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The Journal of Manual & Manipulative... Feb 2022To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF).
METHODS
An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF.
RESULTS
Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was -10.2 points (p = 0.02), the DASH was -9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3-7 days was -14.58 ml (p = 0.03), at 17-21 days -17.96 ml (p = 0.009), at 33-42 days -15.34 ml (p = 0.003), and at 63-68 days -13.97 ml (p = 0.002).
CONCLUSION
There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.
Topics: Exercise Therapy; Humans; Musculoskeletal Manipulations; Physical Therapy Modalities; Radius Fractures; Range of Motion, Articular
PubMed: 34668847
DOI: 10.1080/10669817.2021.1992090 -
Medicine Apr 2021Prolonged hospitalization and immobility of critical care patients elevate the risk of long-term physical and cognitive impairments. However, the therapeutic effects of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prolonged hospitalization and immobility of critical care patients elevate the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. We conducted a meta-analysis to assess the effects of early mobilization therapy on cardiac surgery patients in the intensive care unit (ICU).
METHODS
PubMed, Excerpta Medica database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were comprehensively searched from their inception to September 2018. Randomized controlled trials were included if patients were adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who were treated with experimental physiotherapy initiated in the ICU (pre, post, or peri-operative). Data were extracted by 2 reviewers independently using a pre-constructed data extraction form. Length of ICU and hospital stay was evaluated as the primary outcomes. Physical function and adverse events were assessed as the secondary outcomes. Review Manager 5.3 (RevMan 5.3) was used for statistical analysis. For all dichotomous variables, relative risks or odds ratios with 95% confidence intervals (CI) were presented. For all continuous variables, mean differences (MDs) or standard MDs with 95% CIs were calculated.
RESULTS
The 5 studies with a total of 652 patients were included in the data synthesis final meta-analysis. While a slight favorable effect was detected in 3 out of the 5 studies, the overall effects were not significant, even after adjusting for heterogeneity.
CONCLUSIONS
This population-specific evaluation of the efficacy of early mobilization to reduce hospitalization duration suggests that intervention may not universally justify the labor barriers and resource costs in patients undergoing non-emergency cardiac surgery.
PROSPERO RESEARCH REGISTRATION IDENTIFYING NUMBER
CRD42019135338.
Topics: Cardiac Surgical Procedures; Early Ambulation; Humans; Intensive Care Units; Length of Stay; Physical Functional Performance; Physical Therapy Modalities; Randomized Controlled Trials as Topic
PubMed: 33847630
DOI: 10.1097/MD.0000000000025314 -
International Journal of Environmental... May 2022Background: Hand trauma requires specific rehabilitation protocol depending on the different structures involved. According to type of surgical intervention, and for... (Meta-Analysis)
Meta-Analysis
Background: Hand trauma requires specific rehabilitation protocol depending on the different structures involved. According to type of surgical intervention, and for monitoring pain and edema, post-operative rehabilitation of a hand that has experienced trauma involves different timings for immobilization. Several protocols have been used to reduce immobilization time, and various techniques and methods are adopted, depending on the structures involved. Objective: To measure the effects of mirror neurons-based rehabilitation techniques in hand injuries throughout a systematic review and meta-analysis. Methods: The protocol was accepted in PROSPERO database. A literature search was conducted in Cinahl, Scopus, Medline, PEDro, OTseeker. Two authors independently identified eligible studies, based on predefined inclusion criteria, and extracted the data. RCT quality was assessed using the JADAD scale. Results: Seventy-nine suitable studies were screened, and only eleven were included for qualitative synthesis, while four studies were selected for quantitative analysis. Four studies were case reports/series, and seven were RCTs. Nine investigate the effect of Mirror Therapy and two the effect of Motor Imagery. Quantitative analyses revealed Mirror Therapy as effective for hand function recovery (mean difference = −14.80 95% Confidence Interval (CI) = −17.22, −12.38) (p < 0.00001) in the short term, as well as in long follow-up groups (mean difference = −13.11 95% Confidence Interval (CI) = −17.53, −8.69) (p < 0.00001). Clinical, but not statistical, efficacy was found for manual dexterity (p = 0.15), while no benefit was reported for range of motion. Conclusions: Mirror neurons-based rehabilitation techniques, combined with conventional occupational and physical therapy, can be a useful approach in hand trauma. Mirror therapy seems to be effective for hand function recovery, but, for motor imagery and action observation, there is not sufficient evidence to recommend its use. Further research on the efficacy of the mirror neurons-based technique in hand injury is recommended.
Topics: Humans; Hand Injuries; Mirror Neurons; Neurological Rehabilitation; Physical Therapy Modalities; Recovery of Function
PubMed: 35564920
DOI: 10.3390/ijerph19095526 -
International Journal of Environmental... Dec 2022This systematic review investigated the effects of high-intensity exercise (HIE) on lower limb (LL) function in acute and subacute stroke patients. A systematic... (Review)
Review
This systematic review investigated the effects of high-intensity exercise (HIE) on lower limb (LL) function in acute and subacute stroke patients. A systematic electronic search was performed in PubMed, CINAHL and the Web of Science from inception to 30 June 2022. Outcomes examined included LL function and measures of activities of daily living such as the Barthel index, 6 min walk test (6MWT), gait speed and Berg balance scale (BBS), adverse events and safety outcomes. The methodological quality and the quality of evidence for each study was assessed using the PEDro scale and the Risk of Bias 2 tool (RoB 2). HIE was defined as achieving at least 60% of the heart rate reserve (HRR) or VO peak, 70% of maximal heart rate (HR), or attaining a score of 14 or more on the rate of perceived exertion Borg scale (6-20 rating scale). This study included randomized controlled trials (RCTs) which compared an intervention group of HIE to a control group of lower intensity exercise, or no intervention. All participants were in the acute (0-3 months) and subacute (3-6 months) stages of stroke recovery. Studies were excluded if they were not RCTs, included participants from a different stage of stroke recovery, or if the intervention did not meet the pre-defined HIE criteria. Overall, seven studies were included that used either high-intensity treadmill walking, stepping, cycling or overground walking exercises compared to either a low-intensity exercise ( = 4) or passive control condition ( = 3). Three studies reported significant improvements in 6MWT and gait speed performance, while only one showed improved BBS scores. No major adverse events were reported, although minor incidents were reported in only one study. This systematic review showed that HIE improved LL functional task performance, namely the 6MWT and gait speed. Previously, there was limited research demonstrating the efficacy of HIE early after stroke. This systematic review provides evidence that HIE may improve LL function with no significant adverse events report for stroke patients in their acute and subacute rehabilitation stages. Hence, HIE should be considered for implementation in this population, taking into account the possible benefits in terms of functional outcomes, as compared to lower intensity interventions.
Topics: Humans; Stroke Rehabilitation; Stroke; Exercise; Walking; Exercise Therapy; Lower Extremity; Randomized Controlled Trials as Topic
PubMed: 36612471
DOI: 10.3390/ijerph20010153 -
Journal of Sport Rehabilitation Mar 2022Patellar tendinopathy presents with persistent tendon pain located in the lower pole of the patella and loss of function related to mechanical load. Although its...
CONTEXT
Patellar tendinopathy presents with persistent tendon pain located in the lower pole of the patella and loss of function related to mechanical load. Although its pathogenesis is not completely clear, conservative treatment including exercise is the main intervention of patellar tendinopathy treatment.
OBJECTIVE
To describe the efficacy of patellar tendinopathy management through therapeutic exercise, and control and monitoring of loads.
EVIDENCE ACQUISITION
MEDLINE, WoS, Cochrane Plus, PEDro, and the gray literature were searched from inception to July 2021. Based on the PICO strategy, the inclusion criteria were clinical trials published in English or Spanish; outcomes of function, pain, and strength; patients with patellar tendinopathy with no age or gender limitations; using an active intervention; and at least a methodological quality equal to or greater than 3 points on the Jadad scale. All data were analyzed by 2 independent reviewers (P.N.-M. and D.H.-G.). Studies were qualitatively synthesized using a descriptive synthesis. The methodological quality and risk of bias assessment were performed with the PEDro and Jadad scale, respectively.
EVIDENCE SYNTHESIS
A total of 136 articles were identified, of which 12 met the eligibility criteria. All of them were regarded as presenting a moderate risk of bias and their methodological quality was considered acceptable to good. Recovering patellar tendinopathy with therapeutic exercise seems to significantly improve function, pain, and strength after intervention and even lasted over time.
CONCLUSION
A treatment based on load monitoring and physical exercise has proven to be effective in rehabilitating patellar tendinopathy, with positive results in the short and medium term.
Topics: Exercise; Exercise Therapy; Humans; Pain; Patella; Tendinopathy
PubMed: 34942594
DOI: 10.1123/jsr.2021-0117 -
JAMA Network Open Nov 2021Persistent (>4 weeks) postconcussion symptoms (PPCS) are challenging for both patients and clinicians. There is uncertainty about the effect of commonly applied... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Persistent (>4 weeks) postconcussion symptoms (PPCS) are challenging for both patients and clinicians. There is uncertainty about the effect of commonly applied nonpharmacological treatments for the management of PPCS.
OBJECTIVE
To systematically assess and summarize evidence for outcomes related to 7 nonpharmacological interventions for PPCS in adults (aged >18 years) and provide recommendations for clinical practice.
DATA SOURCES
Systematic literature searches were performed via Embase, MEDLINE, PsycINFO, CINAHL, PEDro, OTseeker, and Cochrane Reviews (via MEDLINE and Embase) from earliest possible publication year to March 3, 2020. The literature was searched for prior systematic reviews and primary studies. To be included, studies had to be intervention studies with a control group and focus on PPCS.
STUDY SELECTION
A multidisciplinary guideline panel selected interventions based on frequency of use and need for decision support among clinicians, including early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and back, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. To be included, studies had to be intervention studies within the areas of the predefined clinical questions, include a control group, and focus on symptoms after concussion or mild traumatic brain injury.
DATA EXTRACTION AND SYNTHESIS
Extraction was performed independently by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data abstraction and data quality assessment. Included studies were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Cochrane Risk of Bias (randomized clinical trials) tool. Meta-analysis was performed for all interventions where possible. Random-effects models were used to calculate pooled estimates of effects. The level and certainty of evidence was rated and recommendations formulated according to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework.
MAIN OUTCOMES AND MEASURES
All outcomes were planned before data collection began according to a specified protocol. The primary outcomes were the collective burden of PPCS and another outcome reflecting the focus of a particular intervention (eg, physical functioning after graded exercise intervention).
RESULTS
Eleven systematic reviews were identified but did not contribute any primary studies; 19 randomized clinical trials comprising 2007 participants (1064 women [53.0%]) were separately identified and included. Evidence for the 7 interventions ranged from no evidence meeting the inclusion criteria to very low and low levels of evidence. Recommendations were weak for early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of the neck and back, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. No relevant evidence was identified for oculomotor vision treatment, so the panel provided a good clinical practice recommendation based on consensus.
CONCLUSIONS AND RELEVANCE
Based on very low to low certainty of evidence or based on consensus, the guideline panel found weak scientific support for commonly applied nonpharmacological interventions to treat PPCS. Results align with recommendations in international guidelines. Intensified research into all types of intervention for PPCS is needed.
Topics: Adult; Exercise; Humans; Middle Aged; Physical Therapy Modalities; Post-Concussion Syndrome
PubMed: 34751759
DOI: 10.1001/jamanetworkopen.2021.32221 -
The Cochrane Database of Systematic... Nov 2019Many survivors of stroke report attentional impairments, such as diminished concentration and distractibility. However, the effectiveness of cognitive rehabilitation for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many survivors of stroke report attentional impairments, such as diminished concentration and distractibility. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain.This is an update of the Cochrane Review first published in 2000 and previously updated in 2013.
OBJECTIVES
To determine whether people receiving cognitive rehabilitation for attention problems 1. show better outcomes in their attentional functions than those given no treatment or treatment as usual, and 2. have a better functional recovery, in terms of independence in activities of daily living, mood, and quality of life, than those given no treatment or treatment as usual.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PsycBITE, REHABDATA and ongoing trials registers up to February 2019. We screened reference lists and tracked citations using Scopus.
SELECTION CRITERIA
We included controlled clinical trials (CCTs) and randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. We did not consider listening to music, meditation, yoga, or mindfulness to be a form of cognitive rehabilitation. We only considered trials that selected people with demonstrable or self-reported attentional deficits. The primary outcomes were measures of global attentional functions, and secondary outcomes were measures of attentional domains (i.e. alertness, selective attention, sustained attention, divided attention), functional abilities, mood, and quality of life.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials, extracted data, and assessed the risk of bias. We used the GRADE approach to assess the certainty of evidence for each outcome.
MAIN RESULTS
We included no new trials in this update. The results are unchanged from the previous review and are based on the data of six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no convincing effect of cognitive rehabilitation on subjective measures of attention either immediately after treatment (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) -0.03 to 1.08; P = 0.06; 2 studies, 53 participants; very low-quality evidence) or at follow-up (SMD 0.16, 95% CI -0.23 to 0.56; P = 0.41; 2 studies, 99 participants; very low-quality evidence). People receiving cognitive rehabilitation (when compared with control) showed that measures of divided attention recorded immediately after treatment may improve (SMD 0.67, 95% CI 0.35 to 0.98; P < 0.0001; 4 studies, 165 participants; low-quality evidence), but it is uncertain that these effects persisted (SMD 0.36, 95% CI -0.04 to 0.76; P = 0.08; 2 studies, 99 participants; very low-quality evidence). There was no evidence for immediate or persistent effects of cognitive rehabilitation on alertness, selective attention, and sustained attention. There was no convincing evidence for immediate or long-term effects of cognitive rehabilitation for attentional problems on functional abilities, mood, and quality of life after stroke.
AUTHORS' CONCLUSIONS
The effectiveness of cognitive rehabilitation for attention deficits following stroke remains unconfirmed. The results suggest there may be an immediate effect after treatment on attentional abilities, but future studies need to assess what helps this effect persist and generalise to attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.
Topics: Activities of Daily Living; Attention; Cognition Disorders; Cognitive Behavioral Therapy; Humans; Quality of Life; Randomized Controlled Trials as Topic; Recovery of Function; Stroke; Stroke Rehabilitation
PubMed: 31706263
DOI: 10.1002/14651858.CD002842.pub3 -
International Journal of Nursing Studies Jun 2022Heart failure can be classified into chronic heart failure and acute heart failure. Rapid onsets or worsening symptoms characterize acute heart failure, while... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Heart failure can be classified into chronic heart failure and acute heart failure. Rapid onsets or worsening symptoms characterize acute heart failure, while progressive symptoms characterize chronic heart failure. Exercise-based cardiac rehabilitation is recommended for chronic heart failure patients, yet controversies on whether early exercise is safe and advantageous for acute heart failure patients remain unclear.
OBJECTIVES
We performed a systematic review and meta-analysis to explore the effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients.
METHODS
We searched PubMed, Web Of Science, Embase, the Cochrane Library, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Dataset and SinoMed Dataset (from the earliest date available to August 2021) for randomized controlled trials that evaluated the effects of early exercise in acute heart failure patients. Studies were selected according to inclusion and exclusion criteria. Data synthesis was performed with Review Manager 5.2.
RESULTS
13 studies met the study criteria, including 1466 patients. Compared to the control group [routine care], early exercise improved 6 min walk distance[mean difference = 33.10, 95% CI (31.43, 34.77), P < 0.001], short physical performance battery scores[mean difference = 1.40, 95% CI (1.36, 1.44), P < 0.001], N-terminal pro-B-type natriuretic peptide[mean difference = -58.84, 95% CI (-89.25, -28.43), P < 0.001], quality of life assessed by Minnesota heart failure quality of life questionnaire [mean difference = -6.55, 95% CI (-9.99, -3.11), P = 0.0002], quality of life assessed by Kansas city cardiomyopathy questionnaire [mean difference = 7.00, 95% CI (6.58, 7.42), P < 0.001], activities of daily living [mean difference = 4.43, 95% CI (2.20, 6.65), P < 0.001], and all-cause related readmission rate [mean difference = 0.69, 95% CI (0.51, 0.94), P = 0.02]. No significant difference in left ventricular ejection fraction [mean difference = 1.93, 95% CI (-2.19, 6.05), P = 0.36], heart failure-related readmission rate [mean difference = 0.76, 95% CI (0.50, 1.17), P = 0.21] and all-cause mortality [mean difference = 0.63, 95% CI (0.18, 2.24), P = 0.47] was found between early exercise group and control group. No adverse events occurred during the intervention.
CONCLUSION
Compared to routine care, early exercise could significantly improve the effect of physical capacity, physiological outcomes and clinical outcomes in acute heart failure patients, and appeared to be safe.
Topics: Activities of Daily Living; Cardiac Rehabilitation; Chronic Disease; Heart Failure; Humans; Quality of Life; Stroke Volume; Ventricular Function, Left
PubMed: 35421772
DOI: 10.1016/j.ijnurstu.2022.104237 -
International Journal of Environmental... Feb 2023Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate... (Review)
Review
UNLABELLED
Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed.
METHODS
We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group.
RESULTS
a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the studies, results proved to be similar for telerehabilitation and face-to-face rehabilitation in both groups when measuring functionality, quality of life and satisfaction.
CONCLUSION
this review generally concludes that intervention through telerehabilitation programs is as feasible and efficient as conventional physiotherapy in terms of functionality level and quality of life. In addition, telerehabilitation shows high levels of patients' satisfaction and adherence, being values equivalent to traditional rehabilitation.
Topics: Humans; Quality of Life; Telerehabilitation; Physical Therapy Modalities; Exercise Therapy; Patient Satisfaction
PubMed: 36901375
DOI: 10.3390/ijerph20054358 -
Complementary Therapies in Clinical... Feb 2022and purpose: Although proprioceptive neuromuscular facilitation (PNF) exercises are used in rehabilitation practice, their effects in patients with low back pain (LBP)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
and purpose: Although proprioceptive neuromuscular facilitation (PNF) exercises are used in rehabilitation practice, their effects in patients with low back pain (LBP) remain unclear. This study aimed to investigate the efficacy of PNF training for pain and disability in patients with LBP.
METHODS
In this systematic review, we searched five databases from the earliest date available to October 2020. Three comparisons were performed: PNF versus control, PNF versus core strengthening, and PNF versus conventional physical therapy.
RESULTS
Sixteen studies met the eligibility criteria (722 patients). PNF training improved pain (standardized mean difference [SMD]: -2.6; 95% confidence interval [CI]: -4.2 to -0.9, n = 174) and disability (SMD: -3.29; 95% CI: -5.3 to -1.3, n = 144) compared to the control. PNF training also yielded a greater benefit for pain reduction (mean difference [MD]: -1.8, 95% CI: -2.2 to -0.3, n = 177) and disability improvement (MD: -6.6, 95% CI: -9.3 to -3.8, n = 113) than did core strengthening.
CONCLUSION
PNF training seems to be a useful strategy for decreasing pain and improving disability in patients with LBP. However, the quality of evidence for the outcomes of both pain and disability was low to moderate.
Topics: Chronic Pain; Humans; Low Back Pain; Muscle Stretching Exercises; Physical Therapy Modalities
PubMed: 34852989
DOI: 10.1016/j.ctcp.2021.101505