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Maturitas Feb 2020The accessibility, low cost and motivation generated by exergames has fostered its rapid expansion as a rehabilitation technique. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The accessibility, low cost and motivation generated by exergames has fostered its rapid expansion as a rehabilitation technique.
OBJECTIVE
To estimate the effectiveness of rehabilitation programs using IVGT in improving walking capacity of people aged 60 years and over.
MATERIALS AND METHODS
The electronic data research following the PRISMA Statement (Scopus, Cochrane, Web of Science, OT Seeker, National Guideline Clearinghouse, Trip Database, CSIC Spanish National Research Council) was completed in September 2018. The results of randomized clinical trials using exergames for rehabilitation of walking capacity were combined. The calculations have followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of the evidence.
RESULTS
We obtained data from 14 trials, including 11 meta-analysis studies. The size of exergames effects on walking capacity is moderate, but significant (SMD -0.56; 95 % CI: -0.90, -0.21; p = 0.002). Effectiveness was greater to recover the ability to transfer from one position or place to another (SMD -1.02; CI 95 %: -1.70, -0.35; P = 0.003). The intervention protocols, their duration and intensity varied considerably. The lack of masking, the allocation concealment, the absence of assessor blinding were the main causes of bias so the final grade of evidence has been low for walking and very low for transfers.
CONCLUSIONS
Positive clinical effects of exergames have been found to improve walking capacity, but the quality of evidence to refute its effectiveness is weak with risk of bias. Further research is needed in order to know the actual magnitude of its effect.
Topics: Aged; Aged, 80 and over; Exercise Tolerance; Humans; Middle Aged; Mobility Limitation; Randomized Controlled Trials as Topic; Rehabilitation; Video Games; Virtual Reality; Walking
PubMed: 31883662
DOI: 10.1016/j.maturitas.2019.12.006 -
Physiotherapy Jun 2021To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and...
OBJECTIVES
To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19.
METHODS
The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools.
RESULTS
Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence.
CONCLUSIONS
Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19. Registration: Open Science Framework https://osf.io/prc2y.
Topics: Activities of Daily Living; COVID-19; Early Ambulation; Electric Stimulation Therapy; Exercise Therapy; Humans; Intensive Care Units; Mobility Limitation; Patient Discharge; SARS-CoV-2
PubMed: 33637294
DOI: 10.1016/j.physio.2021.01.007 -
International Journal of Nursing Studies Jun 2021Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in negative consequences on an individual's physical and psychosocial functions. Sitting Tai Chi, a derivative form of traditional Tai Chi, has been found to increase the flexibility of all joints involved and enhance the ability to perform physical activity. However, the evidence of sitting Tai Chi on physical and psychosocial health outcomes on individuals with impaired physical mobility is limited.
OBJECTIVES
To critically synthesize evidence that evaluates the effects of sitting Tai Chi on health outcomes among individuals with impaired physical mobility and to identify implementation strategies for the sitting Tai Chi intervention.
METHODS
Searches were performed across 11 English and two Chinese databases systematically from inception to January 2020. Randomised controlled trials and non-randomised controlled trials, written in English or Chinese were included. Two independent reviewers screened all eligible studies, appraised risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were performed where meta-analysis was inappropriate. The certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool. This study was registered in PROSPERO.
RESULTS
A total of 1,446 records were generated and 11 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favouring sitting Tai Chi on depressive symptoms (SMD: -1.53, 95% CI: -2.81 to -0.21, 2 studies; very low quality), heart rate (MD: -5.72, 95% CI: -11.16 to -0.29, 2 studies; low quality) and social domain of quality of life (MD: 1.42, 95% CI: 0.66 to 2.19, 3 studies; low quality).
CONCLUSIONS
Sitting Tai Chi was found to have favourable effects on depressive symptoms, heart rate, and social domain of quality of life of individuals with impaired physical mobility. Very low to low quality evidence does not support the effectiveness of sitting Tai Chi on dynamic sitting balance, handgrip strength, and the physical and psychological domains of quality of life. There was limited evidence to suggest the best implementation strategies for the sitting Tai Chi intervention. It is anticipated that more well-designed studies will continue developing high quality evidence in this field.
Topics: Exercise; Hand Strength; Humans; Outcome Assessment, Health Care; Quality of Life; Tai Ji
PubMed: 33751992
DOI: 10.1016/j.ijnurstu.2021.103911 -
Hematology, Transfusion and Cell Therapy 2021Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and... (Review)
Review
Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and psychological impairments. Physical exercise is a therapy that can restore physical and functional capacities; however, it is necessary to understand the effects of its practice in post-HSCT individuals. The purpose of this systematic review (SR) was to assess the impact of physical exercise in children and adolescents undergoing HSCT. The SR was conducted following the PRISMA guidelines through search in the electronic databases Embase, Lilacs, PEDro, PubMed and SCOPUS, without limitation of dates and languages. Randomized or non-randomized clinical trials with children and adolescents who underwent HSCT, aged between 3 to 19 years old, who participated in a regular physical activity program, were assessed. After removing duplicates and selecting studies according to the eligibility criteria, seven parallel studies incorporating hospitalized and discharged participants undertaking aerobic and strengthening exercises were included in this study. The main outcomes analyzed were exercise capacity, quality-of-life, body composition and freedom. Five studies comprised the meta-analysis regarding the effects of the distance walked in the 6-min walk test and quality-of-life. Physical exercise is considered to be safe, feasible and efficacious to prevent the decline of the quality-of-life in children and adolescents undergoing HCST, as well as a considerable improvement in physical capacity.
PubMed: 33288491
DOI: 10.1016/j.htct.2020.07.013 -
European Review of Aging and Physical... 2020Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive... (Review)
Review
BACKGROUND
Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive functions are important for daily-life function and mobility. This systematic review investigated the effectiveness of cognitive-motor training including exergaming on executive function (EF, set-shifting, working memory, inhibitory control) in healthy older people.
METHODS
An electronic database search for randomised controlled trials (RCT), controlled clinical trials (CCT) and parallel group trials was performed using MEDLINE, EMBASE, and PsychINFO following PRISMA guidelines. Inclusion criteria were: (1) community-dwelling participants > 60 years without a medical condition or medical treatment, (2) reporting at least one cognitive-motor intervention while standing or walking, (3) use of dual-task interventions using traditional methods or modern technology to deliver a cognitive-motor task, (4) inclusion of at least one cognitive outcome. The PEDro scale was used for quality assessment.
RESULTS
A total of 1557 studies were retrieved, of which 25 studies were included in this review. Eleven studies used a technology-based dual-task intervention, while 14 trials conducted a general cognitive-motor training. The age range of the cohort was 69 to 87 years. The interventions demonstrated positive effects on global cognitive function [mean difference 0.6, 95% CI 0.29-0.90] and inhibitory control [mean difference 0.61, 95% CI 0.28-0.94]. Effects were heterogeneous (I range: 60-95) and did not remain after a sensitivity analysis. Processing speed and dual-task costs also improved, but meta-analysis was not possible.
CONCLUSION
Cognitive-motor and technology-based interventions had a positive impact on some cognitive functions. Dual-task interventions led to improvements of domains related global cognitive functions and inhibitory control. Likewise, technology-based exergame interventions improved functions related to processing speed, attentional and inhibitory control. Training interventions with a certain level of exercise load such as progression in difficulty and task specificity were more effective to gain task-related adaptations on cognitive functions.
PubMed: 32636957
DOI: 10.1186/s11556-020-00240-y -
Physical Therapy Dec 2022Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of RBT on falls in daily life among individuals at increased risk of falls and to document associated adverse events.
METHODS
Databases searched were Ovid MEDLINE (1946 to March 2022), Embase Classic and Embase (1947 to March 2022), Cochrane Central Register of Controlled Trials (2014 to March 2022), and Physiotherapy Evidence Database (PEDro; searched on 22 March 2022). Randomized controlled trials of RBT were included. The literature search was limited to the English language. Records were screened by 2 investigators separately. Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information.
RESULTS
Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events. Participants assigned to RBT groups were less likely to fall compared with control groups (fall risk ratio = 0.76; 95% CI = 0.63-0.92; I2 = 32%) and reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45-0.83; I2 = 81%). Prevalence of adverse events was higher in RBT (29%) compared with control groups (20%).
CONCLUSION
RBT reduced the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported in RBT than control groups.
IMPACT
Balance training that evokes balance reactions can reduce falls among people at increased risk of falls. Older adults and individuals with balance problems were less likely to fall in daily life after participating in RBT compared with traditional balance training.
LAY SUMMARY
If you are an older adult and/or have balance problems, your physical therapist may prescribe reactive balance training rather than traditional balance training in order to reduce your likelihood of falling in daily life.
Topics: Humans; Aged; Accidental Falls; Databases, Factual; Language; Odds Ratio; Physical Therapists
PubMed: 37651698
DOI: 10.1093/ptj/pzac154 -
Age and Ageing Nov 2022regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults.
DESIGN
systematic review and meta-analysis.
PARTICIPANTS
community-dwelling older adults over 65 years.
INTERVENTION
exercises at home through DHI.
OUTCOMES MEASURES
physical function, HRQoL and falls.
RESULTS
twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56 s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004).
CONCLUSION
the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.
Topics: Humans; Aged; Quality of Life; Exercise; Exercise Therapy; Independent Living
PubMed: 36346736
DOI: 10.1093/ageing/afac243 -
Facts, Views & Vision in ObGyn Sep 2022Symptomatic obturator nerve endometriosis is a rare condition. In this paper, we aim to review and discuss the characteristics of obturator nerve endometriosis in light...
BACKGROUND
Symptomatic obturator nerve endometriosis is a rare condition. In this paper, we aim to review and discuss the characteristics of obturator nerve endometriosis in light of current literature.
METHODS
An electronic search was conducted using the PubMed/Medline database.
RESULTS
Symptomatic obturator nerve endometriosis is rare; only 8 cases have been reported in the literature. Symptoms including difficulty walking, weak thigh adduction and pain in the inner thigh, which are all related to obturator nerve function, could be seen in the case of the entrapment of the nerve by endometrial nodules. A history of recurrent symptoms during menstrual cycles and physical examination, combined with appropriate radiologic imaging, led to a suspicion of obturator nerve involvement.
CONCLUSION
Early diagnosis and surgical treatment of obturator nerve endometriosis is essential to minimise the nerve damage caused by recurrent cycles of bleeding and fibrosis, which are characteristics of endometriosis. The laparoscopic minimally invasive technique is feasible for the surgery of obturator nerve endometriosis. It offers the advantage of precise discrimination of vital structures and excellent access to deep anatomic sites.
WHAT IS NEW?
Obturator nerve endometriosis may be a severe cause of chronic pelvic pain in women of reproductive age. Treatment may be achieved surgically and in experienced hands, laparoscopic surgery would be the preferred choice.
PubMed: 36206796
DOI: 10.52054/FVVO.14.3.032 -
Disability and Rehabilitation.... Aug 2023Modified ride-on cars (MROC) are a low-cost option to provide self-directed mobility to children with mobility limitations, in lieu of or as a precursor to other powered...
BACKGROUND
Modified ride-on cars (MROC) are a low-cost option to provide self-directed mobility to children with mobility limitations, in lieu of or as a precursor to other powered mobility devices.
OBJECTIVES
We appraised evidence to (1) describe and categorize MROC study characteristics, (2) synthesize existing knowledge of children's use of MROCs and (3) frame outcomes within the International Classification of Functioning, Disability and Health (ICF) framework.
METHODS
Articles were identified through four electronic databases: Medline, CINAHL, PsycNET, and Web of Science. We included all published, peer-reviewed studies involving MROC use. Relevant data were extracted, and articles were appraised using the American Academy of Cerebral Palsy and Developmental Medicine criteria for group and single-subject designs.
RESULTS
23 studies met inclusion criteria of 204 titles identified from 1980 to 2021. Study designs included case studies, case series, group designs, and qualitative research, but only three studies were rated evidence level III or higher. Children with a range of disabilities used MROCs across multiple settings, including the home, hospital, and community, though use and adherence varied widely. Positive impacts were reported on a range of outcomes related to the ICF framework, with an emphasis on activity and participation.
CONCLUSIONS
MROC studies have primarily addressed activity and participation, with most studies suggesting increased functional mobility and social interactions due to MROC use. More robust research designs with larger samples are needed in order to develop evidence-based strategies for MROC use.IMPLICATIONS FOR REHABILITATIONPhysical and occupational therapists may consider using MROCs as a therapeutic tool or accessible play opportunity as part of a multi-modal approach to increase children's mobility, family engagement, and participation in community life.Personal (e.g., child's enjoyment) and environmental factors (e.g., caregiver attitudes and stress) must be considered when developing plans of MROC use.
Topics: Child; Humans; Disabled Children; Automobiles
PubMed: 34435924
DOI: 10.1080/17483107.2021.1963330 -
Neurological Sciences : Official... Jun 2024To systematically review and conduct a meta-analysis to evaluate the safety and efficacy of the unilateral focused ultrasound (FUS) pallidotomy on motor complications in... (Review)
Review
To systematically review and conduct a meta-analysis to evaluate the safety and efficacy of the unilateral focused ultrasound (FUS) pallidotomy on motor complications in Parkinson's disease (PD) patients. A comprehensive search strategy was implemented through August 15, 2023, and updated on February 13, 2024, across six databases, identifying studies relevant to unilateral focused ultrasound pallidotomy and PD. Eligibility criteria included observational studies, clinical trials, and case series reporting on the impact of the intervention on motor complications in PD patients. The screening and data extraction were done by two independent reviewers. Risk of bias assessment utilized appropriate tools for different study designs. Statistical analysis involved narrative synthesis and meta-analysis. Subgroup analyses and leave-one-out analyses were performed. Five studies were included in our study, involving 112 PD patients undergoing FUS pallidotomy. UPDRS-II analysis revealed a significant improvement from baseline (mean difference (MD): -3.205, 95% CI: -4.501, -1.909, P < 0.001). UPDRS-III overall change was significant (MD: -10.177, 95% CI: [-12.748, -7.606], P < 0.001). UPDRS-IV showed a significant change from baseline (MD: -5.069, 95% CI: [-5.915, -4.224], P < 0.001). UDysRS demonstrated a significant overall improvement (MD: -18.895, 95% CI: [-26.973, -10.818], P < 0.001). The effect of FUS pallidotomy on motor complications in PD patients was effective, with a significant decrease in the UPDRS and UDysRS, reflecting improvement. The incidence of adverse events (headaches, pin-site pain, difficulty walking, and sonication-related head pain) of the FUS pallidotomy was not statistically significant, indicating its safety.
PubMed: 38842771
DOI: 10.1007/s10072-024-07617-2