Routine Physiotherapy Research Articles

Effects of core muscles strengthening exercises with routine physical therapy on trunk balance in stroke patients: A randomized controlled trial.

To compare the effects of core muscle strengthening exercises with and without routine physical therapy on trunk balance in chronic stroke patients. The randomised controlled trial was conducted at Mubarak Medical Complex, Sargodha, Pakistan, from October 28, 2021, to April 28, 2022, and comprised patients of either gender with chronic stroke aged 40-60 years. The subjects were randomised using the lottery method into group A that was managed with routine physical therapy, and group B which was further managed with core strengthening exercises. The intervention comprised 4 sessions per week for 8 weeks. Outcome was measured using Trunk Impairment Scale and Time Up and Go test. Data was collected at baseline, week 4 and post-intervention. Data was analysed using SPSS 23. Of the 80 individuals screened, 74(92.5%) were included. There were 37(50%) patients in group A; 30(81%) males and 7(19%) females with mean age 56.73±2.37 years. The remaining 37(50%) patients were in group B; 27(73%) males and 10(27%) females with mean age 55.65±2.88 years. Trunk balance and functional mobility improved significantly post-intervention in both groups (p<0.05), but group B values were significantly better compared to group A values (p<0.05). Core muscle strengthening exercises combined with routine physical therapy were found to be more effective compared to routine physical therapy alone in chronic stroke patients for improving trunk balance and functional mobility. IRCT20211116053070N1.

The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report

BackgroundTotal pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear.Case presentationA 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis.ConclusionStandardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Effects of Perfetti's Method on Cognition, Dexterity and Sensory Motor Function of the Upper Extremity in Stroke Patients: A Randomized Controlled Tria

Background: A stroke is the sudden loss of neural function caused by an interruption of blood flow to the brain. It causes symptoms such as paresis, hypoesthesia, cognitive impairment, and spasticity. Objective(s): To compare the effects of Perfetti's Method versus routine physical therapy on the upper extremities' cognition, dexterity, and sensorimotor function in stroke patients. Methodology: In this study, 74 stroke participants were enrolled and randomized into two groups by the Goldfish Bowl Procedure, with 37 patients in each group. Group A was treated with routine physical therapy, and Group B was treated with Perfetti's Method and routine physical therapy. The measurements of both groups were recorded at the beginning of the study and after the 12th post-treatment week. Sensorimotor function was measured with the Fugal-Meyer Assessment Upper Extremity (FMA-UE), dexterity was measured with the Box and Block Test (BBT), and level of cognition was measured with the Mini-Mental State Exam (MMSE) in both groups at the beginning of the study and after the end of training (12th post-treatment weak). Results: According to this study, 74 participants had a mean age of 53.21±12.02; males were 45(60.8%), and females were 29(40.2%). The mean Body Mass Index was 23.23±3.47. The right side was affected by 32(43.2%), and Left Side was affected by 42(56.8%). Sensorimotor Function mean was Pre-treatment 66.70±26.88 and posttreatment 110.09±11.91. The level of cognition mean was pre-treatment 22.62±3.30 and post-treatment 29.31±1.47. Dexterity means Pre-treatment was 8.18±11.64 and posttreatment was 84.48±15.03. P-Value was 0.00, which was &lt;0.005, which means that there was a significant difference between the mean value of pre-treatment and post-treatment Sensorimotor function, Level of Cognition, and Dexterity. There was a significant difference between the mean values of Groups A and B in sensorimotor function, level of cognition, and dexterity, as the P-values were 0.027, 0.04, and 0.02, respectively. Conclusion: Perfetti's Method, combined with routine physical therapy, resulted in significantly improved cognition levels, dexterity and sensory motor function in the upper extremity of stroke patients compared to those receiving only routine physical therapy.

Comparative Effect of Augmented Reality and Routine Physical Therapy on Balance and Postural Control in Patients with Parkinson’s disease

Background: Parkinson's disease is a neurodegenerative condition that often manifests in old age with generalized slowness of movements (bradykinesia) and a minimum of one additional symptom of tremor at rest or stiffness. Objective: The purpose is to compare the effects of Augmented Reality and Routine Physical Therapy on balance and Postural Control in Patients with Parkinson's disease. Methodology: It was a randomized clinical trial done in the Neuro medicine and physiotherapy department of Allied Hospital, Faisalabad. A sample size of 62 patients was divided into two equal groups. Patients in Group A had conventional physiotherapy, while those in Group B received augmented reality and conventional physiotherapy. Non probability sampling technique was used. Data was collected on the baseline and then data was collected after 8th weeks, and final data was collected after 12th weeks. Tools for collection of data were the Berg balance scale, timed up and go, and one leg stance test. Results: An Independent sample t-test was used to check the difference between groups in pre and post intervention which shows the statistical difference in both groups after the 8th and 12th weeks of treatment. However, mean differences show that group B has more good results. Repeated measure analysis of variance also shows that there is a significant difference between treatment groups in the within-group analysis. Conclusion: Our study concludes that an augmented reality regimen along with physiotherapy is beneficial for Parkinson’s patients to improve balance and postural control.

Effectiveness of PNF Pattern in Regular Physical Therapy Sessions on Functional Mobility in Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a musculoskeletal condition that presents with symptoms such as discomfort, nocturnal pain, and limited range of motion. Abduction and external rotation are significantly reduced. Objective: To investigate the effectiveness of combining proprioceptive neuromuscular facilitation (PNF) patterns into routine physical therapy sessions for patients with frozen shoulder. Methods: A six-week quasi-experimental study was conducted on a total of 30 participants, divided into group A (n=15) and group B (n = 15), selected from the outpatient department (OPD). Pain, disability, and range of motion were evaluated as outcome measures. The group A received proprioceptive neuromuscular facilitation (PNF) patterns in addition to their usual physical therapy sessions, and group B only received conventional physical therapy sessions. Disabilities of the Arm, Shoulder and Hand (DASH), VAS (Visual Analog Scale) and goniometer were used to assess pain, disability and range of motion (ROM). Data were analyzed using SPSS version 23.0. Results: Both groups showed a significant reduction in DASH and VAS scores and an increase in ROMs, as group A showed a better result in terms of DASH score and abduction range (p&lt;0.05). Conclusions: Both the experimental and control groups had statistically significant outcomes. The PNF pattern and Codman exercises both have a positive impact on rehabilitation. However, PNF is more advanced because it involves a combination of movements that are also useful in daily activities. Additionally, PNF helps develop memory for correct patterned movements. On the other hand, Codman exercises are only effective for retaining and improving shoulder ranges.

Early outcome of palliative limb salvage surgery in patient with right proximal humerus osteosarcoma Enneking III at Dr. Soetomo Academic General Hospital: A case report

Introduction: Osteosarcoma is a type of bone cancer that commonly affects the long bones, including the proximal humerus. This case report aims to investigate the clinical outcomes of patients with osteosarcoma of the proximal humerus enneking III. Follow-up assessments were conducted to evaluate post-operative outcomes. Case Presentation: This was a case report of a 33-year-old man who came to an outpatient clinic referred from another island with a chief complaint huge lump in his right shoulder 6 years ago. The patient got several examinations and was diagnosed with osteosarcoma of proximal humerus enneking III accompanied by lung metastases. From the Clinical Pathological Conference (CPC) patient decided to do neoadjuvant chemotherapy followed by restaging and amputation, but the patient refused amputation. Since it was found that the neurovasculature was not encased, limb salvage palliative surgery was performed, in the form of wide resection surgery, reconstruction with bone cement and spacers, and also shoulder reconstruction with prolene mesh, then followed by adjuvant chemotherapy. Follow-up 15 months post-op showed there were no recurrences, stable lung metastases, and improvement in complications, Musculoskeletal Tumor Society (MSTS) score 26 out of 30 and Disabilities of the Arm, Shoulder and Hand (DASH) scores 37.9 out of 100. Conclusion: In this case, the decision to undergo palliative limb salvage surgery is not an ordinary decision. Even though the outcome is not good, the patient is satisfied with the results, and with routine physiotherapy, we can assess the improvement and progressivity of the results of the operation.

The effectiveness of neck strengthening exercises on jaw mobility and clicking in anterior disc displacement with reduction of temporomandibular joint: A randomized controlled trial

Background: The studies in the literature have focused on the biomechanical and neurophysiological aspects of cervical and temporomandibular joint (TMJ) function. Addressing the cervical spine correlation with the TMJ may lead to long-term improvement in the derangement. This study desired to deduce the effectiveness of deep neck muscle strengthening exercises on jaw motion and clicking sounds in anterior disc displacement with reduction of the TMJ. Methods: This controlled clinical trial was conducted using a single-blinded design in a tertiary care teaching hospital affiliated with The University of Lahore- from March 2020 to January 2021. A count of 68 patients were enrolled each with 34 patients. The inclusion criteria were being 18–50 years old, suffering from TMJ pain and disc displacement with reduction, medical referral for temporomandibular disorders by a dentist or a maxillofacial surgeon, and having symptoms for more than one month before the first treatment. The exclusion criteria were having a tumor, fracture, or trauma in recent medical history, systemic, rheumatic diseases, degenerative changes, and history of surgery of the cervical spine or TMJ. The control group (group A) was only given TMJ mobilization and soft tissue release. The Intervention group (group B) did neck strengthening exercises in addition to the TMJ mobilization. The subjects were assessed twice. Results: To analyze the data, SPSS version.21 was used. To assess the frequency of qualitative factors like clicking, the chi-square test was employed. The mean scores of quantitative factors such as mandibular lateral deviation and maximal mouth opening were approximated between the two categories of subjects using the Mann-Whitney test. The findings demonstrated that there was no change between the groups’ pre- and post-treatment means for jaw mobility and clicking sounds. Nonetheless, the Intervention group’s mandibular lateral deviation significantly improved (P≤0.037). Conclusion: The findings revealed that neck strengthening exercises in addition to routine physical therapy of the TMJ do not affect clicks and mobility between the two groups. The exercises were found out to be effective only in improving the lateral deviation of the mandible.

Effects of virtual reality versus motor imagery versus routine physical therapy in patients with parkinson’s disease: a randomized controlled trial

BackgroundParkinson’s Disease (PD) is the second most common progressive neurodegenerative disorder, mostly affecting balance and motor function caused mainly by a lack of dopamine in the brain. The use of virtual reality (VR) and motor imagery (MI) is emerging as an effective method of rehabilitation for people with Parkinson’s disease. Motor imagery and virtual reality have not been compared in patients with Parkinson’s disease. This randomized clinical trial is unique to compare the effects of virtual reality with routine physical therapy, motor imagery with routine physical therapy, and routine physical therapy alone on balance, motor function, and activities of daily living in patients with Parkinson’s disease.MethodsA total of sixty patients with Parkinson’s disease were randomized into three groups using lottery method; twenty with virtual reality therapy in addition to physical therapy (group A = VR + RPT), twenty with imagery therapy in addition to physical therapy (group B = MI + RPT), and twenty were treated with only routine physical therapy (group C = RPT). All patients were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS) for motor function and activities of daily living, the Berg balance scale (BBS) for balance, and the Activities-specific Balance Confidence Scale (ABCs) for balance confidence at baseline, six and twelve weeks, and one month after treatment discontinuation. The one-way ANOVA was used to compare the outcomes between three groups, and the repeated measures ANOVA was used to compare the outcomes within each of the three groups at a significance level of p-value = 0.05.ResultsAccording to UPDRS III, the VR + RPT group showed significant improvement in motor function, compared to the MI + RPT and RPT groups, as the Mean ± SD at baseline was 33.95 ± 3.501 and at the 12-week assessment was 17.20 ± 9.451 with a p-value = 0.001. In the VR + RPT group, the BBS score at baseline was 37.15 ± 3.437 and at 12th week was 50.10 ± 4.897 with a p-value = 0.019. Among the VR + RPT group, the ABCS score showed significant improvement as the M ± SD at baseline was 57.95 ± 4.629, and at the 12th week was 78.59 ± 6.386 with a p-value = 0.010. At baseline, the UPDRS II for activities of daily living in the VR + RPT group was 25.20 ± 3.036 and at 12th week it was 15.30 ± 2.364 with p-value of 0.000.ConclusionThe current study found that the combination of VR and RPT proved to be the most effective treatment method for improving balance, motor function, and activities of daily living in patients with Parkinson’s disease when compared to MI + RPT or RPT alone.

Effect of Postoperative Kinesio Taping on Knee Edema, Pain, and Range of Motion After Total Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more certainty regarding its clinical worthiness in managing postoperative conditions. This study aims to assess the effect of postoperative KT on knee edema, pain, and range of motion (ROM) when added to routine physiotherapy after knee surgery. In this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases were searched from their inception to July 2023. Randomized controlled trials (RCTs) comparing routine physiotherapy with and without KT were included. Random-effect models were used to calculate the standardized mean difference (SMD), confidence interval, and heterogeneity (I2). Sixteen RCTs on 842 operated knees were included. KT reduced knee edema in first week (SMD, -0.59, p < 0.001), 14th postoperative day (POD) (SMD, -0.78, p < 0.001), and 28 to 42 days postop (SMD, -0.66, p < 0.001). The KT demonstrated significant pain improvement in second week (SMD, -0.87, p < 0.001) and the fourth week (SMD, -0.53, p < 0.001). The KT groups demonstrated ROM improvement within second week (SMD, 0.69, p = 0.010) and in the 28th POD (SMD, 0.89, p = 0.009). Subgroup analysis demonstrated minimal heterogeneity in anterior cruciate ligament reconstruction (ACLR) cases. However, it did not show significant superiority regarding ankle, calf, or thigh edema and Lysholm scale. This study suggests that adding KT to routine postoperative physiotherapy reduces pain and knee edema after total knee arthroplasty or ACLR. Low to very low certainty of evidence for all outcomes and the limited number of studies emphasize the need for more high-quality primary studies to explore the optimal method of KT application and its effectiveness in specific knee surgeries. Level I. See Instructions for Authors for a complete description of levels of evidence.

Effect of Buteyko Breathing Technique as an Adjunct to Routine Physiotherapy on Pulmonary Functions in Patients Undergoing Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial.

Coronary artery disease (CAD) poses a substantial and increasing public health concern in India, particularly among individuals aged 20 and above. The postoperative phase following coronary artery bypass graft (CABG) surgery presents potential complications, notably impacting the pulmonary system. Emerging evidence suggests that the Buteyko breathing technique not only improves lung function but also positively influences the psychological well-being of CABG patients. This study seeks to assess the impact of the Buteyko breathing technique on pulmonary functions in individuals who have undergone off-pump CABG. In this randomized controlled trial, patients undergoing off-pump CABG were allocated to either the Buteyko breathing technique group (n = 35) or the control group (n = 35). The intervention group received supervised Buteyko breathing technique sessions twice daily for 15 minutes, concurrently with cardiac rehabilitation from postoperative day (POD-2 to POD-7). The control group underwent phase I cardiac rehabilitation. Outcome measures, including pulmonary function test (PFT), chest expansion, and breath-holding tests were evaluated at baseline (POD-2) and conclusion (POD-7). Statistical analyses were conducted with a significance level set at p < 0.05. Both the control and intervention groups exhibited statistically significant improvements in pulmonary function, chest expansion at three levels, and breath-holding time (p = 0.0001). However, the Buteyko breathing group demonstrated a more significant improvement compared with the control group. The integration of the Buteyko breathing technique into conventional physiotherapy proves to be a beneficial strategy, leading to improvements in pulmonary function, breath-holding duration, and chest expansion for individuals who underwent off-pump CABG surgery. Mavkar SS, Shukla MP. Effect of Buteyko Breathing Technique as an Adjunct to Routine Physiotherapy on Pulmonary Functions in Patients Undergoing Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial. Indian J Crit Care Med 2024;28(3):280-285.TRI Number: CTRI/2022/12/048295.

Comparative Effects of Hold Relax with Agonist Contraction and Active Release Therapy on Pain, Functional Disability, and Sleep Quality in Piriformis Syndrome

Background: Piriformis syndrome is characterized by pain, numbness, and tingling from the hip down to the leg. It develops from a variety of contributing factors. Objective: The objective of this study was to compare the effects of active release therapy (ART) and hold relax with agonist contraction (HRAC) on pain, functional disability, and sleep quality in patients with piriformis syndrome. Material and Methods: This study was conducted from March 2022 to November 2022. A total of 82 participants of both genders, 25 to 55 years of age, diagnosed with piriformis syndrome were involved in the study. Those with a history of fracture of the pelvis or hip, disc disease, or postural deformity were excluded. Participants were assigned into two groups; HRAC and ART with routine physical therapy. Outcome measures were pain, functional disability, and sleep quality measured by the Numeric Pain Rating Scale, Roland Morris Disability Questionnaire, and Chronic Pain Sleep Inventory respectively. Assessment was made at baseline, at the end of 1st and 2nd week. Mann-Whitney Test was used for between-group analysis and Friedman’s ANOVA was computed for within-group differences. Results: Between-groups analysis showed a statistically significant difference in pain score (P ≤ 0.05), but no significant difference was found between both techniques regarding functional disability and sleep quality (P ≥ 0.05). However, the within-group analysis showed statistically significant results in all outcome measures (P&lt;0.05). Conclusion: ART was more effective in decreasing pain. Whereas, both techniques had equal effects in enhancing sleep quality and reducing functional disability among patients with piriformis syndrome.

Medial Pterygoid Abscess Masquerading as a Temporomandibular Joint Disorder: A Case Report.

A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient's well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.

From awareness to action: Propelling virtual reality into routine physiotherapy in Pakistan

From awareness to action: Propelling virtual reality into routine physiotherapy in Pakistan

Koroner Arter Bypass Greft Cerrahisi Sonrası Fiziksel Aktivite Danışmanlığının Erken Dönem Sonuçlarının İncelenmesi

Objective: Physical inactivity, an important risk factor for coronary artery disease, should be increased after coronary artery bypass graft (CABG) surgery. The aim of this study was to examine the effects of early physical acitivity (PA) counseling in CABG patients. &#x0D; Material and Method: Thirty male patients included in the study were randomly divided into two groups. Fifteen patients received PA counseling and routine physiotherapy, while the others received only standard physiotherapy. PA, exercise capacity, daily living activities, sleep quality, depression, and anxiety were assessed before and two weeks after surgery. All patients received an activity monitor (MF-SenseWear Armband) upon discharge for PA and energy expenditure evaluation. Energy expenditure, average MET, PA duration, laying and sleeping time, and daily steps were monitored for seven days after discharge. &#x0D; Results: The 6-minute walking distance decreased from 507.87±77.70 m to 470.46±69.83 m in the PA group (p=0.001) and from 499.80±82.93 m to 448.00±64.25 m in the control group (p=0.002), but the difference was not significant (p=0.610). PA counseling did not significantly affect total energy expenditure (8516.10±1489.75 vs. 8568.75±999.68 joules, p=0.910), active energy expenditure (307.43 joules (min 13.57- max 3300.57) vs. 303.68 joules (min 30.71-max 11.68), p=0.412), mean metabolic equivalent (1.30±0.16 vs 1.17±0.17, p=0.057), PA duration (16.57 minutes (min 0.71-max 180) vs 16.85 minutes (min 3.57-max 58.71), p=0.367), the number of steps (723.86 steps (min 198.57-max 5944.14) vs 796.28 (min73.86-max 4217.86), p=1.000). &#x0D; Conclusion: Our PA counseling did not improve PA and clinical outcomes after CABG surgery more than conventional treatment. Longer follow-ups are needed to demonstrate efficacy.

EFFECTS OF RELAXING MUSIC THERAPY ALONG WITH TASK-ORIENTED TRAINING OF LOWER LIMB ON BALANCE AND FUNCTIONAL INDEPENDENCE IN PATIENTS WITH CHRONIC STROKE: A RANDOMIZED CLINICAL TRIAL

Background of the Study: To compare the effects of relaxing music therapy with task-oriented training of lower limbs on the balance and functional status in patients with chronic stroke. Methodology: This randomized clinical trial was conducted in three outpatient physiotherapy clinics in Lahore, Pakistan. A sample of 76 participants with chronic stroke, aged 40-60 years, and on assistance walking, were recruited through a purposive sampling technique. Individuals who had physical impairments and visual or hearing deficits were not included in the study. Group A received task-oriented training with routine physical therapy while Group B received Music therapy additionally. Three sessions on alternate days per week for eight weeks were given. Balance and functional independence were the outcome variables measured using the Berg Balance Scale and Functional Independence Measure respectively. Mann-Whitney U test and Friedman ANOVA were applied for between-group and within-group differences respectively. P-value was significant at ≤0.05. Results: The mean age of participants was 54.05 ± 3.64 years, the majority i.e., 55 (72.4%) were male, 46 (60.5%) had ischemic stroke and 53 (69.7%) were presented with left-sided weakness. A statistically significant difference was observed among both groups in balance (p =.000) and functional independence (p=0.000). The within-group difference was also significant for balance (p=0.000) and functional independence (p=0.000). Conclusion: The integration of relaxing music therapy, task-oriented training, and routine physiotherapy is effective in improving balance and functional independence in chronic stroke patients. Keywords: Balance, berg balance scale, functional independence, functional independence measure, music therapy, coordination impairment.

Effect of strengthening exercises in individuals with patellofemoral pain syndrome: a randomised controlled trial

Background/Aims Muscle imbalance in patella stabilisers leads to patellar lateral glide and can cause patellofemoral pain syndrome. This study investigated the effect of progressive strengthening exercises of the vastus medialis oblique on pain and patellar alignment in patients with patellofemoral pain syndrome and patellar lateral glide. Methods A double-blind, randomised controlled trial was conducted with 40 individuals with patellofemoral pain syndrome with patellar lateral glide aged 20–40 years. The study group received vastus medialis oblique-specific strengthening exercises and routine physiotherapy treatment, and the control group received routine physiotherapy treatment only (stretching exercises, gluteal and quadriceps isometric exercises and conventional transcutaneous electrical nerve stimulation). Participants performed these exercises three times a week for 8 weeks. Pain intensity was measured before and after the intervention using a visual analogue scale and patellar alignment was measured using ultrasonographic parameters, including the trochlear angle, patella offset angle and distance between patellar tip and trochlear groove. Results In the between-groups comparison, there was a significant decrease in pain intensity in both the study and control groups, although the study group had a greater decrease (study group before intervention: 71.15 ± 1.54, study group after intervention: 22.21 ± 0.35, P=0.001); control group before intervention: 70.09 ± 1.22, control group after intervention: 31.82 ± 0.36 (P=0.001)) and patella offset angle (in the study group compared to the control group after 8 weeks of intervention. In within-groups comparison, a significant decrease of the patella offset angle in the study group was observed (before intervention: 16.2 ± 1.53; after intervention: 13.2 ± 1.87, P=0.001). No significant differences were found for the other parameters. Conclusions Specific strengthening of the vastus medialis oblique muscle in patients with patellofemoral pain syndrome and patellar lateral glide can lead to pain reduction and improvement of patellar alignment to correct lateralisation. This change may delay the process of patellofemoral joint degeneration. Including vastus medialis oblique-specific strengthening exercises in standard physiotherapy treatments may help to reduce pain levels in people with patellofemoral pain syndrome. Implications for practice Investigating the main cause of patellofemoral pain syndrome could have an essential role in the rehabilitation treatment of patients.

Effectiveness of routine physical therapy with or without home-based intensive bimanual training on clinical outcomes in cerebral palsy children: a randomised controlled trial

IntroductionThis study aimed to test how normal physical treatment, with or without home-based intense bimanual training, affected hand coordination and daily living activities in children with cerebral palsy.MethodsA randomised controlled experiment was carried out at DHQ Hospital in Kasur, Pakistan. Thirty children with unilateral spastic cerebral palsy took part in the study. The first group received standard physical treatment, whereas the second group received bimanual training along with routine physical therapy. Follow-ups were performed in the fourth and sixth weeks. The paediatric motor log activity scale and the ABILHAND questionnaire were used to assess daily activities and coordination, respectively.ResultsAt baseline, no significant association was seen between treatment groups and hand coordination outcome among the patients (p = 0.0450) and no significant difference was seen in patients in both treatment groups regarding their activities of daily living. In group A, no significant improvement was seen in hand coordination from baseline until the 6th week (p = 0.257) while in group B, a significant difference was seen in hand coordination from baseline until the 6th week follow-up (p = 0.000).ConclusionsThis study concluded that the combined effect of home-based bimanual exercises and routine physical therapy shows significant achievements in hand coordination and activities of daily living.

Effects of low-level laser therapy on acupuncture points on knee pain and function in knee osteoarthritis.

Knee osteoarthritis is a common and disabling disease. We aimed to examine the effect of low-level laser therapy in addition to routine physical therapy modalities (transcutaneous electrical stimulation, superficial heating modality of infrared, ultrasound, and exercise) on the functional status and pain in knee osteoarthritis. Patients with knee osteoarthritis (n=71) who underwent physical therapy (transcutaneous electrical stimulation, infrared, ultrasound, exercise therapy, and low-level laser therapy) were retrospectively screened. Patients who received low-level laser therapy on acupuncture points, transcutaneous electrical stimulation, infrared, ultrasound, and exercise were included in the low-level laser therapy (+) (n=35), and patients who received only transcutaneous electrical stimulation, ultrasound, infrared, and exercise were included in the low-level laser therapy (-) group (n=36). The Visual Analog Scale for activity pain, Lysholm Knee Scoring Scale, and walking and stair climbing tests were used before and after treatment obtained from patient files. The post-treatment Visual Analog Scale activity score and walking and stair climbing test results were statistically significantly lower in the low-level laser therapy (+) group than in the low-level laser therapy (-) group. There was no significant difference in post-treatment Lysholm Knee Scoring Scale scores between the two groups. In both groups, the Visual Analog Scale activity, Lysholm Knee Scoring Scale, and walking and stair climbing test scores statistically significantly decreased after treatment. Knee osteoarthritis increases with aging and creates significant functional limitations. low-level laser therapy with routine physiotherapy contributed to the improvement in the pain and functional status of the patients with knee osteoarthritis. Low-level laser therapy can be recommended in osteoarthritis treatment guidelines with the support of further studies, which is an easy-to-apply, effective, and reliable method.

Investigating the Effect of Addition of Cervical Proprioceptive Training to Conventional Physiotherapy on Visual, Vestibular and Proprioceptive Dependency of Postural Control in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Clinical Trial.

While cervical proprioception deficit has been suggested as a contributing factor to clinical consequences of chronic non-specific neck pain (CNSNP), the effect of addressing such impairments on postural control strategies has remained unexplored. The aim of this study was to compare the response of the postural control system to alteration of sensory afferents in CNSNP with asymptomatic individuals. Furthermore, we examined whether proprioceptive training would yield superior outcomes to routine physiotherapy for improvement of postural control, pain and disability. Center of pressure (CoP) variables of sixty CNSNP patients equally distributed in any of the proprioception-specific or conventional physiotherapy groups and 30 asymptomatic participants were evaluated under four standing conditions:1) normal, 2) foam, 3) cervical extension/eyes open and 4) cervical extension/eyes closed standing. CoP anteroposterior range and anteroposterior and mediolateral velocity in patients were significantly higher than the control group under condition 2 (P<0.05). Patients also demonstrated lower anteroposterior lyapunov exponent under conditions 2 and 4 (P<0.05). Both interventions significantly decreased anteroposterior range and anteroposterior velocity(P<0.05). Anteroposterior lyapunov exponent also increased under condition 2 (P<0.05).. After the interventions, CoP anteroposterior range and anteroposterior velocity were significantly lower in the proprioceptive exercise group than the conventional physiotherapy group (P<0.05). Anteroposterior lyapunov exponent was also significantly higher in the proprioceptive exercise group (P<0.05).This while there was no significant difference between these patients and control group participants in any of the CoP variables after intervention. Our results rejected the hypothesis that impaired neck proprioception in the presence of CNSNP is compensated by overweighting other sources of sensory afferent information. The findings also revealed that while proprioceptive exercises successfully returned postural strategies of CNSNP patients to those in asymptomatic participants, they do not add to clinical recovery of these patients.

Study protocol for the validation of a new pictorial functional scale in patients with knee osteoarthritis: the functional activity scoring tool (FAST)

BackgroundPatient-reported outcome measures (PROMs) are required for patient-centred care. There are limited PROMs with good psychometric properties, and limitations to any language-based scale are often constrained by the written words...