Rehabilitation Protocol Research Articles

Rehabilitation to Improve Outcomes after Cervical Spine Surgery: Narrative Review.

The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in optimal recovery after cervical spine surgeries. Nevertheless, there is no agreement in the existing research regarding the most suitable postsurgical rehabilitation program. Consequently, this review assesses the ideal rehabilitation approach for adult patients following cervical spine operations. This review covers activities of daily living and encompasses diverse treatment methods, including physiotherapy, specialized tools, and guidance for everyday activities. The review is organized under three headings: (1) historical perspectives, (2) patient-reported functional outcomes, and (3) general and disease-specific rehabilitation. Rehabilitation programs are determined on the basis of patient-reported outcomes, performance tests, and disease prognosis. CSM requires strengthening of the neck and shoulder muscles that have been surgically invaded. In contrast, the CCI requires mobility according to the severity of the spinal cord injury and functional prognosis. The goal of rehabilitation for CCTs, as for CCIs, is to achieve ambulation, but the prognosis and impact of cancer treatment must be considered. Rehabilitation of the cervical spine after surgery is essential for improving physical function and the ability to perform daily activities and enhancing overall quality of life. The rehabilitation process should encompass general as well as disease-specific exercises. While current rehabilitation protocols heavily focus on strengthening muscles, they often neglect the crucial aspect of spinal balance. Therefore, giving equal attention to muscle reinforcement and the enhancement of spinal balance following surgery on the cervical spine is vital.

Comparison of outcomes after total hip arthroplasty in hip fracture versus elective cases in patients over 60 years of age

BackgroundTotal hip arthroplasty (THA) allows for the replacement of impaired parts of the hip joint with artificial ones. This study aimed to compare the differences in preoperative patient profiles, postoperative complications, and clinical outcomes of two patient groups: those who underwent THA for fractures and those who underwent THA electively for diseases such as osteoarthritis (OA) and avascular necrosis (AVN). MethodsWe retrospectively analyzed the data of patients who underwent THA between March 2012 and December 2021. Of 232 patients, 173 patients who met the exclusion and inclusion criteria were included. Patients were divided into two groups (Group 1: 113 patients diagnosed with OA or AVN; Group 2: 60 patients diagnosed with hip fracture). Pre- and postoperative Visual Analogue Scale (VAS), Koval scores, and postoperative modified Harris Hip Score (mHHS) were used to assess clinical outcomes. Demographic data and postoperative complications of the two groups were compared. After surgery, a rehabilitation protocol was initiated. ResultsPatients in Group 2 (fracture) had more preoperative comorbidities than those in Group 1 (elective). Follow-up months are 26.22 ± 19.78 (Group 1), and 27.42 ± 17.02 (Group 2) respectively (P > 0.05). There were no statistical differences in the prevalence of postoperative complications between two groups (P > 0.05). Compared with Group 1(elective), Group 2(fracture) showed lower VAS (P < 0.01) at last follow-up, and no difference in Koval score (P = 0.77) and mHHS (P = 0.96) at last follow-up. ConclusionConsidering the characteristics of the two groups and their perioperative multidisciplinary care, THA for hip fractures can provide good clinical results compared to those with elective THA.

The program of comprehensive personalized rehabilitation after surgical treatment for endometrial cancer: the results of a prospective randomized comparative study

Background. The problems of diagnosis, treatment and rehabilitation of patients with endometrial cancer (EC) remain relevant for the entire medical community. Radical surgical intervention shows high efficiency among the existing methods of EC treatment. However, it causes many complications that require rehabilitation support for patients. The development of new instruments and protocols for rehabilitation of EC patients is necessary.Objective: to evaluate the effectiveness of comprehensive personalized rehabilitation program in patients after radical surgical EC treatment.Material and methods. A prospective randomized comparative study included 61 patients with histologically verified stage IA endometrioid adenocarcinoma of high or moderate differentiation degree. The patients were divided into two groups: the group of “active” rehabilitation (n=29), and the group of “passive” rehabilitation (n=32). During 1 year, their physical, mental health and social engagement were assessed using questionnaires.Results. The survey showed a low level of physical, functional, emotional and social well-being of EC patients at the first 3–7 days after surgery. After 12 months, a recovery in the quality of life of all participants was observed. However, patients undergoing “active” rehabilitation recovered significantly faster, and their quality of life was significantly higher compared to patients undergoing “passive” rehabilitation.Conclusion. The obtained results indicate the effectiveness of a personalized approach in rehabilitation of EC patients. It is expected that its implementation will considerably reduce the incidence of complications and the burden on the healthcare system.

Qualitative Magnetic Resonance Imaging Assessment of the Semimembranosus Tendon in Patients with Medial Meniscal Tears.

To determine if there is an association between semimembranosus tendinosis and medial meniscal tears using MRI. A retrospective review of knee 3T MRI scans was performed to determine the presence or absence of medial meniscal tears in patients with semimembranosus tendinosis. All studies were interpreted by two musculoskeletal radiologists. Univariate association for the presence of semimembranosus tendinosis and medial meniscal tears was performed with a Chi-square test followed by logistic regression modelling among statistically significant associations. A total of 150 knee MRI scans were reviewed (age 32.8 ± 7.1 years; 70 females). Semimembranosus tendinosis was present in 66 knees (44%) in the patient population. Semimembranosus tendinosis was present in 81% of patients with meniscal tears versus 36% of patients without meniscal tears (p < 0.0001). This association remained statistically significant when adjusted for age and sex with an adjusted odds ratio of 7.0 (p < 0.0003). Models adjusted for the above covariates and containing the interaction term produced an adjusted odds ratio of 13.0 (p < 0.0001) in men, while in women this association was non-significant with an adjusted odds ratio of 2.0 (p = 0.42). Subjects with semimembranosus tendinosis were seven times more likely to have medial meniscal tears even when adjusting for sex and age. This could help guide the appropriate postmeniscal repair rehabilitation protocol.

The influence of rehabilitation on the quality of life after radical treatment of endometrial cancer and atypical endometrial hyperplasia

Background. Gynecological cancers in women are a widespread type of oncology. Among them, endometrial cancer (EC) is often highlighted as one of the most common diseases in this group. The analysis of publications showed insufficient effectiveness of rehabilitation in patients with EC and recurrent atypical endometrial hyperplasia (rAEH).Objective: to compare the state of patients with rAEH or EC after hysterectomy with bilateral salpingo-oophorectomy, depending on the recovery tactics.Material and methods. The study included 119 patients diagnosed with rAEH (n=58) or stage IA EC (n=61) after hysterectomy with bilateral salpingo-oophorectomy. The group of women with rAEH was divided into two subgroups: 1A (“active” rehabilitation, n=27) and 1B (“passive” rehabilitation, n=31); two subgroups were also formed from the cohort of EC patients: 2A (“active” rehabilitation, n=29) and 2B (“passive” rehabilitation, n=32). “Active’ rehabilitation included a comprehensive, personalized program, “passive” one was based on standard rehabilitation protocols. Apart from standard clinical examination of patients, their quality of life (QoL), physical condition as well as the levels of cytokines and other biochemical blood parameters were assessed.Results. An analysis of the overall picture showed a high incidence of rAEH or EC in women aged 40–49 years. Comorbid pathologies, low QoL level and a number of significant changes in laboratory parameters were often observed. Regardless of the approach to rehabilitation, the patients' health improved over the course of 12 months. “Active” rehabilitation significantly improved psychological well-being, sexual function, overall QoL and a number of other objective health indicators of patients with rAEH or EC compared to standard rehabilitation course.Conclusion. The overall picture of rAEH or EC patients was presented, the main factors that reduce QoL in women with these diseases were identified. A system of integral QoL assessment in patients with rAEH or stage IA EC was developed including subjective and objective parameters obtained during general clinical examination, laboratory tests and analysis of questionnairing results, which should be used to adequately monitor the state of patients after surgery and the effectiveness of rehabilitation. The advantage of comprehensive rehabilitation over standard protocols in terms of efficiency and speed of recovery was shown.

Athletes With Adductor-Related Groin Pain: A Narrative Review.

Adductor-related groin pain is extremely common among athletes, and despite its high prevalence and impact, there is no consensus regarding taxonomy, anatomy, physiopathology, or treatment. We performed a comprehensive literature review and tried to demystify this pathology and its treatment. The Doha agreement classification and its impact are scrutinized as well as the complexity of the proximal adductor longus (AL) insertion and its relationship with the pyramidalis-anterior pubic ligament-AL complex. The stress-shielding and compression theories for the origin of AL tendon pathology are exploited along with how this knowledge translates into injury prevention protocols and surgical techniques. The importance of active rehabilitation protocols and intersegmental control-focused programs is highlighted. The role of an enthesis injection in the treatment algorithm is discussed along with when to perform a tenotomy. The differences between selective and complete tenotomy are highlighted.

Return to Sport Following Arthroscopic Management of Femoroacetabular Impingement: A Systematic Review.

Background: Femoroacetabular impingement (FAI) is common. The present systematic review updates the current evidence on return to sport (RTS) in patients who have undergone arthroscopic surgery for FAI in any of its variants (CAM, pincer, or both). Methods: The outcomes of interest were sports-related patient-reported outcome measures (PROMs) and the level and time to RTS. All available clinical studies concerning the RTS following arthroscopic management of FAI were considered. In July 2024, the following databases were accessed following the PRISMA guidelines: Embase, Web of Science, and PubMed. Only studies with a minimum of six months of follow-up were eligible. Results: From 1245 initially identified articles, 43 studies (4103 patients) met the inclusion criteria, in which 32.1% (1317 of 4103 patients) were women. The mean length of follow-up was 33.7 ± 15.8 months. The mean age was 28.1 ± 7.2 years, the mean BMI was 24.7 ± 6.4 kg/m2, and 79.6% ± 27.8% of patients returned to sport at the same or higher level at a mean of 14.3 ± 9.6 months. The mean time away from sports was 8.0 ± 3.3 months. Conclusion: Arthroscopic management for FAI leads to a high rate of RTS, with approximately 80% of patients returning to their preinjury level. Future research should focus on standardised definitions of RTS, sport-specific rehabilitation protocols, and the influence of deformity and procedures on RTS.

Determination of the internal loads experienced by proximal phalanx fracture fixations during rehabilitation exercises.

Phalangeal fractures are common, particularly in younger patients, leading to a large economic burden due to higher incident rates among patients of working age. In traumatic cases where the fracture may be unstable, plate fixation has grown in popularity due to its greater construct rigidity. However, these metal plates have increased reoperation rates due to inflammation of the surrounding soft tissue. To overcome these challenges, a novel osteosynthesis platform, AdhFix, has been developed. This method uses a light-curable polymer that can be shaped in situ around traditional metal screws to create a plate-like structure that has been shown to not induce soft tissue adhesions. However, to effectively evaluate any novel osteosynthesis device, the biomechanical environment must first be understood. In this study, the internal loads in a phalangeal plate osteosynthesis were measured under simulated rehabilitation exercises. In a human hand cadaver study, a plastic plate with known biomechanical properties was used to fix a 3mm osteotomy and each finger was fully flexed to mimic traditional rehabilitation exercises. The displacements of the bone fragments were tracked with a stereographic camera system and coupled with specimen specific finite element (FE) models to calculate the internal loads in the osteosynthesis. Following this, AdhFix patches were created and monotonically tested under similar conditions to determine survival of the novel technique. The internal bending moment in the osteosynthesis was 6.78 ± 1.62Nmm and none of the AdhFix patches failed under the monotonic rehabilitation exercises. This study demonstrates a method to calculate the internal loads on an osteosynthesis device during non-load bearing exercises and that the novel AdhFix solution did not fail under traditional rehabilitation protocols in this controlled setting. Further studies are required prior to clinical application.

Adolescent Shoulder Reconstruction Techniques in Brachial Plexus Birth Injury

Brachial plexus birth injury (BPBI) is common and while most recover, 8-36% of patients experience permanent impairment. Typically, adolescents with untreated BPBI lack active and passive external shoulder rotation (ER) and overhead shoulder function. Limited shoulder function is due to 1) nonoperative BPBI 2) untreated BPBI or 3) unrecognized glenohumeral joint dysplasia. We describe a technique for achieving reanimation in adolescents who did not receive timely/effective BPBI care, a postoperative rehabilitation protocol, and results from a series of eight patients who underwent shoulder reanimation. A comprehensive shoulder reanimation approach is performed. Anteriorly, the pectoralis minor, major, and anterior capsule necessitate release. In severe dysplasia, a coracoidectomy, posterior glenoid osteotomy, and/or subscapularis slide may be necessary. Acromial dysplasia is also common, frequently necessitating osteoplasty. The deltoid is usually nonfunctional, and we use a bipolar latissimus muscle transfer for reanimating abduction and forward flexion. To assist with ease of rehabilitation we will often transfer the tendon of the teres major. Levator scapulae transfer to the supraspinatus is often performed to assist with the initiation of abduction. For external rotation, the ipsilateral lower trapezius is used. Finally, ipsilateral rhomboid advancement and contralateral lower trapezius muscle transfer is performed for dynamic scapular stabilization. After surgery, all patients participated in our rigorous postoperative rehabilitation protocol. Eight patients (13.8±5.6 years, 35±24 weeks follow-up) were included. All patients participated in our rehabilitation protocol. Preoperatively, patients generally achieved 0° ER from neutral and in maximum abduction. Postoperatively, patients achieved an average of 71° (30-90°) ER from neutral and an average of 82° (65-90°) ER in maximum abduction. Preoperatively, patients generally had 0-20° of abduction, which they achieved through scapulothoracic motion. Postoperatively, patients could achieve an average of 115° (90-180°) of abduction. Preoperatively, patients had 0-20° of FF that was mediated through scapulothoracic motion. Postoperatively, patients' FF increased to an average of 91° (20-170°). This technique is intended to restore a congruent glenohumeral joint and reanimate structures allowing for abduction, FF, and ER. While we advocate for early treatment of BPBI, applying this technique to undertreated/untreated adolescent patients paired with our rehabilitation protocol results in significant functional improvement, allowing for an improved quality of life.

Prospective Assessment of Outcomes After Femoral Condyle Osteochondral Allograft Transplantation With Concurrent Meniscus Allograft Transplantation.

Osteochondral allograft transplantation (OCAT) and meniscus allograft transplantation (MAT) have each become more commonly implemented for the treatment of young to middle-aged patients with complex knee pathology. Evidence regarding tibiofemoral OCAT in the setting of concurrent MAT is limited. The purpose of this study was to characterize outcomes for femoral condyle OCAT with concurrent MAT (OCAT+MAT) in the ipsilateral compartment of patients after evidence-based shifts in practice. It was hypothesized that OCAT+MAT would be associated with successful outcomes characterized by statistically significant and clinically meaningful improvements in patient-reported outcome measures (PROMs) of knee pain and function in >80% of patients for at least 2 years after transplantation. Case series; Level of evidence, 4. With institutional review board approval and documented informed consent, patients who underwent primary OCAT+MAT between 2016 and 2020 and enrolled in a lifelong registry for prospective collection of outcomes after OCAT were included. Patients with minimum 2-year follow-up data regarding complications, failures, adherence, and PROMs were analyzed. Patients who required OCAT and/or MAT revision or conversion to arthroplasty were defined as experiencing treatment failures. A total of 23 consecutive patients (mean age, 37.1 years; mean body mass index, 28 kg/m2; 14 men) met the inclusion criteria, with a mean follow-up of 51 months (range, 24-86 months). The initial treatment success rate was 78% based on 5 initial treatment failures, and the overall success rate was 83% based on a successful revision OCAT. All failures occurred in the medial compartment. Older patient age (42.2 vs 32.1 years; P = .046) and nonadherence to postoperative restriction and rehabilitation protocols (P = .033; odds ratio, 14) were significant risk factors for treatment failure. All measured PROMs achieved significant improvements (P < .001) and minimum clinically important differences at a minimum of 2 years postoperatively. OCAT+MAT was associated with successful short- to mid-term outcomes in 83% of cases. Evidence-based shifts in practice were implemented before the enrollment of this patient cohort. Older patients and those who were not adherent to postoperative restriction and rehabilitation protocols had a significantly higher risk for treatment failure and subsequent conversion to arthroplasty.

Subpectoral Biceps Tenodesis Using an All-Suture Anchor

Background: The long head of the biceps tendon (LHBT) has long been considered an intra-articular pain generator in the shoulder. While nonoperative treatment modalities can be acceptable for less severe presentations of LHBT pathology, surgical treatment options such as tenotomy and tenodesis remain controversial for recalcitrant cases. Open subpectoral biceps tenodesis allows for removal of all pathologic tissue from the bicipital groove, and all-suture anchor fixation utilizes a small caliber unicortical drill hole, which can potentially reduce the risk of a stress riser and iatrogenic fracture. Indications: In this study, we present a male patient with a history of left anterolateral shoulder pain worse overhead activities who has failed extensive physical therapy and other conservative measures. After extensive discussion regarding the treatment options, surgery in the form of shoulder arthroscopy, extensive debridement, rotator cuff repair, and open subpectoral biceps tenodesis was recommended and the patient had opted to proceed. For the purposes of this video, we focus on the open subpectoral biceps tenodesis portion of the procedure. Results: Open subpectoral biceps tenodesis can reduce pain with low complication and high satisfaction rates. Discussion: In this surgical technique study, we underline the importance position of the skin incision in axillary crease as well as skin tensioning when making the incision and retracting the conjoint tendon. We also highlight a locking lasso loop and double luggage tag fixation technique using a double-loaded all-suture anchor for the biceps tenodesis. We also provide technique commentary for appropriate restin tension of the LHBT. Finally, we review outcomes, postoperative management, rehabilitation protocol, and technique pearls and pitfalls. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Treatment and rehabilitation of subtalar dislocations: A case series and a review of the literature.

Subtalar dislocation is an uncommon orthopaedic pathology, representing 1 % of all traumatic injuries of the foot and 1-2 % of all dislocations, mostly affecting young male adults. While its urgent treatment consisting in reduction and immobilization of the dislocation has been well described, disagreement exists about post-operative management with specific regards to immobilization length and rehabilitation protocols. A case series of traumatic subtalar dislocations treated with urgent reduction, a mean of 4 weeks immobilization and subsequent rehabilitation is presented, with 1-year minimum clinical and subjective follow up. Also, a systematic review of the literature concerning the post-operative management following a subtalar dislocation, and subsequent results, has been performed. At 1-year minimum follow up, none of the patients presented with complications such as recurrence of dislocation or talus osteonecrosis. Tibio-talar and subtalar range of motion (ROM) were superimposable to the contralateral joints, with a maximum difference of 5°. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score highlighted a good functionality and a full recovery in all patients but one. Pure subtalar dislocations led to better results than complicated ones. Review of current literature available on the topic demonstrated that an earlier mobilization resulted in better ROM, but the global outcome did not differ among 4 to 6 weeks of immobilization. Conflicting reports are present in the literature regarding the most appropriate post-reduction management of subtalar dislocations. In our case series, successful results have been obtained with a mean of 4 weeks of limb immobilization and an early rehabilitation protocol. Although some limitations are present, 4 weeks immobilization appears to be the best balance between a good overall outcome and a better recovery of ROM. Further studies are needed to deepen the subject.

Rehabilitation and Return to Sports after Achilles Tendon Repair.

Rehabilitation protocols post-Achilles tendon repair vary widely, particularly regarding weight bearing (WB) and immobilization duration, impacting recovery trajectories significantly. This commentary focuses on rehabilitation strategies following acute Achilles tendon repair (ATR), emphasizing early mobilization and progressive loading. Techniques such as blood flow restriction training (BFRT) and progressive loading to restore strength and tendon mechanical properties are discussed in the context of optimizing recovery, minimizing tendon elongation and facilitating safe return to sport (RTS). This manuscript highlights current evidence and clinical insights to guide practitioners in optimizing rehabilitation protocols for athletes recovering from ATR, aiming to improve functional outcomes and support safe return to athletic activity.

Comparing Socket Shield Technique and Conventional Immediate Implant Protocol for Anterior Tooth Rehabilitation: A Critical Analysis of a Systematic Review

Comparing Socket Shield Technique and Conventional Immediate Implant Protocol for Anterior Tooth Rehabilitation: A Critical Analysis of a Systematic Review

A Comprehensive Review of Graft Choices and Surgical Techniques in Primary Anterior Cruciate Ligament Reconstruction: An Outcome Analysis.

Anterior cruciate ligament (ACL) injuries are among the most prevalent knee injuries, particularly in athletes engaged in high-impact sports. ACL reconstruction is a widely performed surgical procedure to restore knee stability, prevent further knee damage, and enable patients to return to their previous physical activity levels. However, the success of ACL reconstruction is influenced by various factors, including the choice of graft and the surgical technique employed. This comprehensive review explores the outcomes of different graft options - autografts, allografts, and synthetic grafts - and various surgical techniques such as single-bundle versus double-bundle reconstruction and anatomic versus non-anatomic tunnel placement. The review analyzes the short- and long-term outcomes, including functional recovery, return to sports, complication rates, and the impact of patient-specific factors such as age, activity level, and comorbidities. Additionally, the review discusses the role of rehabilitation protocols in optimizing surgical outcomes. By synthesizing current evidence, this review aims to provide clinicians with insights into the most effective graft choices and surgical techniques for primary ACL reconstruction, ultimately guiding the optimization of patient outcomes and highlighting areas for future research.

Treatment of rotational tibial malunion after minimal invasive plate osteosynthesis (MIPO): Corrective osteotomy with original plate retention (PR-Osteotomy).

Residual axial and rotational deformities in tibial shaft fracture, after minimally invasive osteosynthesis (MIO) treatment, are widely described in literature. Nevertheless, there is still a lack of evidence about the malunion treatment strategies and results. The aim of our study is to present an innovative technique for tibial shaft malunion: a derotational proximal tibial osteotomy without removing the original plate (Plate-Retaining-Osteotomy: PR-Osteotomy). We present the results of two consecutive patients' treatment, affected by tibial shaft fracture malunion, as sequelae of MIO treatment. The two patients, male 60 years old and female 39 years old, underwent previous surgical treatment with an average of 9 months span time before surgical revision. The affected limb showed significant external torsional defect associated with gait impairment, pain and limping. The amount of rotational deformity and the bone healing condition is assessed through a methodical preoperative planning, including weight bearing lower limbs Xray and bilateral computed tomography (CT) scan of the lower limbs. The surgical technique involves a monoplanar tibial osteotomy, in a perpendicular fashion to the tibial axis, at a level that would allow at least 3 proximal screw-holes to become available for subsequent fixation. Proximal to the osteotomy line the screws are removed, while the distal ones, if stable after testing, are left in place. The amount of torsional correction, planned on CT, is reproduced intraoperatively with the assistance of graduated templates. A fibular osteotomy may be performed if required. After temporary stabilization, the correct functional reduction is checked with the aid of fluoroscopy and empirical rod measurement, using the contralateral limb alignment as a reference. Once the desired correction is achieved, absolute stability is applied to the osteotomy site. Postoperative rehabilitation protocol involves partial weight bearing for 6-8 weeks with progression to full weight bearing by 10-12 weeks. Both patients showed complete osteotomy healing at the 13th and 16th week respectively, with no complications and full recovery of normal gait and daily life activities. To our knowledge, this is the first description of such surgical technique. Less invasiveness, fast recovery time and cost reductions are the foremost proposed benefits. Further larger case series with longer follow up are needed to assess the advantages of the proposed treatment strategy.

Comparison of functionality, physical activity, cardiac and respiratory parameters between patients with mood disorders and healthy controls

Background The cardiorespiratory effect in mental illnesses has recently received much attention. However, the cardiovascular and pulmonary effects of mood disorders have not been clearly demonstrated. Aims This study aims to compare individuals with mood disorders and healthy people in terms of exercise capacity, functionality, respiratory muscle strength, pulmonary function, dyspnoea and physical activity level. Method This cross-sectional study involved 30 patients with mood disorders and 35 age- and gender-matched healthy individuals. Exercise capacity (6-Minute Walk Test (6MWT), 3-Minute Step Test (3MST)), functionality (vertical jump test, functional reach test), respiratory parameters (respiratory muscle strength, pulmonary function test), dyspnoea (Modified Medical Research Council Dyspnoea Scale) and physical activity level (Short-Form International Physical Activity Questionnaire (IPAQ)) were evaluated. Results 6MWT results (P &lt; 0.001) and functional test scores (vertical jump test, P = 0.006; functional reach test, P &lt; 0.001) were significantly lower, and heart rate recovery after 3MST (P &lt; 0.001) was higher in mood disorder patients. Although patients' respiratory parameters were lower than healthy individuals, only measured and predicted respiratory muscle strength (P &lt; 0.001), peak expiratory flow rate litres (P &lt; 0.001), forced vital capacity predicted (P = 0.010) and forced expiratory volume in 1 s predicted (P = 0.002) values were statistically significantly different. Dyspnoea with activities was higher in patients (P &lt; 0.001). Patients spent more time sitting (IPAQ, P &lt; 0.001), but overall physical activity levels were similar between the two groups (P &gt; 0.05). Conclusions Patients with mood disorders had decreased exercise capacity and pulmonary function, lower functionality scores and respiratory muscle strength, and increased dyspnoea. Exercise-based rehabilitation protocols are recommended for the management of risk factors affecting the mood disorder patients' cardiorespiratory status.

Electrical Stimulation: Enhancing Axonal Growth following Peripheral Nerve Injury.

Electrical stimulation has been integrated in recent decades into rehabilitation protocols following neuromuscular injuries. Existing literature supports the utilisation of prolonged or continuous stimulation generated by implantable or transcutaneous devices for chronic pain subsidence and muscle trophism maintenance, which improve outcomes following microsurgical interventions. Newer uses include brief electrical stimulation for peripheral nerve injury. Brief electrical stimulation has shown promise in expediting regeneration of both torn and crushed nerve axons in the murine model and has been incorporated into a limited number of clinical studies. Augmentation of the natural response of an injured peripheral nerve by electrical stimulation has the potential to accelerate regeneration, presumably leading to improved function and clinical outcomes. We review the existing literature on intraoperative utilisation of electrical stimulation to enhance regeneration, such as neural mechanisms of action and their microscopic effect in animal models, as well as results from initial human studies. Level of Evidence: Level V (Therapeutic).

Recovery of Muscular Strength Following Total Hip Replacement: A Narrative Review.

This narrative review analyzes muscle strength recovery following total hip replacement (THR) and looks at various factors affecting postoperative muscle function restoration. The review synthesizes evidence from various studies regarding the timing and degree of muscular strength recovery, different rehabilitation protocols, and patient-specific variables such as age, preoperative physical condition, and comorbidities, among others. Overall, it appears that THR is associated with improved hip function and quality of life, but this usually takes a long time due to individualized physical therapy interventions. In addition, postoperative rehabilitation has been found not to exist without any personal factors involved such as age or gender whereby for instance senior citizens have no alternative but to go for THR surgery, making their lower limbs weaker than those who are younger. Based on the findings in this review on muscle recovery after THR surgeries, one may conclude that this endeavor should begin as early as possible and include regular resistance training programswith performance-focused functional training after surgery. In addition, more longitudinal studies should be conducted regarding post-surgical outcomes comparing other traditional medical practices.

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia

ObjectiveThe optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia. MethodsIn a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29–71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29–57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed. ResultsThere was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters. ConclusionEarly dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol. Level of evidenceI, Prospective randomized study