ABSTRACT Background and Purpose Scapular stabilization exercises are commonly used in the rehabilitation of athletes with subacromial pain syndrome (SAPS) and scapular dyskinesis. Whether supplementing scapular stabilization with kinetic‐chain exercises provides greater short‐term benefits remains uncertain. This study compared the short‐term effects of a scapular stabilization program alone with those of the same program supplemented with additional kinetic‐chain exercises. Methods Twenty‐four overhead athletes with SAPS and scapular dyskinesis were randomly assigned to a scapular stabilization group ( n = 12) or a kinetic‐chain‐supplemented group ( n = 12). Both groups performed the same standardized scapular stabilization program; the latter also performed additional trunk, lower‐extremity, balance, and multisegment exercises, resulting in a greater overall exercise stimulus. Outcomes were assessed before and after 4 weeks. The prespecified primary outcome was scapular upward rotation at 90° shoulder elevation. Between‐group differences were analyzed using two‐way mixed repeated‐measures ANOVA, with the group × time interaction as the principal test, and reported with 95% confidence intervals. Holm–Bonferroni adjustment and baseline‐adjusted ANCOVA were conducted as sensitivity analyses. Results For the prespecified primary outcome, scapular upward rotation at 90°, the group × time interaction was not statistically significant ( p = 0.052; ηp 2 = 0.161), with a between‐group difference in change of −4.38° (95% CI, −8.80° to 0.03°). After Holm–Bonferroni adjustment for the 15 group × time comparisons, the primary outcome remained nonsignificant (adjusted p = 0.723). The baseline‐adjusted ANCOVA also showed no statistically significant between‐group difference (−3.51°, 95% CI, −7.33° to 0.31°; p = 0.070); however, the significant group × baseline interaction ( p = 0.002) indicated that the homogeneity‐of‐regression‐slopes assumption was not met. An unadjusted significant group × time interaction was observed for scapular upward rotation at 45° ( p = 0.028), but this finding did not remain significant after Holm–Bonferroni adjustment (adjusted p = 0.426). No other group × time interaction remained statistically significant after adjustment for multiple comparisons. Conclusion Both rehabilitation programs were associated with short‐term improvements in patient‐reported outcomes. However, adding kinetic‐chain exercises did not result in a clear additional short‐term benefit compared with scapular stabilization alone. Because the kinetic‐chain group also completed more exercises overall, the specific contribution of the kinetic‐chain component cannot be determined. Given the small sample size and uncertainty surrounding the primary outcome, smaller but potentially meaningful differences between the programs cannot be excluded. Trial Registration IRCT20240614062130N1, registered July 20, 2024
ABSTRACT Background and Purpose Therapeutic exercise is central to knee osteoarthritis (KOA) management, but movement‐evoked pain may limit adherence and outcomes. High‐frequency transcutaneous electrical nerve stimulation may reduce pain during movement and enhance exercise‐related outcomes. This study evaluated whether high‐frequency transcutaneous electrical nerve stimulation applied during an exercise therapy program provides additional benefits over sham stimulation in individuals with KOA. Methods In this randomized, sham‐controlled superiority trial with intended participant blinding and blinded outcome assessment, 96 individuals with KOA were randomized to exercise therapy plus active high‐frequency transcutaneous electrical nerve stimulation or exercise therapy plus sham transcutaneous electrical nerve stimulation. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score Pain subscale. Secondary outcomes included the remaining Knee Injury and Osteoarthritis Outcome Score subscales, pain intensity, pain‐related self‐efficacy, patient‐specific function, disability, quadriceps isometric strength, and physical function. Outcomes were assessed at baseline, post‐intervention, and 1 month follow‐up. Linear mixed models were used for analysis. Results Active high‐frequency transcutaneous electrical nerve stimulation did not provide additional benefit over sham stimulation for the Knee Injury and Osteoarthritis Outcome Score Pain subscale at post‐intervention (adjusted mean difference, 1.05 points; 95% CI, −5.19 to 7.29) or at 1 month follow‐up (0.40 points; 95% CI, −5.91 to 6.71). These confidence intervals did not reach the predefined 10‐point minimal clinically important difference. No statistically significant between‐group differences were observed for any secondary outcome. No adverse effects were reported. Discussion Adding high‐frequency transcutaneous electrical nerve stimulation to a structured exercise therapy program did not confer additional benefits over sham stimulation in individuals with KOA. These findings should be interpreted in light of the absence of formal blinding assessment, the short follow‐up, and the absence of an exercise‐only group. Trial Registration This trial was registered at ClinicalTrials.gov on December 14, 2023, under the identifier NCT06184451
ABSTRACT Background Complex Regional Pain Syndrome type 1 (CRPS‐I) following stroke has been managed by several conservative methods to date. But the efficacy of Low‐level laser therapy (LLLT) was never compared with the Mirror therapy (MT) in these cases. Aim and Objective To compare the efficacy of LLLT versus MT in post‐stroke CRPS‐I. Material and Methods This comparative interventional study (Trial registration number: CTRI/2025/05/086943) was initially conducted with 47 patients with post‐stroke CRPS‐I after considering the inclusion and exclusion criteria. After obtaining informed consent, they were randomly divided into two groups. Along with kinesiotherapy in both the groups, LLLT was administered for Group 1 and MT for Group 2. Intensity of pain was measured by the Numerical Rating Scale (NRS), and the Fugl‐Meyer Assessment‐Upper Extremity (FMA‐UE) was used for assessing sensorimotor recovery. All the variables were measured at the baseline, 4 weeks/visit 2, 8 weeks/visit 3 and 12 weeks/visit 4. A total of 44 cases (22 in each group) were analysed, as there were 3 dropouts on subsequent follow‐ups. Results Intra‐group analysis showed significant improvement in both the parameters during all the follow‐ups ( p < 0.001). During inter group comparison, Group1 showed a significant improvement during follow‐up at 4 weeks in terms of both pain intensity ( P adj = 0.039) and sensorimotor recovery ( P adj = 0.022), but subsequent follow‐up visits showed no significant difference between the groups ( P adj > 0.05). Conclusion LLLT demonstrated an early between‐group advantage over MT at 4 weeks in pain reduction and sensorimotor recovery in post‐stroke CRPS‐I. However, in the long run, no overall between‐group superiority was noted, as both groups achieved comparable outcomes. Trial Registration Institutional Scientific and Ethics committee (Reg. No: ECINEW/INST/2023/1862) approval no: NRSMC/IEC/149/2024.Trial Reg. no of this study under Clinical Trials Registry—India: CTRI/2025/05/086943
ABSTRACT Objective To translate, cross‐culturally adapt, and validate the short version of the Patterns of Activity Measure‐Pain (POAM‐P) in Brazilian individuals with chronic pain. Methods This was a questionnaire validation study. Brazilian participants reporting pain for more than 3 months were included. The measurement properties assessed were structural validity, construct validity, reliability, internal consistency, and agreement. Results The study included 125 individuals with chronic pain for the analysis of structural and construct validity. The internal structure of the reduced version of the POAM‐P, comprising 3 domains and 15 items, was considered adequate (comparative fit index = 0.98; Tucker‐Lewis index = 0.97; root mean square error of approximation = 0.07; standardized root mean square residual = 0.06; and chi‐square/degrees of freedom = 1.55). Correlations ranging from 0.30 to 0.50 were observed between the avoidance and pacing domains and kinesiophobia, catastrophizing, and disability. The overdoing domain showed no significant correlations with external measures, associating negatively only with the avoidance and pacing domains. Internal consistency was assessed in the total sample ( n = 125) using composite reliability (CR), with values ranging from 0.76 to 0.93 across the three POAM‐P domains. Test–retest reliability was assessed in a subsample of 33 individuals and proved satisfactory, with intraclass correlation coefficients ≥ 0.79. The test–retest interval was planned to range from 7 to 14 days, with an observed mean of 8 days (7–13). Agreement, assessed via Bland‐Altman plots in the same subsample ( n = 33), was considered acceptable. No ceiling or floor effects were identified. Conclusion The Brazilian short version of the POAM‐P demonstrated adequate structural validity, internal consistency, and test–retest reliability. Nevertheless, further studies with larger retest samples are warranted to confirm the stability of these findings. Regarding construct validity, the avoidance and pacing domains showed correlations with external measures as expected, whereas the overdoing domain was correlated only with the other domains of the instrument.
ABSTRACT Background and Purpose Although neural mobilization techniques (NMTs) and proprioceptive neuromuscular facilitation (PNF) are well‐known therapeutic techniques among physical therapists, evidence regarding the additional benefit of combining these approaches in the management of adhesive capsulitis (AC) remains limited. This study was established to determine the effectiveness of combined NMTs and PNF techniques on pain intensity, functional disability and passive ROM of the shoulder joint in patients with AC. Methods Fifty‐six patients with AC of both genders were randomly assigned to two groups of equal size. The experimental group received combined slider median nerve NMTs, PNF and conventional physical therapy, while the control group received PNF and the same conventional physical therapy, three sessions per week for 6 weeks. Patients were evaluated for pain intensity, functional disability and passive ROM of the shoulder joint at baseline and after the 6th week. Results After adjusting for baseline values using ANCOVA, the experimental group demonstrated significantly greater improvements across all outcomes. The adjusted between‐group differences (95% CI) were: VAS (0–10 scale) − 0.88 (−1.24, −0.52; p < 0.001, η 2 = 0.313); SPADI −5.69 (−9.83, −1.55; p = 0.008, η 2 = 0.125); abduction 14.08° (11.22, 16.94; p < 0.001, η 2 = 0.647); external rotation 6.71° (5.26, 8.16; p < 0.001, η 2 = 0.619); and internal rotation 1.83° (0.94, 2.72; p < 0.001, η 2 = 0.244). When evaluated against established MCID thresholds, the 14.08° improvement in shoulder abduction was the only outcome that approached the established MCID and exceeded measurement error, indicating a possible clinically meaningful benefit. Conversely, changes in pain and disability did not reach their respective MCID thresholds and should therefore be interpreted cautiously, with confirmation in larger studies warranted. Discussion The combination of NMTs with PNF and conventional physical therapy resulted in statistically significant short‐term improvements in pain, disability, and passive shoulder ROM. However, the between‐group difference in pain and disability did not reach the reported MCID limits, and shoulder abduction had the most potential therapeutic value. Consequently, the results indicate that NMTs may provide additional advantages, especially for shoulder mobility, but do not show a clinically significant effect on other outcomes. Larger trials with longer follow‐up are necessary to corroborate these findings. Trial Registration NCT06664437
