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PURPOSE: A remotely delivered cognitive behavioral coaching (CBC) program was offered as a service benefit for commercial health plan members with low back pain (LBP). This study describes changes in self-rated functional disability in a sample of plan members participating in the program (N=423). METHODS: Independent measures included demographics, length of program enrollment, total CBC sessions, and baseline self-reported patient activation and presenteeism levels. Participants rated their functional disability level due to LBP using the Oswestry Disability Index (ODI). Dependent outcomes quantified change in participant functional disability rating (final ODI score minus baseline ODI score). Nonparametric tests compare differences between groups and within-group ODI score change. Two generalized linear models test for associations between independent variables and the ODI change score. RESULTS: A significant difference between baseline and final ODI scores was observed at the overall program level (p

Introduction Venous leg ulcer (VLU) is a therapeutic challenge. The mainstay of care is compression therapy and wound care. Exercise is also recommended for facilitating wound healing. This study aimed to determine whether adding tailored exercise training to conventional treatment would be superior on wound healing, ankle mobility, calf muscle function, and functional ability compared to those with the conventional treatment alone. Methods A randomized controlled trial, single-blinded was conducted. VLU patients were randomized to the conventional treatment plus tailored exercise training (intervention group) and the conventional treatment alone (control group) (12/group). The conventional treatment contained foam dressing and short-stretch bandage, while the tailored exercise training consisted of stretching, resistive, and aerobic exercise sessions (3-day/week, for 12-week). Primary outcomes included healing rate and wound size parameters. Secondary outcomes were ankle range of motion (ROM), calf circumference, calf muscle endurance and strength, and functional ability. All outcomes were assessed at baseline, 6-, and 12-week intervention. Results The intervention group had a higher trend of healing rate after 12-week training than those in the control group, but this trend was not significantly different (92% versus 58%, p = 0.06). After training, the intervention group had significantly decreased wound size. The intervention group had significantly higher ankle ROM and dorsiflexor muscle strength after 6- and 12-week training than those in the control group. Conclusion Adding the tailored exercise training incorporated with the conventional treatment may provide a greater tendency on wound healing and have the potential to improve ankle mobility than the conventional treatment alone. Trial registration number TCTR20170405002.

Topic Significance & Study Purpose/Background/Rationale High dose chemotherapy followed by hematopoietic cell transplantation (HCT) is an intensive cancer treatment associated with devastating complications. Persistent physical inactivity after HCT is sufficient to cause muscle mass loss, decreased strength, physical deconditioning, and potential progression to disability. Sustainable physical activity incorporated into activities of daily living may break this negative cycle. This pilot, randomized controlled trial tested the feasibility and preliminary effects of a free-living physical activity intervention (STEPS) compared to usual care on fatigue (primary outcome), functional ability, muscle strength, physical activity, and quality of life (secondary outcomes) in people with multiple myeloma treated with autologous HCT. Methods, Intervention, & Analysis This study used a two-group, randomized block, repeated measures design (n = 32). The six-week STEPS intervention aimed to increase physical activity by 10% weekly through education, goal-setting, daily step tracking using wearable technology, and guided integration of physical activity into daily routines. Data were collected using self-report questionnaires, physical performance tests, and wrist actigraphy prior to HCT and seven weeks following hospital discharge. Split-plot 2 × 2 ANOVAs were used to analyze the preliminary group (STEPS versus usual care), time (prior to HCT versus seven weeks after hospital discharge), and group x time interactions effects. Findings & Interpretation The STEPS group achieved their daily physical activity goal 53% of the time. Compared to usual care, the STEPS group experienced greater appetite loss (p = .05), more diarrhea (p = .05), and slept more (p = .03). Both groups reported improvements in mental fatigue (p = .02), emotional functioning (p = .01), pain (p = .009), sleep disturbance (p = .001), anger (p = .003), anxiety (p = .001), and depression (p = .02) seven weeks after HCT discharge compared to baseline. Conversely, both groups climbed the stairs slower (p = .003) and had weaker hand-grips (p Discussion & Implications The STEPS intervention is feasible for people with multiple myeloma treated with HCT. Although preliminary, differential improvement in the STEPS group's patient outcomes did not occur (no significant group x time interactions). Both groups reported improved symptoms and experienced some declines in physical function seven weeks after HCT hospital discharge.

Background Total knee arthroplasty (TKA) is commonly performed to reduce knee pain and improve physical function. Compared with the values for healthy, age-matched women, previous studies have reported large deficits in functional ability, such as muscle strength and ambulatory ability, in women 1 year post-TKA. Ambulatory ability is to move around, particularly by walking and is clinically assessed by the timed up and go test (TUG). Aim This study aimed to clarify the characteristics of knee functions in female patients whose ambulatory ability recovered to a normal level at 1 year after TKA. Methods This cross-sectional study included 151 female patients who underwent TKA. The muscle strength of the lower extremity was measured, and the 2011 Knee Society Scoring (2011 KSS) system was used postoperatively. The TUG was conducted to assess ambulatory ability after TKA; then the patients were classified into the fast and slow ambulation groups based on previously reported gait-speed values of healthy female individuals. Then, we identified significant indicators of ambulatory ability at 1 year after TKA. Results Forty-nine percent of patients after TKA achieved the level of ambulatory ability of a healthy female. Logistic regression analysis identified that the non-operative side knee extensor strength and the functional activity score, as assessed by the 2011 KSS, were variables significantly associated with the mid-term ambulatory ability after TKA. Conclusion Female patients with high non-operative knee extensor strength and a functional activity score at 1 year postoperatively can achieve better ambulatory ability than those of healthy, age-matched females.

Carpal Tunnel Syndrome (CTS) is a medianus nerve clamp due to entrapment neuropathy when going through the carpal tunnel in the wrist precisely under the flexor retinaculum. The goal of this study is to find out the effectiveness of wrist stretching, tendon and nerve gliding exercise in reducing pain and improving functional wrist in people with Carpal Tunnel Syndrome. To find out the effectiveness of wrist stretching, tendon and nerve in reducing pain and improving functional wrist in cases of Carpal Tunnel Syndrome. A 58-year-old woman with a job before the doughnut seller pandemic. Patients complain of pain in the wrist spreading and feel tingling / numbness in the fingers 1-3, the fingers feel stiff and difficult to shake. Patients therapy for 2x / week in 3 weeks, one patient therapy followed for 20-30 minutes. Patients are given therapy in the form of wrist stretching, tendon and nerve gliding exercise. Pain was measured using numeric rating scale (NRS) and Boston Carpal Tunnel Questionair (BCTQ) for the severity of CTS. After therapy was given the result of a decrease in press pain and motion pain by 1 point, and there was a slight improvement in the functional ability of the wrist measured using BCTQ. The provision of therapy in the form of wrist stretching, tendon and nerve gliding exercise can reduce pain and improve the functional ability of the wrist.

Introduction Continuous passive motion (CPM) is a frequently used method in the early post-operative rehabilitation of patients after knee surgery. In this study, the effectiveness of the CPM method was evaluated after primary total knee arthroplasty during an early recovery period. Methods Eighty patients undergoing total knee arthroplasty were assigned into two groups. The experimental group received CPM and active exercises, while the control group active exercises only. All subjects were evaluated once before the surgery and at a discharge, in terms of mean active range of motion (AROM), mean Knee Society Score (KSS), and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Results The mean AROM for the experimental group was 82.3° ± 14.3° and 76.1° ± 22.2° for the control. The mean KSS score was 136.4 ± 19.3 points for the experimental group, and 135.7 ± 15.1 for the control. There were no statistical differences between the two groups. The KSS functional score was 66.4 ± 8.1 points for the experimental group compared to 62.2 ± 7.3 points for the control, but there was a statistically significant difference between the groups at discharge from the hospital (p = 0.009). A subjective estimation of the pain level, joint stiffness and function also showed a statistically significant difference between the two groups (38.6 ± 14.3 points for the CPM group and 21.2 ± 15.7 for the control). Conclusion These findings show that there is no significant effect of CPM in terms of improving clinical measurements. However, there was a significant beneficial effect on the subjective assessment of pain level, joint stiffness, and functional ability.

Introduction. Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes, however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after SLAP repair to understand the need for standardization to improve patient outcomes. Methods. Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement/ biceps tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded. Results. Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusion. There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of Orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.

Background: Genu osteoarthritis (OA) is the most common arthritis disease caused by a degenerative joint process that causes knee pain and functional disorders. One of the recommended therapies for the treatment of OA genu from several studies is hydrotherapy exercises. Hydrotherapy exercises can reduce pain and improve the patient's quality of life. This study aims to determine the effect of hydrothera py exercises on pain intensity and functional ability in OA genu patients. Methods: This study is a quasi-experimental study with a one group pretest-posttest design concted by the Medical Rehabilitation Installation of dr. Mohammad Hoesin Palembang duri ng the month of October-November 2019. Primary data was collected using interviews to assess pain intensity based on the Numerical Paon Rating Scale (NPRS) score and functional ability based on the WOMAC (Western Ontario and McMaster Universiti es Osteoarthritis Index) questionnaire before and after training. hydrotherapy for 4 weeks for one therapy a week. The data was carried out by the Shapiro-Wilk normality test, then analyzed using the paired T -test or Wilcoxon test using the SPSS tool. Results: Asmany as 31 study subjects, the results showed that there was a significant effect before and after hydrotherapy exercises on reducing pain intensity (p = 0.000) and improving functional ability (p = 0.000) in patients with OA genu for 4 weeks. Conclusion: There is an effect of hydrotherapy exercise on pain intensity and functional ability in genu.

Background Whole-body vibration (WBV) could be an alternative training method for elderly with a high risk of falling. Research question What acute effects of sinus-like and random WBV intervention occur in this risk group and how do they differ? Methods This prospective pilot study was performed on two days separated by a one-week wash-out phase. Twelve subjects (10 women and 2 men, age 77.7 ± 5.3; 162.3 ± 7.4 cm; 82.4 ± 15.2 kg; BMI 31.2 ± 5.1 kg/m²) undertook sinus-like WBV intervention. One week later random WBV were performed. This consisted of six intervals each lasting 60 s, with heart and respiratory rates monitored. Feasibility outcomes involved safety and compliance. The primary endpoint was postural control, measured by a static posturography before and after the first interval and complete intervention. Secondary outcomes measured before and after the intervention were a Timed-Up-and-Go-Test (TUGT) and an instrumental gait analysis. Results Random WBV intervention showed positive acute effect on postural control (Standard deviation (SD) Ellipse area p = 0.007; SD of the Center of force (CoF) independent from direction p = 0.017; SD of the CoF in the antero-posterior direction p = 0.011). There were no significant acute effects on TUGT or gait analysis (comparison between sinus-like and random WBV: Single Task: ΔVelocity p = 0.373, ΔStep time p = 0.077, ΔStep length p = 0.369, ΔStride length p = 0.408, ΔDouble-support-time p = 0.492; Dual task: ΔVelocity p = 0.580, ΔStep-time p = 0.559, ΔStep length p = 0.626, ΔStride length p = 0.584, ΔDouble-support-time p = 0.550). During sinus-like WBV, heart rate increased significantly from rest 69.7 ± 20.9bpm to max.146.0 ± 24.9bpm (p = 0.025). Respiratory rate increased significantly from 10.0 ± 1.0 to max.32.0 ± 6.0 (p = 0.011) during random WBV. No undesirable side effects were observed. Significance Findings demonstrate that random WBV improves acute functional ability of postural control, but not gait for elderly people with a high risk of falling. Intervention with WBV seems safe and well accepted by participants. Monitoring of heart and respiratory rate offers protection for subjects with heart disease.

Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690.

A Quasi experimental design was adopted for this study to find out the effectiveness of quadriceps strengthening exercise program on pain and functional ability of women with knee osteoarthritis (OA). Fifty women with OA were selected in which first 25 women were enrolled in the control group and second 25 women were allotted in the exercise group. Assessments were performed at baseline and at 8 weeks. The functional ability was assessed using the Timed Up and Go (TUG) test and Numerical Rating Scale (NRS) was used to assess the pain level .For the exercise group, quadriceps strengthening exercises were taught and asked the patients to follow the exercise schedule for 8 weeks. The study results show that the pain and functional abilty scores were improved in the exercise group and the difference was statistically significant (p

Background: Total hip arthroplasty (THA) is one of the greatest successful orthopedic procedures achieved today. For patients with hip pain due to a diversity conditions, total hip arthroplasty can relieve pain, restore function, and improve quality of life. Patient education is carefully related to the early recovery process and promotes outcomes after hip replacement by supporting people to become empowered during the period of regaining. The study aimed to evaluate the effect of bundled care on self-efficacy and functional outcomes among patients undergoing total hip arthroplasty. Study design: A quasi-experimental design was used to attain this aim. Setting: This study was conducted at orthopedic surgery departments and Joint outpatient clinic at El-Demerdash Surgical Hospital, affiliated with Ain Shams University Hospitals, Cairo. Sample: A purposive sample included 78 patients. Tools of data collection: Data were collected using four tools:1- Patient’s Interview Questionnaire, 2- Hip disability and osteoarthritis outcome score scale, 3-Self- efficacy for rehabilitation outcome scale and 4-Hip Strengthening exercises performance checklist. Results: This study shows a statistically significant difference between study and control groups regarding Hip disability and osteoarthritis outcome score, self-efficacy level, and Hip Strengthening exercises performance as indicators of functional outcomes post bundled care application at p (

Janice Johnston,1 Karen Brown,2 Jeffrey Muir,3 Michael J Sloniewsky4 1Arrowhead Health Centers, Glendale, AZ, USA; 2KLEO Research, Missoula, MT, USA; 3Motion Research, Ancaster, ON, Canada; 4RMG Holding, Inc., Florence, SC, USACorrespondence: Jeffrey MuirMotion Research, 3-35 Stone Church Road, Ste. 215, Ancaster, ON, L9K 1S4, CanadaEmail drjeffmuir@gmail.comIntroduction: Viscosupplementation (VS) is a safe and effective local treatment for osteoarthritis (OA) of the knee. While much research has been completed evaluating its efficacy, comparatively little research has been completed examining the effects of multiple, repeat courses of treatment versus a single course of treatment.Methods: We retrospectively reviewed real-world data from a large cohort of patients receiving treatment for OA of the knee at 16 rehabilitation clinics. Patients were grouped based on whether they received a single course of treatment or multiple courses. Outcomes for this study included pain (measured via the visual analog scale, VAS) and functional ability (measured via the Western Ontario and McMaster Universities Arthritis Index (WOMAC)). Pain and function scores were collected at baseline (prior to treatment administration) and one week following each course of treatment.Results: Patients receiving multiple courses of treatment saw greater improvements than those receiving a single course. For VAS, maximal improvement occurred after the fourth course (66% improvement: 1.7± 1.2 vs 5.0± 2.4 at baseline, p< 0.0001). WOMAC scores saw maximal improvement up to the fourth course for all domains (pain: 74%: 2.5± 3.3 vs 9.5± 5.3, p< 0.0001; stiffness: 61%: 1.3± 1.0 vs 3.3± 2.0, p< 0.0001; function: 66%: 9.5± 7.2 vs 28.3± 14.1, p< 0.0001). When scores from multiple courses were averaged, improvements were maintained through the fourth course for VAS (3.4± 2.8) and all WOMAC domains (pain: 6.1± 5.0; stiffness: 3.0± 2.2; function: 23.4± 17.3).Discussion: Our results indicate that multiple courses of treatment are associated with greater improvements than a single course of VS, and that these improvements continue through four courses of treatment.Keywords: viscosupplementation, hyaluronic acid, knee osteoarthritis, repeat treatment, longitudinal study

BACKGROUND: Rehabilitation outcomes of COVID-19 patients are unknown. OBJECTIVE: The purpose of this study is to describe COVID-19 patients undergoing inpatient rehabilitation and their rehabilitation outcomes. METHODS: Retrospective observational cohort study of all inpatients from a rehabilitation hospital between March 1 and September 30, 2020. Inclusion criteria are: ≥18 years of age and admission and discharge within the study time frame. The initial search yielded 920 patients; 896 met the inclusion criteria. Data was derived from the eRehabData database. Subjects were stratified by COVID-19 status and rehabilitation impairment. Data included age, gender, body mass index (BMI), length of stay (LOS), discharge location, and functional ability measures for self-care and mobility (FA-SC, FA-Mob). Descriptive statistics included age, BMI, gender, LOS, and discharge location. One-sample t-tests were used to assess the difference of age, BMI, LOS, FA-SC, FA-Mob, and FA efficiency between COVID-19+ and COVID-19- patients. RESULTS: COVID-19+ patients were younger (59·4 years vs 62·9 years; t(894)= -2·05, p=0·04) with a higher mean BMI (32 vs 28; t(894)= 3·51, p

Purpose: assessment of functional indices of external respiration, the level of physical health and the general state of the autonomic nervous system of university students. Material: There were examined 192 students aged 18-21 years. All examined were divided into groups depending on gender, age and future profession. Anthropometric indices and parameters of the circulatory system were studied. Spirometer was used to measure the respiratory system functional indices. An express assessment of physical health level was made. Index of functional changes, the Kerdo vegetation index, the orthostatic index, and the Skibinskaya index were calculated. Stange test, Hench test and Martin-Kushelevsky’s test were conducted. Results: The results are showed that the minute blood volume was higher in all examined young girls, whereas in young boys designers and pharmacists aged 17-18 years and 19-21 years, respectively it was lower than due values. Similar data were obtained after the Ruffier test (dynamic load tolerance). The index of vital lung capacity (VC) was significantly lower than due values in all students. The parameters of maximal pulmonary ventilation indicated good functional ability of the external respiration apparatus in young boys. This index was higher than that of young girls and exceeded due values. The adaptation capacities of the student body (index of functional changes (IFI)) were at a satisfactory level. The indices of physical health level of all students had average values. Conclusions: Studies have revealed the most characteristic shifts of cardiorespiratory system indices, which are most expressed in students. Cardiorespiratory system shifts are caused by the influence of a complex of factors: increased academic load; requirements for the professionalization process continuity; performance of various structured activity types, manipulations, a high degree of responsibility. Increased pulse rate and minute blood volume; prevalence of the hyperkinetic type of blood circulation self-regulation at rest; irrational cardiovascular system response to dosed physical load; positive value of the Kerdo vegetation index; decreased ventilatory lung capacity and reserve capacity of cardiorespiratory system; tension of adaptation mechanisms; average level of physical health were recorded in students.

Background Osteoarthritis is a degenerative disease caused by joint cartilage damage. The main symptoms of osteoarthritis are pain and movement disorders that can affect the functional disorders. The prevalence of knee osteoarthritis in Indonesia is quite high reaching 15.5% in men and 12.7% in women. It is estimated that 1 to 2 million older people in Indonesia suffer from disabilities due to osteoarthritis. Osteoarthritis treatment is intended to reduce pain improve functional ability and prevent deformity. Elastic band strengthening exercises are exercises that can be used to reduce pain increase muscle strength and functional ability. Objective This study aims at determining the effect of elastic band strengthening exercises in improving knee osteoarthritis functional capabilities. Method The method used in this study was quasi-experimental with pre and post-test control group design. The number of respondents of this study was 20 respondents diagnosed with knee osteoarthritis in Condong Catur Hospital Sleman. Respondents were randomly divided into two groups namely the treatment group that received elastic band strengthening exercise treatment and the control group that received standard treatment given at the hospital. The treatment was given twice a week for four weeks. Measurement of functional ability was done using WOMAC score. Results There was a decrease in pain level in the treatment group while in the control group the pain level was still the same as before. In the functional ability there was an increase in the treatment group. The statistical test showed that there was an influence between the treatment group and the control group. Conclusion Elastic band strengthening exercises effectively improved functional capabilities in knee osteoarthritis in Condong Catur Hospital Sleman. Keywords elastic band strengthening exercises functional capabilities knee osteoarthritis

Introduction: Osteoarthritis is thought to be the most prevalent chronic joint disease. Total knee arthroplasty is now s reliable treatment for severe arthritis and is commonly done for end stage arthritis of knee. The results of TKA are predictable in majority of cases, but with geriatric population, arthritis is often associated with other co-morbid condition along with age, which makes the results of TKA less predictable. So the present study was conducted to evaluate the clinical and functional outcome of TKA in this subset population.Materials and Methods: This prospective study was done at a tertiary center of new civil hospital surat. A total of 25 Consecutive patients who consented and underwent TKA were assessed clinically, functionally using the knee society score at 6 months.Results: The average pre-op knee Functional score was 65.8 which improved to an average post-op score of 83.68 At 6 month follow up, 19 patients (76%) had excellent, 2 patients (8%) had good, 2 patients (8%) had fair, and 2 patients (8%) had poor results as per KFS. The average pre op knee Clinical score was 47.4, which improved to a post op score of 83.84. At 6 month follow up, 18 patients (53%) had excellent, 5 patients (20%) had well, 1 Patient (4%) had fair and 1 patient (4%) had poor results as per KCS. Conclusion: Total knee arthroplasty improves the functional ability of the old patient above 60 years and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post op knee clinical score and knee functional score.

Background Systemic lupus erythematosus (SLE) is a complex rheumatic autoimmune disease characterized by periods of exacerbations that can present damage in organs with important clinical manifestations. Objective: The aim of this study was to evaluate the effect of 12-week whole-body vibration exercise (WBVE) on the fatigue, functional ability and quality of life of women with systemic lupus erythematosus (SLE) in chronic glucocorticoids use (CGU). Methods: Twenty-one women were allocated randomly in the WBVE group or isometry group. The participants of WBVE group were positioned on the vibrating platform with 130° knee flexion and received the intervention twice a week for 12 weeks. The isometry group performed the same position and time, but without the stimulus of mechanical vibration. Fatigue, functional ability and the quality of life were evaluated at weeks 0, 6, and 12. Results: From a sample of seventy-seven individuals, seventeen participants completed the study, 8 in WBVE group and 9 in isometry group. Fatigue reduced in the WBVE group at 6 and 12 weeks of intervention (p = 0.04) and (p = 0.03) respectively. There was a significant improvement in the functional ability evaluated by the Health Assessment Questionnaire in the WBVE group compared to the isometry group (p = 0.03). Conclusion: WBVE would be a useful intervention for control of fatigue and improvement of the functional ability of women with SLE in CGU.

Background Delays in starting physical therapy after hospital discharge worsen deconditioning in older adults. Intervening quickly can minimize the negative effects of deconditioning. Telerehabilitation is a strategy that increases access to rehabilitation, improves clinical outcomes, and reduces costs. This paper presents the protocol for a pragmatic clinical trial that aims to determine the effectiveness and cost-effectiveness of a multi-component intervention offered by telerehabilitation for discharged older adults awaiting physical therapy for any specific medical condition. Methods This is a pragmatic randomized controlled clinical trial with two groups: telerehabilitation and control. Participants (n=230) will be recruited among individuals discharged from hospitals who are in the public healthcare system physical therapy waiting lists. The telerehabilitation group will receive a smartphone app with a personalized program (based on individual’s functional ability) of resistance, balance, and daily activity training exercises. The intervention will be implemented at the individuals’ homes. This group will be monitored weekly by phone and monthly through a face-to-face meeting until they start physical therapy. The control group will adhere to the public healthcare system’s usual flow and will be monitored weekly by telephone until they start physical therapy. The primary outcome will be a physical function (Timed Up and Go and 30-s Chair Stand Test). The measurements will take place in baseline, start, and discharge of outpatient physical therapy. The economic evaluations will be performed from the perspective of society and the Brazilian public healthcare system. Discussion The study will produce evidence on the effectiveness and cost-effectiveness of multi-component telerehabilitation intervention for discharged older adult patients awaiting physical therapy, providing input that can aid the implementation of similar proposals in other patient groups. Trial registration Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020.

Background Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke currently remain uncertain. This is an update of the review published in 2017. Objectives To assess the effects of rPMS in improving activities of daily living and functional ability in people after stroke. Search methods On 7 January 2019, we searched the Cochrane Stroke Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); Occupational Therapy Systematic Evaluation of Evidence (OTseeker); the Physiotherapy Evidence Database (PEDro); ICHUSHI Web; and six ongoing trial registries. We screened reference lists, and we contacted experts in the field. We placed no restrictions on the language or date of publication when searching electronic databases. Selection criteria We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only. Data collection and analysis Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias, undertook data extraction, and used the GRADE approach to assess the quality of evidence. We contacted trial authors to request unpublished information if necessary. We resolved all disagreements through discussion. Main results We included four trials (three RCTs and one cross-over trial) involving 139 participants. Blinding of participants and physicians was well reported within all trials. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We observed a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03; P = 0.03; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-quality evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the quality of evidence related to the primary outcome as low, owing to the small sample size of the studies. Authors' conclusions Available trials provided insufficient evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Background Ankylosing spondylitis (AS) is a chronic systemic autoimmune disease with high disability rate. Conventional treatment regimens have long medication cycles and are associated with adverse reactions. Therapeutic exercise is also considered to be an effective treatment for AS. Evidence suggests that Yijinjing as a low-energy exercise has advantages in adjuncting AS, but there is a lack of standard clinical studies to evaluate its efficacy and safety. Methods This is a prospective randomized controlled trial to investigate the efficacy and safety of Yijinjing in the adjuvant treatment of AS. Approved by the Clinical Research Ethics Association of our hospital, patients were randomly divided into treatment or control groups in a ratio of 1:1. The treatment group received 4-month Yijinjing training on the basis of conventional treatment, while the control group received conventional treatment and maintained their current lifestyle. The outcome indicators included: activity index, functional ability, Bath Ankylosing Spondylitis Metrology Index, adverse reaction, etc. Finally, SPASS 22.0 software was used for statistical analysis of the data. Discussion This study evaluated the clinical efficacy of Yijinjing exercise in the adjuvant treatment of AS, and the results of our study will provide a reference for the clinical use of Yijinjing exercise as an effective complementary alternative for the treatment of AS.

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has spread at an alarming rate worldwide. Its dominant feature is arterial hypoxemia seen due to ventilation perfusion mismatch. This causes reduced oxygen diffusion that affects functional capacity. Six-minute walk test is one of the commonly used test which is used to assess functional ability. However, it is more time-consuming and requires a 30-m corridor which is not always easily available. Studies have shown that the 1-minute sit to stand test (1-MSTST) is also useful for assessing functional capacity of patients with respiratory dysfunction. The aim of the study was to understand COVID-19 patient’s response to 1-MSTST with respect to number of repetitions, oxygen saturation, heart rate and perceived rate of exertion. Statistically significant difference was seen in pre and post parameters of heart rate (Pre: 91.73 ±17.12, Post: 116.06 ± 20.18, p< 0.0001); SpO2 (Pre: 97.04 ± 3.37, Post: 95.40 ± 3.93, p=0.005) and RPE (Pre: 0. 07 ± 0.25, Post: 1.49 ± 1.22, p< 0.0001). A mean of 21.26 ± 6.84 repetitions of sit to stand were performed in a minute. COVID-19 patients, thus, have significantly reduced functional capacity similar to that of patients with other respiratory dysfunctions. Thus, results of this study will enable therapist to plan the rehabilitation in COVID-19 patients to improve their functional capacity. This will enhance their ability to perform in activities of daily living and to participate in societal work and therefore will help in improving their quality of life. Key words: COVID-19, Physiotherapy, Sit to stand test, Functional Capacity Rehabilitation.

Objectives: We aimed to analyze the effects of a tailored rehabilitation nursing care program on functional ability and quality of life in patients with conservative treatment for rib fractures. Design: Randomized controlled trial. Setting: Inpatient rehabilitation hospital. Subjects: Rib fracture patients treated conservatively were randomized into two groups (experimental and control group). Interventions: Patients in control group received Treatment as Usual (TAU) and patients included in experimental group received TAU and an added tailored rehabilitation nursing care program (RNT). Main measures: At baseline, and end of hospitalization treatment, the functional ability was assessed with the Barthel Index, and the quality of life was evaluated with the EuroQol-5D. Additionally, the outcomes were assessed at six-month follow-up. Results: A total of 80 patients were included in the study, whose mean age was 77.19 SD 7.71 in the RNT group and 75.55 SD 9.46 in the TAU group. Our data showed a significant difference in the post-treatment gains in overall quality of life (74.25 SD 20.62 vs 60.28 SD 20.54), and functional ability (71.79 SD 23.85 vs 69.41 SD 24.30) between the RNT group and the TAU group ( P Conclusions: A tailored rehabilitation nursing care program added to the conservative treatment during hospitalization can improve the functional ability and quality of life of patients after rib fractures at discharge and at six-month follow-up. Trial registration: ClinicalTrial.gov Identifier: NCT04168996

Objectives Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non-dialysis patients. Design/setting/participants A pre- and post-retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). Intervention Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co-management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. Measurements Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. Results Patient characteristics: general rehabilitation patients (n = 1395, mean age = 79.7, 50.1% female) and dialysis rehabilitation patients (n = 838, mean age = 72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD = 5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD = 5.88). Changes in length of stay (24.9%-28.1% reduction) and service interruption frequency (34.3%-49.7% reduction) were also observed. Conclusion Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care.

Background: Rheumatoid arthritis is a chronic systemic disease that affects the joints, connective tissues, tendons, and fibrous tissues. Despite early interventions, there is significant activity limitation due to moderate and high pain intensities in majority of affected individuals.The study set out to determine the effect of physical activity on pain and functional ability among rheumatoid arthritis patients.Methods:A pre-test, post-test quasi experimental study conducted among 60 rheumatoid arthritis patients (divided into intervention and control groups) were recruited from the Autoimmune clinic of Korle Bu Teaching Hospital for this quasi-experimental study. The international physical activity questionnaire, multidimensional health assessment questionnaire and numerical pain rating scale were used to obtain data. Pedometers and a stationary cycle were used for physical activity (intervention). Paired t-test was used to compare outcomes between the level of physical activity in relation to pain and functional ability and outcomes between pre and post functional abilities at a 0.05 level of significance.Results: Majority 24 (80.0%) of participants from the intervention group reported low, while 6 (20.0%) reported moderate physical activity levels. Thirteen (43.4%) and 10 (33.3%) participants from the intervention and control groups reported moderate pain on NPRS before intervention, which reduced to 7 (23.3%) in the intervention group, as compared to 9 (30%) in the control group. There was a significant difference (p0.05) for most domains of functional ability except health concern (p = 0.034) among the control group.Conclusion: Patients with RA have a relatively low physical activity level but benefit significantly from a moderate intensity aerobic exercises such as cycling and walking by improving pain levels, functional ability and general health.Clinicians should promote and encourage patients with RA to engage in physical and recreational activities.

BACKGROUND Physical elder abuse affects a substantial number of older adults, leaving victims at increased risk for negative health outcomes. Improved detection of abuse-related injuries may increase victim access to professional support, but providers report difficulties distinguishing between accidental and abuse-related injuries, due in part to victims' pre-existing health conditions and medication use. OBJECTIVES To describe the spectrum and characteristics of injuries among physically abused older adults and identify injury characteristics associated with abuse. DESIGN Case-control study. SETTING Physically abused adult protective services clients were interviewed in their home; non-abused comparison group participants were interviewed in an outpatient geriatrics clinic. PARTICIPANTS Sample included 156 community-dwelling adults aged 65 and older, including 57 physically abused and 99 non-abused individuals. Self-reported abuse history was confirmed through independent case assessment by a LEAD (Longitudinal, Expert All-Data) panel of clinicians with family violence expertise. MEASUREMENTS Full-body assessments were conducted, documenting injury incidence, diagnosis, and location. We also collected sociodemographic characteristics, level of social support, functional ability, medical history, and medication use. RESULTS Physically abused older adults were more likely to be injured upon assessment (79.0% vs 63.6%; p

IntroductionSystemic sclerosis/scleroderma (SSc) is a chronic autoimmune disease with connective tissue, multi-organ, and multisystem involvement. The disease has three main characteristics, namely vasculopathy, fibrosis, and autoimmunity. The effect of high-intensity interval training (HIIT) in aerobic exercise on other rheumatic diseases has been studied, for example in patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). The purpose of this work is to investigate the effectiveness of HIIT of aerobics exercise on improving the inspiratory muscle, quality of life and functional ability for systemic sclerosis subjects.Material and methodsThe study was conducted on patients with confirmed systemic sclerosis who met the inclusion criteria. The research was carried out for 12 months in the outpatient clinic and gait laboratory of the Department of Physical Medicine and Rehabilitation.ResultsAfter HIIT in aerobic exercise, we found significant changes in inspiratory muscle (SNIP values 45.67 [30.92] vs. 54.25 [22.71]), handgrip (13.14 [4.42] vs. 15.63 [4.08]), walking speed (184.70 [26.86] vs. 246.6 [12.30]), metabolic equivalent (3.53 [0.30] vs. 4.21 [1.25]) and Scleroderma-Specific Health Assessment Questionnaire Disability Index for all visual analog scale (VAS) domains except Disability Index. Exercise approaches are characterized by repeated cycles of exercise interrupted by rest. For a range of clinical conditions, HIIT in aerobic exercise is known to remedy blood vessel function.ConclusionsOur results suggest that HIIT in aerobic exercise has improved functional ability, respiratory muscle strength, and quality of life in SSc subjects. Training twice a week in a 12-week HIIT program is considered to be safe for this population. We have to consider internal and external factors that influenced the result. A larger sample and further exploration of the feasibility of combined exercise in SSc patients should be the focus for future research.

The aim of this study was to analyse the short-distance sprint performance (SDSP) differences between functional International Wheelchair Basketball Federation (IWBF) classes in elite wheelchair basketball (WB) women players. Additionally, the association between WB experience and the IWBF functional classification score and SDSP was assessed. Sixteen WB women players belonging to the Spanish national WB team were grouped according to the functional IWBF classes: group 1 (class 1 and 1.5), group 2 (class 2 and 2.5), group 3 (class 3 and 3.5) and group 4 (class 4 and 4.5). Each participant completed 2 sets of 12-m wheeling sprints at maximum speed, and split times at 3, 5 and 12 m were recorded. Major significant differences were observed in SDSP between groups 1 and 4 (p

Carpal Tunnel Syndrome (CTS) is a median nerve entrapment syndrome that occurs in the carpal tunnel and causes a variety of motor and sensory impairments in the upper limb including pain and reduced functioning. The application of manual techniques in the context of physiotherapy improves the pain and functional ability of the upper limb. However, their effects require further research. The aim of this review is to investigate the effectiveness of manual techniques in the symptoms of CTS. Method: The Google Scholar and PubMed databases were searched during the period of February – April. The following search terms were used: Carpal Tunnel Syndrome, Manual Therapy, Neurodymamic Therapy, Rehabilitation. Results: 10 studies (clinical studies and crossover studies) were included in this review. Discussion - Conclusions: The application of manual techniques seems to be an effective approach to improving the symptoms of mild to moderate CTS. From the results of the studies included in this review, it seems that out of all the manual techniques, the combination of soft tissue mobilization techniques and neurodynamic therapy provide the best results. More future research should focus on implementing protocols with this therapeutic combination.

Introduction Telehealth is an increasingly common approach to improve healthcare delivery, especially within the Veterans Health Administration and Department of Defense (DoD). Telehealth has diminished many challenges to direct access for clinical follow-up; however, the use of mobile telehealth for specialty rehabilitative care is emerging and is referred to as telerehabilitation. As early adopters of telehealth, the Veterans Affairs and DoD have supported collaborated efforts for programs designed to increase the access and quality of rehabilitative care while improving the functional ability of our service members (SMs) and veterans with lower limb amputation (LLA). The DoD and Veterans Health Administration collaborated on a Mobile Device Outcomes-based Rehabilitation Program (MDORP) to help injured SMs and veterans with LLA. The MDORP project utilized a mobile health system called the Rehabilitative Lower Limb Orthopedic Accommodating Device (ReLOAD) to assess walking quality. The ReLOAD system includes real-time auditory biofeedback to notify the user of their most prominent gait deviation and then recommends exercises that address specific balance and strength impairments. The purpose of this study was to describe the responses to a postintervention survey evaluating the feasibility and usability of ReLOAD completed by SMs and veterans with LLA who used the system for 5 months. Materials and Methods A link to an anonymous usability survey was emailed to all participants who completed MDORP. The survey was modeled after the System Usability Scale, with agreeableness to items rated on a 5-point Likert-style questionnaire in addition to open feedback. Data visualization of Likert-style questionnaires was conducted using ggplot2 and reshape2 statistical packages and was analyzed using R. We obtained institutional review board approval through both Miami Veterans Affairs Healthcare System and Walter Reed National Military Medical Center. Results The majority of participants reported that they would use the system again for home rehabilitation (65%) and that auditory biofeedback helped them walk better (59%). Participants also suggested that future work should include a greater variety of exercise options and the use of smart phones for the ReLOAD application in addition to the iPad tablet. Conclusions The participants provided positive and constructive feedback that will enhance the value and usability of telerehabilitation interventions like the ReLOAD system for future users.

As our population ages, the prevalence of brain injuries increases due to strokes and falls. Brain injuries are a leading cause of rehospitalization for patients, and most brain injury survivors experience depression soon after hospital discharge. This study assessed the difference between: 1) survivors of brain injury’s baseline and 30-day depression, functional ability, and quality of life and caregivers’ depression and caregiver burden among those that received the Care Transitions intervention, and 2) 30-day hospital readmissions between survivors of brain injury that received Care Transitions and a control group. The study used a quasi-experimental pre-posttest design. Participants included people with brain injuries who received the Care Transitions intervention (n = 22) and their caregivers (n = 20) compared to a services-as-usual control group of brain injury survivors (n = 27). Care Transitions is a 90-day family-focused, home visitation, coaching hospital-to-home transition intervention. Outcomes were self-reported baseline and 30-day depression, functional independence, quality of life, and caregiver burden. Hospital record data was used to report readmissions. Study results showed that there were statistically significant differences between depression, functional ability, and caregiver burden between pre- and post-survey scores among Care Transitions participants. Care transitions’ participants experienced lower brain injury-related hospital readmissions than the services as usual control group. Social work hospital discharge planning needs to continue beyond the hospital and include home visitation to ensure patient and caregiver needs are met post-hospital discharge.

To compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI).A randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up.Tertiary rehabilitation centers and several communities.Independent ambulatory individuals (N=54) with SCI who walked with or without a walking device.Participants were randomly arranged into a control group (overground walking training, n=26) or experimental group (walking training over a WTDS, n=28) for 30 min/d, 5 d/wk over 4 weeks.The 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months.Participants who walked with an average speed of 0.52 m/s and postinjury time7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (P.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n=5, 18%) fewer than those in the control group (n=12, 46%).Being at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.

A significant percentage of stroke survivors are reported to have anxiety and depression. Autogenic Relaxation Training (ART), a psychophysiological self-control therapy which aims to induce relaxation proved to be effective in reducing the anxiety and depression in some health conditions. However, there is lack of studies which evaluated the effects of ART in the rehabilitation of stroke survivors. The aim of this experimental pilot study is to evaluate the feasibility and outcomes of ART in addition to usual physiotherapy for stroke survivors. A total of 14 sub-acute stroke survivors from a teaching hospital were enrolled in this study. All participants received 20 minutes ART followed by 40 minutes usual physiotherapy once a week and they were requested to carry out the intervention at home for twice per week, for six weeks. Intervention outcomes were assessed using Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Barthel Index (BI), Timed Up and Go (TUG) and EuroQol 5-Dimension 5 Levels (EQ5D5L). Changes in all outcome measures were analysed using paired t-test and Wilcoxon signed rank test, with level of significance set at p

BACKGROUND: Brain injuries such as strokes cause damage and death of the neuron cells. Physiotherapy interventions help to improve patient’s performance and ability. However, this is only theorized but the impact of the physiotherapy intervention on brain plasticity is not known. OBJECTIVE: The present study aimed to investigate the effect of physiotherapy interventions on brain neuroplasticity by evaluating the brain plasticity regeneration, balance and functional ability. METHODS: A randomized controlled trial was conducted with 64 stroke patients from three hospitals in the Surakarta region, Indonesia. Control groups (n = 32) received conventional physiotherapy and intervention groups (n = 32) received neurorestoration protocol, which both lasted for seven days. Efficacy of the interventions were measured on brain-derived neurotropic factor serum analysis, Berg Balance Scale and Barthel Index, respectively. RESULTS: Both groups showed improvements in all parameters but only balance and functional performance had a statistically significant outcome. CONCLUSION: Neurorestoration protocol that combined several established physiotherapy interventions was effective in improving balance and functional ability of stroke patients in only a seven days period.

INTRODUCTION: This two-part study explored the safety, feasibility, and efficacy of a mild-moderate resistance isometric leg exercise program in ambulatory boys with Duchenne Muscular Dystrophy (DMD). METHODS: First, we used a dose escalation paradigm with varying intensity and frequency of leg isometric exercise to determine the dose response and safety in 10 boys. Second, we examined safety and feasibility of a 12-week in-home, remotely-supervised, mild-moderate intensity strengthening program in 8 boys. Safety measures included T(2) MRI, creatine kinase levels, and pain. Peak strength and function (time to ascend/descend 4 stairs) were also measured. RESULTS: Dose-escalation revealed no signs of muscle damage. Seven of the 8 boys completed the 12-week in-home program with a compliance of 84.9%, no signs of muscle damage, and improvements in strength (knee extensors p < 0.01; knee flexors p < 0.05) and function (descending steps p < 0.05). DISCUSSION: An in-home, mild-moderate intensity leg exercise program is safe with potential to positively impact both strength and function in ambulatory boys with DMD.

Objectives Migraine is a common disabling neurological disorder. Current acute treatments for migraine in adolescents are mostly pharmacological and may have limited effectiveness, can cause side effects, and may lead to medication overuse. There is an unmet need for effective and well-tolerated treatments. Remote electrical neuromodulation (REN) is a novel acute treatment of migraine that stimulates upper arm peripheral nerves to induce conditioned pain modulation (CPM)-an endogenous analgesic mechanism. The REN device (Nerivio® , Theranica Bio-Electronics Ltd., Israel) is a FDA-authorized device for acute treatment of migraine in adults. This study assessed the efficacy and safety of REN in adolescents with migraine. Design and methods This was an open-label, single-arm, multicenter study in adolescents (ages 12-17 years) with migraine. Participants underwent a 4-week run-in phase. Eligible participants continued to an 8-week treatment phase with the device. Pain severity, associated symptoms, and functional disability were recorded at treatment initiation, and 2 and 24 hours post-treatment. The primary endpoints of this study were related to the safety and tolerability of REN. The secondary endpoints were related to device efficacy and included the proportion of participants who achieved pain relief at 2 hours post-treatment and the proportion of participants who achieved pain freedom at 2 hours. The presented results reflect an interim analysis with subsequent stopping of the rest of the study. Results Sixty participants were enrolled for the study; of these, 14 failed to meet the run-in criteria and 1 was lost to follow-up. Forty-five participants performed at least one treatment, of which 39 participants completed a test treatment with REN. One device-related adverse event (2%) was reported in which a temporary feeling of pain in the arm was felt. Pain relief and pain-free at 2 hours were achieved by 71% (28/39) and 35% (14/39) participants, respectively. At 2 hours, 69% (23/33) participants experienced improvement in functional ability. Conclusions REN may offer a safe and effective non-pharmacological alternative for acute treatment in adolescents.

The evidence base for use of different rehabilitation programs is discussed in the article. The most effective approaches to the rehabilitation organization and patients education are presented together with the different types of physical rehabilitation, ergotherapy and physical activities useful for the development of the maximum functional ability and social integration of rheumatic patients. The positive impact of the motivational interview in work with rheumatic patients, the results of the clinical studies on evaluation of the patients education influence on their functional abilities and psychologic status; recommendations on ortheses use are discussed in the article. The recommendations of the leading international expert groups about exercises, physiotherapy, ergotherapy prescribing to the patients with rheumatoid arthritis, osteoarthritis and connective tissue systemic diseases are given; the attention is drown to the methods of evaluation of patients physical status; patients education about energy saving technologies use for maximum possible functional and physical loads and patients autonomy at hom aend social life realization. Implementation of the given rehabilitation algorithms can help to realize holistic patient-centered approach, improve patients quality of life and functional capacity.

Objective To determine the reliability, responsiveness, and convergent validity of the Four-Meter Walk Test (4mWT) compared to the Six-Minute Walk Test (6MWT) surrounding total knee arthroplasty (TKA). Design Secondary analysis of a randomized controlled trial. Setting Research laboratory. Participants One hundred sixty-two patients (aged 63.5 ± 7.4 (mean ± sd) years; 89 females) undergoing TKA participated. Main outcome measures 4mWT (usual and fastest) and 6MWT were measured 1-2 weeks preoperatively, and 1, 2, 3, 6 and 12 months post-operatively. Results 4mWT demonstrated excellent test-retest reliability with Interclass Correlation Coefficients (ICC's) ranging from 0.80 to 0.93 s. 4mWT also demonstrated small measurement error with Standard Error of Measurement (SEM) ranging from 0.15 to 0.35 s. 4mWT (fastest) demonstrated similar responsiveness to 6mWT in the first 2 months after surgery and better responsiveness from 2 to 3 months after surgery. Convergent validity between 6MWT and 4mWT (fastest) was high, with Pearson correlation coefficients ranging from 0.73 to 0.81. Conclusions The 4mWT (fastest) has excellent test-retest reliability, shows high responsiveness sufficient for clinical outcomes in the immediate postoperative time periods, and exhibits high convergent validity with 6MWT. Given space and time requirements to conduct each test, 4mWT may be preferred for routine clinical assessment. IMPLICATIONS FOR REHABILITATION Walking ability •Walking is an important functional ability for patients who undergo total knee arthroplasty (TKA). •While the Six-Minute Walk Test is a validated measure of walking ability in the TKA population, its clinical utility is limited by the space and time it takes to perform the test. •The Four-Meter Walk Test (fastest speed) is a valid, reliable, and responsive alternative to the 6MWT and is recommended for routine clinical use after TKA.

Introduction: Osteoarthritis is a slowly progressive non-inflamation in diarthrodial (synovial) joints which increasingly occurs as one ages, showing such initial symptom as pain in the joints during activities. The pain gets worse over time, causing the obstruction of joint movements and affects the patient’s functional ability. The aim of the study was to identify the effect of red ginger compress therapy and kinesio tapping on pain and stiffness in the joints and functional ability. Methods: This research used the Quasi Experiment pre and post test design with control group. A simple random technique to collect 112 respondents who were devided into intervention group receiving red ginger compress therapy, kinesiotaping group, combination of red ginger compress therapy and kinesiotaping group, and control group, each of which consisted of 28 respondents in Pangesti Elderly Home Lawang and Pangesti Tresno Mukti Elderly Home Turen. Results: Evaluation based on WOMAC index was applied on day one, three, five and seven. The result of ANCOVA showed the red ginger compress intervention with p = 0.005, kinesiotaping with p = 0.005 and red ginger compress + kinesiotaping with p = 0.005 in reducing pain, joint stiffness and difficulty functional ability. Conclusion: This research findings are expected to be one of non-pharmcological therapies recommended to patients with OA.

Breast cancer ranks highest in incidence and mortality among females and second among both genders. Lebanon has the second highest rate of breast cancer worldwide for those 35-39 years old and the highest for those 40-49. Mastectomy often results in deceased shoulder and arm mobility and decreased quality of life. The objective of this study was to assess the effect of an educational program of therapeutic exercises on the quality of life and functional ability in women after a mastectomy. Sixty women undergoing a mastectomy were randomly assigned to either an intervention or control group. The intervention group received extensive pre-surgery education as well as training on therapeutic exercises. Follow-up phone calls to the intervention group were made to ensure that the exercises were being done. Both groups were visited at home at two and four weeks to obtain the outcome variables. The Breast Cancer Patient Version was used to assess quality of life, and the "Goniometer" was used to assess the range of motion of the affected shoulder. At two and four weeks after surgery, women in the intervention group had significant improvements in their shoulder range of motion: flexion, extension, and abduction were significantly different between the control and intervention group at p = 0.04-0.00. For quality of life, physical, psychological, psychological, social, and spiritual well-being were significantly higher for the intervention group at both two and four weeks after surgery, p < 0.001. In a middle-income country, one-to-one education provided by a nurse, which included demonstrations, back demonstrations, and weekly phone calls had a positive impact on women's shoulder range of motion and quality of life. NCT04184102.

Background: Frozen shoulder is a condition of the shoulder joint that experiences inflammation, pain, adhesions, atrophyand shortening of the joint capsule resulting in limited motion. In frozen shoulder patients, the limited range of motion ofthe shoulder joint can affect and reduce functional ability. This study aims to analyze the correlation between the limitedarea of motion of the shoulder joint with the functional ability of frozen shoulder patients at the Medical RehabilitationInstallation Dr. Mohammad Hoesin Palembang. Methods: This study was an observational analytic study, correlationtest, with a cross sectional design. There were 29 frozen shoulder patients who met the inclusion criteria in the MedicalRehabilitation Installation Dr. Mohammad Hoesin Palembang in November 2018 was taken as a sample using consecutivesampling techniques. Functional ability was assessed using the quickDASH questionnaire and the area of motion wasmeasured using a goniometer, then analyzed. Results: The results of the correlation test showed significant resultsbetween functional abilities and the area of motion of the shoulder joints. Active flexion (p = 0.000; r = -0.669), activeextension (p = 0.004; r = -0.520), active abduction (p = 0.000; r = -0.663), active adduction (p = 0.022; r = -0.423 ), passiveflexion (p = 0.001; r = -0.589), passive extension (p = 0.002; r = -0.543), passive abduction (p = 0.000; r = -0.676), passiveadduction (p = 0.038; r = -0.388). Conclusion: There is a significant correlation between limited joint motion andfunctional ability in frozen shoulder patients at the Medical Rehabilitation Installation of Dr. Mohammad HoesinPalembang

The effect of hydrotherapy on pain intensity and functional ability in lumbar disk herniation (LDH) patients thatundergo non-operative procedure; pre-experimental study at medical rehabilitation installation of RSUPdr. Mohammad Hoesin Palembang. Lumbar disk herniation (LDH) is the most common disease that becaused low backpain and functional disability. Some studies mentioned that hydrotherapy is an effective treatment for low back pain.Therefore, this study was conducted to determine the effect of hydrotherapy on reducing pain intensity and improvingfunctional ability in LDH patients. This study was a pre-experimental study with one group pretest-posttest design. Datawas collected by direct interviews to the patients using visual analogue scale (VAS) to measure pain intensity andModified Oswestry Low Back Pain Disability Questionnaire to assess functional ability before and after underwenthydrotherapy once a week for 4 weeks. The data then undergo Shapiro-Wilk normality test and continue with Paired t-Test or Wilcoxon test. From 30 subjects, it was found that there are effects of hydrotherapy on reducing pain intensity(p