Physiotherapy Management Research Articles

Deciphering classification systems for neck pain—Understanding the content of classification systems to enhance physiotherapy management of neck pain

AbstractBackgroundNeck pain is a prevalent and disabling condition. Conservative management of this condition has shown only moderate effects. A solution to improve treatment effectiveness is to sub‐group patients into a classification system (CS) that allows for more personalised care. However, current stratification methods have only shown short‐term efficacy for pain. Given the limitations of these tools, it is pertinent to understand how these CSs are composed to be able to propose alternative patient management solutions.ObjectiveTo identify and examine the different components of classification systems specific to patients with neck‐related conditions.MethodA systematic literature search was performed on 3 databases (PubMed, Scopus and CINAHL). Only systematic reviews, with or without meta‐analysis, and scoping reviews reporting CS with associated treatment for neck pain were included. Bias evaluation was performed through risk of bias in systematic review tools.ResultsFrom the search strategy, 741 citations were retrieved, and seven studies were included. From these studies, 37 CS with associated treatments were extracted. Mobilisations showed that 64% were constructed using physical findings, 61% of CS were guided by symptom modulation, 25% used results of self‐reported questionnaire, 14% used individual characteristics, 14% incorporated cognitive findings, 8% used neurological findings, 3% used results of medical diagnostic test, and 3% incorporated environmental findings. Fear‐avoidance beliefs was the only cognitive parameter considered among CS.ConclusionThis study shows that existing classification systems for neck pain are limited and lack coverage of all potential drivers of pain and disability. The lack of recognition of psychosocial and pain neuroscience parameters may partly explain the limited effectiveness of these tools.

Can first cervical vertebrae misalignment be one of the possible etiology of globus pharyngeus?

Globus pharyngeus (GP) is a problem characterised by the sensation of a foreign body in the throat. Although it was previously considered as a psychological problem, it has been associated with various etiological factors such as gastrointestinal problems and cervical pathologies. The etiology and treatment of globus pharyngeus is still controversial in the literature. The hyoid muscles are innervated by the trigeminus (V), facialis (VII) and ansa cervicalis (hypoglossus (XII) and cervical spinal nerves (C1-2 nerves)). We hypothesized that C1 vertebra misalignment may cause cervical spinal nerve impingement and affect the hyoid muscles via the ansa cervicalis or the trigeminal convergence pathway in the descending pathways and cause GP. In the present case report, C1 vertebra misalignment was observed in the radiographic evaluations of a 26-year-old male patient who was admitted with the diagnosis of GB. After 5 weeks (once a week/30 min) of cervical manual physical therapy by a physiotherapist, the C1 misalignment improved, and all complaints were resolved. Based on our hypothesis, cervical misalignment should be considered as an etiological factor in patients with GP. Accordingly, cervical manual physical therapy approaches may be effective in the treatment of GP.

Sleep Disturbance among Chronic Low Back Patients: A Short Survey

Introduction: In the realm of modern health challenges, Chronic Low Back Pain (CLBP) and sleep disturbances is an issue of concern, casting a shadow over millions worldwide CLBP has a direct impact on the sleep disturbance leading to physical and mental disabilities. Physiotherapy is pivotal in management of Primary and secondary complications like sleep disturbances associated with CLBP. Aim: To evaluate and analyse various domains of sleep hygiene among CLBP patients through Pittsburgh Sleep Quality Index (PSQI). Materials and Methods: A survey using the gold standard method was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, among 8 patients with CLBP and the sleep was evaluated through PSQI which serves as a seven component subjective questionnaire that evaluated the state of sleep and interruptions during a one-month period. Results: Data analysis showed that PSQI has significant improvements (p<0.05) after manual and conventional physiotherapy. Conclusion: Physiotherapy plays a crucial role in management of chronic low back pain and secondary complications such as sleep disturbance associated with it. Using both manual and conventional physiotherapy techniques greatly improves the outcome of treating CLBP.

Ab. No. 95 Integrated Effect of Photobiomodulation Therapy Along With Surface Spinal Stimulation and Activity-Based Therapy on Locomotion in an Individual With Traumatic Incomplete Spinal Cord Injury - Single Case Study

Introduction: The purpose of the study was to examine the integrated effect of photobiomodulation therapy (PBMT) along with surface spinal stimulation (SSS) and activity-based therapy (ABT) on the locomotion in an individual with traumatic incomplete spinal cord injury (SCI). The study aims to provide an insight for advanced non-invasive treatment approach useful in activating central pattern generator by bio-modulating the state of spinal cord. Methods: Individual diagnosed with traumatic spinal cord injury, Motor incomplete ASIA grade B. A 36-year-old male pre-diagnosed with D12-L1 vertebrae fracture and anterolisthesis of D11 over D12 vertebra had undergone surgical management in august 2023. Physiotherapy management was given with PBMT using Class IV LASER (2000 joules at 7 watts) on lesion site, SSS (2500 Hz carrier frequency, 80 Hz beat frequency for 20 minutes) on paravertebral area and activity-based therapy (trunk control exercises, body weight supported treadmill training, overground walking for 45 minutes) for 6 sessions per week for duration of 5 weeks. Pre and Post intervention assessment was done using International Standards for Neurological Classification of Spinal cord injury- ASIA Impairment Scale, Walking Index for spinal cord injury-II (WISCII-II) and Spinal cord independence measure-III (SCIM-III) at day 0, 15 and 30. Results: ASIA motor score of right lower limb, SCIM-III and WISCI-II had shown significant improvement. ASIA motor score of right lower limb improved from 0 to 1, SCIM-III from 42 to 54 and WISCI-II from 0 to 6 between day 0 and day 30. Conclusion: The study concluded that combined photobiomodulation therapy using class IV LASER along with surface spinal stimulation and activity-based therapy has positive effect in enhancing the locomotion in an individual with traumatic incomplete SCI. Implications: This integrated non-invasive treatment approach can be used as management guideline for enhancing locomotion in individuals with incomplete SCI.

Patient with Transverse Myelitis and Physiotherapy Management: A Case Study

Patient with Transverse Myelitis and Physiotherapy Management: A Case Study

Approach towards osteoarthritis in physiotherapy management

Approach towards osteoarthritis in physiotherapy management

Ab. No. 122 Functional Restoration Approach in the Management of Complex Regional Pain Syndrome (Crps) Caused By Onychomycosis: A Case Report

Introduction: The objective of this case report is to highlight the importance of incorporating functional restoration approach in the physiotherapy management of CRPS. The significant pain and disability associated with CRPS is not only biomedically faceted but frequently encompasses psychosocial aspects too. Physiotherapy management should address both these aspects. The functional restoration approach emphasizes gradual progression, starting with pre-sensorimotor cortices activation, then advancing to functional tasks. Methods: This is a case review of a 61 year old man with history of Onychomycosis presenting with left shoulder, wrist and hand stiffness and pain 6 months post the infection. Patient also presented with fear of movement and was reported to have had not used the arm functionally for daily activities since the onset of the infection. Patient is a k/c/o intentional tremors since 25 years. The functional restoration approach included patient education, desensitization using kinetic sand, followed by movement with Mulligan’s technique and graded functional activity by perpetual training over subsequent sessions. Pre and post assessments after a 3-week intervention included Kinesiophobia, Function, Pain, ROM, and grip strength. Additionally, the Archimedes spiral test was used to gauge tremor severity as a secondary outcome. Results: Post-intervention, positive changes were observed in outcome measures: a 16% decrease in Tampa Scale of Kinesiophobia, 10% improvement in Michigan Hand Outcome, 7% in grip strength, and 7% and 8% in wrist and shoulder ROM, respectively. The Archimedes spiral test also showed a notable improvement. Conclusion: The approach demonstrated improvement in Function, pain, and Kinesiophobia, with notable changes in range of motion, grip strength, and tremors as well. Implication: Functional restoration approach is a comprehensive method of managing CRPS since it addresses the syndrome’s multifaceted nature. Simultaneous assessment of biopsychosocial components aids in tracking progress and predicting better outcomes.

Скелетно-мышечная боль: патогенетические, диагностические особенности, принципы медикаментозного и восстановительного лечения

Low back pain is one of the most common reasons for visits to a neurologist. The prevalence of Low back pain increases with age. The main causes of Low back pain include nonspecific (musculoskeletal) pain, compression radiculopathy, lumbar stenosis, as well as specific pain caused by “serious pathology” (for example: tumor, fracture, infection, osteoporosis, etc.). Musculoskeletal pain is one of the common causes of temporary disability, ahead of cardiovascular diseases and cancer. According to numerous literature data from both domestic and foreign authors, pain in the neck and lower back reaches 80-90% in the population. The relevance of the problem is due to the progressive course of the disease, as well as its frequent occurrence in people of working age. Many authors point to a higher incidence, as well as a more severe course of the disease, in people who have unfavorable production factors, which include heavy physical labor, static loads in non-physiological positions, monotony of the work process, hypothermia and overheating, as well as significant psycho-emotional stress. The review presents data on the pathogenetic, clinical and diagnostic features of musculoskeletal pain, as well as discloses aspects of drug therapy and describes methods of restorative treatment of musculoskeletal pain. Based on the above critical review of the literature on musculoskeletal pain, it should be noted that musculoskeletal pain is a fairly common pathology that occurs in almost half of the population. Drug treatment of musculoskeletal pain is not always effective, which necessitates a unified multidisciplinary approach for specialists dealing with this pathology, with a wider involvement of manual therapy and physiotherapy in the complex of rehabilitation measures, which will increase the effectiveness of the treatment, will reduce the incidence of musculoskeletal pain, and will also significantly increase the period of remission.

A Boy With KIF11‐Associated Disorder Along With ADHD and ASD: Collaboration Between Paediatrics and Child Psychiatry

Kinesin family member 11 (KIF11)‐associated disorder, a rare condition caused by autosomal dominant mutations in the KIF11 gene, presents with microcephaly, chorioretinal dysplasia, lymphoedema, and varying degrees of intellectual disability. While intellectual disability is often described in the literature on KIF11 mutations, autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) are only mentioned by a few authors but not thoroughly investigated. We present a case report of an 8‐year‐old boy with KIF11‐associated disorder alongside ADHD and ASD but without intellectual disability. Genetic testing confirmed a KIF11 mutation. Cognitive, language, and motor assessments revealed delays in fine motor skills and attention deficits. The diagnosis of ADHD was confirmed by a child neurologist through multidisciplinary investigations, while the ASD diagnosis was established by a child psychiatrist. Despite the challenges of delayed psychiatric assessment, interventions including physiotherapy and medication management were initiated with positive results. We designed a parent support group survey that showed a higher prevalence of neurodevelopmental disorders in children with KIF11 mutations compared to the general population. Therefore, low‐threshold referrals to a child psychiatrist have to be made when the potential presence of developmental problems is suspected. Collaboration between ophthalmologists, paediatricians, and child psychiatrists is crucial for early detection and intervention. Addressing developmental disorders promptly improves long‐term outcomes and enhances quality of life. Moreover, gaining a deeper understanding of the higher prevalence of ASD and ADHD in individuals with KIF11 mutations could offer valuable insights into the genetic mechanisms underlying neurodevelopmental disorders.

Effect of Single Session Three Therapistadministered Posterolateral Mobilisation with Movement Glide on Shoulder Range of Motion: A Case Report

Frozen shoulder, or adhesive capsulitis, is a condition characterised by pain and stiffness in the shoulder joint. It gradually worsens over time, making it difficult to move the shoulder. The exact cause is not always clear, but it can be associated with injury, surgery, or certain medical conditions. Treatment typically involves physiotherapy and pain management. The authors present a case of a 41-year-old male who complained of acute pain in the right shoulder joint over a period of 15 days. Examination revealed a restriction in shoulder Range Of Motion (ROM). The case was treated with a single session of three therapist-administered posterolateral Mobilisation With Movement (MWM) glides. No medication was prescribed to the patient and he was asked to follow-up in the Outpatient Department (OPD) for three days. The single session of posterolateral MWM glide, along with conventional physiotherapy, led to an increase in shoulder ROM and a reduction in pain. This approach can be considered a viable treatment option for frozen shoulder.

A Systematic Review on the Efficacy of Multidisciplinary Approaches in the Management of Chronic Pain

Background: Chronic pain presents widespread challenges globally. Multidisciplinary team (MDT) interventions have emerged as comprehensive approaches involving specialists from various medical fields to address the complexities of chronic pain management. This systematic review aims to synthesize evidence about the efficacy of multidisciplinary approaches in management of chronic non-specific musculoskeletal pain. Methods: This systematic review included randomized controlled trials (RCTs) of adults with chronic non-specific musculoskeletal pain. Multidisciplinary treatments involved at least three of: psychotherapy, physiotherapy, relaxation techniques, medical treatment, patient education, or vocational therapy. Exclusions were specific pathological entities, non-English studies, and follow-up less than one month. Searches were conducted across Cochrane evidence library, PubMed, and EMBASE. Primary outcomes encompassed pain intensity, quality of life, disability, and other functional measures. Results: Of the 100 articles identified, 6 studies met the inclusion criteria. These RCTs were conducted in Western countries, published between 2008 and 2019, and their sample size ranged from 132 to 401. Their interventions included Comprehensive Symptom Management, Assistance with Pain Management, physiotherapy, and telecare management. Two studies found significant improvements in pain intensity, while one demonstrated improved social functioning. However, no study found significant differences in disability scores or mental health outcomes. None of the studies assessed patient satisfaction with the interventions. Conclusion: Multidisciplinary team interventions for chronic pain show promise in improving pain intensity, particularly with Comprehensive Symptom Management and Pain Management Assistance. To strengthen these findings and address study limitations, future research with larger sample sizes is necessary.

Impact of Manual Physiotherapy Technics with Ultra Sound Therapy on Treatment of Chronic PLID Patient: A Clinical Case Study of Ashulia Women and Children Hospital

Impact of Manual Physiotherapy Technics with Ultra Sound Therapy on Treatment of Chronic PLID Patient: A Clinical Case Study of Ashulia Women and Children Hospital

Recent Physiotherapy Management of Peripheral Vascular Disease: A Review

Recent Physiotherapy Management of Peripheral Vascular Disease: A Review

Physiotherapy Management of Rheumatic Diseases

Physiotherapy Management of Rheumatic Diseases

Combined face-to-face and telerehabilitation physiotherapy management in a patient with chronic pain related to piriformis syndrome: A case report

<abstract> <p>Piriformis syndrome is characterised as being one of the possible causes of sciatic pain, as well as being a syndrome that tends to become chronic. Because of this, different types of treatments for both this syndrome and the associated pain it causes have been investigated over the years. Nowadays, the evidence increasingly favors treating chronic pain with a multimodal physiotherapy treatment based on a biobehavioral approach. This case report describes the physiotherapy intervention performed on a 44-year-old woman with chronic pain related to piriformis syndrome. The multimodal intervention lasted for 9 weeks with a total of 12 sessions and included manual therapy, therapeutic exercise, neural mobilization, and pain neuroscience education. Initially, the pain characteristics alongside somatosensory, motor-functional, and psychosocial factors were assessed. Due to the Covid-19 pandemic, only the pain characteristics and psychosocial factors could be reassessed post intervention. Improvements in both pain characteristics and psychosocial factors were achieved, resulting in a better general condition of the patient. This case report suggests that a multimodal physiotherapy intervention adapted to telerehabilitation was an effective option to improve the pain symptoms and psychosocial factors in the reported patient during the Covid-19 pandemic. Therefore, this may be a treatment option in patients with chronic pain that are in a situation where face-to-face physiotherapy is not feasible.</p> </abstract>

Recent Advances in Exercise Intervention for Athletes with Ankle Injury

Ankle sprain reported among 16%-40% of all sports-related injuries and most common frequent lower limb injury among athletes. It is particularly prevalent in soccer, American football, and basketball. The most commonly injured ligament is the lateral ligaments especially anterior talofibular ligament and quite a large percentage of patients report persistent symptoms and experience recurrent injuries. To prevent injuries and instability around ankle joint, various interventions evidenced are immobilization, cryotherapy, compression, elevation, analgesics, bracing, foot orthosis, exercises, electrophysical methods, and surgical interventions. Among these therapies physical exercises and splints are highly recommended across levels of rehabilitation. PubMed was used for literature search and articles on randomized control trail, systematic reviews and meta-analysis between 2017 to 2022 were included. Articles on advanced physiotherapy management for ankle injuries were included. Results from reviewing 6 RCT reported progressive exercises training significantly improved flexibility, strength, endurance, agility and balance in the ankle complex. Exercise techniques targeting the ligaments, muscle and structures around ankle joint based on the clinical presentation can lead to improved ankle joint performance in individuals diagnosed with ankle instability. Keywords: Ankle injury, Ankle sprain, Exercise, Instablity

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

Physiotherapy Management for Cases of Achilles Tendinopathy in Indonesian Para Athletics Athletes : Case Report

Achilles tendinopathy is a degenerative process due to excessive and cumulative use of microtrauma with internal and external risk factor. Approximately 52% of runners experience an Achilles tendinopathy (AT) injury during their lifetime. Achilles Tendinopathy can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for Achilles Tendinopathy cases in Indonesian para-athletics. This research is a descriptive case studyinvolving one client with participatory observation. The physiotherapy intervention involved modality intervention using Eccentric exercises, ESWT, Stretching, Muscle release, Electrical Stimulation, and Cryotheraphy. The subject of the study was An. B, a 28 year old para athlete with height 182 cm, weight 77 kg, and BMI 23.3 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain and burning in the left leg. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 0/10, tenderness 9/10, and motion pain 7/10 were found. The diagnosis of Achilles Tendinopathy sinistra was confirmed through specific examination. After four physiotherapy sessions Based on the results of studies that have been carried out, ESWT and Eccentric exercise can reduce pain, increase joint range of motion, increase muscle strength, increase ankle stability and improve functional abilities in Achilles tendinopathy patients.

APCP CONFERENCE ABSTRACTS: 2023

APCP CONFERENCE ABSTRACTS: 2023

Physiotherapy Management for Cases of Iliotibial Band Syndrome in Indonesian Para Athletics Athletes : Case Report

Iliotibial band syndrome (ITBS) is an overuse syndrome that commonly causes knee pain and is common in athletics. The prevalence of ITBS in runners ranges from 5%-14%, with a higher prevalence in women (16%-50%) than in men (50%-81%). ITBS can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for ITBS cases in Indonesian para-athletics. This research is a descriptive case study involving one client with a participatory observation method. The physiotherapy intervention involved Shock Wave Therapy (SWT) and Static Stretching Exercise. The subject of the study was 22 year old national para athlete with height 182 cm, weight 70 kg, and BMI 21.1 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain in the outer side of the right knee. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 2/10, tenderness 4/10, and motion pain 5/10 were found. The diagnosis of ITBS dextra was confirmed through specific examination. After six physiotherapy sessions with SWT and Static Stretching Exercise, there was a significant decrease in pain and an increase in functional activity in ITBS patients. Patients are advised to undergo physiotherapy regularly, do stretching exercises before and after activities, and compress with warm water if experiencing pain.