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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: 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.)

Background: Low back pain is one of the most common disabling pathologies in humanity worldwide. Physical exercises have been used in recent decades to reduce the pain, improve the functionality of the lumbar spine and avoid relapses. The purpose of the study is to analyze the effect of a program based on re-education exercises involving preactivation of the abdominal transverse muscle compared to conventional treatment in adults with chronic nonspecific low back pain., Methods: A two-arm, single-blind randomized control trial with 35 primary care patients with chronic nonspecific low back pain. Both groups received a 4-week intervention. Data were collected at baseline and at the end of the intervention. Sixteen patients participated in the intervention group, and 19 patients in the control group., Results: For the experimental group, the outcomes of disability and activation of the abdominal transverse muscle decreased significantly (MD -2.9; CI 95% -5.6 to -0.35; η2 = 0.14; p = 0.028) and (MD 2.3; CI 95% 0.91 to 3.67; η2 = 0.25; p = 0.002) respectively, with a large effect size, compared to the control group. There were no differences between the groups in pain intensity, thickness, and resistance of the transverse abdominal muscle., Conclusion: A 4-week specific program based on re-education exercises of the preactivation of the abdominal transverse muscle is more effective than conventional treatment for reducing disability and increasing the activation of the abdominal transverse muscle measured by VAS scale and PBU., Trial Registration: Clinicaltrials.gov identifier: NCT03097497. Date of registration: 31/03/2017., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: This study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases., Methods: A Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the questionnaire was designed following the results of the Delphi study and content validity, the reliability, validity, and the Rasch model of the questionnaire were examined., Results: Two rounds of the Delphi study were carried out. A total of 73 participants (42 experts and 31 users) participated in round 1, and 59 people (27 experts and 32 users) in round 2. A total of 53 and 29 items were identified in rounds 1 and 2, respectively. In the content validity, we found nine items above the threshold of 0.58. Finally, ten items were included in the questionnaire. Fifty-one participants participate in the reliability and validity of the questionnaire. The internal consistency reliability of the questionnaire analyzed by Cronbach's Alpha was α = 0,895. There was moderate to considerable concordance among our questionnaire items test-retest in the Kappa coefficient and a strong association between test-retest in the Spearman's coefficient ρ = 0.818 (p<0,001). The intraclass correlation coefficient was 0,869 with a 95% confidence interval (0,781;0,923). There was a strong correlation between the total scores of the new questionnaire and other validated questionnaires analyzed with Spearman's coefficient ρ = 0.756 (p<0,001). The ten items demonstrated a satisfactory fit to the Rasch model., Conclusions: The present study suggested that the new questionnaire is a reliable 10-item usability questionnaire that allows subjective and quick assessment of the usability of assistive technologies by people with neurological diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Masbernat-Almenara 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.)

Aim: To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers., Design: Generic qualitative study., Methods: Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software., Results: Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain., Conclusion: Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology., Trial Registration: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/11/2016., (© 2022. The Author(s).)