Standard Physiotherapy Research Articles

Heel Raises and Calf Stretches Exercises Versus Medication Only in Ischemic Intermittent Claudication: A Randomized Controlled Trial.

Intermittent claudication is a primary symptom of peripheral artery disease (PAD). a chronic progressive disease caused primarily by atherosclerosis. It is usually characterized by leg pain, aches, cramps, or fatigue when walking, which improves with rest. Physical therapy, including a supervised exercise program, is often recommended as the first treatment for sprains. This study aims to evaluate the short-term effects of incorporating heel raise and calf stretch exercises with standard medical therapy compared to medical therapy alone in managing intermittent claudication. From May 2022 to November 2023, 160 patients with Stage II Fontaine PAD were randomly assigned to two equal groups. Group A (80 patients) received heel raise and calf stretch exercises in addition to medical treatment, while Group B (80 patients) received only medical treatment. Both groups underwent treadmill walking tests before and after three months to measure absolute walking distance (ACD), peak walking time (PWT), and Walking Impairment Questionnaire (WIQ) scores, including distance, speed, and symptom severity. At baseline, there were no significant differences between the groups in terms of ACD, peak walking time, ankle-brachial index, distance, speed, and symptoms. At follow-up, Group A showed significantly greater improvements in ACD (312.00 ± 45.43 m), peak walking time (8.54 ± 1.55 min), distance (29.46 ± 4.63 km), speed (20.01 ± 3.13 kph), and WIQ symptoms (22.10 ± 1.02) compared to Group B, which had ACD (276.55 ± 29.07 m), peak walking time (6.72 ± 1.70 min), distance (23.68 ± 3.89 km), speed (15.71 ± 2.71 kph), and WIQ symptoms (20.80 ± 1.47) (P < .001). The ankle-brachial index remained similar between the groups (P > .05). We concluded that integrating standard physical therapy exercises, such as calf raises and leg stretches, with medical therapy significantly enhances walking function in patients with ischemic intermittent claudication.

Physical Therapy for Knee Pain Relief Induces Changes in Gut Microbiome Composition: A Secondary Analysis of Data From a Randomized Controlled Trial.

Aerobic exercise alters gut microbiome composition, yet the impact of gentle physiotherapy on gut microbiome and its relation to muscle strengthening and physical function remains unexplored. Physiotherapy exercises modulate gut microbiome composition and changes in gut microbes are linked to improvements in muscle strength or function. Secondary data analysis of samples from a randomized controlled trial. Level 2b. Data from a 6-week randomized controlled trial of physiotherapy for knee pain were analyzed. Gut microbiota profiling utilized 16S sequencing. We compared intervention and control (usual care) groups using microbial diversity metrics. Amplicon sequence variants (ASVs) that changed after the program were identified with ALDEX2, and correlations between these ASVs and measures of physical function, muscle strength, and interleukin-6 (IL-6) were explored. No diversity changes were observed between standard care (n = 43) and physiotherapy (n = 34). Physiotherapy led to significant increases in Alistipes, Bacteroides, Clostridium sensu stricto 1, and Faecalibacterium ASVs. Of these, Clostridium sensu stricto 1 and Faecalibacterium were associated with postintervention muscle strength. Increase in Faecalibacterium was correlated with a decrease in IL-6 in the physiotherapy group. Physiotherapy had modest effects on gut microbiome composition affecting 4 taxa. Increases in muscle strength were correlated with increases in 2 taxa including Faecalibacterium. Faecalibacterium was also linked to reduced inflammation. Improved walking speed was linked to an increase in Alistipes with no differences found for strength or squatting ability. Improved gut microbiome composition is linked to better overall health outcomes, including enhanced immune function, reduced inflammation, and improved metabolic health. This is particularly relevant for patients with osteoarthritis, who are known to have a high prevalence of cardiometabolic comorbidities. Integrating physiotherapy protocols that positively influence the gut microbiome can thus enhance overall patient outcomes.

Efficacy of pelvic floor muscle training with physical therapy for low back pain: A systematic review and meta-analysis.

To assess the efficacy of pelvic floor muscle training and physical therapy interventions in patients with low back pain. The Ovid-Medline, Ovid-Embase, Cochrane Library, CINAHL, Web of Science, and PEDro databases were searched for randomised, controlled trials published in English or Korean between database inception and September 2024. Studies providing pelvic floor muscle training in individuals with low back pain were included. The risk of bias using the Cochrane Risk of Bias 2 tool and the grading of recommendation, assessment, development, and evaluation (GRADE) system was used to evaluate the quality of evidence. The meta-analysis was performed using Review Manager software 5.4. Nineteen studies were included in this review. Pelvic floor muscle training showed low certainty evidence for improving pain (standardised mean difference = -0.73, 95% CI [-1.10, -0.36]) and reflected a clinically meaningful reduction in pain. The evidence for disability improvement had a low certainty (mean difference = -5.21, 95% CI [-7.15, -3.26]) due to high heterogeneity. Substantial improvements in pain and disability were observed when pelvic floor muscle training was added to standard physical therapy, with low certainty of evidence supporting these findings. Whereas pelvic floor muscle training substantially improved pain compared to other interventions, there was no marked improvement in disability. Pelvic floor muscle training is potentially beneficial in addition to physical therapy for reducing low back pain, particularly in pregnancy-related cases. However, the evidence should be interpreted considering the quality and risk of bias.

Harnessing the Power of Water: A Scoping Review of Hydrokinesiotherapy as a Game-Changer in Knee Osteoarthritis Management.

Background: Knee osteoarthritis (OA) is a prevalent condition that significantly impairs pain, mobility, and quality of life. Hydrokinesiotherapy, a water-based exercise therapy, is gaining traction as a potential alternative to traditional land-based rehabilitation for managing knee OA symptoms. Methods: This scoping review aimed to evaluate the effectiveness of hydrokinesiotherapy compared to standard land-based physical therapy and self-administered exercise regimens in improving pain, joint mobility, quality of life, and physical function in patients with knee OA. Five randomized controlled trials (RCTs) were included, assessing outcomes using measures such as the WOMAC score, Visual Analog Scale (VAS), and SF-12. The studies were critically appraised using the PEDro scale and the RoB-2 tool to determine the quality and risk of bias. Results: Hydrokinesiotherapy consistently demonstrated superior outcomes in pain reduction, joint mobility, and physical function across all studies. Patients in the hydrokinesiotherapy groups reported significant improvements in pain and mobility, which were strongly associated with enhanced quality of life. The review also highlighted the potential for hydrokinesiotherapy to serve as an effective alternative or complement to land-based exercises, particularly in populations experiencing severe symptoms. Conclusions: Hydrokinesiotherapy is an effective intervention for managing knee OA, offering significant improvements in key clinical outcomes. Given its benefits, hydrokinesiotherapy should be considered a valuable addition to knee OA treatment protocols. However, further research is needed to confirm long-term effects and to explore ways to improve accessibility to this therapeutic option.

Illusory movements for immobile patients with extensive burns (IMMOBILE): A randomized, controlled, cross-over trial

IntroductionPatients who have sustained extensive burns frequently exhibit substantial damage to skeletal muscle and associated complications. The rehabilitation of these patients can be challenging due to the nature of the injury and the subsequent complications. Nevertheless, there is a possibility that functional proprioceptive stimulation (illusory movements) may facilitate effective rehabilitation in patients with limited physiotherapy options. Nevertheless, this approach has yet to be tested in patients with burn injuries. Material and methodologyA prospective, randomised, crossover trial was conducted at a burn centre in a tertiary teaching hospital. The objective was to assess the effects of illusory movements on energy metabolism, insulin sensitivity, and skeletal muscle biology in adult critically ill patients with deep burns covering 30 % or more of the total body surface area. Two 30-minute daily sessions of functional proprioceptive stimulation were administered in addition to the standard physical therapy or physical activity regimen. Subsequently, the patients proceeded to the next stage of the trial, which involved a two-week crossover period. Measurements and main resultsDaily indirect calorimetry and calculation of nitrogen balance. Skeletal muscle biopsies from vastus lateralis for high resolution respirometry and euglycemic clamps to assess whole body glucose disposal were performed three times: at baseline and then fortnightly after each intervention period. The intervention was feasible and well tolerated in both early and late stages of burn disease. It did not change energy expenditure (mean change −33 [95 % CI: −292;+227] kcal .24 h−1, p = 0.79), nitrogen balance (+2.0 [95 % CI: −3.1;+7.1] g N .1.73 m−2 BSA .24 h−1), or insulin sensitivity (mean change of insulin-mediated glucose disposal −0.33 [95 % CI: −1.18;+0.53] mmol.h−1). At the cellular level, the intervention increased the capacity of mitochondria to synthesize ATP by aerobic phosphorylation and tended to increase mitochondrial coupling. Functional capacities of fatty acid oxidation and electron transfer chain complexes I, II, and IV were unaffected. ConclusionsCompared to physical therapy alone, two daily sessions of functional proprioceptive stimulation in addition to usual physical therapy in patients with extensive burns did not change energy expenditure, insulin sensitivity, nitrogen balance, or energy substrate oxidation. At cellular level, the intervention improved the capacity of aerobic phosphorylation in skeletal muscle mitochondria. Clinical effects remain to be demonstrated in adequately powered trials.

Use of a surgical referral algorithm within a standardized shoulder physical therapy program to assist clinical decision-making

Purpose Determine (a) utility of a shoulder referral algorithm, (b) patients improving ≥15% on the Western Ontario Rotator Cuff(WORC) score with standardized Physical Therapy(PT) +home exercises, and (c) presenting characteristics among PT-Only, PT + Surgical Consult and Surgery participants. Materials and Methods Prospective cohort study of patients 30–65 years old with shoulder pain. A standardized PT program assessed pain, ROM, strength and exercise tolerance (i.e., referral algorithm) at 2-, 6- and 12-weeks to determine if a surgical consultation might be beneficial. A blinded research assessor evaluated pain, ROM, strength and WORC score at 6-, 12-weeks and 6-months. The proportion improving WORC scores ≥15% and group differences were also evaluated. Results 32/128 (25%) participants underwent consultation with 16 (12.5%) undergoing surgery. WORC scores improved ≥15% by 12-weeks in most PT-Only/PT + Surgical Consult participants (n = 77[70%]) and was maintained at 6-months. Surgery participants used more NSAIDs (p = 0.01), injections (p = 0.002) and trended to higher opioid use (p = 0.06). PT + Surgical Consult/Surgery participants (n = 16/32; 50%) knew diagnostic imaging results more than PT-Only (n = 26; 31%) (p = 0.02). Surgery participants presented with worse pain, ROM, strength and WORC scores than PT-Only (p < 0.05). Conclusions The algorithm identified those with worse symptomology (25%), 50% of whom underwent surgery. WORC scores improved ≥15% in most participants (70%). Presenting characteristics were significantly worse between PT-Only and Surgery participants.

The effect of kinesio taping on joint range of motion and balance in total knee replacement patients.

We adopted a within-subjects quasi-experimental approach to assess the impact of kinesio taping (KT) on joint range of motion (ROM), static balance, and dynamic balance. The research subjects were 15 patients who had, within the previous 3 weeks, undergone total knee replacement (TKR) by an orthopedic surgeon in 2022. We measured the ROM, static balance, and dynamic balance of the knee joint before and after applying KT. We then compared the pre- and post-tape measurements to assess the effects of KT on joint function and balance. The ROM of the knee joint was measured using a goniometer in the supine position before the KT application. The static and dynamic balance were assessed using a balance assessment device by measuring the sway area and length of the center of gravity during the measurement period. The effects of KT on the ROM and static and dynamic balance of the knee joint were investigated. The differences in joint ROM and static and dynamic balance between pre- and post-KT applications were analyzed using a paired-sample t-test. This study found that the ROM of the knee joint was significantly increased after applying KT. For static and dynamic balance, both the sway area and length of the center of gravity decreased after applying KT, indicating a significant improvement in static and dynamic balance. KT, when combined with standard physiotherapy, can be a useful therapeutic approach for TKR patients, effectively enhancing joint ROM and balance function.

Effectiveness of adding dry needling of the upper trapezius muscle to the usual physiotherapy for managing chronic neck pain: A randomized controlled trial with a 7-week follow-up

BackgroundMyofascial pain syndrome (MPS) is a chronic condition caused by sensitive pressure regions within the muscles known as myofascial trigger points (MTrPs). ObjectiveThe purpose of this randomized controlled trial (RCT) was to assess the effectiveness of adding dry needling (DN) to activate MTrPs in the upper trapezius muscle compared with usual physiotherapy among individuals with chronic neck pain. MethodsThirty participants were recruited from a private clinic in Saudi Arabia. Their mean age was 29.7 ± 4.4 years. The subjects were randomized into two groups: the experimental group (application of DN to the MTrPs coupled with usual physiotherapy (n = 15)) and the control group (usual physiotherapy alone (n = 15)). The primary outcomes were pain (assessed using the visual analog scale) and disability (Neck Disability Index), and the secondary outcomes were neck active range of motion (AROM; assessed using cervical ROM) and depression (Beck's Depression Inventory). ResultsSignificant between-group difference in pain intensity was observed immediately post-intervention. Participants in the experimental group had significantly higher pain (mean difference = 1.27, 95% confidence interval [CI] 0.20, 2.33, p = 0.022, Cohen's d = 0.889) than those in the control group. There was no significant difference between both groups in pain intensity during the follow-up. There were no between-group differences in disability immediately post-intervention. However, there was a between-group difference in disability at follow-up; participants in the experimental group had significantly lower disability (mean difference = −3.13, 95%CI -5.07, −1.20, p = 0.003, Cohen's d = 1.211) than those in the control group. Immediately post-intervention, the experimental group showed greater flexion AROM compared to the control group, with no differences in other AROM measures. At follow-up, the experimental group exhibited significantly higher neck AROM in extension, flexion, right and left side bending, and lower depression, while no differences were observed in right- and left-rotation AROMs between groups. ConclusionsThe addition of DN to standard physiotherapy effectively improved disability, AROM (extension, flexion, and side bending), and depression among patients with chronic neck pain.

Recovery of balance and walking in people with ataxia after acute cerebral stroke: study protocol for a prospective, monocentric, single-blinded, randomized controlled trial

IntroductionPosterior circulation stroke can lead to ataxia, manifesting in a loss of coordination and balance. Patients experience difficulty in activities of daily living and an increased risk of falling, both profoundly affecting quality of life. In individuals with neurodegenerative diseases, coordination exercises have been shown to lead to a reduction in ataxic symptoms. There is, however, limited evidence on the effect of physical therapy, specifically coordination exercises in patients with stroke-related ataxia. We therefore present a study protocol for a prospective trial.MethodsThe purpose of this trial is to investigate the effects of coordination exercises compared to standard physiotherapy on balance and walking in ataxic stroke patients. Therefore, a prospective, single-blinded randomized controlled trial is currently ongoing at the Clinical Department of Neurology, Medical University of Innsbruck, Austria, in collaboration with two local rehabilitation facilities in Austria, Hochzirl Hospital and the Clinic for Rehabilitation Münster. Balance is the primary outcome of the study as assessed using the Berg Balance Scale. Secondary outcomes are concerned with walking, risk and number of falls, independence in daily life, and quality of life, rated using appropriate scales and scores. Patients are allocated applying a 1:1 ratio and a stratified block randomization. In both groups recruited individuals undergo five 45-min treatment sessions per week, totaling 20 sessions of coordination exercises (IG) or standard physiotherapy (CG) over the course of 4 weeks. Data is collected at the baseline (T0), after the 4-week supervised practice (T1), and after another 8 weeks of independent home-based training (T2).DiscussionThis is the first randomized controlled trial investigating the effects of coordination exercises on balance and walking in people with stroke-related ataxia. As stroke guidelines emphasize the limited evidence of treatment for ataxic symptoms, this study aims to contribute further knowledge regarding tailored interventions for these patients.Clinical Trial RegistrationGerman Clinical Trials Registry (drks.de). Identifier: DRKS00020825.

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.

Harnessing Mirror Neurons: A New Frontier in Parkinson's Disease Rehabilitation-A Scoping Review of the Literature.

Background: Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, and bradykinesia. Rehabilitation utilizing mirror neurons leverages the brain's capacity for action observation (AO) and motor imagery (MI) to enhance motor function. This approach involves patients imitating movements observed in therapists or videos, aiming to improve gait, coordination, and overall quality of life. Mirror neuron activation facilitates motor learning and may decelerate disease progression, thus enhancing patient mobility and independence. Methods: This scoping review aimed to map current evidence on PD therapies employing mirror neuron-based rehabilitation. Databases searched included PubMed, PEDro, and Cochrane. The review included randomized controlled trials (RCTs) and systematic reviews that examined the effects of AO and MI in PD rehabilitation. Results: Five studies met the inclusion criteria, encompassing various rehabilitation techniques focusing on AO and MI. These studies consistently demonstrated positive outcomes, such as reduced disease severity and improved quality of life, gait, and balance in PD patients. The activation of mirror neurons through AO and MI was shown to facilitate motor learning and contribute to improved functional mobility. Conclusions: Although the included studies support the beneficial impact of AO and MI techniques in PD rehabilitation, numerous questions remain unresolved. Further research is necessary to evaluate the potential integration of these techniques into standard physiotherapy routines for PD patients. This review highlights the promise of AO and MI in enhancing motor rehabilitation for PD, suggesting the need for more comprehensive studies to validate and refine these therapeutic approaches.

Short-Term Efficacy of Integrating the Easy-Flex Device With Inpatient Rehabilitation in Individuals With Total Knee Arthroplasty: Insights From a Single-Blind Randomized Controlled Trial

ObjectiveTo determine the effect of Easy-Flex as an adjunct to standard inpatient rehabilitation on clinical and functional outcomes. DesignProspective randomized controlled trial. SettingOutpatient clinic and research laboratory. ParticipantsA total of 44 patients were randomized to the Easy-Flex Group (EFG) or Control Group (CG). InterventionsA rehabilitation program averaging 50-60 minutes per day was implemented for the patients with CG. In the EFG, in addition to 30-40 minutes of exercise with the Easy-Flex, the rehabilitation program applied to the CG was integrated with reduced sets and repetitions, with an average duration of 20 minutes. All interventions were performed under the supervision of a physiotherapist during hospitalization. After discharge, both groups received the same home exercise program. Main Outcome MeasuresThe primary outcome is the flexion and extension range of motion (ROM). The secondary outcomes include the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Five Times Sit-to-Stand Test (5-TSST), 10-Meter Walking Test (10-MWT), Short Form (SF)-12v2, and Global Rating of Change scale. ResultsAfter 6 weeks, the overall group-by-time interaction for the 2 × 3 mixed-model analysis of variance was found to be significant for flexion ROM (P=.005), NPRS-rest (P=.04), NPRS-activity (P=.01), 10-MWT (P=.003), WOMAC (P=.021), and SF-12 physical component summary (PCS) (P=.032) in favor of EFG exercising with Easy-Flex in addition to standard rehabilitation. The between-group differences in favor of the EFG were −8.0° knee ROM, 1.35-1.5 points for pain intensity, and 0.12 m/s for gait speed. Furthermore, differences favoring EFG in NPRS-rest, 10-MWT speed, and SF-12 PCS were greater than the reported minimum clinically important difference. ConclusionsIncorporating Easy-Flex into standard physical therapy can be a beneficial, safe, and effective approach in clinical practice, as patients undergoing total knee arthroplasty typically prioritize improving their quality of life by reducing pain and increasing ROM.

Overground Gait Training With a Wearable Robot in Children With Cerebral Palsy: A Randomized Clinical Trial.

Cerebral palsy (CP) is the most common developmental motor disorder in children. Robot-assisted gait training (RAGT) using a wearable robot can provide intensive overground walking experience. To investigate the effectiveness of overground RAGT in children with CP using an untethered, torque-assisted, wearable exoskeletal robot. This multicenter, single-blind randomized clinical trial was conducted from September 1, 2021, to March 31, 2023, at 5 rehabilitation institutions in Korea. Ninety children with CP in Gross Motor Function Classification System levels II to IV were randomized. The RAGT group underwent 18 sessions of RAGT during 6 weeks, whereas the control group received standard physical therapy for the same number of sessions during the same period. The primary outcome measure was the Gross Motor Function Measure 88 (GMFM-88) score. Secondary outcome measures were the GMFM-66, Pediatric Balance Scale, selective control assessment of the lower extremity, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), 6-minute walking test scores (distance and oxygen consumption), muscle and fat mass via bioelectrical impedance analysis, and gait parameters measured via 3-dimensional analysis. All assessments were performed for all patients at baseline, at the end of the 6-week intervention, and after the 4-week follow-up. Of the 90 children (mean [SD] age, 9.51 [2.48] years; 49 [54.4%] male and 41 [45.6%] female) in the study, 78 (86.7%) completed the intervention, with 37 participants (mean [SD] age, 9.57 [2.38] years; 19 [51.4%] male) and 41 participants (mean [SD] age, 9.32 [2.37] years; 26 [63.4%] male) randomly assigned to the RAGT and control groups, respectively. Changes in the RAGT group significantly exceeded changes in the control group in GMFM-88 total (mean difference, 2.64; 95% CI, 0.50-4.78), GMFM-E (mean difference, 2.70; 95% CI, 0.08-5.33), GMFM-66 (mean difference, 1.31; 95% CI, 0.01-2.60), and PEDI-CAT responsibility domain scores (mean difference, 2.52; 95% CI, 0.42-4.63), indicating independence in daily living at postintervention assessment. At the 4-week follow-up, the RAGT group showed significantly greater improvements in balance control (mean difference, 1.48; 95% CI, 0.03-2.94) and Gait Deviation Index (mean difference, 6.48; 95% CI, 2.77-10.19) compared with the control group. In this randomized clinical trial, overground RAGT using a wearable robot significantly improved gross motor function and gait pattern. This new torque-assisted wearable exoskeletal robot, based on assist-as-needed control, may complement standard rehabilitation by providing adequate assistance and therapeutic support to children with CP. CRIS Identifier: KCT0006273.

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.

The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort.

A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort. At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery. Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers' Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period. Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.

Effect of Aerobic Exercise on Static &amp; Dynamic Balance in Children with Down Syndrome

Background: Down syndrome, characterized by an extra chromosome 21, affects physical and developmental growth. Children with Down syndrome often exhibit impairments in balance and motor function, necessitating interventions that enhance physical capabilities and overall quality of life. Objective: To evaluate the efficacy of aerobic exercises compared to standard physical therapy in improving static and dynamic balance in children with Down syndrome. Methods: This randomized controlled trial included 20 children aged 5-12 years with Down syndrome, recruited from the Rising Sun Institute of Special Education. Participants were randomly divided into a control group, which received standard physical therapy, and an experimental group, which engaged in aerobic exercise (cycling) three times a week for 30 minutes over an 8-week period. The primary outcomes, static and dynamic balance, were assessed using the Pediatric Balance Scale (PBS) and the 6-Minute Walk Test (6MWT) before and after the intervention. Results: The experimental group showed significant improvements compared to the control group. The mean changes in the Timed Up and Go test were reduced by 3.67 seconds (p &lt; 0.05), the PBS scores increased by 10.23 points (p &lt; 0.05), and the 6MWT distance extended by 66.11 meters (p &lt; 0.05). Conclusion: Aerobic exercise interventions significantly enhance static and dynamic balance in children with Down syndrome, surpassing the effects of standard physical therapy. Incorporating structured aerobic exercises into rehabilitation programs is recommended to optimize developmental outcomes in this population. Keywords: Down Syndrome, Aerobic Exercise, Pediatric Balance Scale, 6-Minute Walk Test, Static Balance, Dynamic Balance, Randomized Controlled Trial.

Melanoma and People of Color: The Role of Physical Therapists

While the incidence of melanoma in people of color is low, when melanoma is diagnosed, it is often at later stages, resulting in the likelihood of death when compared to non-Hispanic White individuals. This is a health disparity that needs to be addressed. This disparity demands the attention of first-line health care providers, especially providers serving minority populations. Physical therapists (PTs) in the United States are allowed direct access to patients (access specifics vary by state) and are well-positioned to be part of the solution to this health disparity. The skin is an organ highly accessible to and frequently encountered by PTs, and early detection is associated with better melanoma-related outcomes. However, there is limited literature available regarding PTs and their role in aiding melanoma detection in skin, much less among people of color. This perspective paper introduces a novel, inclusive screening approach, following the mnemonic NO SUN, as an adjunct to the well-established asymmetry, borders, color, diameter, and evolution/evolving rule to address the disparity. The mnemonic NO SUN stands for Non-sun-exposed, Oral, Soles and palms, Underneath genitalia, and Nail beds—areas where suspicious lesions are commonly found in people of color. Both patient and PT education on melanoma and how its presentation differs in people of color are included in this strategy. Highlighting the needs of this special population and addressing those needs with standard physical therapy practice serves as a path toward health equity within an interdisciplinary framework.

Effects of Non-Invasive Ventilation with different modalities in patients undergoing heart surgery: Protocol for a randomized controlled clinical trial.

The thoracic surgical procedure leads to a reduction in respiratory muscle strength. To restore it, certain strategies must be employed. Physiotherapy utilizes resources and techniques such as deep breathing stimulation, cough stimulation, use of incentive spirometers, mobilization, and ambulation. However, at times these resources and techniques may prove insufficient, and additional measures, such as Non-Invasive Ventilation (NIV), are employed Pieczkoski (2017). Non-Invasive Positive Pressure Ventilation (NPPV) has been utilized to expedite pulmonary function recovery as well as to prevent and treat postoperative pulmonary complications Nasrala 2018. NIV diminishes the risk of ventilator-associated complications due to its non-invasive nature. Consequently, NIV has been adopted to avert post-extubation complications in postoperative patients Liu 2020. The objective of this study is to conduct a randomized clinical trial and assess the efficacy of NIV in comparison to conventional physiotherapy in terms of pulmonary function among patients undergoing cardiac surgery at a selected hospital in Campina Grande, Paraíba, Brazil. This randomized, controlled, double-blind (patient and analyst) clinical trial will be conducted at Hospital João XXIII in Campina Grande, Paraíba, Brazil. Patients do not know which group they are allocated to. Those in the group that use CPAP or BIPAP will not be able to distinguish one from the other. The data analyst at the end of the collections will also be blinded. Only the health professional who will be applying the protocol cannot be blinded. The sample size, determined via sample calculation, yielded a total of 21 patients per group (63 patients). The patients will be allocated into 3 groups (CPAP group - CPAP + standard physiotherapy, BiPAP group - BiPAP + standard physiotherapy, and Control group - standard physiotherapy) in a 1:1:1 allocation ratio. The control group will receive the usual physiotherapeutic treatment as per the kinesiotherapy protocol. The treatment will be administered twice daily, starting in the ICU and progressing to the ward. In the CPAP group, nasal CPAP at 10cmH2O will be administered for 1 hour, twice daily, using an approved device. In the BiPAP group, nasal BiPAP with an IPAP of 13cmH2O and EPAP of 8cmH2O will be administered for 1 hour, twice daily, using an approved device. The NIV sessions will be conducted over the course of 5 days of hospitalization, both in the ICU and the ward. Assessments will be conducted at two time points: on day 1 preoperatively and on day 5 postoperatively. The following measures will be evaluated: pulmonary function, length of hospital stay, presence of postoperative pulmonary complications, score of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in its Portuguese version, functional capacity, the Global Perception of Change Scale, and the Functional Independence Measure (MIF). The normality of variables will be assessed using the Shapiro-Wilk test. IBM SPSS Statistics Base 25.0, using the Shapiro-Wilk test for normality and paired Student's t-test for pre-post intervention comparison. They will use linear mixed effects models for longitudinal analysis and GLMMs to compare NIV effects over time between groups. They will employ ITT for missing data, INAR models for time dependence, fixed effects models for endogeneity, and Cohen's d for effect sizes. Parametric model assumptions will be checked, and various models will be considered for data characteristics. Pulmonary function, Length of hospital stay. Score of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in Portuguese version, Funcional capacity, The global perception of change scale, The functional independence measure (MIF), pO2 (partial pressure of oxygen), pCO2 (partial pressure of carbon dioxide), HCO3 (bicarbonate), Arterial Oxygen Saturation (SaO2), Base Excess (BE), Presence of lung complications. Duration of cardiopulmonary bypass, type of surgery, personal history, preoperative ejection fraction, previous respiratory complications, body mass index (BMI), gender and age. Trial register number NCT05966337.

Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial.

Low back pain stands as a prevalent contributor to pain-related disability on a global scale. In addressing chronic low back pain (CLBP), there is a growing emphasis on incorporating psychological strategies into the management process. Among these, pain education interventions strive to reshape pain beliefs and mitigate the perceived threat of pain. This randomized controlled trial sought to assess the effects of pain education on various aspects, including pain levels, disability, quality of life, self-efficacy, and prognostic characteristics in individuals grappling with CLBP. The clinical trial, retrospectively registered with the Clinical Trials Registry of India (CTRI/2021/08/035963), employed a two-arm parallel randomized design. Ninety-two participants with CLBP were randomly assigned to either the standard physiotherapy care with a pain education program or the control group. Both groups underwent a 6-week intervention. Assessment of pain intensity (using NPRS), disability (using RMDQ), self-efficacy (using the general self-efficacy scale), and well-being (using WHO 5I) occurred both before and after the 6-week study intervention. Post-intervention score comparisons between the groups revealed that the pain education intervention led to a significant reduction in disability compared to the usual standard care at 6 weeks (mean difference 8.2, p < 0.001, effect size Cohen d = 0.75), a decrease in pain intensity (mean difference 3.5, p < 0.001, effect size Cohen d = 0.82), and an improvement in the well-being index (mean difference 13.7, p < 0.001, effect size Cohen d = 0.58). The findings suggest that integrating a pain education program enhances the therapeutic benefits of standard physiotherapy care for individuals dealing with chronic LBP. In conclusion, the clinical benefits of pain education become apparent when delivered in conjunction with standard care physiotherapy during the management of chronic low back pain.

Treatment of anterior knee pain due to chondromalacia patellae with platelet-rich plasma and hyaluronic acid in young and middle-aged adults, a cohort study.

Anterior knee pain commonly affects young women resulting in the declination of the quality of life. One of the possible pathologies causing this symptom is chondromalacia patellae (CMP). Although CMP is used to describe the softening of patellar articular cartilage, it remains a general descriptive term as it cannot be associated with a specific pathophysiologic mechanism. The objective of this study is to investigate the effect of injectable PRP on patients with anterior knee pain in absence of altered patellofemoral joint anatomy. For this purpose, 43 patients of the affected population were recruited to participate in this non-randomized controlled trial, 28 patients in the injection group and 15 in the only-physiotherapy group. While patients in the experimental group received three PRP injections and one injection of hyaluronic acid (HA), comparators received the standard physical therapy regimen. The treatment choice was based on patients own decree. Patients between the ages of 18 to 50 years with anterior knee pain and positive Clarke´s sign were eligible for inclusion. Patients with evident anatomical abnormalities, chronic conditions affecting the knee and severe symptoms such as blocking, were excluded from the study. Patient related measures (PROMS) in the form of the VAS and the Kujala scores were the main outcome of interest. All outcomes were measured at baseline, and after 3 and 6 months after the treatment. Although an improvement was seen in both groups, a statistically significant difference favoring the injection of PRP over the physiotherapy-only group was observed (p < 0.001). The superiority of the therapeutic modality under investigation was observed at 3 and 6 months after the initial diagnosis was made. Furthermore, the results of this study revealed a significant improvement at 3 and 6 months when compared to baseline measures. The analysis of the patients age showed a negative correlation when baseline values were compared to measures at 3 and 6 months, meaning younger patients had more benefit from the treatment. The main results of this study affirm the positive effects of PRP and HA for the treatment of anterior knee pain described by previous research and the subsequent improvement of the quality of life. Relatively little information was found in the literature search regarding the therapeutic effects of PRP on anterior knee pain and chondropathies. While a previous radiologic study found no evidence regarding the effect of PRP, this study found a benefit when comparing PROMs between patient groups.