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Introduction: Worldwide, the unmet rehabilitation needs of adults with musculoskeletal disorders are high. Aquatic exercise is clinically effective in managing musculoskeletal disorders, but access to rehabilitative services is limited., Objective: To determine the feasibility of a community-based aquatic exercise and peer support intervention for patients with musculoskeletal disorders delivered via a multisector partnership between an NHS physiotherapy service, a leisure operator and a social enterprise that creates personalised exercise programmes delivered through an application on a tablet computer. Cost-sharing was implemented after an initial complimentary session., Methods: A mixed method service evaluation was undertaken. Patient demographics, attendance, and patient-reported outcomes were summarised using descriptive statistics. Semi-structured interviews and an online survey were employed to explore patient acceptability of the intervention., Results: Thirty four patients accessed the intervention during the 6-month pilot. Over half were from minority ethnic groups and nearly two thirds were in the bottom three deciles relating to low income. Patients exercised in a group of up to eight, supported by NHS rehabilitation professionals and volunteers. Provision of post-session refreshments encouraged connectivity between patients. Weekly attendance at the programme was high. Patient-reported outcome measures showed favourable changes in pain intensity and function following the intervention. Qualitative data suggest that the intervention was acceptable to patients., Conclusion: Implementation of a community-based aquatic exercise and peer support intervention for people with musculoskeletal disorders via a cross-sector partnership involving the NHS appears feasible and acceptable to patients. Further research is needed to assess the impact on musculoskeletal health and health inequalities., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Musculoskeletal disorders (MSDs) impact people globally, cause occupational illness and reduce productivity. Exercise therapy is the gold standard treatment for MSDs and can be provided by physiotherapists and/or also via mobile apps. Apart from the obvious differences between physiotherapists and mobile apps regarding communication, empathy and physical touch, mobile apps potentially offer less personalized exercises. The use of artificial intelligence (AI) may overcome this issue by processing different pain parameters, comorbidities and patient-specific lifestyle factors and thereby enabling individually adapted exercise therapy. The aim of this study is to investigate the risks of AI-recommended strength, mobility and release exercises for people with MSDs, using physiotherapist risk assessment and retrospective consideration of patient feedback on risk and non-risk exercises. 80 patients with various MSDs received exercise recommendations from the AI-system. Physiotherapists rated exercises as risk or non-risk, based on patient information, e.g. pain intensity (NRS), pain quality, pain location, work type. The analysis of physiotherapists' agreement was based on the frequencies of mentioned risk, the percentage distribution and the Fleiss- or Cohens-Kappa. After completion of the exercises, the patients provided feedback for each exercise on an 11-point Likert scale., e.g. the feedback question for release exercises was "How did the stretch feel to you?" with the answer options ranging from "painful (0 points)" to "not noticeable (10 points)". The statistical analysis was carried out separately for the three types of exercises. For this, an independent t-test was performed. 20 physiotherapists assessed 80 patient examples, receiving a total of 944 exercises. In a three-way agreement of the physiotherapists, 0.08% of the exercises were judged as having a potential risk of increasing patients' pain. The evaluation showed 90.5% agreement, that exercises had no risk. Exercises that were considered by physiotherapists to be potentially risky for patients also received lower feedback ratings from patients. For the 'release' exercise type, risk exercises received lower feedback, indicating that the patient felt more pain (risk: 4.65 (1.88), non-risk: 5.56 (1.88)). The study shows that AI can recommend almost risk-free exercises for patients with MSDs, which is an effective way to create individualized exercise plans without putting patients at risk for higher pain intensity or discomfort. In addition, the study shows significant agreement between physiotherapists in the risk assessment of AI-recommended exercises and highlights the importance of considering individual patient perspectives for treatment planning. The extent to which other aspects of face-to-face physiotherapy, such as communication and education, provide additional benefits beyond the individualization of exercises compared to AI and app-based exercises should be further investigated.Trial registration: 30.12.2021 via OSF Registries, https://doi.org/10.17605/OSF.IO/YCNJQ ., (© 2024. The Author(s).)

Purpose: To synthesize common or differing perceptions of patients' and clinicians' that influence uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions., Methods: Eight databases were searched from inception to April 2023 for studies including (1) patients with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality. Perceptions of patients' and clinicians' influencing uptake of ODEPs were extracted. Quantitative and qualitative data were synthesised and integrated., Results: Twenty-one studies were included (twelve quantitative, seven qualitative, and two mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A ( n  = 7), mode B ( n  = 8), and mode C ( n  = 6). Sixteen of the 23 identified perceptions related to satisfaction, acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake and 30% hindering uptake., Conclusions: Findings highlight the need to promote targeted education for patients and clinicians addressing interconnected perceptions, and to develop evidence-based perception-centred strategies encouraging integrated care and guideline-based management of chronic MSK conditions.

Introduction: The REFORM (REhabilitation FOR Musculoskeletal conditions) trial is a non-inferiority randomised controlled trial (n=210) designed to determine whether a supported home exercise programme is as good or better than a course of face-to-face physiotherapy for the management of some musculoskeletal conditions. The trial is currently being conducted across Sydney government hospitals in Australia. This process evaluation will run alongside the REFORM trial. It combines qualitative and quantitative data to help explain the trial results and determine the feasibility of rolling out supported home exercise programmes in settings similar to the REFORM trial., Methods and Analysis: Two theoretical frameworks underpin our process evaluation methodology: the Realist framework (context, mechanism, outcomes) considers the causal assumptions as to why a supported home exercise programme may be as good or better than face-to-face physiotherapy in terms of the context, mechanisms and outcomes of the trial. The RE-AIM framework describes the Reach, Effectiveness, Adoption, Implementation and Maintenance of the intervention. These two frameworks will be broadly used to guide this process evaluation using a mixed-methods approach. For example, qualitative data will be derived from interviews with patients, healthcare professionals and stakeholders, and quantitative data will be collected to determine the cost and feasibility of providing supported home exercise programmes. These data will be analysed iteratively before the analysis of the trial results and will be triangulated with the results of the primary and secondary outcomes., Ethics and Dissemination: This trial will be conducted in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2018) and the Note for Good Clinical Practice (CPMP/ICH-135/95). Ethical approval was obtained on 17 March 2017 from the Northern Sydney Local Health District Human Research Ethics Committee (trial number: HREC/16HAWKE/431-RESP/16/287) with an amendment for the process evaluation approved on 4 February 2020. The results of the process evaluation will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences., Trial Registration Number: ACTRN12619000065190., Competing Interests: Competing interests: MLF is supported by a National Health and Medical Research Council of Australia Investigator Fellowship. JRZ is supported by a National Health and Medical Research Council of Australia Investigator Fellowship, (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To compare the efficacy of region-specific exercises to general exercises approaches for adults with spinal or peripheral musculoskeletal disorders (MSKDs)., Data Sources: Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health., Study Selection: Randomized control trials (RCTs) on the efficacy of region-specific exercises compared to general exercises approaches for adults with various MSKDs., Data Extraction: Mean differences and standardized mean differences were calculated using random-effects inverse variance modeling. Eighteen RCTs (n=1719) were included. Cohorts were composed of participants with chronic neck (n=313) or low back disorders (n=1096) and knee osteoarthritis (OA) (n=310)., Data Synthesis: Based on low-quality evidence in the short-term and very low-quality in the mid- and long-term, there were no statistically significant differences between region-specific and general exercises in terms of pain and disability reductions for adults with spinal disorders or knee OA. Secondary analyses for pain reduction in the short-term for neck or low back disorders did not report any statistically significant differences according to very low- to low-quality of evidence., Conclusions: The difference in treatment effect remains uncertain between region-specific and general exercises approaches. Based on very low- to low-quality evidence, there appear to have no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders. Future trials may change the current conclusions. More evidence is needed for region-specific exercises compared to general exercises for other peripheral MSKDs including knee OA., (Copyright © 2021. Published by Elsevier Inc.)

Objective: The purpose of this review was to compare the efficacy of motor control exercises (MCEs) to strengthening exercises for adults with upper- or lower-extremity musculoskeletal disorders (MSKDs)., Methods: Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL, and CINAHL. Randomized controlled trials were identified on the efficacy of MCEs compared to strengthening exercises for adults with upper- or lower-extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MDs) and standardized mean differences (SMDs) were calculated using random-effects inverse variance models., Results: Twenty-one randomized controlled trials (n = 1244 participants) were included. Based on moderate-quality evidence, MCEs lead to greater pain (MD = -0.41 out of 10 points; 95% CI = -0.72 to -0.10; n = 626) and disability reductions (SMD = -0.28; 95% CI = -0.43 to -0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain, or patellofemoral pain syndrome, there is moderate quality evidence that MCEs lead to greater pain (MD = -0.74 out of 10 points; 95% CI = -1.22 to -0.26; n = 293) and disability reductions (SMD = -0.40; 95% CI = -0.61 to -0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important., Conclusions: MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve OA. Inclusion of new trials might modify these conclusions., Impact: These results suggest that MCEs could be prioritized over strengthening exercises for adults with the included non-OA MSKDs; however, results are unclear for OA disorders., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Exercise adherence is important for achieving a long-term effect from musculoskeletal management. The Exercise Adherence Rating Scale (EARS), which was developed in 2017 as a patient reported outcome measure to assess exercise adherence in those with chronic low back pain in the UK, has demonstrated acceptable validity and reliability and is a robust measure of exercise adherence. This study aimed to undertake cross-cultural adaptation of the EARS into Japanese and investigate its structural validity in participants with musculoskeletal disorders., Methods: The current study was composed of two phases, where a provisional Japanese version of the EARS was developed employing an international guideline for cross-cultural adaptation (Phase A), and structural validity was then evaluated using the Rasch analysis (Phase B). Participants with musculoskeletal disorders who have individualized home exercises prescribed by a physical therapist were recruited., Results: In Phase A, the pilot testing was conducted twice because the initial testing detected some uncertainty revealed in comments from 17 participants (5 males and 12 females, 18-79 years of age) about which activities and exercises were supposed to be included. We therefore modified the draft by identifying a person who prescribed/recommended activities and exercises as per the Working Alliance Inventory. The second pilot testing using this draft recruited 30 participants (6 males and 24 females, 18-79 years of age), who provided no further comments, demonstrating the Japanese version of the EARS (EARS-J) had been successfully developed. In Phase B, data from 200 participants who completed the EARS-J (63 males and 127 females, mean ± SD of age = 53.6 ± 17.0) were analyzed using the Andrich's Rating Scale Model. Rasch statics indicated unidimensionality of the six items of the EARS-J. The Cronbach α was 0.77. Substantial ceiling effect (21.0%) was observed, with no floor effect (0.5%)., Conclusions: A Japanese version of the EARS has been developed, which demonstrated acceptable structural validity with the evidence of unidimensionality in the Rasch analysis in Japanese people with musculoskeletal disorders who were prescribed individualized home exercises. However, there was a substantial ceiling effect and further studies are required to comprehensively establish validity and reliability of the EARS-J.

Background: Low-level laser therapy as an adjunct to exercise is common in clinical practice; however, existing evidence for its recommendation is low. To determine whether low-level laser therapy provides additional benefits to exercise in patients with various shoulder musculoskeletal disorders., Material and Methods: An electronic search was conducted on seven databases, including The Cochrane Library, MEDLINE, and CINAH as well as grey literatures, for randomised controlled trials published in English from 1996 to 2018. Selected studies were independently screened and assessed for quality according to the Cochrane Grade of Recommendations, Assessment, Development and Evaluation., Results: Eleven studies met the inclusion criteria for this review. Moderate evidence indicates that low-level laser therapy provides additional short-term benefit to exercise in improving overall pain (10cm-VAS) (6 RCTs, GRADE quality moderate) (WMD: 1.75; 95% CI: 1.43 to 2.07). However, low evidence indicates that low-level laser therapy provides no additional benefit to exercise for shoulder function [5 RCTs; SWMD: -0.14; 95% CI: -0.79 to 0.25] and range of motions., Conclusions: 1. Physiotherapists may consider the use of low-laser therapy as an adjunct to exercise in the short run to improve pain in patients with shoulder musculoskeletal disorders. 2. However, low-laser therapy with exercise in the short-term is no more effective than exercise alone in improving shoulder function and range of motions.

Purpose: A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. Methods: The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Results: Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Conclusion: Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients customarily use to adhere to other activities may inform strategies to promote prescribed home exercise adherence.

Objective: The aim of the study was to evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions., Design: Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomized to the following: (a) control (home exercise prescribed by therapist's usual methods) or (b) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point Numeric Rating Scales. Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included., Results: We enrolled 305 participants, with loss to follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference Numeric Rating Scale units (95% confidence intervals): adherence overall -1.0 [-1.6 to -0.3] and regarding number of exercises in session -0.7 [-1.3 to -0.1], number of repetitions -0.8 [-1.4 to -0.2], and number of sessions -1.0 [-1.6 to -0.3]). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction., Conclusions: A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.

People with end-stage kidney disease (ESKD) receiving peritoneal dialysis (PD) are physically inactive leading to low physical function and poor health outcomes. Guidelines recommend that nephrologists encourage PD patients to increase their activity levels; however, PD patients are often discouraged from participating in exercise programs because of perceived barriers and a lack of precision about the appropriate exercise regimen. This review suggests ways forward to assist nephrology professionals to encourage PD patients to exercise, instead of creating barriers. The paper draws on the literature in addition to the experience of programs in France, the United States, and Australia to demonstrate the possibilities when considering increasing physical activity in this group., (© 2019 Wiley Periodicals, Inc.)

Theory-driven interventions are required to increase the adoption and implementation of physical activity and exercise programs among patients with ESKD. The Behavior Change Wheel (BCW) represents a synthesis of behavior change theories and can be used to aid the systematic development of theory-driven interventions designed to change exercise behavior. The goal of this review was to synthesize barriers and facilitators to engagement and implementation of exercise and develop theory-based recommendations for exercise behavior change interventions in patients with ESKD. We applied the BCW in the current context of exercise for ESKD patients and conducted an analysis of patients' and health care professionals' (HCPs) capabilities, opportunities, and motivations to engage or promote exercise, respectively. Our analysis identified a number of salient barriers that could be targeted via intervention to increase levels of physical activity and exercise. Intervention functions identified as most likely to change patient behavior included training, enablement, education, restructuring environment, persuasion, modeling, incentivizing, and coercion. Similarly, intervention functions most likely to change HCPs behavior for exercise promotion included training, modeling, education, environmental restructuring, persuasion, and incentivizing. We also considered potential over-arching policy changes required to support these interventions. Our findings provide theory-based recommendations that can help inform future clinical and research decision-making for implementing exercise interventions in these patients. However, high-quality research in this area is desperately needed to ensure that interventions not only be theory-driven, but evidence-based., (© 2019 Wiley Periodicals, Inc.)

Purpose The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes. Methods We searched Medline, Cochrane Library, Scopus, Web of Science, Academic Search Premier, Africa-Wide Information, CINAHL, OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Results Initial search located 1071 articles, of which 80 were full text reviewed. Twenty-eight articles were included, reporting on various outcomes relating to a total of seventeen studies. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n = 3), ergonomic training and workstation adjustments (n = 4), exercise and resistance training (n = 6), clinic-based versus workplace-based work hardening (n = 1), nurse case manager training (n = 1), physiotherapy versus Feldenkrais (n = 1), and ambulant myofeedback training (n = 1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusion While there is substantial evidence for workplace exercise programs, other workplace-based interventions require further high quality research. Systematic review registration PROSPERO CRD42017059708.

Objective:: To investigate the effectiveness of backward walking in the treatment of people with gait impairments related to neurological and musculoskeletal disorders., Design:: Systematic review and meta-analysis of randomized and quasi-randomized control studies., Data Sources:: Searched from the date of inception to March 2018, and included PubMed, Scopus, Cochrane Library, PEDro, CINAHL, and the MEDLINE databases., Methods:: Investigating the effects of backward walking on pain, functional disability, muscle strength, gait parameters, balance, stability, and plantar pressure in people with gait impairments. The PEDro scale was used to assess the quality. Similar outcomes were pooled by calculating the standardized mean difference., Results:: Of the 21 studies (neurological 11 and musculoskeletal 10), 635 participants were included. The average PEDro score was 5.4/10. The meta-analysis demonstrated significant standardized mean difference values in favour of backward walking, with conventional physiotherapy treatment for two to four weeks to reduce pain (-0.87) and functional disability (-1.19) and to improve quadriceps strength (1.22) in patients suffering from knee osteoarthritis. The balance and stability in cases of juvenile rheumatoid arthritis, and gait parameters and muscle strength in anterior cruciate ligament injury improved significantly when backward walking was included as an exercise. There was no significant evidence in favour of backward walking in any of the other conditions., Conclusion:: The systematic review and meta-analysis suggests that backward walking with conventional physiotherapy treatment is effective and clinically worthwhile in patients with knee osteoarthritis. Insufficient evidence was available for the remaining gait impairment conditions and no conclusions could be drawn.

Objective:: To explore the feasibility of a rehabilitation program and its effect on the performance-related musculoskeletal symptoms and functional limitations of orchestral musicians., Design:: Single-blind pilot randomized controlled trial with exercise group and control group., Setting:: Workplace of professional symphony orchestra and tertiary-level conservatory orchestral musicians., Participants:: Professional and student orchestral musicians with or without performance-related musculoskeletal disorders., Interventions:: A rehabilitation program including an educational presentation, an 11-week home exercise program and three supervised exercise sessions, versus no intervention., Measures:: Feasibility measures included adherence and drop-out rate. The Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians (MPIIQM) measured symptom intensity and functional limitations, while the Nordic Musculoskeletal Questionnaire (NMQ) measured symptom prevalence and frequency., Results:: A total of 30 participants were recruited ( n = 15 per group). Exercise group adherence was 97.7% for the supervised sessions and 89% for the home exercise program. There were no drop-outs. Significant group-time interactions were obtained for both the pain intensity (partial η 2  = 0.166; P = 0.025) and pain interference (partial η 2  = 0.186; P = 0.017) sections of the MPIIQM. Mean (standard deviation) pain intensity score changes from baseline to 11 weeks were control group: 0.40 (5.04); P = 0.763; partial η 2  = 0.007; and exercise group: -4.07 (5.31); P = 0.010; partial η 2  = 0.386. For pain interference, mean score changes were control group: 0.20 (9.10); P = 0.933; partial η 2  = 0.001; and exercise group: -9.00 (10.73); P = 0.006; partial η 2  = 0.430. NMQ analyses revealed no significant interaction ( P > 0.05)., Conclusion:: Results suggest that the studied program is feasible and effective in decreasing the intensity and functional impact of musicians' symptoms. However, no significant medium-term effect on the prevalence and frequency of symptoms was shown.

Objectives: Low self-efficacy is a barrier to rehabilitation adherence. Before an intervention can be implemented to improve self-efficacy, assessment is required. It is currently unknown if a standard measure of self-efficacy has been used to assess this in patients with musculoskeletal conditions, specifically for home exercise programmes (HEPs). The aim of the present study was to determine which self-efficacy scales are being used in conjunction with exercise adherence, identify if any scale has been developed to evaluate self-efficacy for HEPs and evaluate their psychometric properties., Methods: Data sources included CINAHL, MEDLINE, Pubmed, PsycInfo, and Sport Discus. Studies had to include patients suffering from a musculoskeletal injury, pain or disorder; a measure of rehabilitation adherence; and patient's self-efficacy. The study population, self-efficacy measurement used, study quality as identified with the Modified Downs and Black checklist, results pertaining to self-efficacy, and level of evidence were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and 29 articles were included., Results: A total of 14 scales assessing self-efficacy were identified but no scale to assess self-efficacy for HEPs was found. Many scales report internal consistency but lack test-retest reliability and validity., Conclusions: The scales identified were specific to condition or tasks, and not applicable for all musculoskeletal patient populations. It is important, both for use in the clinic and for research, that outcome measures used are reliable and valid. Unfortunately, no scale was found to assess self-efficacy for HEPs, which is problematic as self-efficacy is task specific. As HEPs are essential to rehabilitation, there should be a scale designed specifically to assess self-efficacy for this task., (© 2018 John Wiley & Sons, Ltd.)

Background: Exercise referral schemes within clinical populations may offer benefits for inactive and sedentary individuals, and improve and aid treatment of specific health disorders. This systematic review aims to provide an overview, and examine the impact, of exercise referral schemes in patients with cardiovascular, mental health, and musculoskeletal disorders. This review focuses on populations within the United Kingdom (UK) only, with an aim to inform national exercise referral policies and guidelines., Method: Data was collected from specific sources using validated methodology through PRISMA. Systematic searches were performed using Locate, PubMed, Scopus and Pro Quest: Public Health databases. Thirteen studies met inclusion criteria set for each sub group. This included that all studies aimed to prevent, observe, or decrease ill-health relating to the disorder, participants over the age of sixteen, and health disorders and outcomes were reviewed. All studies were conducted in the UK only., Results: In the 13 articles, a variety of modes and types of exercise were utilised. One-to-one supervised exercise sessions based in a gym environment were most frequently employed. Results showed that longer length schemes (20+ weeks) produced better health outcomes, and had higher adherence to physical activity prescribed, than those of shorter length (8-12 weeks). In patients referred with cardiovascular disorders, cardiovascular-related measures showed significant decreases including blood pressure. Schemes increased physical activity levels over the length of scheme for all disorders., Conclusion: Longer length schemes (20+ weeks) improved adherence to physical activity prescribed over the course of the scheme, and could support longer term exercise adherence upon completion, however additional research on larger samples should examine this further. An implication is that schemes currently recommended in guidelines do not tailor programmes to support long term adherence to exercise, which must be addressed. There is currently a lack of research examining programmes tailored to suit the individual's health conditions thus further research might allow providers to tailor delivery and build upon policy recommendations in the UK.

Introduction: Musculoskeletal disorders (MSDs) are a burden on the healthcare system. Exercise therapy is an important part of MSD rehabilitation. Motion detection systems are developed to support exercise therapy settings. This systematic review aimed: 1) at investigating which types of motion detection systems have been used as a technological support for exercise therapy; 2) at investigating the characteristics of motion detection supported exercise therapy in relation to its clinical indications; and 3) at evaluating the effectiveness of motion detection supported exercise therapy, in MSD rehabilitation., Evidence Aqcuisition: A systematic literature search for RCTs was performed in six databases (PubMed, CINAHL, EMBASE, ACM, Cochrane, and IEEE). Studies eligible for inclusion had to evaluate exercise therapy for persons with MSDs, provide a motion detection system capable of as well measuring active movement of the participant during exercise therapy as evaluating the movement in order to provide qualitative feedback, and should present at least one measure of the following ICF function (pain, muscle strength, mobility), activity (disease-related functional disability, balance) or participation (quality of life) level. Two reviewers independently screened articles, appraised study quality, extracted data, and evaluated effectiveness of selected outcome measures. This review was registered in the International prospective register of systematic reviews (Prospero) under registration number CRD42016035273., Evidence Synthesis: Nine RCTs (N.=432 participants) were included. Eight different motion detection technologies were used such as an accelerometer, gyroscope, magnetometer etc. All systems provided visual feedback. Knee disorders were evaluated most frequently, followed by low back pain and shoulder disorders. Therapy consisted of mobility, balance or proprioception exercises. Main outcomes were pain, disability, mobility and muscle strength. Motion detection supported exercise therapy showed similar or enhanced results on all outcomes compared to conventional exercise therapy. However, a limitation of this study was the low methodological quality of the studies., Conclusions: To date, a variety of motion detection systems have been developed to support the rehabilitation of MSDs. Results show similar effectiveness of motion detection supported exercise therapy compared to conventional exercise therapy. More research is needed to provide insight in the added value of motion detection systems in musculoskeletal rehabilitation.

Objective: To evaluate the effectiveness of exercise, ergonomic modification, and a combination of training exercise and ergonomic modification on the scores of pain in office workers with neck, shoulders, and lower back pain., Methods: Participants (N=142) in this randomized controlled trial were office workers aged 20-50 years old with neck, shoulders, and lower back pain. They were randomly assigned to either the ergonomic modification group, the exercise group, the combined exercise and ergonomic modification group, or the control group (no-treatment). The exercise training group performed a series of stretching exercises, while the ergonomic group received some modification in the working place. Outcome measures were assessed by the Cornell Musculoskeletal Disorders Questionnaire at baseline, after 2, 4, and 6 months of intervention., Results: There was significant differences in pain scores for neck (MD -10.55; 95%CI -14.36 to -6.74), right shoulder (MD -12.17; 95%CI -16.87 to -7.47), left shoulder (MD -11.1; 95%CI -15.1 to -7.09) and lower back (MD -7.8; 95%CI -11.08 to -4.53) between the exercise and control groups. Also, significant differences were seen in pain scores for neck (MD -9.99; 95%CI -13.63 to -6.36), right shoulder (MD -11.12; 95%CI -15.59 to -6.65), left shoulder (MD -10.67; 95%CI -14.49 to -6.85) and lower back (MD -6.87; 95%CI -10 to -3.74) between the combined exercise and ergonomic modification and control groups. The significant improvement from month 4 to 6, was only seen in exercise group (p<0.05)., Conclusion: To have a long term effective on MSDs, physical therapists and occupational therapists should use stretching exercises in their treatment programs rather than solely rely on ergonomic modification., Clinical Trial Id: NCT02874950 - https://www.clinicaltrials.gov/ct2/show/NCT02874950., (Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Aim of This Study: This study describes the quantitative importance of exercise therapy in German medical rehabilitation based on 2014 routine data of the German Pension Insurance. It also shows changes in comparison with data from 2007., Methods: Data from 710012 rehabilitation discharge letters comprising 83677802 treatments from central indications in medical rehabilitation were analysed descriptively., Results: Overall 35.4% of treatments could be classified as exercise therapy. Total and relative duration, percentage of individual treatment and kind of exercise treatment varied between indications in 2007 as well as in 2014. There were also differences between sexes, age groups and settings., Conclusion: During the period examined the high importance of exercise therapy in German medical rehabilitation has increased. The results point at a meaningful concept behind the composition of exercise therapy taking indications and disease related factors into account., Competing Interests: Die Autorinnen sind Mitarbeiterinnen der Deutschen Rentenversicherung Bund. Es liegen keine Interessenkonflikte vor., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Physical activity (PA) decreases during hospitalization. In particular, the amount of PA engaged in by older people who are hospitalized following musculoskeletal injury is likely to be limited for months after discharge home. Given the importance of an active lifestyle for their recovery and the prevention of future adverse outcomes, there is clearly a need for interventions to increase PA. This article describes the protocol of a randomized controlled trial set up to investigate the effects of a physical activity oriented home rehabilitation program (ProPA) on PA and the restoration of mobility in community-dwelling older people., Methods: Men and women aged 60 years or older hospitalized due to a musculoskeletal injury or disorder in the back or lower limbs are recruited. After discharge from hospital to home, participants are randomized into a six-month ProPA program or a standard care (control) group. The ProPA program consists of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program and physical activity counseling. In addition, frail participants who are not able to go outdoors alone receive support from volunteers. Primary outcomes are PA measured using a 3-dimentional accelerometer, and mobility assessed by the Short Physical Performance Battery and self-reports. Secondary outcomes are life space mobility, participation restriction, fear of falling, pain, mood, and grip strength. Information on barriers to and enablers of PA participation are also collected. Data on mortality and use of health services are collected from the national register. In this 6-month intervention, all participants are assessed in their homes at baseline and after three and six months, and at 12 months after randomization they will receive a follow-up questionnaire., Discussion: This study investigates the effects of a rehabilitation program on PA and mobility among older people at risk for increased sedentary time and mobility problems. If positive effects are observed, the program can be considered for incorporation into the health care system and thereby contribute to the rehabilitation of older people who have recently been discharged from hospital., Trial Registration: ISRCTN13461584 . Registered 27 January 2016.

The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks. Implications for Rehabilitation There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand. Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks.

Question: Do people with musculoskeletal conditions better adhere to their home exercise programs when these are provided to them on an app with remote support compared to paper handouts?, Design: Randomised, parallel-group trial with intention-to-treat analysis., Participants: Eighty participants with upper or lower limb musculoskeletal conditions were recruited to the trial. Each participant was prescribed a 4-week home exercise program by a physiotherapist at a tertiary teaching hospital in Australia. Participants were randomly assigned via a computer-generated concealed block randomisation procedure to either intervention (n=40) or control (n=40) groups., Intervention: Participants in the intervention group received their home exercise programs on an app linked to the freely available website www.physiotherapyexercises.com. They also received supplementary phone calls and motivational text messages. Participants in the control group received their home exercise programs as a paper handout., Outcome Measures: Blinded assessors collected outcome measures at baseline and 4 weeks. The primary outcome was self-reported exercise adherence. There were five secondary outcomes, which captured functional performance, disability, patient satisfaction, perceptions of treatment effectiveness, and different aspects of adherence., Results: Outcomes were available on 77 participants. The mean between-group difference for self-reported exercise adherence at 4 weeks was 1.3/11 points (95% CI 0.2 to 2.3), favouring the intervention group. The mean between-group difference for function was 0.9/11 points (95% CI 0.1 to 1.7) on the Patient-Specific Functional Scale, also favouring the intervention group. There were no significant between-group differences for the remaining outcomes., Conclusion: People with musculoskeletal conditions adhere better to their home exercise programs when the programs are provided on an app with remote support compared to paper handouts; however, the clinical importance of this added adherence is unclear., Trial Registration: ACTRN12616000066482. [Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, Pratt CA, Tatum HJ, Bowden JL, Lucas BR (2017) An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy 63: 161-167]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

The aim of the present study was to determine whether the application of isometric horizontal abduction (IHA) differentially affected two weight-bearing push-up plus exercises by examining activation of the scapulothoracic muscles in subjects with scapular winging. Fifteen male subjects performed standard push-up plus (SPP) and wall push-up plus (WPP), with and without IHA. Two-way analyses of variance using two within-subject factors were used to determine the statistical significance of observed differences in upper trapezius (UT), pectoralis major (PM), and serratus anterior (SA) muscle activities and UT/SA and PM/SA muscle activity ratios. UT and SA muscle activities were greater during SPP than WPP. PM muscle activity was lower with IHA application. The UT/SA and PM/SA muscle activity ratios were lower during SPP than WPP. The PM/SA muscle activity ratio was lower with IHA application. The results suggest that IHA application using a Thera-Band can effectively reduce PM muscle activity during SPP and WPP exercises. Moreover, the SPP exercise can be used to increase UT and SA muscle activity and reduce the UT/SA and PM/SA muscle activity ratios in subjects with scapular winging., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background and Objective: Low-load exercise training with blood flow restriction (BFR) can increase muscle strength and may offer an effective clinical musculoskeletal (MSK) rehabilitation tool. The aim of this review was to systematically analyse the evidence regarding the effectiveness of this novel training modality in clinical MSK rehabilitation., Design: This is a systematic review and meta-analysis of peer-reviewed literature examining BFR training in clinical MSK rehabilitation (Research Registry; researchregistry91)., Data Sources: A literature search was conducted across SPORTDiscus (EBSCO), PubMed and Science Direct databases, including the reference lists of relevant papers. Two independent reviewers extracted study characteristics and MSK and functional outcome measures. Study quality and reporting was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise., Eligibility: Search results were limited to exercise training studies investigating BFR training in clinical MSK rehabilitation, published in a scientific peer-reviewed journal in English., Results: Twenty studies were eligible, including ACL reconstruction (n=3), knee osteoarthritis (n=3), older adults at risk of sarcopenia (n=13) and patients with sporadic inclusion body myositis (n=1). Analysis of pooled data indicated low-load BFR training had a moderate effect on increasing strength (Hedges' g=0.523, 95% CI 0.263 to 0.784, p<0.001), but was less effective than heavy-load training (Hedges' g=0.674, 95% CI 0.296 to 1.052, p<0.001)., Conclusion: Compared with low-load training, low-load BFR training is more effective, tolerable and therefore a potential clinical rehabilitation tool. There is a need for the development of an individualised approach to training prescription to minimise patient risk and increase effectiveness., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To recommend robust and relevant measures of exercise adherence for application in the musculoskeletal field., Method: A systematic review of measures was conducted in two phases. Phase 1 sought to identify all reproducible measures used to assess exercise adherence in a musculoskeletal setting. Phase 2 identified published evidence of measurement and practical properties of identified measures. Eight databases were searched (from inception to February 2016). Study quality was assessed against the Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. Measurement quality was assessed against accepted standards., Results: Phase 1: from 8511 records, 326 full-text articles were reviewed; 45 reproducible measures were identified. Phase 2: from 2977 records, 110 full-text articles were assessed for eligibility; 10 articles provided evidence of measurement/practical properties for just seven measures. Six were exercise adherence-specific measures; one was specific to physical activity but applied as a measure of exercise adherence. Evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development or evaluation of any measure., Conclusion: The significant methodological and quality issues encountered prevent the clear recommendation of any measure; future applications should be undertaken cautiously until greater clarity of the conceptual underpinning of each measure is provided and acceptable evidence of essential measurement properties is established. Future research should seek to engage collaboratively with relevant stakeholders to ensure that exercise adherence assessment is high quality, relevant and acceptable., (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: Musculoskeletal pain is common and its treatment costly. Both group and individual physiotherapy interventions which incorporate exercise aim to reduce pain and disability. Do the additional time and costs of individual physiotherapy result in superior outcomes?, Objective: To compare the effectiveness of group and individual physiotherapy including exercise on musculoskeletal pain and disability., Methods: Eleven electronic databases were searched by two independent reviewers. Randomised controlled trials (RCTs) including participants with musculoskeletal conditions which compared group and individual physiotherapy interventions that incorporated exercise were eligible. Study quality was assessed using the PEDro scale by two independent reviewers, and treatment effects were compared by meta-analyses., Results: Fourteen RCTs were eligible, including patients with low back pain (7 studies), neck pain (4), knee pain (2) and shoulder pain (1). We found no clinically significant differences in pain and disability between group and individual physiotherapy involving exercise., Conclusions: Only small, clinically irrelevant differences in pain or disability outcomes were found between group and individual physiotherapy incorporating exercise. Since all but one study included other interventions together with exercise in either the group or individual arm, deciphering the unique effect of the way in which exercise is delivered is difficult. Group interventions may need to be considered more often, given their similar effectiveness and potentially lower healthcare costs., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise., (© 2015 The Authors. Scandinavian Journal of Medicine & Science in Sports published by John Wiley & Sons Ltd.)

Objective: The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand., Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology., Results: We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits., Conclusion: The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration., (Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate any change in self-reported level of physical activity in patients receiving a general physical exercise programme in addition to disease-specific physiotherapy treatment., Design: Pre-post-intervention study., Setting: Outpatient physiotherapy clinics., Participants: One hundred and ninety patients with long-term musculoskeletal conditions attending outpatient physiotherapy were recruited from seven physiotherapy clinics., Interventions: Physiotherapy including disease-specific modalities and a general individually tailored exercise programme. Patients were evaluated at baseline and at the end of the programme., Main Outcome Measures: International Physical Activity Questionnaire short form (IPAQ-sf) and COOP WONCA functional assessment charts., Results: Forty-two patients were excluded from the analysis because they did not complete the IPAQ-sf correctly or dropped out during the treatment period. There was a significant increase in the number of metabolic equivalent task (MET)-min/week for vigorous and moderate-intensity activities, walking and total physical activity. The number of exercise sessions per week increased from 1.8 [standard deviation (SD) 0.9] to 2.2 (SD 1.2) (P=0.001). The proportion of patients with a low level of physical activity decreased by 12%, and the proportion of the participants who did not/could not exercise decreased from 26% to 8%. The COOP WONCA charts showed significant improvements in the physical fitness, feelings, daily activities and social activities items., Conclusion: A significant increase was found in the number of MET-min/week for all activity levels. Therefore, a general physical exercise programme initiated by a physiotherapist led to a positive change in level of physical activity., (Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Objective: To identify patient characteristics that influence physiotherapist's decisions on enrollment and attendance in a structured aerobic exercise program early after stroke., Design: Retrospective chart review., Setting: Rehabilitation hospital., Participants: Consecutive sample of people (N=345) admitted to inpatient stroke rehabilitation over a 2-year period., Interventions: Not applicable., Main Outcome Measures: Patient demographic characteristics, preexisting medical conditions, and poststroke outcome variables (neurological deficit, physical impairment, balance control, and functional mobility and independence) were compared between individuals enrolled and not enrolled in a structured aerobic exercise program. The rate of attendance was calculated for the enrolled group., Results: One hundred twenty-nine patients (38%) were enrolled in the structured aerobic exercise program. Patients who were older (P=.0093) and had cardiac disease (P=.012), cardioembolic sources (P=.0094), and arthritis (P=.031) were less likely to be enrolled in the structured aerobic exercise program. Poststroke outcome variables were not associated with enrollment. Among those enrolled, the rate of attendance was positively correlated with the FIM cognitive rating (r=.27; P=.0031)., Conclusions: Enrollment in structured aerobic exercise programs during inpatient stroke rehabilitation can be limited by safety concerns related to patients' cardiovascular and musculoskeletal status. Barriers associated with the perception of cardiovascular risk factors should be confronted because they do not preclude participation in cardiac rehabilitation. In addition, poststroke deficits do not limit participation in adapted aerobic exercise early after stroke. It is likely that the characteristics of the structured aerobic exercise program were integral to accommodate the breadth of poststroke deficits encountered in this study. Future research investigating physiotherapist and practice environment factors that influence the decision to prescribe and implement aerobic exercise is warranted., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Low-level laser therapy is one of the adjunct treatments of choice with exercise therapy for shoulder rehabilitation in physiotherapy clinical practices. Although previous reviews have found little use of low-level laser therapy, there are recent trials whose findings are yet to be systematically reviewed., Methods: We plan to do a systematic review to assess the effects of low-level laser therapy with exercise and exercise alone in participants who are 18 years and above, with a clinical or radiological diagnosis of various shoulder pathologies. We will search CENTRAL, MEDLINE, CINAHL, PEDro, Science Direct, Scopus and Physiotherapy Choices regardless of publication status. We will hand search for subject-specific journals (PhotoMedicine and Laser Surgery, Lasers in Surgery and Medicine and Journals of Lasers in Medical Science) and conference proceedings of World Association for Laser Therapy. Two review authors will independently screen, select studies, extract data and assess the risk of bias based on a priori criteria. Disagreements between review authors will be resolved either through discussion or consultation with a third review author. If there are at least two clinically homogeneous studies, we will perform meta-analysis., Discussion: The findings will shed more light on the benefit of low-level laser therapy as an adjunct treatment to exercise in the management of shoulder disorders. The findings may also inform decision makers in the review and development of guidelines for shoulder rehabilitation in physiotherapy practices., Systematic Review Registration: PROSPERO CRD42014013691.

The objectives of this study were to determine the effectiveness of a programme of prevention exercises conducted in a corporate environment in poultry industry slaughterers suffering from musculoskeletal disorders. Forty workers, 70% female (mean ± SD age: 44.4 ± 8.4 years) were consecutively, in an alternative way, assigned to one of two groups receiving either set of 10 sessions (experimental or control group). The experimental group followed an exercise programme for a period of five weeks and a protocol of home exercises. The control group performed the exercise protocol only at home. The Roland Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI) to measure disability, the Visual Analogue Scale (VAS) score and the Pain Drawing to measure pain were used as outcome evaluations. A significant effect of time interaction (all P <0.001 and; F = 40.673; F = 33.907 and F = 25.447) existed for lumbar VAS, RMDQ and ODI immediately after the intervention (all P < 0.006). No significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. This study shows that a programme of prevention exercises may have a positive effect in improving musculoskeletal disorders of slaughterhouse workers. Pain decreased in the lumbar region, and there was an almost significant reduction in disability., (Copyright © 2014 John Wiley & Sons, Ltd.)

Work-related musculoskeletal disorders (WRMDs) are a leading cause of work-related disability and loss of productivity in the developed countries; these disorders may concur with the indirect costs of an illness or injury included losses of potential output. Literature on workplace physical activity program provided a mixed but positive impact on health and important worksite outcomes. Therefore, programs of physical activity organized and performed in the workplace could reveal as essential tool to reduce musculoskeletal symptoms. This investigation aimed to assess the effectiveness of a tailored physical activity program, performed in a work-environment, to reduce the symptoms in upper extremities and neck with the novelty in personalizing the approach applied to the exercise protocol, basing on pain and disability levels, to reduce the onset and symptoms in upper extremity and neck WRMDs increasing upper-limb strength and flexibility. 68 metalworkers were recruited, 34 were randomly allocated to an intervention group (IG), while the other 34 to a control group. Primary outcomes concerned pain symptoms measured with visual analog scales while disability was measured by DASH (Disability of the Arm, Shoulder and Hand), and NPDS-I (Neck Pain and Disability Scale) questionnaires. Grip strength, upper-limb mobility, neck and shoulder range of motion were also assessed. After the 9-month intervention, IG reduced pain symptoms on neck, shoulders, elbows and on wrists. Grip strength and upper-limb mobility improved as well as scores on questionnaires. This protocol suggests that performing a tailored physical activity program is beneficial to reduce pain and disability on upper-limb WRMDs., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the effect of a purpose-designed exercise program on performance-related musculoskeletal disorders (PRMDs) and associated risk factors in a sample of professional orchestral musicians., Methods: A 10-week exercise program was made available to full-time musicians employed by the eight premier symphony orchestras of Australia. Questionnaires were administered before, immediately after (T1), and 6 months after interventions (T2) containing questions relating to change in frequency and severity of PRMDs, ratings of perceived exertion (RPE) during rehearsal, private practice, and performance, as well as nine performance-related factors. Participants were also asked to rate whether these performance-related factors affected their overall playing capacity during different playing situations. A comparative control group of musicians had no intervention and completed a modified questionnaire at the same time points., Results: Exercise participants (n=30) reported a reduction in frequency (p<0.05) and severity (p<0.05) of PRMDs at T1 but not at T2 compared to controls (n=23). The exercise group reported a significant improvement in RPE during private practice at T1 (p<0.01) and T2 (p<0.01), but not during rehearsal and performance. At T1, the intervention was rated to be moderately to highly effective for three performance-related factors: strengthening muscles that support playing, learning techniques that support playing, and posture. Further, participants reported an intervention effect on overall playing capacity during rehearsal at T1 and T2., Conclusions: A tailored exercise program for musicians was effective at managing PRMDs, especially in reducing the frequency and severity of PRMDs. Physical therapy exercises should be considered in modifying performance-related factors that have been reported to be predictors of PRMDs.

Objective: To investigate the effectiveness of aquatic exercise in the management of musculoskeletal conditions., Data Sources: A systematic review was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and The Cochrane Central Register of Controlled Trials from earliest record to May 2013., Study Selection: We searched for randomized controlled trials (RCTs) and quasi-RCTs evaluating aquatic exercise for adults with musculoskeletal conditions compared with no exercise or land-based exercise. Outcomes of interest were pain, physical function, and quality of life. The electronic search identified 1199 potential studies. Of these, 1136 studies were excluded based on title and abstract. A further 36 studies were excluded after full text review, and the remaining 26 studies were included in this review., Data Extraction: Two reviewers independently extracted demographic data and intervention characteristics from included trials. Outcome data, including mean scores and SDs, were also extracted., Data Synthesis: The Physiotherapy Evidence Database (PEDro) Scale identified 20 studies with high methodologic quality (PEDro score ≥6). Compared with no exercise, aquatic exercise achieved moderate improvements in pain (standardized mean difference [SMD]=-.37; 95% confidence interval [CI], -.56 to -.18), physical function (SMD=.32; 95% CI, .13-.51), and quality of life (SMD=.39; 95% CI, .06-.73). No significant differences were observed between the effects of aquatic and land-based exercise on pain (SMD=-.11; 95% CI, -.27 to .04), physical function (SMD=-.03; 95% CI, -.19 to .12), or quality of life (SMD=-.10; 95% CI, -.29 to .09)., Conclusions: The evidence suggests that aquatic exercise has moderate beneficial effects on pain, physical function, and quality of life in adults with musculoskeletal conditions. These benefits appear comparable across conditions and with those achieved with land-based exercise. Further research is needed to understand the characteristics of aquatic exercise programs that provide the most benefit., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Knee injuries often occur in pivoting activities but most existing training and rehabilitation devices mainly involve sagittal movements. A pivoting elliptical training system (PETS) was developed to train and evaluate neuromuscular control in pivoting for the purposes of prevention and rehabilitation of musculoskeletal injuries. The PETS have capabilities of controlling two footplates individually or simultaneously through servomotor control so that the footplates behave like two torsional springs with adjustable offset and stiffness, slippery surface, or under external perturbations. Feasibility of the PETS in improving pivoting neuromuscular control and pivoting neuromechanical properties was demonstrated through experiments on healthy subjects, with reduced pivoting instability and reaction time, and improved proprioceptive acuity following training. The PETS can potentially be used as a therapeutic and research tool to investigate mechanisms underlying pivoting-related injuries and train human subjects for improving neuromuscular control during risky pivoting activities.

Land-based exercise is often difficult for people with chronic obstructive pulmonary disease (COPD) who have coexisting obesity or musculoskeletal or neurological conditions. This randomised controlled trial aimed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to land-based exercise training and control (no exercise) in people with COPD and physical comorbidities. Participants referred to pulmonary rehabilitation were randomly allocated to a water-based exercise, land-based exercise or the control group. The two exercise groups trained for 8 weeks, completing three sessions per week. 45 out of 53 participants (mean ± SD age 72 ± 9 years; forced expiratory volume in 1 s 59 ± 15% predicted) completed the study. Compared to controls, water-based exercise training significantly increased 6-min walking distance, incremental and endurance shuttle walk distances, and improved Chronic Respiratory Disease Questionnaire (CRDQ) dyspnoea and fatigue. Compared to land-based exercise training, water-based exercise training significantly increased incremental shuttle walk distance (mean difference 39 m, 95% CI 5-72 m), endurance shuttle walk distance (mean difference 228 m, 95% CI 19-438 m) and improved CRDQ fatigue. Water-based exercise training was significantly more effective than land-based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical comorbidities.

Background: In Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model., Methods: 120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen's kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care., Results: The majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly more education and prescribed more NSAIDs, joint injections, exercises and supervised physiotherapy (p<0.05). Patient satisfaction was significantly higher for APP care than for the surgeons care (p<0.05)., Conclusion: The diagnoses and triage recommendations for patients with hip and knee disorders made by the APP were similar to the orthopaedic surgeons. These results provide evidence supporting the APP model for orthopaedic care.

Proprioception, or kinesthesia, is the sense of orientation responsible for perception of body and relative position of its parts. Kinaesthesia is received by receptors located in muscles and tendons. In this study a set of proprioception developing exercises was presented. Proprioception should be restored in case of musculoskeletal and neurological disorders. Proprioception training can also be used as a prophylaxis before starting various sporting activities. Proprioception developing exercises have significant meaning for the elderly, who are at risk of balance disorders. These exercises help developing motor memory and at the same time protect from falls.

Recently, clinicians have focused much attention on the importance of hip strength for the rehabilitation of not only patients with low back pain but also lower extremity pathology. Properly designing a rehabilitation program for the gluteal muscles requires careful consideration of biomechanical principles, such as length of the external moment arm, gravity, and subject positioning. Understanding the anatomy and function of these muscles also is essential. Electromyography (EMG) provides a useful means to determine muscle activation levels during specific exercises. Descriptions of specific exercises, as they relate to the gluteal muscles, are described. The specific performance of these exercises, the reliability of such EMG measures, and descriptive figures are also detailed. Of utmost importance to practicing clinicians is the interpretation of such data and how it can be best used in exercise prescription when formulating a treatment plan.

Background: Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers., Methods: Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9)., Results: 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group--for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders., Conclusion: High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain., Trial Registration: NCT01071980.

During the past decade, our understanding of biomechanics and its importance in rehabilitation has advanced significantly. The kinetic chain, a concept borrowed from engineering, has helped us better understand the underlying physiology of human movement. This understanding, in turn, has facilitated the development of new and more rational rehabilitation strategies. The kinetic chain concept has application in a wide spectrum of clinical conditions, including musculoskeletal medicine, sports medicine, and neurorehabilitation, as well as prosthetics and orthotics. The purpose of this review is to provide insights into the biomechanics related to the concept of kinetic chains, with a specific focus on closed kinetic chains and its clinical applications in rehabilitation., (Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Exercise-based therapies are the cornerstone of rehabilitation programs. While the benefits of exercise on systemic and tissue function are generally accepted, mechanisms underlying these benefits are sometimes poorly understood. An improved understanding of the effects of mechanical loading on molecular and cellular processes has the potential to lead to more disease-specific and efficacious exercise-based therapies. The purpose of this paper is to review the current literature examining the role of mechanical signaling on muscle and cartilage biology., (Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Objective: To review the literature regarding the effects of exercise in patients with musculoskeletal pain on modifying: (1) the plasma or cerebral spinal fluid concentrations of pain-relieving peptides and (2) changing the cerebral activity of areas linked with pain processing and modulation systematically., Methods: An extensive search of bibliographic databases including MEDLINE, EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, PeDro, AMED, and CINAHL was made. Two independent investigators screened the titles of publications and completed quality assessment of the selected studies., Results: The search of the literature resulted in a total of 1819 published studies. Of these only 1 study of low methodological quality was considered to be relevant. The agreement between reviewers to select the articles was κ=1. The agreement for the methodological quality evaluation was κ=0.9., Discussion: Given the small number of studies identified and the low quality of research, no firm conclusions could be reached about the impact of therapeutic exercise on modifying concentrations of pain-relieving peptides or its effect on changing the cerebral activity of areas linked with pain processing in patients with musculoskeletal pain. There is a clear need for well-designed trials examining exercise therapy interventions and their effect on both pain-relieving peptides and cerebral activity in patients with musculoskeletal pain.

The aims of this randomized, single-blind crossover trial were to investigate the effect of adding a simulated bowling video game via the Nintendo Wii(®) gaming system to the standard exercise regimen of cognitively intact residents of long-term care (LTC) with upper extremity dysfunction and to identify individual characteristics that might predict improvement. Residents (n=34) were recruited through two LTC facilities in southwestern Ontario and were randomized into a standard exercise (SG) or standard exercise plus Wii bowling (Wii) arm. After 4 weeks of intervention, the groups were crossed over to the opposite arm. Outcomes included measures of pain intensity and bothersomeness, physical activity enjoyment, and a six-item measure of functional capacity designed specifically for residents of LTC. Results suggest that subjects improved on all outcomes from pre- to postintervention but that only enjoyment of activity showed a significant difference between the SG and Wii groups. Effect sizes (Cohen's d) ranged from small (0.30 for bothersomeness) to large (1.77 for functional capacity). Responders, defined as those subjects who reported any degree of improvement following the Wii intervention, were less likely to complain of stiffness or shoulder symptoms and were more likely to complain of hand symptoms than non-responders. Limitations in interpretation and recommendations for future research are presented.

Purpose: To summarize and discuss current evidence and understanding of clinical pediatric exercise physiology focusing on the work the research group at Utrecht and others have performed in the last decade in a variety of chronic childhood conditions as a continuation of the legacy of Dr Bar-Or., Key Points: The report discusses current research findings on the cardiopulmonary exercise performance of children (and adolescents) with juvenile idiopathic arthritis, osteogenesis imperfecta, achondroplasia, hemophilia, cerebral palsy, spina bifida, cystic fibrosis, and childhood cancer. Exercise recommendations and contraindications are provided for each condition. Implications for clinical practice and future research in this area are discussed for each of the chronic conditions presented., Clinical Implications: The authors provide a basic framework for developing an individual and/or disease-specific training program, introduce the physical activity pyramid, and recommend a core set of clinical measures to be used in clinical research.

Background: Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach., Methods/design: A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius.An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week.The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination. Secondary outcomes are strength and work disability., Trial Registration: ClinicalTrials (NCT): NCT01205542.