Background: The incidence of stroke has increased globally, leading to mortality and disability. Approximately 30–66% of stroke survivors are unable to regain motor functions in the affected hand throughout their lives, which significantly impacts their functionality and daily activities. Objective: This study aimed to determine the effects of robotic glove-assisted task-oriented mirror therapy in comparison with task-oriented mirror therapy on the motor functions of the hand in sub-acute stroke. Methods: This was a non-blinded, randomised controlled trial conducted at the National Institute of Rehabilitation Medicine (NIRM) and Athlean Physical Therapy (APT), Islamabad. A total of thirty eligible participants were assigned randomly to Groups (A) and (B) through a pre-sealed envelope. Group (A) received robotic glove-assisted task-oriented mirror therapy. Group (B) received task-oriented mirror therapy. Intervention was given 30[Formula: see text]min daily after 30[Formula: see text]min of conventional treatment, five times a week for eight weeks. Outcomes were measured using the Box and Block Test (BBT), Fugl–Meyer Assessment scale Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT). Results: The mean age of all patients was ([Formula: see text]) years. Between-group analysis showed that the robotic glove-assisted task-oriented mirror therapy group had a significant difference in hand motor functions as compared to the task-oriented mirror therapy group, as measured by BBT, FMA-UE, and ARAT ([Formula: see text]). Within-group analysis of both groups showed a significant difference in pre- and post-treatment on all outcome measures ([Formula: see text]). Conclusion: The study concluded that robotic glove-assisted task-oriented mirror therapy, along with conventional physical therapy, is more effective than task-oriented mirror therapy in improving hand motor functions in patients with sub-acute stroke.
Background: Patellofemoral pain syndrome (PFPS) is associated with altered activation of the lower-limb muscles during functional tasks such as the single-leg squat (SLS). Although trunk position can influence the recruitment of the hip and knee muscles, the effects of different trunk lean angles on muscle activation ratios in individuals with PFPS remain unclear. Objective: This study aimed to examine how trunk lean angles of 0°, 15°, and 30° affect lower-limb muscle activation ratios during SLS in individuals with PFPS. Methods: Thirty-two adults with PFPS performed SLS at 60° of knee flexion under three trunk lean conditions (0°, 15°, and 30°) while surface electromyography was used to record the activation of the vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (Gmed), gluteus maximus (Gmax), tensor fascia latae (TFL), semitendinosus (ST), and biceps femoris (BF). Muscle activity ratios, including VMO: VL, Gmed:TFL, quadriceps-to-hamstrings (Q:H), and Gmax:H were calculated, and a repeated-measures analysis of variance with Bonferroni correction was used to compare differences across trunk lean angles. Results: The Gmed:TFL ratio was significantly higher at 30° of trunk lean than at 0° and 15°, and the Q:H ratio decreased progressively as trunk lean increased ([Formula: see text]). No significant differences were observed in the VMO:VL or Gmax:H ratios across conditions. Conclusion: These findings suggest that increasing trunk lean during SLS may enhance Gmed activation relative to the TFL and may contribute to a decrease in the Q:H ratio, whereas VMO:VL and Gmax:H ratios appeared relatively unaffected by trunk lean angle. Performing SLS with greater trunk inclination may optimize lower-limb muscle coordination and may offer clinical benefits for individuals with PFPS.
Background: Spinal cord injury (SCI) is an unfortunate and terrible condition that causes serious locomotor illness, spasticity, neurological pain, bowel-bladder problems, pressure ulcers, and a decline in functional capacities. Aerobic physical training is increasingly incorporated into rehabilitation programs; however, its specific effectiveness for individuals with SCI-related paraplegia remains unclear. Objectives: The objective of this review was to investigate the evidence on the effectiveness of aerobic physical training on rehabilitation outcomes in individuals with paraplegia following SCI. Methods: A narrative mini-review was conducted using PubMed, PEDro, CINAHL, and EMBASE. Randomised controlled trials and clinical trials published in English between 2011 and 2022 were included where “spinal cord injury” was identified as the primary concern and “aerobic training” was one of the treatment options. Results: The search identified 54 studies, from which 11 were considered potentially suitable. Ultimately, four studies were selected for the narrative review conclusions. The included studies reported improvements across several outcome domains, including aerobic capacity, walking performance, muscle strength, and psychological well-being. However, the evidence base was limited by small sample sizes, variability in training protocols, and short intervention durations. Aerobic physical training appears to have beneficial effects on physical and psychological outcomes in individuals with SCI-related paraplegia. Despite methodological variations and limited studies, evaluations indicate that aerobic exercise positively impacts patients with SCI. Conclusion: A longer rehabilitation program may be necessary to obtain more benefits from aerobic exercises in SCI patients. Further high-quality, long-term studies are needed to establish optimal aerobic training protocols for SCI rehabilitation.
Background: Arthrogenic muscle inhibition (AMI) and altered neuromuscular control commonly arise after anterior cruciate ligament (ACL) injury and may persist both preoperatively and after anterior cruciate ligament reconstruction (ACLR), potentially impairing functional recovery. Objective: To synthesise randomised controlled trial (RCT) evidence on functional rehabilitation interventions targeting neuromuscular control after ACLR, using electromyography (EMG)-derived outcomes. Methods: PubMed, Cochrane Library, Embase, CINAHL, Web of Science, and SPORTDiscus were searched from January 1, 2015, to December 4, 2025; duplicates were removed ([Formula: see text]). RCTs involving individuals undergoing ACLR (pre-operative) and/or following ACLR (post-operative) were included if they reported EMG-derived neuromuscular outcomes following functional rehabilitation. Due to heterogeneity in interventions, EMG normalisation, and outcome definitions, a structured narrative synthesis was performed. Results: Nine RCTs (total [Formula: see text]) were included. One trial examined preoperative blood flow restriction training (BFRT) preconditioning (5 sessions over 8 days before surgery), whereas the remaining interventions were delivered postoperatively. Jump training reduced quadriceps–hamstring co-contraction by 50% ([Formula: see text]). Preoperative BFRT preserved quadriceps endurance at 4 weeks post-ACLR compared with sham (sham reduction: [Formula: see text][Formula: see text]s) and increased root mean square (RMS) EMG amplitude by [Formula: see text] at week 4. Aquatic proprioceptive training improved muscle activation similarity and magnitude ([Formula: see text]). Sand-based training and cross-education interventions increased EMG activity during gait phases ([Formula: see text]). Vibration therapy and postoperative BFRT produced mixed or non-significant effects. Evidence for several intervention types was limited to single trials and should be interpreted cautiously. Conclusion: Functional rehabilitation strategies show limited but promising potential to improve neuromuscular outcomes following ACLR. Phase-specific approaches may be appropriate: early-phase interventions (e.g., BFRT preconditioning, vibration therapy, and cross-education) may help mitigate AMI and preserve neuromuscular capacity, whereas later-phase strategies (e.g., plyometrics and aquatic proprioceptive training) may support movement quality and motor control. Future RCTs should prioritise standardised EMG methodology and clinically meaningful endpoints (e.g., return-to-sport and reinjury).
Background: Total knee arthroplasty (TKA) is the most effective surgical method for end-stage knee joint diseases, yet chronic postoperative pain related to pain catastrophisation remains a major cause of patient dissatisfaction, warranting evaluation of Empowered Relief (ER) in TKA patients. Objective: This quasi-experimental study evaluated digital ER’s effectiveness in reducing pain catastrophizing post-TKA. Methods: This quasi-experimental study enrolled 70 primary unilateral TKA patients at a tertiary hospital in Lanzhou, China (March–June 2023). Participants were allocated by admission date: the intervention group (March–April, [Formula: see text] 35) received enhanced recovery protocols with standard pain management, while the control group (May–June, [Formula: see text] 35) received standard management alone. Pain outcomes were assessed at postoperative weeks 2 (T1), 1 month (T2), and 3 months (T3) using validated tools: Pain Catastrophizing Scale (PCS), Numerical Rating Scale (NRS), and APS-POQ-C (Chinese version) to evaluate catastrophisation, intensity, and management efficacy. Generalized Estimating Equations (GEEs) were employed for longitudinal statistical analysis. Results: The ER program showed statistically significant main effects across groups ([Formula: see text]), temporal effects (P Γ 0.001), and group-time interaction effects ([Formula: see text]) on pain catastrophisation scores, pain intensity scores, and pain management outcomes, respectively. And as time went on, the intervention group showed greater improvement than the control group in pain catastrophizing (PCS:T1[Formula: see text]16,T2[Formula: see text]9,T3[Formula: see text]5 versus T1[Formula: see text]29,T2[Formula: see text]23,T3[Formula: see text]19.5), pain intensity (Pain: T1[Formula: see text]4,T2[Formula: see text]2.5,T3[Formula: see text]1 versus T1[Formula: see text]4,T2[Formula: see text]3,T3[Formula: see text]2) and pain management outcomes (APS-POQ-C: T1[Formula: see text]12.125,T2[Formula: see text]3.875,T3[Formula: see text]1.25 versus T1[Formula: see text]15.75,T2[Formula: see text]9.5,T3[Formula: see text]5). Conclusions: The ER program significantly reduced postoperative pain intensity and catastrophisation in TKA patients, enhancing pain management outcomes compared to conventional therapies. Its concentrated 2 h format demonstrates promising efficacy over standard care, offering a streamlined alternative to traditional postoperative regimens.
Background: Trigger finger causes pain and impaired hand function. Ultrasound and paraffin wax are commonly used but have cost and accessibility limitations; cassava wax may be a low-cost alternative, though its effectiveness remains unclear. Objective: To evaluate the immediate, short-term, and post-intervention effects of cassava wax immersion combined with ultrasound therapy on pain, pressure pain threshold, and upper extremity function in patients with trigger finger. Methods: In this single-blind, randomised controlled trial, 38 participants were randomly assigned to two groups ([Formula: see text] each). The experimental group received ultrasound therapy and cassava wax immersion. The control group received only ultrasound therapy. Both groups were treated three times per week for four weeks. Outcome measures included pain intensity (Visual Analogue Scale), pressure pain threshold, frequency of finger locking, and upper extremity function (Disabilities of the Arm, Shoulder, and Hand questionnaire). Results: Both groups showed significant improvements in all outcomes ([Formula: see text]). Significant between-group differences in pain intensity were observed at all post-treatment time points, with lower pain intensity in the experimental group. The experimental group demonstrated greater increases in pressure pain threshold at immediate and short-term follow-ups and better upper extremity function at short-term and post-intervention follow-ups ([Formula: see text]). Conclusion: Ultrasound therapy combined with cassava wax immersion is more effective than ultrasound therapy alone for managing trigger finger, providing greater pain reduction and improved upper extremity function. Cassava wax may be a valuable, natural, and cost-effective option.
Background: Subclinical cardiac dysfunction is a growing concern in cancer patients receiving chemotherapy. Early detection before treatment initiation is crucial to prevent overt cardiotoxicity. Objective: This study evaluates the association between comorbidity burden and subclinical cardiac dysfunction, using echocardiographic parameters, in cancer patients prior to chemotherapy. Method: This retrospective observational study analysed 110 cancer patients who underwent transthoracic echocardiography before chemotherapy. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI) and Karnofsky Performance Status (KPS). Echocardiographic evaluation included Global Longitudinal Strain (GLS), the E/e[Formula: see text] ratio (early transmitral inflow velocity to early diastolic mitral annular velocity) and left atrial volume index (LAVI). Subclinical dysfunction was defined as [Formula: see text] and/or diastolic dysfunction. Spearman’s rank correlation and multivariable linear regression were performed. Results: Abnormal GLS ([Formula: see text]) was found in 68 patients (61.8%), while 42 patients (38.2%) had normal GLS values. Higher comorbidity burden (CCI) was modestly associated with worse GLS ([Formula: see text], [Formula: see text]) and higher E/e[Formula: see text] ([Formula: see text], [Formula: see text]), whereas better functional status (Karnofsky score) correlated with more preserved GLS ([Formula: see text], [Formula: see text]). Higher age was independently associated with higher E/e[Formula: see text] ([Formula: see text], 95% CI 0.005–0.065, [Formula: see text], [Formula: see text]), whereas the association between CCI and E/e[Formula: see text] was of borderline significance ([Formula: see text], 95% CI −0.024–0.396, [Formula: see text], [Formula: see text]). Conclusion: This study showed a significant correlation between comorbidity indices and GLS as well as diastolic function parameters. This suggests that comorbidity burden and functional status are significantly associated with subclinical cardiac abnormalities before chemotherapy.
Background:Elderly individuals with type 2 diabetes mellitus (T2DM) often experience reduced ventilatory function and functional capacity, which negatively impact their quality of life (QoL), yet effective non-pharmacological interventions remain limited. Objective:To determine the effect of manual diaphragmatic release (MDR) added to aerobic training (AT) on ventilatory function, functional capacity, and QoL, compared to AT alone in elderly women with T2DM. Methods:Sixty elderly type 2 diabetic women were randomly assigned in equal numbers to either the MDR or control group. For 8 weeks, the MDR group received MDR in addition to AT, while the control group received AT alone. Outcomes included measures of forced vital capacity (FVC) and total lung capacity (TLC), 6 min walk test (6MWT), and Diabetic Quality of Life Questionnaire (DQoL). Between-group differences were analysed by ANCOVA. Results:At the end of the study, there were significant group effects for all outcome measures ( p < 0 . 05 ). Adjusted between-group differences favoured the MDR group for FVC (mean difference = 3 . 17 % ; 95% CI: 1.07-5.27), TLC (mean difference = 2 . 28 % ; 95% CI: 1.22-3.33), 6MWT distance (mean difference = 22 . 58 m; 95% CI: 10.17-34.99), and DQoL score (mean difference = 0 . 94 ; 95% CI: 0.31-1.57). Conclusion:Adding MDR to AT is more beneficial than AT only for enhancing ventilatory function, functional capacity and QoL in such elderly type 2 diabetic women. However, further studies with larger sample sizes and longer intervention durations are warranted to confirm these findings.
Background: The application of positive pressure (CPAP) improves pulmonary ventilation, but may negatively impact diaphragm geometry and function. Diaphragm mobility and strength are essential for lung function. Consequently, impairment of the diaphragm can reduce respiratory capacity.Objective: This study aims to evaluate the effects of positive pressure on diaphragm mobility in healthy individuals during spontaneous breathing.Methods: This is a randomised, crossover, double-blind clinical trial involving asymptomatic individuals aged 18-50 years. Participants randomly received the following non-invasive ventilation: continuous positive airway pressure (CPAP) of 5, 10, and 15 cmH2O, or bi-level inspiratory positive airway pressure (IPAP) of 10, 12, and 15 cmH2O with Positive end-expiratory pressure (PEEP) of 5cmH2O. Diaphragm mobility was assessed using ultrasound imaging during spontaneous breathing and the six levels of positive pressure. Data were analysed using a mixed linear model and Dunn-Sidak post-test.Results: The study included 82 volunteers. Diaphragmatic mobility increased during CPAP at 15cmH2O and in bi-level modes with inspiratory positive airway pressures (IPAPs) of 10, 12, and 15cmH2O (with PEEP fixed at 5cmH2O), compared to spontaneous breathing. The mean differences and confidence intervals for these comparisons were as follows: [CPAP 15cmH2O versus spontaneous breathing (SB) (+3.81mm; 95% CI: 0.95-6.67), IPAP 10 + PEEP 5 cmH2O versus SB (+3.44mm; 95% CI: 0.58-6.30), IPAP 12 + PEEP 5cmH2O versus SB (+3.96mm; 95% CI: 1.10-6.82), and IPAP 15 + PEEP 5cmH2O versus SB (+6.21mm; 95% CI: 3.35-9.07)].Conclusion: The positive inspiratory and expiratory pressures were sufficient to increase diaphragmatic kinetics, particularly when higher positive pressures were used.
Background:Knee osteoarthritis (KOA) is a common musculoskeletal disease causing locomotor disability, particularly in elderly women. Obesity and being overweight worsen disease progression and negatively impact mobility and overall health. Obese and overweight women face greater disability and reduced quality of life (QoL) compared to others. Tele-rehabilitation offers a promising approach to improve health outcomes by providing accessible, remote management for this vulnerable group. Objective:The objective of this study was to examine the effects of tele-rehabilitation on pain intensity, range of motion (ROM), functional disability, gait parameters, sleep quality, and QoL in overweight and obese middle-aged women with KOA. Methods:Fifty-six eligible participants were randomised into two groups: active group ( n = 28 ) and control group ( n = 28 ). Participants in the active group received tele-rehabilitation (supervised training), and the control group received a brochure explaining how to do each exercise. Both groups performed these exercises five times a week for 8 weeks. The primary outcome was pain intensity and the secondary outcome measures were range of motion, functional disability, gait parameters, sleep quality and the QoL. The measurements were taken at baseline, at 2 months, and at the 6-month follow-up. The analysis of variance through a linear mixed model (LMM) was used to compare the effects between the active and control groups. Results:Demographic characteristics such as age, height, weight, body mass index (BMI), and duration of symptoms did not show any statistically significant differences between the groups ( p > 0 . 05 ). The VAS score at 2 months showed an improvement of 2.47 (95%CI 2.26-2.67) in the active group compared to the control group. Similar effects were noted after 6 months, 1.88 (95%CI 1.80-1.95), follow-up period. Similar statistically significant improvements were found in the secondary outcome measures such as ROM, functional disability, gait parameters (gait velocity, step length, and cadence), sleep quality and QoL ( p = 0 . 001 ). Conclusion:The study found that, tele-rehabilitation proved to be an effective intervention for improving health outcomes in overweight and obese elderly women with locomotor disabilities due to KOA. The findings suggest that remote rehabilitation can reduce pain, enhance mobility, reduce disability, and better QoL, making it a valuable alternative to conventional care in this high-risk population.
Background: Hemodialysis (HD) is the most common kidney replacement therapy for end-stage chronic kidney disease. Elderly HD patients, particularly, often struggle with low physical activity, leading to poor physical function, which makes exercise therapy a significant challenge. Objectives: This study aims to evaluate the effects of a combined intradialytic core stability and breathing exercise program on activities of daily living (ADLs), fatigue, balance, and cognitive function in patients on maintenance HD. Method: Sixty patients on maintenance HD were randomly assigned into two equal groups. All patients underwent an intradialytic exercise program. The study group received breathing exercises followed by core stability exercises for 30–45[Formula: see text]min, three times per week for 12 weeks, while the control group underwent only breathing exercises. Results: Baseline characteristics were comparable between groups ([Formula: see text]). Post 12-week intervention, [Formula: see text] mixed ANOVA revealed significant time and interaction effects across all outcomes. The study group showed greater post-intervention improvements than the control in functional independence (Δ [Formula: see text] vs. [Formula: see text]7.4; [Formula: see text]), fatigue (Δ [Formula: see text] vs. −6.4; [Formula: see text]), balance (Δ [Formula: see text] vs. −4.2[Formula: see text]s; [Formula: see text]), and cognition (Δ [Formula: see text]6.0 vs. [Formula: see text]2.4; [Formula: see text]) (all [Formula: see text]), demonstrating superior benefits of the combined exercise program. Conclusion: Integrating core stability with breathing exercises produces significantly greater improvements in ADLs, fatigue, balance, and cognition than breathing alone in haemodialysis patients. This superior, multifaceted approach should be adopted into routine clinical practice to optimise patient quality of life.
Background:Chronic low back pain (CLBP) is a highly prevalent condition and a leading cause of disability worldwide. Given its complex etiology, there is growing interest in applying the biopsychosocial model to CLBP management in order to address psychological barriers - such as low motivation - that influence pain perception, exercise adherence, and overall treatment outcomes. Physiotherapy-informed Acceptance and Commitment Therapy (PACT) - a third-wave cognitive-behavioral approach - has shown promise in chronic pain management by promoting psychological flexibility and values-based action. Objective:The primary objective of this study is to evaluate patients' exercise motivation of PACT versus usual physiotherapy care (UC). Secondary objectives are to assess and compare the efficacy of PACT versus UC on functioning and disability, adherence to exercise, acceptance of pain and autonomy support from physiotherapists. Both interventions incorporated dynamic neuromuscular stabilization (DNS)-based graded exercise as a core physiotherapy approach. Methods:Fifty patients with CLBP participated in this study. All participants completed paper-and-pencil self-reported questionnaires to assess relevant outcome measures. Data were collected at two time points: baseline (prior to the first therapy session) and at week 6, immediately following the completion of the intervention period (post-intervention). Participants were randomly assigned to one of two groups. The PACT group received ACT-based physiotherapy combined with DNS-based graded exercise. The usual care (UC) group received individualized graded therapeutic exercise based on the DNS concept, complemented by manual therapy. Results:The PACT group showed significantly higher levels of exercise motivation compared to the UC group, with greater scores in introjected motivation (baseline: 4 . 15 ± 1 . 56 versus 3 . 19 ± 1 . 38 , p = 0 . 029 , r = 0 . 31 ; post-intervention: 4 . 49 ± 1 . 05 versus 3 . 27 ± 1 . 43 , p = 0 . 001 , d = 0 . 97 ) and identified motivation (post-intervention: 6 . 25 ± 0 . 76 versus 5 . 35 ± 1 . 31 , p = 0 . 015 , r = 0 . 35 ). Within-group comparisons revealed no significant changes in the UC group, whereas the PACT group demonstrated a decrease in external motivation ( diff =- 0 . 40 ± 0 . 74 , p = 0 . 027 , r = 0 . 55 ) and increases in identified ( diff = 0 . 45 ± 0 . 95 , p < 0 . 034 , r = 0 . 54 ) and intrinsic motivation ( diff = 0 . 80 ± 1 . 13 , p < 0 . 001 , r = 0 . 76 ). Participants in the PACT group also reported significantly higher perceived autonomy support from the physiotherapist ( 6 . 52 ± 0 . 54 , p = 0 . 027 ) than those in the UC group ( 5 . 86 ± 0 . 90 ) ( p = 0 . 027 , d = 0 . 40 ). Furthermore, adherence to the recommended physical activity was significantly greater in the PACT group ( 18 . 96 ± 3 . 17 , p < 0 . 001 ) compared with the UC group ( 13 . 32 ± 2 . 58 ) ( p < 0 . 001 , r = 0 . 71 ). No statistically significant differences were observed between groups for measures of functioning and pain acceptance, however, both groups demonstrated significant within-group improvements. Disability decreased in UC ( diff =- 1 . 04 ± 1 . 27 , p = 0 . 001 , r = 0 . 63 ) and PACT ( diff =- 1 . 08 ± 2 . 10 , p = 0 . 018 , r = 0 . 63 ) while pain acceptance increased in UC ( diff = 1 . 12 ± 2 . 42 , p = 0 . 047 , r = 0 . 72 ) and PACT ( diff = 1 . 24 ± 1 . 98 , p = 0 . 002 , d = 0 . 89 ). Conclusions:PACT, combined with DNS-based graded exercise, enhanced exercise motivation, perceived autonomy support, and adherence to exercise in patients with CLBP compared to UC. However, no significant improvements were observed in functioning or pain acceptance. These findings suggest that integrating ACT into physiotherapy care may improve motivational outcomes and engagement in physical activity, which are crucial in the management of CLBP. However, further studies with larger samples and longer follow-up periods are necessary to confirm the stability and durability of these positive effects.
Background: Non-Specific Neck Pain (NSNP) is a common musculoskeletal disorder with a multifactorial etiology. Manual therapy techniques, including Mulligan and Maitland mobilisations, are widely used for pain management and functional improvement in NSNP. However, their comparative effectiveness remains insufficiently investigated. Objective: To compare the short-term effectiveness of Mulligan and Maitland mobilisation techniques when combined with a home-based Therapeutic Exercise (TE) program. Methods: A total of 43 adults with NSNP were randomly assigned to three groups: Mulligan + TE (n=14), Maitland + TE (n=14), and a control group receiving TE alone (n=15). The TE program was performed daily at home for two weeks, while manual therapy interventions were administered twice per week for a total of four sessions. Pain intensity, functional ability, pain pressure threshold, Range of Motion (ROM), pain catastrophising, and kinesiophobia were assessed before and after the intervention. Results: All three groups demonstrated significant improvements in all outcome measures by the second week. However, no statistically significant differences were found between groups (p>0.05). These findings reflect short-term outcomes only and should be interpreted with caution given the limited two-week intervention period. Conclusion: Neither mobilisation technique demonstrated superiority over the other. The combination of Mulligan or Maitland mobilisation with TE did not provide greater benefits than TE alone. The short intervention duration and absence of long-term follow-up represent key study limitations. Further high-quality randomised controlled trials are needed to establish more definitive conclusions.
Background: Accurate assessment of muscle strength is crucial for clinical practice. While traditional methods like manual muscle testing (MMT) are accessible, isokinetic dynamometry (ID) is the gold standard due to its reliability, although it is expensive, space-consuming, and requires extensive training. Hand-held dynamometers (HHDs) have demonstrated a strong correlation with ID values, suggesting good to excellent validity. However, factors such as muscle group, evaluator proficiency, and protocol standardization can influence hand-held dynamometer (HHD) measurements.Objectives: This systematic review aimed to evaluate the inter- and intra-rater reliability and validity of HHDs for lower extremity strength assessment in healthy adults and to identify common test protocols.Methods: A comprehensive electronic search was conducted in six databases (PubMed, Medline and CINAHL via Ebsco host, ISI Web of Science, ProQuest, and Science Direct) from January 2017 to May 2023. Studies were included if they assessed asymptomatic participants using HHDs for isometric or concentric contractions of the hip, knee, or ankle and focused on psychometric properties. The QAREL and QUADAS-2 checklists were used to assess reliability and validity, respectively. To complement these 2 checklists, GRADE was used to determine the certainty of evidence. A meta-analysis was conducted to quantify the pooled reliability and validity of HHDs.Results: Eighteen studies were included. Sixteen investigated HHD reliability, with eight being solely reliability studies. Reliability was operationalized through the intraclass correlation coefficient (ICC). Eight studies received high QAREL scores, indicating strong methodological quality. The remaining studies received low QAREL scores, suggesting methodological weaknesses. These reliability studies revealed moderate to very high correlations for inter-rater and intra-rater reliability, indicating HHDs can be a dependable tool for evaluating lower limb muscle strength. Ten studies investigated the validity of HHD for measuring muscle strength in the lower limbs. Pearson correlation coefficients showed moderate to perfect positive correlations between HHD and ID measurements, suggesting alignment. Four studies provided data for meta-analysis. The pooled estimate for internal consistency for all hip and knee movement strength assessments across studies was high to very high, indicating minimal measurement error and reliable measurements.Conclusion: HHDs are reliable and valid for assessing lower extremity muscle strength in healthy adults. Their ease of use, affordability, and portability make them a valuable asset for clinical practice. This research was funded by DOST-SEI. The systematic review is registered in PROSPERO (CRD42023399215).
Background:Aging is associated with declines in balance, gait, and cognitive functions, increasing fall risk and diminishing quality of life. Exergame training, which integrates cognitive and motor tasks, has emerged as a promising intervention to address these issues. Objective:The purpose of this study was to compare the effects of exergame-based training and conventional dual-task training on physical function in older adults. Methods:Thirty community-dwelling older adults aged 60-75 years were randomly assigned to an exergame group ( n = 15 ) or a dual-task group (n = 15). Both groups completed 30 min training sessions three times per week for 12 weeks. The exergame group performed interactive cognitive-motor stepping tasks with real-time visual and auditory feedback using the Dividat Senso platform, whereas the dual-task group performed conventional physical exercises combined with simultaneous cognitive tasks. Balance (surface area, weight distribution, and limit of stability) was assessed using a Physiosensing platform; gait (cadence, velocity, and stride length) was measured with a G-Walk sensor; and cognitive function was evaluated using the Korean version of the Montreal Cognitive Assessment (MoCA-K). Paired t-tests and analysis of covariance (ANCOVA) were used for statistical analysis. The study protocol was approved by the Sehan University Institutional Review Board (IRB No. SH-IRB 2025-006). Results:Both groups showed significant improvements across all measures ( p < 0 . 05 ). The exergame group demonstrated greater gains in surface area, limit of stability, cadence, and velocity ( p < 0 . 05 ), whereas weight distribution, stride length, and cognitive scores did not differ significantly between groups. Conclusion:A 12-week exergame program yielded superior improvements in dynamic balance and gait speed compared with dual-task training, supporting its use as an effective strategy for enhancing mobility and preventing falls in older adults.
Objective: To investigate the effectiveness of the standardised stroke upper extremity rehabilitation program with stratification using shortened Fugl–Meyer assessment (S-FM). Methods: A new stroke upper extremity rehabilitation program was designed. Participants were randomly allocated to standardised program group or conventional training group. Both groups received training for 60–90 min/session, 5 sessions/week and 5–20 sessions in total. Outcome measures, including S-FM, functional test for the hemiplegic upper extremity (FTHUE) and modified Barthel index (MBI), were taken before and after training. Results: Outcomes of 19 participants in standardised program group and 20 participants in conventional training group were analysed. Both groups showed improvements in S-FM, FTHUE and MBI after training but there were no statistically significant interactions between the groups, upper extremity impairment levels and time. In participants with severe upper extremity impairment, the standardised program group showed greater improvements in S-FM and FTHUE compared to the conventional training group, with the change in S-FM exceeding the minimal clinically important difference. However, these differences did not reach statistical significance. Conclusion: The standardised stroke upper extremity rehabilitation program with S-FM stratification may have slightly better upper extremity functional outcomes in people with stroke having severe upper extremity impairment when compared to the conventional training. Clinical trial registration number: NCT06902948
Background: Exergames have gained attention as interactive technologies that combine exercise and gaming to enhance rehabilitation outcomes. Despite their potential, their use in clinical practice remains limited in Saudi Arabia. A validated survey was administered to healthcare practitioners to investigate their familiarity and attitudes (advantages and barriers) towards the utilisation of exergames in rehabilitation settings. Objective: The objective was to identify the factors influencing the successful implementation of exergames as a therapeutic modality. Methods: A cross-sectional study design was used to investigate healthcare practitioners’ familiarity and attitudes towards exergames in rehabilitation settings in Saudi Arabia. A survey was developed to encompass these three constructs. A conceptual framework for the survey was established through a comprehensive literature review and expert consultation to ensure the content’s validity and comprehensiveness. Results: A total of 244 responses were received, mainly from physiotherapists and occupational therapists. The findings indicated that the use of exergames in rehabilitation was limited, with only 17% of healthcare practitioners ([Formula: see text]/244) reporting their use. Despite this, there was an overall positive attitude towards exergames. The most commonly reported advantage of exergames was their ability to increase training motivation ([Formula: see text]/244, 95%), while the primary barrier to adoption was the cost associated with purchasing the necessary devices and games ([Formula: see text]/244, 76%). Conclusion: The reported advantages of using exergames significantly outweighed the perceived barriers, suggesting a positive attitude and high acceptance rate among healthcare practitioners in Saudi Arabia towards this technology.
Background: Anterior cruciate ligament reconstruction (ACLR) often results in residual strength deficits in knee muscles, which may affect an athlete’s return to performance. Isokinetic testing and thigh circumference measurements offer valuable insights into recovery, with thigh circumference potentially serving as a quick indicator of quadriceps strength. Objectives: To evaluate the isokinetic capability of knee extensors and flexors two years after ACLR and examine the correlation between isokinetic peak torque of knee extensors and thigh circumference of the operated limb. Methods: Seventeen professional soccer players, two years post-ACLR, participated. Thigh circumference was measured at 10[Formula: see text]cm and 20[Formula: see text]cm from the patella. The peak torque of knee flexors and extensors was assessed at various speeds. Hamstring-to-quadriceps ratios (H/Qconv and H/Qfunc) were evaluated. Paired-Samples T Test compared peak torque, thigh circumference, H/Qconv, and H/Qfunc between limbs. Pearson Correlation determined the relationship between peak torque of knee extensors and thigh circumference. Results: Two years post-ACLR, peak torque was significantly reduced for knee extensors at 60 ∘ /s, 180 ∘ /s, and 300 ∘ /s ([Formula: see text]) and for knee flexors at 60 ∘ /s ([Formula: see text]). No significant differences were found for H/Qconv and H/Qfunc. Thigh circumference differed significantly at 20[Formula: see text]cm from the patella ([Formula: see text]) and correlated with the peak torque of knee extensors ([Formula: see text]–0.863). Conclusions: Knee extensors and flexors show reduced peak torque two years post-ACLR. A strong correlation exists between peak torque of knee extensors and thigh circumference. Isokinetic evaluation is effective at functional velocities, and thigh circumference measurement is a viable alternative for assessing quadriceps strength.
Background: Achieving community ambulation is a common goal for many patients seeking to improve their quality of life. Rehabilitation professionals are tasked with preparing patients to meet the demands of their environment. In Singapore, rapid infrastructural development over the past two decades could alter these environmental challenges and affect functional community ambulation. Objectives: This study aims to provide current recommendations of distance, step count and speed requirements for therapists to determine their patients’ suitability for community ambulation in Singapore, as well as to deepen understanding of current environmental barriers and enablers. Methods: A quantitative surveillance data collection was conducted on 510 public housing blocks sampled across the country (North, North-East, Central, East and West sectors) to determine ambulation requirements for accessing five essential amenities of daily living (eatery, clinic, grocery, automated teller machine and public transport). Measurements of distance, step count and number of obstacles encountered en route to each amenity were collected. Walking speed was calculated by measuring the length and time allocated for traffic junction crossings. Results: The average distance to amenities was found to be 294.3[Formula: see text]m, with 441 steps taken. Public transport was the nearest amenity (190.8[Formula: see text]m), while grocery stores were the furthest (382.7[Formula: see text]m). There was a significant variation in the distance to reach amenities (ranging from 10.0[Formula: see text]m to 1611.2[Formula: see text]m). The most common obstacles encountered were curbs and stairs. The average walking speed to cross traffic junctions safely was 0.74[Formula: see text]m/s. Conclusion: This study aids rehabilitation professionals in better understanding Singapore’s urban landscape and planning realistic rehabilitation goals with their clients to achieve functional community ambulation.
Background: Self-efficacy in pain sufferers includes beliefs about one’s capacity to tolerate pain. For usage by Arabic-speaking individuals, the Chronic Pain Self-Efficacy Scale (CPSS), which was initially developed in English, must be translated and modified into the Arabic language. Objective: To assess the CPSS’s psychometric qualities for subjects suffering from chronic pain in Arabic. Methods: This was a cross-sectional survey that followed Beaton et al.’s guidelines. The CPSS underwent cross-cultural adaptation and Arabic translation in the initial phase. Then, the reliability and validity of the Arabic version of CPSS were examined. A total of 329 patients completed the questionnaire (40.7% males and 59.3% females). Results: The subscales had good internal consistency, the Cronbach’s alpha was 0.870 for subscale 1 (self-efficacy for managing pain), 0.935 for subscale 2 (physical function self-efficacy), and 0.925 for subscale 3 (coping with other symptoms self-efficacy). Test–retest total scores had an acceptable intraclass correlation coefficient (ICC) of 0.743 (95% CI −0.29 to −0.196, [Formula: see text]). When performing principal component analysis with varimax rotation [exploratory factor analysis [Formula: see text]], the test is helpful. Regarding construct validity, the correlation between the total score of Beck depression inventory (BDI) and CPSS subscales and total score have significant moderate negative correlations ([Formula: see text]; [Formula: see text]) except the pain management subscale has significantly weak negative correlations ([Formula: see text]; [Formula: see text]). Conclusion: The Arabic version seems to be a reliable and valid instrument for evaluating a person’s self-efficacy in chronic pain among Arabic-speaking individuals making it a good and acceptable instrument.
