Rehabilitation Modalities Research Articles

Clin-STAR Corner: Rehabilitation for Older Adults With Heart Failure.

Heart failure is a major contributor to morbidity, mortality, and healthcare costs, especially among older adults. Despite a large body of evidence supporting the benefits of cardiac rehabilitation, less than 30% of eligible Medicare beneficiaries participate in cardiac rehabilitation. Thus, it is essential to examine alternatives, such as physical rehabilitation, a rehabilitation approach that focuses on physical activity and function. We systematically identified and summarized four key articles published between 2022 and 2024 that highlight innovations in rehabilitation with the potential of increasing utilization. These articles emphasize three areas of opportunity: (1) home-based telerehabilitation; (2) research focused on underrepresented and underserved populations; and (3) economic evaluations. Additional research on alternative modes of cardiac or physical rehabilitation, strategies to address heart failure-related health inequities, and implementation studies incorporating cost-effectiveness are needed to support increased utilization of cardiac and physical rehabilitation.

Evaluation of health-related quality of life and performance in intestinal transplant and rehabilitation patients: a cross-sectional study.

We aimed to evaluate health-related quality of life (HRQoL) in intestinal failure (IF) patients after different modes of intestinal rehabilitation. HRQoL was assessed using the generic 36-item Short Form Survey (SF-36, ver. 2) and visual analogue scale (VAS) in 6 different areas: diet, sleep, gastrointestinal (GI) symptoms, diarrhea, musculoskeletal pain, and other symptoms. Twenty-two patients completed the questionnaires, of which 7 had received intestinal transplant (ITx), 9 were continuing home total parenteral nutrition (HPN), and 6 had tapered off total parenteral nutrition (TPN). SF-36 physical component summary scores were highest in the ITx group (median, 65.6; interquartile range [IQR], 31.6-80.3) compared to the HPN (median, 48.4; IQR, 44.7-66.3) or tapered group (median, 54.2; IQR, 45.2-61.6). Mental component summary scores were lowest in the ITx group (median, 48.8; IQR, 37.1-63.6), compared to the TPN (median, 60.2; IQR, 41.6-78.5) or tapered group (median, 51.0; IQR, 48.8-56.0). Differences were not significant in all items of the SF-36. VAS scores showed that patients in the ITx group showed the best results in diet (0.9), gastrointestinal (GI) symptoms (1.4), and musculoskeletal pain (2.4). There was a significant difference in sleep (P = 0.036), with the ITx (1.43) and HPN groups (1.33) showing better outcomes compared with the tapered group (4.67). Patients in the tapered group showed the least favorable results in all performance areas, except GI symptoms. SF-36 did not show a significant difference between the ITx, HPN, and tapered groups, but VAS showed a significant difference in sleep between groups. Further studies, including serial data, will allow a better understanding of the effects of different modes of intestinal rehabilitation.

The Impact of Cardiac Telerehabilitation on Health-Related Quality of Life in Patients Undergoing Percutaneous Coronary Intervention (PCI): A Systematic Review Protocol.

Cardiac rehabilitation (CR) is an intervention to improve health and quality of life in patients undergoing percutaneous coronary intervention (PCI). The use of digital technology for healthcare promotion, such as telemedicine, has received growing attention in recent years due to the possibility of offering remote and individualized cardiac rehabilitation to patients undergoing coronary interventions. However, the impact of cardiac telerehabilitation on health-related quality of life (HRQoL) is not fully understood. This systematic review aims to analyze through meta-analyses and synthesized comments the current knowledge on the effectiveness of cardiac telerehabilitation in improving HRQoL in patients undergoing PCI. This manuscript presents a protocol for a systematic review to assess the effects of cardiac telerehabilitation on HRQoL in cardiac patients after PCI. Furthermore, the systematic review will explore the different modalities of remote rehabilitation documented in scientific literature. The literature review protocol was developed according to the PRISMA guidelines for systematic reviews. Search terms were structured according to the PIO (Population-Intervention-Outcome) framework. All relevant available studies will be identified using the main databases (PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library) and included in the review. Methodological quality and risk of bias will be evaluated using the Crowe Critical Appraisal Tool (CCAT). This review protocol has been registered on PROSPERO (No. CRD42024582933). This systematic review will comprehensively investigate the effects of cardiac telerehabilitation on QoL improvements in patients after PCI.

COMPARATIVE EFFECTS OF VIRTUAL REALITY AND FRENKEL’S EXERCISES ON BALANCE, GAIT AND QUALITY OF LIFE IN PATIENTS WITH STROKE

Background: Stroke is a leading cause of disability and mortality worldwide, often resulting in significant motor deficits, including gait and balance impairments. Rehabilitation interventions, such as virtual reality and Frenkel’s exercises, are widely employed to improve motor function and quality of life in stroke patients. These techniques focus on enhancing neuromuscular control, coordination, and functional independence during the recovery process. Despite their established benefits, direct comparative evidence between these two modalities remains limited. Objective: To compare the effects of virtual reality and Frenkel’s exercises on balance, gait, and quality of life in stroke patients. Methods: A randomized clinical trial was conducted at the outpatient department of Islam Central Hospital, Sialkot, with a sample of 36 stroke patients selected through non-probability convenience sampling. Participants were randomly divided into two groups: Group A (virtual reality) and Group B (Frenkel’s exercises), each comprising 18 participants. Balance, gait, and quality of life were evaluated using the Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, and Stroke-Specific Quality of Life (SS-QOL) assessment, respectively. Each intervention was administered three times weekly for 30 minutes per session over six weeks. Data normality was assessed, and parametric tests, including paired and independent sample t-tests, were used for statistical analysis. A p-value of <0.05 was considered significant. Results: Group A showed a significant improvement in BBS scores (35.81 ± 4.34 to 45.38 ± 3.32, p < 0.001) and SS-QOL scores (124.56 ± 19.59 to 209.06 ± 10.18, p < 0.001). Group B also demonstrated significant improvements, with BBS scores increasing from 35.50 ± 4.38 to 41.94 ± 2.64 (p < 0.001) and SS-QOL scores rising from 129.94 ± 17.19 to 188.94 ± 11.17 (p < 0.001). TUG test results revealed greater improvement in Group B (21.69 ± 2.89 to 13.81 ± 2.56, p < 0.001) compared to Group A (21.69 ± 2.77 to 16.69 ± 2.63, p < 0.001). Between-group analysis demonstrated that virtual reality was superior for balance and quality of life (BBS: p = 0.003; SS-QOL: p < 0.001), while Frenkel’s exercises showed a greater effect on gait (TUG: p = 0.004). Conclusion: Virtual reality training significantly improved balance and quality of life in stroke patients, whereas Frenkel’s exercises were more effective in enhancing gait. These findings highlight the complementary benefits of both modalities in stroke rehabilitation, providing valuable insight for individualized patient care.

Effectiveness of physiotherapy modalities on persisting dyspnoea in long COVID: A systematic review and meta-analysis.

Dyspnoea is often found months and years later in the "long-covid" syndrome, impairing quality of life and further perpetuating anxiety and post-traumatic stress disorders. Physiotherapy was recommended as a treatment in long-covid, but there is still insufficient evidence on its effectiveness. We conducted a systematic literature search on MEDLINE, PEDro, WOS, Scopus, VHL and the Cochrane Library until July 2023 (PROSPERO registration number: CRD42023427464). We selected comparative trials including adults with persistent breathlessness following COVID-19, regardless of the initial severity, for whom physiotherapy was implemented as a treatment for dyspnoea. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the PEDro Scale. 19 studies that included 1292 adults fulfilled the inclusion criteria, of which 15 were randomised controlled trials and 4 non-randomised controlled trials. As for the rehabilitation modalities, 6 studies used respiratory muscle training, 6 studies used low to moderate intensity rehabilitation, 6 used high intensity rehabilitation and one used passive rehabilitation. The methods used between and within each group differed greatly, leading to an expected high heterogeneity of results. Nethertheless the random-effects model found a significant difference favouring physiotherapy (SMD -0.63, 95 CI [-1.03; -0.24], p<0.001, I2=88%). Subgroup analysis showed a significant effect in the high intensity rehabilitation group alone, with null heterogeneity. In people suffering from dyspnoea following a SARS-CoV-2 infection, physiotherapy and especially pulmonary rehabilitation may help alleviate respiratory symptoms. Future studies will need to provide more consistent rehabilitation methods and better descriptions of them so as to reveal clear effects and avoid the confusion caused by using too many rehabilitation modalities.

Neuroticism Overestimated? Neuroticism Versus Hypertonia, Pain and Rehabilitation Outcomes in Post-Spinal Cord Injury Patients Rehabilitated Conventionally and with Robotic-Assisted Gait Training.

The aim of the present study was to analyse the association between neuroticism (one of the Big Five personality traits) and the most common secondary sensorimotor complications occurring in patients after spinal cord injury (SCI), i.e., muscle spasticity (hypertonia) and pain, and to investigate the associations between neuroticism and the effects of conventional rehabilitation (dynamic parapodium) and those using robotic-assisted gait training (RAGT) in this group of patients. In addition, the association of neuroticism with self-efficacy, personal beliefs about pain control, and adopted coping strategies among SCI patients was analysed. These data can be used as a reference for designing effective forms of therapy and support dedicated to this group of patients. Quantitative analysis included 110 patients after SCI. The participants were divided by simple randomisation into a rehabilitation group with RAGT and a rehabilitation group with dynamic parapodium therapy (DPT). The following survey instruments were used for data collection: Revised NEO Personality Inventory (NEO-PI-R); Ashworth Scale; the Spinal Cord Independence Measure III (SCIM III); the Walking Index for Spinal Cord Injury II (WISCI-II); the American Spinal Injury Association Impairment Scale (AIS); the Pain Coping Strategies Questionnaire-CSQ; and the Beliefs about Pain Control Questionnaire-BPCQ. analyses showed a positive association between neuroticism and spastic tension (rho = 0.39; p < 0.001). the study showed that a high level of neuroticism correlates with a higher level of spasticity, but no such correlation was observed for pain. Additionally, the study did not show a significant correlation between neuroticism and rehabilitation outcome depending on the rehabilitation modality (RAGT vs. DPT). The results underline the importance of carrying out a psychological diagnosis of patients to provide therapeutic support in the rehabilitation process.

Megaformer as a Rehabilitation Modality for Hamstring Strain Injury in Division I American Football: A Case Study

BACKGROUND: With athletes striving for peak performance, noncontact muscle strain injuries are increasingly common. Hamstring strain injuries (HSIs) make up the largest portion of noncontact injuries and provide further difficulty because of the high reinjury rate. This case study explores the Megaformer as a modality to treat HSIs with the potential to reduce the return to play timetable and recurrence rate. CASE PRESENTATION: A 23-year-old male American football player with a history of hamstring injuries presented with pain in the right proximal hamstring and deficits in strength and mobility testing as a result of sustained hyperflexion of the right hip with full knee extension. Magnetic resonance imaging (MRI) confirmed a recurrent proximal hamstring strain. OUTCOME AND FOLLOW-UP: Subsequent strength and range of motion testing revealed no impactful tenderness or pain during active participation or palpation after 9 days, and complete alleviation of symptoms at 6 weeks. No reinjury occurred during the remaining football season. DISCUSSION: This case study highlights possible advantageous features of the Megaformer as a recovery modality for HSIs. The Megaformer aims to improve flexibility, strengthen primary and secondary muscles, and enhance neuromuscular coordination to attempt to decrease the return to play timetable and reduce injury recurrence.

Experiences and needs of older patients with stroke in China involved in rehabilitation decision-making: a qualitative study

BackgroundShared decision-making is recommended for stroke rehabilitation. However, the complexity of the rehabilitation modalities exposes patients to decision-making conflicts, exacerbates their disabilities, and diminishes their quality of life. This study aimed to explore the experiences and needs of older patients with stroke in China during rehabilitation decision-making, providing a reference for developing decision-support strategies.MethodsA qualitative phenomenological design was used to explore the experiences and needs of older patients with stroke in China. Purposive sampling was used to recruit 31 older Chinese patients with stroke. The participants participated in face-to-face, semi-structured, and in-depth interviews. Data were analyzed using inductive thematic analysis.ResultsThe key themes identified include (1) mixed feelings in shared decision-making, (2) multiple barriers hinder the possibility of participating in shared decision-making, (3) Delegating rehabilitation decisions to surrogates, (4) gaps between reality and expectation, and (5) decision fatigue from lack of continuity in the rehabilitation health care system.ConclusionsOlder patients with stroke in China have complex rehabilitation decision-making experiences and needs and face multiple obstacles when participating in shared decision-making. They lack an effective shared decision-making support system to assist them. Providing patients with comprehensive support (such as emotional and informational), strengthening the construction of a continuous rehabilitation system, alleviating economic pressure, and promoting patient participation in rehabilitation decision-making are necessary.

Virtual Reality Gaming in Occupational Rehabilitation - User Experiences and Perceptions.

In Norway, individuals who struggle to participate in the workforce can take part in rehabilitation programmes to improve their work ability. The goal is to return to work by working with cognitive, physical, and environmental processes. Virtual Reality (VR) technology has become a popular and common tool in many healthcare and rehabilitation services but has not yet been systematically applied in occupational rehabilitation. This study aimed to investigate the experiences of participants who engaged in a game-based, immersive VR activity as part of an occupational rehabilitation program. Semi-structured interviews were conducted with individuals on long-term sick leave. In total, 12 women and three men (median age 45 years) from three rehabilitation centres (five individuals from each centre) were interviewed before and after discharge from the inpatient stay. The transcripts were analysed using Systematic Text Condensation. When analysing the data material, four themes were consistent. The first and the second theme contained information about how the VR headset and the game influenced the participants. The headset forced them to pay full attention and gave a feeling of protection from external stimuli. The game brought joy, energy, and endurance with its music and rhythm. The third and fourth themes provided information about how the gaming activity influenced the participants. They experienced that it provided a free space and symptom relief. In addition, they got carried away, broke barriers, and challenged themselves. The study results indicated that a gamified VR activity in occupational rehabilitation may be a new and powerful experience, substantially different from other rehabilitation modalities. VR training can facilitate a here-and-now feeling distracted from the outside world. More knowledge is needed on possible synergies between VR and other components of occupational rehabilitation and on how it may influence return to work for individuals on long-term sick leave.

The achilles tendon rupture: A deeper dive into its impact on professional and high-performance athletes

Background: The Achilles tendon rupture (ATR) is an injury that has been detrimental to professional athletes over the years, recently rising to unforeseen heights as the intensity of sports has increased. Methods: To obtain relevant statistics for this paper, a review of prior research, including original research and case studies, was conducted. Digital publications and clinical data were reviewed to dissect factors such as injury causes, operations, current initiatives, the role of technology, and future implications. Results: The data revealed a significant increase in documented ATRs in athletes and the National Football League (NFL) over the years; most recently, these injuries increased from 11 in the 2019-2020 season to 24 in the 2021-2022 season.3 Despite advancements in technology and recovery methods, dynamic changes involving training, conditioning, physicality, and intensity in sports have greatly contributed to the increased rates of injuries. With modernized resources such as advanced testing and rehabilitation procedures incorporating artificial intelligence (AI), specialists continue to search for new ways to treat injury and improve functional outcomes more effectively. Conclusion: This paper examines ATRs in athletes, its risk factors, current surgical methods for treatment, and modern rehabilitation methods. Future research should continue to develop comprehensive assessment and treatment methods to decrease the time to return to play, reduce the risk of re-injuries, and ensure cost-effective standards in implementing advanced rehabilitation modalities.

Surface electromyography: A pilot study in canine spinal muscles

In veterinary practice, rehabilitation modalities are often used to help in the recovery of animals affected by InterVertebral Disc Disease (IVDD), a condition frequently observed in chondrodystrophic dog breeds and can lead to Spinal Cord Injury (SCI), resulting in pain, motor impairments and neurological deficits, but there is a lack of objective assessment tools for patient evolution. In this work, an innovative approach using surface ElectroMyoGraphy (sEMG) is proposed to be applied in the field of veterinary medicine rehabilitation. The observed results are thought to be a direct result of nerve compression, leading to unusual patterns of muscle activation; this phenomenon can be attributed to muscle denervation, where the loss of Motor Units (MU) is the primary cause. This is thought to be responsible for the decrease in recorded sEMG amplitude and the increase in frequency observed in the pathological group.•This study involved rigorous animal preparation and signal acquisition protocols, involving multiple exercises and sub-movements, which were subsequently analysed.•RMSA is most used metric to analyse amplitude in sEMG signals, as it results in a more representative measurement of the signal variability than the Mean amplitude or the Standard Deviation.

Innovations in Sports: A Key to Enhancing Rehabilitation Outcomes

Introduction and purpose: Traditional rehabilitation methods often have limitations in improving motor function and cognitive abilities. This review aims to provide an updated overview of innovative methods in rehabilitation, focusing on the role of immersive and interactive technologies in enhancing rehabilitation outcomes. The literature suggests that these technologies can improve upper limb mobility, grip strength, and manual dexterity, as well as cognitive function, attention, and spatial awareness. Additionally, innovative balance and gait rehabilitation programs have been shown to improve functional mobility and reduce the risk of falls. The use of these technologies in combination with other rehabilitation modalities, such as electrostimulation and robotic assistance, may lead to even greater improvements in motor function and cognitive abilities. While more research is needed to fully understand the benefits and limitations of these innovative approaches, the existing evidence suggests that they have the potential to revolutionize rehabilitation and improve quality of life for patients. Materials and Methods: A literature review was conducted using PubMed with search phrases immersive and interactive technologies and rehabilitation. Description of the state of knowledge: Traditional rehabilitation methods often have limitations in improving motor function and cognitive abilities.Upper extremity impairment is a common and debilitating consequence of stroke. Summary: imersive and interactive technologies have the potential to improve upper limb mobility, grip strength, and manual dexterity, as well as cognitive function, attention, and spatial awareness. Innovative balance and gait rehabilitation programs have been shown to improve functional mobility and reduce the risk of falls. The use of these technologies in combination with other rehabilitation modalities may lead to even greater improvements in motor function and cognitive abilities.

Alternative Modes of Delivery in Pulmonary Rehabilitation: A Critical Appraisal of the Literature.

This review presents an overview of the safety and efficacy of alternative modes of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD). We identified recently published systematic reviews, meta-analyses, and guidelines, as well as relevant studies, exploring the safety and effectiveness of community-based PR, home-based PR, telerehabilitation, and web-based rehabilitation in people with COPD. A narrative summary of the main findings is presented. Although evidence suggests that community-based PR, home-based PR, telerehabilitation, and web-based rehabilitation are effective alternatives to center-based PR, it requires a careful interpretation as several of these programs do not comply with PR definition and have been compared with center-based PR programs that do not reach the minimal clinically important differences. Moreover, there is a huge heterogeneity among programs, and the confidence and quality of the evidence is mostly low. Hence, these novel modes of PR and center-based PR are not interchangeable. Instead, these are alternative modes aiming to increase access to PR. Questions remain regarding the most efficient way of implementing each PR mode, level of access, reimbursement policies, and data privacy in the use of technology. Standard protocols on how to set up each alternative PR mode need to be developed. Future research needs to explore how to use the treatable traits approach in combination with individual preferences and needs, program availability, safety, social support network, digital literacy, and health system context to identify the optimal PR program for each patient.

Beyond Simple Tapping: Is Timed Body Movement Influenced When Balance Is Threatened?

The tapping paradigm offers valuable insights into movement timing; however, it simplifies mechanics by minimizing force, restricting motion, and relying on a clear contact endpoint. Thus, it may not fully capture the complexity of larger-scale multi-segmental (or single-segment) timed body movements. The aim of this study was to extend beyond the tapping paradigm by examining the timing of two large-scale movements commonly performed in physical fitness or rehabilitation modalities, with varying inherent balance threats: two-legged squatting (low balance threat) and standing hip abduction (higher balance threat) paced by a metronome set at the participants’ preferred tempo (N = 39, all physically active). In synchronization with the metronome audio signal, the trunk and shank angular velocities were also recorded to extract the entrainment, synchronization, and pace stability metrics. Paired t-tests indicated similar entrainment in both movements (p &gt; 0.05 for IRI match) but significant differences in timing metrics’ manifestations (p ≤ 0.05, standing hip abduction: 50% greater IRI error, 30% lower synchronization error, 2.6% units lower pace stability). The similar entrainment but different synchronization error and pace stability highlight a complex timing interplay between balance threat/challenges and movement complexity concerning the two large-scale movements employed in physical fitness and rehabilitation modalities.

Rehabilitation Recommendations According to § 31 SGB XI: Empiricism, Discussion and Health Policy Implications

The principle of "rehabilitation before care" is a principle of social law. The recommendation of the Medical Service (MD) as part of the assessment (§ 31 SGB XI) plays an important role in rehabilitation recommendations. In around 3% of its assessments, the MD recommends implementation of rehabilitation. Only every fourth to fifth recommendation is actually carried out. The aim of the study was to find out if rehabilitation recommendations are utilized and exploited. This study aimed to examine the perspective of insured persons whose recommended rehabilitation was actually carried out. After evaluating 586,228 routine data records with care assessments by the MD, 1,972 survey questionnaires were sent out in March 2023, and 1,116 analyzable questionnaires were included in the data analysis. In seven questions, the respondents were asked to retrospectively assess the overall success and satisfaction with rehabilitation procedures carried out. The evaluation of the results showed that 87% of the study participants would be ready to undergo repeat rehabilitation. The assessment of the success of rehabilitation in terms of remaining at home for a longer period of time also carried weight. On the other hand, only around 10% of rehabilitation was carried out on an outpatient basis. One previously assumed reason for the low rate of patients taking advantage of recommended rehabilitation was that those in need of care had already received rehabilitation in the previous year. In this study focussing on whether recommended rehabilitation is taken advantage of, this assumption was found not to be correct. The question needs to be raised whether the strong focus in Germany on inpatient rehabilitation is up-to-date, both medically and with regard to the preferences of those entitled to rehabilitation. In contrast to inpatient rehabilitation, individual, outpatient and, if necessary, mobile rehabilitation offers might be more suitable, and these would also take into consideration issues of individual mobility and patient autonomy. The offer of different modes of rehabilitation also enables meeting the wish of those patients who prefer to have rehabilitation carried out in a home environment.

Italian Speech-Language Pathologists and Telerehabilitation for Voice Disorders: A Survey on Satisfaction, Effectiveness, Limits, and Future Prospects.

Introduction: The aim of this study was to evaluate the distribution of virtual voice therapy during the coronavirus disease 2019 (COVID-19) lockdown in Italy via the collection of opinions of speech-language pathologists (SLPs). Methods: All SLPs who regularly carried out their professional activity in public hospitals, private hospitals, or private practices in Italy were asked to fill out an online survey consisting of two sections: (1) demographic information (age, gender, work setting, seniority, working time, and regular use of virtual voice therapy) and (2) opinions regarding telerehabilitation (motivation, personal satisfaction, effectiveness, and future needs and uses). Results: A total of 299 SLPs (mean age 39.1 ± 12.4 years) completed the survey. Overall, a regular use of virtual voice therapy was declared by 31.1% (93/299) of SLPs, with the highest prevalence for SLPs working in fully private facilities (46.7%; p < 0.001). Among all respondents, 25.4% had a highly positive opinion on the possible use of virtual voice therapy, even in nonemergency situations, and 55.8% planned to maintain this rehabilitation modality in the future. Discussion: Italian SLPs, regardless of age, had a positive impact with the new telerehabilitation practices. Investments in training and updating SLPs through specific courses would help to break down the strong barriers to telepractice acceptance, such as lack of familiarity with new technologies and lack of adequate preparation. Virtual voice therapy, which had never been experienced in such a way in Italy before the COVID-19 pandemic, promises to be a valuable future addition to the current traditional rehabilitation approaches.

Efficacy of rehabilitation interventions on functioning in patients with hemophilic arthropathy: A systematic review with meta-analysis.

Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients.In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: -1.10 cm (-1.37, -0.82), p< 0.00001], joint health [ES: -1.10 (-1.38, -0.82), p< 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: -2.54 (-3.25, -1.83), p< 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p< 0.0000)]. Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy.

The association of the ACE gene I/D polymorphism and in-game performance in elite Rugby Union players

Genetic variation has been proposed as a factor in human athletic performance. The angiotensin converting enzyme (ACE) gene has been studied extensively albeit with heterogeneous results. The insertion (I) and deletion (D) alleles have been associated with altered serum and tissue ACE, as well as endurance- and power-based performance respectively. It is suggested the distinction in rugby union performance can be partly attributed to variations in the ACE gene. The aim of this study was to identify associations between the ACE I/D genetic polymorphism and in-game performance in elite (≥ 5 games at top-flight) rugby union athletes. The athlete cohort consisted of 347 Caucasian men, divided into positional groups (backs and forwards) and positional subgroups (front five, back row, halves, centres, and back three). Ethical approval was provided by Manchester Metropolitan University with written informed consent obtained from all participants. Genotyping and genotype analysis was performed using a combination of the X9 High-Throughput Genomics System (Standard BioTools) and the StepOnePlus™ Real-Time PCR System (Applied Biosystems) and their respective corresponding software. IBM SPSS Statistics 28 (SPSS, Chicago, IL) software was used to conduct Pearson's Chi-square (χ2) test of independence comparing genotype and allelic frequencies and the Kruskal-Wallis H and Mann-Whitney U tests to investigate differences between genotypes. Genotypic and allelic frequencies did not differ at the population level, nor at the positional group/subgroup levels. Performance did not differ between genotypes nor alleles at the population and positional group levels. Back row II genotypes beat more defenders than IDs (P = 0.008) but completed fewer tackles than both IDs (P = 0.05) and DDs (P = 0.013). Halfback DDs missed fewer tackles than both IDs (P = 0.003) and IIs (P = 0.01). Centre DD genotypes made more carries than IIs (P = 0.006). Back three IIs scored more tries than both IDs (P = 0.005) and DDs (P = 0.007) and made more clean breaks than IDs (P = 0.004). Most of the existing literature has been concerned with identifying the ACE gene as a marker of elite performance. To our knowledge, this is the first study to elucidate how the inter-personal differences in rugby union performance are influenced by the ACE I/D polymorphism. The findings from this study may provide novel insight into the specialisation of training and rehabilitation modalities for athletes, based on their genetic makeup.

Study protocol - assessing parkrun for walking rehabilitation for people living with, and beyond, cancer: acceptability, adherence, social support and physical function

IntroductionDue to a variety of barriers, the majority of cancer survivors do not do enough physical activity to meet current recommendations. This study will assess the feasibility of participation in parkrun walk-run events as a novel mode of community rehabilitation exercise.MethodsThis protocol describes a single-arm intervention study with participants acting as their own controls. The study accepts adults diagnosed with any type of cancer, undergoing treatment or in remission. Participants must be able to walk and have medical clearance to exercise. A sample of 100 participants will be recruited across the Sunshine Coast over two years. Data will be collected over 9-months at 4 time points: Baseline (T1); after 4-weeks of usual daily activities and cancer management prior to parkrun participation(T2); after a 6-month parkrun intervention (T3); at 2-month follow-up (T4). The primary objectives are to assess the acceptability of, and adherence to, parkrun as rehabilitation exercise. Secondary outcomes include wellness, health-related quality of life, anxiety, depression, mood, physical function, parkrun metrics, dietary intake, and diet and exercise behaviour.ConclusionThis study will be the first to examine the long-term effects of parkrun as a cancer rehabilitation modality with regard to physical function, psychosocial outcomes and dietary intake.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12623000473662 registered 09/05/2023.Approved by UniSC Human Research Ethics Committee (A221828) and the UK parkrun Research Board. Original protocol. Authors SB, RB, HHW, MM, YK.

Advances in cervical spinal cord injury rehabilitation

Objective Provide background in cervical spinal cord injury and updates in rehabilitation for patients with cervical spinal cord injury.Findings Cervical Spinal Cord injury is a catastrophic event that can be life-altering. The introduction of physiatrists, along with the rehabilitation team, early after cervical spinal cord injury has been shown to help decrease acute care length of stay and medical complications and provide education to patients and families facing life with spinal cord injury.Conclusion There are newer technologies and modalities in spinal cord rehabilitation, including but not limited to functional electrical stimulation, epidural stimulation, and robot-assist gait training that are opening up the prospect of prolonged recovery after spinal cord injury and are an area of future potential and innovation.