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Objective: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Design: Randomised placebo-controlled study with three intervention groups. Setting: The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Participants: Eighty-one patients with chronic non-specific low back pain aged 18–80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. Intervention: The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. Main measures: The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. Results: The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = −3.6, −0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. Conclusion: The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. Design: Randomized, single-blinded, multicenter, parallel-group trial. Setting: Thirteen outpatient physical therapy clinics in nine different US states. Participants: One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. Intervention: Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. Main measures: The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. Results: The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. Conclusions: The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy. Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017. [ABSTRACT FROM AUTHOR]

Objective: Verify the effect of non-periodized and linear periodized combined training on body image perception and body dissatisfaction in adults with obesity. Design: A randomized clinical trial on the effect of two types of combined training periodization was carried out on people with grade I and II obesity. Setting: Participants were allocated into three groups: non-periodized periodization group, linear periodization group, and control group, with 23 participants in each. Subjects: Adults with obesity, with a body mass index between 30 kg/m² and 40 kg/m². Interventions: The intervention lasted 16 weeks (separated into three mesocycles of 4 weeks and 1 week of familiarization), in 3 weekly sessions of 1 hour each, composed of aerobic (30 min) and muscle strength exercises (six exercises) in the same session. The group with non-periodized model maintained uniform intensity, volume, and workload throughout the mesocycles. The group with the linear periodization model started with low initial intensity, subsequently introducing a gradual increase of intensity in the mesocycles. Main measures: Body image perception (current and ideal silhouette) and body dissatisfaction were assessed using the Stunkard silhouette scale. Results: The perception of the current silhouette increased only in the control group (Δ = 1.16; p = 0.04). There was a significant reduction in the ideal silhouette over time (p = 0.001), especially in non-periodized group (Δ = −1.26). Body dissatisfaction increased significantly only over time (p = 0.001), especially for control group (Δ = 1.47). Conclusions: Regardless of periodization, combined training effectively maintained the perception of the current silhouette and reduced the ideal silhouette in adults with obesity. Trial registration: Brazilian Registry of Clinical Trials (RBR-3c7rt3). [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. Design: A randomized-controlled trial. Setting: Special Rehabilitation Services in Taboão da Serra. Participants: Patients with bilateral knee osteoarthritis. Intervention: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. Main outcome measures: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). Results: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was −3.08 points (95% confidence interval −4.13; −2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was −2.40 points (95% confidence interval −3.34; −1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was −4.08 points (95% confidence interval −5.89; −2.26), p < 0.01 with an effect size of 1.04. Conclusion: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of inpatient medical ward exercise on physical and health outcomes in adults compared with usual care. Data sources: Medline, CINAHL and EMBASE were searched from inception to 20 April 2023. Review methods: Randomised-controlled trials in English that reported physical and health outcomes of adults who received an exercise intervention on an acute medical ward were included. Two reviewers independently extracted data. Methodological quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed the quality of evidence to evaluate the certainty of effect. Meta-analyses were performed where possible. Results: Thirteen studies were included, with 1273 unique participants (mean [SD] age, 75.5 [11] years), which compared exercise intervention with usual care. Low quality evidence demonstrated a significant improvement in aerobic capacity ([MD], 1.39 m [95% CI, 0.23, 2.55], p = 0.02) and maximum isometric strength ([MD], 2.3 kg [95% CI, 2.2, 2.4], p < 0.001) for the exercise intervention compared with usual care. Low quality evidence demonstrated no difference for in-hospital falls count ([OR], 1.93 [95% CI, 0.61, 6.12] p = 0.27) or mortality ([OR], 0.77 [95% CI, 0.48, 1.23], p = 0.27). Moderate quality evidence demonstrated no difference for length of stay ([MD], −0.10 days [95% CI, −0.31, 0.11] p = 0.36). Conclusion: Exercise prescribed during an acute medical ward stay improves aerobic capacity and maximum isometric strength but may not reduce length of stay, in-hospital falls or mortality. [ABSTRACT FROM AUTHOR]

Objective: To determine whether implementing a Facebook training program improves the effectiveness of computerized cognitive training (CCT) in older adults. Design: Randomized, controlled, double single-blind trial with parallel groups. Setting: Community centers. Subjects: Eighty-six adults between 60 and 90 years old. Interventions: Nine face-to-face 60-min sessions of CCT with VIRTRAEL for all participants. The experimental group received an additional 30 min of Facebook training per session. Main measures: Attention (d2 Test of Attention); learning and verbal memory (Hopkins Verbal Learning Test-Revised); working memory (Letter-Number Sequencing test), semantic and abstract reasoning (Similarities and Matrix Reasoning tests); and planning (Key Search test). Results: There was a significant Group*Time interaction in the Hopkins Verbal Learning Test-Revised-Trial 3, Letter-Number sequencing, and Matrix tests. Between groups, post-hoc analyses showed a difference in Matrix reasoning (p <.001; d = 0.893) at post-intervention in favor of the experimental group. Significant main effects of time were found in the CCT group between baseline and 3-month follow-up for Concentration (F = 26.431, p ≤.001), Letters and Numbers (F = 30.549, p ≤.001), Learning (F = 38.678, p ≤.001), Similarities (F = 69.885, p ≤.001), Matrix (F = 90.342, p ≤.001), and Key Search (F = 7.904, p =.006) tests. Conclusions: The utilization of CCT with VIRTRAEL, a freely accessible tool with broad applicability, resulted in enhanced attention, verbal learning, working memory, abstract and semantic reasoning, and planning among older adults. These improvements were sustained for at least three months post-training. Additional training in Facebook did not enhance the effectiveness of CCT. [ABSTRACT FROM AUTHOR]

Objective: Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. Design: Randomised, assessor-blinded, controlled trial. Setting: Primary care. Subjects: Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40–74. Intervention: The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. Main measures: Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. Results: There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74–130) minutes/week at baseline to 214 (95% CI 183–245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103–157) to 176 (95% CI 145–207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by −514 (95% CI −567–462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was −852 (95% CI −900–804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5–8.2) and in the prescription group by 14.7 points (95% CI 14.3–15.1) from baseline to 24 months (p = 0.024 between groups). Conclusions: There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the effectiveness of virtual reality-based treadmill training on gait performance and tolerance in the elderly. Design: Two-armed randomized controlled trial. Setting: The Medical Rehabilitation Sciences Department, Umm Al Qura University, Saudi Arabia. Participants: Sixty Saudi elderly of both sexes, aged 65–75 years, were included. Interventions: Participants were divided into two groups. The control group received treadmill training without virtual reality, alongside a conventional exercise program. The experimental group received a training program that was similar to the control group's exercises but with C-Mill virtual reality treadmill training. The program lasted one hour, three times per week, over four consecutive weeks. Main Measures: The study assessed changes in outcome measures at baseline, Post-1 (after four weeks of training), and Post-2 (four weeks post-training). These measures encompassed the primary outcome, the 6-minute walk test (meter), as well as secondary outcomes such as stride length (meter), stride time (second), cadence (steps/minute), and velocity (meter/second). These parameters were evaluated using the GaitRite electronic gait analysis walkway. Results: The experimental group showed better improvement in the mean values of the 6-minute walk test, stride length, stride time, cadence, and velocity compared to the control group at post-1 and post-2. The P -values were respectively at post-1 (0.019, 0.015, 0.041, 0.013, and 0.021) and (0.011, 0.025, 0.073, 0.061, and 0.017) at post-2 (all, P <.05). Conclusions: C-Mill virtual reality treadmill training shows potential in improving gait parameters and walking tolerance in the elderly in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of Baduanjin exercise on executive function in community-dwelling older adults with cognitive frailty. Design: Randomized controlled trial. Setting: Community residential centers. Subjects: 120 eligible older adults. Interventions: Baduanjin training group received supervised Baduanjin training, 60 min sessions three times per week for 24 weeks. The control group did not receive any exercise intervention. Main measures: Primary outcome was executive function, assessed using Clock Drawing Test. Secondary outcomes included the subcomponents of executive function (working memory, inhibitory control and cognitive flexibility), attention and cognitive frailty (global cognitive function, physical frailty) assessed using Verbal Fluency Test, Trail Making Test-A/B, Stroop Test, Montreal Cognitive Assessment and Edmonton Frailty Scale, respectively, at baseline and 24 weeks after intervention. Results: After the 24-week intervention, the scores of Clock Drawing Test and Verbal Fluency Test, the Trail Making Test-B time and the Card correct numbers of Stroop Test in Baduanjin training group showed significant improvement compared with control group (all P < 0.05) with small to moderate effect sizes and the significant interaction effect of group by time in the Clock Drawing Test and Trail Making Test-B test (P = 0.003 and P = 0.043); cognitive frailty variables, including Montreal Cognitive Assessment and Edmonton Frail Scale scores, also showed significant improvement (P = 0.002 and P = 0.004) with a moderate effect sizes and a significant interaction effect (P < 0.001, P = 0.013). No adverse events were reported. Conclusion: Regular Baduanjin training may be an effective and safe intervention to improve cognitive frailty and executive function in community-dwelling older adults with cognitive frailty. Trial registration: Chinese Clinical Trial Registry, ChiCTR2100050857. Data of registration: 8/5/2020, https://www.chictr.org.cn/showproj.html?proj = 133037. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the influence of aerobic exercise training on inhibitory control of executive functions in children with hemiplegic cerebral palsy. Design: Single-blind randomized controlled trial. Setting: Outpatient Physical Therapy Clinic. Participants: Children aged 7–11 with left-sided hemiplegic cerebral palsy with emotional and behavioral dysregulation evidenced by scores >28 on Paediatric Symptom Checklist and GMFCS I or II (n = 60). Intervention: Participants were randomly allocated into two equal groups. The control group received standard-of-care physical therapy for 1 h, and the aerobic exercise group received standard-of-care physical therapy for 30 min and moderate-intensity continuous exercise on a bicycle ergometer for 30 min. All groups received treatment three times a week for 12 weeks. Main Measures: The Eriksen Flanker test and Stroop Color–Word test were used to assess inhibitory control of executive function at the baseline and after 12 weeks. Results: Differences between pre- and post-treatment values in the exercise group showed significant improvement in Flanker response accuracy and Stroop response accuracy (p = 0.001) and significant decreases in Flanker congruent reaction time and Stroop congruent reaction time (p < 0.05). However, there were no significant differences between both groups in Flanker incongruent reaction time and Stroop incongruent reaction time (p > 0.05). Conclusions: Aerobic exercise has a promising effect on inhibitory control of executive function in children with left-sided hemiplegic cerebral palsy. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of electrical dry needling with a non-invasive multi-component intervention in patients with chronic low back pain. Design: A randomised single-blind clinical trial. Setting: Outpatient Physiotherapy Clinic; home. Participants: Sixty-four patients with chronic low back pain aged 30–65 years. Interventions: Six-week electrical dry needling on myofascial trigger points, and a non-invasive multicomponent intervention (home exercise programme, stretching and ischemic compression). Main measures: Pain (Visual Analogue Scale), disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), kinesiophobia (Tampa Scale of Kinesiophobia), quality of life and sleep (Short Form 36-item Health Survey and Pittsburgh Sleep Quality Index), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion (finger-to-floor distance), and pressure pain threshold (algometer) were assessed at baseline, after 6 weeks, and after 2 months. Results: ANOVA showed statistically significant differences in group-by-time interaction for most pain pressure thresholds of myofascial trigger points (P < 0.05), for disability (Roland-Morris Disability Questionnaire: F = 6.14, P = 0.016; and Oswestry Disability Index: F = 7.36, P = 0.009), for trunk anteflexion (F = 10.03, P = 0.002) and for habitual sleep efficacy (F = 6.65, P = 0.012), use of hypnotics (F = 4.77, P = 0.033) and total score of quality of sleep (F = 8.23, P = 0.006). Conclusions: In comparison to a non-invasive multicomponent intervention, electrical dry needling has more positive effects on disability, pain intensity, kinesiophobia, and reducing patients' sensitivity to myofascial trigger points pressure, at post-treatment and at 2 months. Clinical Trial Registration number: NCT04804228. Registered on May 28th, 2021. Available at https://clinicaltrials.gov/ct2/show/NCT04804228 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis. Design: A prospective, single-blinded, randomised controlled trial. Setting: Single medical centre. Participants: Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31). Interventions: Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy. Outcome measures: The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection. Results: At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05). Conclusion: The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks. Trial registration: ClinicalTrials.gov: NCT02708706. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of a McKenzie Method intervention in patients with sciatica with guideline-based patient education. Design: Multi-centre, assessor-blinded, parallel-group, randomised trial Setting: Two tertiary hospitals providing operative spinal care. Subjects: Sciatica patients with magnetic resonance imaging-confirmed lumbar disc herniation compressing a nerve root. Interventions: The McKenzie group received specific back exercises for seven visits combined with an educational book, and the Control group received a single session of self-management guidance according to usual practices. Main measures: The primary outcome was the number of surgical operations. Secondary outcomes were pain measured using the Visual Analogue Scale, disability using the Oswestry Disability Index and health-related quality of life using a RAND-36 questionnaire at baseline and 24-month follow-up. Results: Altogether 66 patients, mean age of 43 years, of which 50% were females with long-lasting sciatica, mean 16 weeks, were randomised to two groups. Nineteen patients (29%) had surgery. There was no significant difference in surgery rates between the groups. Back and leg pain decreased, and disability improved in both groups. Health-related quality of life improved in six dimensions out of eight in both groups. There were no significant between-group changes in the patient-reported outcomes at the follow-up. Conclusions: Multiple sessions of McKenzie-based back exercises with a McKenzie-specific patient's educational book produced effects equal to guideline-based advice at long-term follow-up. However, the power of these results is diminished due to the small patient population and confounding factors. [ABSTRACT FROM AUTHOR]

Objective: Compare the effectiveness of a problem-solving, individualised, home-based occupational therapy intervention (ABLE 2.0), to usual occupational therapy, on activities of daily living (ADL) ability in persons with chronic conditions. Design: A single-centre, double-blinded, randomised controlled trial with 10- and 26-week follow-up. Setting: A Danish municipality. Subjects: Persons with chronic conditions experiencing problems performing ADL tasks (n = 80). Interventions: ABLE 2.0 was compared with usual occupational therapy. Main measures: Coprimary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 10. Secondary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 26, and perceived satisfaction with ADL ability (ADL-Interview Satisfaction) and observed ADL process ability (Assessment of Motor and Process Skills) at Weeks 10 and 26. Results: In total, 78 persons were randomly assigned: 40 to usual occupational therapy and 38 to ABLE 2.0. No statistically significant nor clinically relevant difference between group mean changes in primary outcomes was identified from baseline to Week 10 (ADL-Interview Performance [−0.16; 95% CI: −0.38 to 0.06] and Assessment of Motor and Process Skills ADL motor ability [−0.1; 95% CI: −0.3 to 0.1]). At Week 26, a statistically significant and clinically relevant difference was found in Assessment of Motor and Process Skills ADL motor ability (LS mean change: −0.3; 95% CI: −0.5 to −0.1) between groups. Conclusion: ABLE 2.0 was effective in improving observed ADL motor ability at 26 weeks. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of sport climbing on a biomechanical marker of axial posture in patients with Parkinson's disease, as well as its association with age, body mass index and health-related quality-of-life outcome measures. Design: Pre-planned secondary analysis of our randomized controlled, semi-blind trial (unblinded patients, blinded assessors) comparing sport climbing to unsupervised exercise. Setting: Single-centre study conducted at the Department of Neurology of the Medical University of Vienna, Austria. Participants: Forty-eight Parkinson's disease patients (aged 64 ± 8 years, Hoehn & Yahr stage 2–3) were included. Intervention: Sport climbers (n = 24) followed a 12-week, 90 min/week supervised top-rope sport climbing course in an indoor climbing gym. The unsupervised training group (n = 24) independently followed the 'European Physiotherapy Guidelines for Parkinson's Disease' and World Health Organization recommendations for an active lifestyle for 12 weeks. Main measures: Posture was assessed with the horizontal distance of the seventh cervical vertebra to the wall at baseline and after the intervention. Results: Participating in the sport climbing group significantly predicted the biomechanical marker of axial posture (P = 0.044). The improvement in the biomechanical marker did not affect the quality of life, depression, fatigue, physical activity or fear of falling. Participants in the sport climbing group showed a significantly decreased horizontal distance of the seventh cervical vertebra to the wall after the intervention (−1.7 cm (95%CI [−2.6, −0.8]). In the unsupervised training group, no difference was found (−0.5 cm; 95%CI −1.3, 0.2]). Conclusions: We conclude that sport climbing improves a biomechanical marker of axial posture in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of aerobic training, resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease. Design: Randomized controlled trial. Setting: The Fourth Rehabilitation Hospital of Shanghai, China. Participants: 82 (67.0 ± 6.5 years, 59.8% male) patients with stable chronic obstructive pulmonary disease were randomized to intervention group 1 (n = 27), intervention group 2 (n = 28), and control group (n = 27). Intervention: Intervention group 1 received aerobic and resistance training, while intervention group 2 received additional external diaphragm pacing. Control group received aerobic training only. Main measures: 1-year follow-up of physical activity, body composition, respiratory function and diaphragm function. Results: Intervention groups 1 and 2 showed statistically improvements in the difference value compared with control group in terms of 6-min walk distance (−95.28 ± 20.09 and −101.92 ± 34.91 vs −63.58 ± 23.38), forced expiratory volume in 1 s (−0.042 ± 0.027 and −0.130 ± 0.050 vs −0.005 ± 0.068), fat-free mass (−2.11 ± 3.74 and −3.82 ± 3.74vs 0.28 ± 1.49) and chronic obstructive pulmonary disease assessment test value (2.16 ± 0.85 and 2.38 ± 1.02 vs 1.50 ± 0.93). Intervention group 2 showed significant difference in arterial oxygen pressure (−4.46 ± 3.22 vs −1.92 ± 3.45), diaphragm excursion during deep breaths (−0.82 ± 0.74 vs −0.38 ± 0.29), and diaphragm thickness fraction (−8.77 ± 3.22 vs −4.88 ± 2.69) compared with control group. Conclusion: The combination of aerobic training, resistance training, and external diaphragm pacing obtained significant improvements in physical activity, respiratory function, body composition, arterial oxygen pressure, and diaphragm function in patients with chronic obstructive pulmonary disease. Trial registration: ChiCTR1800020257, www.chictr.org.cn/index.aspx [ABSTRACT FROM AUTHOR]

Objective: To determine the safety and efficacy of early postoperative mobilization in patients who have undergone surgical repair of acute type A aortic dissection. Design: Randomized controlled trial. Setting: Heart Medical Center. Subjects: Seventy-seven patients with acute type A aortic dissection were assessed. Intervention: Patients were randomly allocated into: (1) the control group (usual care) (n = 38) and (2) the intervention group (early goal-directed mobilization) (n = 39). Main Measures: The primary outcome was the patient's functional status. The secondary outcomes included vital signs, serious adverse events, muscle strength, intensive care unit-acquired weakness, grip strength, duration of mechanical ventilation, length of stay, readmission rate, and health-related quality of life after 3 months. Results: The vital signs of the patients were within the tolerable ranges during the entire intervention. No serious exercise-related adverse events were observed in the intervention group. The Barthel Index score (P = 0.013), Medical Research Council score (P = 0.001), grip strength (P = 0.001), and health-related quality of life (P = 0.001) were higher in the intervention group. Intensive care unit acquired weakness (P = 0.019), duration of mechanical ventilation (P = 0.002), intensive care unit stay (P = 0.002), and total length of stay (P = 0.010) were lower in the intervention group. Patients in the intervention group had a higher physical health-related quality of life (P = 0.015) at 3 months post-surgery. There was no difference in readmission rates. Conclusions: Delivery of early goal-directed mobilization in acute type A aortic dissection was safe and facilitated the recovery of daily living ability, shorter hospital stay, and improved quality of life after discharge. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. Design: A pragmatic stepped-wedge cluster randomized trial. Setting: Eight rehabilitation centers in secondary healthcare, Norway. Participants: A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). Interventions: A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients' needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. Main measures: Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients' goal attainment measured by the Patient Specific Functional Scale (0–10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. Results: No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: −0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. Conclusion: The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of telerehabilitation on oral function of oral and maxillofacial tumor patients. Design: Unicentral, single-blind, randomized controlled trial. Setting: Community. Subjects: Patients with primary oral and maxillofacial tumor receiving surgical treatment. Interventions: Telerehabilitation guidance from therapists. Main measures: At the beginning of training (T0) and 1 month (T1), 3 months (T2) and 6 months (T3) after training, patients' masticatory ability (mastication efficiency—masticatory performance evaluating gum, maximum bite force and mouth opening) and swallowing ability (water swallowing test) was measured. Modified Sato questionnaire and MD Anderson dysphagia inventory (MDADI) were used for self-evaluation of masticatory and swallowing ability. Results: A total of 64 participants (intervention: 33; control: 31) were included. The masticatory efficiency scores of the intervention group were significantly better than those of the control group at T2 (intervention: 3.67 (0.48); control: 3.03 (0.85)) and T3 (intervention: 4.20 (0.30); control: 3.50 (0.79)); and maximum mouth opening was better at T2 (intervention: 3.18 (0.59); control: 2.77 (0.54)) and T3 (intervention: 3.54 (0.58); control: 3.09 (0.41)). In water swallowing test, the intervention group had better scores at T2 and T3. The scores of MDADI scale in intervention group were better than those in the control group after 3 months of training. In subgroup analysis, the intervention group of oral cancer patients had better swallowing function at T2 and T3, but no significant difference was found in the subgroup of oropharyngeal cancer. Conclusions: Telerehabilitation could greatly improve the long-term (3–6 months) training effect under the condition of greatly saving medical resources and reducing personnel contact. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis. Design: Prospective, three-arm randomised controlled trial. Setting: Rehabilitation department of an academic hospital. Subjects: Patients with chronic subacromial bursitis. Interventions: Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group. Main outcome measures: The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient's evaluation of treatment effect, and symptom recurrence. Results: Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient's evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient's evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001). Conclusion: Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group. [ABSTRACT FROM AUTHOR]

Objective: To test for effects of a problem-solving intervention for stroke caregivers on stroke survivor activities of daily living. Design: Two-arm parallel randomized clinical trial with repeated measures at 11 weeks and 19 weeks. Setting: Medical centers for US military Veterans. Subjects: Caregivers of stroke survivors. Intervention: A registered nurse guided caregivers in using problem-solving strategies emphasizing creative thinking, optimism, planning, and expert information to address challenges associated with caregiving. Caregivers in the intervention completed one telephone orientation session followed by eight online, asynchronous messaging center sessions. The messaging center sessions involved (a) education on the Resources and Education for Stroke Caregivers' Understanding and Empowerment website (https://www.stroke.cindrr.research.va.gov/en/), (b) supportive communication between the nurse and caregiver, (c) nurse and caregiver interactions to improve problem-solving, and (d) maintain adherence to discharge planning instructions. Main Outcome: The Barthel Index was used to measure activities of daily living. Results: 174 participants (standard care n = 88, intervention n = 86) were enrolled at baseline. There were no significant differences between groups at baseline. Change scores in activities of daily living between baseline and 11 weeks were significantly higher in the intervention group than the standard care group (group difference = 6.43, 95% confidence interval: 1.28, 11.58). Group differences in change scores between baseline and 19 weeks were not statistically significant (group difference = 3.89, 95% confidence interval: −3.58, 11.36). Conclusions: This web-based caregiver intervention improved stroke survivor activities of daily living by 11 weeks, but intervention effects were undetectable after 19 weeks. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy. Study Design: Randomised crossover trial. Setting: Biomechanics laboratory. Subjects: 27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration. Interventions: Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions. Main measures: Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions. Results: There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F2,52 = 0.02, p = 0.98; extended position: F2,52 = 2.26, p = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F1,26 = 0.94, p = 0.34; extended position: F1,26 = 0.79, p = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F1.51,39.17 = 0.54, p = 0.54) or across timepoints (affected lateral epicondyle: F1,26 = 0.94, p = 0.34). Conclusion: Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist. [ABSTRACT FROM AUTHOR]

Objective: To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. Design: Economic evaluation alongside a pragmatic randomized controlled trial. Participants: 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention (n = 149) or usual care control group (n = 151). Main measures: Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. Results: The mean cost saving for the intervention group at 6 months was AU$2286 (95% Bootstrapped cost CI: −$11,190 to $6410) per participant; 68% and 67% of bootstraps showed the intervention to be dominant (i.e. more effective and cost saving) for mobility and quality-adjusted life years, respectively. The probability of the intervention being cost-effective considering a willingness to pay threshold of AU$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. Conclusions: The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on upper limb motor recovery during post-stroke rehabilitation. Design: Single-blind, randomized controlled trial. Setting: Four inpatient rehabilitation facilities. Subjects: A total of 204 stroke patients with unilateral upper limb motor impairment were randomly 1:1 allocated to TEAS or sham TEAS group. Baseline demographic and clinical characteristics were comparable between the two groups. Interventions: Both groups received conventional physical and occupational therapies. TEAS and sham TEAS therapy were administered to two acupoints (LI10 and TE5) with a pulse duration of 300 µ s at 2 Hz on the affected forearm for 30 times over 6 weeks. Outcome measures: The upper-extremity Fugl-Meyer score (primary outcome), manual muscle testing, modified Ashworth scale, Lindmark hand function score, and Barthel index were evaluated by blinded assessors at baseline, 2, 4, 6, 10, and 18 weeks. Results: The number of patients who completed the treatment was 99 and 97 in the TEAS and the sham group. No significant between-group difference was found in the Upper-Extremity Fugl-Meyer score, Modified Ashworth Scale, Lindmark hand function score, and Barthel Index after intervention and during follow-up. However, the TEAS group exhibited 0.29 (95% CI 0.02 to 0.55) greater improvements in Manual Muscle Testing of wrist extension than the sham group (p = 0.037) at 18 weeks. Conclusions: Administration of TEAS therapy to hemiplegic forearm could not improve the upper extremity motor recovery. However, TEAS on the forearm might provide potential benefits for strength improvement of the wrist [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of sensory-motor training and resistance training in patients with knee osteoarthritis. Design: Randomized controlled trial. Setting: Istanbul University, Department of Physiotherapy and Rehabilitation. Subjects: Forty-eight participants with knee osteoarthritis. Interventions: Following baseline assessment, participants were randomly allocated to sensory-motor training (n = 24) and resistance training (n = 24). Both groups received training three times a week for 8 weeks. Main measures: The primary outcome measure was the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The secondary outcome measures were pain level, muscle strength, proprioception, range of motion, quality of life, and patient satisfaction with treatment. Patients were assessed before and after four- and eight-week interventions. Results: There was no significant difference between the groups' total WOMAC scores after four- and eight-week interventions (respectively, p = 0.415, p = 0.828). There was a significant improvement in pain level during movement and in the energy subscale SF-36 for resistance training after the four-week intervention (respectively, p = 0.012, p = 0.007). After the eight-week intervention, a significant difference was noted in favor of resistance training in the secondary outcome measure quality of life (QoL). No significant difference was found in other secondary outcomes. Conclusions: At the end of the treatment, it was observed that sensory-motor training had a similar effect in the treatment of knee osteoarthritis symptoms to resistance training. These findings may suggest that sensory-motor training is an effective new method to treat patients with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effect of a perioperative pelvic floor muscle training program on urinary incontinence symptoms and the quality of life of patients after radical prostatectomy. Methods: This single-center, parallel-group, randomized, controlled study was conducted with a total of 60 patients undergoing open radical prostatectomy in a training and research hospital in Turkey. Patients were randomly assigned to the pelvic floor muscle training group (n = 30) and the control group (n = 30). The data were collected by face-to-face and phone interviews following surgery at seven days after removal of the urethral catheter (baseline) and 3 months using the Patient Information Form, the International Consultation on Incontinence Questionnaire Short Form and the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. Descriptive statistics, Chi-square test, Independent-samples t -test, and paired-samples test were used to analyze the data. Primary and secondary endpoints were the differences between groups in terms of both scale scores after 3 months. Findings: After 3 months, Incontinence Questionnaire Short Form scores (P < 0.001) and "voiding, incontinence, frequency, nocturia" symptoms scores (P < 0.001) were significantly lower in the pelvic floor muscle training group, and quality of life scores were higher than in the control group (P < 0.001). Conclusion: According to this study, the perioperative pelvic floor muscle training program was effective on patients' urinary incontinence symptoms and quality of life 3 months after radical prostatectomy. Evidence-based practices should be used for patients to alleviate common urinary symptoms and to accelerate the recovery of urinary continence. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effects on sedentary behaviour of an approach that promotes reduction in sedentary behaviour in patients with minor ischaemic stroke after intervention and at follow-up. Design: A randomised controlled trial. Setting: During hospitalisation and after hospital discharge Subjects: In total, 86 patients with minor ischaemic stroke admitted to an acute care hospital were assigned to the intervention (n = 43) and control (n = 43) groups. Intervention: An intervention group that received an approach to reduce sedentary behaviour upon hospital admission until 3 months after discharge (education, self-monitoring, phone calls, etc.) and a control group that received the usual care during hospitalisation. From 3 to 6 months after discharge, no group received any intervention. Main Outcome: The primary outcome was the change (%) in sedentary behaviour from baseline to post-intervention (3 months after discharge) and follow-up (6 months after discharge). Sedentary behaviour was measured at baseline (upon hospital admission), post-intervention, and at follow-up using accelerometers. Results: At the post-intervention stage, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, −22.7%; control group, −14.9%; P = 0.013; effect size = 0.58). At follow-up too, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, −20.4%; control group, −13.6%; P = 0.025; effect size = 0.54). Conclusions: An approach to reduce sedentary behaviour in patients with minor ischaemic stroke effectively reduces sedentary behaviour, which is sustained up to follow-up. Trial registration: This study is registered at www.umin.ac.jp/ctr/index/htm UMIN000038616. [ABSTRACT FROM AUTHOR]

Objective: Investigate feasibility and acceptability of prism adaptation training for people with inattention (spatial neglect), early after stroke, during usual care. Design: Phase II feasibility randomised controlled trial with 3:1 stratified allocation to standard occupational therapy with or without intervention, and nested process evaluation. Setting: Ten hospital sites providing in-patient stroke services. Participants: Screened positive for inattention more than one-week post-stroke; informal carers. Occupational therapists participated in qualitative interviews. Intervention: Adjunctive prism adaptation training at the start of standard occupational therapy sessions for three weeks. Main measures: Feasibility measures included recruitment and retention rates, intervention fidelity and attrition. Outcomes collected at baseline, 3 weeks and 12 weeks tested measures including Nottingham Extended Activities of Daily Living Scale. Acceptability was explored through qualitative interviews and structured questions. Results: Eighty (31%) patients were eligible, 57 (71%) consented, 54 randomised (40:13, +1 exclusion) and 39 (74%) completed 12-week outcomes. Treatment fidelity was good: participants received median eight intervention sessions (IQR: 5, 12) lasting 4.7 min (IQR: 4.1, 5.0). All six serious adverse events were unrelated. There was no signal that patients allocated to intervention did better than controls. Twenty five of 35 recruited carers provided outcomes with excellent data completeness. Therapists, patients and carers found prism adaptation training acceptable. Conclusions: It is feasible and acceptable to conduct a high-quality definitive trial of prism adaptation training within occupational therapy early after stroke in usual care setting, but difficult to justify given no sign of benefit over standard occupational therapy. Clinical trial registration: https://www.isrctn.com/ Ref ISRCTN88395268. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI). Design: Two-arm, parallel-group, randomized, double-blind, controlled trial. Participants: 60 patients with unilateral CAI. Intervention: integral physiotherapy (n = 30) or conventional physiotherapy (n = 30). Outcomes: Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention. Results: The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (meanintegral = 20.14 (14.95–25.37), meanConventional = 29.46 (24.09–34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05). Conclusion: Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients' functional ability. [ABSTRACT FROM AUTHOR]

Background: Stroke is a disabling, long-term condition that challenges the mental and physical health of stroke-survivors concurrently with their primary family-caregivers (dyad). However, there has been a lack of emphasis on this dyadic need. Thus, this study aims to investigate the impacts of two interventions on hope, self-esteem and hedonic wellbeing on depression among the stroke-survivor–caregiver dyad. Methods: This randomized-controlled-trial applied the actor–partner interdependence model to 100 randomly-selected dyads (N = 200) of stroke-survivors, mean (SD) age was 73.63(7.22) and family-caregivers, mean (SD) age was 62.49(14.44) years, recruited from Hong Kong hospitals and rehabilitation centres. The intervention was eight-weekly two-hour narrative therapy group sessions (n = 54 dyads), compared with the current model of psychoeducational group to each dyad as needed. Outcomes were collected via questionnaires and interviews, at four time-points: baseline (T1), during-intervention (T2) (1-month), immediately post-intervention (T3) (2-months) and follow-up (T4) (6-months). Results: The results demonstrated that there are actor effects on stroke-survivors (β = −0.353, p < 0.05) and caregivers (β = −0.383, p < 0.05), where higher levels of hedonic wellbeing were associated with fewer depressive symptoms. Partner effects were observed as caregivers' depressive symptoms were possessing a significant negative relationship with stroke survivors' wellbeing (β = −0.387, p < 0.05). Those stroke survivors in the intervention group had a significantly higher level of self-esteem associated with lower levels of depression (β = −0.314, p < 0.05). Conclusions: Improving hope, self-esteem and wellbeing through narrative therapy significantly mediates depressive symptoms, strengthening the dyadic support of stroke survivors and family caregivers. [ABSTRACT FROM AUTHOR]

Objective: To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. Design: A randomized controlled trial with embedded qualitative analysis. Setting: Community. Participants: Aged at least 60 years and living in the community after hip fracture. Interventions: In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking. Main outcome measures: Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy. Results: Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2–13). There were no between-group differences in mobility, walking confidence or quality of life. Conclusion: A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of integrating an individualized, evidence-based low back pain comprehensive education package on low back pain treatment outcomes. Design: Single-blind, controlled clinical study using the alternate allocation of patients. Setting: Outpatient clinic. Subjects: In total, 54 participants with chronic low back pain (46.75 ± 11.11 years, 80% females) were randomized to intervention (n = 27) or a control group (n = 27). Intervention: The intervention group received additional four one-hour low back pain-related education sessions to eight 45 minutesstandard physical therapy sessions over 4 weeks. Outcome measures: Assessed at baseline, post-intervention, and 3 months. Outcome measures included pain intensity (Visual Analogue Scale), knowledge (Low Back Pain Knowledge Questionnaire), attitude (the Back Pain Attitudes Questionnaire), disability (the Oswestry Disability Index), mental health symptoms (Depression Anxiety Stress Scale, DASS-21 scale), and fear-avoidance (Fear-Avoidance Beliefs Questionnaire). Results: The intervention group showed significantly lower pain intensity ((4 weeks (3.58 ± 1.50 vs. 5.54 ± 1.92), 3 months (3.21 ± 1.74 vs. 5.69 ± 2.51)), higher knowledge ((4 weeks (21.67 ± 2.12 vs. 11.62 ± 3.47), three months (22.08 ± 3.40 vs. 12.23 ± 3.24)), lower negative attitudes ((4 weeks (99.29 ± 11.02 vs. 134.31 ± 12.97), 3 months (102.92 ± 15.58 vs. 132.42 ± 17.79)), lower disability ((4 weeks (26.30 ± 11.37 vs. 45.14 ± 18.67), 3 months (22.83 ± 16.06 vs. 44.13 ± 15.02)), lower stress score ((4 weeks (3.54 ± 3.01 vs. 8.81 ± 5.19), 3 months (3.21 ± 3.22 vs. 7.21 ± 4.36)), lower anxiety ((4 weeks (2.63 ± 3.16 vs. 6.42 ± 4.75), three months (2.63 ± 3.80 vs. 5.73 ± 4.44)), lower depression ((4 weeks (2.42 ± 2.15 vs. 6.42 ± 3.68), three months (2.63 ± 4.18 vs. 7.08 ± 4.41)), and lower fear-avoidance ((4 weeks (13.88 ± 12.32 vs. 50.88 ± 23.25), three months (15.50 ± 16.75 vs. 54.65 ± 31.81)). Conclusion: Integrating low back pain comprehensive education into standard physical therapy might optimize the treatment outcomes of low back pain. [ABSTRACT FROM AUTHOR]

Objective: Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting. Methods: A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks. Results: 55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median −8.5°, interquartile range [IQR] −13.5, −5) and serial casting (median −11.0°, IQR −16, −5) resulted in significant reduction of contracture (P < 0. 001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up (P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively. Conclusion: The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients. [ABSTRACT FROM AUTHOR]

Objective: Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis. Design: A single-center randomized trial with three parallel arms. Setting: A tertiary health care facility in Turkey. Participants: Female patients with knee osteoarthritis aged 40–70 years. Interventions: Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups. Main measures: Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score). Results: Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance – Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor. Conclusions: Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of foot orthoses on pain, disability and foot functionality in patients with Systemic Lupus Erythematosus. Design: Randomized clinical trial. Setting: University Podiatric Clinical Area. Subjects: Patients with systemic lupus erythematosus. Interventions: Patients were randomly assigned to either group A, which received custom-made functional foot orthoses, or group B, which received flat cushioning insoles, for three months. Main measures: The primary outcome was foot pain, measured by 11-point numeric pain rating scale. Foot functionality and foot-related disability were evaluated using the foot function index, the Manchester foot pain and disability, at the beginning and at days 90. Results: Sixty-six participants (age 47.3 ± 11.9 years) suffering from foot pain, received either the custom-made foot orthoses (N = 33) or the flat cushioning insoles (N = 33). For the analysis of the data, only participants who had finished the follow-up period (90 days) were included. None statistically significant difference between groups were found. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.8 ± 1.6 and 4.2 ± 2.9 in group A, at baseline and at 90 days, respectively, group B showed 6.5 ± 1.5 and 4.7 ± 3.0 at baseline and at 90 days, respectively. Conclusion: Both groups showed a reduction in foot pain. This study suggests that not only controlling the foot function, but providing cushioning to the foot, may have positive effects to manage foot pain in patients with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of Action Observation and Motor Imagery administered the day before surgery on functional recovery in patients after total hip arthroplasty. Design: Randomised controlled trial. Setting: Humanitas Clinical and Research Center, Milan, Italy Participants: Eighty inpatients with end-stage hip osteoarthritis undergoing total hip arthroplasty. Interventions: All patients followed a standardized postoperative rehabilitation program. Experimental group (AO + MI) performed two 12-minute Action Observation and Motor Imagery sessions on the preoperative day, whereas control group underwent usual care consisting of education without any additional preoperative activity. Outcome measures: A blinded physiotherapist assessed participants for functional mobility (Timed Up and Go – TUG) (primary outcome), maximum walking speed (10-Meter Walk Test – 10MWT), pain (Numeric Pain Rating Scale – NPRS) and fear of movement (Tampa Scale of Kinesiophobia – TSK) the day before and at four days after surgery. Results: No between-group differences were found at baseline. Although TUG and 10MWT worsened in both groups (p < 0.001), better TUG was found for AO + MI group at four days (mean difference −5.8 s, 95% confidence interval from −11.3 to −0.3 s, p = 0.039). NPRS (p < 0.001) and TSK (p = 0.036 for AO + MI group, p = 0.003 for control group) improved after surgery without between-group differences. Conclusions: Patients undergoing Action Observation and Motor Imagery on the day before surgery showed less functional decline than control group in the first days after total hip arthroplasty. This intervention may contribute to a safer discharge with higher functional abilities in patients hospitalized for total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the effectiveness of supervised and unsupervised functional level-based exercises program for elderly inpatients on physical activity, mobility, health-related quality of life and depression status. Design: A single-blinded randomised controlled trial. Setting: Internal medicine service. Subjects: Patients aged 65 years or older. Interventions: A supervised functional level-based exercise program was applied to the intervention group by a physiotherapist, for 40 min 5 times a week during their hospitalisation. Patients in the control group were asked to perform an unsupervised functional level-based exercise program which was described by the physiotherapist during the first visit. Main measures: Mobility, physical activity level and health-related quality of life were assessed at admission and discharge in both groups. Depression status was evaluated at admission and 3 months after discharge. Results: Sociodemographic features between intervention group (n = 62) and control group (n = 62) were similar. The intervention group showed a higher increment in mobility, physical activity level and quality of life scores than the control group (d = 0.62, p < 0.05; d = 0.57, p < 0.05; d = 1.12, p < 0.05 respectively). Inpatients in the intervention group, depression scores were lower 3 months after discharge (d = 0.42, p < 0.05). The length of stay in the hospital was not different between the groups. Conclusions: A supervised functional level-based exercise program is more effective than an unsupervised functional level-based exercise program for mobility, physical activity, depression and quality of life in elderly inpatients. These positive contributions are seen within a short period like a 5 to 10 days stay in hospital. Trial Registration: ClinicalTrials.gov(NCT03516032). [ABSTRACT FROM AUTHOR]

Introduction: The increasing burden of self-limiting forms of HIV-associated neurocognitive disorder (HAND) in the antiretroviral therapy era calls for adjunctive interventions. The study aimed to determine the effects of a 12-week aerobic exercise programme on HAND. Methods: This is a parallel-group, randomized controlled trial with concealed allocation and intention-to-treat analysis. This study was a clinic-based programme. Seventy-three patients with HAND were enrolled in the trial. The intervention comprised a moderate-intensity aerobic exercise, 20–60 min per session, three times per week, for twelve weeks. The control group received exercise education. Prevalence of HAND constituted the primary outcome. HAND was identified and classified following the Frascati criteria. We computed the odds ratio and number needed-to-treat to estimate the treatment effect. Results: There were 73 patients (38 in exercise and 35 in control arm). Individuals in the exercise arm recorded a significantly higher reduction in working memory deficit (OR = 5.14; CI = 2.6–10.4; NNT = 6) but not in attention-deficit (OR = 0.31, CI = 0.2–0.5; NNT = −5) compared to the control group at twelve-week. Reductions in attention deficit (OR = 1.55, 95 CI = 1.0–2.4; NNT = 5) and HAND prevalence (OR = 1.8, 95 CI = 1.2–2.8); NNT = 8) were significantly higher in the exercise group compared the control group at three-month. No significant between-group difference in functional independence was observed immediately after exercise (p > 0.05). Discussion: The neuroprotective effects of aerobic exercise appear selective and vary with cognitive abilities impaired and aerobic capacity, with a greater change occurring with improved aerobic capacity. Conclusion: Individuals with working memory and attention deficits may benefit more from moderate-intensity aerobic exercise. [ABSTRACT FROM AUTHOR]

Objective: To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes. Design: Randomised controlled parallel group trial. Setting: Three Scottish stroke services. Subjects: Stroke survivors with fatigue three months to two years post-stroke onset. Interventions: Seven telephone calls (fortnightly then a 'booster session' at 16 weeks) of a manualised intervention, plus information about fatigue, versus information only. Main measures: Feasibility of trial methods, and collected outcome measures (fatigue, mood, anxiety, social participation, quality of life, return to work) just before randomisation, at the end of treatment (four months after randomisation) and at six months after randomisation. Results: Between October 2018 and January 2020, we invited 886 stroke survivors to participate in postal screening: 188/886 (21%) returned questionnaires and consented, of whom 76/188 (40%) were eligible and returned baseline forms; 64/76 (84%) returned six month follow-up questionnaires. Of the 39 allocated the intervention, 23 (59%) attended at least four sessions. At six months, there were no significant differences between the groups (adjusted mean differences in Fatigue Assessment Scale −0.619 (95% CI −4.9631, 3.694; p = 0.768), the Generalised Anxiety Disorder 7 −0.178 (95% CI −3.823, 3.467, p = 0.92), and the Patient Health Questionnaire −0.247 (95% CI −2.935, 2.442, p = 0.851). There were no between-group differences in quality of life, social participation or return to work. Conclusion: Patients can be recruited to a trial of this design. These data will inform the design of further trials in post-stroke fatigue. [ABSTRACT FROM AUTHOR]

Objective: To assess the sustained effects of a buddy-style intervention aiming to improve physical activity. Design: A parallel-group, open-label, randomized controlled trial. Setting: Three adult day-care centers. Participants: Sixty-five community-dwelling older adults with disabilities. Intervention: All participants received a 12-week home-based exercise program. An intervention group (n = 33) received a 5–10 min buddy-style intervention once a week at an adult day-care center for older adults. Main measures: The primary outcome was the average daily time spent performing "walking outside home" and "muscle strength exercises" at 24 weeks follow-up post-intervention. Results: Of the 65 participants, one participant in each group dropped out before the program began, 4 and 5 in the intervention and control groups by the 12-week assessment, and 4 and 3 by the 24-week assessment, respectively. Analysis of covariance of the 47 participants who were able to be assessed after 24 weeks revealed that outdoor walking time (min/day) was significantly longer in the intervention group (n = 24) than in the control group (n = 23) at 24 weeks (intervention group, 73.5 [66.1]; control group, 42.7 [45.5]; P = 0.030, f = 0.38). There was no significant difference in the duration of muscle strength exercises (min/day) between the two groups at 24 weeks (intervention group, 8.2 [9.7]; control group, 6.5 [9.3]; P = 0.593, f = 0.08). Conclusions: The buddy-style intervention increased the duration of outdoor walking, with a sustained effect up to 12 weeks after the end of the intervention. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of thermal and sub-thermal capacitive-resistive monopolar radiofrequency at 448 kHz plus exercising compared to sham radiofrequency plus exercising on pain, functionality, and quality of life in patients with subacromial pain. Design: Randomized, controlled, parallel, double-blind, three-arm clinical trial. Setting: Hospital and Primary Care. Subjects: Eighty-one participants with subacromial pain in three intervention groups. Interventions: Three interventions with capacitive-resistive radiofrequency (thermal, sub-thermal, and sham) over 9 sessions (3 per week) plus an exercising protocol identical for all groups over 15 sessions (5 per week). Outcome measures: Visual analogue scale and pressure pain threshold for pain, Shoulder Pain and Disability Index and Quick-Disabilities of the Arm, Shoulder and Hand for functionality, and quality of life via the European Quality of Life-Five Dimensions were assessed at baseline, immediately posttreatment, and 1 month and 3 months post-intervention. Results: No between-group differences were found in the pain visual analogue scale (F = 1.0; P = 0.37), Shoulder Pain and Disability Index (F = 1.0; P = 0.36), European Quality of Life-Five Dimensions (F = 0.76; P = 0.47), and pressure pain (F = 0.14; P = 0.86) outcomes, with a statistical power < 0.30 for all comparisons. Between-group differences were found in the Quick-Disabilities of the Arm, Shoulder and Hand (F = 3.4; P < 0.038), with an improvement of −14.1 points (confidence interval at 95% (95% CI) −28.1 to −0.1) in the thermal versus the sham group at 1 month follow-up. The mobility dimension of European Quality of Life-Five Dimensions improved in a greater proportion of participants in the thermal group (22.2% thermal, 7.4% sub-thermal, and 0.0% sham; P = 0.02) Conclusion: Adding thermal radiofrequency to exercising can further improve slightly functionality and mobility in people with subacromial pain in the short term, but not pain perception. Future studies with larger sample sizes are warranted to increase statistical power. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of a progressive bridging exercise on force, time, and pressure during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke. Design: A single-blinded randomised controlled trial. Setting: Hospital. Participants: Forty-eight individuals with acute ischemic stroke, not at brainstem and cerebellum, randomly allocated to the intervention (n = 24) and control (n = 24) groups. Five participants dropped out during the 2-month follow-up, but they were in the intention-to-treat analysis. Interventions : The intervention group undertook a 45-min conventional physiotherapy and a 30-min progressive bridging exercise. The control group received only the conventional exercise. Main measures: Peak vertical ground reaction force, time to peak force, peak foot pressure, and regional peak foot pressure during the extension phase of sit-to-stand, and sitting-to-standing item of the Motor Assessment Scale were assessed before training, after 4-week training, and 2-month follow-up. Results: The intervention group showed significantly (p < 0.001) less difference in peak vertical ground reaction force between feet during the extension phase of sit-to-stand than the control after 4-week training (mean ± standard deviation; intervention, 5.38 ± 3.99; control, 17.1 ± 10.3) and 2-month follow-up (intervention, 6.79 ± 3.84; control, 17.5 ± 9.89), and demonstrated significantly (p < 0.001) higher score in sit-to-stand than the control after training [mean (interquartile range); intervention, 5 (2-5); control, 2 (1-2)] and follow-up [intervention, 2 (2-5); control, 2 (1-2)]. Both groups demonstrated peak foot pressure on the medial and lateral heels, metatarsals, and hallux regions. Conclusion : Progressive bridging exercise improved symmetrical weight bearing during the extension phase of sit-to-stand, consequently enhanced sit-to-stand ability in individuals with stroke. [ABSTRACT FROM AUTHOR]

To investigate whether nerve mobilization related to nerve mobility or the removal of edema using lymphatic drainage affects the cross-sectional area of the nerve, hand function, and symptom severity in carpal tunnel syndrome.The study is a prospective randomized controlled trial. Data were analyzed between groups using ANOVA, Chi-squared test, and Kruskal–Wallis test.Treatment lasted 4 weeks. Splint group wore the splint daily. Splint+manual lymphatic drainage received lymphatic drainage 5 days a week. Splint+nerve mobilization performed neuromobilization exercises as home exercises 5 days a week. Evaluations were conducted before and after 4 weeks of treatment.The study included 80 patients with mild-to-moderate carpal tunnel syndrome.The patients were randomly divided into three groups: splint (n = 27), splint+manual lymphatic drainage (n = 27), or the splint+nerve mobilization (n = 26).The main outcome measures were ultrasound assessments and the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Boston Functional Status Scale).Compared to the other groups, the nerve cross-sectional area decreased at both the carpal tunnel (p = 0.003) and mid-forearm (p = 0.014) levels in the drainage group. Nerve mobilization did not result in a significant change in the nerve cross-sectional area. All groups showed significant improvements in both symptom severity and functional status scores (p < 0.001).The reduction of edema through lymphatic drainage contributes to a decrease in the cross-sectional area of the median nerve. Additionally, all three methods appear to positively impact the functional capacity of the hand and alleviate symptoms. [ABSTRACT FROM AUTHOR]

To understand the nature and effectiveness of interventions aimed at improving informal stroke caregiver burden, stress, and strain.In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of CENTRAL, CINAHL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted in May 2022.Studies were eligible if they included an intervention designed for informal stroke caregivers, reported on caregiver burden, strain, or stress, were published in English, and used a randomized controlled trial design. An updated search was conducted in June 2024. The methodological quality of studies was appraised using the Cochrane risk-of-bias tool for randomized trials. The data were pooled, and a meta-analysis was completed for caregiver burden and strain outcomes.Nineteen studies met inclusion criteria and were meta-analyzed. Interventions ranged from 4 days to 12 months. Most studies incorporated educational and/or support components. Meta-analyses revealed nonsignificant effects on caregiver burden or strain. Significant between-group differences for caregiver strain and burden were, however, found in seven studies.Limited studies, small sample sizes, and conflicting results made definitive conclusions on the most effective intervention characteristics for improving caregiver outcomes difficult. Of the 19 studies, seven found significant between-group differences for caregiver outcomes postintervention, and these tended to incorporate educational components and comprised between seven and nine sessions. Further high-quality research is required to identify optimal format, duration, and frequency for improving caregiver outcomes. [ABSTRACT FROM AUTHOR]

To examine the effects of the transitional tele-rehabilitation programme on quality of life of adult burn survivors.A prospective, single centre, randomised controlled trial and reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.Adult burn survivors aged ≥18 years with burn size ≥10% total body surface area irrespective of the depth was considered eligible to participate.The intervention was in two phases: pre-discharge and active follow-up phase (which occurred via WeChat). In both phases, comprehensive assessment and intervention guided by the Omaha System and evidenced-based protocols guided the care delivery over an 8-week period.The outcome of interest was quality of life. Two outcome measures were used to assess the outcome of interest: Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L tools. The outcome was assessed at three time points: T0 (baseline), T1 (immediate post-intervention) and T2 (4 weeks from T1).In total, 60 adult burn survivors were randomly allocated to undergo the new programme. The transitional tele-rehabilitation programme elicited statistically significant improvement in simple abilities, affect, interpersonal relationship (T2) and overall quality life (T1 and T2) measured on the BSHS-B.Ongoing rehabilitative care is essential to support the recovery process of burn survivors considering that some quality-of-life subscales may improve faster than others. The study findings highlight the potential of employing a social media platform to improve post-burn quality of life outcomes.ClinicalTrials.govNCT04517721. Registered on 20 August 2020 [ABSTRACT FROM AUTHOR]

To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema.Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil.Women in control phase of the breast cancer-related lymphedema.Compared use of ACWs versus compressive mesh.Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval.Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p = .041, ES 0.20), with improved functionality (p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p = .023, ES 0.26) and demonstrated improvement functionality (p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome—excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p > .05) at both times.Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema. [ABSTRACT FROM AUTHOR]

To assess the added value of caregiver-mediated exercises combined with telerehabilitation in addition to usual care compared to usual care alone on the self-reported mobility outcome after subacute stroke.Multicentre, observer-blinded, parallel randomised controlled trial. An off-site researcher allocated treatments using minimisation.Four rehabilitation centres in the Netherlands.Forty-one patient–caregiver dyads within 3 months poststroke.Eight-week blended care program with caregiver-mediated mobility exercises for 2.5 h per week supported by telerehabilitation and four face-to-face sessions in addition to usual care.Self-reported mobility domain of the Stroke Impact Scale postintervention. Secondary outcomes were functional outcome, dyads’ psychosocial wellbeing, care transition to the community postintervention and after 6 months.Forty-one dyads (21 intervention, 20 control) were randomised, and 37 (N = 18; N = 19) were analysed following intention-to-treat. The Stroke Impact Scale mobility was not significantly different between groups postintervention (B 0.8, 95% CI –6.8–8.5, p = 0.826). The secondary outcomes, namely, (a) caregivers’ quality of life postintervention (p = 0.013), (b) caregivers’ symptoms of depression postintervention (p = 0.025), and (c) independence in leisurely activities at 6 months (p = 0.024), showed significant benefits in favour of caregiver-mediated exercises with telerehabilitation. A significant difference favouring controls was found in self-reported muscle strength at 6 months (p = 0.002).Caregiver-mediated exercises combined with telerehabilitation yielded no differential effect on our primary outcome self-reported mobility. Although the trial is underpowered, current findings are in line with previous trials. Future studies should further explore beneficial effects of caregiver involvement in stroke rehabilitation targeting psychosocial wellbeing. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of prolonged low-level laser therapy application combined with exercise on pain and disability in patients with osteoarthritis of the knee. Design: A randomized controlled trial. Setting: Special rehabilitation services. Subjects: Forty-three participants with knee osteoarthritis. Intervention: Following initial assessment, participants were randomly allocated to the Laser group (n = 22, 44 knees) and received low-level laser therapy while the Placebo group (n = 21, 42 knees) received placebo therapy three times a week for 3 weeks. Both groups then received low-level laser therapy combined with exercise three times a week for the following 8 weeks. Main outcome measures: The primary outcome was change in knee pain and disability (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscular strength (dynamometer), activity (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and medication intake and relief. Results: Mean (SD) age of participants was 63.02 (9.9) years. Pain scores at baseline, 3 weeks, 11 weeks, and 6 months follow-up were 9.1 (1.3), 2.6 (2.3), 0.2 (0.9), and 0.2 (0.8) for the Laser group and 9.5 (8.0), 7.7 (5.3), 5.6 (2.4), and 7.4 (5.0) for the Placebo group, respectively. Disability scores at baseline, 3 weeks, 11 weeks, and 6 months follow-up were 14.9 (4.7), 7.6 (4.8), 3.9 (4.2), and 3.5 (4.1) for the Laser group and 17.8 (14.7), 15.2 (11.5), 11.6 (6.4), and 15.8 (11.9) for the Placebo Group, respectively. Conclusion: In participants with osteoarthritis of the knee, the isolated application of low-level laser therapy in the initial 3 weeks and combined with exercises in the final 8 weeks reduced pain, disability, and intake of medication over a 6-month period. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy. Design: Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year. Setting: Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments. Subjects: 40 patients (n = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups. Interventions: The experimental group received the MEPP program (motor imagery + manipulations + facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments. Outcome measures: Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naïve judges. Results: Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) = 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures (p = 0.008) and for quality-of-life ratings (mean (SD) score = 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP (p = 0.002)). No group difference was found for perceived speech intelligibility. Conclusion: The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy. [ABSTRACT FROM AUTHOR]

Objective: This study was to investigate the impact of breathing exercises on recovery in elderly patients receiving laparoscopic colorectal surgery. Design: A prospective randomized controlled trial. Setting: University hospital. Subject: A total of 264 elder patients undergoing laparoscopic colorectal surgery participated in this study. Intervention: Patients in intervention group received respiratory-related exercises based on standardized enhanced recovery after surgery strategies from admission to 90 days after surgery. The control group received perioperative standardized enhanced recovery after surgery strategies without formatted breathing exercises. Main measures: The primary outcome was the incidence of postoperative pulmonary complications. The secondary outcomes included 6-minute walking distance, surgery-related complications, length of stay, mortality postoperatively, and hospitalization costs. Results: Completion rate of breathing exercise in intervention group was over 80% till 90 days postoperatively. The incidence of postoperative pulmonary complications was lower in breathing exercises group (17/132 [12.9%] vs. 43/132 [32.6%], p < 0.001). The mean value of 6-minute walking distance increased more in intervention group compared with baseline values preoperatively (44.2 ± 4.3 vs. 3.2 ± 0.2, p < 0.001). On 90 days postoperatively, the mean value of 6-minute walking distance in breathing exercises group increased by 18.8 m compared with its baseline (557.0 ± 133.5 vs. 538.2 ± 112.7, p = 0.022), while that of control group decreased by 53.2 m from baseline (481.9 ± 102.5 vs. 535.1 ± 123.4, p < 0.001). Patients who received breathing exercises had shorter length of stay and lower hospitalization costs (p < 0.050). Conclusions: Perioperative breathing exercises helped prevent postoperative pulmonary complications and improve long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery. [ABSTRACT FROM AUTHOR]