Routine Physiotherapy Research Articles

Effects of Scapular Proprioceptive Neuromuscular Facilitation Techniques in Addition to Routine Physical Therapy on Clinical Outcomes in Patients with Adhesive Capsulitis: A Randomized Controlled Trial

Background: Adhesive capsulitis is a painful condition comprises of reduced glenohumeral joint movement and the scapular neuromuscular facilitation techniques is considered effective, non-invasive approach for treating this condition. Objective: To compare the effects of neuromuscular facilitation techniques on clinical outcomes in patients with adhesive capsulitis. Methods: This trial was registered in ClinicaTrials.gov (ref: NCT05151783) and approval was taken (IRB No. 818-II). This single-blinded randomized controlled trial was conducted on patients (n=96) having adhesive capsulitis in six months. Non-probability purposive sampling technique was used for randomization via sealed envelope method. Conventional group received routine physiotherapy including ultrasound, hot packs, shoulder range of motion, stretching exercises, and joint mobilization five times per week for four weeks with 40 minutes’ duration of each session. Glenohumeral joint distraction, caudal, dorsal, and ventral glides were given at a rate of 2-3/second oscillations for 1-2 minutes to patients. Visual analogue scale, functional activity was calculated at baseline, 2nd and 4th week. The descriptive statistics (continuous variables) values for each variable in form of means and standard deviations were calculated and their p-values were also calculated using an independent sample t-test. For the qualitative data (categorical variables), frequency and percentage were estimated. Frequencies and percentages of different variables like gender had also been calculated. Repeated measure analysis of variance (ANOVA) was calculated to calculate within-group differences in the mean of each variable between the assessment points. Results: Test of within subject effects showed significant difference for all variables at follow-up and difference between groups also showed significant difference at different follow-ups (p-value≤0.001). Both groups showed statistically significant results (p≤0.001), but scores were higher in experimental group. Conclusion: Scapular proprioceptive neuromuscular facilitation technique along with routine physical therapy are more effective as compared to routine physical therapy alone in patients with adhesive capsulitis.

Role of High Power Laser Therapy on Pain Reduction in Patients with Patellofemoral Pain Syndrome

Background: Patellofemoral pain syndrome also known as chondromalacia patella is a very common musculoskeletal disorder in adolescents and athletes. The underlying cause of PFPS is unknown, but some medical experts believe that pain in the knee area is caused by other soft tissue, muscular, and biomechanical abnormalities. If PFPS is not treated in a controlled manner, then it can cause quadriceps muscle weakness. PFPS affects both adults and teens with a prevalence rate of 23% for most people. The prevalence of PFPS is higher for women compared to men. Usually, the diagnosis of PFPS is slow because there is a cluster of signs and symptoms. Aim: To determine the effects of high power laser therapy on pain reduction in patients with patellofemoral pain syndrome. Methodology: It is a RCT (randomized controlled trial). There were two groups i.e. Control group (routine physiotherapy) and treatment group(routine physiotherapy + Hi power laser therapy) with 33 patients in each group (total of 66 participants of study). VAS scoring was used to interpret the data. The data was analyzed statistically and then was compared to study the difference between two groups. Results: The data was statistically analyzed and showed the difference between two groups of the study. The value of P is less than 0.05 which was considered significant. Conclusion: It is concluded that the patients who receive HPLT (high power laser therapy) along with routine physiotherapy showed better results and progress in pain reduction than those who only receive routine physiotherapy treatment. Keywords: High Power Laser therapy, Patellofemoral Pain Syndrome, Visual Analogue Scale

Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome.

Background Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation

Objective(s)To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics. DesignDirect non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively. Setting6 UK Stroke Units Participants89 therapy sessions were observed, involving 55 clinicians and 57 patients. ResultsProportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1–8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset. ConclusionsTo optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke. Trial registration numberClinicaltrials.gov (NCT03792126). Contribution of the Paper•The findings from this study highlight opportunities for therapists to consider how they use verbal instructions and feedback in a specific and precise way, in order to support the process of motor learning. There is scope within routine clinical practice to use the many and varied types of feedback more robustly.•This study provides insight into how therapists apply motor learning principles stroke rehabilitation settings, and potential associations with a range of patient characteristics.

Efficacy of balance training on balance performance in obese patients undergoing sleeve gastrectomy

Background: The goal of this study was to investigate the effect of balance training on balance performance in obese patients undergoing sleeve gastrectomy. Study Design: in the current study the participants will be selected from the police hospital Subjects & Methods: Sixty patients who had sleeve gastrectomy were randomly divided into two equal groups. interventions. Group (A) received a program of balance training programs Periodic exercises were frequently performed for 45 min without rest among workouts with routine physical therapy program post abdominal surgical (breathing exercise, cough, and regular exercise). for three days per week for four weeks. Group (B): who takes sleeve gastrectomy with routine physical therapy program post abdominal surgery (breathing exercise, cough, and regular exercise). Main outcome measure: visual analog scale (VAS) and the Biodex Balance System (BBS). Results: Comparing both groups post- program revealed a statistically significant reduction in pain and increase in the Medio lateral stability index, anteroposterior stability index, and overall stability index in standing in both legs, on standing in RT leg only and standing in the left leg only. . All statistical measures were carried out using the statistical program for social sciences (SPSS) with version 27.

Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial

BackgroundStroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial.ObjectiveThe aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke.MethodsIt was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22.ResultsThe trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted.ConclusionsVR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability.Trial RegistrationIranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view

Effects of home-based exercise program on physical functioning of hemodialysis patients: A randomized controlled trial

Chronic kidney disease is one of the leading causes of death, which is often neglected due to lack of knowledge and resources. The objective of this study was to determine the effects of home-based exercise on physical functioning, quality of life and fatigue assessment for patients on hemodialysis. A randomized control trial was conducted, with participants divided into two groups. Twenty-six (26) participants were enrolled, and were assigned equally to each group. The control group received hospital-based care, and the intervention group received a home exercise program. Both groups received three sessions per week, for six weeks. Outcome measures included six-minute walk test, standing balance, 4-metre gait speed, chair stand, fatigue assessment scale and quality of life. Significant improvement in sixminute walk test, fatigue assessment scale, 4 meter gait speed, chair stand test and standing balance was noted in the intervention group as compared with control group. This study concluded that aerobic and resistance exercises are more effective in improving the functional outcomes of patients on hemodialysis as compared to routine physical therapy.

Effect of Transcranial direct current stimulation (tDCS) on altered conscious patients after traumatic brain injury &amp; cerebrovascular accident: A randomized clinical control trial

Background &amp; Objective: Traumatic brain injury and cerebrovascular accidents can result in altered levels of consciousness. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on the level of consciousness in these patients. Methods: A total of 100 patients admitted to the neurological ICU of the hospital were screened and 40 subjects after satisfying inclusion criteria were recruited within the first one to two weeks of injury. They were randomly divided into two groups after written consent from a caretaker, Group A (experimental) (n=20) and Group B (control) (n=20) by computerized randomization. Group A received Anodal tDCS to the motor area (C3/C4 ipsilesional), sensory area (P3/P4 ipsilesional) and left dorsolateral prefrontal cortex (F3) according to the 10/20 EEG montage for two sessions of 20min/day for 7 consecutive days and routine physiotherapy. Group B only received routine physiotherapy similar to Group A. Glasgow coma scale (GCS) and Rancho Los Amigos scale (RLAS) was taken pre and post- intervention to assess the level of consciousness. Results: The pretest and post- test GCS and RLAS scores in groups A and B showed statistical significance at p&lt;0.01. The differences of mean GCS and RLAS between pretest and posttest in group A showed better improvement than that of group B. The results were statistically significant at p&lt;0.01. The effect size was large, calculated by Cohen’s d. Conclusion: The tDCS can be effective in improving GCS and RLAS in altered consciousness patients in the acute period after injury. It is non-invasive, cost-effective with minimal contraindications, and doesnot interfere with other modalities in the intensive care unit.

Effects of Neurodevelopmental Therapy on Gross Motor Function and Postural Control in Children with Spastic Cerebral Palsy: A Randomized Controlled Trial

Cerebral palsy (CP) is one of the most prevalent childhood-onset causes of permanent disability affecting gross motor functioning and postural control ability. Objective: To determine the effects of neurodevelopmental treatment on the gross motor function postural control among children with spastic CP. Methods: A single-blinded randomized controlled trial was carried out at Sher e Rabbani Hospital, Department of Pediatric Rehabilitation, Sheikhupura. 66 children fulfilling the inclusion criteria were recruited using the non-probability sampling technique. Participants were divided into two groups, Group A which received beuro developmental techniques along with routine physical therapy while Group B received only routine physical therapy treatment. To collect data, Gross motor function measure scale (GMFM-88) and posture and postural ability scale (PPAS) were employed as outcome measures. Results: Repeated measure ANOVA and an independent t-test were executed for parametric data after assuming normality. Pairwise comparison of both groups demonstrated that gross motor function was significantly improved from baseline to 4th, 8th, and 12th week after applying NDT treatment (p-value≤ 0.05). Pairwise comparison of both groups revealed that postural ability post NDT treatment and significant improvement was observed after 12 weeks in comparison to baseline. While within-group comparison at different follows up for gross motor function measure and postural control also expressed p≤ 0.05 as significant. Conclusions: Children with spastic CP who received Neurodevelopmental Therapy along with conventional physical therapy treatment showed significant improvements in gross motor function and postural control as compared to the control group.

Comparison of muscle energy techniques with and without routine physical therapy in mechanical neck pain

Comparison of muscle energy techniques with and without routine physical therapy in mechanical neck pain

Comparative Effects of Mulligan’s Two Leg Rotation Technique and Muscle Energy Technique on Hamstring Flexibility

Aim: To compare the effects of the Mulligan two-leg rotation technique (TLR) and the Muscle Energy Technique (MET) on hamstring flexibility. Methods: The Double-blinded randomized controlled trial was conducted among 108 subjects including both males and females with the age group of 18-35 years and on examination having hamstring tightness measured by an Active Knee Extension (AKE) Test. Group A was given Mulligan’s Two leg rotation (TLR) technique with routine physiotherapy, and Group B was given Muscle energy technique (MET) with routine physiotherapy. A total of 12 sessions were given to both groups, 3 sessions per week. Data was calculated at baseline and after every 6th session. Results: Group A had 50% males and females and Group B had 53.7% males and 46.3% females. There was a significant improvement in the flexibility of the hamstring with the application of Mulligan-TLR and MET. However, the increase in AKE range of motion was higher in MET compared to the Mulligan TLR group. Mann-Whitney U test was used to compare the mean between the two groups and shows a significant difference in values of Numeric Pain Rating scale (NPRS) (P˂0.005) and AKE (P˂0.005) after 12 sessions. Conclusion: The study demonstrated that both techniques are effective in improving hamstrings flexibility but better results are shown with MET. Therefore, it is concluded that both can be administered in clinical practice for improving hamstring flexibility. Keywords: Knee, Low back pain, Pain

The Effects of Photobiomodulation on Shoulder Pain, Muscle Thickness, and Function in Subjects With Adhesive Capsulitis

Background: Adhesive capsulitis or frozen shoulder is among the most prevalent causes of pain and disability in individuals. Objectives: We aimed to evaluate the effect of Photobiomodulation (PBM) on pain, range of motion, and thickness and function of supraspinatus muscle in patients with adhesive capsulitis. Materials &amp; Methods: Overall, 52 subjects (n=26/group) with adhesive capsulitis referring to Poorsina Hospital, physiotherapy ward, Rasht City, Iran, in 2019 participated in this study. They were randomly assigned to 2 groups of control or routine physical therapy and PBM group. The variables were pain (Visual Analogue Scale, VAS), range of motion (goniometer), the supraspinatus muscle thickness in rest and contraction, and muscle function (ultrasonography). The outcomes were examined before, after 5 and 10 sessions, and at a 1-month follow-up. Results: There were no significant differences between the two groups regarding the demographic characteristics and studied variables. The interaction of group and time (2×4) was significant for pain (P=0.02). Finally, the Bonferroni post hoc test data indicated the pain reduction in the PBM group was higher than the control group at the follow-up (P=0.03). The mixed two-factor analysis of variance indicated that the interaction of the group and time of shoulder abduction (P=0.6), shoulder external rotation (P=0.46), supraspinatus muscle thickness, rest (P=0.31), supraspinatus muscle thickness, contraction (P=0.11), and rest-contraction (P=0.66) were not significant. Conclusion: The PBM revealed greater analgesic effects than routine physical therapy in the short term and one-month follow-up. However, the effects on a range of motion and muscle thickness and function were insignificant.

Brief physical activity counselling by physiotherapists (BEHAVIOUR): protocol for an effectiveness-implementation hybrid type II cluster randomised controlled trial

BackgroundPhysical inactivity is a leading risk factor for chronic disease. Brief physical activity counselling delivered within healthcare systems has been shown to increase physical activity levels; however, implementation efforts have mostly targeted primary healthcare and uptake has been sub-optimal. The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to address this evidence-practice gap by evaluating (i) the effectiveness of a multi-faceted implementation strategy, relative to usual practice for improving the proportion of patients receiving brief physical activity counselling as part of their routine hospital-based physiotherapy care and (ii) effectiveness of brief physical activity counselling embedded in routine physiotherapy care, relative to routine physiotherapy care, at improving physical activity levels among patients receiving physiotherapy care.MethodsEffectiveness-implementation hybrid type II cluster randomised controlled trial with embedded economic evaluation, qualitative study and culturally adapted patient-level outcome measures. The trial will be conducted across five hospitals in a local health district in Sydney, Australia, with a lower socioeconomic and culturally diverse population. The evidence-based intervention is brief physical activity counselling informed by the 5As counselling model and behavioural theory, embedded into routine physiotherapy care. The multi-faceted strategy to support the implementation of the counselling intervention was developed with key stakeholders guided by the Consolidated Framework for Implementation Research and the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model, and consists of clinician education and training, creating a learning collaborative, tailored strategies to address community referral barriers, team facilitation, and audit and feedback. Thirty teams of physiotherapists will be randomised to receive the multi-faceted implementation strategy immediately or after a 9-month delay. Each physiotherapy team will recruit an average of 10 patients (n=300) to collect effectiveness outcomes at baseline and 6 months. The primary effectiveness outcome is self-reported planned physical activity using the Incidental and Planned Exercise Questionnaire, and the primary implementation outcome is reach (proportion of eligible new physiotherapy patients who receive brief physical activity counselling). Secondary effectiveness and implementation outcomes will also be collected.DiscussionThis project focuses on physiotherapists as health professionals with the requisite skills and patterns of practice to tackle the increasing burden of chronic disease in a high-risk population.Trial registrationANZCTR, ACTRN12621000194864. Registered on 23 February 2021.

Efficacy of Treatment Based on the Movement System Impairment Classification in People with Knee Pain: A Study Protocol

Background: Detection of abnormal movement patterns and disorders and their classification into specific sub-categories may result in effective therapeutic choices. Classification of movement system impairments has provided seven sub-categories for movement disorders in the knee joint with specific treatment recommendations for each. Objective: This study aimed to investigate the effectiveness of specific treatments proposed by this classification method and compare the effectiveness of this treatment method with routine ones. Materials and Methods: Participants who met the inclusion criterion were randomly assigned into control and experimental groups after the diagnosis of their movement impairment. Subcategories including patellar lateral glide syndrome and tibiofemoral rotation syndrome were recruited. Experimental groups were treated specifically based on their impairment; however, all control groups received the same routine physiotherapy, regardless of their movement impairment. Two knee function and disability instruments were used, including Knee Injury and Osteoarthritis Outcome Score and the Lower Extremity Functional Scale. Eventually, each experimental group’s outcome scores on the visual analog scale and frontal plane projection angles were compared with those in the control group. Results: Conclusion: We will try to figure out whether the specific treatments based on the movement impairment classification have any benefit over the routine treatment. This would also give clues about the validity of this classification in knee pain. If this is the case, detecting the movement impairment and giving treatment on this basis could be used as a comprehensive guideline.

Effect of median nerve neuromobilization on functional status in patients with carpal tunnel syndrome: A double blinded randomized control trial.

To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. ChiCTR2000029377(http://www.chictr.org.cn/showproj.aspx?proj=48704).

Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure

Introduction Although pain is not considered a hallmark heart failure (HF) symptom, 51% - 85% of patients with HF experience pain. Lack of accurate pain assessment can lead to ineffective pain management which may negatively impact HF management. Older adult patients (≥ 65 years old) with HF often under-report pain symptoms. Little is known about clinicians’ perspectives of pain assessment and the pain management that they provide to older adult patients with HF. Aim . To describe clinicians’ experiences of pain assessment and management in older adult patients with HF in an effort to improve the management of pain in this population. Methods This was a qualitative research study that employed in-depth interviews with clinicians who primarily take care of patients with HF across different states. Three coders reviewed transcripts using an approach and organized codes into themes from the pattern of descriptors. Results The median age of participants (N=20) was 42 years, 20% were male, and 90% were white. We identified 4 distinct themes: (1) general differences between elderly patients and younger adult patients while providing care; (2) strategies and challenges of pain assessment: (3) strategies and challenges of pain management; and (4) recommendations for improving pain assessment/management practice. Most participants noted that providing care to older patients was more complicated due to comorbid conditions such as high fall risk and kidney disease. Even though all participants assess pain briefly as a routine physical assessment, most stated that pain was not addressed as much as it should be. Participants also faced challenges with pain assessment in older patients who often express their experience of pain using descriptive words versus numbers on a pain scale. In terms of pain management, most recommended using analgesics for older adults, not so much using non-pharmacological interventions. Most participants were unaware of any educational materials or guidelines to manage pain or symptoms for patients with HF. A few participants suggested a higher integration between a HF clinic and pain specialists and developing non-pharmacological interventions such as routine physical therapy that could potentially be a helpful resource for pain management in this population. Conclusions Using consistent pain assessment for clinicians and integrating non-pharmacological pain management approaches into routine clinical care should be tested as methods for improving symptom control among older adult patients with HF. Although pain is not considered a hallmark heart failure (HF) symptom, 51% - 85% of patients with HF experience pain. Lack of accurate pain assessment can lead to ineffective pain management which may negatively impact HF management. Older adult patients (≥ 65 years old) with HF often under-report pain symptoms. Little is known about clinicians’ perspectives of pain assessment and the pain management that they provide to older adult patients with HF. . To describe clinicians’ experiences of pain assessment and management in older adult patients with HF in an effort to improve the management of pain in this population. This was a qualitative research study that employed in-depth interviews with clinicians who primarily take care of patients with HF across different states. Three coders reviewed transcripts using an approach and organized codes into themes from the pattern of descriptors. The median age of participants (N=20) was 42 years, 20% were male, and 90% were white. We identified 4 distinct themes: (1) general differences between elderly patients and younger adult patients while providing care; (2) strategies and challenges of pain assessment: (3) strategies and challenges of pain management; and (4) recommendations for improving pain assessment/management practice. Most participants noted that providing care to older patients was more complicated due to comorbid conditions such as high fall risk and kidney disease. Even though all participants assess pain briefly as a routine physical assessment, most stated that pain was not addressed as much as it should be. Participants also faced challenges with pain assessment in older patients who often express their experience of pain using descriptive words versus numbers on a pain scale. In terms of pain management, most recommended using analgesics for older adults, not so much using non-pharmacological interventions. Most participants were unaware of any educational materials or guidelines to manage pain or symptoms for patients with HF. A few participants suggested a higher integration between a HF clinic and pain specialists and developing non-pharmacological interventions such as routine physical therapy that could potentially be a helpful resource for pain management in this population. Using consistent pain assessment for clinicians and integrating non-pharmacological pain management approaches into routine clinical care should be tested as methods for improving symptom control among older adult patients with HF.

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

IntroductionChronic pain and disability are now well-recognised long-term complications of blunt chest wall trauma. Limited research exists regarding therapeutic interventions that can be used to address these complications. A recent...

Effect of Physical Therapy Treatment in Knee Osteoarthritis with and without Wedge Insole: Randomized Controlled Trial

The purpose of this study was to determine the effects of physical therapy treatment in knee osteoarthritis with and without wedge support.Methods: This randomized controlled trail was conducted at Outpatient Department of Physical Therapy, Mayo Hospital, Lahore and Mid City Hospital, Lahore. Eighty patients with knee osteoarthritis were selected using a predefined inclusion and exclusion criteria and randomly allocated in two treatment groups; Group A (Routine physiotherapy treatment) and Group B (Routine physiotherapy with wedge insole). Outcome were recorded at the start and at the end of treatment at 3 weeks in terms of pain and disability as recorded on Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) respectively. The collected data was entered and analyzed using SPSS v25 with p value &lt; 0.05 as significant.Results: At the end of the third week, there was a statistically significant difference between the two treatment groups in terms of VAS (Mean Difference 1.55; p value 0.05) and WOMAC (Mean Difference 5.53; p value 0.0001). A statistically significant difference in before and after treatment VAS and WOMAC score was also noted within each group with p value &lt;0.0001.Conclusion: In comparison to conventional physical therapy alone, adding wedge insoles to the routine physical therapy treatment of Knee Osteoarthritis results in better pain relief and function improvement.

Comparative effectiveness of proprioceptive neuromuscular facilitation and passive vertebral mobilization for neck disability in patients with mechanical neck pain: A randomized controlled trial

ObjectiveTo compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) and Passive Vertebral Mobilization (PVM), both when given in adjunct to routine physical therapy (RPT), on neck disability in patients with mechanical neck pain (MNP). MethodsA single-blinded randomized controlled trial was conducted on 90 patients with MNP at the National Institute of Rehabilitation Medicine, Islamabad, Pakistan, from September 2015 to March 2018. The participants aged between 18 and 65 years were recruited through a simple random sampling technique and randomly divided into three groups i.e. PNF + RPT, PVM + RPT, and RPT. Each participant was evaluated pre and post-intervention (after four weeks) through neck disability index (NDI). The data were analyzed by using SPSS version 21. ResultsThe MANOVA was run on the pre-post mean differences of the variables to determine the changes within the groups which showed that the participants improved significantly in all the groups in terms of the NDI components and overall NDI score (p < 0.05). Univariate analysis with the post-hoc comparison and Tuckey HSD correction was used to determine the differences between the groups which showed that there was a significant difference between the interventional groups in the overall pain intensity, as well as pain experienced while performing personal care activities, reading, doing work, driving, sleeping, recreation and in the total NDI score (p < 0.05). ConclusionPVM (in adjunct to RPT) was more effective than PNF (in adjunct to RPT) for the patients with MNP to manage themselves in daily activities. Clinical trial registrationNCT03813680 (at clinicaltrials.gov) (https://clinicaltrials.gov/ct2/show/NCT03813680)

The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial.

A randomized controlled trial of forty-five females over 18 years of age with diagnosis of thumb basal osteoarthritis in their dominant hand and with a minimum pain rating of 4/10 on the Visual Analogue Scale (VAS) during activities of daily living (ADLs) were recruited from March to June 2021. The group receiving proprioception training was compared to routine conservative physiotherapy treatment. The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis. Primary outcome was joint position sense (JPS) for the assessment of CMC proprioception and secondary outcomes were Visual Analogue Scale (VAS) and Canadian Occupational Performance Measure (COPM) for the assessment of patient satisfaction and the Quick-DASH which assessed upper limb function. A block randomization was carried out for the control group (n = 22) and experimental group (n = 23). Participants and evaluator were blinded to the group assignment. Proprioception training produced a statistically significant reduction in pain post intervention, but this reduction was small (d = 0.1) at the 3-month follow-up. JPS accuracy demonstrated statistically significant differences between the groups (p = 0.001) post-intervention and at the 3-month follow-up (p < 0.003). Statistically significant differences between means were found in both the Quick-Dash and COPM post intervention (both, p < 0.001), as well as at the 3-month follow-up (both, p < 0.001). There was a significant time factor for the reduction of pain intensity over time but effect sizes between groups was small at the 3-month follow-up period. Proprioceptive training improves thumb JPS accuracy; however, it does not contribute to a reduction in pain intensity in the long term. The inclusion of a proprioceptive program may be beneficial for improving individuals with thumb CMC OA sensorimotor performance. The study was registered at ClinicalTrials.gov NCT04738201. No funding was provided for this study.