Standard Physical Therapy Program Research Articles

Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos

To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sector's standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). The early mobilization group showed gains in inspiratory and peripheral muscle strength.

Does standard phisiotherapy influence the health-related quality of life of JIA patients?

Methods Clinical trial of a consecutive sample of 26 JIA (ILAR) patients of the Oligoarticular (46,2%), Polyarticular (23,1%) and Systemic (30,7)% subtypes, with an average 11,2±4,1 years of age. The patients participated in a standard physiotherapy program twice a week for 6 months. The Chi-square test has been used in order to evaluate the attendance to the program. The HRQL has been assessed by means of the PedsQL 4.0 and the Kruskal-Wallis test with post hoc the Duunn test has been used in order to compare the median and percentiles (25 and 75) of the scores of these instruments in the baseline and end-of-6-months periods.

Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention

An allogeneic hematopoietic stem cell transplantation (HSCT) can have profound and lasting adverse effects on a patient's physical and psychological well-being. So far, only few studies have investigated the effectiveness of physical activity over the entire inpatient phase of an allogeneic HSCT. We performed a randomized controlled study to examine the influence of a controlled moderate exercise program starting parallel to chemotherapeutic conditioning and total body irradiation on the patient's physical and psychological constitution. Forty-seven patients undergoing an allogeneic HSCT were randomly assigned to an exercise group (EG) or a control group (CG). While the EG took part in an endurance and activity of daily living-training twice a day, the CG received the clinic's standard physiotherapy program once a day. Significant differences and/or trends in favor of the EG were observed regarding the primary endpoint endurance performance (P=0.002), muscular strength (P=0.022), fatigue (P=0.046), and emotional state (P=0.028) without posing an additional risk for the individual. The results show that the training program is feasible and seems to have positive influences on physical performance and quality of life in patients undergoing an allogeneic HSCT. However, further studies are necessary to confirm these results.

The Effect of Physiotherapy on Interleukin-8 Levels in Patients with Chronic Obstructive Pulmonary Disease

Interleukin-8 (IL-8, CXCL8), chemokine produced by macrophages and epithelium cells, plays a major role in activating neutrophils and eosinophils in the airways of patients with COPD and might act as a stimulator of inflammatory process. The aim of the research was to assess whether pulmonary physiotherapy influences the concentration of IL-8 in the induced sputum of patients with COPD. The study included 44 patients (21 males, 23 females, average age 56.47 ± 9.52) with COPD treated in Physiotherapy Department of MSWiA Hospital in Glucholazy, with unchanged pharmacological treatment for the duration of the therapy. Before treatment, efficiency treadmill test by Bruce modified protocol and dyspnea assessment with the modified 20-point Borg scale was given to qualify each patient for physiotherapy. All patients participated in a 3-week multi-treatment pulmonary physiotherapy programme based on efficiency training on a cycloergometer. The physical workload was determined individually for each patient based on the assessment of individual exercise tolerance. Standard physiotherapy programme also included respiratory muscles' training with particular emphasis on training of abdominal muscles and diaphragm, inhalations with isotonic saline, drainage, chest clapping, relaxations and walking. IL-8 concentration in each patient's induced sputum was collected prior to complex physiotherapy, and after it has been completed. IL-8 concentration was determined with the use of the ELISA test. It was found that the concentration of IL-8 was significantly lower in patients with COPD after a 3-week physiotherapy programme. It fell from 18.91 ± 25.2 to 9.69 ± 14.06 ng/ml (p = 0.0215). The most significant IL-8 concentration decrease was observed in patients with the highest initial level of IL-8. The study shows that multi-treatment pulmonary physiotherapy causes decrease of IL-8 level in the induced sputum in patients with COPD, what can suggest decrease activity of neutrophils, which may be one of the factors leading to the improvement in patients' clinical condition.

Two- to 4-Year Follow-up to a Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction

Background: There have been no long-term follow-up studies comparing a predominantly home-based rehabilitation program with a standard physical therapy program after anterior cruciate ligament (ACL) reconstruction. Demonstrating the long-term success of such a cost-effective program would be beneficial to guide future rehabilitation practice. Purpose: To determine whether there were any differences in long-term outcome between recreational athletes who performed a physical therapy-supervised rehabilitation program and those who performed a primarily home-based rehabilitation program in the first 3 months after ACL reconstruction. Study Design: Randomized clinical trial; Level of evidence, 1. Methods: Patients were randomized before ACL reconstruction surgery to either the physical therapy-supervised (17 physical therapy sessions) or home-based (4 physical therapy sessions) program. Eighty-eight of the original 129 patients returned 2 to 4 years after surgery to assess their long-term clinical outcomes. Primary outcome was the ACL quality of life questionnaire (ACL QOL). Secondary outcomes were bilateral difference in knee extension and flexion range of motion, sagittal plane knee laxity, relative quadriceps and hamstring strength, and objective International Knee Documentation Committee score. Unpaired t tests and a chi-square test were used for the comparisons. Results: The home-based group had a significantly higher mean ACL QOL score (80.0 ± 16.2) than the physical therapy-supervised group (69.9 ± 22.0) a mean of 38 months after surgery (P = .02, 95% confidence interval [CI]: 1.7, 18.4). The mean change in ACL QOL score from before surgery to follow-up was not significantly different between the groups (physical therapy = 40.0, home = 45.8, P = .26, 95% CI: −15.8, 4.4). There were no significant differences in the secondary outcome measures. Conclusion: This long-term study upholds the short-term findings of the original randomized clinical trial by demonstrating that patients who participate in a predominantly home-based rehabilitation program in the first 3 months after ACL reconstruction have similar 2- to 4-year outcomes compared with those patients who participate in a more clinically supervised program.

Is a formal physical therapy program necessary after total shoulder arthroplasty for osteoarthritis?

A retrospective analysis was conducted of 2 consecutive groups of patients undergoing total shoulder arthroplasty (TSA) for primary osteoarthritis. One group was treated with formal physical therapy (PT), and one group was treated with home-based, physician-guided PT. We hypothesized that patients with a formal postoperative PT protocol would have significantly better postoperative clinical outcomes than patients with no formal PT. Group A (43 patients) had a standard PT program. Group B (38 patients) had a home-based, physician-guided PT program. Clinical outcomes (preoperatively, 3, 6, and 12 months and most recent follow-up) were analyzed. A minimum sample size of 31 patients gives power to detect a 10-point American Shoulder and Elbow Surgeons (ASES) score (alpha=0.05, beta=0.80). ASES and Simple Shoulder Test (SST) scores significantly improved in both groups at all follow-up periods. Forward flexion and abduction were significantly improved in group B at all time points, whereas an initial improvement in forward flexion and abduction in group A was lost at final follow-up. There were no significant differences in final ASES or SST scores between groups at final follow-up. However, forward flexion, abduction, and the Short Form-36 physical component summary in group B were significantly better than group A at final follow-up. No significant improvements in internal rotation or SF-36 mental component summary were seen within or between the groups at final follow-up. Overall, there was no difference in patient satisfaction, with 88% satisfaction in group A and 95% satisfaction in group B (chi(2)=0.471, P=.4924). A home-based, physician-guided therapy program may provide adequate rehabilitation after TSA, allowing for a reduction in cost for the overall procedure.

Präoperatives, sensomotorisches Training bei Implantation einer Hüft-Totalprothese: eine randomisierte kontrollierte Studie

AIMS: The aim of this study was to investigate whether pre-operative, sensory-motor movement-training as a standard treatment-programme results in improved Physical Function, Quality-of-Life and Sensory-Motor-Function and reduced Disability in patients undergoing Total-Hip-Replacement. METHODS: 80 subjects awaiting Total-Hip-Replacement (mean-age 66.8±10.3; 31 women) at a Swiss regional hospital were consecutively recruited to this Randomised Controlled Trial. The intervention-group undertook a pre-operative 2-6 week home-exercise sensory-motor training-programme, the control-group received no therapy. Following surgery both groups underwent a standard physiotherapy-programme. The Primary Outcome-Measure was Physical Function, secondary Outcome-Measures were Quality-of-Life, Disability and Sensory-Motor-Function. Outcomes were measured using patient-administered generic (SF-36) and disease-specific (WOMAC) questionnaires as well as objectively assessed balance-ability (Biodex-Balance-System). Measurements were taken one day before the Total-Hip-Replacement and 10 days, 4 and 12 months following. Treatment-effect was determined pre-operatively with t-test and post-operatively with analysis-of-variance as well as effect-size. RESULTS: The intervention improved Quality-of-Life (subscale pain; p<0.05) and Sensory-Motor-Function (balance-ability; p<0.05) compared to no intervention before operation. These effects were lost following surgery. The intervention-group estimated Disability (p=0.055) at 4 months more negatively than the control-group. At one-year-follow-up group-membership influenced Quality-of-Life-score (subscales vitality and mental-health; p<0.05) different depending on the measurement-time-point. CONCLUSIONS: No useful effect was identified for a pre-operative sensory-motor training-programme. The intervention appears to have initiated a psychosomatic process. Further studies are needed to assess whether a personalized, ability-specific home-programme would be more effective. The psychological aspects following Total-Hip-Replacement need to be considered in such a training-programme in order to facilitate coping-strategies, reduce unrealistic expectations and increase satisfaction.

Conservative Treatment for Late-Diagnosed Spinal Accessory Nerve Injury

Spinal accessory nerve (SAN) injuries cause considerable shoulder joint dysfunction and pain, but are often underdiagnosed or diagnosed late. The aim of this study was to present the clinical and electrophysiological features and response to conservative treatment of the patients with late-diagnosed SAN injury. Nine patients diagnosed with SAN injury based on clinical and electrophysiological examinations were evaluated. All patients were treated with a standard physical therapy and rehabilitation program and then received home exercise program. Shoulder pain during rest and activity and pain causing sleep disturbances were evaluated using a visual analog scale. Constant scale investigated shoulder function. Shoulder disability questionnaire evaluated daily living activities. Results were assessed before treatment, after one month of treatment, and years after treatment. According to the electrophysiological studies, seven patients had partial and two patients had total axonal SAN injuries. The delay from the time of injury to diagnosis ranged between 12 and 84 mo (median 14 mo). When compared with the baseline values, visual analog scale, Constant scale, and shoulder disability questionnaire scores were significantly improved in all of the patients. For patients with late-diagnosed SAN injury, conservative treatment seems to be an effective treatment option.

Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture

The primary aim of this study was to determine the effectiveness and cost-effectiveness of adding manual therapy to a physiotherapy programme for ankle fracture. Assessor-blinded randomized controlled trial. Ninety-four adults were recruited within one week of cast removal for isolated ankle fracture. Inclusion criteria were: they were able to weight-bear as tolerated or partial weight-bear, were referred for physiotherapy, and experienced pain. Ninety-one participants completed the study. Participants were randomly allocated to receive manual therapy (anterior-posterior joint mobilization over the talus) plus a standard physiotherapy programme (experimental), or the standard physiotherapy programme only (control). They were assessed by a blinded assessor at baseline, and at 4, 12 and 24 weeks. The main outcomes were activity limitation and quality of life. Information on costs and healthcare utilization was collected every 4 weeks up to 24 weeks. There were no clinically worthwhile differences in activity limitation or quality of life between groups at any time-point. There was also no between-group difference in quality-adjusted life-years, but the experimental group incurred higher out-of-pocket costs (mean between-group difference = AU$200, 95% confidence interval 26-432). When provided in addition to a physiotherapy programme, manual therapy did not enhance outcome in adults after ankle fracture.

Effects of acupuncture and sham acupuncture in addition to physiotherapy in patients undergoing bilateral total knee arthroplasty — a randomized controlled trial

Objective: To compare the acute effects of acupuncture with sham acupuncture on knee pain, range of motion and ambulation in patients with knee osteoarthritis undergoing bilateral total knee arthroplasty, when added to a standard postoperative physiotherapy programme. Design: Prospective patient- and assessor-blinded randomized controlled trial. Setting: Acute inpatient physiotherapy department. Patients: Thirty patients (24 women and 6 men) undergoing bilateral total knee arthroplasty were included for final analysis in the study. Interventions: Both groups received a standard postoperative physiotherapy programme. Each patient was also given either 10 sessions of acupuncture or sham acupuncture within two weeks. Main outcome measures: The primary outcome measures were the levels of pain at rest and at maximum after exercise measured by the numeric pain rating scale. Other outcome measures included active and passive ranges of knee motion measured by standard goniometer, and ambulation measured by the timed up-and-go test. Results: Thirty-six patients were recruited at the start of the study with 18 patients allocated to the acupuncture group and another 18 patients to the sham acupuncture group. On postoperative day 15, there were 30 patients with complete data; three patients in each group dropped out from the study. The mean differences (95% confidence interval (CI)) in overall averages of postoperative mean pain levels were 0.4 (—0.6 to 1.3) and —0.8 (—2.0 to 0.4) at rest and at maximum respectively. There were no significant differences in the active and passive ranges of knee motion and the time for the timed up-and-go test between the two groups. Conclusion: There is no difference between the acute effects of acupuncture and sham acupuncture in addition to standard postoperative physiotherapy programme in patients with knee osteoarthritis undergoing bilateral total knee arthroplasty.

Traction for Low Back Pain With or Without Sciatica: An Updated Systematic Review Within the Framework of the Cochrane Collaboration

Systematic review. To determine if traction is more effective than reference treatments, placebo/sham traction, or no treatment for low back pain (LBP). Various types of traction are used in the treatment of LBP, often in conjunction with other treatments. We searched MEDLINE, EMBASE, and CINAHL to November 2004, and screened the latest issue of the Cochrane Library (2004, issue 4) and references in relevant reviews and our personal files. We selected randomized controlled trials (RCTs) involving any type of traction for the treatment of acute (less than 4 weeks duration), subacute (4-12 weeks), or chronic (more than 12 weeks) nonspecific LBP with or without sciatica. Sets of 2 reviewers independently performed study selection, methodological quality assessment, and data extraction. Because available studies did not provide sufficient data for statistical pooling, we performed a qualitative "levels of evidence" analysis, systematically estimating the strength of the cumulative evidence on the difference/lack of difference observed in trial outcomes. A total of 24 RCTs (2177 patients) were included. There were 5 trials considered high quality. For mixed groups of patients with LBP with and without sciatica, we found: (1) strong evidence that there is no statistically significant difference in short or long-term outcomes between traction as a single treatment, (continuous or intermittent) and placebo, sham, or no treatment; (2) moderate evidence that traction as a single treatment is no more effective than other treatments; and (3) limited evidence that adding traction to a standard physiotherapy program does not result in significantly different outcomes. For LBP with sciatica, we found conflicting evidence in several of the comparisons: autotraction compared to placebo, sham, or no treatment; other forms of traction compared to other treatments; and different forms of traction. In the remaining comparisons, there were no statistically significant differences; level of evidence is moderate regarding continuous or intermittent traction compared to placebo, sham, or no treatment, and is limited regarding different forms of traction. Based on the current evidence, intermittent or continuous traction as a single treatment for LBP cannot be recommended for mixed groups of patients with LBP with and without sciatica. Neither can traction be recommended for patients with sciatica because of inconsistent results and methodological problems in most of the studies involved. However, because high-quality studies within the field are scarce, because many are underpowered, and because traction often is supplied in combination with other treatment modalities, the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP.

THE EFFECT OF TWO REHABILITATION PROGRAMS ON ISOMETRIC QUADRICEPS STRENGTH IN PATELLOFEMORAL PAIN PATIENTS

1712 Patients diagnosed with Patellofemoral Pain Syndrome (PFPS) most commonly undergo a conservative treatment protocol. The aim of this study was to determine if there was a difference in the effect of a course of physical therapy versus a home exercise program on isometric quadriceps strength over a 42 day interval. Thirty-five subjects, with no history of knee disorders that were diagnosed with PFPS, were randomly assigned into a standard physical therapy program or a standard home exercise program. Eight females and seven males (mean age 27.1 ± 4.8) underwent a course of physical therapy twice a week for approximately forty minutes per session. Eight females and eight males (mean age 26.2 ± 2.3) underwent a structured home exercise program recommended at five times per week at twenty minutes per session and were monitored by an exercise log. Seventeen non-pathological subjects served as controls (mean age 25.6 ± 1.8). The force exerted by the quadriceps at a 30 ° angle of knee flexion during three maximal voluntary isometric contractions (MVICs) was evaluated at entrance into each program and at completion of each program using the Kincom 125 AP (Chattanouga, Tennessee). The mean increase in maximal force from day 1 to day 42 of the home exercise group was 14.73% and in the physical therapy group it was 22.42%. The mean increase in the control population was 0.25%. The intergroup difference was significant (p=.0014). This study suggests that both rehabilitative programs were effective for gains in force exerted by the quadriceps. However, the physical therapy program showed a greater increase in force over the study's duration.

Effect of respiratory physiotherapy on arterial oxygen tension.

The effect of deep breathing on arterial oxygen tension was investigated in 45 postoperative patients. Arterial oxygen tension was estimated by the transcutaneous oxygen tension method, which allows continuous non-invasive measurement of the arterial oxygen tension changes. Three deep breaths in 1 min, assisted by three respiratory therapy devices, were compared to a standard physiotherapy programme. A peak increase in arterial oxygen tension of 3--4.5 mmHg occurred after 1 min, and significantly increased values were seen for 2--4 min following deep breathing with the three respiratory devices. From the various physiotherapeutic procedures, verbally and manually assisted deep breathing gave a 7 mmHg PO2 peak and significantly increased values for 6 min. The sign mechanism is discussed in the light of the present knowledge of airway closure, which gives a satisfactory explanation of the short-lasting increase in oxygen tension.