Kinesiotherapy Program Research Articles

Značaj kineziterapije u lečenju hroničnog bolnog lumbalnog sindroma - pregled literature

Kinesiotherapy, or movement therapy, is the oldest and most significant method in physical medicine. Through purposeful, systematic, and strictly dosed exercises, it can be applied to human health both preventively and therapeutically. Kinesiotherapy aims is to increase strength and improve the function of muscles and joints, which has a positive effect on reducing pain and disability, accelerating recovery, and helping the patient return to regular activities. There are many kinesiotherapy programs, but chronic low back pain remains a persistent medical issue. Numerous clinical studies confirm the importance of kinesiotherapy in the treatment of CLBP. Experimental studies have shown the positive effects of exercise on pain and functionality, compared to passive therapy modalities and rest. However, it remains unclear which exercise program is the most effective, and which combination of exercises is the most beneficial and applicable in clinical practice. An adequate kinesiotherapy program for chronic low back pain should activate and strengthen the stabilizing muscles while protecting the most vulnerable structures (intervertebral discs and facet joints). The most commonly mentioned exercise programs in the literature are those that include lumbar stabilization exercises, also known as core exercises. Panjabi et al. introduced the first concept of the segmental stabilization system, consisting of three subunits: passive, active, and neural. These three subsystems are interdependent, and a dysfunction in one leads to increased functional demands on the others. Bergmark et al. proposed the hypothesis of two primary muscle systems that control movement and contribute to spinal stability: the global and local systems. The global system consists of the primary trunk movers, which do not have a direct impact on stabilization in the lumbar spine. The local system consists of tonic, postural, and stabilizing muscles of the spine: the psoas major, quadratus lumborum, the lumbar portion of the iliocostalis lumborum, lumbar multifidus (LM), internal oblique, and transversus abdominis (TrA) muscles, also known as the muscles of the inner unit. These muscles are shorter and located closer to the axes of rotation. They are directly connected to the vertebrae, allowing them to stabilize spinal movements. Strengthening the inner unit muscles of the lumbar spine and training static muscle contractions properly enhances lumbar segment stability, providing adequate support for the upper portions of the spine. An individually designed and implemented stabilization exercise program is effective in reducing pain and improving the overall functional status of patients with chronic low back pain.

Effects of Functional Electrical Stimulation with and without Kinesiotherapy on Pain, Range of Motion and Quality of Life in Patients with Cervical Dystonia; A Randomized Clinical Trial

Methods: This study was a Randomized Controlled Trial conducted at The University of Lahore Teaching Hospital, University Institute of Physical Therapy, Lahore. n= 84 patients with Cervical Dystonia were recruited in this study using non- probability convenient sampling technique. Patients suffering with Cervical Dystonia who aged between 30 till 50 years were randomly assigned into two groups, 42 patients in each group. First Group A which was the control group which was treated with Functional Electrical Stimulation and routine physical therapy only while Group B was the Experimental group which was treated with Functional Electrical Stimulation also with kinesiotherapy and routine physical therapy. Both the groups were evaluated and assessed using the Toronto Western Spasmodic Torticollis Rating Scale, the Pain Numerating Scale, the 36- item short form health survey( SF-36), Neck Disability index and range of motion of neck flexion, neck extension and neck rotation was measured using universal goniometer. Results: Functional Electrical Stimulation combined with kinesiotherapy given to the experimental group showed more improvement in range of motion, quality of life , functional disability and the symptom of the pain also was reduced in the experimental group as compared to the control group. The mean values showed that there was a statistically significant difference in different variables between both the groups. When the scores( scores at baseline and at 16th week) for Toronto Western Spasmodic Torticollis Rating Scale for both the groups were compared it showed statistical difference between both the groups(p<0.05). Conclusion: Despite the fact that cervical dystonia has central neurological etiology, this study concludes that multimodal kinesiotherapy program which included stretching and relaxation, active exercises in addition to Functional Electrical Stimulation and Routine Physical Therapy tempts to have beneficial effects on a patient suffering from Cervical Dystonia. It showed beneficial effects on pain, quality of life, functional disability and range of motion of patients with cervical dystonia. Key Words: Functional Electrical Stimulation, Kinesiotherapy, Cervical Dystonia, Pain, Rang of Motion, Quality of life

The benefits of the TECAR therapy in flexion recovery after revision of the anterior cruciate ligament (ACL)

Abstract Purpose The following research highlighted the importance of the TECAR therapy in recovering after anterior cruciate ligament surgery in performance athletes. Methods The study took place at Fizionova Medical Recovery Center in Targu Mures, on a period of 6 weeks between 24.01.2020 and 07.03.2020, on a sample of 10 subjects with anterior cruciate ligament surgery (5 subjects in the experiment group that followed the TECAR recovery program and 5 subjects that only followed a physiotherapy program for recovering from anterior cruciate ligament surgery), 7 male subjects and 3 female subjects with ages between 24 and 44 years. The research method was mostly experimental. We worked with TECAR therapy, muscular electrostimulation, and a series of kinesiotherapy exercises. For the statistical interpretation, we used the GraphPad Prism program using the Shapiro-Wilk test, t-Student test, Mann-Whitney, and Wilcoxon tests. Results The results of the investigation showed statistically significant differences between the experiment and control group after 4 and 6 weeks of a TECAR and kinesiotherapy recovery program. Conclusions The conclusions of our investigation highlighted the importance of implementing a supplementary kinesiotherapy program using the TECAR therapy in athletes who recover from anterior cruciate ligament surgery.

Predicting functional disability in patients with spondyloarthritis using a CRP-based algorithm: A 3-year prospective study.

This prospective study explored the link between values of C-reactive protein (CRP) in patients with SpA (ankylosing spondylitis, psoriatic arthritis, reactive arthritis, or arthritis-related inflammatory bowel disease) and functional disability in order to derive an algorithm that may predict functional disability based on disease activity. Patients diagnosed with Spa were classified into five groups based on the type of therapy and they were followed up for 3 years. Group 1: Symptomatic medication alone; Group 2: Disease-modifying antirheumatic drugs (DMARDs); Group 3: DMARDs and 30 rehabilitation sessions twice a year; Group 4: Group 3 therapy and biologic anti-tumor necrosis factor-alpha (anti-TNF-α) drugs; and Group 5: Group 4 therapy and, in addition, a daily home-adapted kinesiotherapy program. CRP, modified Health Assessment Questionnaire (mHAQ-S), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and T-score of the patients were recorded. Correlation and multivariate regression analyses were conducted using demographic data, CRP, and mHAQ-S scores to derive the CRP-mHAQ-S correlation algorithm. Statistical analysis included the chi-square, Mann-Whitney, and multiple regression tests and repeated measures analysis of variance. A total of 144 patients were enrolled, all of whom completed the study. The best predictive model (P<0.001) provided the algorithm mHAQ-S36=17.14+0.12xCRP0-0.24xCRP12-0.15xCRP36 (CRP0, CRP12, and CRP36 correspond to CRP levels at baseline, 12, and 36 months, respectively, and mHAQ-S36 to mHAQ-S score at 36 months). This derived algorithm based on objective CRP assessment may have implications in the prediction of functional disability evolution in patients with SpA.

Trial on the efficiency of the recovery treatment for patients with distal radius fractures

The hand is considered to be one of the most important structures of the human body, with the help of which we can do different kinds of activities. A lesion of the hand can destabilise the patient from a physical point of view but also from a psycho-social one. The distal radius fractures are the cause of morbidity for patients and determine the decrease of the workforce, despite the restoration of the bone alignment and even if the fracture is cured from an anatomical point of view. The hand traumatisms, especially the fractures, may have as causes osteoporosis, age, medication by corticoids, repeated traumatisms and physical deficiences. The objective of this trial is the evaluation of parameters (the movement amplitude, the muscular force, the prehension, the functional coefficient, the quality of life) which enable the clinical - functional recovery of patients who had hand traumatisms and their social- professional reinsertion. The study was conducted for a period of 6 months in the ambulatory and included 20 patients diagnosed with post-fracture sequelae at the distal radius level. The evaluation of the patients was made at the beginning and at the end of the treatment, as well as at the examination 6 weeks after the end of the treatment. For this purpose, electrotherapy, lymphatic drainage massage and the kinesiotherapy program were applied. After making the joint balance sheet, it is found the favorable evolution in the recovery on all the mobilisation directions, but also the functional coefficient, in all the evaluation moments: initial, final and control. By applying the evaluation methods and scales to the 3 moments of assessing the patients, the efficiency of the complex recovery program can be seen. Key words: clinical - functional recovery, hand traumatisms, the distal radius fractures,

Geotherapy combined with kinesiotherapy is efficient in reducing pain in patients with osteoarthritis

IntroductionPatients with osteoarthritis (OA) suffer from a degenerative disease that causes several physical disabilities and pain. Despite the few studies involving exercise combined with geotherapy (a therapy using poultices made from earth materials such as clay or mud) for patients with OA, this subject is still under debate, as effect of the earth material remains unclear. The aim of this study was to compare pain, joint stiffness and disability in patients who underwent kinesiotherapy (K) or geotherapy combined with kinesiotherapy (GK). MethodThis was a clinical randomized single-blinded prospective study, in which 48 individuals participated. Volunteers were evaluated for pain perception, pressure pain tolerance thresholds, and responded to questionnaires about pain, joint stiffness and physical disability (WOMAC) and about symptoms and disability (Lequesne Algofunctional Index). Patients in K group underwent 15 twice-weekly sessions of kinesiotherapy consisting of stretching and strengthening exercises for lower limbs. GK patients received a poultice of powder dolomite mixed with hot water on the knees for 25 min before each of the 15 sessions of the same kinesiotherapy program. ResultsBoth interventions were effective in reducing pain, joint stiffness and physical disability (p < 0.001), and in increasing pressure pain thresholds (p < 0.05); however, patients who underwent GK presented a more pronounced reduction in pain perception (p = 0.006) than those in K group. They also exhibited more tolerance to pain in all sites evaluated. ConclusionBoth interventions were effective in reducing pain, joint stiffness and physical disability, but GK produced significantly better results in pain perception.

Prophylaxis of knee joint contractures after primary knee replacement with kinesiotherapy (metaanalysis and literature review)

Primary knee replacement is one of the most common orthopedic procedures. However, in some cases, after surgical treatment, functional disorders in the form of joint contractures, reduced strength of periarticular muscles, persistent pain syndrome, and a high level of disability can persist.Methods: we analyzed randomized controlled studies which reflect the results of kinesiotherapy before and after primary knee replacement in patients with knee joints osteoarthritis. Study included the results of rehabilitation programs for patients with hip and knee joints osteoarthritis, who underwent a primary total replacement of the affected joint. A literature search was conducted in the MEDLINE database for the period 2009–2017.Results: present methods of kinesiotherapy are aimed at early mobilization of patients and the achievement of functional independence. A comparative analysis of the data of the primary (before the beginning of rehabilitation activities) and control (after the end of treatment) examinations in the main and control groups of patients revealed a significant improvement in joint function (p &lt; 0.05). However, in the long-term follow-up, 12 months or more after the end of the kinesiotherapy program, the differences in the studied parameters between the participants of the main and control groups were not significant. The presence of unfavorable results of the primary knee replacement to a certain extent is associated with a decrease in the functional capabilities of the quadriceps femoris due to the development of degenerative disorders and reflex arthrogenic muscle inhibition.Conclusions: there are no individual kinesiotherapy programs that determine the regimen, dosage, and intensity of physical exercises in this category of patients, depending on the initial functionality level of the knee joint and the musculoskeletal system as a whole, and the features of the postoperative recovery period.

A importância pratica da cinesioterapia em grupo na qualidade de vida de idosos

Objective: Analyze the effect of group kinesiotherapy on quality of life, adherence and discontinuation of the program, functional ability, balance and gait of sedentary elderly women. Method: Experimental study, with a sample of elderly women over the age of 60 years (N=30). They were submitted to a kinesiotherapy protocol for twelve weeks after being randomized into three groups: collective kinesiotherapy (CK), individual kinesiotherapy (IK), and control group (CG). Quality of life with SF-36 survey, and the variables of balance and gait with Tinetti test were assessed. Descriptive statistical procedures and the Wilcoxon test were applied to evaluate the effect intra group and the Kruskal-wallis test for analyzing the variance between groups, with significance of p<0.05. Results: Adherence were: CK, n=10; IK, n=10; and CG, n=10. Tinetti test (before x after): CK total score, 9.26 X 13.1; IK total score, 11.37X14.5. There was not improvement in CG. SF-36 (mean scores, before x afer): CK Pain, 33.2 X 70.7; CK Emotional wellbeing 33.3X66.6; IK Functional capacity: 64X 85.5; IK Emotional aspects: 77.7 X 88; IK Functional limitation: 72.5X 100. There were no statistically significant changes in CG. Conclusion: We found no expressive differences regarding the kinesiotherapy program discontinuation between the intervention groups. However, both groups presented significant differences after the interventions in improvement of the emotional aspects, improvement of physical impairments, pain reduction, improvement of balance and gait, what evidences the efficacy and the relevance of this activity.

Effectiveness of diathermy in patients with low back and pelvic pain referred to lower limb: A pilot study

Objectives: Low Back and pelvic pain is a major problem and a common cause of disability and health care utilization. To evaluate diathermy efficacy for low back and pelvic pain treatment.Methods: Reports of 20 multifidus in subjects with a previous low back and pelvic pain diagnosis. A randomized trial blinded with two randomized groups, group A diathermy, group B sham diathermy to check efficacy of diathermy.Results: Diathermy group don´t show significate differences versus sham group due to be apply as an isolated technique but this technique rarely is reported in this way and is frequently associated to perturbational training or a kinesiotherapy program during his activation. A better correlation was achieved by diathermy in Tensomiography values.Conslusions: Further studies are necessary to improve knowledge about physical effects of diathermy due to this technique is frequently associated with a kinesiotherapy program to get better results in patients with prevalent illness as lumbar and pelvic pain referred to lower limb.

Rehabilitation in multiple sclerosis.

The aim of the study is to present a strategy of rehabilitation in multiple sclerosis on the basis of the latest developments in the field of physiotherapy. The publications on the problem discuss a wide range of methods of physiotherapy that can be used in order to reduce the degree of disability and alleviate the symptoms associated with the disease. The complexity of the disease, the difficulty in determining the appropriate treatment and a wide range of symptoms require a comprehensive approach to the patient, which would include both pharmacology and neurorehabilitation. Rehabilitation, which includes psychotherapy and symptomatic therapy, is regarded nowadays as the best form of treatment for multiple sclerosis. An indepth diagnostic assessment of functional status and prognosis should be carried out before the start of the rehabilitation process. The prognosis should take into account the mental state, the neurological status and the awareness of the patient. The kinesiotherapy program in multiple sclerosis is based on a gradation of physiotherapy which assumes a gradual transition from basic movements to more complex ones till global functions are obtained. The most appropriate form of treatment is functional rehabilitation combined with physical procedures. Recent reports indicate the need for aerobic training to be included in the rehabilitation program. The introduction of physical activities, regardless of the severity of the disease, will reduce the negative effects of akinesia, and thus increase the functional capabilities of all body systems.

Preventive physical therapy and care humanization in the treatment of a bedridden, home care, neurologic patient

Abstract Introduction: This case study investigated the impact of preventive physical therapy on shoulder problems and the prevention of pressure ulcers (PU) in a bedridden, home care, post-neurological surgery patient. Objective: To highlight the importance of physical therapy in the prevention of comorbidities, chronic neurological sequelae, and PU. Materials and Methods: In the immediate post-surgical phase, the patient was treated with preventive measures against PU, according to the Pressure Ulcer Prevention Protocol of the University of São Paulo, the National Pressure Ulcer Advisory Panel, and the Braden Scale. In addition, we used the modified Ashworth scale to assess spasticity. A kinesiotherapy program based on the Bobath's concept was used to prevent subluxation of the plegic arm and help in the recovery of functional movements. Results: The use of preventive measures and delivery of humanized care during a six-month period helped prevent the development of stage 3 and 4 PU and physical, functional, and respiratory complications. By the end of six months, the patient was found to be at low risk of developing PU. Conclusion: Notwithstanding the difficulties experienced during treatment, especially for the positioning of the arm and performance of transferring and positioning techniques, the results of this study are in agreement with aspects considered important for treatment outcomes.

Los predictores psiconeuroinmunológicos de la sobrecarga de cuidado en ancianos cuidadores de pacientes con enfermedad de Alzheimer

IntroductionThe responsibility of giving care to patients with Alzheimer's disease (AD) may result in health changes in the older caregiver. It is important to explore the factors which influence the presence of care burden and to create strategies to face this condition. In this context, the aims of present study were to investigate the relationships between psychoneuroimmunological parameters and determine the predictors to burden in older caregivers of patients with AD. Material and methodsA total of 30 AD older caregivers participating in the «Cognitive and Functional Kinesiotherapy Program in Elderly with Alzheimer's disease«(PRO-CDA)», de Rio Claro, SP-Brazil, were submitted to an assessment protocol to evaluate the psychoneuroimmunological parameters. A descriptive statistical analysis, Pearson correlation and multiple linear regressions were performed. ResultsThe mean age of caregivers was 71.3 (± 9.3), and predominantly are first-grade relatives. The caregiver burden was associated with depressive symptoms (r=0.60, P<.001), caregiver distress (r=0.68, P<.001), and neuropsychiatric disorders of AD patients (r=0.53, P<.001). The multiple regression analysis confirmed depressive symptoms and neuropsychiatric disturbances as predictors of caregiver burden. ConclusionCaregiver burden is associated with, and influenced by parameters related to the caregiver psychological suffering and to characteristics inherent to AD. Thus, it is important to find strategies and implement non-pharmacological programs to provide support to older caregivers, and to assist in the treatment of patients with AD, in order to improve the integral health of this population.

Urinary incontinence: an interdisciplinary approach in the Basic Health Care

Introduction: The urinary incontinence (UI) occurs among 30 and 60% of women during menopause. It generates a negative impact interfering in aspects such as physical, psychological and social women daily routine, affecting their quality of life. Considering these implications and, based on the consideration that every woman experience this problem in a unique way, an integrated approach is required, anchored in humanized precepts. Objective: To report the implementation of a women´s group focused in the health education, urinary incontinence prevention and treatment in a Basic Health Unit in the city of Porto Alegre. Description of the experience: The work was based in an open group dynamic, focused on achievement and learning of kinesiotherapeutic techniques to reeducate the pelvic floor function, along with the promotion of a support program to exchange urinary incontinence related information and experiences. The meetings were held weekly and divided into two parts: open dialogue and, after, the kinesiotherapy program. Conclusion: The activities encouraged the exchange of experiences and knowledge construction in the aspects related to UI. The group work showed to be viable and inexpensive, allowing easy access to information about UI to a greater number of women. The group implementation, with an interdisciplinary focus, contributed to expand the health vision in order to an integral and humanized assistance in urinary incontinence related aspects.

The Alzheimer functional status instrument: An instrument to assess rehabilitation strategies for Alzheimer patients

The Alzheimer Functional St atus Inventory (AFSI) was developed to assess a kinesiotherapy program for 22 randomized pairs ofpatients with Senile Dementia of the Alzheimer Type (SDAT) residing in the Dementia Study Unit of the Edith Nourse Rogers Memorial VA Medical Center; Bedford, Massachusetts. The AFSI was developed by an interdisciplinary team to overcome some of the limitations of standard geriatric instruments to detect changes in functional status in SDAT patients following a rehabilitation program. The AFSI, which is performance-based, includes items adapted from Granger's PULSES Profile and activity disturbances itemsfrom the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), items on mood andbehaviorduring assessment, as well as, one on communication status. The AFSI thus includes items which evaluate physical, psychosocial, and cognitive dimensions offunctional status. These dimensions are: • Sensory function; • Range of motion skills including lower limb and upper limbfunction; • Mood state; • Behavioral status; and • Time to complete tasks.