BACKGROUND AND PURPOSE:Robot-assisted gait training (RAGT) is well established for post-stroke gait rehabilitation, but its potential effects on psychological and behavioral outcomes are less clear. This study investigated the effects of adding RAGT to conventional rehabilitation on balance, gait, kinesiophobia, and movement confidence in individuals with post-stroke hemiparesis. METHODS:This single-blind, parallel-group randomized controlled trial included 60 individuals with post-stroke hemiparesis (50-75 years), randomly allocated to an RAGT group (n = 30) or control group (n = 30). Ethical approval was obtained from the Clinical Research Ethics Committee of Istanbul Yeni Yüzyıl University (Approval No. 20.01.2022/05; approval date: 20 January 2022). Both groups received conventional rehabilitation for 8 weeks; the RAGT group additionally received 24 sessions of RAGT. Kinesiophobia was a prespecified study outcome assessed using the Kinesiophobia Causes Scale (KCS); balance, gait, and balance confidence were also assessed. All 60 randomized participants completed follow-up and were analyzed in their assigned groups. RESULTS:Significant group × time interactions were observed for several outcomes, including BBS, TUG duration, 10MWT walking speed, ABC, and KCS total score (p < 0.05). The between-group difference in change for KCS total score was -0.36 (95% CI: -0.51 to -0.21; partial eta squared = 0.292). In post hoc analyses adjusting each outcome for its baseline value, significant group effects remained for BBS, TUG duration, 10MWT walking speed, ABC, KCS biological domain, and KCS total score (p< = 0.031), whereas 10MWT step count and the KCS psychological domain were no longer statistically significant. DISCUSSION:Adding RAGT to conventional rehabilitation was associated with greater improvements in several balance, mobility, walking-speed, balance-confidence, and kinesiophobia outcomes compared with conventional rehabilitation alone. These findings suggest potential additional physical and psychological benefits of incorporating RAGT into post-stroke rehabilitation. However, because the RAGT group received greater overall treatment exposure, the observed between-group differences cannot be attributed solely to the robotic component. The principal contribution of this study is the concurrent evaluation of kinesiophobia and movement confidence alongside physical outcomes.
BACKGROUND:Although numerous interventions have been investigated to alleviate fatigue in people with multiple sclerosis (PwMS), evidence regarding the effects of upper extremity rehabilitation on fatigue remains limited. OBJECTIVE:The objective of this review was to evaluate and synthesize the available evidence on the effects of upper extremity rehabilitation interventions on fatigue in PwMS. METHODS:This review was conducted in accordance with the PRISMA guidelines and was prospectively registered in the PROSPERO database. A systematic search of PubMed, Web of Science, and Scopus was performed up to August 2026. Studies were eligible if they investigated the effects of upper extremity rehabilitation interventions on fatigue in PwMS. The risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 (RoB 2), and the certainty of the evidence was appraised using the GRADE methodology. RESULTS:Nine studies including 250 participants (136 intervention, 114 control) met the inclusion criteria. The included studies evaluated a range of technology-assisted, exercise-based, home-based, and task-oriented upper extremity rehabilitation approaches, with some interventions incorporating more than one therapeutic or technological component. Fatigue outcomes were measured using the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Risk of bias was low in three randomized controlled trials, with some concerns in two and high in two; among the two crossover studies, one was rated as low risk and one as high risk. GRADE assessment showed low certainty of evidence for studies using the FSS and very low certainty for those using the MFIS, indicating an overall low certainty of the available evidence. CONCLUSIONS:The available evidence is insufficient to draw definitive conclusions regarding the effects of upper extremity rehabilitation on fatigue in PwMS. Further high-quality randomized controlled trials are required.
BACKGROUND AND PURPOSE:Exercise therapy is a core treatment for knee osteoarthritis (KOA), but the effects of different exercise modalities on endogenous pain modulation remain unclear. This trial will compare a cycling-based aerobic exercise program with a resistance and neuromuscular exercise program on exercise-induced hypoalgesia (EIH) in people with KOA and altered baseline EIH. METHODS:This randomized, two-arm, controlled, single-blind trial will include 90 participants aged 40-75 years with symptomatic KOA, knee pain intensity of at least 3 points on the Numerical Pain Rating Scale, and altered baseline EIH. Participants will be randomized 1:1 to the Cycling-Based Aerobic Exercise Group (CAEG) or the Resistance and Neuromuscular Exercise Group (RNEG). Both groups will receive 30 supervised sessions over 10 weeks. The primary treatment effect will be the adjusted mean between-group difference in within-session change in pressure pain threshold at the most symptomatic knee, averaged across weeks 1, 4, 7, and 10. Secondary outcomes include EIH at other sites, conditioned pain modulation, pain, self-efficacy, function, performance, strength, global perceived effect, adherence, and enjoyment. RESULTS:This trial will evaluate whether the two exercise programs differ in their capacity to elicit EIH in KOA. DISCUSSION:This trial may clarify whether different exercise modalities produce distinct effects on acute endogenous pain modulation in KOA and may support a more precise exercise prescription for pain management. TRIAL REGISTRATION:ClinicalTrials.gov, identifier NTC07302204.
BACKGROUND AND PURPOSE:Noninvasive brain stimulation is a promising neuromodulatory intervention for chronic pain. This study aimed to determine the impact that transcranial direct current stimulation (tDCS) in combination with individualized physical therapy (PT) has on pain and function in individuals with chronic knee pain. METHODS:This study was a preliminary pragmatic, triple-blinded, randomized, and sham-controlled clinical trial performed in an outpatient orthopedic physical therapy clinic. Participants participated in 5 sessions of active or sham tDCS followed by individualized PT intervention. Pain outcomes included the Numeric Pain Rating Scale, Movement-Evoked Pain, pressure pain thresholds (PPT), and the Central Sensitization Inventory. Functional outcomes included the 2-minute walk test, 5-time sit-to-stand test, quadriceps strength, knee range of motion, Patient Specific Functional Scale, and the Lower Extremity Functional Scale. RESULTS:Thirty participants with chronic knee pain completed the study. There were no significant differences observed for primary patient-centered pain and functional outcomes. For secondary outcomes, the active tDCS group had a significant effect (p < 0.05) on percent change in lateral joint line PPT and a significant multivariate effect of group on PPT change scores for 3-site and 5-site clusters (p < 0.05). Exploratory responder analyses demonstrated that the active tDCS group was 12.8 times more likely to achieve the minimum detectable change in quadriceps strength improvement compared with the sham tDCS group (p < 0.05). DISCUSSION:There were no significant between-group differences for primary pain and functional outcomes. However, the active tDCS group showed improvements in pain sensitivity, as measured by PPT, and quadriceps strength, which were superior to those seen in the sham tDCS group. These preliminary findings provide insight into possible mechanisms of tDCS in addressing pain as opposed to efficacy. Given that there were no clear between-group differences in patient-centered outcomes, there is insufficient evidence for routine tDCS use for chronic knee pain. TRIAL REGISTRATION:NCT06132412.
BACKGROUND AND PURPOSE:Phase angle (PhA), derived from bioelectrical impedance analysis, is a noninvasive indicator of muscle quality. It is unclear whether PhA better reflects the morphological or functional muscle quality in community-dwelling older adults, and whether these relationships differ by sex. Therefore, this study aimed to investigate sex differences in the relationships between PhA and morphological and functional muscle quality in community-dwelling older adults. METHODS:This cross-sectional study enrolled 323 participants from the Health Check Program. PhA was measured using a multifrequency bioelectrical impedance analyzer. Morphological muscle quality was evaluated based on the echo intensity of the rectus femoris (RF) obtained via ultrasound. Functional muscle quality was calculated as the isometric knee extension strength divided by lower extremity muscle mass or RF muscle thickness. Multiple regression analyses were performed using morphological and functional muscle quality as dependent variables and lower extremity PhA as the independent variable, stratified by sex. RESULTS:A total of 231 participants were included in the analyses. Based on lower extremity muscle mass, PhA was more strongly associated with functional muscle quality (β = 0.48, p < 0.001) than with morphological muscle quality in men (β = -0.23, p = 0.044), whereas in women, PhA was more strongly associated with morphological muscle quality (β = -0.52, p < 0.001) than with functional muscle quality (β = 0.22, p = 0.030). No significant association between PhA and muscle quality based on muscle thickness was detected in either sex. CONCLUSIONS:In community-dwelling older adults, there are possible sex differences in the muscle quality reflected by PhA; therefore, when using PhA to assess muscle quality and interpret the results, these possible sex differences must be taken into account.
BACKGROUND:Widely used to assess the quality of trials in physical therapy, the Physiotherapy Evidence Database (PEDro) scale has been translated into several languages, including Spanish. Nevertheless, no data are available on the use of the Spanish version of the scale or its adoption by Spanish-speaking authors. PURPOSE:To examine the use of the PEDro scale by Spanish-speaking authors, and the application of its Spanish version since its publication. METHODS:A meta-research study of systematic reviews was conducted to identify potentially eligible systematic reviews. From 6349 references screened, 4196 reports fulfilled our inclusion criteria and were sought for retrieval. A data extraction form was developed and piloted with a random sample of 32.6% of the included papers, with average inter-coder agreement of Kappa = 0.84 for categorical variables, and an average intra-class correlation of ICC = 0.98 for continuous variables. Primary outcomes included the language, Spanish-speaking country of the study, country of the authors, and use of the PEDro scale and field of application. RESULTS:This meta-research included a total of 650 studies in Spanish or English that applied the PEDro scale and had primary authors affiliated with a research institution in Spain or another Spanish-speaking country. The publication language was predominantly English (477 studies), and the most common Spanish-speaking countries listed were Spain (531), Chile (42), and Colombia (41). 612 systematic reviews reported having used the PEDro scale, providing 809 citations from 33 studies. A total of 21 studies specified the scale language, which was Spanish in 13 studies, and 51 studies stated having used the Spanish version of the PEDro scale. CONCLUSIONS:Only 3.5% of the 650 systematic reviews published by authors from Spanish-speaking countries specified the scale language, which was Spanish in 13 studies. STUDY REGISTRATION:The protocol for this study was registered on PROSPERO under code CRD42024575584.
BACKGROUND:Non-specific neck pain (NSNP) is a frequent issue that can negatively affect both mobility and function. Recently, there has been growing interest in newer therapeutic approaches, including rib mobilization and diaphragm release techniques, as potential ways to address NSNP and support better outcomes for those affected. PURPOSE:To find out the immediate effects of how (DRT) combined with (RMT) affects the level of pain and the extent to which patients' functional abilities are improved in cases of NSNP. METHODS:For this prospective RCT, 96 participants aged 20 to 45 years were randomly assigned to one of three equal groups based on their pain score (VAS). Group B engaged in (DRT) for 40 minutes, three times weekly for 8 weeks, in contrast to Group A, which got both RMT combined with DRT. Group C (active control) received advice and some exercises. Measurements were collected before and after the intervention; the primary outcomes included pain severity, evaluated using a visual analog scale (VAS); active neck range of motion (ROM), measured with a cervical range of motion (CROM) device; and neck flexion endurance. Additionally, the secondary outcome of neck-related disability was assessed using the Neck Disability Index (NDI). RESULTS:No statistically significant difference was identified among the three groups at baseline; nevertheless, a treatment effect emerged after 8 weeks (p = 0.001 and f-value = 4.15, ƞ2 = 0.306). A statistically significant time-treatment interaction was seen when comparing the pre- and post-treatment periods in groups A and B (p = 0.001, f-value = 3.16, ƞ2 = 0.251). CONCLUSION:The addition of rib mobilization to diaphragm release techniques in patients with non-specific neck pain resulted in statistically significant improvements in pain intensity, cervical flexion, right lateral rotation, left lateral rotation, right rotation, and neck flexor endurance, with moderate to large effect sizes for pain reduction and cervical motion. However, no statistically significant differences were observed between groups for cervical extension, left rotation, or the Neck Disability Index (NDI), and only a marginal clinical improvement in NDI was noted in Group A. The observed benefits in the combined intervention group may not be attributable solely to rib mobilization. The increased treatment complexity and greater therapist interaction inherent in the combined approach could also have influenced the outcomes. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT07133646.
OBJECTIVES:To evaluate differences in spatiotemporal gait parameters in individuals with transfemoral (TFA) and transtibial amputation (TTA) compared with physically able individuals. METHODS:This systematic review with meta-analysis was conducted according to the MOOSE guidelines. Cross-sectional studies or clinical trials that assessed spatiotemporal gait parameters in adults with unilateral TFA or TTA were included. Searches were performed in Medline (via PubMed), CINAHL, Scopus, LILACS, Cochrane Library, and Embase using descriptors related to amputation and gait. Risk of bias was assessed using the Joanna Briggs Institute scale for cross-sectional studies, whereas the meta-analysis was performed using quantitative data for the following outcomes: walking speed, step length, stride length, step width, cadence, stance time, swing time, step time, or stride time. RESULTS:A total of 12 cross-sectional studies involving 150 individuals with amputation (86 TTA and 64 TFA) and 138 healthy controls were included. Meta-analysis demonstrated a significant reduction in walking speed (mean difference of -0.24; 95% CI -0.32 to -0.17; p < 0.0001; I2 = 61%) and cadence (mean difference of -6.01; 95% CI -9.69 to -2.34; p = 0.001; I2: 54%) in patients with amputation compared with healthy individuals. A reduction in stride length (mean difference of -11.71; 95% CI -23.37 to -0.04; p = 0.05; I2: 85%) and an increase in step width (mean difference of 5.22; 95% CI 2.99 to 7.45; p < 0.0001; I2: 71%) were also observed. Step time showed no significant difference between groups (mean difference of 0.06; 95% CI -0.01 to 0.14; p = 0.11; I2: 93%). Patients with TFA amputation exhibited greater impairment in gait variables, particularly cadence, when compared with a healthy individual. CONCLUSIONS:Patients with lower limb amputation present with functionally compromised gait, characterized by reduced walking speed. Increased step width and reduced stride length are findings that may suggest compensatory strategies during gait and improved balance, which are important requirements for amputee patients. These findings reinforce the need for rehabilitation interventions focused on improving propulsion and postural safety. TRIAL REGISTRATION:PROSPERO: CRD42024620098.
BACKGROUND:Effective rehabilitation interventions are needed to support recovery in people living with long-term post-stroke disability. Cocreation has been proposed as a method for enhancing the acceptability of technology-supported rehabilitation and may improve rehabilitation outcomes. OBJECTIVE:To observe changes in outcome following participation in a multi-technology rehabilitation intervention for motor recovery in people with chronic stroke and to explore factors associated with differential response. DESIGN:Pre-post, single-arm intervention study. METHODS:Participants with stroke ≥ 12 months previously and persistent motor impairment, completed an 8-week, group-based circuit class incorporating multiple rehabilitation technologies. Standardised measures of activity and participation were collected at baseline, pre-intervention, and post-intervention. RESULTS:Sixty-seven participants (mean age 60.49 ± 14.44 years; mean 41.87 ± 41.31 months post-stroke) were enroled and 59 (88.06%) completed a mean of 18.52 ± 6.44 sessions. Eight did not complete, mainly due to transport or illness. Statistically significant (p < 0.05) changes from pre-to post-intervention were observed across all outcomes. Subgroup analysis showed that participants with poorer balance, upper-limb function and global disability at baseline showed greater pre-post improvements than higher-functioning participants. CONCLUSIONS:Improvements in mobility and global function were observed following participation in a cocreated, multi-technology group rehabilitation programme for people with chronic stroke. Greater pre-post improvements were observed among participants with greater initial disability. These preliminary findings need confirmation in controlled studies. TRIAL REGISTRATION:Clinical Trial registration: NCT06787768.
BACKGROUND AND PURPOSE:Interventions to enhance tactile sensitivity, such as warming the feet, positively affect skin sensitivity with varying influence on postural control. Here, we hypothesize that foot warming may benefit tactile sensitivity and postural control in older adults, particularly those with obesity. METHODS:Fifty participants divided into 16 middle-aged adults (14 women, mean ± standard deviation: age 40.29 ± 3.73 years, body mass index, BMI, 24.51 ± 1.70 kg/m2), 17 non-obese older adults (12 women, 72.71 ± 6.36 years, BMI 25.09 ± 2.84 kg/m2), and 17 obese older adults (13 women, 69.59 ± 7.19 years, BMI 32.65 ± 6.31 kg/m2) were evaluated for foot tactile sensitivity and center of pressure (CoP) displacement during natural and semi-tandem stance before and after a warming protocol increasing foot skin temperature by approximately 6°C. RESULTS:Acute foot warming consistently enhanced plantar tactile sensitivity across adulthood and aging, with the largest improvements observed in obese older adults. In contrast, effects on postural control were limited. DISCUSSION:Consistent with previous studies, we found that foot warming acutely enhances plantar tactile sensitivity across adulthood and aging, with novelty and larger sensory benefits observed in obese older adults. However, improvements in postural control were not identified across different postural tasks. These findings identify foot warming as a simple strategy to acutely enhance plantar sensory function, particularly in older adults with obesity.
BACKGROUND AND PURPOSE:The Pelvic Floor Distress Inventory-20 (PFDI-20) is a widely recognized clinical tool designed to assess the severity of distress caused by pelvic floor symptoms. Within the context of conservative physiotherapy and pelvic floor rehabilitation, this study aimed to determine the responsiveness, smallest detectable change (SDC), and minimal important change (MIC) of the Turkish PFDI-20 in women with pelvic floor dysfunction (PFD). METHODS:This multicenter, retrospective study consisted of 200 women (mean age, 46.92 ± 11.13 years) with PFD recruited across three clinical sites who had undergone a standardized 8-week conservative pelvic floor muscle training intervention. The PFDI-20, which includes three subscales (Pelvic Organ Prolapse Distress Inventory [POPDI-6], Colorectal-Anal Distress Inventory [CRADI-8], and Urinary Distress Inventory [UDI-6]), was administered at baseline and follow-up clinical assessments. The instrument's responsiveness was assessed using the Wilcoxon signed-rank test, standardized response means (SRMs), and effect sizes (ESs). The preliminary SDC estimates were calculated at the 95% confidence level. Receiver operating characteristic (ROC) analysis was used to determine preliminary MIC values, maximizing both sensitivity and specificity. RESULTS:For PFDI-20 and UDI-6, the responsiveness was excellent (ES: 1.24, SRM: 1.41, for PFDI; ES: 1.47, SRM: 1.53, for UDI-6), moderate to good (ES: 0.78, SRM: 0.94), and moderate (ES: 0.55, SRM: 0.76) for POPDI-6 and CRADI-8, respectively. The preliminary SDC and MIC values were 55.60 and 20.83, 23.39 and 20.83, 17.71 and 9.37, 29.13 and 25.00, for PFDI-20, POPDI-6, CRADI-8, and UDI-6, respectively. The ROC analyses showed moderate to excellent discriminative ability, with an area under the curve of 0.85, 0.72, 0.72, and 0.85 for PFDI-20, POPDI-6, CRADI-8, and UDI-6, respectively. DISCUSSION:These findings support the responsiveness of the Turkish PFDI-20 when applied in a conservative physiotherapy setting, providing preliminary estimates, specifically a SDC of 55.60 alongside a MIC of 20.83. However, derived from an active intervention cohort and imbalanced anchor groups, these values should be interpreted with caution as practical response thresholds within longitudinal clinical evaluations.
BACKGROUND AND PURPOSE:The mechanistic rationale for treating the foot in anterior knee pain (AKP) is well established in the biomechanics literature; however, translating it into a clinically actionable evidence-supported rehabilitation protocol has proven difficult. This investigation pursued two aims: to characterize the functional and biomechanical differences between patients with AKP with and without pronated foot posture, and to compare the short-term effectiveness of two foot-targeted physiotherapy regimens, manual therapy with augmented low-dye taping (MT + ALDT) and neuromuscular training with ALDT (NMT + ALDT), against routine physiotherapy care. METHODS:A sequential two-phase design was employed in the outpatient physiotherapy department of Mediclinic Al Noor Hospital, Abu Dhabi, UAE. Phase 1 was a prospective case-control study (n = 50; pronated foot, n = 30; neutral/supinated, n = 20). Phase 2 was a single-blind parallel-group RCT that randomized 31 participants with confirmed pronation 1:1:1 to MT + ALDT (n = 11), NMT + ALDT (n = 10), or routine physiotherapy (n = 10) across 12 sessions in 4 weeks. Four outcomes were assessed at baseline and post-intervention: NPRS, Kujala AKPS, FPI-6, and DVI. RESULTS:Phase 1 revealed a 33.7-point AKPS gap between pronated and neutral/supinated participants (50.20 vs. 83.90; p < 0.001, Mann-Whitney U) and a significant FPI-6-DVI association (χ2 = 4.22, p = 0.04). In Phase 2, ANCOVA confirmed that both foot-targeted regimens significantly outperformed routine care on all four outcomes (all p < 0.001), with MT + ALDT demonstrating the greatest improvements. Effect sizes were large (η2 = 0.646-0.958; 95% CIs reported in Results) and are treated as preliminary estimates warranting cautious interpretation given the small sample and single-center setting. DISCUSSION:Foot pronation was strongly associated with impaired patellofemoral function, although the cross-sectional design of Phase 1 precluded causal inference. Both foot-targeted regimens outperformed routine care, and MT + ALDT demonstrated a stronger clinical profile. The equivalent biomechanical outcomes across both experimental arms were consistent with a contribution from ALDT, but its independent role could not be isolated without a taping-isolated comparator arm. These preliminary single-center findings support further investigation of foot posture assessment and distal intervention in AKP pending confirmation in adequately powered multicenter trials. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT05917080.
BACKGROUND AND PURPOSE:Intensive, high-repetition practice is one of the strategies incorporated into upper-limb task-oriented training (UL-TOT) to promote experience-dependent neural plasticity after stroke. Although a target of 300 repetitions during a one-hour UL-TOT session is feasible, considerable variability in the practice dosage achieved across individuals has been observed. Multiple factors may influence practice dosage during UL-TOT. Therefore, this exploratory secondary analysis aimed to examine factors associated with practice dosage during UL-TOT in individuals with stroke. METHODS:This secondary analysis included data from 33 individuals with subacute stroke enrolled in a randomized controlled trial. Associations between age, sex, stroke type, lesion location and volume, poststroke duration, upper-limb paresis severity, spasticity severity, and depression severity (independent variables), and practice dosage (dependent variable) were analyzed using stepwise multiple linear regression. RESULTS:Among the variables examined, upper-limb paresis severity was the only factor retained in the final stepwise multiple linear regression model and was significantly associated with practice dosage within this dataset (β = 0.804; p < 0.001). The regression model was statistically significant and explained 63.4% of the variance in practice dosage (adjusted R2 = 0.634). DISCUSSION:Upper-limb paresis severity was the only factor significantly associated with practice dosage during therapist-guided UL-TOT in individuals with subacute stroke within this dataset. However, these findings should be interpreted with caution, given the small sample size and the exploratory nature of the analysis.
BACKGROUND AND PURPOSE:Total hip arthroplasty (THA) may induce acute alterations in spinopelvic alignment and compel the cervical spine to compensate for postural balance. Although these changes may biomechanically affect swallowing speed, the relationship between cervical range of motion (ROM) and swallowing speed in older adults after THA remains unclear. Therefore, this study aimed to investigate the relationship between cervical ROM and swallowing speed in older women after THA. METHODS:This cross-sectional study included 60 older women (mean age 71.6 ± 5.5 years) without clinically significant self-reported dysphagia (10-item eating assessment tool < 3) undergoing rehabilitation after THA. Swallowing speed was assessed using a 100-mL water swallowing test. Cervical ROM (flexion and extension) was measured using a CROM3 device. Multiple regression analyses were performed adjusting for age, potentially inappropriate medications, and maximum tongue pressure (MTP) to investigate the association between swallowing speed and cervical ROM. RESULTS:Correlation analysis showed a weak positive correlation between cervical extension ROM and swallowing speed (rs = 0.27, 95% confidence interval [CI]: 0.02 to 0.49, p = 0.036). Multiple linear regression analysis showed that cervical extension ROM (Estimate: 0.054, 95% CI: 0.011 to 0.097, β = 0.310, p = 0.015) and MTP (Estimate: 0.079, 95% CI: 0.012 to 0.146, β = 0.294, p = 0.021) were independently associated with swallowing speed. DISCUSSION:Restricted cervical extension ROM was weakly associated with decreased swallowing speed in older women after THA. This association suggests only a modest relationship without direct predictive value for clinical swallowing speed. Therefore, evaluating cervical extension ROM may be considered an adjunctive observation rather than a screening tool for swallowing dysfunction.
BACKGROUND:Breast cancer survival has improved substantially, yet many women continue to experience late effects that may require physiotherapy. Shoulder impairment, lymphedema, and fatigue are among the most common physiotherapy-relevant late effects following primary breast cancer treatment. Understanding how guideline treatments for breast cancer influence these impairments is essential for the early identification of high-risk patients and the development of targeted rehabilitation strategies. PURPOSE:To investigate the association between Danish guideline treatments for breast cancer and the risk of three physiotherapy-relevant self-reported late effect dimensions 3-7 years postoperatively. METHODS:National cohort study of 5729 women who underwent surgical treatment for primary breast cancer between 2015 and 2019. Participants completed a questionnaire 3-7 years postoperatively addressing shoulder impairment, lymphedema, and fatigue. Treatment codes were extracted from the Danish National Patient Registry and categorized according to Danish guideline regimens for surgery and radiotherapy. Logistic regression analyses, adjusted for relevant confounders, were performed to estimate associations, and absolute risks were calculated. RESULTS:Compared with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB) with radiotherapy, treatment combinations involving mastectomy or axillary lymph node dissection (ALND) with radiotherapy were associated with approximately threefold higher odds of self-reported late effects. The highest risk was observed after mastectomy and SLNB with radiotherapy (ORadj 3.10, 95% CI 2.48-3.88), followed by mastectomy with ALND and radiotherapy (ORadj 2.90, 95% CI 2.02-4.15) and BCS with ALND and radiotherapy (ORadj 2.76, 95% CI 2.25-3.39). Shoulder impairment was consistently the most frequent self-reported late effect across all treatment types. DISCUSSION:Guideline treatments involving mastectomy, and/or ALND in combination with radiotherapy substantially increased the risk of self-reported late effects, particularly shoulder impairment. These findings highlight the need for early targeted physiotherapy interventions and improved detection strategies to mitigate late effects in breast cancer survivors.
BACKGROUND AND PURPOSE:Current guidelines for the management of lumbar radiculopathy recommend patient education, staying active, manual therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments. Physiotherapy-specific interventions for low back pain that radiates to the leg include specific trunk muscle activation, muscle strengthening and endurance, movement control, centralisation, directional preference exercises and nerve mobilisation. While exercise therapy is widely recognised as an effective non-invasive intervention, there is currently limited evidence for a standardised framework that integrates different evidence-based exercise approaches and clinical expertise into a structured, practically applicable protocol. The purpose of this study was to develop and content-validate a structured, evidence-based exercise framework for the physiotherapy management of lumbar radiculopathy. METHODS:A comprehensive review of the literature supplemented by expert input with at least 10 years of experience was conducted to identify commonly prescribed exercise interventions for lumbar radiculopathy. Based on the identified impairments and functional deficits associated with the condition, an initial draft framework, which included trunk stabilization, mobility and flexibility training, was constructed. The draft framework was then subjected to expert validation using the content validity index (CVI) and modified kappa to confirm the relevance and perceived ease of performance of exercise by 10 physiotherapists. RESULTS:The 4-stage exercise framework demonstrated excellent agreement with high CVI (100%-90%) and modified kappa (1-0.90). While some exercises of phase 2 and phase 3 were considered slightly difficult to perform, they were relevant for the condition. DISCUSSION:The developed exercise framework exhibited excellent content validity, supporting its relevance and perceived ease of performance in physiotherapy practice for managing patients with lumbar radiculopathy.
BACKGROUND AND PURPOSE:Cognitive impairment manifests early in Parkinson's disease (PD), adversely affecting patients' daily activities and mental health. Utilizing exergames via the Xbox 360 Kinect (XBK) console presents a promising therapeutic avenue to mitigate cognitive decline in PD. This study aimed to assess the efficacy of the XBK system in enhancing cognitive performance and reducing anxiety levels among individuals with PD. METHOD:A non-randomized controlled trial, controlled, single-blind clinical trial was conducted. Forty-three PD participants were selected through convenience sampling and non-randomly assigned to either the XBK experimental group (n = 23) or the Control Group (n = 23). Participants underwent pre, post, and 30-day post-intervention evaluations using the Digit Span Tests, Semantics, Verbal Fluency Test, and Beck Anxiety Inventory. The control group received no intervention, while the experimental group underwent 10 sessions employing four XBK games. This study was approved by the Institutional Ethics Committee of the University of Brasília (Approval No. 2.109.826). Analysis of variance (ANOVA 2 × 3) with Sidak post hoc test and Bonferroni correction was utilized to examine intergroup outcomes. RESULTS:The XBK-trained group exhibited enhancements in short-term memory post-intervention (p = 0.04) and at follow-up (p = 0.01), as well as operational memory post-intervention (p = 0.006) and at follow-up (p = 0.001), although without significant between-group differences. Although no significant interaction effect was observed (p = 0.126), a reduction in anxiety levels was verified up to 30 days post-training (p = 0.03), exclusively within the XBK group, accompanied by a significant between-group difference (p = 0.01), also in follow-up. DISCUSSION:Although the intervention did not demonstrate a superior effect compared with the control group, our findings suggest that training with the Xbox 360 Kinect may have the potential to reduce anxiety in individuals with Parkinson's disease. Further research through randomized clinical trials is necessary to validate these findings and evaluate the long-term benefits of this intervention. TRAIL REGISTRATION:University of Brasília, CAAE: 12248513.9.0000.0030. N°: 2.109.826 https://ensaiosclinicos.gov.br/rg/RBR-7h6b8mg.
BACKGROUND:Hamstring flexibility can potentially affect the mobility and function of remote musculoskeletal areas, including the cervical spine and temporomandibular joint (TMJ), thereby increasing tension along the myofascial chain and potentially reducing mouth opening, contributing to orofacial discomfort. This review aims to inform clinical practice by exploring the integrated impact of these interventions within the framework of neuro-myofascial connectivity. METHODS:A comprehensive search was performed across PubMed, Scopus, Web of Science, and PEDro databases spanning the period from the year 2006-2025, restricted to studies published in the English language. Keywords and MeSH terms corresponding to hamstring stretching, mouth opening and Temporomandibular Joint (TMJ) mobility were used incorporating Boolean operators. Randomized control trials and experimental studies investigating acute or short term effects of hamstring stretching on Temporomandibular Joint (TMJ) pain and mouth opening were included. RESULTS:The preliminary results indicate that hamstring stretching can result in temporary improvements in pressure pain threshold and mouth opening; however, the results should be interpreted with caution and the number of the RCTs is small and heterogeneous. CONCLUSION:The findings support the possibility of myofascial and neural interconnections between the posterior chain and masticatory system; however, the current evidence is insufficient to establish definitive mechanistic conclusions. TRIAL REGISTRATION:PROSPERO number: CRD420251173297.
OBJECTIVE:To map and synthesize methodological approaches used for ultrasound (US) assessment of peripheral (upper- and lower-limb) and abdominal muscle thickness in critically ill patients, and to propose a preliminary Standard Operating Procedure (SOP) as a structured reporting framework. METHODS:A review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist, using systematic searches on PubMed, BIREME (including MEDLINE, LILACS and IBECS) and Embase. Two reviewers independently screened, selected, and extracted data from studies published between 2015 and 2025. Extracted data included muscle groups assessed, thickness measurement criteria, patient and probe positioning, operational US parameters, and reliability information. The proposed SOP was developed based on recurring methodological patterns identified in the literature and subsequently refined through external expert review and pilot feasibility testing in ICU settings. RESULTS:Of 2.293 identified records, 29 studies (1.736 patients) were included. B-mode imaging and linear transducers were the most frequently reported US parameters, and the supine position with the head of the bed elevated to 30° was the predominant patient position. Although 79.3% of studies described muscle thickness measurement criteria, important methodological details such as depth, gain, and anatomical landmarks were inconsistently reported. Lower-limb muscles were the most frequently assessed, whereas upper-limb and abdominal muscles remained comparatively underrepresented. Considerable variability was identified across acquisition procedures, anatomical landmarks, measurement criteria, and reporting practices. CONCLUSIONS:Ultrasound assessment of muscle thickness in critically ill patients shows substantial methodological and reporting variability. A preliminary SOP was developed and pilot-tested to improve consistency and comparability. Standardization may support bedside monitoring and inform physiotherapy assessment and rehabilitation decisions, although multicenter validation is required. TRIAL REGISTRATION:Open Science Framework: https://doi.org/10.17605/OSF.IO/S95MJ.
BACKGROUND AND PURPOSE:Neck pain is prevalent in postpartum women due to postural stress and muscle dysfunction. Although postural correction exercises are widely used, adding manual therapy techniques such as positional release and Tui-Na may enhance outcomes. However, comparative evidence, particularly using surface electromyography (sEMG), remains limited. This study examined the effects of Tui-Na (TN) versus positional release techniques (PRT) added to postural correction exercises (PCEs) on postpartum neck pain. METHODS:Sixty women with postpartum neck pain were randomly assigned to three groups for 4 weeks of prescribed treatment. Group A (control) received PCEs, while either PRT or Tui-Na were added to PCEs for Groups B and C, respectively. The primary outcome was neck pain intensity measured by the Visual Analogue Scale (VAS). Secondary outcomes included the Neck Disability Index (NDI) and upper trapezius electromyographic characteristics (normalized root mean square [RMS] and median frequency [MDF]). A two-way repeated-measures MANOVA was used for statistical analysis. RESULTS:Significant multivariate effects were observed for group effects (F = 4.798, p < 0.001, partial η2 = 0.147), time (F = 851.51, p < 0.001, partial η2 = 0.968), and group-by-time interaction (F = 3.87, p < 0.001, partial η2 = 0.122). Pain intensity was significantly reduced in both groups B (p = 0.035) and C (p = 0.003) when compared to group A. UT-MDF was significantly increased in group C when compared to groups A (p < 0.001) or B (p = 0.02). All groups demonstrated significant within-group improvements in all outcome measures. DISCUSSION:Both Tui-Na and PRT combined with PCEs improved pain and disability in postpartum women with neck pain. Compared with PRT, Tui-Na demonstrated greater improvements in pain intensity and upper trapezius EMG frequency characteristics. However, these findings should be interpreted cautiously because of the short intervention period and lack of long-term follow-up. TRIAL REGISTRATION:NCT07261605.
