Supervised Physiotherapy Program Research Articles

Does physiotherapy after rotator cuff repair require supervision by a physical therapist?: a meta-analysis.

A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI], -32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, -2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I.

Ultrasound-Guided Hydrodistension for Adhesive Capsulitis: Is There Any Adjunct Effect of Immediate Post-Procedural Manipulation Over Instructed Physical Therapy?

To compare the additive value of immediate post-procedural manipulation versus physiotherapy, following ultrasound (US)-guided hydrodistention of the glenohumeral joint (GHJ) in patients with adhesive capsulitis (AC) and define predictors of outcome. Within a 19-month period, 161 consecutive patients with AC were prospectively enrolled and allocated to two groups according to treatment, based on patients' individual preferences: 1) group-I, US-guided hydrodistension plus immediate post-procedural manipulations and 2) group-II, US-guided hydrodistension plus supervised physiotherapy program. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a visual analog scale (VAS) were used for clinical assessment at baseline (immediately after treatment), 1, 3, and 6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value <.05 defined significance. GHJ hydrodistension with manipulation or physiotherapy was linked to clinical improvement at all follow-up time-points. DASH scores of group-I remained constantly lower than DASH scores of group-II at all time-points (P < .001). VAS scores were lower in group-I than group-II at 1 and 3 months (P < .001 and P=.0019, respectively). Both groups had improved to a similar degree with respect to pain at 6 months (P=.29). The performance of post-interventional manipulations was predictive of improved shoulder functionality (as assessed with DASH scores) at all time-points, while low-grade disease and milder symptoms at presentation were associated with improved short-term pain. Immediate post-procedural manipulations appeared to be superior to physiotherapy following GHJ hydrodistension for AC in terms of shoulder functionality during a 6-month follow-up period. Post-interventional manipulations, the stage of AC and lower DASH and VAS scores at presentations were predictive of improved outcome.

Isokinetic Muscle Strength in Elite Soccer Players 3 and 6 months After Anterior Cruciate Ligament Reconstruction.

Milutinović, A, Jakovljević, V, Dabović, M, Faude, O, Radovanović, D, and Stojanović, E. Isokinetic muscle strength in elite soccer players 3 months and 6 months after anterior cruciate ligament reconstruction. J Strength Cond Res 37(4): e297-e304, 2023-The aim of this study was to evaluate interlimb symmetry in quadriceps and hamstring peak torque of elite soccer players at 3 months (stage 1) and 6 months (stage 2) after anterior cruciate ligament (ACL) reconstruction. Eight male professional soccer players competing at the highest level across different European countries, who had undergone ACL reconstruction, participated in this study. All patients underwent a supervised physiotherapy program after surgery. Data analyses included the use of separate two-way repeated-measures analyses of variance and effect sizes. Although knee extensor and flexor strength of the non-injured limb was found to be relatively unaltered ( g = -0.10 to 0.00) between stage 1 and stage 2, comparisons across time points revealed moderate improvements in quadriceps peak torque ( p = 0.01, g = 0.52), hamstring peak torque ( p = 0.07, g = 0.51), and hamstring:quadriceps (H/Q) ratio ( p = 0.03, g = -0.68) of the injured leg, as well as small-large improvements in the quadriceps ( p = 0.004, g = 1.24) and hamstring limb symmetry index (LSI) ( p = 0.056, g = 0.41). A time-dependent moderate-large asymmetry observed at stage 1 between the injured and noninjured leg in quadriceps peak torque ( p < 0.001, g = -1.83), hamstring peak torque ( p = 0.157, g = -0.67), and the H:Q ratio ( p = 0.06, g = 1.01), as well as between the hamstring and quadriceps LSI ( p = 0.03, g = -0.74) was eliminated at stage 2 ( g = -0.31 to 0.42). Our findings indicate the importance of supervised and comprehensive therapy, as well as strength screening to assist in recovery aimed at optimizing identified strength deficits following ACL reconstruction.

Comparison of supervised physiotherapy program verses convensional exercises in the management of hemarthrosis in haemophilic patients

Comparison of supervised physiotherapy program verses convensional exercises in the management of hemarthrosis in haemophilic patients

Physiotherapy in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND:Physiotherapy is an essential for the treatment of patients with chronic respiratory non-inflammatory diseases especially for chronic obstructive pulmonary disease (COPD).AIM:To assess the effect of six months physiotherapy (PT) program on functional status in patients with COPD.MATERIAL AND METHODS:The patients were divided into two groups according to the severity of the disease. Group A included 33 patients (mean age 68.6 ± 7.3; GOLD II – III stages). Group B included 32 patients (mean age 71.7 ± 6.9; GOLD I –II). They were referred to supervised PT program performed three times weekly for a half a year. All the patients were on standard medical care. At entry and after PT, six minutes walking test (6 MWT), Borg scale and modified Medical Research Council (mMRC) scale were assessed.RESULTS:Significant changes in 6 MWT (p < 0.001) and mMRC scale (p < 0.001) were found after applied physical therapy program in patients of group A. Exertional dyspnoea decreased significantly in patients with group A (p < 0.001). Positive changes were found in physical tolerance in the patients of group B (p < 0.001).CONCLUSIONS:The present study revealed the positive effect of six months physiotherapy in physical tolerance and dyspnoea in patients with COPD at different stages of the disease.

KinoHaptics: An Automated, Wearable, Haptic Assisted, Physio-therapeutic System for Post-surgery Rehabilitation and Self-care.

A carefully planned, structured, and supervised physiotherapy program, following a surgery, is crucial for the successful diagnosis of physical injuries. Nearly 50 % of the surgeries fail due to unsupervised, and erroneous physiotherapy. The demand for a physiotherapist for an extended period is expensive to afford, and sometimes inaccessible. Researchers have tried to leverage the advancements in wearable sensors and motion tracking by building affordable, automated, physio-therapeutic systems that direct a physiotherapy session by providing audio-visual feedback on patient's performance. There are many aspects of automated physiotherapy program which are yet to be addressed by the existing systems: a wide classification of patients' physiological conditions to be diagnosed, multiple demographics of the patients (blind, deaf, etc.), and the need to pursue patients to adopt the system for an extended period for self-care. In our research, we have tried to address these aspects by building a health behavior change support system called KinoHaptics, for post-surgery rehabilitation. KinoHaptics is an automated, wearable, haptic assisted, physio-therapeutic system that can be used by a wide variety of demographics and for various physiological conditions of the patients. The system provides rich and accurate vibro-haptic feedback that can be felt by the user, irrespective of the physiological limitations. KinoHaptics is built to ensure that no injuries are induced during the rehabilitation period. The persuasive nature of the system allows for personal goal-setting, progress tracking, and most importantly life-style compatibility. The system was evaluated under laboratory conditions, involving 14 users. Results show that KinoHaptics is highly convenient to use, and the vibro-haptic feedback is intuitive, accurate, and has shown to prevent accidental injuries. Also, results show that KinoHaptics is persuasive in nature as it supports behavior change and habit building. The successful acceptance of KinoHaptics, an automated, wearable, haptic assisted, physio-therapeutic system proves the need and future-scope of automated physio-therapeutic systems for self-care and behavior change. It also proves that such systems incorporated with vibro-haptic feedback encourage strong adherence to the physiotherapy program; can have profound impact on the physiotherapy experience resulting in higher acceptance rate.

Training Program and Additional Electric Muscle Stimulation for Patellofemoral Pain Syndrome: A Pilot Study

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study. Objectives To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles. Design A randomized clinical trial. Setting Supervised physiotherapy (PT) training and home-based EMS. Participants Patients (N=38; 14 men, 24 women) with bilateral PFPS. Interventions One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA. Main Outcome Measures Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year. Results Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group. Conclusions A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Conservative management of patellofemoral pain

38 knees of 27 patients with patellofemoral pain were treated by a home exercise program. There were 22 females and 5 males whose ages averaged 28 years (range, 16-45 years). The duration of symptoms varied between one month and ten years (av. 2 years). Follow-up was 6 to 36 months, average 18 months. No exercises had been done to nine knees. The efficiency of the exercise program was 10% to 90%, average 41% for the remaining 29 knees. At the last follow-up there was an average 12 point increase (from 74 to 86) modified Lysholm scores. 27 knees (71 %) had better modified Lysholm scores. Tegner activity levels increased from average 3.3 (2-7) to average 3.8 (2-9). Only two patients (four knees) accepted operation. These results led us to conclude that a tnal of conservative treatment should be done pnor to any surgical procedure including arthroscopy. The success rate might be even higher with a supervised physiotherapy program.

Psychophysiological significance of temporal order in brain chaos

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study.To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.A randomized clinical trial.Supervised physiotherapy (PT) training and home-based EMS.Patients (N=38; 14 men, 24 women) with bilateral PFPS.One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Thoracic outlet syndrome: A useful exercise treatment option

The current study is a prospective evaluation of a supervised physiotherapy program of graduated resisted shoulder elevation exercises in eight patients with thoracic outlet syndrome. All had severe neurovascular symptoms and limited neck movements before treatment. After 3 weeks of intervention, symptoms had significantly improved in all patients, and all achieved a full range of cervical neck and shoulder movement. This study confirms the efficacy of a simple treatment program for patients with thoracic outlet syndrome.