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Arquivos de Neuro-psiquiatria May 2022Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive interventions may be a challenging task.
OBJECTIVES
The objectives of this study are to summarize the most relevant information on the topic "falls in the elderly" and to give a critical view and practical clinical approach on this topic.
METHODS
In March 2022, a search of Pubmed database was performed, using the terms "fall elderly", fall prevention", "fall risk", with the following parameters: five years, review, systematic review, meta-analysis, practice guidelines.
RESULTS
There are several risk factors for falls that can be grouped in different areas (psychosocial, demographic, medical, medication, behavioral, environmental). The clinical evaluation of an older adult prone to falls must include identification of risk factors through history and examination and identification of risk of falls through an assessment tool such as gait velocity, functional reach test, timed up and go, Berg balance test, and miniBEST test. Fall prevention strategies can be single or multiple, and physical activity is the most cited. Technology can be used to detect and prevent falls.
CONCLUSION
A systematic approach to the older patient in risk of falls is feasible and may impact fall prevention.
Topics: Aged; Exercise; Gait; Humans; Physical Therapy Modalities; Postural Balance; Risk Factors
PubMed: 35976297
DOI: 10.1590/0004-282X-ANP-2022-S107 -
Current Diabetes Reviews 2021Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% patients suffering from diabetes. There is the involvement of both... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% patients suffering from diabetes. There is the involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability.
OBJECTIVE
The aim of this study is to assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus.
METHODS
Mean changes in Timed Up and Go test (TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on the PEDro Rating scale. The risk of bias was assessed by the Cochrane collaboration tool of risk of bias. Included studies had a low risk of bias. Sixteen RCT's were included for the meta-analysis.
RESULTS
Results of meta-analysis showed that there was a statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I2 = 84%, p < 0.00001) in the experimental group as compared to control group. There was a statistically significant difference in Berg Balance Scale scores and heterogeneity of I2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I2 = 100%, p =0.01 and eyes closed, heteogeneity I2 = 0%, p =0.01). Sensitivity analysis causes a change in heterogeneity.
CONCLUSION
It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training, etc. have a significant effect on improving balance and posture in diabetic neuropathy.
Topics: Diabetes Mellitus; Diabetic Neuropathies; Exercise; Exercise Therapy; Humans; Postural Balance; Posture; Time and Motion Studies
PubMed: 32619175
DOI: 10.2174/1573399816666200703190437 -
Physiotherapy Research International :... Apr 2023Mirror therapy (MT) has been proposed to be an effective therapeutic regimen for lower limb stroke rehabilitation. This review is the first to evaluate the efficacy of... (Review)
Review
OBJECTIVE
Mirror therapy (MT) has been proposed to be an effective therapeutic regimen for lower limb stroke rehabilitation. This review is the first to evaluate the efficacy of MT in subacute and chronic stroke for lower-limb motor functions, balance and gait focusing on particular stage of stroke with specific outcome measures.
METHODS
According to PRISMA guidelines, all relevant sources were searched from 2005 to 2020 using "PIOD" framework. Search methods included electronic database, hand and citation searching. Screening and quality assessment was performed by two individual reviewers. Data was extracted and synthesised from 10 studies. Thematic analysis was considered, random-effect models were used and pooled analysis was performed using forest plots.
RESULTS
For motor recovery, MT showed statistically significant effects compared to control group using Fugl-Meyer Assessment and Brunnstorm stages as outcome measures (SMD 0.59; 95% CI 0.29 to 0.88; p < 0.0001; I = 0%). Statistical significant improvement was reported for balance in MT compared to control using Berg Balance Scale and Biodex in pooled analysis (SMD 0.47; 95% CI 0.04 to 0.90; p = 0.03; I = 0%). When compared with electric stimulation and action-observation training MT showed no signifiant improvement for balance (SMD -0.21; 95% CI -0.91 to 0.50; p = 0.56; I = 39%). For gait, MT showed statistical and clinical significant improvement compared to control group (SMD 1.13; 95% CI 0.27-2.00; p = 0.01; I = 84%) and when compared to action-observation training and electrical stimulation, presented statistical improvement using 10-m walk test and Motion Capture system (SMD -0.65; 95% CI -1.15 to -0.15; p = 0.01; I = 0%).
CONCLUSION
This review has shown that MT is effective in lower-limb motor recovery, balance and gait in subacute and chronic stroke in patients 18 years or above with no severe cognitive disorder, MMSE score ≥24 and FAC level ≥2. MT could be used for 30 min/day, 5 days/week for 4 weeks, as stand-alone for motor recovery and balance or as an adjunct with electric stimulation for gait for beneficial effects.
Topics: Humans; Mirror Movement Therapy; Recovery of Function; Postural Balance; Stroke; Gait; Stroke Rehabilitation; Lower Extremity; Treatment Outcome
PubMed: 36880119
DOI: 10.1002/pri.1997 -
Brazilian Journal of Physical Therapy 2022Facial palsy (FP) is defined as an injury of the seventh cranial nerve pair, partial or total, which can be classified as central or peripheral. Proprioceptive... (Review)
Review
BACKGROUND
Facial palsy (FP) is defined as an injury of the seventh cranial nerve pair, partial or total, which can be classified as central or peripheral. Proprioceptive neuromuscular facilitation (PNF) is primarily used in the functional recovery of upper and lower limb conditions, however the technique has also been used for FP.
OBJECTIVE
To analyze the effect of PNF in the treatment of dysfunctions in FP.
METHODS
Ten databases including BVS, CENTRAL Cochrane, CINAHL, PEDro, PubMed, Scielo, ScienceDirect, SCOPUS, Web of Science, and Google Scholar were comprehensively searched for dates prior to April 2021. Randomized controlled trials of PNF in individuals with dysfunctions caused by facial paralysis were eligible. Outcomes measures were recovery rate and clinical recovery, both measured by using the House Brackmann Scale. Recovery time was measured in days and synkinesis assessed with the Synkinesis Assessment Questionnaire.
RESULTS
A total of 184 patients were included. In general, the included studies have low methodological quality. None of the five studies used PNF as the sole intervention. In all of the included studies PNF was used in combination with other interventions. Our findings show very low evidence that PNF is more effective than minimal intervention for treating FP.
CONCLUSION
We conclude that given the limited number of studies included and the low methodological quality presented, recommendations based on these studies should be interpreted with caution. The effects of PNF on facial paralysis are not clear.
Topics: Humans; Facial Paralysis; Muscle Stretching Exercises; Synkinesis; Recovery of Function
PubMed: 36279766
DOI: 10.1016/j.bjpt.2022.100454 -
Physiotherapy Theory and Practice Oct 2020In patients with Parkinson's disease (PD), the ability to perform simultaneous tasks may be impaired. However, there is no consensus as to whether the strategy of use...
In patients with Parkinson's disease (PD), the ability to perform simultaneous tasks may be impaired. However, there is no consensus as to whether the strategy of use dual task (DT) should be used with PD patients during gait and balance training because DT can increase the risk of falls. Therefore, it is necessary to critically analyze the relevant studies and evaluate the indications for the use of DT and its effects as a therapeutic strategy. The aim of this systematic review was to explore the effects of DT gait and balance training in individuals with PD. A total of 602 studies were found. After applying the eligibility criteria, seven studies were selected (three clinical trials, one uncontrolled clinical trial, and three pilot studies). Despite the poor methodological quality, the studies indicated the use of DT during gait and balance training may be beneficial for people with mild to moderate PD in compare of single-task or no intervention. The use of DT during training presented benefits related to gait (gait speed, step length and cadence) and balance (mediolateral and anteroposterior balance in closed-eyes tests). The current scenario shows that using DT in the training seems not to be harmful and could be part of the rehabilitation of PD patients. Further clinical trials are needed to confirm the findings, and it would be the most importance that these studies stratify individuals with degrees of disease severity to verify the effect of using the DT during training.
Topics: Exercise Therapy; Gait Disorders, Neurologic; Humans; Parkinson Disease; Postural Balance; Task Performance and Analysis
PubMed: 30501424
DOI: 10.1080/09593985.2018.1551455 -
Medicina (Kaunas, Lithuania) May 2022: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both... (Review)
Review
: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. : A systematic literature search was performed in the online databases PubMed, PEDro and Cochrane Library using the following search keywords: "prehabilitation", "preoperative care", and "total hip replacement". : A total of 400 potentially relevant studies were identified. After title, abstract and full-text screening, 14 studies fulfilled all inclusion criteria and were included in this systematic review. Patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention in the following tests: six-minute walk test, Timed Up and Go test, chair-rise test, and stair climbing. For various other assessments, such as the widely used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip disability and Osteoarthritis Outcome Score (HOOS), 36-item Short Form Survey (SF-36) and Barthel Index, no significant differences in outcomes regarding exercise therapy were reported in the included studies. Education alone had no effect on postoperative outcomes. : Prehabilitation in the form of a prehabilitation exercise therapy is an effective prehabilitation measure with regard to postoperative physical functioning, while prehabilitation in the form of education has no significant effects. No negative effects of prehabilitation on the outcomes examined were reported.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Osteoarthritis; Postural Balance; Preoperative Care; Preoperative Exercise; Time and Motion Studies
PubMed: 35744005
DOI: 10.3390/medicina58060742 -
Otology & Neurotology : Official... Aug 2021Vertigo is a debilitating symptom, leading to increased healthcare utilization and lost patient productivity. Vestibular rehabilitation is used to manage the symptomatic...
INTRODUCTION
Vertigo is a debilitating symptom, leading to increased healthcare utilization and lost patient productivity. Vestibular rehabilitation is used to manage the symptomatic manifestations of vestibular disease. However, vestibular rehabilitation is limited by accessibility and time commitment. Recently, virtual reality has been described as a vestibular rehabilitation tool that may circumvent these barriers to treatment. Despite this, the efficacy of virtual reality for vestibular rehabilitation remains unclear. This study aims to review and summarize the current literature on the effectiveness of virtual reality-based vestibular rehabilitation.
METHODS
A systematic review of the MEDLINE, EMBASE, and Alternative and Complementary Medicine databases was conducted for prospective studies describing virtual reality-based vestibular rehabilitation.
RESULTS
Our search identified 382 unique articles. Six randomized controlled trials and four other studies were ultimately included. Study sample sizes ranged from 13 to 70 participants and varied in diagnoses from any unilateral peripheral vertigo to specific pathologies. Different virtual reality interventions were used. Comparator groups ranged from supervised vestibular rehabilitation to independent Cawthorne-Cooksey exercises. Outcomes consisted of validated questionnaires, objective clinical tests, and measurements of balance or reflexes.
CONCLUSION
The studies reviewed in this study are preliminary evidence to suggest the benefit of virtual reality-based vestibular rehabilitation. However, these studies are limited by their inclusion criteria, heterogeneity, comparator design, and evidence-based clinical outcomes. Further research should address these limitations.
Topics: Humans; Postural Balance; Prospective Studies; Vertigo; Vestibular Diseases; Virtual Reality
PubMed: 33782257
DOI: 10.1097/MAO.0000000000003155 -
JAMA Network Open Sep 2020Falls increase morbidity and mortality in adults 65 years and older. The role of dance-based mind-motor activities in preventing falls among healthy older adults is not... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Falls increase morbidity and mortality in adults 65 years and older. The role of dance-based mind-motor activities in preventing falls among healthy older adults is not well established.
OBJECTIVE
To assess the effectiveness of dance-based mind-motor activities in preventing falls.
DATA SOURCES
Systematic search included the PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsychINFO, Abstracts in Social Gerontology, AgeLine, AMED, and Scopus databases from database inception to February 18, 2018, using the Medical Subject Headings aged 65 and older, accidental falls, and dancing.
STUDY SELECTION
This systematic review and meta-analysis included 29 randomized clinical trials that evaluated a dance-based mind-motor activity in healthy older adults with regard to fall risk, fall rate, or well-established measures of physical function in the domains of balance, mobility, and strength. The included studies targeted participants without comorbidities associated with higher fall risk. Dance-based mind-motor activities were defined as coordinated upright mind-motor movements that emphasize dynamic balance, structured through music or an inner rhythm (eg, breathing) and distinctive instructions or choreography, and that involve social interaction.
DATA EXTRACTION AND SYNTHESIS
Standardized independent screening, data extraction, and bias assessment were performed. Data were pooled using random-effects models. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline.
MAIN OUTCOMES AND MEASURES
Primary outcomes were risk of falling and rate of falls. For the secondary end points of physical function (balance, mobility, and strength), standardized mean differences (SMDs) were estimated and pooled (Hedges g).
RESULTS
In this systematic review and meta-analysis of 29 randomized clinical trials, dance-based mind-motor activities were significantly associated with reduced (37%) risk of falling (risk ratio, 0.63; 95% CI, 0.49-0.80; 8 trials, 1579 participants) and a significantly reduced (31%) rate of falls (incidence rate ratio, 0.69; 95% CI, 0.53-0.89; 7 trials, 2012 participants). In addition, dance-based mind-motor activities were significantly associated with improved physical function in the domains of balance (standardized mean difference [SMD], 0.62; 95% CI, 0.33-0.90; 15 trials, 1476 participants), mobility (SMD, -0.56; 95% CI, -0.81 to -0.31; 13 trials, 1379 participants), and lower body strength (SMD, 0.57; 95% CI, 0.23-0.91; 13 trials, 1613 participants) but not upper body strength (SMD, 0.18; 95% CI, -0.03 to 0.38; 4 trials, 414 participants).
CONCLUSION AND RELEVANCE
Among healthy older adults, dance-based mind-motor activities were associated with decreased risk of falling and rate of falls and improved balance, mobility, and lower body strength. This type of activity may be useful in preventing falls in this population.
Topics: Accidental Falls; Aged; Aged, 80 and over; Dance Therapy; Dancing; Female; Healthy Volunteers; Humans; Independent Living; Male; Muscle Strength; Physical Functional Performance; Postural Balance; Psychomotor Performance; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 32975570
DOI: 10.1001/jamanetworkopen.2020.17688 -
The Physician and Sportsmedicine Nov 2020Ankle sprains are a common sports-related injury, and female athletes are more likely to sustain this injury than their male counterparts. Previous reviews have...
Ankle sprains are a common sports-related injury, and female athletes are more likely to sustain this injury than their male counterparts. Previous reviews have evaluated the efficacy of prevention programs in reducing ankle sprains in athletes, but no reviews have specifically focused on female athletes. The objective of this systematic review was to examine the sex-specific effectiveness of neuromuscular training (NMT) programs in reducing the risk of ankle sprains in female athletes. A search of PubMed, Ovid Medline, Embase, and Web of Science databases was performed using the terms: . Studies selected for inclusion were written in English, evaluated female athletes in organized athletics or reported female-specific data for mixed-sex cohorts, included a non-NMT comparison, and used ankle injury rate outcome measures. Seven articles were selected for inclusion, which evaluated a combined 5,187 female basketball, handball, volleyball, soccer, and floorball players. Two studies reported significant differences between NMT participants and controls, concluding the greatest effects were observed in preventing non-contact ankle sprains. The remaining 5 studies, although not statistically significant, revealed an evident trend toward the efficacy of ankle injury prevention with NMT programs. Current available evidence supports the efficacy of NMT in preventing ankle sprains in female athletes. When designing NMT programs, investigators should consider utilizing comprehensive approaches that incorporate strength, balance, plyometric, and agility training as the studies with significant findings created comprehensive NMT programs. Further investigations into sport- and female-specific programs are warranted.
Topics: Ankle Injuries; Athletic Injuries; Basketball; Female; Humans; Physical Conditioning, Human; Proprioception; Soccer; Sprains and Strains; Volleyball
PubMed: 32067546
DOI: 10.1080/00913847.2020.1732246 -
International Journal of Environmental... Oct 2022The Feldenkrais Method (FM) is based on the learning of alternative movement patterns, carried out in an active and conscious way, which may have therapeutic effects.... (Meta-Analysis)
Meta-Analysis Review
The Feldenkrais Method (FM) is based on the learning of alternative movement patterns, carried out in an active and conscious way, which may have therapeutic effects. The objective of this systematic review is to identify the populations and conditions for which the FM can be used in physiotherapy and to determine the intervention modalities. Research in PubMed, Cochrane and PEDro databases was performed. The PEDro scale was employed to assess the methodological quality. Meta-analyses (MA) were performed whenever populations and outcome measures were comparable in at least two studies. Sixteen studies were included. In elderly people, in three of the four selected trials, the FM group significantly improved gait, balance, mobility and quality of life. The MA showed significant differences between interventions in the Timed-Up-and-Go test [Cohen's d = -1.14, 95% CI (-1.78, -0.49), = 0.0006]. FM significantly improved pain, functional balance, and perceived exertion in three trials performed on subjects with cervical, dorsal, or shoulder pain. FM demonstrated improvements in pain, disability, quality of life and interoceptive awareness in the three trials performed in subjects with chronic low back pain. In multiple sclerosis, an improvement in functional capacity was observed in the two selected studies. The MA showed no significant differences between groups in the Function ( = 0.97) and Control ( = 0.82) dimensions of the Multiple Sclerosis Self-Efficacy Scale. In Parkinson's disease, two studies showed significant effects on quality of life and functional tests. In conclusion, evidence shows that FM has therapeutic effects comparable to other physiotherapy techniques in patients with spine pain. In addition, improvements in mobility and balance were seen in the elderly and people with neurodegenerative diseases.
Topics: Humans; Aged; Postural Balance; Quality of Life; Time and Motion Studies; Randomized Controlled Trials as Topic; Physical Therapy Modalities; Low Back Pain; Multiple Sclerosis
PubMed: 36360614
DOI: 10.3390/ijerph192113734