Functional Outcomes After a Physiotherapy Program in Elderly Patients With Complex Regional Pain Syndrome Type I After Distal Radius Fracture: A Prospective Observational Study

Background: No published prospective studies have reported the clinical effects of physiotherapy at 1-year follow-up in patients with complex regional pain syndrome type I (CRPS I) after distal radius fracture (DRF). The purpose of this study was to evaluate at 1-year follow-up the functional effects of physiotherapy program in elderly patients with CRPS I after extra-articular DRF. Methods: A total of 72 patients with CRPS I after DRF were prospectively recruited. All patients were treated with a 6-week supervised physiotherapy treatment. Three evaluations were performed: at the beginning, at the end of the treatment, and at 1-year follow-up. Wrist function, upper limb function, grip strength, and pain intensity were assessed with the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), Jamar dynamometer, and Visual Analogue Scale (VAS), respectively. Results: At 1-year follow-up, the PRWE showed a decrease of 21.6 points (Cohen’s d = 2.8; 95% confidence interval [CI] = 18.6-24.6; P < .05); the DASH showed a decrease of 23.8 points (Cohen’s d = 2.9; 95% CI = 20.8-26.7; P < .05); grip strength showed an increase of 40.6% (Cohen’s d = 5.0; 95% CI = 43.5-37.6; P < .05); and the VAS showed a decrease of 2.6 cm (Cohen’s d = 1.9; 95% CI = 2.11-3.16; P < .05). Conclusion: At 1-year follow-up, a physiotherapy program showed clinically and statistically significant results in all functional outcomes in elderly patients with CRPS I after extra-articular DRF.

The Use of Scoring Hip Osteoarthritis with MRI as an Assessment Tool for Physiotherapeutic Treatment in Patients with Osteoarthritis of the Hip

Rehabilitation programs are considered effective at reducing the impact of osteoarthritis (OA) of the hip; however, studies using reliable measures related to OA biomarkers to assess the effects of rehabilitation are lacking. The objective of this study was to investigate whether an MRI-based (Magnetic Resonance Imaging-based), semi-quantitative system for an OA severity assessment is feasible for the evaluation of the structural changes in the joint observed during a long-term physiotherapy program in patients with hip OA. The study group consisted of 37 adult OA patients who participated in a 12-month physiotherapy program. The Scoring hip osteoarthritis with MRI (SHOMRI) system was used to evaluate the severity of structural changes related to hip OA. Hip disability and the osteoarthritis outcome score (HOOS) and the core set of performance-based tests recommended by Osteoarthritis Research Society International were used for functional assessment. SHOMRI showed excellent inter- and intra-rater agreement, proving to be a reliable method for the evaluation of hip abnormalities. At the 12-month follow-up no statistically significant changes were observed within the hip joint; however, a trend of structural progression was detected. There was a negative correlation between most of the SHOMRI and HOOS subscales at baseline and the 12-month follow-up. Although SHOMRI provides a reliable assessment of the hip joint in patients with OA it showed a limited value in detecting significant changes over time in the patients receiving physiotherapy over a 12-month period.

Physiotherapy Rehabilitation in Subjects Diagnosed with Subacromial Impingement Syndrome Does Not Normalize Periscapular and Rotator Cuff Muscle Onset Time of Activation

Clinicians suggest that rehabilitation of Subacromial Impingement Syndrome (SIS) should target improving movement patterns to ensure better clinical outcomes. Understanding changes in onset time of activation patterns and associated changes in clinical outcomes could improve our understanding of rehabilitation strategies. In this prospective longitudinal study, we examined neuromuscular firing patterns and clinical features before and after a standardized physiotherapy program in subjects diagnosed with SIS. Electromyography (EMG) recordings of eleven shoulder muscles were taken at the initial and discharge consultation in 34 male volunteers diagnosed with SIS. EMG recording was performed during flexion, scaption, and abduction at slow, medium, and fast speeds with a loaded (3 kg) and unloaded arm, as well as rotational motion, rotational strength, pain, and shoulder function. Completion of standardized shoulder physiotherapy program for SIS resulted in improvements in clinical outcomes. Resulted showed inconsistent differences of onset time of activation mainly in some of the periscapular muscles for all movements. No differences were seen on the EMG recordings for rotator cuff muscles. Differences in range of motion, strength and function were shown. Despite some changes in onset time of activation, this study was not able to demonstrate consistent changes of onset time of activation of the periscapular and rotator cuff muscles.

Effects of Physiotherapy vs. Acupuncture in Quality of Life, Pain, Stiffness, Difficulty to Work and Depression of Women with Fibromyalgia: A Randomized Controlled Trial

Background: Fibromyalgia is a chronic clinical condition characterized by pain and other associated symptoms that have a negative impact on the quality of life of the affected person. The objective of this study was to assess the effectiveness of a core stability training physiotherapy program compared to an acupuncture treatment on quality of life, pain, joint stiffness, difficulty to work and depression of women with fibromyalgia. Methods: This was a single-blind, randomized clinical controlled trial. Women with fibromyalgia were randomized to a core stability physiotherapy program group (n = 45), an acupuncture treatment group (n = 45) and a control group (n = 45) for 13 weeks. Measurements were taken at baseline (week 0), post-intervention (week 6) and at follow-up (week 13). The primary outcome measure was quality of life (Spanish Fibromyalgia Impact Questionnaire). The secondary outcome measures were pain, joint stiffness, difficulty to work and depression (Visual Analogue Scale). Results: In total, 103 participants completed the study. The results, from a descriptive perspective, showed improvements in all the outcome measures in both intervention groups (physiotherapy and acupuncture) at weeks 6 and 13 in relation to week 0 and in comparison to the control group. Only the difficulty to work measure in the acupuncture group showed a slight decrease at week 13. In particular, mean (±SD) Spanish Fibromyalgia Impact Questionnaire score at 6 weeks was 62.89 ± 16.91 for the physiotherapy group, 62.5 ± 18.09 for the acupuncture group and 67.45 ± 17.07 for the control group. However, these improvements were not statistically significant. Conclusion: Core stability-based physiotherapy and acupuncture showed non-significant improvements in quality of life, pain, joint stiffness, difficulty to work and depression in women with fibromyalgia.

Early Rehabilitation Protocol for Bullae Repair and Pleurectomy: A Case Report

Objectives: Postoperative physiotherapy is routinely prescribed for patients after thoracic surgeries. There are no established guidelines for exercise prescription after pleural resection surgeries. The present study aimed to determine the effect of an individualized postoperative physiotherapy program on a patient who underwent pleurectomy. Methods: A 19-year-old female patient was admitted to Kasturba Medical College, Mangalore in February 2019. She was diagnosed with right spontaneous pneumothorax; then, she underwent bullae repair and pleurectomy and was given a 7-day individualized postoperative physiotherapy. The severity of dyspnoea, chest expansion, and right shoulder range of motion was recorded on postoperative day 2 and the day of discharge; the six-minute walk distance was measured on postoperative day 4 and the day of discharge. Results: Significant improvements in all the outcomes were found after the individualized post-operative physiotherapy program in the reported patient. Discussion: The provided individualized 7-day physiotherapy program improved the chest expansion, shoulder range of motion, rating of perceived exertion scores, and functional capacity in the reported patient who underwent bullae repair and pleurectomy.

Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis

There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. Method: This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. Results: While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. Conclusion: The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.

Impact of cardiac physiotherapy on the functional capacity of elderly people in primary care

Funding Acknowledgements Type of funding sources: None. Introduction Primary health care (PHC) is the first level of health care, and it includes health promotion and protection, as well as the prevention of aggravations from chronic diseases and comorbidities. The cardiovascular physiotherapy program in PHC is an important ally in prevention chronic diseases and maintaining functional capacity. Purpose: to evaluate the impact of a cardiovascular physiotherapy program on a functional capacity of elderly people in primary care. Methods: This is a randomized clinical trial, carried out with 30 elderly people who attended the FISIOCAP (cardiovascular physiotherapy program in primary care) program for at least 6 months. The assessment of functional capacity was performed through the six-minute walk (6MWT) and 1-min sit-to-stand test (1-MSTS). The patients were submitted to a supervised exercise program lasting 90 minutes, twice a week, for a period of 16 weeks. Each session consisted of a warm-up phase (10 minutes), conditioning (60 minutes), calm down (10 minutes) and health education (10 minutes). At the end of 16 weeks, the elderly underwent a reassessment on the 1MSTS and 6MWT. Results: After the cardiovascular physiotherapy program, the participants increased the distance covered by the 6MWT by 19% (p = 0.002) and significantly exceeded the distance covered predicted for gender and age. In 1MSTS, the participants obtained a significant improvement in the number of repetitions in the test (25.25 ± 5.72 to 27.67 ± 5.55, p = 0.04). Conclusion: The cardiovascular physiotherapy program significantly benefited the functional capacity of elderly patients attending PHC.