Physiotherapy Research Articles

TOXINA BOTULÍNICA ASSOCIADA À FISIOTERAPIA NEUROFUNCIONAL EM PACIENTES PEDIÁTRICOS ESPÁSTICOS: UMA REVISÃO INTEGRATIVA DA LITERATURA

Introduction: Cerebral palsy (CP) is the leading cause of motor disability in children, affecting movement and posture due to non-progressive brain injuries during development. Globally, the prevalence of CP is 2 to 3 cases per 1,000 live births, with prematurity being a significant risk factor. Methodology: This study conducted an Integrative Literature Review to evaluate physical therapy approaches in children with spastic CP following the use of botulinum toxin (BTX). Descriptors such as Cerebral Palsy, Physiotherapy, Botulinum Toxin, and Spasticity were used, with searches performed in databases like PubMed and Cochrane. From an initial 153 articles, after exclusion of duplicates and screening, seven studies were selected for analysis. Results and Discussion: The results indicate that the combination of BTX with physical therapy improves functionality and quality of life in children with CP. BTX reduces muscle spasticity, allowing physical therapy interventions such as stretching and strengthening to be more effective, potentially delaying surgical interventions. Studies have shown that this integrated strategy promotes motor rehabilitation and contributes to increased patient independence. Conclusion: The combination of BTX and physical therapy is a promising approach in managing spasticity in CP, standing out as an effective treatment for improving motor functionality and quality of life in these patients, as well as providing a foundation for future research.

New Non‐Invasive Approach for a Woman With Dyssynergic Defecation Associated With Dyspareunia: A Case Report

ABSTRACTBackgroundThe pelvic floor muscles are a complicated muscular structure with three major functions: defecation, urination, and sexual function. Constipated patients rarely have sexual or urinary complaints. The objective of this case is to provide a new and successful therapy strategy for a patient with dyssynergic defection and dyspareunia.Study DesignThe case study below discusses physical therapy rehabilitation and the consequences for both current and future physical therapy programs of constipation caused by PFM dyssynergia and dyspareunia.Case DescriptionA 22‐year‐old married nulliparous woman was referred by her urogynecologist for the management of PFM tightness, with the main complaints being pain during intercourse and chronic constipation. The diagnosis had been confirmed by MR defecography, which revealed puborectalis and external anal muscle tightness. Neuromuscular reeducation employing electromyography biofeedback, improved rectal sensation, intravagival massage, the application of an intermittent pneumatic compression belt on the abdominiopelvic region, and suprapubic water bag ultrasound therapy were among the pelvic floor rehabitation strategies.ConclusionThe intermittent pneumatic compression belt and water bag ultrasound approach, combined with standard program rehabitation, was successfully used in patients with defection dyssynergia and dyspareunia. After 3 weeks, stool frequency decreased from once every 10 days to one bowel movement per week; a condition reported less bloating and stomach pain, as well as a pain rating of 5/10 during sexual activity and 0/10 immediately afterward; and FSFI increased from 15.1 to 19.1. After 12 weeks, stool frequency is three bowel movements per week, a condition has less bloating and stomach discomfort and rates pain as 1/10 during sexual activity and 0/10 immediately, and FSFI has risen from 15.1 to 25.1.

Use of machine learning to identify prognostic variables for outcomes in chronic low back pain treatment: a retrospective analysis

ABSTRACT Objectives Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed ‘Holy Grail’ questions, one being: ‘What are the most important (preventable) predictors of chronicity’ for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses. Methods This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables. Results The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender. Conclusion This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates.

A ATUAÇÃO DO FISIOTERAPEUTA NA ATENÇÃO PRIMÁRIA À SAÚDE NO CONTEXTO DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA DO BRASIL

The physical therapist has been gradually integrated into the family health strategy (FHS), acting in a relevant role in the national healthcarenetwork. The objective of this studywas to investigate, through an integrative literature review, scientific evidence on the role of physical therapists in primary care within the context of the FHS. The literature search was conducted in the Google Scholar database, Pubmed, Scientific Electronic Library Online (SciElO), Literatura Latino-Americana e do Caribe em Ciências em Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Periódicos CAPES databases. A total of 45 articles published between 2014 and 2024 were included in the study.. The analysis of the studies demonstrated that the integration of physical therapists into the FHS, alongside the multidisciplinary team, is essential to providing comprehensive care and individualized attention, ensuring efficient assistance.. The study concludes that the role of physical therapists in Primary Health Care is of great importance to public healthgreat importance to public health, as these professionals contribute to the promotion, prevention, and recovery of both individual and collective health, restoring functionality, enhancing quality of life, and helping to reduce waiting times for care in the Unified Health System.. The expansion of the presence of physical therapists in Primary Care, specifically in the Family Health Strategy, is not onlybeneficial for the population but also enhances humanized care and functionality. Therefore, in addition to acknowledging the evidence, there is a need to recognize and support investments from health managers.

Knowledge and practice of hand hygiene among practicing physical therapists of Lahore after covid-19 pandemic

Background: Hand hygiene has become an important factor after Covid-19 pandemic. The practicing physical therapists are more prone to infections due to direct contact with patients. The knowledge and practice is therefore very important for them. Methods: This study is descriptive cross sectional. It was conducted among practising physiotherapist of CMH Hospital and private clinical setups of Lahore. Non probability convenient sampling was used for participant selection. Window SPSS 23.0 was used for statistical analysis. Results: The data was collected from 206 participants. 123 participants were males and 83 participants were females. In answer to if the participants received education of hand hygiene, 81 participants answered no and 125 answered in yes. In an another question about the use of alcohol based hand rub for hand hygiene 60 participants answered no and 146 participants answered yes. The total score for knowledge and practice of hand hygiene was 64 from question number 3-11. Question number 7 of the questionnaire consists of further 8 parts, that’s why the total score becomes 64. The mean score percentage was 70.59±16.94. In question 12 the participants were asked about who have given the idea to perform hand hygiene, 104 told that their manager, 89 told that their peer and 13 participants told that their patients remind them about hand hygiene. The participants faced some barriers in this regard e.g. out of product material, too busy in work, forget about hand hygiene etc. Conclusion: The study shows that most physical therapists of Lahore have better knowledge and practice of hand hygiene. Both male and female practicing physical therapists are well aware of the importance of hand hygiene. But few barriers such as non-convenient, out of product material influence in practicing hand hygiene.

Association between varus thrust and foot alignment and flexibility in knee osteoarthritis.

Varus thrust (VT) is a frequently reported abnormal gait pattern in patients with medial knee osteoarthritis (KOA). VT is important to prevent KOA progression. However, there is no consensus on the relationship between VT and foot alignment and flexibility, although it has been reported that patients with KOA have pronated foot. In this study, we examined the relationship between VT, foot alignment, and flexibility in patients with KOA. Twenty patients with unilateral KOA were included in this study (mean age: 71.5 ± 4.7 years). KOA severity ranged from grade III (8 patients) to grade IV (12 patients) based on the Kellgren-Lawrence classification. Gait analysis using inertial sensors was performed to determine the difference between the VT of KOA side and the contralateral side without symptoms. The correlations between VT, foot alignment, and flexibility were also analyzed. VT was significantly greater on the side with KOA than on the contralateral side without KOA (d = 1.09, p = .002). VT was not significantly correlated with foot alignment but was significantly correlated with the arch stiffness index, which indicates foot flexibility (r = 0.642, p = .003). This study suggests that foot flexibility may play a more significant role than foot alignment in addressing VT in patients with KOA. When performing physical therapy for VT, evaluating foot flexibility in addition to foot alignment may help reduce this condition. Further studies with larger sample sizes and more detailed statistical analyses are needed to validate these findings.

Effect of Radial Extracorporeal Shockwave Therapy on Pain Intensity Level in Patient with Calcaneal Spur

Background: Heel pain is a common musculoskeletal issue that significantly impacts patient daily activities and, consequently, their quality of life. This clinical study aims to evaluate the effectiveness of radial extracorporeal shockwave therapy in reducing pain intensity in patients with calcaneal spurs.Objective: To investigate the effects of radial extracorporeal shockwave therapy on pain intensity in patient with calcaneal spur.Methods: A total of 60 patients diagnosed with calcaneal spurs based on clinical examination and lateral radiography between September 2022 and June 2023 were included in this study. Participants were randomly assigned to two groups: Group A (radial extracorporeal shockwave therapy) and Group B (traditional physical therapy). All participants followed an exercise program; however, those in Group A received six sessions of radial extracorporeal shockwave therapy (10 Hz, 2000 pulses, at 2.4 bar). The Visual Analog Scale (VAS) was used to assess pain intensity both before and after treatment in all participants.Results: No significant differences were observed between Group A and Group B regarding gender, affected side, condition distribution, age, weight, height, or BMI (p > 0.05). Both groups experienced significant reductions in VAS scores post-treatment (p < 0.001); however, Group A demonstrated a greater improvement, with a percentage reduction in pain of -50.65%, compared to -28.17% in Group B. Additionally, post-treatment VAS scores were significantly lower in Group A than in Group B (p = 0.003), indicating that shockwave therapy yielded a more substantial reduction in painConclusions: Both radial extracorporeal shockwave therapy and traditional physical therapy programs significantly reduced pain intensity in patients with calcaneal spurs, with a favorable effect observed for radial extracorporeal shockwave therapy. These methods can be considered effective, safe, and conservative treatment options for managing calcaneal spurs.

Duration of In-patient Physical Therapy at a Tertiary Hospital: Implications of a Time and Motion Study

Background and Objectives. Inpatient physical therapy (PT) care entails careful provision of service for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during their hospital admission. The main difficulty is identifying adequate time allocation for safe patient service within an eight-hour working time frame. At a selected tertiary teaching government-run hospital, an arbitrary personnel-population ratio method is used for human resource allocation which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume non-clinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling, however, there is a lack of available guidelines regarding physical therapy practice in the hospital or acute care setting for developing countries. The purpose of this study was to determine the duration of care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of care with months of experience. Methods. A continuous observation time motion study of a typical workday of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer will time the tasks done by the PT. The external observer kept distance from the direct patient encounter to minimize interference that may affect timing. Patients with conditions of different etiologies and functional levels were included. Results. Nineteen physical therapists with a mean experience of 54.63 months were observed. There were no adverse events during the implementation of this study. The total mean time in minutes of management of neurological patients is 37:32, and musculoskeletal patients is 28:30. Time for administrative tasks took an average of 20:33 minutes. There was also a low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p=0.0471). Results showed that the allocated treatment duration is determined to be sufficient for performing PT activities. The optimal number of patients to be decked can also be appropriately determined to optimize resource allocation. Conclusion. Our pilot study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. Although descriptive statistics and a weak to insignificant correlation was seen in most of the variables, there may be some benefit in gathering more duration data across different acute care settings within the country. Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and development. Figures have been presented which could be the basis for future policy research for management science and resource allocation studies.

Total Elbow Replacement in Swine: Surgical Technique and Initial Clinical Experience in a Kunekune Sow.

The aim of this study was to describe the development of a total elbow replacement (TER) technique in swine and report the outcome of TER in a Kunekune sow (61 kg) with severe elbow osteoarthritis. The technique was developed by operating on three pig cadavers (Yorkshire 40-50 kg). The TATE Elbow implant fit was confirmed with modeling to the patient's computed tomography imaging. Patient-specific instrumentation was printed for attempted use. Total elbow replacement was performed using a lateral approach, including lateral epicondylar osteotomy, careful retraction of the radial nerve, and preservation of the lateral collateral ligament. Postoperative care included controlled exercise and physical therapy. A lateral approach to the pig elbow for TATE TER was successfully developed. The bulk of the lateral head of the triceps muscle precluded use of the patient-specific instrumentation; the procedure was performed using standard instrumentation. Radiographic evidence up to 9 months postoperatively showed adequate implant alignment and satisfactory osteointegration of humeral and radioulnar components. There were not any postoperative complications and the patient's comfort was improved by 6 months and sustained at 18 months. A lateral approach for TATE TER in a pig with advanced elbow osteoarthritis proved feasible and effective. With the expansion of the TATE Elbow line, it is possible that a larger range of pigs could be treated. This report suggests that a lateral approach for TATE TER in dogs could represent a suitable alternative to the medial approach currently used.

Management of Post-RALP SUI and ED - What are and What Should we be Doing?

Although there have been advancements in minimally invasive surgical techniques for radical prostatectomy, surgery can still significantly impact continence and erectile function (EF), resulting in considerable quality-of-life impairment. This review critically evaluates existing treatment options for male stress urinary incontinence (SUI) and erectile dysfunction (ED) post-robotic-assisted laparoscopic prostatectomy (RALP), alongside exploring emerging trends and discussing future directions for managing and preventing both conditions. Patient history is pivotal in guiding surgical decisions, with the intensity of symptoms and their impact on the patient's life being primary influences for deciding the best treatment options for both SUI and ED. Penile rehabilitation strategies (PR) show promise in mitigating the effects of prostate cancer treatments on EF and improving overall health, though consensus is lacking on specific programs or initiation of timing for optimal recovery post-surgery. All patients undergoing RALP should receive preoperative counseling about SUI and early pelvic floor physical therapy. Fixed and adjustable slings effectively treat mild-to-moderate post-RALP SUI, while the artificial urinary sphincter is the gold standard for men with moderate or severe SUI. EF recovery after RALP faces obstacles such as patient characteristics, compliance, and cost, with no standardized PR approach. Future research should prioritize studies aiming to optimize treatment methods and enhance patient compliance.

Strategic Learning Principles Are Related to Academic Scores for Doctor of Physical Therapy Students

Abstract Introduction The Learning and Study Strategies Inventory (LASSI) is a self-assessment of strategic learning principles with scores representing areas for growth. The purpose of this study was to measure LASSI scores at 2 points in time for Doctor of Physical Therapy (DPT) students in a 2-year hybrid program to see if scores changed after a science of learning course and two quarters of the program. The authors then examined the relationship between LASSI scores and academic scores (DPT program GPA, anatomy, and physiology grades). Methods Retrospective descriptive analysis of LASSI scores with comparisons between baseline and after a science of learning course and two quarters of the program using a paired t-test; bivariate correlations examined the relationship of LASSI scores to academic scores. Results Data was collected for 259 matriculated DPT students. Three of the 10 LASSI scales had significant change after the science of learning course and two quarters of the program; however, the effect sizes were small (0.2 or less). Anxiety management (t(258) = 2.340, p = .020) scores improved, while both concentrations (t(258) = − 3.229, p = .001) and the use of academic resources (t(258) = − 1.999, p = .047) had lower scores. There were several LASSI scores with significant correlations to academic scores (ρ = .132 to .431). Discussion/Conclusion LASSI was related to academic scores, although the strength of the relationship was low to negligible. LASSI showed small changes over time. There could be various reasons for scores improving or declining, but the awareness of scores and change in scores can provide a solid foundation for individualized coaching to DPT students as they navigate the rigor of a graduate level professional program.

Current State of Dry Needling Practices: A Comprehensive Analysis on Use, Training, and Safety

Background and Objectives: Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction. Despite its efficacy in a broad plethora of musculoskeletal pain conditions, its safety remains a topic of debate among clinicians and researchers. The aim of this study was to provide an overview of the current practice of DN through a national survey, focusing on the frequency of its use and the incidence of adverse events (AEs), considering factors including physiotherapist experience, clinical workload, the extent of training received by practitioners, and the use of ultrasound guidance. Materials and Methods: An online cross-sectional survey was conducted. Respondents were licensed physical therapists (PTs) working in Spain. The survey covered demographics, professional data, frequency of adverse effects, and if they use ultrasound routinary for guiding interventions. Results: A total of 422 PTs participated in the study, mostly having 21–60 h of DN training (38.6%), less than 2 years of experience (36%), and not using ultrasound during the interventions (85.5%). Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported. Adverse event frequencies varied significantly based on training hours, experience, patient percentage treated with DN, and weekly clinical dedication. Clinicians with more hours of DN training or fewer years of experience reported higher incidences of certain complications. Conclusions: DN is a common intervention among PTs, with minor AEs frequently occurring and major AEs being less common but still significant. The accidental puncture of non-desired structures highlights the necessity for improve training on anatomical landmarks, needle insertion depth, cross-sectional anatomy education, and patient monitoring. To ensure safe practice, emphasize comprehensive training, adhere to safety protocols, exercise caution, and prioritize the use of ultrasound-guide is encouraged.

Gaps in PM&R for Blindness & Low Vision: The Imperative of Rehabilitation for Visual Disability

Abstract Persons with blindness and low vision (pBLV) experience increased fall and injury risk beyond atypical biomechanics and balance impairments. Falling risk doubles with blindness, and more than triples with depth perception losses. Despite this, physical therapy (PT) focuses on musculoskeletal injuries post-event rather than taking a proactive and preventative approach for pBLV. We posit that PT implemented pre-injury, alongside orientation and mobility (O&M) training of adapted movement protocols could positively affect injury avoidance and severity for pBLV. The global VISION 2020 initiative seeks increased access to rehabilitation services and treatments to enhance quality-of-life for pBLV. In support, this paper reviews research studies in rehabilitation science that promote physical health and wellbeing, and stresses preventative skilled mobility and therapeutic exercise to mitigate injury. To reduce the personal, financial, and societal costs associated with BLV, as well as position patients for better outcomes, we review an evidence base that may generate immediate impact in this area. While these recommendations provide an initial framework, the role of PT in pre-habilitative care remains a critical gap that must be addressed. It is imperative that interventions, guidelines, impairment/severity-specific practices, and overall health promotion are re-evaluated and redesigned for pBLV, affording equity for health and mobility.

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Online Graded Motor Imagery Is Effective in Women Diagnosed with Pelvic Pain: A Randomized Controlled Trial.

Effective therapeutic strategies are crucial for managing Genito-Pelvic Pain/Penetration Disorder (GPPPD), a condition presenting challenges for both patients and health care providers. This study aims to assess the effectiveness of an online Graded Motor Imagery program in alleviating pain intensity and improving sexual function in women diagnosed with GPPPD. Eighty-seven women were randomly assigned to either an online Graded Motor Imagery group or a control group. The online Graded Motor Imagery protocol involved engaging participants in 2-week segments of left/right judgment exercises, mental simulation of movements, and gradual exposure therapy. After 6weeks, we assessed pain intensity and sexual function. The control group gained access to the program upon study completion. The online Graded Motor Imagery group demonstrated a significant reduction in pain intensity, coupled with improvements in sexual function. Notably, participants with enhanced movement imagery abilities experienced greater improvements, while those with negative beliefs and thoughts regarding vaginal penetration showed lower sexual function scores. An online Graded Motor Imagery program is effective in alleviating the pain burden faced by women dealing with GPPPD. Effectively addressing pelvic pain in patients remains a daunting challenge for physical therapists. Therefore, implementing efficient and easily accessible strategies is crucial. The incorporation of Graded Motor Imagery intervention proves to be an effective approach for improving both pain and sexual functioning in women with GPPPD.

Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis.

Genital gender-affirming surgery has become a crucial step in the transitioning process of numerous transgender people. To highlight the consequences of genital gender-affirming surgery on pelvic floor function in transgender people. Medical databases (PubMed, EMBASE, and Cochrane Library) were consulted according to a combination of keywords. All papers published up to February 29, 2024 were considered. Two reviewers independently screened the abstracts of the selected studies and extracted data from the full-text articles included. Data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the Observational Study Quality Evaluation (OSQE) method. This study is registered on PROSPERO number CRD42024522580. Pelvic floor dysfunctions in individuals who undergo gender-affirming surgery, factors that may be involved in the increased prevalence of these dysfunctions and perspectives of treatment of the complications through pelvic floor physical therapy. Twenty-five papers were considered for systematic review, while 17 studies were included for meta-analysis. There was significant statistical heterogeneity across the included studies. Among transwomen who had undergone vaginoplasty, pelvic organ prolapse occurred in 1%-7.5% of patients, urinary incontinence affected up to 15% of patients, while urinary irritative symptoms up to 20%. Sexual dysfunctions were reported by 25%-75% of patients. Among transmen who underwent hysterectomy and phalloplasty, pelvic organ prolapse occurred in 3.8% of patients, urinary incontinence affected up to 50% of patients, while urinary irritative symptoms up to 37%. Finally, sexual dysfunctions were reported by 54% of patients. The findings of this study could be helpful for transgender patients pre-operative counselling. This is the first systematic review and meta-analysis about pelvic floor dysfunctions in transgender people undergoing genital gender-affirming surgery. The main limitations are the limited number of studies included and their heterogeneity. Pelvic floor dysfunctions following genital gender-affirming surgery are an emerging issue. Adequate information for each surgical procedure, explicit postoperative instructions, continuity of care, communication with healthcare providers, and recommendation for tailored perioperative pelvic floor physiotherapy are necessary for a better surgical result.

3D printing of the brachial plexus and its osseous landmarks using magnetic resonance neurography for thoracic outlet syndrome evaluation.

Patient-specific three-dimensional (3D) printed anatomic models are valuable clinical tools that facilitate enhanced visualization of pertinent anatomic structures and have demonstrated benefits of reduced surgical times, increased surgeon confidence, and improved operative results and subsequent patient outcomes. Medical image-based 3D printed anatomic models are generally created from computed tomography (CT), however magnetic resonance imaging (MRI), which offers exquisite soft tissue characterization and flexible contrast avoiding the use of ionizing radiation, is an attractive alternative. Herein, the application of 3D printing incorporating both MR neurography and zero-echo time (ZTE) MRI for visualization of the brachial plexus anatomy in a subject with thoracic outlet syndrome (TOS) is described. A 28-year-old man presented with chronic right upper limb discomfort and paresthesias extending from the shoulder region to the third and fourth digits. The subject underwent evaluation with a unilateral brachial plexus MR neurography protocol at 3.0 Tesla for suspicion of TOS. The protocol included T2-weighted, 3D fast spin echo short-tau inversion recovery (STIR-FSE) and 3D radial ZTE sequences for depiction of the nerves and bones, respectively. The first rib and its synostosis impinged upon the inferior aspect of the T1 nerve root (T1NR), with accompanying mild enlargement of the T1NR. A 3D printed anatomic model was created and included: (1) bone (spine, ribs, clavicle, scapula, and humerus), (2) brachial plexus, and (3) costal cartilage. The 3D printed model clearly demonstrated a T1NR impingement from the synostosis, confirming the diagnosis of neurologic thoracic outlet syndrome (TOS) and guided the treatment approach in prescribing TOS-specific physical therapy, which led to significant improvements in the patient's condition. To our knowledge, this is the first in-vivo human 3D printed case for TOS using MRI-only data. The 3D printed model allowed for improved visualization and understanding of the spatial relationships between the nerves of the brachial plexus and surrounding osseous structures responsible for the patient's symptoms. Not applicable.

Physical and occupational therapy service delivery models for populations identified as hard-to-reach: A scoping review.

The delivery of rehabilitation services for hard-to-reach populations (e.g., refugees) is highly complex. There is a need for evidence-based approaches to deliver physiotherapy (PT) or occupational therapy (OT) services to this underserved group. The purpose of this scoping review was to identify PT and OT service delivery models that have been implemented, for populations typically identified as hard-to-reach and their associated health outcomes. Articles were eligible if they described PT and/or OT services for hard-to-reach populations. There were no restrictions on study design. Six electronic databases (AMED, CINAHL, MEDLINE, EMBASE, Healthstar, and PsycINFO) were searched from January 2000 to June 2023. Articles were screened in duplicate by two independent reviewers, and conflicts were resolved by consensus. Twenty-one articles with variable sample sizes (min, max n = 3 to 237) were included and detailed PT and/or OT services for immigrants/migrants, refugees, hard-to-reach veterans, people experiencing homelessness, lower incomes, trauma/torture, and those living in rehabilitation-deficient areas. Common rehabilitation needs (e.g., clinician to client connectivity), barriers (e.g., high transportation costs) and facilitators (e.g., encouragement) were identified among the various populations, mainly due to intersecting identities such as those who are both traumatized and refugees. Unique factors pertaining to the PT and OT services were also identified in some groups, including access to child and family services for people experiencing homelessness. Despite common and individual needs, barriers, and facilitators in hard-to-reach groups in the literature, there is a need for studies with larger sample sizes, rigorous methodology and a conscious effort to publish the results of interventions to generate stronger recommendations for practice.

Outcomes of Conservative Treatments Evaluations for Lumbar Radiculopathy

Background: Lumbar Radiculopathy (LR) is a condition characterized by motor, reflex and sensory changes, often causing significant pain and disability. Conservative treatments are commonly recommended as initial management options. This study aims to evaluate the outcomes of various conservative treatments for LR. Materials and methods: This prospective cohort study involved 100 patients diagnosed with LR who underwent conservative treatments between January 2023 and December 2023 at our Physical Medicine Department, Institute of Applied Health Sciences (IAHS). Treatments included physical therapy, NSAIDs, epidural steroid injections and activity modification. Baseline data, including demographic information, pain intensity (VAS) functional status (ODI) and quality of life (SF-36), were collected. Follow-up assessments were conducted at 6 weeks, 3 months and 6 months. Primary outcomes were changes in VAS, ODI and SF-36 scores. Secondary outcomes included patient satisfaction and the need for additional interventions. Data were analyzed using descriptive statistics, paired t-tests and ANOVA. Results: The mean age of participants was 45.3 years, with a slight male predominance (56%). At baseline, mean VAS was 7.8, ODI was 45.6 and SF-36 was 62.5. Significant reductions in VAS (2.6), ODI (18.7), and improvements in SF-36 physical (80.3) and mental (81.7) scores were observed at 6 months (p&lt;0.05). Patient satisfaction at 6 months was highest for epidural injections (90%), followed by NSAIDs (85%), physical therapy (80%) and activity modification (70%). The need for additional interventions decreased to 8%. The incidence of adverse events was low, with physical therapy showing the lowest rates. Initial ODI score was a significant predictor of positive outcomes (p=0.03). Conclusion: Conservative treatments for LR are effective in reducing pain and disability and improving quality of life. All treatment modalities showed comparable efficacy, with low adverse event rates, supporting their use as first-line treatments. Initial disability levels should be considered in treatment planning to optimize outcomes. Further research is needed to refine predictive models and enhance individualized treatment strategies. IAHS Medical Journal Vol 7(1), June 2024; 80-85

Changes in Physical Function After Long Corrective Fusion to the Ilium for Adult Spinal Deformity

Study Design. Prospective cohort study. Objective. To investigate longitudinal changes in physical functional status after long corrective fusion in patients with adult spinal deformity (ASD) during 2 years of follow-up. Summary of Background Data. In ASD surgery, reports assessing physical functional status in long-term observations for more than a year are lacking. Assessing whether patients maintain significant improvements in their physical status with a longer follow-up duration is crucial. Methods. A total of 70 female patients with ASD who underwent long corrective fusion of ≥ 7 segments between June 2016 and June 2022 were included in this study. Preoperative and postoperative assessments (at 6 months, 1 year, and 2 years) included radiographic spinopelvic parameters, health-related quality of life (HRQOL) using the Scoliosis Research Society Outcome Instrument-22 (SRS-22) questionnaire, and physical function tests conducted by a physical therapist. Results. All domains of the SRS-22 improved the most in the first 6 months after surgery (P &lt;0.0001); however, the Pain and Function domains continued to improve gradually until 2 years postoperatively. Regarding trunk dynamic balance, the timed up-and-go test score improved gradually until 2 years postoperatively (P &lt;0.0001). Regarding gait performance, gait speed and the 6-minute walking test improved the most in the first 6 months after surgery (P &lt;0.01) and almost reached a plateau 1 year postoperatively. Conclusions. Long corrective fusion for ASD significantly enhanced physical function and HRQOL within 2 years, with the greatest improvement in the first 6 months after surgery. These findings underscore the importance of increasing activities of daily living through early exercise instruction, as well as preventive measures to avoid early surgery-related complications. Level of Evidence. 3