Standard Rehabilitation Program Research Articles

Systematic Review and Meta-Analysis of the Application of T-PEP in the Therapeutic Management of COPD Patients.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by chronic mucus hypersecretion (CMH) that exacerbates airway obstruction and accelerates disease progression. Effective airway clearance techniques are essential to improve respiratory function and reduce exacerbations. Temporary Positive Expiratory Pressure (T-PEP) is a novel airway clearance device that has shown promise in managing COPD. Objectives: This meta-analysis aimed to evaluate the efficacy of T-PEP in a standard pulmonary rehabilitation program. Methods: Following PRISMA guidelines, a comprehensive search of randomized controlled trials (RCTs) was conducted in the MEDLINE and PEDro databases. Data from 162 subjects, including those with severe COPD and bronchiectasis, were analyzed. Key outcomes assessed were changes in lung function (FVC, FEV1, TLC), inspiratory and expiratory pressures (MIP, MEP), gas exchange (PaO2, PaCO2), exercise capacity (6MWT), symptom severity (mMRC, CAT, BCSS), and exacerbation rates. Results: T-PEP significantly improved FVC, FEV1, TLC, MIP, MEP, and DLCO compared to baseline, with heterogeneity noted across studies. Improvements in gas exchange and physical capacity were observed, with PaO2 increasing and PaCO2 decreasing. T-PEP also reduced symptoms of cough and dyspnea, improving quality-of-life scores. Additionally, a notable reduction in acute exacerbations of COPD was seen after one month and three months of treatment. Conclusions: T-PEP therapy shows substantial benefits in improving lung function, exercise capacity, and quality of life while reducing exacerbation rates in COPD patients. Although promising, these findings require further confirmation through randomized clinical trials to establish the optimal application of T-PEP in various clinical settings and patient phenotypes.

Exploring the Impact of Extended Amino Acid Supplementation on Body Composition and Psychopathology in Patients with Eating Disorders Undergoing Psycho-Nutritional Rehabilitation.

Eating disorders are frequently linked to protein-energy malnutrition, resulting from chronic energy intake reduction, and leading to reduced body weight and altered body composition. A nutritional approach based on the supplementation with a mixture of essential amino acids has proven effective in conditions characterized by reduced dietary intake and increased degradation of endogenous proteins and might also contribute to correct the amino acid deficiency possibly involved in the pathogenesis of eating disorders. This study aimed to explore the effects of amino acid supplementation in conjunction with a standard psycho-nutritional rehabilitation program on body composition, symptoms and psychopathology status in 30 female patients with eating disorders hospitalized at the Residenza Palazzo Francisci in Todi, Italy. Enrolled patients were divided in two groups receiving amino acid supplementation for 45 and 90 days, respectively. Each patient underwent bioelectrical impedance analysis at baseline, after 45 days and after 90 days. Validated psychometric tests were administered at study entry and study end to all enrolled patients. Results from bioelectrical impedance analysis suggest that amino acid supplementation contributes to restoring nutritional and metabolic balance, with effects proportional to the duration of administration. Conversely, interpreting the effects on psychopathologic state and symptoms was challenging, probably due to the small sample size and short observation period. Prolonged amino acid supplementation may play a role in the management of patients with eating disorders, favoring the correction of the catabolic state and possibly contributing to improvement of the psychopathologic state.

MODERN REHABILITATION METHODS FOR THORACIC BACK PAIN SYNDROME: A VERTEBRODYNAMIC PERSPECTIVE

The purpose of the study is to optimize rehabilitation measures for patients with degenerative-dystrophic pathology of the thoracic spine (DDPS) and thoracic back pain syndrome, based on vertebrodynamic indicators. Materials and methods. The patients’ ages ranged from 18 to 54 years, with 51 women (41.2%) and 73 men (58.8%). The duration of the disease varied from 2 to 23 years. A rehabilitation examination was conducted, assessing vertebrodynamic disorders using A. Stoddard's method. Functional block (FB) of the second degree was identified in the vertebral-motor segments (VMS) of the thoracic spine for all patients. The patients were divided into two groups, comparable in age and disease severity. The first group (n=56) received a standard rehabilitation program, including drug treatment (nonsteroidal anti-inflammatory drugs, muscle relaxants, analgesics), massage, personalized therapeutic exercise sets, and physical therapy methods (magnetotherapy, ultrasound therapy). The second group (n=68) received the basic treatment plus sessions of post-isometric and post-reciprocal muscle relaxation, mobilization techniques according to K. Lewit, R. Maigne, and V. Gubenko, as well as original kinesiotherapy methods developed based on vertebrodynamic indicators. The outpatient rehabilitation cycle lasted 14 days. Results. The subjective assessment of pain by all patients after the first one-time procedure decreased from 4.78±0.20 to 2.64±0.58 VAS points (p<0.05). Treatment of dysfunctions allowed the patients of the 2nd group to estimate pain sensations by 0.91±0.24 points (р<0.05). In patients of the 1st group, the subjective assessment of pain decreased significantly less (to 2.72±0.24 at p<0.05). After the rehabilitation cycle, in 78.6% of the patients of the 1st group, improvement of vertebrodynamic parameters was achieved, namely: restoration of the range of motion in the VMS at the chest level. In the 2nd group of patients, positive dynamics were observed in a larger proportion compared to the 1st group—94.1% of cases. Signs of functional block (FB) persisted in 12 (21.4%) of 56 patients in the 1st group and in 4 (5.9%) of 68 patients in the 2nd group. Thus, with the use of kinesiotherapy treatment techniques, the 2nd group achieved better rehabilitation outcomes. Conclusions. The implementation of our proposed optimized rehabilitation and treatment methods for thoracalgias caused by degenerative-dystrophic pathology of the thoracic spine (DDPS), incorporating original kinesiotherapy techniques, is recommended for clinical practice by physical and rehabilitation medicine specialists, neurologists, and other rehabilitation professionals.

The effectiveness of Cytoflavin in the medical rehabilitation of elderly and senile patients

Study the effectiveness of Cytoflavin in the medical rehabilitation of elderly and senile patients after pneumonia associated with a new coronavirus infection (COVID-19) at the outpatient stage. A prospective observational randomized study involving 66 patients (45 women and 21 men, average age 66.5±5.1 years) undergoing outpatient medical rehabilitation after pneumonia associated with COVID-19, divided into 2 groups, comparable in age and gender. A standardized comprehensive rehabilitation program was conducted in both groups. Patients of the main group were additionally prescribed Cytoflavin according to the standard regimen. Testing was carried out on scales reflecting the physical condition, degree of asthenization, psycho-emotional and cognitive status (Borg scale, 6-minute walk test, SHAS-scale, Multidimensional Fatigue Inventory, Mini-mental State Examination, Hospital Anxiety and Depression Scale) upon admission to outpatient treatment and upon discharge. Against the background of Cytoflavin therapy, positive dynamics was observed in patients of the main group in the form of a decrease in the values of SHAS-scale (86.5 [7.3] vs 56.3 [7.2]; p=0.00001), Multidimensional Fatigue Inventory (68.6 [14.7] vs 43.6 [12.8]; p=0.025); improvements in TSH (383.3 m [48.2] vs 550 m [32.5]; p=0.0248) and the Borg scale 4.5 [1.32] vs 2.2 [0.52]; p=0.038); the severity of cognitive impairment on the Mini-Mental State Examination decreased (26.05 [1.3] vs 28.47 [0.86]; p=0.0001); the emotional background improved - a decrease in the level of anxiety (10.7 [1.25] vs 5.6 [0.81]; p=0.0001) and depression (11.8 [1.48] vs 7.0 [1.24]; p=0.0001). The standard course of Cytoflavin therapy in the medical rehabilitation of elderly and senile patients after pneumonia associated with COVID-19 significantly reduces the severity of cognitive impairment, fatigue and depressive disorders, improves indicators of the emotional and volitional sphere, increases exercise tolerance.

Short-term effects of Kinesiotaping combined with a rehabilitation program for rotator cuff-related shoulder pain: a randomized, assessor-blinded clinical trial

ABSTRACT Objectives This study aimed to determine the clinical efficacy of Kinesiotaping (KT) combined with a rehabilitation program to reduce symptoms and functional limitations in patients with Rotator Cuff-Related Shoulder Pain (RCRSP) in Vietnam. Methods In total, 82 participants who were diagnosed with RCRSP were randomly allocated into two groups. Both groups received a standard rehabilitation program; additionally, the intervention group was treated with KT. Outcomes, assessed at baseline, and 3, 7, and 14 days postintervention, included pain intensity (Visual Analogue Scale, VAS), functional disability (Shoulder Pain and Disability Index, SPADI), and active range of motion (ROM). Results The KT group exhibited significant improvements in all outcome measures. VAS scores decreased by an average of 13.3 points in the KT group at 14 days, which was notably greater than that in the control group (95% CI: −17.77 to −8.82). SPADI scores also improved significantly in the KT group, with reductions of −11.36, −15.27, and −13.3 at days 3, 7, and 14, respectively. Regarding ROM, the KT group showed notable improvements in flexion and external rotation, with flexion ROM differences of 10.78, 10.35, and 11.8 degrees at the respective time points. No significant changes were observed in the abduction or internal rotation ROM. After adjusting for age, baseline scores, and gender, there was a statistically significant interaction between Group and Time on the VAS, SPADI, and ROM abduction. Conclusion Incorporating KT into a standard rehabilitation program for RCRSP demonstrated enhanced efficacy in reducing pain and improving shoulder function. The results suggest that KT can be a valuable component of the treatment regimen for RCRSP.

Intermittent Hypoxic-Hyperoxic Training During Inpatient Rehabilitation Improves Exercise Capacity and Functional Outcome in Patients With Long Covid: Results of a Controlled Clinical Pilot Trial.

Long COVID-19 illness is a severely disabling disease with shortness of breath, weakness and fatigue as leading symptoms, resulting in poor quality of life and substantial delay in return to work. No specific respiratory therapy has been validated for patients with long COVID. The intermittent hypoxia-hyperoxia training (IHHT) is a respiratory therapeutic modality to improve exercise performance via controlled respiratory conditioning. The purpose of the present study is to investigate the therapeutic effect of IHHT on functional and symptomatic recovery of patients with long COVID syndrome. A prospective, controlled, open-treatment interventional study was conducted in patients with long COVID who were admitted to an inpatient rehabilitation programme. Patients were assigned nonrandomized to receive IHHT in addition to the standardized rehabilitation programme (IHHT group) or standard rehabilitation alone (control group). The IHHT group received supervised sessions of intermittent hypoxic (10-12% O2) and hyperoxic (30-35% O2) breathing three times per week throughout the rehabilitation period. Primary endpoint was improved walking distance in a 6-min walk test (6MWT) between study groups. Secondary endpoints were change in stair climbing power, dyspnoea (Borg dyspnoea Scale), fatigue assessment scale (FAS) and change in health-related quality of life (HRQoL) assessed by patient global assessment (PGA), EQ-5D analogue scale and the MEDIAN Corona Recovery Score (MCRS). Further assessments included maximum handgrip strength, nine hole peg test, timed up-and-go, respiratory function and functional ambulation category (FAC), serum analyses and safety of the intervention. A total of 145 patients were included in the study (74% female, mean age 53 ± 12 years) and assigned to IHHT (n = 70) or standard care (n = 75). The 6MWT distance improved 2.8-fold in the IHHT group compared to the control group (91.7 ± 50.1 m vs. 32.6 ± 54.2 m, ANCOVA p < 0.001). Stair climbing power improved 3.7-fold in the IHHT group compared to controls (-1.91 ± 2.23 s vs. -0.51 ± 1.93 s, p < 0.001). Secondary endpoints on dyspnoea, fatigue and HRQoL (PGA, EQ-5D and MCRS) improved significantly in the IHHT group compared to controls. The IHHT group exhibited a significant decrease in blood pressure, heart rate and increase in haemoglobin levels that was not observed in the control group. No adverse events were observed. Respiratory treatment with IHHT in addition to a multidisciplinary rehabilitation programme improves functional capacity, symptomatic status and quality of life in patients with disabling long COVID. IHHT has been demonstrated to be safe, well tolerated and feasible to be integrated in an inpatient rehabilitation programme to improve outcome in long COVID.

Changes in Exercise Performance in Patients During a 6-Week Inpatient Psychiatric Rehabilitation Program and Associated Effects on Depressive Symptoms.

Background/Objectives: The impact of exercise on affective disorders has been demonstrated in various studies. However, almost no data are available on performance effects. Therefore, this study investigated exercise performance related to the severity of depression symptoms in a pre-post within-subjects design in a 6-week standard inpatient psychiatric rehabilitation program. Methods: A total of 53 individuals (20 female; mean age, 40.98 ± 11.33) with a primary diagnosis of depression performed a cardiopulmonary exercise test (CPX) to obtain maximal oxygen uptake (VO2max), maximal power output (Pmax), and the first and second ventilatory threshold (VT1, VT2) at the start and the end of the rehabilitation. Degree of depression was assessed by Becks Depression Inventory (BDI) and the Brief Symptom Inventory test (BSI). Overall activity was measured by accelerometer step-counts. Results: Mean total step-count per day during rehabilitation was high (12,586 ± 2819 steps/day). Patients' BDI and BSI at entry were 21.6 ± 8.83 and 65.1 ± 6.8, respectively, and decreased significantly (p < 0.001) following rehabilitation, to 10.1 ± 9.5 and 54.5 ± 11.3, respectively. Pmax and VO2max increased significantly (p < 0.001) from entry values (182.6 ± 58.7 W, 29.74 ± 5.92 mL·kg-1·min-1) following rehabilitation: by 11.91 ± 12.09 W and 1.35 ± 2.78 mL·kg-1·min-1, respectively. VT1 and VT2 showed a similar behavior. An increase in physical performance could predict improvement in BDI (R2 = 0.104, F(1,48) = 5.582, p = 0.022) but not in BSI. Conclusions: The program was associated with improved mental health status in all patients and increased performance in the majority of patients, although increases were small. Since improvements in exercise performance may be positively related to depression symptoms and comorbidities, it is recommended to individualize and tailor exercise programs, which could yield larger effects.

Assessing the Efficacy of Lokomat Training in Pediatric Physiotherapy for Cerebral Palsy: A Progress Evaluation.

Background: Gait disturbances in children with cerebral palsy can increase the hindrance caused by loss of independence and social engagement. The Lokomat, developed by Hocoma, shows promise as a supplementary tool for gait rehabilitation. This study investigates the impact of Lokomat training on gait parameters and trends observed during training. Methods: A total of 26 children (13 male individuals) with a diagnosis of cerebral palsy (CP), aged 4 to 23 years, were enrolled in the study. Patients participated in a standard comprehensive rehabilitation program with additional Lokomat training sessions. Gait function was assessed using the Timed Up and Go Test (TUG) and the 10 m walking test (10mWT) at the beginning and end of the rehabilitation period. Changes in Lokomat parameters (step number, session duration, speed, body weight support, and guidance force) were also analysed. Results: The median duration of the 10mWT and TUG significantly decreased across the groups after the treatment program. The highest increases were observed for the number of steps taken. Across the entire cohort, the linear trend curves for distance and number of steps exhibited near-perpendicular alignment with the horizontal axis, suggesting significant improvement in these parameters. A consistent trend was noted for speed, with the trend line aligned parallel with the horizontal axis. Decreasing trends were observed for body weight support and guidance force. Conclusions: Therapy with the Lokomat functioning as the active gait orthosis can be used as a form of support to the standard rehabilitation protocol for patients with CP.

Effects of VR task-oriented training combined with rTMS on balance function and brain plasticity in stroke patients: a randomized controlled trial study protocol

BackgroundBalance dysfunction affects 70% of stroke patients. Emerging neurophysiological approaches, such as virtual reality therapy (VRT) and repetitive transcranial magnetic stimulation (rTMS), have been proven by clinical studies that the balance function of stroke patients can be improved when applied alone, but there are relatively few studies on the combined treatment of balance dysfunction after stroke. This study aimed to evaluate the impact of a 4-week intensive intervention combining VRT and rTMS on both balance function and brain plasticity among stroke patients.MethodsThis single-blind, randomized controlled trial was conducted at the Rehabilitation Medical Center of the Rehabilitation General Hospital of Ningxia Medical University. A cohort of 136 stroke patients, with durations of 2 to 24 weeks post-stroke, were enrolled in the study. Participants were randomly allocated in a 1:1:1:1 ratio to four groups: the VR group (n = 34), the rTMS group (n = 34), the combined treatment group receiving both VR and rTMS (n = 34), and the control group undergoing traditional balance training (n = 34). All patients underwent a standardized inpatient rehabilitation program over 4 weeks. The VR group received daily 30-min sessions of VR therapy for 20 days. The rTMS group underwent daily sessions of rTMS stimulation for 20 min, targeting the motor imagery region in the affected hemisphere. The combination group received VR therapy after completing their rTMS treatment. The control group received conventional balance training, with each session lasting 30 min. Additionally, all patients received an extra 60 min of standard rehabilitation therapy twice daily. Assessments were conducted at baseline, 2 weeks, and 4 weeks post-treatment, using the Berg Balance Scale (BBS) as the primary measure, and secondary measures including the Timed Up-and-Go Test (TUGT), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), and 6-m walking test (6MWT), as well as assessments for brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VGEF), tyrosine receptor kinase (TrκB), motor-evoked potential latency (PL), central motor conduction time (CMCT), and amplitude.DiscussionThe widespread application of VR technology and rTMS in clinical settings is well-established. However, the potential synergistic effects of combining these modalities on balance function and neuroplasticity in stroke patients remain uncertain. Our hypothesis suggests that the integration of VR with rTMS may result in more pronounced improvements in both balance function and neuroplasticity among stroke patients, surpassing the outcomes achievable with VR alone, rTMS alone, or traditional therapy. The possible mechanism is that VR-based training combined with rTMS plays a superimposed effect, promoting better repair of damaged neurons and ultimately improving balance function in stroke patients. The positive results anticipated from this trial could provide objective evidence advocating for the concurrent use of VR and rTMS in clinical interventions.Trial registrationThe study protocol underwent review and approval by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 26, 2024 (No. KYLL-2024–0162). Subsequently, it was registered in the Chinese Clinical Trial Registry on March 11, 2024 (registration number: ChiCTR2400081775). Currently, the study is still ongoing.

Effect of Sarcopenia on Functional Recovery in Acute Stroke Patients Admitted for Standard Rehabilitation Program.

Background and Objectives: Sarcopenia is a significant concern in stroke rehabilitation, with a high prevalence reported in acute stroke patients. This study examines the effect of sarcopenia on rehabilitation outcomes in acute stroke patients. Materials and Methods: This study was conducted with acute stroke patients admitted within 90 days of onset to the rehabilitation hospital. Participants were divided into a stroke with sarcopenia group and a stroke without sarcopenia group. Evaluations were conducted at baseline, 4 weeks, and 8 weeks, including the following assessments: manual muscle testing (MMT), Berg Balance Scale (BBS), functional ambulation category (FAC), and Modified Barthel Index (MBI). Both groups received an identical rehabilitation program for 8 weeks. Results: Significant within-group improvements were observed in both groups across all measures (p < 0.05). However, the stroke with sarcopenia group showed significantly less improvement in MMT, BBS, FAC, and MBI compared to the stroke without sarcopenia group at both 4 and 8 weeks (p < 0.05). Conclusions: These results underscore the significant impact of sarcopenia on functional recovery in stroke patients, despite both groups receiving identical rehabilitation programs. The presence of sarcopenia was a critical predictor of poorer outcomes in muscle strength, balance, ambulation, and activities of daily living. Given these findings, specific rehabilitation strategies targeting sarcopenia are needed to improve recovery in stroke patients. Future research should include larger sample sizes, longer follow-ups, and sarcopenic patient-specific rehabilitation programs.

The Effectiveness of High Intensity Laser in Improving Motor Deficits in Patients with Lumbar Disc Herniation.

High-Intensity Laser (HIL) therapy, known for its biostimulatory effects on nerve cell growth and repair, shows promise for improving motor deficits caused by morphopathological changes. This research study aimed to comprehensively assess muscle strength changes through muscle testing, complemented by functional tests evaluating factors contributing to disability in patients with Lumbar Disc Herniation (LDH) and associated motor impairment, following a complex rehabilitation protocol incorporating HIL therapy. A total of 133 individuals with LDH and motor deficits were divided into two groups. Group 1 (n = 66) received HIL therapy followed by standard rehabilitation, while Group 2 (n = 67) underwent only the standard rehabilitation program. Functional parameters, including muscle strength, the ability to walk on tiptoes or heels, and self-assessed fall risk, were monitored. Both groups showed statistically significant improvements in all monitored parameters. A comparative analysis revealed a significant result for the HIL therapy regimen across all indicators. The group undergoing a rehabilitation program with integrated HIL therapy displayed significantly greater improvement in motor deficits, affirming the positive impact of HIL therapy on functional parameters among LDH patients.

Efficacy of continuous passive motion compared to physiotherapy in rehabilitation after total knee replacement: a prospective randomized controlled non-inferiority trial.

Successful total knee replacement (TKR) heavily depends on postoperative rehabilitation. This study aims to investigate the efficacy of continuous passive motion (CPM) partially replacing group physiotherapy in an inpatient rehabilitation setting in order to contribute to the lack of physiotherapists in patients' care. Adult patients after TKR were included. A prospective randomized controlled two-center trial was conducted across inpatient rehabilitation facilities in Germany. Participants were randomly assigned to CPM or group physiotherapy. In addition, all participants received the same standard rehabilitation program. Primary outcome was the Staffelstein Score, and secondary outcome measures included Oxford Knee Score, range of motion (ROM), pain, and return to work. Non-inferiority margin for Staffelstein Score was set at ±5% of maximum scores based on previous collected data. Results indicate no significant differences between CPM and physiotherapy groups in the Staffelstein Score (CPM: 94 ± 10 points; group physiotherapy: 92 ± 10 points; P > 0.05), ROM, or pain management at discharge from rehabilitation facility. This study underscores the potential of CPM as a valuable component of TKR rehabilitation, providing comparable outcomes to traditional physiotherapy. However, individualized physiotherapy remains integral to optimizing long-term success. Future research should explore extended follow-up periods and diverse patient populations to further elucidate CPM's role in TKR rehabilitation.

Efficacy of a new video observational training method (intensive visual simulation) for motor recovery in the upper limb in subacute stroke: a feasibility and proof-of-concept study.

To demonstrate the feasibility and efficacy of a new video-observation training method (intensive visual simulation) to improve upper limb function. Small sample, randomized, evaluator-blind, monocentric study. Seventeen early subacute ischaemic stroke patients with complete hemiplegia were randomly assigned to the therapeutic group (n = 8) or control group (CG, n = 9). Thirty sessions of intensive visual simulation combined with corrected visual feedback (therapeutic group) or uncorrected visual feedback (control group) were performed over 6 weeks on top of a standard rehabilitation programme. 400-point hand assessment test (400p-HA). Box and Blocks (B&B), Purdue Pegboard test, Minnesota. The 400p-HA test improved significantly from T0 to 6 months for both groups, with a significant difference between groups at 3 months (MW-UT p = 0.046) and 4 months (MW-UT p = 0.046) in favour of the therapeutic group. One-phase exponential modelling of 400p-HA showed a greater plateau for the therapeutic group (F test p = 0.0021). There was also faster recovery of the ability to perform the B&B tests for the therapeutic group (log-rank test p = 0.03). This study demonstrated the feasibility and potential efficacy of an intensive visual simulation training programme to improve upper limb function in subacute stroke patients. A larger study is needed to confirm these results.

Effect of Core Exercises on Clinical and Functional Outcomes After Total Knee Arthroplasty in Individuals With Knee Osteoarthritis: A Systematic Review.

Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised. The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA). PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full-texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised. A total of 1485 records were retrieved. Sixty-four articles were included for screening full-texts, and four articles were ultimately included. Core exercises were administered for three to 6weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p<0.05). Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted. PROSPERO Registration Number: CRD42024542992.

A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING THE DIRECT SUPERIOR APPROACH WITH THE POSTERIOR APPROACH FOR TOTAL HIP ARTHROPLASTY

The direct superior approach (DSA) is a modification of the posterior approach (PA) that preserves the iliotibial band and short external rotators except for the piriformis or conjoined tendon during total hip arthroplasty (THA). The objective of this study was to compare postoperative pain, early functional rehabilitation, functional outcomes, implant positioning, implant migration, and complications in patients undergoing the DSA versus PA for THA.This study included 80 patients with symptomatic hip arthritis undergoing primary THA. Patients were prospectively randomised to receive either the DSA or PA for THA, surgery was undertaken using identical implant designs in both groups, and all patients received a standardized postoperative rehabilitation programme. Predefined study outcomes were recorded by blinded observers at regular intervals for two-years after THA. Radiosteriometric analysis (RSA) was used to assess implant migration.There were no statistical differences between the DSA and PA in postoperative pain scores (p=0.312), opiate analgesia consumption (p=0.067), and time to hospital discharge (p=0.416). At two years follow-up, both groups had comparable Oxford hip scores (p=0.476); Harris hip scores (p=0.293); Hip disability and osteoarthritis outcome scores (p=0.543); University of California at Los Angeles scores (p=0.609); Western Ontario and McMaster Universities Arthritis Index (p=0.833); and European Quality of Life questionnaire with 5 dimensions scores (p=0.418). Radiographic analysis revealed no difference between the two treatment groups for overall accuracy of acetabular cup positioning (p=0.687) and femoral stem alignment (p=0.564). RSA revealed no difference in femoral component migration (p=0.145) between the groups at two years follow-up.There were no differences between patients undergoing the DSA versus PA for THA with respect to postoperative pain scores, functional rehabilitation, patient-reported outcome measurements, accuracy of implant positioning, and implant migration at two years follow-up. Both treatment groups had excellent outcomes that remained comparable at all follow-up intervals.

Change in Walking Parameters of Paralympic Athletes Diagnosed with Cerebral Palsy Using WALKBOT Training System at Recovery Stage of Rehabilitation

INTRODUCTION: The publication is devoted to studying the rehabilitative effect of the Walkbot innovative training system on restoring the walking function in Paralympic athletes diagnosed with cerebral palsy (CP). The novelty of the developed Walkbot robot-assisted training system (TS) and insufficient experience of its use in rehabilitation practice require investigations on contingents of patients with musculoskeletal disorders in CP to develop protocols and programs of the rehabilitation use of the Walkbot TS. AIM: Study of effectiveness of rehabilitation use of the Walkbot robotic TS to restore the walking function in Paralympic athletes with spastic cerebral palsy. MATERIALS AND METHODS: The study was conducted at the Medical Rehabilitation Center ‘Sergievskie Mineral Waters’ in 2023. Forty Paralympic athletes (all men) aged 30-35 years were examined. The experimental group (EG) and control group (CG) included 20 Paralympic athletes each with standardization of the groups by the main parameters. The classes were conducted for 60 minutes according to the rehabilitation program. In the experimental group, besides exercise therapy (ET), the participants also exercised on the robotic Walkbot TS to restore the walking function, namely, they used Go world game with the known tasks symbolizing counties of the world, Go palace game that permits to take a walk around the palace, when patients move to the right or left as they choose; Go undersea game occurring against the background of a fairy sea world where they must go through the route controlling the direction of movement. The Paralympians of the control group used the standard rehabilitation program including ET with no training and gaming technologies. RESULTS: The obtained results showed a pronounced improvement in the parameters of motor actions in Paralympians of the EG, while in the CG, positive rehabilitation changes were 2–3 times less expressed. At the initial and final rehabilitation stages, an increase of the tolerated duration of classes was recorded: by 5 times in the EG and 3 times in the CG, post-rehabilitation increase in the EG was 23.4% compared to that in CG. After training on the Walkbot TS, the volume of the performed load increased 5.9 times in the EG and 2.1 times in the CG. The increase in the EG made 64.5% compared to the CG, which indicated an increase in speed-strength qualities and endurance of para-athletes. At the end of rehabilitation, the amount of steps on the Walkbot TS in the EG increased 5.9 times (in the CG — 2.9 times), increase in the EG made 48.3% compared to the CG. CONCLUSION: The experiment established a complex multisided positive effect of training sessions on the Walkbot TS in the EG versus the effect of only exercise therapy in the CG. The obtained data suggest that training on the Walkbot TS confer a significant restorative and normalizing effect on the neurophysiological mechanisms of functioning of the central parts of the motor cortex.

Efficiency of interval hypoxia-hyperoxytherapy in the rehabilitation of patients with nonspecific musculosceletal low back pain: results of а randomized placebo-controlled study

BACKGROUND: Considering the high prevalence and social significance of nonspecific musculoskeletal lower back pain, the use of innovative non-drug rehabilitation methods, particularly interval hypoxia-hyperoxytherapy, is relevant. AIM: To evaluate the efficiency of the interval hypoxia-hyperoxytherapy in the complex medical rehabilitation of patients with nonspecific musculoskeletal lower back pain. MATERIALS AND METHODS: This randomized placebo-controlled study enrolled 62 patients (male, n=35; female n=27, aged 34–63 years) with nonspecific musculoskeletal lower back pain. All patients were randomized into two groups. The study group (n=34) received 10 procedures of hypoxia–hyperoxytherapy, and the comparison group (n=28) received 10 placebo procedures of breathing therapy. All groups underwent a 2-week standard rehabilitation program: 10 procedures of low-intensity laser therapy and low-frequency electrostatic therapy and 10 group sessions of physical exercises. The study group was breathing hypoxic (FiO2 13%–15%) and hyperoxic (FiO2 up to 40%) gas mixture through a mask in the interval mode using “ReOxy.” The duration of 1–4 procedures was 30 min and 5–10 procedures took 40 min. The placebo procedures were performed using masks with atmospheric air hole. Rehabilitation diagnosis by domains b28013, b7303, b7600, and d4500 of the International Classification of Functioning, Disability and Health (ICF), back pain and general health on a 100-mm visual analog scale, Lequesne index, 10-m walking test, Spielberger–Khanin reactive anxiety test, and Beck depression inventory were evaluated at baseline and week 2. RESULTS: After 2 weeks the values of the qualifiers of ICF domains significantly improved in the study group, back pain decreased by 65.2% (р 0.01), the Lequesne index by 76.1% (р 0.01), the 10-m walking test by 42.4% (р 0.05), the reactive anxiety level by 50.5% (р 0.01), and depression symptoms by 69.7% (р 0.01), whereas the general health improved by 71.2% (р 0.01), with statistically significant differences from the comparison group in all parameters (р 0.05). CONCLUSION: 2-week rehabilitation program, including interval hypoxia-hyperoxytherapy, reduces back pain and improves rehabilitation diagnosis based on the ICF, general health, functional status and psychoemotional state in patients with nonspecific musculoskeletal lower back pain.

Early integrated rehabilitation and vocational rehabilitation in 435 patients with breast cancer: A comparison between the intervention group and control group in a prospective study.

11007 Background: Return to work is beneficial both for breast cancer (BC) patients and for society. This study explored the impact of early integrated and vocational rehabilitation on sick leave and disability one year after the start of cancer treatment in BC patients. Methods: The subjects of our prospective study were 435 employed female BC patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation in 2019-2022 and were followed for at least one year. There were 211 patients in the control group and 224 in the intervention group. The patients completed three questionnaires (EORTC QLQ - C30, B23, and NCCN): before, half and one year after the start of cancer treatment. The control group received the standard rehabilitation programme, offered to all BC patients before the start of the study. The multidisciplinary rehabilitation team reviewed the documentation of the patients from the intervention group before, half and one year after the start of treatment and recommended appropriate interventions according to the patient's needs in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics and needs reported in questionnaires, the extent of the disease and cancer treatment were collected. These data and the frequency of sick leave and disability retirement one year after the start of treatment in both groups of patients were analysed using the chi-square and ANOVA test. Results: The patients from the intervention group had 50 calendar days shorter sick leave compared to the control group (p = 0.002). Patients without metastatic disease from the intervention group had 52 calendar days shorter sick leave compared to the control group (p = 0.002). The intervention group treated with chemotherapy had 43 calendar days shorter sick leave compared to the control group (p = 0.029). The difference in sick leave of the group of patients who did not receive chemotherapy was statistically borderline significant (50 calendar days, p = 0.053). The patients in the intervention group had a better work ability (p &lt; 0.001) and less disability (p &lt; 0.001) than the patients in the control group one year after the start of treatment. Conclusions: One year after the beginning of cancer treatment, patients from the intervention group had shorter sick leave, better work ability, and a lower proportion of disability compared to the control group.

Virtual Postoperative Rehabilitation after Facial Reanimation Surgery

To develop a standardized post-operative virtual rehabilitation program available to Atlantic Canadians following dual nerve transfer surgery/facial reanimation surgery. To report patient satisfaction outcomes associated with virtual rehabilitation following dual nerve transfer surgery.

Aerobic high-intensity interval training and maximal strength training in patients with unspecific musculoskeletal disorders improve V̇O2peak and maximal strength more than moderate training.

Improving peak oxygen uptake (V̇O2peak) and maximal strength are key objectives of rehabilitation for patients with unspecific musculoskeletal disorders (MSDs). Although high-intensity training yield superior outcomes for these factors, patients with MSDs may not tolerate high-intensity due to pain and fear. Therefore, we examined the effect and feasibility of incorporating aerobic high-intensity intervals (HIITs) and maximal strength training (MST) in a standard clinical rehabilitation program for patients with unspecific MSDs. 73 patients (45±10years) with MSDs partaking in a standard, public, and 4-week rehabilitation program were randomized to high-intensity training (HG: 4×4 minutes intervals at ∼90% of maximal heart rate; HRmax, and 4×4 repetitions leg press at ∼90% of 1 repetition maximum; 1RM, with maximal intended velocity) or keep todays treatment of low-to moderate-intensity training (MG: various cycling, walking, and/or running activities at ∼70%-80% of HRmax and 3×8-10 repetitions leg press at ∼75% of 1RM without maximal intended velocity). HG improved V̇O2peak (12±7%) and leg press 1RM (43±34%) more than moderate-intensity group (V̇O2peak; 5±6%, 1RM; 19±18%, both p<0.001). We observed that no adverse events and no between-group differences in dropout rate or self-reported quality of life (both p>0.05). There were positive correlations between improved V̇O2peak and improved physical (p=0.024) and emotional (0.016) role functioning. We conclude that both high-intensity interval training and MST are feasible and improve V̇O2peak and maximal strength more than standard low-to moderate-intensity treatment of patients with unspecific MSDs. Our findings suggest that high-intensity training should be implemented as a part of standard clinical care of this patient population.