Standard Physiotherapy Treatment Research Articles

Effect of Local Vibration Therapy on Pain, Joint Position Sense, Kinesiophobia, and Disability in Cervical Disc Herniation: A Randomized Controlled Trial.

Background/Objectives: Vibration therapy approaches are an effective and safe treatment option for musculoskeletal disorders. This study examines the effects of vibration therapy using a percussion massage gun (PMG) on joint position sense, range of motion, pain, functionality, and kinesiophobia in individuals with cervical disc herniation (CDH). Methods: This single-blind randomized controlled trial involved 44 CDH patients divided into a Vibration Group (VG) and a Conventional Group (CG). The CG underwent a standard physiotherapy treatment heat application, Transcutaneous Electrical Nerve Stimulation (TENS), and exercises for range of motion and strengthening. VG received conventional therapy augmented with vibration therapy (VT) via a PMG. Joint position sense (JPS) using the Laser Pointer Assisted Angle Repetition Test; pain intensity with the Visual Analog Scale, kinesiophobia with the Tampa Scale for Kinesiophobia, and cervical dysfunction with the Neck Disability Index were assessed. Results: Both groups showed statistically significant improvements in pain, kinesiophobia, disability, and proprioception after treatment (p < 0.05). When comparing the difference values between groups, the VG was found to be more effective than the CG in the parameters of VAS activity (p = 0.013). The CG had more improvement in JPS neck left rotation than the VG (p = 0.000). Conclusions: VT, when combined with conventional physiotherapy, is effective in improving pain, proprioception, and functionality in individuals with CDH. These findings support the inclusion of VT as a beneficial adjunct therapy. Further research with larger sample sizes and longer follow-ups is recommended to validate these results and explore the long-term effects of VT on CDH.

Systemic Inflammatory Changes in Spinal Cord Injured Patients after Adding Aquatic Therapy to Standard Physiotherapy Treatment.

Spinal cord injury (SCI) is a severe medical condition resulting in substantial physiological and functional consequences for the individual. People with SCI are characterised by a chronic, low-grade systemic inflammatory state, which contributes to further undesirable secondary injuries. This study aimed to evaluate the effect of adding aquatic therapy to the standard physiotherapy treatment, implemented in two different schedules, on systemic inflammation in SCI patients. Additionally, the relationship between cytokine blood levels and changes in functionality (measured with the 6MWT, 10MWT, WISCI, BBS, and TUG tests) throughout the study was assessed. A quantitative multiplexed antibody assay was performed to measure the expression level of 20 pro- and anti-inflammatory cytokines in blood samples from SCI patients at three time points: baseline, week 6, and immediately post-intervention (week 12). This study identified a complex signature of five cytokines (IL-12p70, IL-8, MCP-1, IL-1α, and IP10) associated with the time course of the two physiotherapy programs. Two other cytokines (IL-4 and TNF-α) were also associated with the functional recovery of patients. These could be important indicators for SCI prognosis and provide a basis for developing novel targeted therapies.

ROBot-assisted physical training of older patients during acUte hospitaliSaTion—study protocol for a randomised controlled trial (ROBUST)

BackgroundDuring hospitalisation, older patients spend most of their time passive in bed, which increases the risk of functional decline and negative adverse outcomes. Our aim is to examine the impact of robot-assisted physical training on functional status in older geriatric patients during acute hospitalisation.MethodsThis is a single-centre investigator-blinded placebo-controlled randomised controlled trial including geriatric patients aged ≥ 65 years, able to ambulate before hospitalisation, and with expected length of stay ≥ 2 days. In addition to standard physiotherapy treatment, the intervention group receive active robot-assisted resistance training and the control group passive robot-assisted sham training. Exclusion criteria are as follows: ambulation without assistance at the time of inclusion, known severe dementia, delirium, patients who have received less than three training sessions at discharge, terminal illness, recent major surgery/lower extremity fracture, conditions contradicting the use of training robot, lower extremity metastases, deemed unsuitable for robot-assisted training by a healthcare professional, or weight > 165 kg. The primary outcome is functional status assessed by change in Barthel Index-100 and 30-s chair stand test between inclusion and day of discharge. Secondary outcomes include functional status at 1- and 3-month follow-up, quality of life, depression, concern about falling, falls, cognition, qualitative interviews, need of homecare, discharge destination, readmissions, healthcare costs, sarcopenia, muscle quantity (bioimpedance), and mortality.Clinical meaningful change of the Barthel Index is 5 points. A recent study in geriatric patients reported a 6.9-point change following exercise. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 244 participants per group (n = 488) are needed to detect the same mean difference. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 74 participants per group (n = 148) are needed to detect a minimum clinical change of 2.6 repetitions for 30-s chair stand test. Recruitment started in January 2023 and is expected to continue for 19 months including follow-up.DiscussionIf our study shows that in-hospital robot-assisted training prevents functional decline in older patients, this may have a major impact on the individual patient due to increased wellbeing and a higher level of independency. In addition, society will benefit due to potential decrease in the need of municipality-delivered homecare following discharge.Trial registrationClinicalTrials.gov NCT05782855. Registration date: March 24, 2023.

Suggestions and solutions to improve standard physiotherapy treatment of care in India

Physiotherapy profession is a vital component of healthcare in India, yet several challenges impede the delivery of high-quality treatment. This abstract explores key hindrances such as limited access to quality education, inadequate regulatory oversight, resource constraints, and shortages of skilled professionals. Financial barriers, low public awareness, and geographic disparities further complicate the landscape. To address these issues, collaborative efforts are essential, including strengthening education programs, improving regulatory frameworks, and enhancing infrastructure. Initiatives to increase public awareness, foster interdisciplinary collaboration, and mitigate financial barriers are crucial. Overcoming bureaucratic challenges, addressing geographic disparities, and promoting research and innovation will contribute to a more robust physiotherapy landscape. By actively addressing these hindrances, stakeholders can collectively work towards ensuring patients receive optimal physiotherapy treatment, promoting overall health and well-being.

Effects of Decompression therapy in leg pain and straight leg rise in patient with lumbar radiculopathy due to disc protrusion

One among many disc problems is disc protrusion, which has more prevalence in outpatient department physical therapy management Centre globally. The purpose of this study was to compare the effect of lumbar spine decompression therapy and standard physical therapy treatment in patients with lumbar radiculopathy due to disc protrusion. The single-blind randomized control trial of 71 patients was conducted at Max Rehab &amp; Physical Therapy Centre Islamabad, Pakistan. After setting inclusion criteria all the patients were randomly allocated into treatment and control group. Both group received standard physical therapy treatment including, Moist Hot pack, Lumbar Mobilization, Stretching &amp; strengthening exercises. The only difference was that Decompression Group received additional Decompression therapy. The data included demographics and Numeric Pain Rating Scale score in supine lying position for the painful leg and Straight Leg Raise Range for the painful side. The values for leg pain for control group decreased from 6 to 3 and the value for straight leg raise increased from 15° to 49°. The values for leg pain for the Decompression Group decreased from 6 to 2 and the value for the straight leg raise increased from 10° to 48°, the p value for both the variables was &lt;.001 showing statistically significant difference between pre and post values in treating patients leg pain and straight leg raise range of motion. It is concluded that decompression therapy is more effective in managing lumbar radiculopathy.

Effect of Whole-body Vibration on Muscle Tone, Function, and Quality of Life in Children with Spastic Cerebral Palsy: A Systematic Review with Meta-analysis

Cerebral palsy (CP) is a common nonprogressive neurological condition. One of the important signs of CP is the spasticity which can be treated by different methods. Whole-body vibration (WBV) is an example of these treatments. However, its efficacy needs to be accurately studied. This study investigates the effects of WBV on muscle tone, function, and quality of life in children with spastic CP. Systematic review and meta-analysis were performed. We searched the literature using the following electronic databases: Scopus (via Science Direct), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), PubMed, and PEDro and included articles from the year of their inception up to September 2023. The included articles were randomized controlled trials that used WBV on patients with spastic CP in which the outcomes were spasticity, function, and quality of life. Two reviewers independently selected the included trials. The pooled mean differences (PMDs) and 95% confidence intervals (CIs) were calculated using the Rev Man software. Ten trials involving 206 CP patients were included in this meta-analysis. All trials were of fair to good methodological quality as per the PEDro scale. Five trials compared the effect of adding WBV to standard physical therapy compared to standard physical therapy alone on motor function measured by Gross Motor Function Measure (GMFM-88) with both domains D and E. The current meta-analysis showed that the standard physical therapy treatment was statistically significantly better than WBV plus standard physical therapy on both D values ( z = 2.39, P = 0.02, PMD = 3.02, CI: 0.54, 5.49) and E values ( z = 3.04, P = 0.002, PMD = 4.06, CI: 1.44, 6.68). Adding WBV to the standard physical therapy was not superior to standard physical therapy alone in favor of gross motor function in patients with CP. However, it remains imperative to conduct high-quality research examining the effectiveness of whole-body vibration on children diagnosed with spastic CP exhibiting motor dysfunction and evaluating its impact on their quality of life.

The effectiveness of telehealth gait retraining in addition to standard physical therapy treatment for overuse knee injuries in soldiers: a protocol for a randomized clinical trial

IntroductionRunning is the most common cardiovascular exercise in the military. However, there is a high incidence of running-related overuse injuries that reduces military readiness. Gait retraining is a common intervention to treat running-related injuries, but the high cost of equipment and lack of clinician expertise and availability reduces utilization. Gait retraining intervention in a telehealth format might improve feasibility. The purpose of this randomized clinical trial is to determine the effectiveness of a telehealth gait retraining intervention on pain, self-reported function, and biomechanical risk factors for injury in service members who present to a Military Health System physical therapy clinic with an overuse knee injury.MethodsThis is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels: telehealth gait retraining intervention with standard of care or only standard of care) and time (3 levels: baseline, 10 weeks or post-intervention, 14 weeks). Participants between the ages of 18 to 60 years will be included if they report knee pain during and/or after running to be anywhere from a 3 to a 7 on the numerical pain rating scale and demonstrate a rearfoot strike pattern. The primary dependent variables are as follows: (1) pain (worst pain during and/or after running) and (2) foot strike pattern (conversion rate from rearfoot to non-rearfoot foot strike pattern during running). Secondary outcomes include patient self-reported function and running biomechanics.DiscussionThe effectiveness of a telehealth gait retraining intervention to reduce pain and modify foot strike pattern is not known. The results of this study may help determine the effectiveness and feasibility of a telehealth gait retraining intervention to reduce pain, change foot strike, improve function, and improve running gait biomechanics.Trial registrationClinicalTrials.gov, NCT04269473. Registered 05 February 2020.

Substantiation of the possibility of using osteopathic correction in the complex treatment of patients with shoulder-shoulder pain syndrome

Introduction. Shoulder pain is one of the most common causes of disability in the population. Modern approaches to the treatment of shoulder pain syndrome give preference to the use of drug therapy. However, frequent side effects remain relevant the wider introduction of non-pharmacological methods of treatment. Osteopathy is one of such promising method. In this regard, the assessment of the effectiveness of osteopathic correction of patients with humeroscapular pain syndrome is in demand.The aim to substantiate the possibility of using osteopathic correction in the complex treatment of patients with shoulder pain syndrome.Materials and methods. The study involved 40 patients with shoulder pain syndrome. By the method of randomization using randomization envelopes, the 20 patients were included in the control group and the 20 patients in the main group. Participants of the control group received standard drug and physiotherapy treatment, participants of the main group additionally received a course of osteopathic correction. In both groups, before and after treatment, there were assessed the osteopathic status, the severity of pain syndrome by a 10-point visual analogue scale, the state (functioning) of the shoulder joints, and daily life activities by a 30-point Swanson scale. The duration of temporary disability in both groups was also recorded.Results. At the start of the study, a number of regional (most often — the neck region, structural component, and the chest region — visceral and structural component) and local (most often — the shoulder joint and temporomandibular joint) somatic dysfunctions were detected in patients with humeroscapular syndrome. After treatment in the main group, a statistically significant (p&lt;0,05) positive dynamics was recorded in relation to disorders of the neck region (structural component), thoracic region (visceral and structural component), and pelvic region (structural component). In the control group, significant positive dynamics was observed only in relation to disorders of the thoracic region (visceral component). The groups began to differ significantly (p&lt;0,05) by the disorders detection frequency of the neck and pelvis region (structural component). Also a statistically significant (p&lt;0,05) positive dynamics was recorded in relation to disorders of the shoulder joint and temporomandibular joint in the main group, and in the control group it was detected only in relation to the shoulder joint disorders. At the start of the study, patients in both groups were characterized by a fairly intense pain syndrome (mean score over seven in both groups). After treatment, significant (p&lt;0,05) positive dynamics was observed in both groups, but in the main group the result was significantly (p&lt;0,05) more pronounced: 1,6±0,89 points in the main group versus 2,7±0,86 points in the control group. The shoulder joints state and the daily life activity at the study start moment were characterized by relatively low rates — the average total value was no more than 15 points in both the control and main groups. After the treatment, significant (p&lt;0,05) positive dynamics was observed in both groups, but in the main group the result was more pronounced: 28,0±1,86 points in the main group versus 22,1±2,34 points in the control group (p&lt;0,05). The average duration of temporary disability in days was 8,1±1,07 days in the main group and 15,0±1,84 days in the control group, the difference between the groups is statistically significant (p&lt;0,05).Conclusion. Based on the obtained results, it can be assumed that osteopathic correction included in the complex treatment contributes to faster recovery of the patient, improvement of the shoulder joint functioning, pain relief and increased daily life activity, and this allows us to recommend it for use in patients with such pathology.

Effectiveness of standard cervical physiotherapy plus diaphragm manual therapy on pain in patients with chronic neck pain: A randomized controlled trial

BackgroundLiterature concerning the effect of diaphragm treatment to reduce neck pain symptoms is scarce. Aim of this trial was to investigate the effects of diaphragm manual therapy associated with standard physiotherapy treatment on pain in patients with Chronic Neck Pain (CNP). MethodsIn a private practice clinic, subjects with CNP were randomly assigned to receive three 30-min treatment sessions of standard cervical physiotherapy and Diaphragm Manual Therapy (DMT) or Sham Diaphragm Technique (SDT). Participants and assessors were blinded to the assignment. Primary outcome was pain, secondary outcomes were cervical active range of motion, pain pressure threshold, disability and quality of life measured at baseline, before and after each session, at 3 and 6-months. Adverse events were monitored. A non-parametric multivariate approach (combined permutation test) was applied to assess the effect of the treatment on all the outcomes. An intention to treat analysis was performed. ResultsForty patients were randomly allocated to DMT and SDT groups. Combined permutation test showed a significant higher improvement in DMT group compared to SDT group (p-value = 0.0002). The between-group comparisons on single outcomes showed a statistically significant improvement only for pain pressure threshold on upper trapezius (adjusted p-value = 0.029). No adverse events related to the intervention were registered. ConclusionsIn patients with CNP, addition of diaphragm manual techniques to standard cervical treatment seems to give a better global outcome, but this improvement is of unclear clinical relevance; the primary outcome seems not to have a role. Further studies are needed to confirm and clarify these results. Trial registrationRelease Date: July 18, 2017 Registered in ClinicalTrial.gov database ID: NCT03223285A.

Medical stretching devices are effective in the treatment of knee arthrofibrosis: A systematic review.

AimsThis systematic review examines the available evidence on the use of medical stretching devices to treat knee arthrofibrosis, it suggests a focus for future studies addressing limitations in current research and identifies gaps in the published literature to facilitate future works.Materials and methodsArticles were identified using the Cochrane Library, MEDLINE, PubMed and SCOPUS databases. Articles from peer reviewed journals investigating the effectiveness of medical stretching devices to increase range of movement when treating arthrofibrosis of the knee were included.ResultsA total of 13 studies (558 participants) met the inclusion criteria with the devices falling into the following categories; CPM, load control or displacement control stretching devices. A statistically significant increase in range of movement was demonstrated in CPM, load-control and displacement-control studies (p ​< ​0.001). The results show that the stretch doses applied using the CPM, load-control devices were performed over a considerably longer treatment time and involved significantly more additional physiotherapy compared to the displacement-control and patient actuated serial stretching devices.ConclusionThe systematic review indicates that load-control and displacement-control devices are effective in increasing range of movement in the treatment of knee arthrofibrosis. Displacement-control devices involving patient actuated serial stretching techniques, may be more effective in increasing knee flexion than those utilising static progressive stretch.The paucity of research in this field indicates that more randomised controlled trials are required to investigate the superiority of the different types of displacement-control stretching devices and which of these would be most effective for use in clinical practice and to compare these with standard physiotherapy treatment.

The effectiveness of battlefield acupuncture in addition to standard physical therapy treatment after shoulder surgery: a protocol for a randomized clinical trial

IntroductionThere is a large incidence of shoulder instability among active young athletes and military personnel. Shoulder stabilization surgery is the commonly employed intervention for treating individuals with instability. Following surgery, a substantial proportion of individuals experience acute post-operative pain, which is usually managed with opioid pain medications. Unfortunately, the extended use of opioid medications can have adverse effects that impair function and reduce military operational readiness, but there are currently few alternatives. However, battlefield acupuncture (BFA) is a minimally invasive therapy demonstrating promise as a non-pharmaceutical intervention for managing acute post-operative pain.MethodsThis is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels, standard physical therapy and standard physical therapy plus battlefield acupuncture) and time (5 levels, 24 h, 48 h, 72 h, 1 week, and 4 weeks post shoulder stabilization surgery). The primary dependent variables are worst and average pain as measured on the visual analog scale. Secondary outcomes include medication usage, Profile of Mood States, and Global Rating of Change.DiscussionThe magnitude of the effect of BFA is uncertain; current studies report confidence intervals of between-group differences that include minimal clinically important differences between intervention and control groups. The results of this study may help determine if BFA is an effective adjunct to physical therapy in reducing pain and opioid usage in acute pain conditions.Trial registrationClinicalTrials.gov NCT04094246. Registered on 16 September 2019.

Effect of dynamic stabilisation exercise therapy enhanced with muscles energy technique on some selected patients outcomes and trunk muscles function in patients with chronic non-specific low back pain: a study protocol

Background Non-specific low back pain (NSLBP) is a common musculoskeletal condition causing functional disability and affecting the quality of life. Exercise therapy especially Dynamic Stabilisation Exercises (DSE) and Muscle Energy Techniques (MET) are frequently used in the treatment of NSLBP. However there are some inconsistencies with the use of DSE and the physiological mechanisms underlying the therapeutic effects of MET are currently unclear, and a review of literature on these interventions recommend further research. Therefore this study was designed to determine the effect of DSE and MET for the management of patients with NSLBP. Methods This study will involve 141 participants with chronic NSLBP. They will be randomised into three groups: two intervention groups i.e. DSE plus MET group, DSE alone and control (standard physiotherapy treatment). Outcomes that include trunk range of motion, Transverse Abdominus contraction rate, trunk muscles endurance, level of pain perception, quality of life, functional disability, activity limitation and participation restrictions will be assessed at baseline, 6th and 12th week of intervention, however, while follow-up assessment at 3-months after the intervention. Data will be analysed using descriptive statistics and inferential statistics of repeated ANOVA; P < 0.05. Discussion The study outcome will determine the combined effect of DSE plus MET on trunk muscles functions, level of pain perception, quality of life, functional disability, activity limitations and participation restrictions in patients with chronic NSLBP. Trial Registration www.ClinicalTrials.gov: NCT03449810

Dry needling in addition to standard physical therapy treatment for sub-acromial pain syndrome: a randomized controlled trial protocol

BackgroundTrigger point dry needling interventions are utilized by physical therapists to manage shoulder pain. Observational studies have shown positive short-term outcomes in patients with subacromial pain syndrome receiving trigger point dry needling. However, little research has been done to evaluate the long-term effectiveness of trigger point dry needling specifically as it compares to other commonly utilized interventions such as exercise and manual therapy. The purpose of this study is to assess the additive short and long-term effectiveness of trigger point dry needling to a standard physical therapy approach of manual therapy and exercise for patients with subacromial pain syndrome. MethodsThis multicenter randomized trial with 3 arms was designed following the standard protocol items for randomized interventional trials. Results will be reported consistent with the consolidated standards of reporting trials guidelines. 130 participants will be randomized to receive standard PT interventions alone (manual therapy and exercise), standard PT and trigger point dry needling or standard PT and sham trigger point dry needling. The primary outcome measures will be the Shoulder Pain and Disability Index and Patient Reported Outcomes Measurement Information Systems (PROMIS-57) scores collected at baseline, 6-weeks, 6-months and one year. Healthcare utilization will be collected for 12 months following enrollment and groups analyzed for differences. DiscussionIt is not known if trigger point dry needling provides long-term benefit for individuals with subacromial pain syndrome. This study will help determine if this intervention provides additive benefits over those observed with the commonly applied interventions of exercise and manual therapy. Trial registrationIdentifier: NCT03442894 (https://clinicaltrials.gov/ct2/show/NCT03442894) on 22 February 2018.

Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study

BackgroundConnective tissue mobility alters motor unit recruitment, but the restoration of fascial mobility allows for optimal motor function. The Fascial Manipulation® (FM®) method is a multiplanar approach that assesses and treats the mobility of deep fascia in specific anatomical locations where motor units converge. ObjectivesTo assess the effects of FM® vs. standard physical therapy treatment (SPT) in patients with low back pain (LBP). DesignSix-months controlled clinical trial. Method102 participants with LBP received SPT or FM®. Numeric Pain Rating Scale (NPRS), 15- point Global Rating of Change (GROC), and Oswestry Disability Index (ODI) were used to monitor progress. ResultsThe FM® group had a significantly lower ODI (p < 0.009) and NPS scores (p < 0.0001) and significantly higher GROC scores (p < 0.003) once their means were adjusted for initial scores. When comparing the SPT to FM®, the final ODI decreased by at least 1 category in 48.9% of the SPT cases, while in 36.2% of the cases was no change. ODI minimal clinical importance difference (MCID) change of 10% decrease in scores occurred in 70.2% of the SPT group compared to 96% of the FM® group (p = 0.003). ODI MCID change of 50% decrease in scores occurred in 40% of the SPT group compared to 64.6% of the FM® group (p = 0.02) 44.7% of the participants in the SPT group had final GROC values above +5 at discharge, compared to 92% of the participants from the FM® group (p = 0.0001). The FM® subjects had almost three times the change in NPRS compared to SPT counterparts (-4.3 ± 2.2 to -1.5 ± 2.4, p=0.0001). ConclusionsFM® appears to improve NPRS, GROC, and ODI more than SPT. FM® may provide an effective treatment technique for LBP.

Systematic Review of the Addition of Hip Strengthening Exercises for Adults with Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder typically occurring in physically active people aged 40 years and younger, causing pain, functional deficits and lower limb weakness. Traditional treatment has been aimed at strengthening the knee, however recent research suggests the muscles around the hip also play an important role in the development and continuity of Patellofemoral Pain Syndrome. Purpose: To investigate the effectiveness of the addition of hip strengthening exercises to standard physiotherapy treatment (knee strengthening and stretching exercises) on reducing pain, and enhancing strength and function when compared to standard physiotherapy treatment alone in adults with Patellofemoral Pain Syndrome. Method: A systematic search of Cochrane, CINAHL, Embase, MEDLINE®, PEDro and SportDiscus was conducted. Studies of participants aged 18 to 44, diagnosed with Patellofemoral Pain Syndrome by a healthcare practitioner, or reporting peripatellar or retropatellar pain with common functional tasks, were included. A critical appraisal, using the Critical Appraisal Skills Program for Randomised Controlled Trials (CASP) was used to assess methodological quality. Results: Five randomised controlled trials of varying methodological quality met the inclusion criteria. The participants in these studies were aged between 18 to 40 years of age. The duration of the intervention ranged from four to six weeks consisting of 12 to 30 supervised exercise sessions. Studies used varying outcome measures for each of the three outcomes. Overall, the studies demonstrated that the addition of hip strengthening exercises to standard physiotherapy care consistently improved pain and function, but the impact on strength was variable. Conclusion: Previously, only a small number of studies have looked at the addition of hip exercises to standard physiotherapy care for treatment of Patellofemoral Pain Syndrome. While there is a growing body of evidence for the efficacy of hip strengthening exercises for Patellofemoral Pain Syndrome, this is constrained by bias towards female participants, lack of true controls in most studies, and low methodological quality of studies overall. Hip exercises added to standard physiotherapy care shows potential as a treatment method for improving outcomes of pain and function in adults with Patellofemoral Pain Syndrome.

Comparison of classification-based cognitive functional therapy for patients with chronic low back pain with standard physiotherapy treatment

Comparison of classification-based cognitive functional therapy for patients with chronic low back pain with standard physiotherapy treatment

Effects of postural specific sensorimotor training in patients with chronic low back pain: study protocol for randomised controlled trial

BackgroundSensorimotor training (SMT) is popularly applied as a preventive or rehabilitative exercise method in various sports and rehabilitation settings. Yet, there is only low-quality evidence on its effect on pain and function. This randomised controlled trial will investigate the effects of a theory-based SMT in rehabilitation of chronic (>3 months) non-specific low back pain (CNLBP) patients.Methods/DesignA pilot study with a parallel, single-blinded, randomised controlled design. Twenty adult patients referred to the clinic for CNLBP treatment will be included, randomised, and allocated to one of two groups. Each group will receive 9 x 30 minutes of standard physiotherapy (PT) treatment. The experimental group will receive an added 15 minutes of SMT. For SMT, proprioceptive postural exercises are performed on a labile platform with adjustable oscillation to provoke training effects on different entry levels. The active comparator group will perform 15 minutes of added sub-effective low-intensity endurance training. Outcomes are assessed on 4 time-points by a treatment blinded tester: eligibility assessment at baseline (BL) 2–4 days prior to intervention, pre-intervention assessment (T0), post-intervention assessment (T1), and at 4 weeks follow-up (FU). At BL, an additional healthy control group (n = 20) will be assessed to allow cross-sectional comparison with symptom-free participants. The main outcomes are self-reported pain (Visual Analogue Scale) and functional status (Oswestry Disability Index). For secondary analysis, postural control variables after an externally perturbed stance on a labile platform are analysed using a video-based marker tracking system and a pressure plate (sagittal joint-angle variability and centre of pressure confidence ellipse). Proprioception is measured as relative cervical joint repositioning error during a head-rotation task. Effect sizes and mixed-model MANOVA (2 groups × 4 measurements for 5 dependent variables) will be calculated.DiscussionThis is the first attempt to systematically investigate effects of a theory-based sensorimotor training in patients with CNLBP. It will provide analysis of several postural segments during a dynamic task for quantitative analysis of quality and change of the task performance in relation to changes in pain and functional status.Trial registrationTrial registry number on cliniclatrials.gov is NCT02304120, first registered on 17 November 2014.

Using Generalized Estimating Equations to Compare the Effect of Two Methods in the Treatment of Knee Osteoarthritis

Background: We aimed to compare the effect of two different treatment methods on severity pain in patients with severe knee osteoarthritis. Materials and Methods: A total of 40 female patients with severe knee OA were randomly assigned into two parallel groups: An intervention group received standard physiotherapy treatment accompanied by knee traction, and a control group received only standard physiotherapy treatment. Both groups were subjected to a follow-up period of 5 weeks (10 times). Generalized Estimating Equations model was used to estimate the odds of a pain as a function of the groups adjusted for potential confounders. Results: Using intervention as the reference group, the pain odds ratios was 3.17 (95% CI: 1.24— 8.09) for control group. Conclusion: We would recommend using of the common physiotherapy treatment accompanied by knee traction instead of common physiotherapy procedure in patients with severe knee OA. Original Research Article Shahmohammadi et al.; ARRB, 5(4): 330-334, 2015; Article no.ARRB.2015.036 331

Effects in Short and Long Term of Global Postural Reeducation (GPR) on Chronic Low Back Pain: A Controlled Study with One-Year Follow-Up.

Objective. Comparing global postural reeducation (GPR) to a standard physiotherapy treatment (PT) based on active exercises, stretching, and massaging for improving pain and function in chronic low back pain (CLBP) patients. Design. Prospective controlled study. Setting. Outpatient rehabilitation facility. Participants. Adult patients with diagnosis of nonspecific, chronic (>6 months) low back pain. Interventions. Both treatments consisted of 15 sessions of one hour each, twice a week including patient education. Measures. Roland Morris Disability Questionnaire to evaluate disability, and Numeric Analog Scale for pain. A score change >30% was considered clinically significant. Past treatments, use of medications, smoking habits, height, weight, profession, and physical activity were also recorded on baseline, on discharge, and 1 year after discharge (resp., T0, T1, and T2). Results. At T0 103 patients with cLBP (51 cases and 52 controls) were recruited. The treatment (T1) has been completed by 79 (T1) of which 60 then carried out the 1-year follow-up (T2). Both GPR and PT at T1 were associated with a significant statistical and clinical improvement in pain and function, compared to T0. At T2, only pain in GPR still registered a statistically significant improvement.

Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis

The aim of this study was to evaluate the clinical results of non surgical knee distraction in patients with severe knee osteoarthritis. forty female patients with severe knee osteoarthritis were randomly divided in two groups. A standard physiotherapy treatment was applied to both groups and in one group it was accompanied with 20 min knee joint distraction. The patients were treated for 10 sessions. Clinical examination consisted of functional examination, completion of a quality of life questionnaire, pain scale, and assessment of joint mobility and joint edema. The standard physiotherapy treatment accompanied by knee distraction resulted in significantly higher improvement in pain (P = 0.004), functional ability (P = 0.02), quality of life (P = 0.002) and knee flexion range of motion (p = 0.02) compared to the standard physiotherapy treatment alone post treatment and after 1 month follow up. Adding knee distraction to standard physiotherapy treatment can result in further improvement in pain relief, increased functional ability and better quality of life in patients with severe knee osteoarthritis.