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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 -
Spinal Cord Jun 2023Systematic review and meta-analysis. Spinal cord injury (SCI) is a pathological condition that provokes the loss of one or more body functions due to an injury to the... (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis. Spinal cord injury (SCI) is a pathological condition that provokes the loss of one or more body functions due to an injury to the spinal cord as a result of trauma or disease. Hydrotherapy plays a key role in the rehabilitation of neurological patients due to the properties of water environments.
OBJECTIVES
The goal of this study was to evaluate the efficacy of hydrotherapy in patients who suffer from SCIs.
METHODS
We searched 5 different databases: CINAHL, PubMed, Scopus, Web of Science, and PEDro for studies to include. Only randomized controlled trials (RCTs) published in English were considered. To evaluate the risk of bias, Jadad and PEDro scales were used.
RESULTS
Eleven Randomized Controlled Trials were included, and 3 articles remained to be analyzed. According to the evaluation through Cochrane Risk of Bias tool, one study had a high level of quality. The remaining 2 studies achieved a score indicative of a low level of quality. A total of 71 individuals with SCI were included in the studies; age and level of injury varied in each study. The outcome measures used in the studies were: Functional Independence Measure (FIM), Ashworth scale, CardioTouch 3000 s in sitting position and Quark CPET.
CONCLUSION
The aquatic environment provides a rehabilitation tool able to facilitate movement, physical and cardiovascular exercise, resistance training, and body relaxation.
Topics: Humans; Spinal Cord Injuries; Aquatic Therapy; Physical Therapy Modalities; Outcome Assessment, Health Care
PubMed: 36966260
DOI: 10.1038/s41393-023-00892-4 -
JAMA Sep 2019Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community. (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community.
OBJECTIVE
To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community.
DESIGN, SETTING, AND PARTICIPANTS
Parallel, 2-group randomized clinical trial conducted at 3 US clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hip fracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily activities at the time of enrollment. A total of 210 participants were randomized and reassessed 16 and 40 weeks later.
INTERVENTIONS
The training intervention (active treatment) (n = 105) included aerobic, strength, balance, and functional training. The active control group (n = 105) received transcutaneous electrical nerve stimulation and active range-of-motion exercises. Both groups received 2 to 3 home visits from a physical therapist weekly for 16 weeks; nutritional counseling; and daily vitamin D (2000 IU), calcium (600 mg), and multivitamins.
MAIN OUTCOMES AND MEASURES
The primary outcome (community ambulation) was defined as walking 300 m or more in 6 minutes at 16 weeks after randomization. The study was designed to test a 1-sided hypothesis of superiority of training compared with active control.
RESULTS
Among 210 randomized participants (mean age, 80.8 years; 161 women [76.7%]), 197 (93.8%) completed the trial (187 [89.0%] by completing the 6-minute walk test at 16 weeks and 10 [4.8%] by adjudication of the primary outcome). Among these, 22 of 96 training participants (22.9%) and 18 of 101 active control participants (17.8%) (difference, 5.1% [1-sided 97.5% CI, -∞ to 16.3%]; 1-sided P = .19) became community ambulators. Seventeen training participants (16.2%) and 15 control participants (14.3%) had 1 or more reportable adverse events during the intervention period. The most common reportable adverse events reported were falls (training: 6 [5.7%], control: 4 [3.8%]), femur/hip fracture (2 in each group), pneumonia (training: 2, control: 0), urinary tract infection (training: 2, control: 0), dehydration (training: 0, control: 2), and dyspnea (training: 0, control: 2).
CONCLUSIONS AND RELEVANCE
Among older adults with a hip fracture, a multicomponent home-based physical therapy intervention compared with an active control that included transcutaneous electrical nerve stimulation and active range-of-motion exercises did not result in a statistically significant improvement in the ability to walk 300 m or more in 6 minutes after 16 weeks.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01783704.
Topics: Aged; Aged, 80 and over; Exercise Therapy; Female; Hip Fractures; Home Care Services; Humans; Male; Physical Therapy Modalities; Range of Motion, Articular; Transcutaneous Electric Nerve Stimulation; Walk Test
PubMed: 31503309
DOI: 10.1001/jama.2019.12964 -
Physical Therapy May 2023Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of pulmonary rehabilitation to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of pulmonary rehabilitation to a greater number of people with chronic obstructive pulmonary disease (COPD). The effectiveness of minimal equipment programs in people with COPD is unclear. This systematic review and meta-analysis aimed to determine the effects of pulmonary rehabilitation using minimal equipment for aerobic and/or resistance training in people with COPD.
METHODS
Literature databases were searched up to September 2022 for randomized controlled trials (RCTs) comparing the effect of minimal equipment programs with usual care or with exercise equipment-based programs for exercise capacity, health-related quality of life (HRQoL), and strength.
RESULTS
Nineteen RCTs were included in the review and 14 RCTs were included in the meta-analyses, which reported low to moderate certainty of evidence. Compared with usual care, minimal equipment programs increased 6-minute walk distance (6MWD) by 85 m (95% CI = 37 to 132 m). No difference in 6MWD was observed between minimal equipment and exercise equipment-based programs (14 m, 95% CI = -27 to 56 m). Minimal equipment programs were more effective than usual care for improving HRQoL (standardized mean difference = 0.99, 95% CI = 0.31 to 1.67) and were not different from exercise equipment-based programs for improving upper limb strength (6 N, 95% CI = -2 to 13 N) or lower limb strength (20 N, 95% CI = -30 to 71 N).
CONCLUSION
In people with COPD, pulmonary rehabilitation programs using minimal equipment elicit clinically significant improvements in 6MWD and HRQoL and are comparable with exercise equipment-based programs for improving 6MWD and strength.
IMPACT
Pulmonary rehabilitation programs using minimal equipment may be a suitable alternative in settings where access to gymnasium equipment is limited. Delivery of pulmonary rehabilitation programs using minimal equipment may improve access to pulmonary rehabilitation worldwide, particularly in rural and remote areas and in developing countries.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Resistance Training; Exercise Therapy; Exercise Tolerance
PubMed: 37140475
DOI: 10.1093/ptj/pzad013 -
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 -
Pediatric Physical Therapy : the... Jul 2022To conduct a systematic review and meta-analysis on the effect of motor intervention on motor function of infants and toddlers with cerebral palsy (CP). (Meta-Analysis)
Meta-Analysis
PURPOSE
To conduct a systematic review and meta-analysis on the effect of motor intervention on motor function of infants and toddlers with cerebral palsy (CP).
METHODS
Four databases were searched for randomized controlled trials (RCTs) of motor interventions for children with or at high risk of CP younger than 36 months. Studies were excluded if less than 50% of children developed CP.
RESULTS
Eleven RCTs included 363 children; 85% diagnosed with CP. Very low-quality evidence supports that: (1) task-specific motor training was more effective than standard care for improving motor function (small effect), (2) constraint-induced movement therapy (CIMT) may be more effective than bimanual play or massage for improving function of the more affected hand (moderate effect), and high-intensity treadmill training is no more effective than low-intensity for improving walking.
CONCLUSIONS
Very low-quality evidence supports that task-specific motor training and CIMT may improve motor function of infants and toddlers with CP.The Supplemental Digital Content Video Abstract is available at: http://links.lww.com/PPT/A382 .
Topics: Cerebral Palsy; Child, Preschool; Hand; Humans; Infant; Massage; Physical Therapy Modalities; Walking
PubMed: 35671383
DOI: 10.1097/PEP.0000000000000914 -
Intensive Care Medicine Jul 2023
Topics: Humans; Intensive Care Units; Exercise Therapy; Critical Care; Critical Illness; Physical Therapy Modalities
PubMed: 37209121
DOI: 10.1007/s00134-023-07099-4 -
La Clinica Terapeutica 2020Apraxia affects 20% of the right brain-damaged patients and 50% of the left brain-damaged patients. This disorder of motor programming reduces patients' independence and... (Meta-Analysis)
Meta-Analysis
Apraxia affects 20% of the right brain-damaged patients and 50% of the left brain-damaged patients. This disorder of motor programming reduces patients' independence and there are few guidelines on the rehabilitative treatment in the physiotherapy and speech therapy field.The aim of this study was to assess which therapeutic interventions are the most effective in stroke patients with apraxia in considering the mentioned purviews. Four databases were systematically searched in order to detect all available studies investigating the physical and speech rehabilitation of patients. The literature research produced five studies including 168 patients for the physiotherapy and 50 for speech therapy fields; two were eligible for meta-analysis. Quality was rated with Jadad, PEDro scale and Cochrane Risk Of Bias Tool. Both for physiotherapy and speech therapy fields, the RCTs interventions obtained statistically significant results for outcomes of interest. Despite this, it is still not possible to determine the best approach due to the low number of patients involved, the lack of maintenance of the results at follow up and the timing of the revaluation period being very short to confirm the efficacy of treatments.
Topics: Apraxias; Humans; Physical Therapy Modalities; Speech Therapy; Stroke
PubMed: 32901792
DOI: 10.7417/CT.2020.2257 -
Games For Health Journal Aug 2021This study aimed to investigate the effects of nonimmersive virtual reality (VR) as complementary rehabilitation on functional mobility and gait in children with mild... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aimed to investigate the effects of nonimmersive virtual reality (VR) as complementary rehabilitation on functional mobility and gait in children with mild unilateral cerebral palsy (CP). Prospective, randomized, controlled, clinical trial. Twenty-two children with unilateral CP were randomized into two groups: intervention group (IG) ( = 11) and control group ( = 11). After baseline assessments, the participants either started the VR intervention (IG) associated with conventional therapy, or continued conventional physical therapy (control group). Participants in the IG attended 45-minute training sessions twice a week for 8 weeks (total: 16 sessions and 12 hours of training). Participants in the control group underwent standard therapy for 50 minutes, twice a week. Timed Up and Go test (TUG), gait spatiotemporal variables, and pelvic angles were measured at baseline and after treatment sessions. When compared with the control group, the IG performed the following activities in decreased time: TUG, and stride time. Also, the IG increased the velocity of walking and the pelvis retroversion, and decreased the pelvis interval/external rotations and amplitude of pelvis rotation while walking. A rehabilitative approach based on a nonimmersive VR as complementary rehabilitation may improve functional mobility and change joint mobility functions during gait of children with mild unilateral CP. The results of the study demonstrate that the insertion of a therapy based on VR may help in better strategies in the gait of children with CP. Thus, rehabilitation professionals can use this tool combined with conventional therapy.
Topics: Cerebral Palsy; Child; Child, Preschool; Female; Gait; Humans; Male; Physical Therapy Modalities; Postural Balance; Prospective Studies; Rehabilitation; Statistics, Nonparametric; Virtual Reality
PubMed: 34370612
DOI: 10.1089/g4h.2021.0009 -
Physiotherapy Sep 2022Aquatic exercise therapy is used for the treatment and management of chronic low back pain (CLBP). However, to the authors' knowledge, no studies to date have compared...
OBJECTIVE
Aquatic exercise therapy is used for the treatment and management of chronic low back pain (CLBP). However, to the authors' knowledge, no studies to date have compared muscle activity between different aquatic exercises performed by people with CLBP. As such, this study assessed and compared muscle activity, pain, perceived exertion and exercise intensity between different rehabilitative aquatic exercises.
DESIGN
Cross-sectional.
SETTING
A 25-m indoor swimming pool within a university building.
PARTICIPANTS
Twenty participants with non-specific CLBP.
ASSESSMENT
Twenty-six aquatic exercises in shallow water (1.25-m depth). Muscle activity was quantified bilaterally for the erector spinae, multifidus, gluteus maximus and medius, rectus abdominis, and external and internal obliques.
MAIN OUTCOMES
Mean and peak muscle activity, pain (visual analogue scale), perceived exertion (Borg scale) and exercise intensity (heart rate).
RESULTS
Hip abduction/adduction and extension/flexion exercises produced higher activity for gluteal muscles. Variations of squat exercises increased the activity of back extensors. Higher abdominal muscle activity was produced with exercises that made use of buoyancy equipment and included leg and trunk movements while floating on the back, and with some proprioceptive and dynamic lower limb exercises. Pain occurrence and intensity were very low, with 17 exercises being pain free.
CONCLUSIONS
This study provides evidence on trunk and gluteal muscle activity, pain, intensity and perceived exertion for people with CLBP performing aquatic exercises. The findings may be useful when prescribing exercises for rehabilitation, as physiotherapists seek to implement progression in effort and muscle activity, variation in exercise type, and may wish to target or avoid particular muscles. CONTRIBUTION OF THE PAPER.
Topics: Cross-Sectional Studies; Electromyography; Exercise Therapy; Humans; Low Back Pain; Muscle, Skeletal; Paraspinal Muscles; Water
PubMed: 35709587
DOI: 10.1016/j.physio.2022.03.003