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Purpose: This qualitative evidence synthesis aimed to identify and integrate findings where adults with fibromyalgia discussed how they managed their pain, and their perceptions of prescribed treatments from healthcare professionals., Materials and Methods: A comprehensive search strategy was implemented in PubMed, Scopus, ISI Web of Science, and Cinahl Plus databases. The GRADE-CERQual framework was used to evaluate the findings confidence. The findings were analyzed using an inductive thematic analysis approach., Results: A total of 35 studies ( N  = 728) were included. The confidence in the findings ranged from high to low confidence. Patients with fibromyalgia often do not benefit from seeking medical attention due to provider stigma, and have varying views on medication effectiveness commonly reporting feeling like "walking chemists." They find mixed effects from exercise, and consider psychological support essential, although the benefits of cognitive-behavioral therapy were controversial. Combining cognitive-behavioral therapy with physical exercise appears more effective, while natural and complementary therapies have short-term benefits and high costs., Conclusions: Pain management is a source for frustration and an unmet need for patients with fibromyalgia. The current findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management.Implications for RehabilitationChronic widespread pain is the defining feature of fibromyalgia, yet pain reduction is often an unmet need for these individuals.The lack of effective treatments resulting in long-term relief proves frustrating for patients and healthcare providers.Rehabilitation professional should consider the unique insight into this complex, heterogeneous condition that this qualitative synthesis provides to better understand their patient's perspective on pain management.Given the differing perspectives on pain treatment approaches individuals with fibromyalgia report, providers should discuss with each patient their current strategies and take a patient-centered, individualized approach to form an effective treatment plan.

A higher level of education was correlated with less severe motor impairment in Parkinson's Disease (PD). Nevertheless, there is limited evidence on the relationship between cognitive reserve and motor performance in complex situations in PD. To investigate the association between cognitive reserve and the dual-task gait effect in PD. Additionally, we examined the relationship between executive function, clinical and sociodemographic variables and, dual-task gait effects. We conducted a cross-sectional study with 44 PD participants. We evaluated dual-task effect on cadence, stride length, and gait velocity. Dual-task effects were correlated with neurophysiological factors, including cognitive reserve (Cognitive Reserve Index Questionnaire), overall cognitive performance of executive functions, a specific executive function domain (Trail Making Test), and the global cognitive status (Montreal Cognitive Assessment and Mini-Mental State Examination). Age, gender, and disease severity were considered as variables to be examined for correlation. We found that cognitive reserve did not influence gait performance under dual-task conditions in this sample. However, executive functions, age, and disease severity were associated with the dual-task effect on gait. The overall cognitive performance with respect to the Trail Making Test showed an inverse relationship in the dual-task gait effect on cadence. Our study's findings have important implications for understanding the association between executive functions, age, and disease severity with the dual-task effect on gait in PD. Pre-life factors, such as education, occupation, and leisure activity, did not contribute to coping with complex gait situations in PD., (© 2024. The Author(s).)

Background: Parkinson's Disease (PD) affects movement and cognition, and physiotherapy, particularly treadmill gait training, has potential in addressing movement dysfunctions in PD. However, treadmill training falls short in addressing cognitive aspects and adherence. Virtual reality (VR) and gamification can enhance motor and cognitive retraining and improve adherence. People with Parkinson's Disease (PWPD) have decreased motor skill learning efficiency, but tDCS can improve motor and cognitive learning., Methods: 78 participants with PD will be randomly allocated in a 1:1:1 ratio to one of three groups: (1) treadmill + Gamified Virtual Reality Environment (GVRE) + tDCS training group; (2) treadmill + GVRE training group or (3) treadmill training group. Participants will follow a 6-week, 12-session treadmill gait training plan, gradually increasing session duration from 20 to 45 minutes. Participants in (1) and (2) will undergo a GVRE training protocol, with (1) also receiving tDCS for the first 20 minutes of each session. Assessments will occur at baseline, post-intervention, and at a 6-week follow-up. The primary outcome measure will be gait speed during single and dual-task performance. Secondary measures will include additional gait parameters, executive tests for cognitive performance, and clinical outcomes for disease stage, cognitive status, and physical condition., Discussion: This randomized clinical trial presents an innovative neurorehabilitation protocol that aims to improve gait and cognition in PWPD. The study also examines how tDCS can enhance motor and cognitive training. Results could contribute to enhancing the motor and cognitive state of PWPD through a GVRE and tDCS-based neurorehabilitation protocol., Trial Registration: NCT05243394. 28/02/2024 -v3.2., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bosch-Barceló et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Treadmill gait training has been shown to improve gait performance in People with Parkinson's Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD., Methods: The GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention's acceptability, feedback and in-game performance was collected from participants., Results: Results showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases., Conclusions: This intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression., Trial Registration Number: NCT05243394-01/20/2022., (© 2024. The Author(s).)

Background: Core stability exercises (CSE) have been shown to be effective in improving trunk function in several neurological diseases, but the evidence is scarce on Hereditary Ataxias (HA)., Objective: To evaluate the effectiveness of a 5-week home-based CSE program in terms of ataxia severity, trunk function, balance confidence, gait speed, lower limb motor function, quality of life, health status and falls rate in HA individuals at short- and long-term., Methods: This is an assessor-blind randomized controlled clinical trial parallel group 1:1. The individuals were divided in experimental group (EG) performed standard care in addition to CSE, and control group (CG) performed standard care alone. The CSE home-program was conducted 1-h/day, 5-day/week for 5-week. The assessment was performed at baseline, endpoint (5-week), and follow-up (10-week). The primary outcomes were ataxia severity assessed by the Scale for the Assessment and Rating of Ataxia and trunk function assessed by Spanish-version of Trunk Impairment Scale 2.0. The secondary outcomes were balance confidence assessed by Activities-specific Balance Confidence (ABC), gait speed by 4-meter walk test (4-MWT), the lower limb motor function by 30-s sit-to-stand, quality of life by EuroQol 5-dimension 5-level (EQ-5D-5L), health-status by EQ-5D and falls rate., Results: Twenty-three HA individuals were recruited (51.8 ± 11.10 years). Statistically significant group-time interaction was shown in ABC (F:5.539; P = 0.007), EQ-5D-5L Total (F:4.836; P = 0.013), EQ 5D (F:7.207; P = 0.006)., Conclusions: No statistical differences between groups for ataxia severity and trunk function were observed. However, were differences for balance confidence, gait speed, quality of life, and falls rate in HA individuals., (© 2024 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: This systematic review and meta-analysis aimed to evaluate the effectiveness of aquatic therapy on pain, sleep quality, psychological symptoms, quality of life, and health status in people diagnosed with fibromyalgia., Methods: We searched PubMed, CINAHL, The Cochrane Library, PEDro and Scopus databases. Articles were eligible if they were randomised controlled trials (RCTs) analysing the effects of aquatic therapy in adult people diagnosed with fibromyalgia, and published by October of 2022 in English or Spanish. The Cochrane Risk of Bias tool was employed to conduct the methodological quality assessment of the encompassed studies, and the overall quality of evidence for each comparison was determined using the GRADE approach., Results: Of 375 articles found, 22 met the inclusion criteria. Forest plot analysis of Pittsburgh sleep quality index at short- and mid-term follow-up showed a trend in favour of aquatic therapy, although not statistically significant, with weighted mean difference (WMD) = -1.71 (95% CI: -4.17 to -0.75, p = 0.17). Heterogeneity was substantial (χ 2 = 8.74, df = 5 (p < 0.000001; I 2 = 95%). Relating the pain outcome by fibromyalgia impact questionnaire (FIQ) short term showed a trend in favour of the aquatic therapy group with WMD = -5.04 (95% CI: - 9.26 to - 0.82, p =  = 0.02) with heterogeneity χ 2 = 11.07, df = 4 (p = 0.03; I 2 = 64%). Great heterogeneity was found between trials in medium term., Conclusion: This systematic review and meta-analysis demonstrated the effectiveness of aquatic therapy as an adjunct treatment to usual care in people suffering from fibromyalgia. Aquatic therapeutic exercise improves the symptomats of sleep quality, pain, and quality of life of adults with fibromyalgia. Further research on long-term outcomes may contribute to the currently available evidence., (© 2023. The Author(s).)

Background: Physiotherapists had faced a new healthcare scenario characterised by the restrictions caused by the COVID-19 pandemic., Purpose: To explore the impact of the COVID-19 pandemic on the physiotherapy profession from the perspective of physiotherapists working in the public and private sectors., Methods: Qualitative study based on semi-structured personal interviews with 16 physiotherapists working in public, private, or public-private partnership sectors in Spain. The data were collected between March and June 2020. Inductive qualitative content analysis was performed., Results: The participants (13 women, 3 men; aged 24-44 years) had professional experience in diverse healthcare settings (primary, hospital, home, consultations, insurance companies, associations). Five categories were identified: (1) the impact of lockdown on the health of physiotherapy users; (2) managing the demand for physiotherapy services during lockdown; (3) introducing protocols and protective measures in physiotherapy consultations; (4) changes in therapeutic approaches; and (5) future expectations in the physiotherapy care model. Physiotherapists perceived that lockdown caused a decline in the functionality of people with chronic conditions, together with a reduction in the physiotherapy services. Difficulties in prioritising users considered urgent became evident, and the inclusion of prophylactic measures affected treatment duration differently depending on the care setting and the pandemic prompted the use of telerehabilitation., Discussion: The pandemic affected the functional status of chronic physiotherapy users and made treatment time, quality of care and triage protocols visible. In physiotherapy, technological barriers need to be solved, such as digital literacy, families without resources, situations of dependency and cultural barriers., (© 2023 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.)

Introduction: Mild cognitive impairment is one of the consequences of ageing, causing functional disability, a poor quality of life and an increased socioeconomic expenditure. Evidence shows that patients go through a long preclinical stage in which cognitive deficits appear subtly until they reach the threshold of dementia. Non-pharmacological interventions have been gaining ground as prevention of modifiable factors of cognitive decline such as obesity, diabetes, physical inactivity or social isolation. Along these lines, Information and Communication Technologies (ICTs) can be a tool for cognitive stimulation, cognitive training and cognitive rehabilitation. The main objective of the systematic review will be to review and analyse the use of ICTs for the improvement of cognitive functions in healthy older adult population aged 50 and over, for the prevention of cognitive impairment METHODS: A systematic review will be conducted including randomised clinical trials in adults without diseases or accidents associated with cognitive impairment, and whom have used ICTs for the improvement of cognitive functions between 2010 and 2020 in English or Spanish. The articles that report data on cognitive function by domain, for example, memory or executive functions, or by test will be included. The databases Medline (PubMed), CinahlPlus, Scopus, ISI WoS, CENTRAL and IEEE Xplore will be searched. Studies that meet the inclusion criteria will be analysed according to the Cochrane RoB2 tool for risk of bias assessment., Ethics and Dissemination: Ethical approval is not necessary as this is a systematic review. The results will be published in scientific journals, as well as in specialised congresses on the subject of study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: This study aimed to explore the experience and management of poor sleep quality in Spanish women with fibromyalgia (FM)., Design: This was a qualitative study based on one-to-one interviews., Methods: Twenty-one adult women diagnosed with FM were recruited from the community between January and March 2020. Data were collected through in-depth semistructured one-to-one interviews, using an interview guide of open questions about the experience and management of poor sleep quality, and were analyzed with thematic qualitative analysis. The symptom management theory was used as a biopsychosocial conceptual framework., Results: The results were organized into two themes: (a) experience of poor sleep quality and (b) management strategies for poor sleep quality. Poor sleep quality was found to be a severe symptom of FM that negatively impacts pain, fatigue, stiffness, mental health, and quality of life. The participants perceived pharmacological treatment to be the main approach of health care professionals for improving sleep, and most did not want this form of treatment. Self-management strategies lack clear beneficial effects on sleep quality., Conclusion: Women with FM recognize that they need to receive more information from nurses and allied professions about sleep in the context of FM and how to effectively manage poor sleep quality., Impact: This study contributes to a better understanding of how women with FM experience and manage poor sleep quality. More information about management strategies for poor sleep quality from nurses and other health care professionals is needed in women with FM. The results of this study can be applied by nurses and health care professionals, including sleep educators, in the treatment of this patient group., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: The reviewed studies on center of pressure (COP) displacement in Parkinson's disease (PD) subjects show important methodological differences and contradictory results with regard to healthy subjects. The dual-task paradigm method has been used to examine cognitive prioritization strategies to control concurrent postural and cognitive tasks. The motor requirements, such as pronouncing words, involved in the cognitive tasks used in double-task conditions could be related to the heterogeneity of the results., Research Objective: To compare postural sway and cognitive performance in subjects with PD and controls using a dual-task paradigm with a cognitive task free of motor demands. We tried to examine the prioritization strategy of PD patients regarding healthy adults to control for concurrent postural and cognitive tasks., Materials and Methods: 25 subjects with PD and 20 healthy controls carried out a postural task under both single-task and dual-task conditions. The postural task was to stand as still as possible, with eyes first open and then closed. The dual-task condition added a concurrent cognitive task based on phoneme monitoring. COP displacement variables and cognitive performance were compared between the groups and within-subject factors were also examined., Results: PD participants showed higher COP displacement results than the controls. All participants shortened the mean sway radius in dual-task conditions compared with single-task conditions; only healthy subjects presented less transversal COP sway in dual-task conditions than in single-task conditions. The cognitive performance of PD patients on a phoneme monitoring task worsened when they carried it out while maintaining balance in a standing position compared to sitting. The opposite effect occurred in control subjects., Conclusion: This study confirms the negative influence of Parkinson's disease on the control of standing stability, increasing the COP sway amplitude. The attentional demands of a postural task, such as standing balance, may be greater in PD patients than in healthy subjects. This would affect the performance of patients during dual-task conditions to be able to control a postural task while performing other cognitive tasks. In these conditions, cognitive performance would be negatively affected. These results suggest that subjects with PD, at least during initial disease stages, prioritize postural control over other concurrent tasks, as is also seen in healthy subjects., (Copyright © 2020 Morenilla, Márquez, Sánchez, Bello, López-Alonso, Fernández-Lago and Fernández-del-Olmo.)

Background: The use of the treadmill as a gait rehabilitation tool has provided novel options for treatment of gait impairments in Parkinson's Disease (PD). However, the neural mechanisms underlying these therapeutic effects in PD remain unknown and whether any therapeutic effects from treadmill training can be reproduced on overground walking., Objective: To examine the immediate short-term effects of a single session of treadmill and overground walking on gait, spinal and corticospinal parameters in PD.METHODSPD participants (N = 15) were evaluated in two separate sessions under two walking conditions: walking over a treadmill and walking overground. Overground walking performance, the Soleus H-reflex, Reciprocal Ia-Inhibition, Intracortical Facilitation (ICF) and Short Intracortical Inhibition (SICI), were evaluated before and after each condition., Results: Gait speed and stride length improved in post-treadmill compared with pre-treadmill. No significant changes in these gait parameters were found for the pre vs. post-overground condition. ICF values and Hmax/Mmax ratio decreased after, compared with before, the two walking conditions., Conclusions: Treadmill walking, but not overground walking, lead to an improvement in the stride length and gait speed in the PD patients without evidence of different modulation on spinal and corticospinal parameters.

Objective: We tested the hypothesis that combining treadmill walking with transcranial direct current stimulation (tDCS) enhances the gait improvements associated with treadmill walking in Parkinson disease. We explored the effects of these combined methodologies on corticospinal parameters., Design: Eighteen participants with Parkinson disease were evaluated under the following three conditions: treadmill walking alone (treadmill), treadmill walking combined with anodal tDCS (AtDCS+treadmill) delivered over the motor cortex, and treadmill walking combined with sham stimulation (StDCS+treadmill). Overground walking performance, soleus H-reflex, reciprocal Ia inhibition from the tibialis anterior to the soleus muscle, intracortical facilitation, and short intracortical inhibition of the tibialis anterior muscle, were measured before and after each treadmill condition. The soleus H-reflex and walking performance on the treadmill were also evaluated., Results: All treadmill conditions improved walking performance and modulated spinal and corticospinal parameters in a similar way. However, AtDCS+treadmill lead to a different modulation of reciprocal Ia inhibition in comparison with the other treadmill conditions., Conclusions: A single session combining treadmill walking and anodal tDCS delivered over the motor cortex resulted in a specific modulation of the reciprocal Ia inhibition from the tibialis anterior to the soleus muscle. However, this acute effect did not result in improvements of gait parameters associated with treadmill walking in Parkinson disease.

Objective: The aim of this study was to explore whether attentional demands are involved in gait improvements in Parkinson disease (PD) patients when they walk on a treadmill., Design: Nineteen individuals with idiopathic PD and 19 age-matched healthy controls participated in this study. Participants walked on a treadmill and on overground under single task (walk only) and dual task (walk performing a simultaneous cognitive task) conditions. The dual-task paradigm was used to reveal the attention allocation behavior. Gait pattern and cognitive performance was measured., Results: The PD group showed reduced gait variability when walking on a treadmill in comparison with overground. However, this reduction did not deteriorate during the dual task. Moreover, there were no differences in the cognitive performance between treadmill and overground walking., Conclusions: This study does not support the proposition attentional resource allocation as a possible mechanism for the treadmill-associated gait improvements observed in PD.