Physiotherapy Treatment For Patients Research Articles

Dog-assisted physiotherapy in amyotrophic lateral sclerosis: a randomized controlled pilot study.

Animal-assisted therapy (AAT) is an intervention in which the animal acts as a co-therapist. It has been mainly used in the context of patients with dementia, showing positive effects on psychological symptoms, but its potential as a physiotherapy treatment for patients with neuromuscular disorders, amyotrophic lateral sclerosis (ALS) in particular, has not yet been investigated. The aim of the study was to evaluate the impact of AAT, specifically of dog-assisted therapy, on motor functions and psychological status in patients with ALS. This study was a randomized controlled pilot study. The study was carried out at the Rehabilitation Unit NEuroMuscular Omnicenter (NEMO) of Arenzano, Genoa. Sixty hospitalized ALS patients were enrolled. All patients ran a regular two-weeks neurorehabilitation program twice a day. For three days a week, in place of the morning traditional treatment, the AAT group performed a rehabilitation session with a simultaneous interaction with the therapy-dog, while the control group performed a traditional rehabilitation session. The outcome measures were the Timed Up and Go Test, the Short Physical Performance Battery (SPPB), the Six Minutes Walk Test, the Ten Meters walking Test and the Hospital Anxiety and Depression Scale. Both groups showed an amelioration in motor scales. However, SPPB subscales as well as HADS scores showed a statistically significant improvement only in the AAT group (P values from <0.0001 to 0.0004). Additionally, across almost all motor and psychological measures, post-treatments values were significantly better for the AAT group (P values from <0.0001 to 0.01). The obtained results not only suggest that AAT is comparable to traditional physiotherapy treatments, but also evidence that this type of treatment has greater beneficial effects on motor and psychological symptoms in patients with ALS. This study provides first evidence that AAT is a powerful rehabilitation strategy in patients with ALS, improving both motor and psychological symptoms, and therefore possibly ameliorating quality of life.

Combination of Chest Physiotherapy and Postural Drainage for Airway Clearance in Bronchopneumonia: A Case Study

Background: Respiratory diseases such as bronchopneumonia contribute to the highest cause of death in children aged less than two years. Airway clearance becomes a problem due to the accumulation of secretions, resulting in airway obstruction. Independent nursing interventions such as chest physiotherapy can be carried out to free the airway and reduce the burden of breathing. Objective: This study aimed to analyze the application of chest physiotherapy intervention in bronchopneumonia children with airway clearance problems. Method: The research design uses a case study with a nursing process approach. The sample for this study was one child patient aged nine months with bronchopneumonia who was taken using a convenience sampling technique. Data was collected using interviews, observation, and documentation studies using pediatric nursing care format instruments. Chest physiotherapy intervention was carried out three times with a duration of 10-15 minutes with a combination of postural drainage, which was then evaluated before and after the procedure. Results: Chest physiotherapy intervention in patients can improve coughing ability, increase sputum production and respiratory rate 40 times per minute, and decrease rhonchi and oxygen saturation by 96%. Conclusion: Chest physiotherapy can be an effective independent nursing intervention to overcome the problem of ineffective airway clearance nursing in children with bronchopneumonia.

Efficacy of a Psychologically-Informed Physiotherapy Intervention in Patients with Chronic Low Back Pain at High Risk of Poor Prognosis: A Pilot and Feasibility Randomized Controlled Trial.

To determine the feasibility of a randomized controlled trial (RCT) testing the efficacy of psychologically-informed physiotherapy (PIPT), which includes usual physiotherapy (UP) interventions, compared with UP, and to explore the preliminary effectiveness of the interventions. People with chronic low back pain at high risk of poor prognosis (using the STarT Back screening tool) were recruited and allocated to PIPT or UP. Effectiveness of recruitment strategies, adherence to intervention, risk of contamination, and specific challenges were assessed. Functional capacity, pain, quality of life, kinesiophobia, catastrophization, central sensitization, and self-efficacy were measured at baseline, 6-, 12- and 24-week follow-ups. Forty participants were recruited mainly by diffusing through Laval University's email list, and 10 physiotherapists treated the participants recruited. The retention rate of participants at 24 weeks was 72.5%. Adherence to treatment by participants and physiotherapists was very good. The risk of contamination was low, and the specific challenges identified were modifiable. Significant improvement over time in all clinical variables of interest, except self-efficacy, was observed with no difference between groups. As most success criteria were met, conducting an RCT evaluating PIPT and PU is feasible with modifications. PIPT and UP appear to be similarly effective.

Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain.

Chronic low-back pain (CLBP) is the leading cause of years lived with disability. Physiotherapy is the most common treatment option for CLBP, but effects are often unsatisfactory. Virtual reality (VR) offers possibilities to enhance the effectiveness of physiotherapy treatment. Primary aim was to develop and test a personalized VR intervention integrated within a physiotherapy treatment for patients with CLBP. This study describes an intervention development process using mixed methods design that followed the Medical Research Council (MRC) framework. This involved a cocreation process with patients, physiotherapists, and researchers. A draft intervention was constructed based on a literature review and focus groups, and subsequently tested in a feasibility study and evaluated in focus groups. Focus group data were analyzed using thematic analysis. This intervention development process resulted in a final intervention. Focus group data showed that VR and physiotherapy can strengthen each other when they are well integrated, and that VR needs to be administered under the right conditions including flawless technology, physiotherapists with sufficient affinity and training, and the right expectations from patients. The draft intervention was considered feasible after evaluation by four patients and three physiotherapists and was further complemented by expanding the training for physiotherapists and improving the protocols for physiotherapists and patients. The final intervention consisted of a 12-week physiotherapy treatment with three integrated VR modules: pain education, physical exercise, and relaxation. Using the MRC framework in cocreation with the end users, a personalized VR intervention integrated within a physiotherapy treatment for patients with CLBP was developed. This intervention was found to be feasible and will subsequently be evaluated for (cost-)effectiveness in a cluster randomized controlled trial.

Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda

ObjectiveTo evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). MethodsQuasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. ResultsThe study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). ConclusionsMI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health.

Investigating the Responsiveness of the Persian Version of the Core Outcome Measure Index Neck Questionnaire in People With Non-specific Chronic Neck Pain

Background and Objectives: This study aims to investigate the responsiveness of the Persian version of the core outcome measure index (COMI) neck questionnaire in patients with chronic non-specific neck pain. Methods: The participants included 104 subjects in the age range of 18 to 15 years with non-specific chronic neck pain who were undergoing physiotherapy intervention. The participants received and completed the Persian version of the COMI neck questionnaire before the first session of physiotherapy treatment. After completing the treatment sessions, the subjects were re-evaluated and completed the Persian version of the COMI neck questionnaire. In this study, to evaluate external responsiveness, in addition to completing the mentioned questionnaire, the participants received and completed the global rating of change questionnaire in the final session of the treatment. The internal responsiveness was evaluated by performing the paired t-test in addition to evaluating changes in the Persian version of COMI neck scores before and after treatment and calculating the effect size consisting of standard response mean and Cohen d. Meanwhile, the external responsiveness was calculated via the receiver operating characteristic curve and the correlation analysis. Results: The Persian version of the COMI neck questionnaire has acceptable external responsiveness. The standard response mean was large and the Cohen d was very large. Significant changes were observed between the scores of the COMI neck questionnaire before and after the treatment. In this study, the minimal clinically important difference was 1.82. Also, a good correlation was found between COMI neck and the global rating of change questionnaire. Conclusion: The Persian version of the COMI neck questionnaire has acceptable responsiveness. This questionnaire can be used to study the effects of physiotherapy intervention in patients with chronic non-specific neck pain.

The Effect of Combined Treatment with Passive Therapy, Physical Exercises, Lumbar Traction, and Walking Program on Chronic Low Back Pain

Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders worldwide with far-reaching implications for social, economic, and public health. The study aimed to compare the effect of combined physiotherapy treatment in patients with CLBP. This observational retrospective randomized controlled study involved reviewing medical records of patients who were treated during a period of 6 weeks in the physiotherapy department of the Special Hospital for General Rehabilitation “Banja e Kllokotit,” Kllokot, Republic of Kosovo. The observational research was conducted for 60 patients, divided into two groups: Group 1: experimental group (n=30), with mean age of 41.7 years, average height of 1.68 cm, and average body mass index (BMI) of 71.7 for both sexes; Group 2: control group (n=30) with mean age of 43.1 years, average height of 1.66 cm, and average body mass index (BMI) of 71.5 for both sexes. In Group 1, combined treatment with passive therapy [thermotherapy and transcutaneous electrical nerve stimulation (TENS)], physical exercises, lumbar traction, and walking program was applied, while in Group 2, passive therapy like thermotherapy and TENS was applied. Outcome measurements included pain intensity, lumbar flexibility, revised Oswestry disability index (ODI), and self-confidence, which were assessed pre-treatment, at 3 weeks, and after 6 weeks of clinical treatment. The results showed significant improvement in both groups. However, the improvement was greater and with a significant difference only after 6 weeks in Group 1 compared to Group 2. The differences were observed in various outcome measures, including the visual analog scale for pain (VAS; p&lt;0.0001), fingertip-to-floor distance (FTF; p&lt;0.0001), ODI (p&lt;0.0001), and Rosenberg self-esteem scale (RSE; p=0.0002). According to our data, combined treatment with thermotherapy, therapeutic exercises, lumbar traction, TENS, and walking program was more effective and can be considered as a treatment protocol for patients with CLBP. However, further research is recommended on the efficacy of combined physiotherapy treatment, especially lumbar traction for longer periods.

Experiences of shifts in physiotherapy for rheumatoid arthritis over time – an autoethnography

ABSTRACT Introduction Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. Objective This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author’s work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. Methods A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. Results The storyline from the 1980s to approximately the turn of the millennium is called ‘Shifts determined mainly by clinical context-driven events’ which occurred in response to medical advances and physiotherapists’ clinical experiences. These shifts were later justified by physiotherapists’ research in the clinical context. The other storyline covers mainly the 2000s and is called ‘Shifts increasingly determined by events beyond clinical physiotherapy context.’ They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. Conclusion These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities.

The Responsiveness of Three Persian Outcome Measures Following Physiotherapy Intervention in Patients with Chronic Non-Specific Neck Pain.

A prospective cohort study to evaluate and compare the responsiveness of the Persian version of the neck disability index (NDI), neck pain & disability scale (NPDS), neck outcome score (NOOS), and to determine the minimal clinically important difference (MCID) and minimal detectable change (MDC). To date, no studies have made a direct comparison between the responsiveness of the Persian version of NPDS, NDI, and NOOS questionnaires. At the end of the study, 55 patients with chronic non-specific neck pain completed the NPDS, NDI, and NOOS questionnaires at the beginning and end of three weeks of physiotherapy treatment. Additionally, patients completed the global rating of change scale to differentiate between improved and unimproved patients. Comparison of responsiveness was performed using anchor-based methods (receiver operating characteristic (ROC) curve and correlation analysis). MCID and MDC were assessed to investigate relevant changes for each questionnaire. ROC curves analysis showed areas under the curves of 0.70, 0.64, and 0.43 to 0.63 for the NPDS, NDI, and NOOS subscales, respectively. The correlation coefficients between the global rating of the change scale and the change scores of the NPDS and NDI were 0.38 (P<0.01) and 0.30 (P<0.05), respectively. There were no significant correlations between NOOS subscales and global rating of change score (r=0.001- 0.21, P>0.05). The MCID for the NPDS, NDI, and NOOS subscales were 28.09 (score 0-100), 7.5 (score 0-50), and 13.75 to 28.64 (score 0-100), respectively. The MDCs were found to be in the following order: 47.1 points for NPDS, 36.1 for NDI, and 23.5 to 39.7 for NOOS subscales. The Persian NPDS seems more responsive than the NDI and NOOS questionnaires. The level of clinically meaningful change in NDI, NPDS, and NOOS questionnaires is in the range of measurement error.

Cardiopulmonary and hematological effects of infrared LED photobiomodulation in the treatment of SARS-COV2.

COVID-19 disease is caused by SARS-CoV-2 which can trigger acute respiratory syndrome, which presents with dense alveolar and interstitial infiltrates and pulmonary edema, causing severe hypoxemia and significant alteration to pulmonary mechanics with reduced pulmonary compliance. The photobiomodulation technique alters cellular and molecular metabolism, showing promising results regarding the reduction of acute pulmonary inflammation. To compare the photomodulation technique using near-infrared LED to conventional respiratory physiotherapy treatment in patients with COVID-19 in reversing acute conditions, reducing hospitalization time, and decreasing the need for oxygen therapy. The cohort was comprised of 30 patients undergoing COVID-19 treatment who were divided and allocated into two equal groups randomly: the LED group (LED), treated with infrared LED at 940nm and conventional therapy, and the control group (CON), who received conventional treatment (antibiotic therapy for preventing superimposed bacterial infections, and physiotherapy) with LED irradiation off. Phototherapy used a vest with an array of 300 LEDs (940nm) mounted on a 36cm×58cm area and positioned in the patient's anterior thoracic and abdominal regions. The total power was 6W, with 15min irradiation time. Cardiopulmonary functions and blood count were monitored before and after treatment. The patients were treated daily for 7days. Statistical analysis was conducted using a two-tailed unpaired Student's t-test at a significance level of α=0.05. Post-treatment, the LED group showed a reduction in hospital discharge time and a statistically significant improvement for the following cardiopulmonary functions: Partial Oxygen Saturation, Tidal Volume, Maximum Inspiratory, and Expiratory Pressures, Respiratory Frequency, Heart Rate, and Systolic Blood Pressure (p<0.05). Regarding blood count, it was observed that post-treatment, the LED group presented with significant differences in the count of leukocytes, neutrophils, and lymphocytes. Photobiomodulation therapy can be used as a complement to conventional treatment of COVID-19, promoting the improvement of cardiopulmonary functions, and minimization of respiratory symptoms.

Inter-individual variability in mechanical pain sensation in patients with cervicogenic headache: an explorative study

Currently, evidence for effective physiotherapy interventions in patients with cervicogenic headache (CeH) is inconsistent. Although inter-individual variability in pain response is predictive for successful physiotherapy interventions, it was never explored in patients with CeH. Therefore the objective of the current study was to explore inter-individual variability in mechanical pain sensation, and its association with biopsychosocial-lifestyle (BPSL) characteristics in patients with CeH. A cross-sectional explorative analysis of inter-individual variability in mechanical pain sensation in 18 participants with CeH (29–51 years) was conducted. Inter-individual variability in mechanical pain sensation (standard deviations (SDs), F-statistics, Measurement System Analysis) was deducted from bilateral pressure pain thresholds of the suboccipitals, erector spine, tibialis anterior. BPSL-characteristics depression, anxiety, stress (Depression Anxiety Stress Scale-21), quality of life (Headache Impact Test-6), sleep-quality (Pittsburgh Sleep Quality Index), and sedentary time (hours/week) were questioned. Inter-individual variability in mechanical pain sensation explained 69.2% (suboccipital left), 86.8% (suboccipital right), 94.6% (erector spine left), 93.2% (erector spine right), 91.7% (tibialis anterior left), and 82% (tibialis anterior right) of the total variability in patients with CeH. The significant p-values and large F-statistic values indicate inter-individual differences in SDs. Significant associations between (1) lower quality of life and lower SDs of the suboccipital left PPT (p .005), and (2) longer sedentary time and higher SDs of the suboccipital left PPT (p .001) were observed. Results from our explorative study could suggest inter-individual variability in mechanical pain sensation at the left suboccipitals which associates with quality of life and sedentary time. These novel findings should be considered when phenotyping patients and ‘individually’ match interventions.

Physiotherapy exercise protocol of pelvic floor muscles for young female athletes with urinary incontinence

Intense physical activity or certain branches of sport have many health benefits but can also have harmful effects on the pelvic floor. In medical literature, intensive exercise is mentioned as a risk factor for urinary incontinence by loss of anticipated cushion contraction during physical exertion, impairment of pelvic muscle tone and strength, lack of pelvic floor muscle relaxation, which may lead to muscle exhaustion, all of this causing a lack of response during the rapid increase of intra-abdominal pressure. This study aims to design a recovery protocol to reduce or eliminate symptoms of urinary incontinence in young female athletes affected by this condition through a complex approach to the rehabilitation of pelvic floor muscle tone and strength and specific training programmes to create a “perineal blockage”, the automatic contraction of pelvic floor muscles during physical exertion and relaxation at rest, the correction of both lumbar posture and muscle imbalance in the abdominal-lumbo-pelvic (core) area. The case studies included two patients, young female athletes aged 15 and 20, suffering from urinary incontinence. The methods used were: literature review, observation, questionnaire survey (Contilife questionnaire), graphical method, mathematical and statistical method. The results show that the symptoms of involuntary urine leakage have disappeared from the physiotherapy treatment of patients and their quality of life has increased. However, it is recommended that this exercise protocol be continued at home or introduced to sports training at least once a week to maintain the outcome and prevent recurrence.

Bilateral Lower Limb Training for Post-stroke Survivors: A Bibliometric Analysis.

Stroke is one of the most disabling conditions affecting the middle-aged population all around the world. This study aims to explore the rehabilitation of stroke patients using bibliometric analysis, which includes statisticalanalysis of recent articles, books, and other kinds of publications, to assess scientific output and determine the significance of scientific investigations in terms of both quality and quantity. In this study, an analysis of global trends in research in bilateral lower limb training for training balance and walking for patients in the subacute stage post-stroke between 1988 and 2021 was done. All the articles were obtained from PubMed databases. CiteSpace software was used to analyze the relationship between publications and country, journals, institutions, authors, references, and the keywords used. A total of 160 publications were included in the analysis. There was a tremendous increase in the research of physiotherapy intervention in patients who had residual disability post-stroke with a publication rate of 7.1 articles per year of publications. The use of the sophisticated PubMed database to extract articles allowed for a thorough and powerful bibliometric analysis of stroke rehabilitation research published between 1988 and 2020. In general, the number of studies on bilateral training has increased in recent decades. This historical overview of rehabilitation for post-stroke survivors will serve as a valuable starting point for future study into possible collaborators, focus issues, and trends. This bibliometric analysis highlights the potential value of exercise therapy for stroke survivors in creating more effective hemiplegia rehabilitation programs. This research may encourage the use of strengthening in the therapeutic therapy of hemiplegia balance. The groundwork will be laid for future research on strengthening stroke to be organized and given top priority.

The Western Ontario and McMaster Universities Osteoarthritis, Lequesne Algofunctional index, Arthritis Impact Measurement Scale-short form, and Visual Analogue Scale in patients with knee osteoarthritis: responsiveness and minimal clinically important differences

Purpose The goal of this study was to see whether the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), Lequesne Algofunctional index and the Arthritis Impact Measurement Scale-short form (AIMS2-SF) could changes after physiotherapy interventions (i.e., responsiveness) and to determine Minimal Clinically Important Difference (MCID) in the performance of the people with knee osteoarthritis. Materials and methods A convenient sample of 116 people with knee osteoarthritis completed the tools at baseline and then again after 10 sessions physiotherapy intervention. Two techniques were used to determine responsiveness: The receiver operating characteristics (ROC) method and the correlation analysis. Result All of the tools showed the AUC of greater than 0.70 (AUC ranges = 0.72 − 0.83). For the WOMAC, Lequesne Algofunctional index, AIMS2-SF and VAS-pain, optimal cutoff points were 12.5, 2.75, 4.5 and 2.5 points, respectively. The gamma correlation between WOMAC, Lequesne Algofunctional index, AIMS2-SF, VAS-pain, and Global Rating Change (GRC) scores was 0.55, 0.52, 0.40, and 0.46, respectively. Conclusion In people with knee osteoarthritis, the WOMAC has the maximum responsiveness to clinical changes. The MCID values identify in this study will aid in determining whether or not an individual with knee osteoarthritis has undergone a true improvement since receiving physiotherapy. IMPLICATIONS FOR REHABILITATION The results of this study provide valuable information regarding to the ability of outcome measures to detect treatment effects in patients with knee osteoarthritis. The WOMAC questionnaire is a responsive tool to measure the changes in functional activity due to physiotherapy intervention in patients with knee osteoarthritis. A patient with knee osteoarthritis had to change at least 12.5 scores on the WOMAC to be judged as having clinically changed.

Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review.

To determine the efficacy of physiotherapy approaches used in the treatment of LSS and compare their delivery characteristics. A systematic search was conducted using MEDLINE/PubMed, EMBASE, Scopus, PEDro, CINAHL and Web of Science databases, from inception until March 2021. Inclusion criteria were clinical diagnosis of LSS confirmed through imaging techniques, RCTs written in English comparing physiotherapy interventions among them or versus placebo or usual care without restrictions on treatment and follow-up duration, outcomes related to pain, physical function, disability and quality of life. Two independent reviewers assessed records for eligibility and methodological quality (PEDro scale) and extracted participants' characteristics, interventions details and outcome measures at each timepoint. Pooled or un-pooled findings were reported as mean difference with 95% confidence interval, depending on heterogeneity. Evidence quality was rated using the GRADE approach. Twelve studies (944 patients, mean PEDro score 7.6, range 5-9) were included. Three weeks of weight-supported walking improved pain and disability, while 8weeks of aquatic exercises improved pain and walking tolerance (very low evidence). Six weeks of cycling reduced disability compared to weight-supported walking (low evidence). Six weeks of manual therapy plus exercise was not superior to supervised exercises (low evidence), but improved pain, walking tolerance, disability and quality of life compared to home/group exercises (moderate to very low evidence). Very low evidence supported 2weeks of electromagnetic fields, whereas TENS (low evidence) and ultrasounds (very low evidence) revealed no effects. These findings may assist clinicians in delivering effective physiotherapy interventions in LSS patients.

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial.

BackgroundPatient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning.ObjectiveThis study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP.MethodsThe study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up.ResultsBoth the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes.ConclusionsThe stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.Trial RegistrationISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203International Registered Report Identifier (IRRID)RR2-https://doi.org/10.1186/s12891-020-3174-z

Effectiveness of adding virtual reality to physiotherapeutic treatment in patients with total hip arthroplasty. A randomized controlled trial

Objective To determine the clinical effectiveness of adding virtual reality via the Nintendo Wii console and its Wii Balance Board to physiotherapy treatment in patients with total hip arthroplasty. Design Randomized controlled trial. Setting Clinical Hospital San Borja Arriaran, Santiago, Chile. Participants A total of 73 patients over 50 years of age with total hip arthroplasty were randomly allocated to two groups. Interventions The control group (n = 37) received 6 weeks of physiotherapy treatment; the intervention group (n = 36) received the same treatment plus virtual reality exercises with the Nintendo Wii console. Outcome measures The two groups were assessed at baseline and after the 6 weeks of treatment. The primary outcome assessed was the function with the WOMAC questionnaire. The secondary outcomes were the Berg Balance Scale, distance covered with the six-minute walk test, and difference in weight load on the lower extremities. Results A total of 73 patients, 37 patients in the control group (20 women; mean age of 70.9 ± 9.16 years) and 36 patients in the intervention group (18 women; mean age of 70.39 ± 9.02 years) were analyzed. At the end of the treatment, the difference between groups for the total WOMAC score was −10.4 points (p = 0.00), 4.7 points (p = 0.00) for the Berg Balance Scale, and 45.2 mt (p = 0.00) for the six-minute walk test All differences were in favor of the intervention group. Conclusions In the short term, the addition of virtual reality via the Nintendo Wii and its Wii Balance Board platform showed statistically significant differences in the function of patients with total hip replacement, but these differences were not minimally clinically important. Trial registration: This research was registered in the Clinical Trials Registry of Australia and New Zealand, with reference ACTRN12618001252202.

Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial

BackgroundThe benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered.AimTo explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period.DesignAn embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis.ParticipantsPurposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited.ResultsAnalysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities.ConclusionOur findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT.

Combating a Case of COVID Pneumonia with ARDS – a Physiotherapist’s Standpoint

Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, affecting multiple organ systems. The disease usually presents as mild to moderate respiratory illness but in many cases has progressed to development of pneumonia and ARDS ultimately requiring ventilatory support and prolonged ICU stay. Prolonged immobilization itself is a harbinger of various complications drastically altering a patient’s functional status. Physiotherapy plays a vital role in the management of COVID-19 symptoms as well as in the prevention of complications. &#x0D; Case Study: This case report describes the progress of a 44-year old female patient diagnosed with COVID-19 presenting with subsequent pneumonia and ARDS. The patient was started with medical management and supplemental oxygen therapy. In combination to the above-mentioned protocols, physiotherapy treatment was also initiated. After 2 weeks of rehabilitation and drug therapy, the patient displayed improved respiratory function at room air and was able to independently ambulate with minimal breathing difficulty.&#x0D; Discussion: This case report aims to highlight the importance of early intervention of physiotherapy in COVID-19 patients. The scope of physiotherapy treatment in patients with COVID-19 pneumonia is vast. The treatment protocol adapted for this patient are in tune with the various research articles analysed to ensure evidence-based care. This will enable the healthcare professionals to ensure timely referral and early initiation of Physiotherapy treatment.&#x0D; Conclusion: As per the findings and results of this case report, it is evident that the patient benefited from the timely advent of physiotherapy intervention. The key factor was the correct identification of the problematic areas and accurate prioritization based on the clinical presentation and investigation findings

Physiotherapeutic behavioral pattern of carpal tunnel syndrome induced by occupational activities

Introduction: Carpal tunnel syndrome (CTS) is the most common compression neuropathy that can lead to functional disability at working age. Since 2003, it has been registered in the list of occupational diseases of the European Union. In 2001, the disease was the sixth most frequent among all occupational diseases recognized in the European Union. Often underestimated, CTS can cause serious changes in the quality of life of the patients—their professional and usual daily activities, social and household contacts are violated. Aim: The aim of this article is to analyze the results of physiotherapy treatment in patients with mild and moderate form of CTS induced by excessive upper limb load in terms of their working ability, daily activities and their social activity based on anamnestic data, a survey and a Boston questionnaire for carpal tunnel syndrome. Material and Methods: A total of 57 patients with mild to moderate degree of manifestation of the syndrome were investigated—22 (38.60%)—with right hand affected, 9 patients (15.80%) with affected left hand, and 26 patients (45.60%) with bilateral involvement. In the last group, both hands were examined, i.e. 57 patients and 82 hands were examined. Conclusion: The combination of kinesitherapy with physical physiotherapy methods has a favorable effect on both subjective complaints and clinical symptoms as well as the extent of restoration of affected hand functions at the end of the physiotherapy course, this tendency being maintained for 4 to 8 months after physiotherapeutical treatment . The Boston Questionnaire is a reliable tool for diagnosing, processing, analyzing and evaluating the results of one or another type of CTS treatment. The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages resulting from its compression in the carpal canal is a reversible process. A comprehensive approach to CTS treatment, including early diagnosis and prevention, is a pledge to achieve success in mild and moderate forms of the syndrome, and competent and timely medical counseling is often of great importance for shortening recovery time, improving the function of the hand, quality of life of the patient and resulting in significant socioeconomic effects.