Regular Physiotherapy Research Articles

Six-minute walk test and factors affecting exercise capacity in children with cystic fibrosis.

This study aimed to compare the result of the six-minute walk test (6MWT) in patients with cystic fibrosis (CF) aged < 20 years old and individuals without CF. In this cross-sectional study, 50 children and adolescents with CF and 20 children and adolescents without CF underwent the 6MWT. Vital signs before and immediately after the 6MWT and six-minute walk distance (6MWD) were evaluated. The mean change in heart rate, percentage of peripheral oxygen saturation (SpO2%), systolic blood pressure, respiratory rate, and dyspnea severity during the 6MWT was significantly higher in patients with CF. In the case group, 6MWD was associated with regular chest physical therapy (CPT) and forced expiratory volume (FEV)> 80%. Patients with CF receiving regular CPT or mechanical vibration and with FEV in the first second > 80% showed better physical capacity during the 6MWT (smaller Sp02% decline and lower dyspnea perception). Children and adolescents with CF have lower physical capacity compared to individuals without CF. CPT and mechanical vibration could be used to increase physical capacity in this population.

59 The effectiveness of a progressive resistance exercise class for Sarcopenic hospitalised older adults

Abstract Background Sarcopenia is common in the older inpatient population with an estimated prevalence of 22.6%. A Progressive Resistance Training (PRT) program addressing sarcopenia is recommended to counteract its adverse effects of increased falls and mortality. The delivery of exercise in the acute setting can pose a challenge for health care professionals. Therefore, this study aimed to examine the effectiveness of a PRT exercise class for older adults in an acute setting. Methods This was an observational study using a convenience sample of older adults undergoing physiotherapy within the hospital. All participants deemed medically suitable were referred by their primary physiotherapist. Participants underwent PRT including upper and lower body exercises, twice a week. These patients also undertook regular physiotherapy outside of the class. The primary outcome measures were the five times Sit-to-Stand (5STS) and bilateral hand-grip recorded by their primary physiotherapist pre-class attendance and on their last class. Results A total of 10 participants engaged in the PRT class. 70% were male and 30% were female with and average age of 77.5 years. The average number of classes attended was 3.1. Participants demonstrated an improvement in sarcopenic measure of 5STS, median change of 7.9 seconds (interquartile range [IQR] 4.88–11.75 seconds), and grip strength, median improvement in left 0.96 kgs (IQR -3.85-5.18) and right 0.1kgs (IQR -1.55-1.68). Conclusion This PRT exercise class demonstrated an improvement in sarcopenic measures in hospitalised older adults. These results are not exclusively due to PRT class attendance however this programme is an example of an effective way to address the negative effects of sarcopenia and the identified research gap in providing exercise in the acute setting. Further research is required to examine the effect of combining nutritional education with PRT training as an intervention for older adults with sarcopenia.

Suspicion of Duchenne Muscular Dystrophy in A 7-Year-Old Madurese Boy: A Rare Case Report

Introduction: Duchenne Muscular Dystrophy (DMD) is an X-linked disorder presenting in early childhood and characterized by proximal muscle weakness and calf hypertrophy in affected boys associated with a functional deficiency of dystrophin. The incidence of these cases reached 1 in 3500-6000 male births. Research at RSUPN Dr Cipto Mangunkusumo (RSCM) showed that DMD is the second most frequent neuromuscular disorder in children regardless there is no prevalence data available yet in Indonesia. It is quite complicated to diagnose DMD due to the limited facilities of genetic testing and its high cost. Case Presentation: A 7-year-old boy came with the main complaint of weakness in both legs progressively two years before admission. He had to hold onto the floor and then both knees when started to stand. There was a history of motor and speech delay but family history was denied. Vital signs and nutritional status were within normal. Laboratory examination revealed significantly elevated levels of CK, ALT, and AST. The EMG result supported the presence of myopathy. Due to a lack of facilities, genetic testing or muscle biopsy could not be done. He received prednisone once a day with a 14 mg dose and was scheduled to attend regular physiotherapy. Conclusion: In a limited facilities area, the clinician should have a suspicion of DMD not only by anamnesis and clinical features, but also by considering the elevated levels of CK and myopathies on EMG.

Median to Radial Nerve Transfer: An 8-Year Experience From a Lower-Middle Income Country

IntroductionWith an incidence of 2-16%, radial nerve palsy is one of the common forms of nerve injuries globally. Radial nerve palsy causes debilitating effects including loss of elbow extension, wrist drop and loss of finger extension. Reparative surgical pathways range from primary repair and neurolysis, to nerve grafting, nerve transfers, and tendon transfers. Due to ease of performance and acceptability and reproducibility of outcomes, tendon transfers are considered the gold standard of radial nerve palsy repair. However, independent finger function cannot be achieved and as such may not give truly desirable results. In lower-middle income countries, the question of nerve transfer versus tendon transfer for patients who are keen to get back to work is key. While tendon transfer recovery is faster, the functional loss is often considered devastating for fine hand function due to loss of grip secondary to lack of wrist and finger extension. In this study, we present our experience of performing median nerve transfers for radial nerve palsy in Pakistan. MethodsWe performed a retrospective case-series of patients undergoing median to radial nerve transfer for radial nerve palsy over a period of 6 y, from 2012 to 2019. Patients with radial nerve palsy were diagnosed via electromyography and nerve conduction studies. The procedure involved coapting the branches of the flexor carpi radialis and flexor digitorum superficialis (long and ring finger) nerves to the posterior interosseous nerve and extensor carpi radialis brevis, respectively. Patients were assessed using the Medical Research Council scale for muscle strength of wrist, finger and thumb extension separately at 1 y time. Our results were then compared to results from similar nerve transfer studies. ResultsWe operated on 10 right-hand dominant patients, eight males and two females with a median age of 33 y (6-63 y). four sustained injury to the right hand and six to the left. Causes of the injuries included road traffic accident (n = 3), firearm injury (n = 4), shrapnel (n = 1), iatrogenic injury (injection in deltoid region (n = 1) and fall (n = 1). Types of fracture included mid humerus fracture, fracture of the surgical neck of the humerus, and supracondylar fracture of the humerus. Median time to surgery since injury was 4 mo (1-8 mo). Independent wrist extension was M4+ in all patients and independent finger extension was M4+ in seven and M4-in two patients. However, a patient who presented late at 8 mo had poorer finger outcomes with extension at M2-. All patients had independent movement of fingers. ConclusionsNerve transfer is a reliable method of post traumatic nerve repair and reinnervation, particularly in lower-middle income countries, even in cases where the nerve damage is severe and extensive and up to 6 mo may have elapsed between injury and presentation. Timely median to radial nerve transfer is a highly recommended option for radial nerve palsy, with regular follow-ups and physical therapy added to ensure positive outcomes.

Physiotherapy Management for Complete Right Lung Collapse- is there role of mechanical insufflation and exsufflation? -A Case Report

We are reporting, a case of 52 year old male, with obstructive uropathy who underwent cystolithotripsy surgery associated with chronic kidney disease presented with respiratory distress, tachypnea and hypoxia on 3rd post-operative day. He was on maintenance hemodialysis. Examination revealed absent air-entry on right side, dull percussion note on right side and positive trail sign. Chest X-ray and HRCT showed complete collapse of right lung with ipsilateral shift of trachea with mediastinum. Conventional physiotherapy postural drainage, breathing exercises, active cycle of breathing technique, forced expiratory techniques, spirometry, nebulization given for a day, no improvement seen because patient had strong cough reflex but unable to expectorate; any effort to cough caused more distress and breathing difficulty. Mechanical insufflation-exsufflation, a therapy in which the device which inflates the lungs(Insufflation pressure start at 15-20 cmH2O and increase to give an inspiration to total lung capacity, last for 2 second) followed by an immediate and abrupt change to negative pressure (exsufflation pressure same as the insufflation, then increase up to 10–20cmH2O, held for 3-6 second), which produces rapid exhalation, simulates cough and thus moves secretions cephaladly. Thus device helps patient cough out effectively. Lung collapse resolved within 1 day, regular physiotherapy was given to prevent recurrent lung collapse until discharge, X-ray and auscultation findings and oxygen saturation improved. It concludes, successful utilization of chest physiotherapy and mechanical insufflators-exsufflators aids in the resolution of lung collapse in an urgent situation. KEYWORDS: Mechanical insufflator-exsufflator, Atelectasis, chronic kidney disease, cystolithotripsy

Effects of compression garments on balance in hypermobile Ehlers-Danlos syndrome: a randomized controlled trial

Purpose To evaluate the immediate and 4-week effects of compression garments (CG) on balance using a force platform during 8 different visual, static, and dynamic conditions in hypermobile Ehlers-Danlos Syndrome (hEDS) patients. Methods Thirty-six participants were randomly assigned to a group: physiotherapy alone (PT, n = 19) or physiotherapy and daily CG wearing for 4 weeks (PT + CG, n = 17). Both attended 12 physiotherapy sessions (strengthening, proprioception, and balance exercises) for 4 weeks. Primary outcome: sway velocity of the centre of pressure (COP) measured before, immediately with the CG, and at 4 weeks. Secondary outcomes: ellipse area, Romberg quotient, and pain. Results Sway velocity in dynamic conditions decreased immediately with the CG. After 4 weeks of intervention, sway velocity (95% CI 4.36–39.23, effect size 0.93) and area (95% CI 146–3274, effect size 0.45) on the laterally oscillating platform with eyes-closed improved more in the PT + CG group than the PT group. Romberg quotient on foam cushion improved more in the PT + CG than the PT group. Pain decreased in both groups after 4 weeks with no between-group difference. Conclusion CG combined with physiotherapy improved dynamic balance measured with COP variables significantly more than physiotherapy alone in people with hEDS. Trial Registration NCT03359135

Impact of the COVID-19 pandemic on the quality of life and accessing rehabilitation services among patients with spinal cord injury and their fear of COVID-19

BackgroundThe unanticipated coronavirus disease (COVID-19) had a negative effect on the quality of life (QoL) of patients with spinal cord injury (SCI) and made significant changes in their daily routine. Patients with SCI face additional health risks, especially mental, behavioral, and physical. Without regular physiotherapy sessions, patients' psychological and functional abilities can deteriorate, and complications can occur. There is little information available about the impact of COVID-19 on the quality of life of patients with SCI, and their access to rehabilitation services during the pandemic.ObjectiveThis study was designed to examine the effects of the COVID-19 pandemic on the quality of life of patients with SCI and also their fear of COVID-19. The pandemic’s impact on the accessibility of rehabilitation services and attendance at physiotherapy sessions in one Chinese hospital were also documented.DesignAn observational study based on an online survey.SettingOutpatients clinic at the rehabilitation department of Wuhan's Tongji Hospital.ParticipantsPeople who had been diagnosed with a spinal cord injury (SCI) and who were receiving regular medical monitoring as outpatients at the rehabilitation department were invited to participate in our study (n = 127).InterventionNot applicable.Outcome measuresA 12-Item Short-Form Health Survey (SF-12) designed to measure participants' quality of life before and during the pandemic. Their fear of COVID-19 was quantified using the Fear of COVID-19 Scale (FCV-19S). Demographic and medical status information was extracted from their medical records. Their use of rehabilitation services and attendance at physical therapy sessions was also documented.ResultsSeventy-nine patients with SCI completed the SF-12 and FCV-19 scale. The mental and physical aspects of the participants’ quality of life declined significantly, during the epidemic compared to the pre-epidemic period. More than half of the participants have experienced fear of COVID-19 based on FCV-19S. Most received only irregular physical therapy during routine checkups. Worry about virus transmission was the most common cause cited for not attending regular physical therapy sessions.ConclusionsThe quality of life of these Chinese patients with SCI declined during the pandemic. Most of the participants were shown a high level of fear of COVID-19 and were classified as having an intense fear of COVID-19, in addition to the impact of the pandemic on their access to rehabilitation services and attendance at physical therapy sessions.

Resistance Training in Wilson Disease: A Case Study

A 15-year-old boy was diagnosed with Wilson disease and referred to a physiotherapy clinic for treatment. He received daily physical therapy exercises with resistance training three times a week for 70 minutes for 8 weeks. The performance of daily activities was evaluated using the Persian version of the disabilities of the arm, shoulder, and hand (DASH) questionnaire. Upper limb muscle strength was assessed using a manual muscle strength test. The DASH questionnaire score decreased from 67.24 before treatment to 46.55 after 4 weeks and 36.20 after 8 weeks. In addition, shoulder flexion and extension are improved. The analysis of resistance exercises to facilitate distal muscles through the use of manual muscle tests showed an improvement in the strength of both hands. The present study suggests that regular physical therapy and exercise may help improve daily activity and muscle strength in Wilson disease.

EFFECT OF COMPLEMENTARY THERAPY ON HIP ABDUCTION IN CHILDREN WITH CEREBRAL PALSY

Background: Mechanical Horse Riding Simulator (MHRS) is one of the complementary therapy used in the rehabilitation of children with cerebral palsy which produces rhythmical and repetitive movements. It is working under the principles of hippotherapy and considered an alternative method for hippotherapy. Purpose: This study aimed to nd out the effectiveness of a mechanical horse riding simulator on hip abduction range of motion in children with spastic diplegia and evaluate the magnitude of improvement at different periods (2 weeks, 4 weeks, and 6 weeks). This study included 30 childre Methods: n with spastic diplegia and was divided into two groups, the experimental and the control group. The experimental group received 15 minutes of complementary therapy with MHRS, 3 days/ week for 6 weeks along with regular physiotherapy, while the control group received 15 minutes of conventional trunk control exercise along with the regular physiotherapy session. Hip abduction passive range of motion (PROM) was measured with the Goniometer. Pre and postintervention scores were recorded and analyzed with appropriate statistical tools. The baseline characteristics were similar in both Results: groups before the intervention with the p-value (p&gt;0.01). The observed mean value of hip abduction PROM has been improved in both groups over 6 weeks and the experimental group shows signicantly better improvement (p&lt;0.01) than the control group in all the weeks. Conclusion: The study results conrmed that gradual improvement of hip abduction passive range of motion (both sides) was observed in both groups. Children exposed to MHRS show better improvement than the children in the control group. It was concluded that the MHRS is an effective complementary therapy improving hip abduction passive range of motion (both sides) in children with spastic diplegia and the provision of MHRS in longer duration provides more benets than the shorter duration.

Effectiveness of Home Based Telerehabilitation for Forward Versus Backward Stepping Strategy in Ground Walking Training on Functional Mobility and Balance Among Spastic Diplegic Cerebral Palsy-- A Simple Experimental Study

Background: The primary focus of physiotherapy interventions for children with CP is to improve locomotor function and functional activities. It is suggested that walking training activates neural circuits that mediate central pattern generators to activate limb muscles repetitively and produced rhythmic movements. Additionally, it adjusts control between agonist and antagonist muscles, leading to enhanced walking speed, and static and functional balance. The purpose of the study is to find out the effectiveness of home based telerehabilitation for forward stepping vs backward stepping strategy in ground walking training on functional mobility and balance among spastic diplegic cerebral palsy. Methodology: A simple experimental study was conducted on 24 spastic diplegic cerebral palsy who fulfill the selection criteria were selected for this study at the telerehabilitation Unit. A clear explanation was given to every subject and parents/guardian about the procedures and a written consent was obtained from them. Twenty spastic diplegic children were evaluated in person in the department for pre-training and post-training were used as a study design with total study duration was six weeks. (from April 2021 to May 2021). The subjects in group A&amp;B were consisting of 12 subjects and they were treated with home based telerehabilitation for forward and backward ground walking training. Along with that both the group children received routine physiotherapy. Both the groups were received intervention for 15-30 minutes per session, 5 days in a week for a period of 6 weeks. The pre and post score values of balance and functional mobility were measured by using, GMFM walking dimension, modified timed get up and go test and Pediatric Berg balance scale. The values were recorded and documented. Result: In the statistical analysis of pretest values of both group A and group B were calculated. The pre mean values of PBS for both groups were 33.33 and 33.38. The T-value was 0.3721 the obtained t-value is lesser than the table value and the P-value showed there were no significant in pretest comparison. The posttest mean values of PBS for both groups were 46.08 and 46.33.The T-value was 2.38967,the obtained t-value is greater than the table value. and the P-value showed there were significant in posttest comparison. Alternative hypothesis was accepted. Hence the statistical report states that there were statistically significant differences in posttest comparison. The post score values of the Gross Motor Function Meaure-88, Pediatric Berg Balance Scale and TUG test score in all the variables showed significant difference. Conclusion: The study concluded that the 6 weeks of backward stepping strategy in ground walking home based telerehabilitation training program along with regular physiotherapy treatment showed statistically significant improvement in balance and functional mobility among spastic diplegic children when compared to forward stepping strategy in ground walking home based telerehabilitation training program.

Symptoms: Dizziness and Deafness

Symptoms: Dizziness and Deafness

Management of Oral Sub Mucous Fibrosis Using Three Different Flaps: Superficial Temporal, Nasolabial Flap, Buccal Fat Pad Flap Along with Active Physiotherapy- A Comparative Study.

To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients.

Postpartum Guillain-Barré syndrome: a case report.

Case of 27 years female with parity 1, living 1, on postpartum day 20 presented to the emergency department (ED) with weakness over legs and hands since 20 days following emergency lower segment cesarean section for her delivery. The weakness prevailed over the lower extremities and progressed to the upper extremities in 4-5 days, affecting her grip strength and ability to stand alone. No history of prior diarrheal or respiratory illness. Cerebrospinal fluid analysis revealed albuminocytologic dissociation. A nerve conduction study showed in-excitable bilateral radial, median, ulnar, and sural nerves. Intravenous immunoglobulin was administered at the rate of 0.4g/kg once daily for 5 days. Patient was discharged after 2 weeks with regular physiotherapy follow-up. GBS in the postpartum period is very rare. There must be a high degree of suspicion among physicians for GBS if a pregnant female or a woman during her postpartum period presents with ascending muscle paralysis, even if there is no recent antecedent history of diarrheal episodes or respiratory illness. An early diagnosis with multidisciplinary supportive measures helps improve the prognosis for both the mother and the fetus.

Web-based E-survey in identifying current physiotherapy practices in paediatric burns

IntroductionPhysiotherapy practices in pediatric burns involves relaxation techniques and exercise training for attaining physical fitness, improving quality of life and, thereby to prevent primary and secondary complications. Physical activity and exercise act as a meaningful and purposeful tool for attaining physical fitness after burn injury. AimThe aim of this e-survey is to identify the current practices of physiotherapy interventions in pediatric burn rehabilitation among physiotherapy students and professionals. MethodsThe e-survey was created with validated questionnaire using a Google Forms to gather the information related to current physiotherapy practices in pediatric burns. After the sample size estimation, survey link were sent to identified 144 physiotherapy students and professionals using social networking sites which includes, WhatsApp, Facebook and Instagram for this cross-sectional e-survey. The frequency and percentage of survey responses were analyzed. ResultsAmong 144 identified participants, 62 participants completed the survey, resulting in the response rate of (43.0%). The findings of this study revealed that> 50% of physiotherapy students, and professionals, are performing pain and scar assessment, along with their regular physiotherapy management in children with burns. In addition to these, they also practice physiotherapy for burn conditions in pediatric intensive care units (PICU), pediatric wards, and clinical outpatient department (OPD) settings. ConclusionPhysiotherapy students and professionals have sufficient knowledge regarding pediatric burns complications, and also, they are well aware regarding recent physiotherapy practices in pediatric burn care management.

Positive effects of neuromuscular exercises on pain and active range of motion in idiopathic frozen shoulder: a randomized controlled trial

Background and objectivesFrozen shoulder (FS) is characterized by pain and significant loss of active and passive shoulder motion. Strengthening exercises are among the standard exercises used for FS. Neuromuscular exercise (NME) effectively improved pain and the range of motion in shoulder. However, no prior research has looked into the effects of NME compared to strengthening exercises in FS rehabilitation. The aim of the present study was to evaluate the effects of NME compared to strengthening exercises on pain and active range of motion (AROM) in individuals with idiopathic frozen shoulder.MethodsForty individuals with idiopathic frozen shoulder were randomly assigned to either the experimental group (NME with regular physical therapy, n = 20) or the control group (strengthening exercises with regular physical therapy, n = 20). In both groups, the interventions were performed once a day, 5 days a week for 8 weeks. Pain scores on the visual analogue scale (VAS) and AROM of the shoulder were assessed at baseline and after the 8-week treatment. The primary analysis was the group × time interaction.ResultsTwo-by-two mixed analysis of variance (ANOVA) revealed a significant group × time interaction for VAS (F = 29.67; p < 0.01); AROM in flexion (F = 12.05; p < 0.01), internal rotation (F = 6.62; p < 0.05) and external rotation (F = 16.93; p < 0.01) in favor of the experimental group. The two-by-two mixed ANOVA revealed a significant main effect of time for VAS (F = 1648.47; p < 0.01); AROM in flexion (F = 591.70; p < 0.01), extension (F = 114.57; p < 0.01), abduction (F = 1602.04; p < 0.01), internal rotation (F = 664.14; p < 0.01) and external rotation (F = 1096.92; p < 0.01). No other significant differences were found.ConclusionsNME is superior to strengthening exercises in terms of pain and AROM of shoulder flexion, internal rotation and external rotation in individuals with idiopathic FS. NME could be used to treat individuals with FS.Trial registrationTrial registration number: ChiCTR2100054453. Registration date: 17/12/2021.

Is modified constraint-induced movement therapy effective in improving motor performance in patients with hemiplegia?

Aim: To investigate the effect of modified constraint-induced movement therapy (mCIMT) on upper extremity motor recovery, performance, and functional independence in addition to conventional rehabilitation in stroke patients.Methods: The study included 40 participants, including 20 chronic stroke cases in the intervention group (IG) (64.45±9.18 years) and 20 chronic stroke cases in the control group (CG) (64.45±9.18 years) who met the selection criteria. IG received mCIMT with regular physiotherapy, while CG received only regular physiotherapy. The patients were evaluated with the Motor Activity Log-28 (MAL-28), the Functional Independence Measure (FIM), and the Fugl-Meyer Upper Extremity Scale (FMUES) before treatment, immediately after treatment (post-treatment), and at three months after treatment (follow-up).Results: The MAL-28 and FIM scores significantly increased in both groups compared with the baseline values after treatment and at the third-month follow-up (p&amp;lt;0.05). After treatment and at the third-month follow-up, the FMUES scores significantly increased in both groups compared with the baseline values (p&amp;lt;0.001).Conclusion: This study showed that mCIMT added to conventional therapy improved upper extremity motor function, performance, and functional independence in chronic stroke patients; however, mCIMT had no additional benefit to conventional therapy.

A creative approach to managing a case of haemophilia A with inhibitors in a low-resource country: case report

Abstract The development of antibodies to therapeutic factor VIII, known as inhibitors, is a leading cause of morbidity and mortality in people with haemophilia. This is particularly challenging in areas where access to novel treatment options is limited. This case report presents a clinical scenario in South Western India involving a 16-year-old male with severe haemophilia A with high titre inhibitors, who sustained a tibia-fibula shaft fracture necessitating emergency surgical intervention. The successful management of this patient required a multidisciplinary approach, encompassing haemostasis optimisation, innovative factor replacement strategies to work around financial constraints, and a comprehensive rehabilitation plan. The patient’s history of multiple factor VIII concentrate transfusions contributed to inhibitor development. Limited funds for bypassing agents prompted the utilisation of fresh frozen plasma to achieve haemostasis before access to FEIBA and recombinant factor VII. Emicizumab, a subcutaneously administered bispecific antibody, was used to assist perioperative haemostasis. A comprehensive rehabilitation plan with regular physiotherapy was followed. Emicizumab prophylaxis was initiated and the patient now shows improvement. This case emphasises the importance of novel treatment options such as FEIBA and emicizumab in dealing with complications in haemophilia such as inhibitors. In resource-limited settings, there is still a need to improve the availability of these life-saving interventions to optimise surgical outcomes in such cases.

Assessment of the Effectiveness of Kinetic Chain Approach for Primary Adhesive Capsulitis of ShoulderAn Experimental Study

Introduction: Idiopathic adhesive capsulitis is characterised by gradual onset of pain in shoulder and its limited mobility of motion due to a thickened capsule with an unknown cause. The peak incidence rate is between the ages of 40 and 60 years with less chances of occurrence in the younger group and individuals, who engage in physical labour are far less likely to experience it. In order to determine whether the kinetic chain approach is more effective, researchers tested it on individuals with adhesive capsulitis. Aim: To assess effectiveness of the kinetic chain approach for treating primary adhesive capsulitis. Materials and Methods: This pre and postexperimental study was conducted at the Department of Physiotherapy, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, for a period of one year from January 2020 to December 2020. A total of 60 patients with primary adhesive capsulitis were included in the trial and were divided into Group-A and Group-B using a systematic random sampling process. Group A received traditional physiotherapy in addition to the Kinetic chain technique. In Group B, regular physiotherapy was the only treatment provided to patients. The Range of Motion (ROM), Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI) were measured in both groups pre, mid and posttreatment groups. Non parametric statistical techniques were used to analyse the data owing its originality. Results: A total of 30 patients in each Group (A and B) were provided with Kinetic chain approach (mean age=53.93 years) and conventional physiotherapy (mean age=55.40 years), respectively. For comparing data within the same group, Wilcoxon signed-ranks test was used for this. Mann Whitney U-test was used to compare the data between groups. The p-values for the VAS, SPADI, and ROM showed statistical significance at the 0.001 level. In terms of pain, functional impairment, and range of motion, with Group A showing greater strides than Group B. Conclusion: The combination of kinetic chain technique and traditional physiotherapy was more beneficial than either group when used singularly to reduce discomfort, increase the range of motion, and enhance functional capacity in adhesive capsulitis patients.

Prediction of 2-year clinical outcome trajectories in patients undergoing anterior cervical discectomy and fusion for spondylotic radiculopathy.

Anterior cervical discectomy and fusion (ACDF) is often described as the gold standard surgical technique for cervical spondylotic radiculopathy. Although outcomes are considered favorable, there is little prognostic evidence to guide patient selection for ACDF. This study aimed to 1) describe the 24-month postoperative trajectories of arm pain, neck pain, and pain-related disability; and 2) identify perioperative prognostic factors that predict trajectories representing poor clinical outcomes. In this retrospective cohort study, patients with cervical spondylotic radiculopathy who underwent ACDF at 1 of 12 orthopedic or neurological surgery centers were recruited. Potential outcome predictors included demographic, health, clinical, and surgery-related prognostic factors. Surgical outcomes were classified by trajectories of arm pain intensity, neck pain intensity (numeric pain rating scales), and pain-related disability (Neck Disability Index) from before surgery to 24 months postsurgery. Trajectories of postoperative pain and disability were estimated with latent class growth analysis, and prognostic factors associated with poor outcome trajectory were identified with robust Poisson models. The authors included data from 352 patients (mean age 50.9 [SD 9.5] years; 43.8% female). The models estimated that 15.5%-23.5% of patients followed a trajectory consistent with a poor clinical outcome. Lower physical and mental health-related quality of life, moderate to severe risk of depression, and longer surgical wait time and procedure time predicted poor postoperative trajectories for all outcomes. Receiving compensation and smoking additionally predicted a poor neck pain outcome. Regular exercise, physiotherapy, and spinal injections before surgery were associated with a lower risk of poor disability outcome. Patients who used daily opioids, those with worse general health, or those who reported predominant neck pain or a history of depression were at greater risk of poor disability outcome. Patients who undergo ACDF for cervical spondylotic radiculopathy experience heterogeneous postoperative trajectories of pain and disability, with 15.5%-23.5% of patients experiencing poor outcomes. Demographic, health, clinical, and surgery-related prognostic factors can predict ACDF outcomes. This information may further assist surgeons with patient selection and with setting realistic expectations. Future studies are needed to replicate and validate these findings prior to confident clinical implementation.

Effect of high-intensity interval exercise on pain, disability, and autonomic balance in female patients with nonspecific chronic low back pain

Aim. to assess the impact of a 6-weeks high-intensity interval exercise (HIIE) regimen on pain, disability, as well as autonomic balance in women with nonspecific chronic low back pain (NSCLBP). Materials and methods. Eighty females with mild to moderate NSCLBP, with ages of 18-65 years, were recruited from the physiotherapy department at King Fahd University Hospital, AlKhobar. They were assigned randomly into the control group (n = 40), which received standard regular physiotherapy, or the experimental group (n = 40), which received HIIE as well as conventional regular physiotherapy. Pre- and post-intervention (after 6 weeks) assessments included pain intensity via Numerical Rating Scale (NRS), disability via Oswestry Disability Index (ODI), as well as autonomic balance via heart rate variability (HRV) parameters &amp; baroreceptor sensitivity (BRS) Both at rest and in reaction to an orthostatic challenge. Results. Both groups experienced significant improvements in pain and disability, with the HIIE group experiencing a higher improvement in both variables. For the HRV parameters after 6 weeks of intervention, the control group had a statistically significant reduction in high frequency (HF), and in response to the orthostatic challenge, a significantly higher rise in the normalized low frequency (LFnu) compared to the baseline. BRS showed a significant reduction and heart rate recovery was significantly faster post-intervention in the HIIE group in the 2nd and 3rd minutes, compared to the baseline values. Conclusions. HIIE can be a valuable addition to NSCLBP patients’ exercise routines in practice, since adding HIIE to standard physiotherapy resulted in more reduction in pain, disability compared to conventional physiotherapy alone, with enhanced autonomic regulation after six weeks of treatment.