Feasibility of an individualised, task-oriented, video-supported home exercise programme for arm function in patients in the subacute phase after stroke: protocol of a randomised controlled pilot study

IntroductionStroke rehabilitation guidelines suggest a high-frequency task-oriented training at high intensity. A targeted and self-paced daily training with intermittent supervision is recommended to improve patients’ self-management and functional output. So far, there is conflicting evidence concerning the most effective home-training delivery method.Methods and analysisThe purpose of this pilot study is to compare the feasibility and preliminary effects of task-oriented home-exercises in patients in the subacute stage after stroke. Twenty-four patients will be randomised (1:1) to a Video group (a) or Paper group (b) of an individualised, task-oriented home-training (50 min, 6×/week, for 4 weeks) based on Wulf and Lewthwaite’s Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory of motor learning. Patient-relevant goals will be identified using Goal Attainment Scaling and exercises progressively adapted. Semistructured interviews and a logbook will be used to monitor adherence, arm use and acceptability. Primary outcome will be the feasibility of the methods and a full-scale trial employing predefined feasibility criteria (recruitment, retention and adherence rates, patients’ satisfaction with the home-exercise programme and their progress, affected hand use and acceptance of the intervention). Assessed at baseline, post intervention and 4-week follow-up, secondary outcomes include self-perceived hand and arm use, actual upper extremity function and dexterity, hand strength, independence in activities of daily living and health-related quality of life. Interview data will be analysed using qualitative content analysis. Medians (ranges) will be reported for ordinal data, means (SD) for continuous and frequency (percentage) for nominal data.Ethics and disseminationThis study follows the Standard Protocol Items: Recommendations for Interventional Trials-Patient-Reported Outcome (PRO) Extension guideline. Ethical approval was received from the Ethics Committee of the Medical University of Innsbruck, Austria (1304/2020). Written informed consent will be obtained from all participants prior to data collection. Study results will be disseminated to participating patients, patient organisations, via the clinic’s homepage, relevant conferences and peer-reviewed journals.Trial registration numberDRKS-ID: DRKS00023395.Study protocol, second revision, 5 December 2021.

An investigation into the use of mHealth in musculoskeletal physiotherapy: Scoping Review (Preprint)

BACKGROUND Musculoskeletal (MSK) physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programmes due to a lack of supervision and low self-efficacy. The use of mHealth interventions could be a possible solution to this problem, helping to promote self-management in the home. However, there is little evidence within MSK physiotherapy on the most effective forms of mHealth. OBJECTIVE The aim of this review was to investigate the literature focusing on the use of mHealth within MSK physiotherapy and summarise the evidence METHODS A scoping review of six peer-reviewed databases was conducted. No date limits were applied, but only articles in the English language were selected. One reviewer screened all articles, followed by two additional researchers screening a random sample prior to data extraction. RESULTS 28 studies (n = 1393) were identified. Intervention characteristics consisted of stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions. The most reported use of mHealth included telephone and/or videoconferencing calls to provide a home exercise programme or used as an adjunct to a physiotherapy MSK assessment. While patient satisfaction with mHealth was reported as high, reasons for disengagement included a lack of high-quality information and poor Internet speeds. Barriers to clinical uptake included insufficient training with the intervention and lack of time to become familiar. CONCLUSIONS MHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost effective. Current use is most effective when ongoing feedback from a healthcare professional is available. CLINICALTRIAL The protocol for this Scoping Review was registered on the Open Science Framework (DOI 10.17605/OSF.IO/2YWPZ).

Face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: protocol of a multicentre, randomised controlled trial—the REFORM trial

IntroductionExercise, support and advice are considered core components of management for most musculoskeletal conditions and are typically provided by physiotherapists through regular face-to-face treatments. However, exercise can be provided remotely as part of a home exercise programme, while support and advice can be provided over the telephone. There is initial evidence from trials and systematic reviews to suggest that remotely provided physiotherapy can be used to manage a variety of musculoskeletal conditions safely and effectively.Methods and analysisThe aim of this single-blind randomised controlled non-inferiority trial is to determine whether a supported home exercise programme is as good as or better than face-to-face physiotherapy for the treatment of musculoskeletal conditions. Two hundred and ten participants will be recruited from five public hospitals in Sydney, Australia. Participants will be randomised to either the supported home exercise group or the face-to-face physiotherapy group. Participants allocated to the supported home exercise group will initially receive one face-to-face session with the trial physiotherapist and will then be managed remotely for the next 6 weeks. Participants allocated to the face-to-face physiotherapy group will receive a course of physiotherapy as typically provided in Sydney government hospitals. The primary outcome is function measured by the Patient Specific Functional Scale at 6 weeks. There will be nine secondary outcomes measured at 6 and 26 weeks. Separate analyses will be conducted on each outcome, and all analyses will be conducted on an intention-to-treat basis. A health economic evaluation will be conducted from a health funder plus patient perspective.Ethics and disseminationEthical approval was obtained on the 17 March 2017 from the Northern Sydney Local Health District HREC, trial number HREC/16HAWKE/431-RESP/16/287. The results of this study will be submitted for publication to peer-reviewed journals and be presented at national and international conferences. Recruitment commenced in March 2019, and it is anticipated that the trial will be completed by December 2021. This trial will investigate two different models of physiotherapy care for people with musculoskeletal conditions.Trial registration numberCPMP/ICH-135/95.Protocol versionThe most recent version of the protocol is V.1.2 dated November 2019.

OTAGO HOME EXERCISE PROGRAMME DAPAT MENINGKATKAN KESEIMBANGAN DINAMIS PADA LANSIA

Latar belakang: Keseimbangan merupakan kemampuan tubuh untuk tetap berada dalam keadaan stimbang dan menyesuaikan diri terhadap gravitasi, permukaan tanah dan objek dalam lingkungannya ketika melakukan aktivitas sehari-hari. Gangguan keseimbangan pada lansia tersebut dapat berdampak pada meningkatnya resiko jatuh pada lansia yang dapat menyebabkan berbagai macam cidera pada lansia seperti patah tulang maupun luka berat bahkan kematian. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui otago home exercise programme dapat meningkatkan keseimbangan dinamis pada lansia. Metode: Penelitian ini bersifat eksperimental dengan rancangan one group pre dan post test design. Sampel penelitian berjumlah 14 orang yang diberikan intervensi otago home exercise programme. Pengukuran keseimbangan dinamis dilakukan dengan menggunakan timed up and go test (TUGT) yang diukur sebelum dan sesudah pemberian intervensi. Hasil: Hasil pengujian hipotesis menggunakan wilcoxon match pair test diperoleh rerata sebelum perlakuan sebesar 16,68 dan setelah perlakuan sebesar 12,09 dengan nilai p=0,001. Kesimpulan: Dari hasil penelitian tersebut dapat disimpulkan otago home exercise programme dapat meningkatkan keseimbangan pada lansia.Kata Kunci: Otago Home Exercise Programme, Keseimbangan Dinamis, Timed Up and Go Test, Lansia

Investigating the feasibility and acceptability of the HOLOBalance system compared with standard care in older adults at risk for falls: study protocol for an assessor blinded pilot randomised controlled study

IntroductionApproximately one in three of all older adults fall each year, with wide ranging physical, psychosocial and healthcare-related consequences. Exercise-based interventions are the cornerstone for falls prevention programmes, yet these are not consistently provided, do not routinely address all components of the balance system and are often not well attended. The HOLOBalance system provides an evidence-based balance training programme delivered to patients in their home environment using a novel technological approach including an augmented reality virtual physiotherapist, exergames and a remote monitoring system. The aims of this proof-of-concept study are to (1) determine the safety, acceptability and feasibility of providing HOLOBalance to community dwelling older adults at risk for falls and (2) provide data to support sample size estimates for a future trial.MethodsA single (assessor) blinded pilot randomised controlled proof of concept study. 120 participants will be randomised to receive an 8-week home exercise programme consisting of either: (1) HOLOBalance or (2) The OTAGO Home Exercise Programme. Participants will be required to complete their exercise programme independently under the supervision of a physiotherapist. Participants will have weekly telephone contact with their physiotherapist, and will receive home visits at weeks 0, 3 and 6. Outcome measures of safety, acceptability and feasibility, clinical measures of balance function, disability, balance confidence and cognitive function will be assessed before and immediately after the 8 week intervention. Acceptability and feasibility will be explored using descriptive statistics, and trends for effectiveness will be explored using general linear model analysis of variance.Ethics and disseminationThis study has received institutional ethical approvals in Germany (reference: 265/19), Greece (reference: 9769/24-6-2019) and the UK (reference: 19/LO/1908). Findings from this study will be submitted for peer-reviewed publications.Trial registration numberNCT04053829.Protocol versionV.2, 20 January 2020

Adherence to self-managed exercises for patients with persistent subacromial pain: the Ad-Shoulder feasibility study

Background Exercise is recommended for patients with subacromial pain. It has been suggested that good exercise adherence improves clinical outcomes. Despite this, little attention has been paid to the need for behavioural frameworks to enhance adherence to home exercise programmes for patients with subacromial pain. Methods A feasibility study with pre-post design was used. Participants aged > 18 years, with subacromial pain, who had received conservative treatment during the past 6 months, were recruited. The Ad-Shoulder intervention consisted of 1–5 individual sessions provided over 3 months and was based on 5 self-management skills, which aimed to enhance the patients’ self-efficacy and adherence to self-managed exercises. The primary objectives were assessed according to predefined progression criteria: (1) the recruitment rate (10 patients enrolled within 12 weeks), (2) follow-up rate (≥ 80% on all self-reported measures), (3) objective physical activity measures (≥ 80% of participants would contribute valid data at each time point), (4) adherence with the self-managed exercises (≥ 80% of the participants would adhere to ≥ 80% of the assigned home exercise programme), (5) fidelity of the delivery of the intervention (the therapists delivered the intervention according to the protocol) and (6) adverse events (< 30% would report adverse events (including mild)). The results were reported using descriptive statistics. Results Eleven patients were recruited during 16 weeks. Ten patients completed the self-reported measures at baseline and week 12. Objective physical activity measures were successfully obtained for 100% (11/11) at baseline, 64% (7/11) at week six and 82% at week 12. Fifty-five percent (6/11) of the participants satisfactorily completed at least 80% of their home exercise programme. All sessions were delivered according to the protocol. None of the patients reported any adverse events. Conclusions Objective physical activity data measures at baseline and week 12, follow-up, the physiotherapists’ fidelity to the intervention and adverse events met our pre-specified progression criteria. Recruitment and adherence to the self-managed exercise programme were both below the anticipated level. Further intervention development is necessary to understand whether adherence to the self-managed exercises could be enhanced and additional methods of recruitment would need to be considered, including additional recruitment sites, in any planning for a future main trial. Trial registration ClinicalTrials.gov, NCT04190836, Registered December 9, 2019—retrospectively registered

Manual therapy of infants with postural and movement asymmetries and positional preference

Background There are different therapeutic approaches to persistent positional preference (kinematic imbalance due to suboccipital strain, KISS) in infants. There are no evidence-based or controlled studies investigating the effect of manual medicine treatment in children aged 3–6 months, particularly in combination with a home exercise programme. The presented monocentric study on one-time manual medicine treatment of infants aged 14–24 exhibiting these symptoms aims to close this gap. Methods This study comprises a controlled double-blind trial and per-protocol-analysis. Primary outcome was the 4-item symmetry score (4–17 points). The second measurement was performed after 4–6 weeks. Results A total of 62 infants were treated and evaluated (mean age 17 weeks). The intervention and control groups started with a symmetry score of 12.9 ± 2.1 and 12.5 ± 1.7 points, respectively. In the intervention group the score improved by 4.9 ± 2.4 to 8.0 ± 2.7 points, in the control group it improved by 2.9 ± 2.9 to 9.6 ± 3.0 points. The difference between the groups was statistically significant (p = 0.03). Both groups had significantly better values over time (p < 0.001). No adverse events or side effects were observed. Conclusion Manual medicine treatment of infants with postural and movement asymmetries as well as positional preference in combination with a home exercise programme is superior to a home exercise programme alone. Both treatment concepts achieved significant improvements. However, the manual medicine treatment played an important role in reducing the symmetry score value for the affected children, such they were no longer in need of treatment.