Institute Of Physical Medicine Research Articles

Physical activity and sleep quality in association to mental health among physical therapy students in different universities of Karachi: A cross sectional survey

Background: Quality sleep is vital for mental function, with its deprivation reducing alertness and impairing concentration. Similarly, a lack of physical activity leads to problematic living and mental health issues such as depression and anxiety. Therefore, the main reason of this study was to solely focus on physiotherapy students and the effect of sleep and physical activity on their mental health. Objective: The research project aimed to observed physical activity and sleep quality in association to mental health among physical therapy students in different universities of Karachi Methods: A cross-sectional study on 360 DPT students in various. Karachi universities was conducted after obtaining approval from the Institute of Physical Medicine and Rehabilitation. The participants, DPT undergraduates aged 18-28 years, were selected through convenient sampling. Exclusion criteria included diagnosed systemic diseases or psychological conditions. The study utilized PSQI, DASS-21, and IPAQ shortform tools. Fisher's exact test was employed to analyse variable associations. Result: The sample's mean age was 21.75 years, Range= 18-28 years. Most (80.60%) were females. Almost all were single (94.90%), and 97.5% were poor sleepers. However, no association was found between sleep quality and depression, anxiety, or stress levels (p values = 0.117, 0.181, 0.293). Conclusion: The study revealed no association was found between poor sleep and physical activity levels with depression, anxiety, and stress in physiotherapy students, even though many face poor sleep. Students with poor sleep quality had higher physical activity levels than those with good sleep quality.

ASSOCIATION OF PECTORALIS MINOR MUSCLE LENGTH AND SHOULDER RANGE OF MOTION AMONG INDIVIDUALS WITH AND WITH OUT SHOULDER PAIN

Background and Aim: To evaluate the association of pectoralis minor muscle length and the shoulder range of motion with and without shoulder pain. Methodology: A sample of 214 participants with and without shoulder pain were enrolled in an analytical cross sectional study at Institute of physical medicine and rehabilitation, Dow University of health sciences, Karachi. Questionnaire was provided to all participants after taking consent. Individuals were categorized into two equal groups i.e. one with and the other without pain). Shoulder active ranges were measured with universal goniometer and pectoralis minor length with measuring tape. Statistical Package of Social Sciences version 21 was used for data analysis. The descriptive variables were assessed for frequencies and percentages. Continuous variables were shown with mean and standard deviations and were correlated with bivariate correlation test. Considered significant was 0.05 p value. Results: Females were 176(82.2%) and males were 38 (17.8%). Mean ± SD of age, weight, height, and BMI were 26.82 ±7.50, 58.45 ±12.11, 160.59 ± 12.43, and 22.18 ±3.78 respectively. The pain intensity negatively correlated with shoulder range of motions (rs = -0.307 to -0.775, p< 0.05) except medial rotation. Significant difference (p< 0.05) is found for length of pectoralis minor and range of motion between groups. There was also weak positive correlation between pectoralis minor index and shoulder lateral rotation (rs =0.215; p = 0.003). Conclusion: The shoulder pain affects shoulder joint range of motion and pectoralis minor length. Decreased pectoralis minor muscle length accompanies limited shoulder range of motion except, medial rotation.

Spinal cord stimulation in chronic pain treatment - first experiences in Bosnia and Herzegovina.

Aim To describe results of spinal cord stimulation technique when the conventional multidisciplinary treatment of neuropathic or mixed pain failed. Methods The research was conducted at the Institute for Physical Medicine and Rehabilitation "Dr. Miroslav Zotović", Banjaluka. Ten patients, who had chronic pain resistant to other therapeutic options and a failed back surgery, were sent for an evaluation. Each patient underwent a 4-week evaluation by a team of medical specialists, phychologist and social workers. Additional diagnostic methods (MRI of the lumbosacral spine, electromyoneurography of lower extermities, congnitive assessment tests) were also performed to establish a proper indication for implantation of the system for spinal cord stimulation. Leads of a system for spinal cord stimulation were implanted percutaneously or surgically at the epidural space. Functional outcome measures (visual analogue scale, Oswestry index, anxiety and depression scales) were taken before the implantation of the system and on several followups. Results Four patients did not meet critea for the inclusion in the study (two were not ready, two showed psychopathological symptoms). One patient had a percutaneous lead implant, but it was removed after six months due to paresthesia. The remaining five had surgicaly implanted epidural leads and showed significant improvement in pain control, Oswestry index had lower values, and all except one patient had improvement registered by anxiety and depression scales. Conclusion. Short-term and long-term follow up showed a long lasting pain reduction and improvement of functionality in all patients.

Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization

Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity. ObjectivesTo test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added. MethodsFrom February 2017 to February 2019, 372 patients after an acute coronary syndrome (72 were excluded according to study criteria) were included, 193 patients in standard rehabilitation and 179 in home rehabilitation. At the end of follow-up, patients of both groups were called on the telephone to collect physical activity items according to a standardized questionnaire. ResultsAt a medium follow-up of 30.1 months, there are more physically active patients in home rehabilitation than in standard, respectively 139 vs 108 patients (77,1% vs. 56%, p < 0,0001).At multivariate analysis, including age, gender, and rehabilitation model, the probability to be fully physically active at the end of the rehabilitation programme, is 3 times higher (OR 3.0 CI 1,9-6,0 p < 0,0001) for home rehabilitation programme compared to standard one. ConclusionsHome rehabilitation, when applied to selected populations, resulted in a feasible and effective strategy to promote long term physical activity in secondary prevention after an acute coronary syndrome.

The effects of walking on spinal mobility of the patient with lumbar syndrome

Introduction/Objective Lumbar syndrome often presents muscle imbalance of the lumbar and abdominal region, most often as a result of sedentary lifestyle and excessive nutrition. The aim of the study was to determine the effects of a separate and associated effect of kinesiotherapy and walking on the outcome of the rehabilitation of people with chronic lumbar syndrome and on the mobility of the lumbosacral part of the spinal column. Methods Sixty persons of both sexes, aged between 45 and 65 years, with episodes of the lumbar syndrome, were included in a three-weeks study conducted at the Institute for Physical Medicine and Rehabilitation "Dr Miroslav Zotović" in Banja Luka - Department VII in Slatina. For the assessment of the subjective feeling of pain, the Visual Analog Scale (VAS) was applied, and for the mobility of the spinal column, the Schober test (SCH). During the rehabilitation treatment, both groups were subjected to standard kinesiotherapy treatment, and the experimental group to walking. Testing the effects of the applied treatments was done using the Repeated measure ANOVA analysis at the conclusion level p≤0.05. Results The effects of the differences in the final measurement in both subsamples were high and statistically significant in both variables in favor of the experimental group: male subsample in the VAS variable -F1,28=30.1; p=.001 i SCH- F1,28=.27.9; p=.001; female subsample in the VAS variable - F1,28=75.2; p=.001 and variable SCH- F1,28=20.73; p=.001. Conclusion The program of kinesiotherapy in conjunction with walking, significantly improves the final outcome of rehabilitation in people with chronic lumbar syndrome, both in the functional and the subjective domain.DOI: https://doi.org/10.24040/sjss.2021.7.2.74-85

Inter-rater reliability of pressure biofeedback unit among individuals with and without chronic low back pain.

Objectives:To determine the inter-rater reliability of pressure biofeedback unit among individuals with and without chronic low back pain.Methods:This cross-sectional survey was conducted from February 2021 to March 2021 at the Physiotherapy Department of the Sindh Institute of Physical Medicine and Rehabilitation. Sixteen subjects which were recruited with and without chronic low back pain.(CLBP). During the test, abdominal drawing in movement was monitored by measuring a change in pressure detected in PBU. Each test was performed once by two trained assessors with period of seven days. Reliability indices of Pressure Biofeedback (PBU) measures including the Intraclass correlation coefficient [ICC] and Band Altman plot were analyzed.Results:This study found an intra-class correlation coefficient (ICC) = 0.94 [95% confidence interval (CI) (0.37, 0.99] for inter-rater reliability in healthy individuals, and an ICC of 0.97 (95% CI 0.97, 0.98) for inter-rater reliability in CLBP. The interrater agreement (Limits of Agreement–LOA=5.92, -3.9 mmHg) in CLBP and the interrater agreement (LOA=5.75, -3.25 mmHg) in healthy individuals were within the limits of agreement on 95% of occasions.Conclusion:Pressure Biofeedback Unit has showed excellent inter-rater reliability in measuring Transverse Abdominis muscle activity for individuals with and without chronic LBP.

Comparison between radiographic and ultrasound angle measurements in the assessment of idiopathic scoliosis

&amp;lt;p&amp;gt;Introduction. Radiological assessment is still being considered a golden standard when it comes to detection, follow-up and treatment of idiopathic scoliosis. However, it has universally been proven that radiation is cumulative and that it has oncogenic effects. For this reason, nowadays it is becoming increasingly popular to perform spinal ultrasounds using the Scolioscan&amp;amp;reg; device. Relevant research has shown diagnostic potential of the device and its application in the assessment and monitoring of idiopathic scoliosis. The aim of our study has been to compare angle measurements in ultrasound and radiological spinal images and to determine the role of ultrasound in the assessment process and follow-up of patients with idiopathic scoliosis. Methods. This cross-sectional study has been conducted on a sample of 172 patients. Its participants are boys and girls, patients of the Team for Scoliosis that operates within the Department for Habilitation and Rehabilitation of Children in the Institute for Physical Medicine and Rehabilitation ''Dr Miroslav Zotović'', Banja Luka, the Republic of Srpska. Radiography and ultrasound of the spine have been performed on every patient on the same day. Three specially trained operators administrated the ultrasound scanning, while four raters (i.e. doctors) measured the radiographic Cobb angle and the ultrasound Scolio angle. Patients have been divided into groups according to gender, curve location and curve severity. Results. In general, ultrasound angles are shown to be smaller compared to Cobb angles, which has been confirmed in previous studies as well. The mean difference between Cobb and Scolio angle is statistically, but not clinically significant (3.62&amp;amp;plusmn;4.39&amp;amp;deg;, p&amp;amp;lt;0.001). There is a statistically significant good positive correlation between the Cobb and the Scolio angle (r=0.675, p&amp;amp;lt;0.001). According to groups, our results indicate a better correlation in the girls group (r=0.688, p&amp;amp;lt;0.001) as opposed to the boys group (r=0.632, p&amp;amp;lt;0.001). The same holds true for the thoracic group (r=0.736, p&amp;amp;lt;0.001), compared to the (thoraco) lumbar group (r=0.654, p&amp;amp;lt;0,001). A stronger correlation can also be seen in the group with a Cobb angle that is equal to or higher than 20&amp;amp;deg; (r=0.518, p&amp;amp;lt;0.05) than in the group with a Cobb angle lower than 20&amp;amp;deg; (r=0.462, p&amp;amp;lt;0.001). Conclusion. The results of our study confirmed a good validity of the ultrasound method using the Scolioscan&amp;amp;reg; device, compared to conventional radiography, taking into account clinically insignificant differences in angle measurements. Using only B-mode ultrasound images - with no additional software analysis, nor 3D reconstruction of spinal deformities - proved to be sufficient for a follow-up of scoliosis, with respect to other parameters, such as clinical assessment, back surface topography, etc.&amp;lt;/p&amp;gt;

Prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy.

Background: Fear-avoidance beliefs and signs specifically non-organics are considered the psychological factors that have been determined in playing a major role in the advancement of prolonged disability. The current study was directed to explore the prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy and identifying the superior level of fear-avoidance beliefs regarding work or bodily performances which causes chronicity and disability in patients.&#x0D; Methodology: An observational study was conducted at the Institute of Physical Medicine &amp; Rehabilitation, Dow University of Health Sciences, Ojha Campus, Karachi-Pakistan, from 1st Dec 2019 to 29th Feb 2020. Standard Fear Avoidance Belief Questionnaire (FAB-Q) was used to assess the fear level. The queries determined from the questionnaire were distributed into two types; FABQ-work-related and FABQ-physical activity-related. &#x0D; Results: A total of 100 patients were included in the study, with a mean age of 45.76 ± 13.75 years. 39.0% patients reported neck pain, whereas 61.0% reported back pain. The prevalence of fear-avoidance belief related to physical activity was 90% and related to work was 91%. The results also showed a significant association between gender and work-related fear-avoidance belief with a p-value of 0.024 (≤ 0.05).&#x0D; Conclusion: It is concluded that neck and backache sufferers show a high prevalence of fear-avoidance behavior of physical pastime and work score, confining their daily activities and not taking part in any bodily activities due to fear.

Effect of cardiovascular training on functional capacity in post-acute rehabilitation of COVID-19 patients

Introduction: In the overall strategy of developing the optimal treatment of patients after COVID-19 infection, recommended by the World Health Organization, rehabilitation plays one of the key roles in improving the functional capacity of these patients and thus their quality of life. The aim of this study was to investigate the effect of cardiovascular training during post-acute rehabilitation on the functional capacity of patients after moderate COVID-19 pneumonia. Methods: The prospective study included 84 patients of both sexes, mean age 57.92 ± 11.79 years, who were hospitalised at the Institute of Physical Medicine and Rehabilitation ''Dr Miroslav Zotović'' Banja Luka due to moderate pneumonia caused by the COVID-19 virus and after they finished acute rehabilitation. All patients underwent cardiovascular training three times per week and occupational therapy during 28 days of stationary post-acute rehabilitation. The follow-up parameter was a six-minute walk (6-MWT) test at admission and discharge from post-acute rehabilitation. Student t-test for paired samples was used for statistical analysis, and the value of p &lt; 0.05 was taken as statistical significance. Results: The functional capacity of the cardiovascular and respiratory system was statistically significantly improved at discharge compared to admission (p &lt; 0.05). Conclusion: Targeted cardiovascular training during post-acute rehabilitation leads to improvement of functional capacities of patients after moderate COVID-19 pneumonia.

Management practices in myofascial pain syndrome among physical therapists in Karachi, Pakistan: A cross sectional survey.

To investigate the treatment practice in myofascial pain syndrome among physical therapists in an urban setting. The cross-sectional study was conducted from June to December, 2016, at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Science, Karachi Pakistan, and comprised qualified physical therapists of either gender working at various health centres in the city. Data was collected using a self-administered questionnaire, and was analysed using SPSS 16. Of the 93 respondents, 37(39.8%) were males and 56(60.2%) were females; 39(41.9%) had Masters level professional education; and 29(31.2%) had 5-8 years of experience. Myofascial Pain Syndrome was diagnosed through physical examination by 78(83.9%) subjects, on the basis of history by 70(75.3%) and palpable band by 75(80%). Preferred treatment strategy was ischaemic compression for 63(67.7%) and postural re-education for 64(68.8%), while dry needling was used by 29(31.2%) subjects. Also, 75(80%) therapists preferred manual therapy superior combined with other treatments. Physical examination was found to be the most common diagnostic method used for myofascial pain syndrome by the therapists.

Efficiency of the Halliwick concept in the rehabilitation of children with cerebral palsy

Background/Aim: Since 2010, the Halliwick Concept has been applied in the rehabilitation of children with neurological disorders at the Department of Habilitation and Rehabilitation of Children and Youth at the Institute for Physical Medicine and Rehabilitation (IPMR) "Dr Miroslav Zotović" in Banja Luka, the Republic of Srpska, Bosna and Herzegovina. Aim of this study was to analyse results of the implementation of the full Halliwick Concept programme over the period from 1 January 2016 to 1 January 2017 and points to the effectiveness of this type of hydrokinesitherapy. Methods: After analysing 40 patients with different diagnoses of neurological disorders: cerebral palsy (CP), arthrogryposis (AG), Down syndrome (DS), and central nervous system (CNS) injury, only patients with CP were represented due to the homogeneity of the diagnosis and were included in analysis (N = 30). Rehabilitation treatment of patients according to the Halliwick concept was performed, over a period of one year, for 60 minutes once a week. Patients were tested by Swimming with Independent Measurement (SWIM) test, Gross Motor Function Measure (GMFM) and Barthel Index before and after treatment. Results: Considering all patients, before and after the application of the concept of individual Halliwick swimming skills/movement in water, a statistically significant difference was detected by assessing the SWIM test and a highly significant difference was detected by evaluating the Gross motor function measure test of GMFM66, as well as in evaluating the Barthel Index test. Assessment of swimming abilities through the SWIM test showed the least progression was in the ability in Getting out of the water, with the greatest progression in the ability in Breathing control. Conslusion: The Halliwick Concept programme at the Department for the Habilitation and Rehabilitation of Children and Youth, IPMR "Dr Miroslav Zotović" in Banja Luka is effective and the results indicate the need for its application in the rehabilitation of children with CP.

Factors predicting rehabilitation outcome in patients after unilateral transtibial amputation due to peripheral vascular disease

Background/Aim. The primary rehabilitation in the prosthetic phase after amputation of lower extremities is of great importance for the improvement of the activities of daily living (ADLs) of persons with amputation and their successful social reintegration. The aim of this study was to examine the influence of independent predictors (age, gender, duration of rehabilitation, time between the amputation and the mounting of the prosthesis) on the success of the primary rehabilitation in the prosthetic phase after amputation of lower extremities. Methods. This retrospective clinical study included patients who underwent the primary rehabilitation in the prosthetic phase at the Institute for Physical Medicine and Rehabilitation ?Dr Miroslav Zotovic?, Banja Luka, in 2015. A total of 75 patients with unilateral transtibial amputation were included. Etiologically, these transtibial amputations occurred as a consequence of vascular complications of diabetes mellitus or peripheral occlusive arterial disease. Evaluation of the success of rehabilitation was performed at the end of the primary rehabilitation in the prosthetic phase and 3 months after the end of the treatment by means of K-levels classification system and Locomotor Capabilities Index (LCI) scale. Depending on the distribution of data, univariate and multivariate multiple regression analysis, post hoc Mann-Whitney test, Spearman?s correlation coefficient and Wilcoxon test were used for statistical analysis. Statistical significance of the found differences was set at p &lt; 0.05. Results. A total of 75 patients, 55 (73.33%) men and 20 (26.67%) women, were included in this clinical trial. Average age of all participants was 63.5 ? 9.06 years, 61.8 ? 9.34 years for males and 68.1 ? 6.4 for females (p &lt; 0.01). Average duration of rehabilitation was 27.69 ? 7.39 days in men and 33.9 ? 6.89 days in women (p &lt; 0.01). Male patients had better functional results compared to females obtained by all analysed outcome measures (p &lt; 0.01). Younger patients achieved better results, with the degree of statistical significance ranging between p &lt; 0.05 and p &lt; 0.001. The time from the amputation to the mounting of prosthesis and the duration of rehabilitation had no influence on the rehabilitation outcome. Conclusion. The present study identified age and gender of patients as relevant independent predictors of the success of rehabilitation. Although it was initially expected, this clinical trial did not prove the importance of the time from the amputation to the start of the primary rehabilitation in the prosthetic phase. In the future research other independent predictive factors, such as comorbidities, first and foremost cardiovascular diseases, medication, laboratory parameters and mental status, should be taken into account.

Conceptual approach of shared decision making in physical therapy: An approach for betterment of patients?

Background: Shared decision making (SDM) depicts the work that patients and clinicians do together to consider the relative benefits of accessible administration choices and choose an arrangement that fits the patient objectives, inclinations and setting. SDM decreases the authoritative control between the patient and physical therapist. SDM allows a balanced relationship between a clinician and patient. The practical application of evidence-based practice in health care is always been a challenge for clinician. The objective of this study was to explore the use of shared decision making among physical therapists in Karachi.&#x0D; Methodology: A cross-sectional study was conducted at the Institute of physical medicine and rehabilitation (IPM&amp;R) department of Dow University of Health Sciences from 3 August 2017 till 13 April 2018. A total of 232 physiotherapists from different hospital and rehabilitation centers of Karachi participated in the study. SDM Q-Doc 9 (a physician version) questionnaire and questions regarding barriers were used to collect data. Those participants who fulfilled the inclusion criteria i.e. graduate physiotherapists and postgraduates and completed the entire survey were included in this study. Following participants were excluded undergraduate physical therapist (PT’s), house officers, internees, technicians, and academic staff of physiotherapy, non- practicing PT’s and other healthcare professionals. Data was analyzed by using SPSS version 20.00. Categorical variables were reported as frequency/percentage, while numerical data was presented as Mean±SD. Descriptive statistics test were applied.&#x0D; Results: The result showed that use of SDM was moderate (70.3%) among physiotherapists and the barriers included were: physician’s instructions (67.7%), lack of time (53.6%) and misconception of patient about disease or treatment (65.9%) which resisted in utilization of SDM.&#x0D; Conclusion: In conclusion we can state that the institutional physical therapists would prefer to use SDM moderately and it could be due to a relatively new concept.

Effect of Exercises on Quality of Life in Patients with Postmenopausal Osteoporosis - Randomized Trial.

BACKGROUND:Osteoporosis is a systemic skeletal disease characterised by a low bone density and microarchitectural deterioration of bone tissue leading to decrease of its strength and increased risk of fracture. Drug therapy decreases the risk of fracture, thus influencing on the mechanism of bone remodelling. Non-pharmacological interventions include specific exercises for osteoporosis that improve muscle strength and balance, decrease pain and improve quality of life.AIM:To compare the quality of life in patients with postmenopausal osteoporosis who practice exercises with those who do not practice on the beginning and after a year.MATERIJAL AND METHODS:A randomised Single-blind randomised controlled prospective trial study, which included 92 women with postmenopausal osteoporosis diagnosed and treated at the Institute of Physical Medicine and Rehabilitation in Skopje, Republic of Macedonia. Patients were randomly assigned to three groups: the first group of patients with exercises and physical modalities (gr. I), the second group with exercises (gr. II), and the third control group of patients who did not practice exercises (gr. III). Exercises were practised 3 times a week; each exercise was repeated for 5-8 times. Patients regularly took bisphosphonates, calcium and vitamin D. The follow-up period lasted for one year. Quality of life was determined with a specific questionnaire Qualeffo-41.RESULTS:The results showed, significant statistical difference in terms of pain, physical activity, social life, the perception of own health were shown between the groups (p < 0.0001), only in term of mental function were no significant (p < 0.3).CONCLUSION:Patients who practice exercises for osteoporosis have a significantly better quality of life than patients who do not perform exercises.

Dr Avram Farkic (1866-1925), the founder and the owner of the first physical therapy institute in Serbia

Methods of physical medicine, many of which have been empirically applied since the ancient times, have become particularly popular in 19th century Europe. The first examples of the works of Serbian doctors in this area originate from the same period. In 1838 and 1839, Dr. Konstantin Peicic wrote about Prissnitz?s method of hydrotherapy. In 1842, Dr. Dimitrije Radulovic published in Latin his doctoral dissertation concerning medical gymnastics. In the middle of the 19th century, in the Principality of Serbia, hydrotherapy treatments (by Dr. Andrija Ivanovic, 1850) and electrotherapy (by Dr. Jovan Valenta, 1857) w?re applied. Among the pioneers of physical medicine in Serbia, Dr Avram Farkic is a very important figure. In 1896, Farkic founded the first Serbian institute for physiotherapy in Belgrade, and, two years later, the First Institute for Orthopedics, Swedish Gymnastics and Massage. These institutions were merged in 1899. After the death of Dr. Farkic in 1925, the Institute worked under his name until the German bombing of Belgrade on April 6, 1941. The diversity and continuous introduction of modern therapeutic procedures were the main characteristics of the Institute during its 45-year-long existence. Dr. Farkic was also the initiator of the establishment of the Therapy Joint Stock Company, which founded the first institute for physical medicine in Vrnjacka Banja, the Therapy Institute for Treatment by Water and Electricity, in 1911. Until the First World War, it was the most modern spa sanatorium in Serbia. During spa seasons of 1911, 1912, 1913, and 1924, Dr. Farkic himself was the manager and the main physician of the Therapy Institute.

Physical medicine and rehabilitation league of Faculdade de Medicina da Universidade de Sao Paulo: An innovative model of undergraduate teaching and learning

Current medical education strategies are based on OSCE, self-assessment, clinical teaching, lectures and textbooks. The predominant method of learning anatomy, for example, consists primarily of reading textbooks and attending classes. Recently a new model of complementary education to graduation has become popular in Brazil: the Academic Leagues of Medicine. The Physical Medicine and Rehabilitation League of the University of São Paulo Medical School (PMR League of FMUSP) aims to complement this traditional method and also provide students with practical activities to improve their knowledge in clinical practice in physical medicine and rehabilitation. We aim to describe the educational, evidence-based assistance, community extension and research experiences gained through PRM League and the rate of medical student's exposure to the field after its implementation. PMR League of FMUSP counts on teaching activities, research projects and university extension to the community. The PMR League of FMUSP promotes the development of educational materials to the population, such as the “Postures’ Manual” adopted in the social project of districts’ revitalization in São Paulo; it also promotes theoretical classes correlating anatomical data with clinical cases and patient care activities. PMR League of FMUSP students and physicians are responsible for the preparation of classes, patient care, research and innovation projects at the Institute of Physical Medicine and Rehabilitation (IMREA). Medical students from the second to fourth grade take part of the PMR League mentored by attending physicians and residents. There was a 150% (from 10 to 35 medical students) increase in the number of members during the first year of activities, with growth prospects still higher in the coming years. PMR League of FMUSP with its activities, introductory course and classes, had a positive influence on student's interest and learning. It may represent a successful initiative for enhancing physical and rehabilitation medicine teaching.

Resultados de um programa de exercícios físicos para indivíduos com hemiplegia pós acidente vascular encefálico

Dentre as várias sequelas causadas pelo acidente vascular encefálico (AVE), destaca-se o comprometimento motor como a hemiplegia e a hemiparesia. A recuperação das sequelas neurológicas pode ocorrer de maneira espontânea, porém parte da recuperação depende de estímulo motor. Isto posto, o exercício físico é um método importante para a reabilitação e promoção da saúde em indivíduos que sofreram AVE. Objetivo: Verificar os resultados obtidos na força muscular global e em equilíbrio dinâmico, em indivíduos com hemiplegia pós AVE, que participaram de um programa de exercícios físicos. Métodos: Participaram do estudo 29 indivíduos, com média de idade de 57 anos. Foram analisados, retrospectivamente, dados dos prontuários de pacientes com diagnóstico de hemiplegia após AVE do Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – IMREA HCFMUSP, unidade Lapa, que participaram de programa de exercícios no serviço de Condicionamento Físico da instituição no período de setembro de 2011 a julho de 2013. Resultados: Observou-se aumento significativo em força muscular (p&lt;0,05) em todas as musculaturas envolvidas no teste de 10 RM. O maior ganho de força foi no grupo dos isquiotibiais (65,85%) e a musculatura com menor ganho de força foi tríceps braquial, com 31,34%. A média total de ganho de força foi de 45,20%. O tempo de realização dos testes Timed Up and Go (TUG) e Teste de Sentar e Levantar (TSL) foi menor ao término do programa, o que significa que os pacientes melhoraram a capacidade de realizar as mesmas funções avaliadas inicialmente. Conclusão: Este estudo mostrou que o treinamento resistido é muito importante para as pessoas com sequelas de hemiplegia pós AVE, por melhorar a capacidade funcional como o equilíbrio dinâmico, além de contribuir em suas atividades cotidianas com o aumento da força muscular global.

Savremeni principi u liječenju sindroma karpalnog kanala

The carpal tunnel syndrome is the most common focal or compressive neuropathy, with chronic flow. The carpal tunnel syndrome affects 1%­3% of general population.(1) The women of the fourth and fifth decade of life have four times greater chance to suffer from this syndrome than men of the same age.(2) The carpal tunnel syndrome also affects the part of pregnant women in the third trimester, immediately after delivery, and affects their both hands. The objective of this paper is to indicate the effect of the ultrasound therapy in the treatment process of carpal tunnel syndrome. The study was retrospectively performed on 30 patients between the ages of 27 and 78, of both gender, in the Institute for Physical Medicine and Rehabilitation 'Dr Miroslav Zotović' in Banja Luka, in the period from 2014 to 2015. The study involved patients with carpal tunnel syndrome confirmed by electromyoneurography examination as the focal neuropathy of n. Medianus in the carpal tunnel. The conclusion is that the Ultrasound therapy, as the modality of physical therapy, provides positive results as confirmed by the results of our study, regardless of age.

DIAGNOSTIC OF SPINAL COLUMN MOBILITY USING SCHOBER’S TEST FOR LUMBAL SYNDROME BY APPLICATION OF PHYSICAL THERAPY AND SPORT RECREATION

The research was conducted on the sample of 90 male and female subjects with chronic lumbar syndrome, aged between 20 and 50, of which 45 men and 45 women who were divided in three groups, 30 subjects per each group, formed on the basis of exercises done by the subjects during and upon the rehabilitation (III groups). The longitudinal and time bound research was executed (8 months). The research was conducted in the Department V “Banja Slatina”, in the Institute for Physical Medicine and Rehabilitation “Dr Miroslav Zotovic” in Banja Luka, including three Fitness centres in Banja Luka. The goal of the research was to compare results of testing of subjects who continued to engage in sport recreation after termination of a rehabilitation process in the Institution for Physical Medicine and Rehabilitation - IPMR “Dr Miroslav Zotovic” in Banja Luka (by means of usual physical procedures) and the results of those subjects who did not continue kinesitherapy, nor sport-recreational activities. For the statistical analysis in the SPSS program ANOVA was used, especially Post Hoc Test – Tukey HSD. The results showed that during the eight-month research there was a statistically significant improvement of the observed parameters (Schober index), but with the application of programmed physiotherapy with recreation (gr. II) the best results were achieved, as well as more stable remission, which could be explained by biological effects of the programmed physiotherapy together with sport recreation. Article visualizations:

Early active rehabilitation after arthroscopic rotator cuff repair: a prospective randomized pilot study

Objective: To compare two different rehabilitation strategies, primary passive motion versus early isometric loading of the rotator cuff. Design: Prospective randomized controlled observer-blinded pilot study. Setting: Institute of Physical Medicine and Rehabilitation. Subjects: Thirty patients after rotator cuff surgery. Intervention: All participants were randomly assigned to one of the two outpatient treatment groups: primary passive motion versus early isometric loading of the rotator cuff. Both groups were treated for 12 weeks and performed additionally a home exercise program. Main measures: The primary outcome measure for functional assessment was the Constant Murley score. The secondary outcome measures were the Disabilities of the Arm, Shoulder and Hand score (DASH), active range of motion, pain level and strength. Patients were assessed before, 6, 12 and 24 weeks after surgery. Results: Repeatedly measured metric variables were compared by the Quade rank analysis of covariance and revealed substantially better Constant Murley scores in the early activated group at all 3 assessments (6 weeks: 41 [31;45] versus 30 [23;37]; 12 weeks: 68 [56;77] versus 59 [53;62]; 24 weeks: 79 [76;81] versus 66 [62;74]; data as median [25%;75%]). Postoperative changes of Constant score were in favour of the active group with the biggest difference at week 12 (28 [38;12] versus 9 [27;-4]). Maximal pain levels showed clear more reduction 6 and 24 weeks after surgery in the early activated group. Conclusions: This pilot study with early isometric loading of the rotator cuff shows better function and less maximal pain. Further research is warranted to confirm our results.