapists' knowledge about the diagnosis, treatment and physical activity of patients with idiopathic scoliosis.

Idiopathic scoliosis (IS) is a three-dimensional spinal deformity with an unknown etiology which, when left untreated, can have negative health consequences. Physiotherapy plays an important role in the treatment of IS, which is why physiotherapists should have adequate theoretical and practical knowledge about IS diagnosis and treatment methods. The aim of this study was to assess physiotherapists' knowledge about IS, its diagnosis, treatment and recommended physical activities for subjects with IS. The influence of post-graduate courses, workplace, academic degree, work experience, education and membership in associations dealing with spinal deformities was also analyzed. The study involved 116 licensed physiotherapists. The research method was a diagnostic survey, and the research tool was a self-designed questionnaire. The questionnaire which included demographic questions to elicit information about the respondents and questions concerning IS, its diagnosis, treatment and recommended physical activity in the course of IS. The questions were created according to the recommendation of the Society on Scoliosis Orthopaedic and Rehabilitation Treatment. In the questionnaire, the respondents' knowledge was assessed on the percent scale (100-90% of correct answers - full knowledge, 89-60% of correct answers - good knowledge, 59-50% of correct answers - moderate knowledge, <50% of correct answers - poor knowledge). The physiotherapists correctly answered from 60 to 89% of the questions which meant their good level of knowledge of IS. Factors such as post-graduate courses, workplace and academic degree influenced the knowledge of Polish physiotherapists regarding IS (p = 0.003, p = 0.036, p = 0.05, respectively). Physiotherapists who completed courses based on physiotherapy recommended by SOSORT demonstrated a higher level of knowledge compared to those without postgraduate courses (p = 0.018). The physiotherapists who ran the private individual physiotherapy practice demonstrated a higher level of knowledge compared to those working in a hospital (p = 0.058). Work experience and education have no influence on the physiotherapists' knowledge about IS. Polish physiotherapists have a good knowledge of IS. Post-graduate courses (courses on Physiotherapeutic Scoliosis Specific Exercises), the respondents' place of employment (private individual physiotherapy practice) and academic degree influence the knowledge about IS. Work experience, education and membership in associations dealing with spinal deformities have no influence on the physiotherapists' knowledge about IS.

Development and feasibility of the Geriatric Activity Program Pellenberg with the Caregiver as an exercise partner (GAPP+Care).

The Geriatric Activation Program Pellenberg (GAPP), among other programs for geriatric rehabilitation, improves patient functioning. However, hospitalized patients rarely move enough to meet the WHO recommendation of 300 minutes of moderate-intensity exercise per week.&#x0D; Increasing exercise time by physiotherapy is hindered by staffing and financial restrictions both being dependent on health care and hospital financing. Integrating unpaid caregivers in an geriatric rehabilitation program could close this gap.&#x0D; Along with the physiotherapist, we wish to make the patient's informal caregiver an exercise partner. We want to teach the caregiver how to literally support their family member in hands-on sessions and to enable them to take part in the pluridisciplinary geriatric rehabilitation team.&#x0D; The development of the Geriatric Activity Program Pellenberg with the Caregiver as an exercise partner (GAPP+Care) was founded on three aspects: 1) the WHO daily activity guideline; 2) the current program GAPP; and 3) a systematic review on the effect of informal caregiver involvement on self-efficacy of hospitalized older adults.&#x0D; We conducted semi-structured interviews to determine the overall perception of patients and caregivers toward the GAPP+Care concept. Based on the findings, GAPP+Care was finalized. The questions were divided into 3 domains: 1) reasons to participate, 2) exercise moments (number, duration and time), and 3) the exercise booklet. The interview started with explaining GAPP+Care and a prototype of the exercise booklet was given. Sixteen patients from UZ Leuven's geriatric rehabilitation ward, as well as 15 informal caregivers, took part in the study. 75% of patients and 80% of family caregivers stated that they would participate in the GAPP+Care exercise program. The main motivations for participating were activation of the patient, to follow their progress, as well as to learn more about their abilities. The main reasons for refusal were a lack of time, greater care load for the caregiver, and the patient's lack of motivation. Although 52% of participants agreed to four additional exercise moments per week, 45% prefers less moments. All participants reported that the instruction booklet was clear, easy to read, and simple to use. With some adjustment GAPP+Care appears to be acceptable for implementation on a geriatric rehabilitation ward.&#x0D; The GAPP+Care program consists of GAPP plus three additional 30-minute exercise sessions each week led by an informal caregiver (+Care). One of these three exercise sessions is always carried out in partnership with a physiotherapist, while the other two can be independently given by the caregiver at any time, such as in the evening or on the weekend. These +Care practice sessions, in addition to the individual physiotherapy treatment, continue in the patient's home for the first six weeks following discharge.&#x0D; GAPP+Care requires an integrated approach towards patients and their family caregivers. We initiated a feasibility study of GAPP+Care (March 2022 - March 2023). In this study we are investigating: 1) the feasibility, appropriateness, barriers and facilitators of GAPP+Care, 2) the fidelity to GAPP+Care, and 3) the percentage (proportion) of eligible individuals and their willingness to participate in GAPP+Care.

Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder

ObjectivesWe report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND).MethodsThe program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman’s ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up).ResultsAnalyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up.DiscussionThis outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.

Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial

BackgroundMany people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP.Methods70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches.ResultsThere were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, − 3.25 to − 1.15). The standardized mean difference and their 95% confidence intervals (Cohen’s d) revealed a large effect of pain at 22 weeks: (Cohen’s d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes.ConclusionsIn this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks.Trial RegistrationClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.

Interdisciplinary pain therapy in the elderly

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be amultimodal therapy based on abio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.

Modern approaches to physical therapy of women with diastasis recti of the abdominal muscles as a result of multiple pregnancy

&#x0D; &#x0D; &#x0D; It is a well-known fact that the development of diastasis of the rectus muscles with the progression of pregnancy is considered a natural and practically physiological phenomenon. World information sources indicate that in the last trimester, diastasis of the rectus muscles is recorded in 66-100% of all pregnancies in women. An increase in the volume of the pregnant uterus leads to an increase in intra-abdominal pressure and stretches the anterior abdominal wall. The development of diastasis is facilitated by a decrease in the strength of connective tissue collagen, which occurs as a result of physiological changes in the body of a pregnant woman. During pregnancy, the production of the hormone relaxin, whose biological function is to inhibit collagen synthesis and stimulate its breakdown, increases dramatically. The purpose of the study is to determine the effectiveness of the author’s physical therapy programme for women with diastasis of the rectus abdominis muscles due to multiple pregnancy and to characterise the diagnostic tools used in the study. Based on the analysis of information sources, effective innovative means of physical therapy for pregnant women with diastasis of the rectus abdominis due to multiple pregnancy were identified. They include (special therapeutic exercises for the indicated dysfunction (diastasis recti); post-isometric relaxation exercises; exercises from the Body&amp;Mind Fitness system such as yoga therapy and elements of the Pilates system; hydroki-&#x0D; &#x0D; &#x0D; &#x0D; nesitherapy and kinesotaping; therapeutic massage and electro-myostimulation). The diagnostic card included such methods of determining such indicators as your pain at rest; determination of cortical muscle tone during movements and palpation using the Lovett manual muscle test; the Pelvic Floor Impact Questionnaire – Short Form 7 (PFIQ-7) was used; the Hospital Anxiety and Depression Scale, SAN, PHQ-9, and Quality of Life were used to determine the psycho-emotional state; and mathemat- ical statistics methods were applied. The paper presents the results of the study obtained during the work with 20 women in labour, on the basis of which the authors draw conclusions about the effec- tiveness of the developed and implemented author’s physical therapy programme. However, realising that the study used a small sample of patients in the main group with the above-mentioned pregnancy characteristics, we continued to work with this contingent and further implement the author’s pro- gramme of physical therapy for parturients with diastasis of the rectus abdominis muscles due to multiple pregnancies. In the course of solving the tasks of the work, the effectiveness of individual and integrated approaches in the construction of individual physical therapy programmes for women withthese dysfunctions due to pregnancy has been proven to significantly improve and contribute to a more complete and qualitative restoration of the functional capabilities of the musculoskeletal system of women with diastasis recti.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

The Effects of Exercise Training on Physical Activity Level, Daily Living Activities, and Participation in Children with Hemophilia.

Hemophilia is an uncommon disorder that is difficult to diagnose and manage. Effective movement and individual physiotherapy interventions can improve physical activity levels, quality of life, and participation in children with hemophilia. This study aimed to investigate the effects of individually planned exercise on joint health, functional level, pain, participation, and quality of life in children with hemophilia. Twenty-nine children with hemophilia (aged 8-18 years) were randomized into either an exercise group with physiotherapists (n = 14) or a counseling home-exercise group (n = 15). Pain, range of motion, and strength were measured using a visual analog scale, goniometer, and digital dynamometer, respectively. Joint health, functional capacity, participation, quality of life, and physical activity were assessed using the Hemophilia Joint Health Status, 6-Minute Walk Test, Canadian Occupation Performance Measure, Pediatrics Quality of Life, and International Physical Activity Questionnaire, respectively. The exercises were planned individually according to the needs of both groups. Additionally, the exercise group performed the exercise with a physiotherapist. Interventions were performed 3 days/week for 8 weeks. The Hemophilia Joint Health Status, 6-Minute Walk Test, Canadian Occupation Performance Measure, International Physical Activity Questionnaire, muscle strength, and range of motion (elbow, knee, and ankle) were significantly improved in both groups (P < .05). Compared with the counseling home-exercise program group, the exercise group had better results in the 6-Minute Walk Test, muscle strength, and range of motion (knee and ankle flexion) (P < .05). No significant difference was found in pain and Pediatrics Quality of Life scores in both groups. Using individually planned exercise in children with hemophilia is an effective physiotherapy approach to improve physical activity, participation, functional level, and joint health.

Physical therapy in patients with rheumatoid arthritis and axial spondyloarthritis: the patients’ perspective

Objective To assess the duration, frequency, and content of individual physical therapy (PT) in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). Method In this cross-sectional study, an electronic questionnaire aimed at people with RA and axSpA was distributed through various communication channels of the Dutch Arthritis Foundation. It comprised questions on sociodemographic and health characteristics, received PT (currently and/or in the past year) and, if applicable, its duration, frequency, and content (active exercises, manual treatment, physical modalities, and/or counselling/education). Results The study included 257 and 94 patients with self-reported diagnoses of RA and axSpA, of whom 163 (63%) and 77 (82%) currently or had recently received individual PT. The duration of individual PT was long-term (> 3 months) in 79% of RA and 83% of axSpA patients, with an average frequency of once per week in most. Although active exercises and counselling/education were each reported by ≥ 73% of the patients with RA and axSpA who received long-term individual PT, passive treatment modalities were also often offered (≥ 89%), in particular massage, kinesiotaping, and/or passive mobilization. The same pattern was seen in patients receiving short-term PT. Conclusion The majority of patients with RA and axSpA received PT currently or in the past year, usually individually, long-term, and at a frequency of once a week. Although active exercises and education are recommended in guidelines, passive treatment options that are not advised were relatively often reported. An implementation study to identify barriers and facilitators regarding adherence to clinical practice guidelines seems warranted.

Getting Recovery Right After Neck Dissection (GRRAND-F): Mixed-methods feasibility study to design a pragmatic randomised controlled trial.

To determine the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention following neck dissection (ND) after head and neck cancer (HNC). Two-arm, open, pragmatic, parallel, multicentre, randomised controlled feasibility trial. Two UK NHS hospitals. People who had HNC in whom a ND was part of their care. We excluded those with a life expectancy of six months or less, pre-existing, long-term neurological disease affecting the shoulder and cognitive impairment. Usual care (standard care supplemented with a booklet on postoperative self-management) was received by all participants. The GRRAND intervention programme consisted of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion and progressive resistance exercises, advice and education. Between sessions, participants were advised to complete a home exercise programme. 1:1 randomisation. Allocation was based on minimisation, stratified by hospital site and spinal accessory nerve sacrifice. It was not possible to mask treatment received. Primary: Participant recruitment, retention and fidelity to the study protocol and interventions from study participants and staff at six months post-randomisation (and 12 months for those reaching that time-point). Secondary: clinical measures of pain, function, physical performance, health-related quality of life, health utilisation and adverse events. 36 participants were recruited and enrolled. The study achieved five of its six feasibility targets. These included consent - 70% of eligible participants were consented; intervention fidelity - 78% participants discharged completed the intervention sessions; contamination - none - no participants in the control arm received the GRRAND-F intervention and retention - 8% of participants were lost to follow-up. The only feasibility target that was not achieved was the recruitment target where only 36 of the planned 60 participants were recruited over 18 months. This was principally due to the COVID-19 pandemic which caused all research activity to be paused or reduced, with a subsequent reduction in. Based on the findings a full-trial can now be designed to better understand whether this proposed intervention is effective. https://www.isrctn.com/ISRCTN1197999, identifier ISRCTN11979997.