Traditional Physical Therapy Intervention Research Articles

The role of Self-Efficacy in Chronic Pain—A Case Report Relating Motivation During The COVID-19 Pandemic and a Patient With Chronic Pain

Research ObjectivesTo analyze patient outcomes and traditional physical therapy interventions for chronic low back back, and discuss the benefits of incorporating self-efficacy techniques to improve patient independence.DesignRetrospective case report.SettingOutpatient physical therapy setting.Participants48-year-old female with complaints of chronic low back pain that has increased significantly over the last six months due to the societal consequences of COVID-19. The patient's past medical history included mild arthritis of her spine. The medications she was using for pain included Naproxen, and the patient also found relief with Salonpas pain relief patches.Interventions1. Trunk flexion AAROM, x 10 repetitions, by rolling swiss ball forward on plinth to promote a stretch of the lower back and eliminate fear of mobility.2. interferential electrical stimulation to low back to decrease pain x 10 min3. bilateral dynamic hip strengthening on hip abduction machine with 45#, 10 reps x 3 sets each4. Functional training such as proper lifting mechanics, 5 repetitions of box lifting5. physiological components aimed to improve self-efficacyMain Outcome Measures1.numerical pain rating scale2. Modified Oswestry Low Back Pain Disability QuestionnaireResultsThe patient's pain improved throughout the 6 weeks that she was seen at physical therapy. This is reflected on her scores on the NPRS. Her baseline pain rating was 9.5/10 and by 6 weeks her score decreased to 3/10. The patient also showed improvements on the Modified Oswestry Disability Index, as seen by a decrease from 42% disability to 10% disability. Improvements were seen in the patient's bed mobility, lumbar flexion AROM, bilateral hip strength, and lower abdominal strength.ConclusionsThis case is an example of someone with chronic low back pain that prior to the pandemic, had enough self efficacy to manager her condition independently. Interventions during physical therapy focused on traditional manual and therapeutic exercise principles as well as physiological components aimed to improve her self-efficacy.Author(s) DisclosuresI declare that I have no relevant or material financial interests that relate to the research described in this paper”.

The Management of Balance and Proprioception Discrepancies for a Patient with Cervicogenic Headache: A Case Report

Introduction: Previous research studies have established a link between cervical dysfunction, proprioception, and balance deficits in patients with cervicogenic headache. However, no current research exists to determine if the implementation of a balance program for these patients has any effect on their balance and proprioception capabilities. This case study aimed to identify if significant changes can be made the overall balance of a patient with cervicogenic headache as measured by the NeuroCom Sensory Organization Test. Case Description: The patient was a 50-year-old female, who had been suffering from long term cervicogenic headaches with increasing frequency and intensity for 6 months. Outcomes: The patient was seen for six visits over six weeks for balance training in addition to traditional physical therapy interventions including manual therapy and therapeutic exercise. After 6 sessions the patient made an overall improvement in balance (+7.9%) measured via the NeuroCom Sensory Organization Test and clinically significant improvements in reported pain via the Headache Disability Index (91.6%), Neck Disability Index (63.6%) and the Visual Analog Scale (2.5 points). Discussion: This case report demonstrates when balance training is added to standard manual therapy interventions for the management of cervicogenic headache you can successfully improve overall balance control measured with the NeuroCom Sensory Organization Test. Further research is necessary to further validate balance programming as a key intervention strategy for the general population with cervicogenic headache and guide decision-making for these patients.

Effects of physical therapy interventions on balance ability in people with traumatic brain injury: A systematic review.

Balance deficits are common impairments in individuals with post-traumatic brain injury (TBI). Balance deficits can restrict the activities of daily living and productive participation in social life. To date, no systematic reviews have examined the impact of physical therapy intervention on balance post-TBI. To examine the effects of physical therapy interventions on balance impairments in individuals with TBI. We systematically searched in PubMed, EMBASE, Scopus, PEDro, MEDLINE, REHABDATA, and Web of Science for randomized controlled trials (RCTs), clinical control trials, and pilot studies that examined the effects of physical therapy interventions on balance deficits in individuals post-TBI. The methodological quality was estimated using the Physiotherapy Evidence Database (PEDro) scale. Eight studies published from 2003 to 2019 were included in this study. A total of 259 TBI participants post-TBI were included in this review, 71 (27.41%) of which were females. The methodological quality of the selected studies ranged from low to high. There were no significant differences between experimental interventions, virtual reality (VR), vestibular rehabilitation therapy (VRT), control group interventions, and other traditional physical therapy interventions. The evidence about the effects of the physical therapy interventions in improving the balance ability post-TBI was limited. Further randomized controlled trials are strongly warranted to understand the role of physical therapy in patients with TBI who complain about balance deficits.

Effect of Core Stability Exercises and Treadmill Training on Balance in Children with Down Syndrome: Randomized Controlled Trial.

Core stability exercises and treadmill training play a crucial role in physical therapy interventions and have an effect on balance in children with Down Syndrome (DS); however, whether core stability exercises or treadmill training has more effect on improving balance has not been investigated yet. The aim of the study was to investigate the effect of core stability training versus treadmill exercises on balance in children with Down Syndrome. Forty-five children aged 4-6years with Down Syndrome were included in the study. The children were equally divided randomly into three groups. Group A received traditional physical therapy intervention strategies to facilitate the balance of participating children. Group B received the same as group A and additional core stability exercise training. Group C received the same intervention strategies as group A in conjunction with a treadmill exercise program. The children's balance was evaluated using the Berg balance scale and the Biodex Balance System. Treatment sessions were for 60min, thrice a week, for 8 consecutive weeks. There were significance improvements in the three groups in functional balance and over all stability indices in favor of groups B and C. Core stability and treadmill training improved balance in children with Down Syndrome and should be applied in conjunction with physical therapy programs.

Dry Needling for Female Chronic Pelvic Pain: A Case Series

Background: Chronic pelvic pain (CPP) is a debilitating condition often associated with lumbopelvic or hip dysfunction because of the involvement of the deep hip rotators. Dry needling (DN) has been shown to reduce pain and improve function in other chronic, musculoskeletal conditions but as we are aware, its use in those with CPP has not been described. Study Design: Case series. Case Description: Two women, 72 and 62 years of age, were referred to physical therapy with CPP. The patients reported substantial functional limitations secondary to pelvic pain and previous treatments had been unsuccessful. In both patients, familiar pain was elicited with palpation of pelvic floor muscles, particularly obturator internus. Dry needling treatment to obturator internus was a primary focus of treatment in both women with secondary DN to their pelvic floor and gluteal muscles in addition to traditional physical therapy interventions. Outcomes: Patient A demonstrated resolution of symptoms, increased range of motion, and improved mobility after 7 treatments. Her Hip Outcome Score improved from 45.31 to 97.06. Patient B reported resolution of her pelvic pain by the fifth treatment. Her Modified Oswestry Disability Index improved from 46% to 2% and her Pelvic Floor Disability Index score improved by 62.5 points. Discussion: Both patients demonstrated substantial improvement following physical therapy with focused DN to the obturator internus, pelvic floor, and gluteal muscles. These outcomes suggest that physical therapy management using DN may prove to be a powerful treatment technique for patients with CPP. Further evaluation of DN in treating pelvic pain is warranted.

Acupressure for chronic low back pain: a single system study.

[Purpose] Low back pain (LBP) is the leading cause of global disability. Acupressure is a manual approach that can be used for self-management of LBP. The purpose of the study was to determine the effectiveness of acupressure in treating chronic LBP. [Subjects and Methods] The research design was a single system study utilizing an AB design. The subject was recruited using convenience sampling. During phase A, the subject received traditional physical therapy interventions. During phase B, the subject received acupressure in addition to traditional physical therapy interventions. Outcomes included the Visual Analog Scale (VAS), the Patient Specific Functional Scale (PSFS), and the Oswestry Disability Index (ODI). [Results] For the VAS, the pain was 38.8 mm at baseline, decreased to 11.3 mm after phase A, and decreased to 2.5 mm after phase B. For the PSFS, the subject’s function was 5/10 at baseline, remained the same after phase A, and increased to 9/10 after phase B. For the ODI, the subject’s disability was moderate (30%) at the baseline, decreased to minimal (14%) after phase A, and completely resolved (0%) after phase B. [Conclusion] The data indicated that integrating acupressure in physical therapy could reduce pain, increase function, and decrease disability.

Effectiveness of Interventions for Children With Developmental Coordination Disorder in Physical Therapy Contexts: A Systematic Literature Review and Meta-Analysis

Purpose:The purpose of this systematic literature review and meta-analysis is to identify the types of interventions in physical therapy contexts that have been explored in children with developmental coordination disorder, the most common variables being addressed, and whether these interventions are effective. Method:This systematic search of MEDLINE, PEDro, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library identified interventions in physical therapy contexts for children and adolescents with DCD, and studies were screened using these criteria and assessed using the PEDro and NIH quality assessment scales. AMSTAR was used to evaluate systematic reviews and a meta-analysis was conducted. Results:From the articles reviewed, 29 articles of moderate to good quality were included in the qualitative analysis. Task-oriented approaches as well as motor skill training–based interventions have shown beneficial effects in improving motor function in children with DCD. Data from 14 articles was extracted for inclusion in the meta-analysis, providing support for the effectiveness of physical therapy interventions against inaction. Conclusion:Researchers recommend the use of task-oriented and traditional physical therapy interventions for children with DCD. In addition, interventions in physical therapy contexts need clear goals and outcome measures for individual children.

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text. Ultimately, 10 studies met the inclusion criteria: (1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison; (2) subjects must have had a diagnosis of CEH; (3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control; and (4) the study included headache pain and frequency as outcome measurements. Seven of the 10 studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from CEH, although heterogeneity of the studies makes it difficult to generalize the findings.

What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?

BackgroundOther than activity and exercise, lifestyle practices such as not smoking and healthy nutrition, well established for preventing and managing lifestyle-related non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive lung disease, diabetes, and obesity), are less emphasized in the physical therapy guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review examines the relationships between lifestyle behaviours and musculoskeletal health, with special reference to chronic pain, and their clinical and research implications.DiscussionA state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle behaviour change; 2) to establish the degree to which adopting healthier lifestyle practices, avoids or reduces the need for conventional physical therapy; and 3) to establish whether patients/clients with healthier lifestyles and who have chronic pain, respond more favourably to conventional physical therapy interventions than those who have less healthy lifestyles.SummaryLifestyle behaviour change is well accepted in addressing lifestyle-related non-communicable diseases. Compelling evidence exists however supporting the need for elucidation of the role of negative lifestyle behaviours on the incidence of chronic pain, and the role of positive lifestyle behaviours on its incidence and effective management. Addressing lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach, but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.

Addition of hip exercises to treatment of patellofemoral pain syndrome: A meta-analysis

Abstract AIM: To determine if the addition of hip-strengthening exercises decreases pain and improves function in patients with patellofemoral pain syndrome. METHODS: The authors completed a systematic review searching eight databases (i.e., PubMed, Cochrane, CINHAL, MEDLINE, SportsDiscus, EMBASE, APTA Hooked on Evidence, and PEDro). Two independent reviewers screened and excluded studies if they did not meet the following inclusion criteria: subjects had a primary diagnosis of patellofemoral pain syndrome (PFPS), intervention group included hip-strengthening exercises, control group included a traditional physical therapy intervention, study included outcome measures of pain and/or function, study used a randomized controlled trial design, PEDro score was ≥ 7, and study was published in a peer-reviewed journal. Primary outcome measures were subjective scales of pain and function. These measures were converted to standardized mean difference [effect size (ES)], and a random-effects model was used to calculate the overall ES.

Does Supplemental Creatine Decrease Rehabilitation Time In Young Adults With Immobilization Related Injuries?

There is a paucity of research on using oral supplements to shorten rehabilitation times. Creatine monohydrate is a dietary supplement ingested orally in powder or tablet form, which has been used heavily by athletes and recreational enthusiasts over the last ten years in an effort to improve strength gains and reduce recovery times. We hypothesize using supplemental creatine as an adjunct to physical therapy interventions will decrease rehabilitation times by improving strength gains and decreasing adverse effects of immobilization. A systematic review of literature was conducted based on the scale provided by the Oxford Centre of Evidence‐based Medicine. The literature reviewed focused on beneficial effects of creatine, physiological pathways within the muscle cell, pharmacokinetics, pharmacodynamics, and potential health risks of creatine use. Based on the evidence gathered, we determined that creatine is effective during glycolysis for energy production, and also in the recovery period after high intensity exercise by reducing lactic acid production, sparing glycogen, promoting myogenic transcription and maintaining a stable environment for protein synthesis. We concluded that creatine might be beneficial as an adjunct to traditional physical therapy interventions in decreasing rehabilitation time.

슬관절 움직임 제한 보조기를 이용한 슬관절 과신전 제한이 편마비 환자의 균형과 보행에 미치는 영향

본 연구는 편마비 환자 중 슬관절 과신전으로 인해 균형 및 보행 장애를 보이는 환자들에게 슬관절 움직임 제한 보조기로 과신전을 제한시킨 연구군과, 치료사의 손으로 과신전을 제한시킨 대조군으로 나누어 전통적인 물리치료를 실시해 치료 전, 후와 두 간을 비교하여, 슬관절 움직임 제한 보조기가 슬관절 과신전이 있는 편마비 환자의 균형과 보행에 미치는 영향을 알아보고자 하였다. 연구 대상은 서울 참병원에서 편마비로 인하여 편마비라고 진단 받고 입원 및 통원 치료를 하는 환자 중 슬관절 과신전을 보이는 20명을 대상으로 무작위로 연구군과 대조군으로 나누어 연구 전, 후를 BBS (Berg Balance Scale), TUG (Time Up & Go Test), 보행 능력 평가를 이용하여 측정 비교 하였다. BBS를 이용해 균형능력을 측정한 결과 연구군, 대조군 모두에서 실험 전, 후에 유의한 차이를 보였다(p<0.05). 또한 TUG를 이용한 균형능력 측정 결과에서도 연구군, 대조군 모두에서 실험 전, 후에 유의한 차이를 보였다(p<0.05). 보행 능력 검사를 이용해 보행능력 평가를 한 결과 연구군, 대조군 모두에서 실험 전, 후에 유의한 차이를 보였다 (p<0.05). 균형 및 보행능력을 주 단위로 측정한 결과 연구군과 대조군 모두에서 유의한 증가를 보였고 (p<0.05), 두군 간에는 균형능력에서만 유의한 차이가 있었다(p<0.05). 하지만 그래프상으로 봤을 때 연구군에서 균형과 보행능력의 더 많은 증가를 보였다. 본 연구 결과 슬관절 움직임 제한 보조기를 사용한 슬관절 과신전 제한 후 치료는 편마비 환자의 보행능력 증진에는 유의한 효과가 없었지만, 균형능력 증진에 유의한 효과가 있었다. The purposes of this study was to determine the effects of limited hyperextension at knee joint using Limited Motion Knee Brace on balance and walking in patients with hemiplegia. The subjects of this study were 20 post-stroke hemiplegic patients admitted. Subjects were randomly assigned to either experimental group (Limited Motion Knee Brace group) or control group (manual restriction group). Both groups received traditional physical therapy intervention. The effects of each therapeutic method were evaluated by measurements of gait ability assesment, Berg balance scale (BBS), 10-meter walk speed (10MWS), Timed Up & Go (TUG) Test. The results of this research were as followings: (1) After treatment, there were significant BBS scores differences in both experimental and control group compared with pre-treatment(p<0.05). (2) After treatment, there were significant TUG test scores differences in both experimental and control group compared with pre-treatment (p<0.05). (3) After treatment, there were significant 10MWS differences in both experimental and control group compared with pre-treatment (p<0.05). (4) There were significant BBS scores differences in third and fourth week between experimental and control group (p<0.05). It was concluded that Limited Motion Knee Brace was effective for improving balance and for reducing fatigue for experimental group. Therefore, further studies are required to investigate the effect of knee orthosis for improving balance and walking in patients with hemiplegia.

Continuing Professional Development Is Associated With Increasing Physical Therapists' Roles in Arthritis Management in Canada and the Netherlands

This study explored the relationships among the roles assumed by physical therapists in arthritis care and their previous participation in arthritis courses for continuing professional development (CPD). A cross-sectional mail survey was conducted. A total of 600 Canadian physical therapists and 461 Dutch physical therapists practicing in orthopedics were randomly selected to participate in a mail survey. The questionnaire covered areas related to their clinical practice, previous participation in arthritis-related CPD courses, and roles in the management of osteoarthritis (OA) and rheumatoid arthritis (RA). Poisson regression was used to explore the associations between physical therapists' participation in arthritis-related CPD courses and the number of roles they assumed in OA and RA care, after adjusting for personal characteristics, arthritis caseload, and country of practice. The survey response rates were 47.7% in Canada and 50.5% in the Netherlands. A total of 424 participants (Canada=224, the Netherlands=200) had treated patients with OA in the previous month, and 259 participants (Canada=68, Netherlands=191) had treated patients with RA in the previous month. The most common roles reported by participants were providing traditional physical therapy interventions and providing postsurgical care. Arthritis-related CPD courses significantly increased (ie, multiplied) the expected number of roles assumed by physical therapists by a factor of 1.32 (95% confidence interval=1.11, 1.56) in OA management and 1.69 (95% confidence interval=1.34, 2.13) in RA management. Physical therapists' roles in arthritis management were obtained through self-reporting, which might differ from their actual clinical practice. This exploratory analysis highlights the association between participation in arthritis-related CPD courses and the roles assumed by physical therapists in OA and RA management. Further research is needed to understand the effects of CPD activities on other areas of physical therapist practice and on patients' outcomes.

Training of Balance Under Single- and Dual-Task Conditions in Older Adults With Balance Impairment

Traditionally, rehabilitation programs emphasize training balance under single-task conditions to improve balance and reduce risk for falls. The purpose of this case report is to describe 3 balance training approaches in older adults with impaired balance. Three patients were randomly assigned to 1 of 3 interventions: (1) single-task balance training, (2) dual-task training under a fixed-priority instructional set, and (3) dual-task training under a variable-priority instructional set. The patients who received balance training under dual-task conditions showed dual-task training benefits; these training benefits were maintained for 3 months. The patient who received variable-priority training showed improvement on novel dual tasks. Older adults may be able to improve their balance under dual-task conditions only following specific types of balance training. This case report gives insight on how this intervention might be combined with more traditional physical therapy intervention.