Physical Therapy Intervention Program Research Articles

A Stratified Approach for Managing Patients With Low Back Pain in Primary Care (SPLIT Program): A Before-and-After Study.

To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care. We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points). We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability (ß, -2.94; 95% CI, -3.63 to -2.24; P ≤ .001), pain (ß, -0.88; 95% CI, -1.18 to -0.57; P ≤ .001), perceived effect of treatment (ß, 1.40; 95% CI, 0.97 to 1.82; P ≤ .001), and health-related quality of life (ß, 0.11; 95% CI, 0.08 to 0.14; P ≤ .001) compared with UC. Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC.

Physical therapy management for muscle tightness in a surfing athlete: a case report study

Background: Muscle tightness refers to the sensation of tension or stiffness in the muscles, often resulting from factors such as excessive physical activity, inadequate warm-up before exercise, muscle injury, or underlying medical conditions. This article describes a case of a surfer patient with muscle tightness who has had ACL reconstruction meniscectomy and physical therapy management.
 Case description: The patient was a 51-year-old male surfing athlete from New Zealand diagnosed with muscle tightness. The patient had a history of ACL and meniscus injuries, followed by ACL reconstruction and meniscectomy of the right knee. The patient was on vacation in Bali, and he was surfing every day. The patient underwent physical therapy twice a week. The intervention program included modalities (transcutaneous electrical nerve stimulation and ultrasound), manual therapy (massage and patellar mobilization), and exercise therapy (range of motion exercises, strength training, and stretching).
 Conclusion: The physical therapy intervention program designed for one week can yield positive results in reducing pain levels, improving the range of motion of the right knee, increasing the circumference of the right knee segment, and enhancing the functional activities of the right knee.

Responsiveness and the Minimal Important Change of Knee Injury and Osteoarthritis Outcome Score Following Physiotherapy Intervention in Iraqi People with Knee Osteoarthritis

Background: The Knee Injury Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported questionnaire to evaluate individuals with knee osteoarthritis or a history of knee injuries. Objectives: The aim of this study was to evaluate the responsiveness and establish the minimal important change (MIC) for the Arabic version of KOOS in Iraqi individuals with knee osteoarthritis following physiotherapy intervention. Methods: Fifty volunteers (13 male and 37 female, mean age: 59.3±9.6 years old) with an orthopedic diagnosis of knee osteoarthritis participated in this study. The Arabic KOOS was completed by the participants once before the intervention and once after completing a 4-week physiotherapy treatment program. A seven-item global rating of change scale was used as an external anchor to assess the participants' opinion about the treatment and its possible changes. Responsiveness was evaluated by calculating the receiver operating characteristic (ROC) curve, and the MIC was established by identifying an optimal cut-off on the ROC curve. Results: All subscales of the Arabic KOOS showed an area under the curve > 0.70. The MICs reflecting the values required by the participants to feel the improvement were 15.5, 14.5, 11, 11.5, and 12.5 for the pain, symptoms, activities of daily living, sports and recreation, and quality of life subscales, respectively. Conclusions: All subscales of the Arabic KOOS are responsive to physiotherapy treatment. Therapists and researchers can use the MIC values to evaluate whether their prescribed treatment was satisfactory and effective from their patients' point of view.

Association between Participation in a Rehabilitation Program and 1-Year Survival in Patients Requiring Prolonged Mechanical Ventilation.

The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.

The Effects of Tissue Flossing on Shoulder Range of Motion and Pain in Patients with Adhesive Capsulitis: A Case Study

Background and Purpose: The purpose of this case report is to describe the tissue flossing interventions for apatient with adhesive capsulitis.Case Description: The patient was a 56-year-old female, who presented with left shoulder pain and limitedrange of motion (ROM) following a fall 9 months prior. The patient had a past medical history of thyroid.The diagnosis of adhesive capsulitis was determined following radiographs, mechanism of injury, past medicalhistory, and physical therapy examination and evaluation.Intervention: The patient was seen for a total of 15 physical therapy sessions over the span of 6 weeks.Interventions included a tissue flossing, home exercise program, instruction in heat/ice use, mobilizations,therapeutic exercises, ROM, stretching, and glides. Outcome measures included ROM measurements, painratings, strength tests and the Shoulder Pain and Disability Index (SPADI).Outcomes: Following 6 weeks of physical therapy intervention, tissue flossing and home exercise program, thepatient demonstrated increased shoulder ROM, decreased pain and improved function based on the improvedSPADI.Discussion: Rationale for treatment was based on textbook information for shoulder interventions and researcharticles. The treatment was altered based on patient’s response.Conclusion: This case report is in concordance with the current research that shows flossing, strengthening,mobilizations, a home exercise program and stretching are appropriate combinations of interventions forindividuals with adhesive capsulitis. This patient returned to his prior level of function following the abovetreatment regimen.

Responsiveness and the Minimal Important Change of Knee Injury and Osteoarthritis Outcome Score Following Physiotherapy Intervention in Iraqi People with Knee Osteoarthritis

Background: The Knee Injury Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported questionnaire to evaluate individuals with knee osteoarthritis or a history of knee injuries. Objectives: The aim of this study was to evaluate the responsiveness and establish the minimal important change (MIC) for the Arabic version of KOOS in Iraqi individuals with knee osteoarthritis following physiotherapy intervention. Methods: Fifty volunteers (13 male and 37 female, mean age: 59.3 ± 9.6 years old) with an orthopedic diagnosis of knee osteoarthritis participated in this study. The Arabic KOOS was completed by the participants once before the intervention and once after completing a 4-week physiotherapy treatment program. A seven-item global rating of change scale was used as an external anchor to assess the participants' opinion about the treatment and its possible changes. Responsiveness was evaluated by calculating the receiver operating characteristic (ROC) curve, and the MIC was established by identifying an optimal cut-off on the ROC curve. Results: All subscales of the Arabic KOOS showed an area under the curve > 0.70. The MICs reflecting the values required by the participants to feel the improvement were 15.5, 14.5, 11, 11.5, and 12.5 for the pain, symptoms, activities of daily living, sports and recreation, and quality of life subscales, respectively. Conclusions: All subscales of the Arabic KOOS are responsive to physiotherapy treatment. Therapists and researchers can use the MIC values to evaluate whether their prescribed treatment was satisfactory and effective from their patients' point of view.

A systematic review to compare physiotherapy treatment programmes for atraumatic shoulder instability.

Optimal physiotherapy treatment is uncertain for atraumatic shoulder instability (ASI), the primary aim of this systematic scoping review was to compare physiotherapy treatment programmes for people with ASI. The secondary aims were to evaluate outcome measures used and to compare the effectiveness of these programmes. CINAHL, EMBASE and Medline databases were searched for studies, except single case studies, published between 1950 and July 2021. 12 critical appraisal items covered three domains; internal validity, transferability to wider population and reporting. Ten studies were included; one randomised controlled trial, 6 cohort studies and 3 case series. There were 491 participants. Treatment programmes included education, movement re-education, static posture correction, shoulder muscle strengthening, functional training, and adjuncts. All studies used patient reported outcome measures (PROMs), 7 of which reported a statistically significant improvement (p < 0.05) post-treatment. There was no clear relationship between programmes and outcomes. PROMs specific to shoulder instability were all found to detect statistically significant differences post-treatment. There does not appear to be one optimal physiotherapy treatment programme for ASI. Future studies should use PROMs that are valid in the shoulder instability population and use more outcome measures that are specific to impairments being targeted.

Evaluation Of Average Length of Follow-Up Duration Post Total Knee Arthroplasty: A Survey

Background: Among the various diseases in the world, osteoarthritis (OA) is a major contributing factor of disability. Total Knee Arthroplasty (TKA) is a widely performed procedure for advanced arthritis of the knee joint. Both subjective and objective assessments are necessary to evaluate the outcomes post TKA. The physiotherapy treatment program following the surgery is designed in a manner which is best suitable to the patient’s need, the efficacy of which will only be determined with regular follow up sessions. Objectives: The primary objective is to find out length of duration of follow up sessions post TKA with the Physiotherapist. The secondary objectives are to determine whether the reason for termination of follow-up is physiotherapist-based or patient-based and to determine whether the discharge criteria are based on measurable assessment tools. Purpose: In spite of the surgery being routinely performed, records of time period of follow up with the surgeons and physiotherapists are not maintained. It is also not documented whether the discharge occurs on the basis of formal functional assessments. Methodology: Pilot study was performed on a group of 10 physiotherapists to calculate the sample size. It was found to be 73. For the final study, candidates fitting in the inclusion criteria were chosen. Oral consent was taken. Self-designed questionnaire in the form of “Google-Form” was administered. The candidates were requested to fill the same. Descriptive analysis of the data obtained was performed to find out the average duration of follow-up post Total Knee Arthroplasty using PRISM Graph-Pad software. Results: Average (median) length of follow-up duration post TKA was found to be 6.000 weeks. Furthermore, the termination criteria of follow-up were more physiotherapist based and objective in nature. Conclusion: The time period of follow-up post TKA is inconsistent with the minimum period required for optimal functional recovery of various clinical parameters. Clinical Implication: A standardized protocol of follow-up post TKA must be devised. The decision making process of termination of follow-up which is based on measurable tools of assessment should be in line with current research findings. KEYWORDS: Total Knee Arthroplasty, Follow-up, Functional Recovery.

EVALUATING IMPEDIMENTS LEADING TO NON-ADHERENCE OF PHYSICAL THERAPY TREATMENT AMONGST INHABITANTS OF ROHTAK DISTRICT

Background:The rate of success of a physiotherapy treatment programme is strongly inuenced by the adherence of the patient with prescribed treatment programme. Non-adherence with the therapy given to the patient is often overlooked and is one of the reasons for failure to achieve desired results aimed for a given disease/condition. Methods:Atotal of 40 geriatric subjects (20 urban and 20 rural) were surveyed for information using self-questionnaire from Rohtak district. Results: Out of 40 subjects (10 urban males and 10 urban females and 10 rural males and 10 rural females) 70% of urban (30% females and 40% males) and 30% of rural (10% females and 20% males) population was found to be adherent to physical therapy treatment. Impediments identied in the current study that were statistically signicantly associated with non-adherence to physical therapy treatment among the geriatric population included residential locality (p=0.02), accessibility to physiotherapy clinics (p=0.001), paying capacity (p=0.003), compliance to unsupervised home based exercise treatment (p=0.01) and cooperation by family members (p= 0.01). A non-signicant relationship was found with ability of doing ADLs (p=0.06). Conclusion: The study shows that geriatric population of Rohtak district residing in urban areas are more adherent to physical therapy treatment programme as compared to those residing in rural areas.

Caregivers and Physical therapists' Perceptions of Telehealth for infants with Down Syndrome during COVID-19: Case reports

The aim of this study is to describe the caregivers and physical therapists’ perceptions of telehealth strategies in two cases of infants with Down syndrome during the COVID-19 pandemic in Brazil. Methodology: The physical therapy intervention program was carried out using synchronous and asynchronous methods according to the social context of each family. Results: The telehealth strategies were positively evaluated by caregivers and physical therapists. Conclusion: The study concluded that telehealth has promoted satisfactory results in infants' physiotherapeutic monitoring, and it could be an additional tool for early intervention after the pandemic.

Effect of Modified Ankle Foot Orthoses (AFO) along with Goal-Oriented Physiotherapy in a Child with Spastic Diplegic Cerebral Palsy–An Interesting Case Report

Cerebral Palsy (CP) is considered as a neurological condition caused by a non-progressive damage ormalformation of the brain that occurs during the developmental process. Body movement and musclesynchronization are mainly impaired in children with Cerebral Palsy. Each cerebral palsy case is uniqueto the person. One person may have complete paralysis and need continuous treatment, while another mayhave mild movement tremors with partial paralysis but require little assistance. The form and the timing ofthe injury to the developing brain are the main reasons for such impairments. Orthoses are primarily used totreat the secondary musculoskeletal problems of muscle contracture and bony deformity. In the Present Casereport a modified Ankle Foot Orthoses (AFO) is used bilaterally by using an extra malleolar orthosis, medialblock to prevent forefoot adduction and an extra strap to prevent navicular drop for a 7-year-old SpasticDiplegic girl child who was in Gross Motor Functional Classification System (GMFCS) grade III. After a3-month goal-oriented physiotherapy treatment program primarily focusing on gait, we observed decreasedNavicular drop, increased ankle stability (Twisting was not seen), improvement in Gait Parameters such asIncreased stride length, Cadence and improved gait velocity.

Efficacy of a multimodal physiotherapy treatment program for postural disorders and pain: a case report

The participant of this study was a 40-year-old female, who mainly complained of middle thoracic stiffness and pain in extension at the mid thoracic level with hyperkyphosis, forward head and mild thoracic dextroscoliosis. The subject participated in multimodal home-based physiotherapy program with the duration of 9 months, consisting of posture exercises, soft tissue massage therapy and thoracic manipulations. Comparison of initial and final evaluation revealed the improvement in all evaluated variables, including the reduction of thoracic hyperkyphosis, forward head posture and thoracic dextroscoliosis, freer and less painful thoracic spine extension mobility, no pain in the sacroiliac joint, and increased satisfaction with the posture. There was also notable improvement in the algometry of the paraspinal muscles, equalization of functional lower-leg length and rib-pelvic distance of both sides of body. In conclusion, the proposed physiotherapy protocol can be beneficial in addressing postural faults such as thoracic hyperkyphosis, forward head and scoliosis. However, further research is needed with a larger sample.

Acquisition of posture control through of high postures in extremely preterm infants with diagnoses of Bronchopulmonary Dysplasia severe: case report.

Introduction: with the increased survival of immature newborns, the incidence of bronchopulmonary dysplasia is increasing, as well as a significant increase in the number of children with delayed neuropsychomotor development. Objective: To report the experiences in a physical therapy intervention program based on the neuroevolutives high positions in the development of cervical control and trunk, in a higk-risk young child diagnosed with bronchopulmonary dysplasia. Method: case report of a female child, chronological age of six months, corrected age of two and a half months, extremely premature very low birth weight, which held 28 sessions of physiotherapy. Results: after treatment, there was an increase of active movement; in the prone position was reached full cervical extension; the roll from supine to prone; in the sitting position remained good postural control; she remained in a standing position with cervical support and trunk requiring support at lower distal members. Conclusion: the high positions allowed greater interaction between child and the environment around herself, thus enabling a breakthrough in motor development for the acquisition of control cervical and trunk.

The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial

ObjectivesTo evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults. DesignRandomized, single-blind, controlled trial. SettingA Spanish nursing home in the autonomous community of Extremadura, Spain. ParticipantsAn initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups. InterventionsBoth the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes. Main Outcome MeasuresTimed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS). ResultsAnalysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42). ConclusionsA proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

Impact of Strength and Nature of Patient Health Values on Compliance and Outcomes for Physiotherapy Treatment for Pelvic Floor Dysfunction

ObjectiveTo determine whether patient values impact on compliance and outcome for physiotherapy treatment for pelvic floor dysfunction. Although studies have related “health values” to behaviors in the laboratory, or to behaviors such as exercise, there have been no studies of the impact of patient values on actual medical treatments. MethodsA prospective observational study of the impact of patient values on compliance and outcomes for physiotherapy treatment for pelvic floor dysfunction was conducted in a physiotherapy clinic in the urogynaecological outpatients unit of a hospital. Two hundred eighteen patients were approached and agreed to participate. Prior to treatment, pelvic floor functioning was assessed using the Oxford Grading System, and Queensland Pelvic Floor Questionnaire, and values were assessed using the Personal Values Questionnaire (PVQ-II). Following a 6-month physiotherapy treatment programme, pelvic floor function was reassessed. ResultsThe strength of patient health-related values measured by the PVQ-II significantly predicted compliance with the intervention, but the nature of health value (intrinsically-valued, as opposed to externally-controlled) predicted objective outcome. ConclusionPatient values impact on physiotherapy adherence and outcomes, and could be considered as part of future assessment/screening procedures.

Treatment of Deformational Plagiocephaly With Physiotherapy.

Non-synostotic plagiocephaly consists in an asymmetry of the skull due to mechanical forces applied in utero or postnatally: main differential diagnosis is with true synostotic asymmetry, which is caused by the premature closure of a suture. The correction of positional forms is mostly conservative, with 3 main strategies: counterpositioning, physiotherapy and helmet therapy. There is no synthesized evidence on which is the most effective. The Authors evaluate the modification of antropometric measurments before and after a pediatric physical therapy program in a sample of patients with non-synostotic skull asymmetry, in order to evaluate the improvements in the skull shape. The hypothesis being tested was that physical therapy alone could improve the antropometric measurments. The authors enrolled in this study 24 patients diagnosed of non-synostotic asymmetry, clinically and with ultrasound, referred to the Maxillo-facial Unit of Policlinico Umberto I, Rome, within 2013 and 2016. A standardized pediatric physical therapy intervention program was designed: it consisted in a combination of excercises and manipulative procedures to reduce positional preference, musculoskeletal disorders and cranial deformity. Infants received 16 sessions of physical therapy, of 40 minutes each, once a week, for four months. The Authors evaluate the variation of four anthropometric measurments, performed before and after the physical therapy program: Argenta scale, Oblique Diameter Difference Index (ODDI), Cranial Proportional Index (CPI) or Cephalic Ratio (CR), Cranial Vault Asymmetry Index (CVAI). Craniometric evaluations were extrapolated by standardized 2D digital photographs of frontal, sagittal and transverse planes, by the same physician to minimize bias. The management of positional cranial deformities is still controversially discussed and especially the effects of physiotherapy and osteopathy have been only marginally researched. Statistical analysis revealed the effectiveness of the protocol: all anthropometric measurements improved with a high rate, major in youngest children (P < 0.5) and in more severe first presentations (P < 0.05 or P < 0.01). The results suggest manipulative approach may improve the outcome in the long term follow up of cranial asymmetries.

Effects of physical therapy on mental function in patients with stroke.

ObjectiveIn this study, we aimed to determine the effects of physical therapy intervention on mental function in patients with stroke.MethodsIn this retrospective experimental study, we included 134 patients previously diagnosed with anxiety and depression who presented to our outdoor physical therapy clinic with hemiplegia owing to stroke during 2016 to 2018. The main interventions were neurodevelopmental techniques, strength training, stationary cycling, and shoulder wheel exercise. The treatment duration was 6 months, 5 days a week. Key outcome measurement tools included the Patient Health Questionnaire-9 (PHQ-9), Disability Rating Scale (DRS), and Functional Independent Measure (FIM). Baseline and post-interventional measurements were compared using a paired-sample t-test.ResultsBaseline scores on the PHQ-9, DRS, and FIM were 24.77±1.24, 19.67±1.25, and 20.77±1.74, respectively; post-intervention scores on these three scales were 9.08±0.49, 7.78±1.49, and 82.52±10.03 respectively. In the comparison, significant differences were observed between baseline and post-interventional scores.ConclusionWe found that physiotherapy interventions improved motor function in patients with stroke as well as their mental function. Patients with stroke with impaired mental function can improve by participating in a physiotherapy treatment program.

Eye Movements, Dizziness, and Mild Traumatic Brain Injury (mTBI): A Topical Review of Emerging Evidence and Screening Measures.

Eye movements may be adversely affected after mild traumatic brain injury (mTBI) and should be examined. The purpose of this topical review is to provide the clinician with the most up-to-date knowledge related to eye movement abnormalities, screening measures, and evidence related to exercise interventions that are designed to enhance outcomes in persons after mTBI. Presence of eye misalignment such as tropias or phoria or symptoms with head/eye movements such as vestibulo-ocular reflex (VOR) × 1, saccades, or smooth pursuits may slow the person's recovery. Tools such as the Convergence Insufficiency Symptom Survey, the Vestibular/Ocular Motor Screening, the Pediatric Vestibular Symptom Questionnaire, and the Pediatric Visually Induced Dizziness questionnaire may aid in identifying visual concerns to target in the physical therapy intervention program. There is emerging evidence that vestibular rehabilitation enhances recovery in persons after mTBI. A thorough eye examination is highly recommended after mTBI to identify targeted areas for intervention.

Impacto de um programa de tratamento em pacientes com alterações na coluna

Objetivo: Avaliar o impacto de um programa de tratamento fisioterápico em pacientes com alterações na coluna. Métodos: Trata-se de um estudo experimental, longitudinal, quantitativo, realizado no município de Araxá. Participaram 81 pacientes do projeto Escola da Coluna, entre os meses de maio 2016 a abril de 2017. Eles deveriam apresentar alguma patologia de coluna, com encaminhamento médico específico e concordar em participar do projeto. Os participantes foram submetidos ao Pilates ou a Reeducação Postural Global, duas vezes por semana durante três meses de tratamento, em grupo, com duração média de 50 minutos. Foi realizada avaliação inicial e final dos distúrbios osteomusculares pelo questionário Nórdico de Sintomas Osteomusculares e avaliação do nível de incapacidade de pelo índice de Owestry. Ao final do programa os pacientes responderam um questionário para avaliar a satisfação com os resultados obtidos. Resultados: Tinham idade média de 49,7±12,34 anos. A média obtida com o questionário Owestry foi de 16,65±8,08 antes da intervenção e 11,63±7,89 após a intervenção. Houve maior proporção de dor incapacitante moderada (50,6%, n=41) antes do tratamento passando para 100% de dor incapacitante leve. Em relação aos resultados obtidos pelo questionário Nórdico de Sintomas Osteomusculares a maioria (76,5%, n=62) apresentou dor na região lombar, seguido pelo pescoço e região dorsal ambas com 49,4%, n=40. Conclusão: O programa de tratamento fisioterápico, por meio da Escola de Coluna, propiciou melhora geral no quadro clínico dos pacientes, principalmente na funcionalidade, limitação e dor.

Physical Therapy Management of a Critically-Ill Infant After Cardiac Surgery: A Case Report and Literature Review

Background and Purpose: This case report describes the physical therapy management of an infant with a congenital heart defect (CHD) from prior to her first palliative surgery until her discharge. A review of the literature identifies treatment interventions after cardiac surgery for children and adults but no specific management that can guide the physical therapy management of neonates and infants. Case Description: A female infant with hypoplastic left heart syndrome underwent a Norwood procedure at 5 days of life with delayed sternal closure on postoperative day 2. She failed the first attempt of extubation on postoperative day 3. Physical therapy was initiated the second day of life, and the last reevaluation was performed prior to discharge at 9 weeks of age. Outcomes: Measurements to identify postural control stability and the infant's reactions to visual and auditory stimuli were performed at 2 days and again at 9 weeks of age. The Test of Infant Motor Performance showed an improvement in scores at the time of discharge. Testing the 2 primitive reflexes evaluated in the study showed interference of one of the reflexes with her motor abilities during hospitalization. The result of the education given to the parents was evaluated through demonstration back of developmental activities, range of motion, and handling of their baby during daily care. Conclusion: The physical therapy intervention program provided to this infant with hypoplastic left heart syndrome exemplifies strategies that may be applicable to infants with complex CHD. It is possible to implement individualized developmental physical therapy interventions and assist in optimizing outcomes for an infant with complex CHD and their family in the cardiovascular intensive care unit setting.