Physiotherapy Management Research Articles

Aplicación de Machine Learning para elproceso de clasificación de datos asociadosal centro médico Celina

The objective of this research project is the application of artificial intelligence through the use of Machine Learning for the data classification process associated with the CMC medical center, in wich CRISP-DM methodology is applied that allows data analysis to obtain useful information through a preference classification process for the medical service provided to patients during the years 2021 and 2022. Parameterized models for prediction are created, for wich, in the application you will find the aforementioned preferences between, medical appointments with their different specialties, manual andtechnological physiotherapy treatments, and vital signs monitoring; from where, we obtain that the client's preference is in the medical appointment service, in the area of Gynecology and Obstetrics. This information is important to identify where the business of the medical center is projected.

Effects of TENS and Physiotherapy on Chronic Constipation in Myelomeningocele

Background: Chronic constipation is a common symptom of myelomeningoceles. TENS has been proven to be effective in treating constipation in different populations and parameters. Physiotherapy is a relatively recent treatment for constipation and has not been extensively studied in pediatrics and spina bifida. This study aimed to examine the role of TENS in myelomeningocele and to increase the number of studies on physiotherapy for pediatric constipation. 
 Aims: To determine a new treatment approach that can be applied in chronic constipation in children with spina bifida using physical therapy techniques.
 Study Design: Randomized Controlled Trial 
 Methods: Constipation symptoms, stool pattern, bladder and bowel dysfunction, muscle strength involved in defecation, pressure pain thresholds (ppt) in these muscles, severity of fecal incontinence, and quality of life were assessed prior to treatment. Physical Therapy (PT) group received manual physical therapy techniques and dietary therapy for six weeks while the Physical Therapy and TENS (PT+T) group also received TENS. The post-treatment evaluations were repeated.
 Results: A total of 28 children, 14 in each group, were included in the treatment plan. The stool form in both groups of children was constipated. There was a significant difference in stool pattern only PT+T group (p

Physiotherapy Management of Urinary and Fecal Incontinence in a Nulliparous Young Athlete Treatment. A Case Report

Physiotherapy Management of Urinary and Fecal Incontinence in a Nulliparous Young Athlete Treatment. A Case Report

International Survey of Cardiopulmonary Physical Therapy Management of Adult Intensive Care Unit Patients and the Impact of COVID-19

Objectives: The aim of this study was to report on the cardiorespiratory assessments, interventions, and outcome measures used by physical therapists with critically ill patients and the impact of COVID-19. Design: An anonymous international online survey of practice (through Google Forms) of physical therapists was conducted. Setting: The study was conducted in adult intensive care units. Participants: A total of 309 physical therapists participated in the study. Interventions: A survey was used to determine current cardiopulmonary physical therapy practices in ICU. Results: Predominantly participants were female (74%), aged 31 to 40 years (40%), having worked in intensive care unit (ICU) for either 0 to 5 years (38%) or 11 to 20 years (28%), and worked full time (72%). Most participants worked in the United Kingdom (36%), Europe (21%), or Australia/Oceania (18%). The 3 most frequently reported assessment indicators for cardiopulmonary physical therapy interventions were lobar collapse/atelectasis, audible secretions, and decreased/added lung auscultation sounds. The 3 most commonly used outcome measures included lung auscultation, arterial blood gas analysis, and transcutaneous arterial saturation. The 3 most commonly used physical therapy interventions (“very often” in a descending order) included patient mobilization, repositioning to optimize gas exchange, and endotracheal suctioning. For the COVID-19 cohort, participants reported similar use of patient repositioning to optimize gas exchange and postural drainage, and lower use of patient mobilization and endotracheal suctioning, deep breathing exercises, active cycle of breathing technique, and oropharyngeal suctioning. Conclusion: This survey reports on the characteristics of physical therapists who work in ICU, and their cardiopulmonary physical therapy assessments, interventions, and outcome measures most commonly used, inclusive of patients with COVID-19. There were some differences in interventions provided to the COVID-19 cohort compared with the non–COVID-19 cohort.

Physical therapy rehabilitation after hospital discharge in patients affected by COVID-19: a systematic review

In 2019, the Coronavirus (SARS-CoV-2) virus was identified, also defined as novel coronavirus or severe acute respiratory syndrome coronavirus 2. The Corona VIrus Disease (COVID-19) pandemic generated several changes in society in 2020 as a result of its rapid spread in humans. The main symptoms are high fever (≥ 37.8 °C), dry cough, dyspnea, upper respiratory symptoms, myalgia, fatigue and diarrhea in the most uncommon cases. Considering the emergency situation caused by the COVID-19 pandemic and the effects attributed to it, rehabilitation professionals have a fundamental role in the functional recovery of patients, independence and improvement of quality of life. This is a systematic review of the literature, with the aim of discussing the main findings on physical therapy management in functional changes in post-COVID-19 patients. Pubmed, Scielo, Sciencedirect, BVS and PEDro databases were used. The terms MESH/DECs used for the searches were: Rehabilitation, Physical Therapy Modalities, Covid-19, Post-acute Syndromes COVID-19 and Physical Fitness, the keywords were also used: rehabilitation, physiotherapy, Covid-19, post- acute syndrome COVID-19 and functional capacity. To cross the terms, Boolean operators (AND and OR) were used. Randomized trials, recommendations, quasi-randomized or prospective controlled trials, reports, guidelines, and field updates were included. As for the selected population, studies were included in individuals of both sexes, with no age restriction, that evaluated physiotherapeutic interventions in patients who had COVID-19. Literature reviews, case studies, conferences, abstracts of articles published in conference proceedings and letters to the editor were excluded from the research. To measure methodological quality, the PEDro scale was used.Searches for articles were performed restricting the period of publication between the years 2019 to 2022. The electronic search strategy identified a total of 364 records from the selected databases. After screening for duplicates, 14 articles were excluded, followed by screening by titles and abstracts, another 298 articles were excluded, of these 47 potentially relevant records were submitted to full text review and of these 5 randomized clinical trials were included in this review. In view of the findings of this study, it can be concluded that physical therapy rehabilitation should continue after hospital discharge, with the aim of improving physical performance and activities of daily living (ADL) in post-COVID-19 patients.

The Efficacy of Physical Therapy and Rehabilitation Approaches in Chronic Migraine: A Systematic Review and Meta-Analysis.

Pharmacological treatment is the primary approach in chronic migraine (CM), although non-drug interventions such as physical therapy are used as adjunct treatments. We aimed to review the efficacy of physical therapy and rehabilitation approaches for CM and their impact on quality of life (QoL) and disability. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included randomized controlled trials (RCTs) in adults with CM. The primary outcomes were changes in intensity, frequency, duration of headache, disability, and QoL. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data synthesis and quantitative analysis were conducted on relevant studies. Seven RCTs were included in the narrative review, and five of them were eligible for quantitative analysis. Aerobic exercise (AE), osteopathic manipulative treatment (OMT), occipital transcutaneous electrical stimulation (OTES), acupressure, hydrotherapy, instrument-assisted soft tissue mobilization (IASTM), facial proprioceptive neuromuscular facilitation (FPNF), and connective tissue massage (CTM) were used in CM. AE combined with pharmacological therapy reduced the frequency, duration, and intensity of headache. OMT combined with medication improved QoL and reduced disability, intensity of pain, and migraine days per month. Hydrotherapy combined with medication also resulted in improvements in the intensity of headache, frequency, and overall QoL. IASTM and OTES reduced the intensity of headache, alleviated neck pain, and improved QoL, although there were conflicting findings following OTES alone on disability and intensity of headache. Both FPNF and CTM reduced the intensity of headache. Acupressure as an adjunct to medication did not show additional benefits on the intensity of headache and QoL. Quantitative analysis of the data showed that manual physical therapy combined with medication reduced the intensity of headache (p = 0.0796), and manual or AE combined with medication reduced the headache days per month (p = 0.047). A limited number of RCTs investigating the efficacy of physical therapy and rehabilitation approaches show promise in improving headache symptoms, reducing disability, and enhancing QoL in CM. Meta-analysis of the data also supported favorable outcomes for both intensity and headache days per month. Further research is needed to better understand the efficacy, optimal duration, and safety of physical therapy and rehabilitation approaches for CM, and to explore alternative interventions.

The 2022 Massive Open Online Course (MOOC) to train physiotherapists in the management of people with spinal cord injuries: a qualitative and quantitative analysis of learners’ experiences and its impact

Study designObservational.ObjectivesTo determine the learners’ experience and the impact of a Massive Open Online Course (MOOC) conducted to teach physiotherapists about the management of people with spinal cord injuries (SCI).MethodsA SCI MOOC for physiotherapists was run in 5 different languages at the end of 2022. Qualitative and quantitative data were collected from different sources including registration details, pre- and post-MOOC Knowledge Assessments, a post-MOOC Evaluation, social media posts and online tracking of websites and emails. The data were used to answer four key questions: (i) what was the reach of the MOOC, (ii) what did participants think about the MOOC (iii) did the MOOC change participants’ knowledge and/or confidence, and (iv) did the MOOC change participants’ clinical practice or the way they teach others?Results25,737 people from 169 countries registered for the MOOC. 98% of participants who completed the Evaluation (n = 2281) rated the MOOC as either “good” or “very good”. Participants’ knowledge improved by a median (IQR) of 25% (10 to 45%) (n = 4016 participants) on the MOOC Knowledge Assessment. Participants reported changes in confidence, and intentions to change clinical practice and incorporate what they had learnt into the way they teach others in response to the MOOC.ConclusionThe MOOC provided an efficient way to increase physiotherapists’ knowledge about the physiotherapy management of people with SCI. Participants enjoyed the MOOC, and indicated an intention to change clinical practice and the way they taught others.

Minimal Clinically Important Differences in Hand Pain Intensity (Numerical Pain Rate Scale) and Related-Function (Boston Carpal Tunnel Questionnaire) in Women With Carpal Tunnel Syndrome

ObjectiveTo calculate the minimal clinically important differences (MCIDs) for hand pain intensity and the Boston Carpal Tunnel Questionnaire (BCTQ) in a sample of women with carpal tunnel syndrome (CTS). DesignSecondary analysis of a randomized controlled trial. SettingA Hospital Rehabilitation Unit. ParticipantsOne hundred twenty women with clinical and electromyographic diagnosis of CTS who were randomly assigned into 2 groups (N=120). InterventionsOne group received 3 sessions of manual physical therapy (n=60) and the other group received surgery (n=60). Main Outcome MeasuresMean and the worst pain intensity (numerical pain rate scale, 0-10 points) and functional status and symptoms’ severity subscales of the BCTQ questionnaire were assessed before and 1 month after treatment. The Global Rating of Change (GROC) was used as the anchor variable for determining the MCID. ResultsA change of 1.5 and 2.5 points in mean and the worst pain intensity represents the MCID for Numerical Pain Rating Scale, whereas a change of 0.23 and 0.64 points in functional status and symptoms’ severity represents the MCID for each subscale of the BCTQ. All variables showed acceptable discrimination between patients classified as “improved” and those classified as “stable/not improved” (area under the curve≥0.72). Mean pain intensity (Youden index, 0.53; sensitivity: 73.3%; specificity: 80%) and symptoms’ severity (Youden index, 0.69; sensitivity: 90%; specificity: 77.8%) showed the best discriminative ability expressed as a percentage of prediction. Participants classified as “improved” had significantly greater improvements in pain intensity, functional status, and symptoms’ severity compared with those classified as “stable/not improved”. ConclusionA change of 1.5 and 2.5 points in mean and the worst pain and a change of 0.23 and 0.64 points in functional status and symptoms’ severity represents the MCID for pain intensity and BCTQ in women with CTS 1 month after treatment.

Effect of Powerbreath Medic Plus versus Threshold IMT on maximal inspiratory pressure and functional capacity in post-operative ventricular septal defect closure: A protocol for a randomized controlled trial

Background: Congenital heart disease is a general phrase that refers to any heart conditions that exist at birth, the most prevalent of which being ventricular septal defects (VSD) and foetal congenital malformations. VSD refers to the presence of aperture between the ventricles which leads to mixing of oxygenated and de-oxygenated blood. Although many VSDs close on their own, failing to do so can result in a number of issues and typically necessitates open heart surgery for closure of the defect. According to various studies, there is reduced functioning of diaphragm post cardiac surgeries which leads to occurrences of pulmonary complications such as lung collapse, fluid accumulation in pleura, pneumonia, acute respiratory distress syndrome and pneumothorax which can be debilitating and jeopardize recovery as well as increase hospital stay. There are several devices which are proven to improve the strength of inspiratory musculature and hence improve maximal inspiratory pressure and functional capacity post cardiac surgeries. Method: In this study we aimed to assess and evaluate the effectiveness of Powerbreath Medic Plus and Threshold Inspiratory Muscle Trainer (IMT) adjunct to conservative physiotherapy management on subjects who underwent VSD closure in a two arm parallel superiority randomized control trial on improving maximal inspiratory pressure and functional capacity. 60 individuals in total will be allocated equally into two groups, and both groups will be receiving treatment for four weeks with five sessions per week. After four weeks of therapy and two weeks after the intervention is through, the results will be assessed for follow-up. Predicted results: By increasing maximal inspiratory pressure and functional capacity, this technique may be used to treat complications following heart surgery if our study's premise is found to be significant. CTRI registration: CTRI/2023/03/051090

Temporomandibular Dysfunction and Voice-Related Quality of Life Impairment.

Muscle tension in the head and neck may co-occur with temporomandibular dysfunction (TMD) possibly leading to voice change. Several studies have reported a correlation between TMD and dysphonia. However, literature on TMD and voice-related quality of life (QOL) is scant. This study aimed to investigate the relationship between TMD and self-perceived voice-related QOL impairment. Patients from TMD clinic were prospectively surveyed on voice-related quality of life using the Voice Handicap Index (VHI) questionnaire. Patients were queried using paper and pen upon initial evaluation in dentistry clinic for temporomandibular disorders by a single dentist or dental assistant in the otolaryngology department. A total of 53 patients completed the VHI. 80% of patients presenting to TMD clinic had VHI scores above zero, but most had minimal to mild impairment. Forty-two patients had scores between 1 and 86, (average 10.98); 11 patients had a score of zero (20.75%). Total average score: 8.70, range: 0-86, median: 4. Functional average score: 3.13, range: 0-29, median: 1. Physical average score: 3.58. range: 0-25, median: 2. Emotional average score: 1.98, range: 0-32, median: 0; these averages did not differ from historical controls. The majority of patients presenting to TMD clinic also presented with some level of voice-related QOL impairment, although minimal and consistent with historical VHI controls. Data indicates that TMD disease may be primarily defined as functionally and physically uncomfortable. Incorporation of interdisciplinary care, with laryngology, speech pathology, physical therapy, counseling, and pain management may be warranted. 4 Laryngoscope, 134:315-317, 2024.

Patient and Caregiver Perceptions of Airway Clearance Methods Used for Cystic Fibrosis.

Cystic Fibrosis Foundation guidelines recommend people with CF perform daily airway clearance. This can be difficult for patients, as some find it time consuming or uncomfortable. Data comparing airway clearance methods are limited. We surveyed patients and their families to understand which methods are preferred and identify obstacles to performing airway clearance. We designed a REDCap survey and enrolled participants in 2021. Respondents reported information on airway clearance usage, time commitment, and medication use. They rated airway clearance methods for effectiveness, comfort, time commitment, importance, and compatibility with other treatments. The analysis included descriptive statistics and clustering. 60 respondents started and 52 completed the survey. The median patient age was 20 years. Respondents experienced a median of four airway clearance methods in their lifetime, including chest wall oscillation (vest, 92%), manual chest physical therapy (CPT, 88%), forced expiration technique (huff or cough, 77%), and exercise (75%). Past 30-day use was highest for exercise (62%) and vest (57%). The time commitment was generally less than 2 hours daily. Of those eligible for CFTR modulators, 53% reported decreased time commitment to airway clearance after starting treatment. On a scale of 0-100, respondents rated CFTR modulators as their most important treatment (median 99.5), followed by exercise (88). Discussion. Patients and caregivers are familiar with several methods of airway clearance for CF. They report distinct strengths and limitations of each method. Exercise and vest are the most common methods of airway clearance. The use of CFTR modulators may reduce patient-reported time commitment to airway clearance.

MANAJEMEN FISIOTERAPI DALAM MENINGKATKAN KETERBATASAN LGS DAN KEKUATAN OTOT PADA KASUS POST OP ACL FASE 2 DI RSUD KMRT WONGSONEGORO SEMARANG: STUDI KASUS

Anterior Cruciate Ligament (ACL) injury is one of the most common injuries among sports athletes. This injury is caused by a tear in the ligament which is characterized by knee instability and a popping “pop” sound after the injury. Reconstructing the ACL is usually done by grafting the disconnected tissue. Patients after ACL reconstruction experience symptoms of complications such as pain, decreased joint range of motion, and muscle weakness. Purpose: This study aims to determine the effect of providing physiotherapy interventions such as cryotherapy, patella mobilization, ROM exercise, and strengthening exercises using resistance bands. Method: The research method was carried out directly on 1 respondent with post-op ACL Phase 2 in 4 therapy sessions. Result: After 4 sessions of therapy, the results showed a decrease in pain, an increase in the value of the range of motion of the joints, and an increase in muscle strength. Conclusion: there is an effect of providing physiotherapy management to reduce pain, increase joint range of motion, and increase muscle strength.

Interdisciplinary interventional and physiotherapy management of facet joint syndrome

Interdisciplinary interventional and physiotherapy management of facet joint syndrome

Effects of different physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women: a systematic review

BackgroundMenopause is the time that marks passing 12 months after the last menstruation cycle in women between ages 40–50. Menopausal women often experience depression and insomnia that significantly impact their overall well-being and quality of life. This systematic review aims to determine the effects of different therapeutic physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women.MethodologyAfter identifying our inclusion/exclusion criteria, we conducted a database search in Ovid Embase, MIDRIS, PubMed, Cochrane, and ScienceOpen, where 4007 papers were identified. By using EndNote software, we excluded duplicates, unrelated, and non-full text papers. Adding more studies from manual search, we finally included 31 papers including 7 physiotherapy modalities: exercise, reflexology, footbath, walking, therapeutic and aromatherapy massage, craniofacial message, and yoga.ResultsReflexology, yoga, walking and aromatherapy massage showed an overall significant impact on decreasing insomnia and depression in menopausal women. Most of exercise and stretching interventions also showed improvement in sleep quality but inconsistent findings regarding depression. However, insufficient evidence was found regarding the effect of craniofacial massage, footbath, and acupressure on improving sleep quality and depression in menopausal women.ConclusionUsing non-pharmaceutical interventions such as therapeutic and manual physiotherapy have an overall positive impact on reducing insomnia and depression in menopausal women.

Effect of diaphragmatic breathing, respiratory muscle stretch gymnastics and conventional physiotherapy on chest expansion, pulmonary function and pain in patients with mechanical neck pain: A single group pretest-posttest quasi-experimental pilot study

BackgroundThere is evidence that mechanical neck pain results in respiratory dysfunction. Physiotherapy management for mechanical neck pain is well documented but the evidence regarding inclusion of breathing strategies to improve pulmonary functions in mechanical neck pain patients is scarce. ObjectiveTo investigate the combined effect of diaphragmatic breathing, respiratory muscles stretch gymnastics (RMSG) and conventional physiotherapy on chest expansion, pulmonary function and pain in patient with mechanical neck pain. MethodThirteen patients with mechanical neck pain (18–35years) with neck pain history of ≥ three months and NPRS (numeric pain rating scale) score ≥3 were recruited for this single group pre pretest-posttest quasi experimental pilot study. Informed consent was taken from all participants. After initial screening and assessment, diaphragmatic breathing, RSMG (5 patterns) and conventional physiotherapy (hot pack and TENS for 10 min) were given for one week. Chest expansion, spirometry (FEV1, FVC, FEV1/FVC, PEFR), NDI (neck disability index) and NPRS were assessed on baseline and after one week following the intervention. ResultsThe normality of data was tested by using Shapiro-wilk test and the data was found to be normally distributed. Paired t-test was used to compare the baseline and post intervention values. Diaphragmatic breathing, RMSG and conventional physiotherapy had significant effect on chest expansion, FEV1, NPRS and NDI in patients with mechanical neck pain. ConclusionThe rehabilitation strategies should emphasize breathing exercises to improve the lung function and pain scores in addition to conventional physiotherapy in rehabilitation of mechanical neck pain patients.

ACTIVE ASSISTED MOVEMENT DALAM MENJAGA KEMAMPUAN FUNGSIONAL PADA KONDISI DUCHENNE MUSCULAR DYSTROPHY

Background: Duchenne muscular dystrophy which is a recessive x-linked disorder that often affects males. Duchenne muscular dystrophy is caused by mutations in the dystrophin gene at the Xp21 locus so that dystrophin protein is not produced or dystrophin deficiency and structural abnormalities occur. Dystrophinopathies are X-linked recessive disorders affecting 1 in 5,000 to 1 in 6,000 live male births. The prevalence of DMD is less than 10 cases per 100,000 males. Objective: Physiotherapy management in this case aims to determine the benefits of providing physiotherapy interventions in the form of active assisted and passive movement and stretching in patients with Duchenne muscular dystrophy. Methods: This case report was conducted at PLDPI Surakarta by taking patients with Duchenne muscular dystrophy cases by providing physiotherapy modalities in the form of active assisted and passive movement and stretching for 3 physiotherapy sessions. Furthermore, measurements were taken with the GMFM and XOTR Scale in the first to third physiotherapy. Results: From the physiotherapy management given, it was found that functional ability and muscle strength remained unchanged and did not develop. Conclusion: Physiotherapy management in this case report is proven to be able to maintain functional ability and muscle strength in patients with Duchenne muscular dystrophy.

Physiotherapy management of moderate-to-severe traumatic brain injury.

Physiotherapy management of moderate-to-severe traumatic brain injury.

Physiotherapy management of children with cerebral palsy in low- and middle-income countries: a scoping review protocol

IntroductionCerebral Palsy (CP) is the most common childhood physical disability worldwide. Approximately 1.5 to 4 children per live births live with CP, globally. There have been no specific treatments that can reverse the brain damage responsible for the complex clinical dysfunctions of CP. There are, however, several interventions that are currently being used by physiotherapists, most of which are deemed to be ineffective and unnecessary. We will conduct a scoping review aimed at mapping evidence on the physiotherapy management of children living with CP in low- and middle-income countries (LMICs).MethodsThe scoping review will be guided by the Arksey and O’Malley and Levac et al. frameworks. The databases that will be used to search for literature include PubMed, MEDLINE, CINAHL, EBSCOhost, Web of Science, and ProQuest One Academic and Scopus. Gray literature articles will also be included in this review, provided they meet our inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRIMSA-ScR) guideline will be used to report the results of the scoping review. The screened results will be reported using the PRISMA flow diagram guidelines, and the results will be charted using an electronic data charting form and analyzed using thematic analysis.DiscussionUnderstanding how physiotherapists manage children with CP in LMICs is essential for the development of internationally sound, yet locally relevant, intervention strategy for physiotherapists. It is anticipated that the results of the scoping review will inform the thinking geared towards the development of a contextualised evidence-based framework for physiotherapists to effectively manage CP in children.Systematic review registrationOpen Science Framework. https://doi.org/10.17605/OSF.IO/VTJ84

Physiotherapists’ views regarding accessibility of Parkinson disease patients to physiotherapy centers

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disease mainly characterized by motor defects such as tremor and postural instability. The number of patients with Parkinson’s disease (PD) is increasing in all aging societies. This population requires immediate physiotherapy management to maintain and improve their quality of life. The aim of study to explore physiotherapists’ views about the barriers facing Parkinson’s patients on access in centres of physiotherapy in Al-Zawia city, Libya. Method: An exploratory qualitative study is design to explain physiotherapists’ views. Twenty physiotherapists from seven physiotherapy centres were approached individually and invited to participate. Participants were interviewed and asked about their experiences with Parkinson's patients. Result and discussion there are barriers in the communication with elderly Parkinson's patients and also, the doctors with physiotherapists, lack of access (referral) and poor awareness of doctors about physical therapy role as one of the barriers, the economic part of barriers that limit patient’s access to the center because as expensive private facilities, and long-term treatment plans with slow improvement lead to a lack of patient's access to the center, on other hand patient fell bored from ong treatment, beside the patients mood that effected in patients treatment such as anxiety and depression, while the anxiety is the most mood disorder . All of these factors and others led to frequent missing sessions and limiting patients’ access to physiotherapy centres. Conclusions: The study found that there were gaps in communication between patients, physiotherapists, and physicians. And there lack of patient access in the physiotherapy centres because of poor referral and awareness/knowledge about the benefits of physiotherapy programs for patients with PD. Another issue the study found there was the high cost of the therapy sessions and long-term program compared with the low level of improvement that made patients discontinue their treatment.

Non-aggressive Treatment in Knee Osteoarthritis Patients: A Review on Literature

Introduction: High prevalence of knee osteoarthritis (OA) in Iran and the subsequent disability have resulted in representing multifarious non-aggressive interventions with distinct influences on the disease. The aim of this study was to review previous domestic studies about the effects of conservative therapeutic options on patients with knee OA.
 Materials and Methods: Using search engines involving IranMedex, MedLib, ISC, Google Scholar, Magiran, SID, rehabilitation, and medical journals based on defined keywords, 98 Persian language articles were found, and 37 studies were finally included in our study after applying the exclusion criteria. The type of study, the pattern of choosing subjects, patient information, the measurements, interventions, and the results were exploited from each article, and the physiotherapy evidence database (PEDro) scale was administrated to evaluate the studies.
 Results: Based on analysis of PEDro scale results (Mean±SD for articles score: 5.89±1.29), the quality of most articles was as fair and good. The focus of conservative treatments was on exercise therapy methods, assistive devices, and physical therapy management. From a clinical perspective, the evidence indicates the appropriate effects of such treatment choices on alleviating pain, enhancing function, and improving quality of life in individuals with knee OA.
 Conclusion: Most conservative methods can reduce pain, and improve quality of life and physical performance in patients with knee OA. However, further high-quality studies with larger sample sizes and long-term follow-ups are required to determine whether knee OA can be managed by conservative methods.