Gait Rehabilitation for Foot and Ankle Impairments in Early Rheumatoid Arthritis: a Feasibility Study of a New Gait Rehabilitation Programme (GREAT Strides)

BackgroundFoot impairments in early rheumatoid arthritis are common and lead to progressive deterioration of lower limb function. A gait rehabilitation programme underpinned by psychological techniques to improve adherence, may preserve gait and lower limb function. This study evaluated the feasibility of a novel gait rehabilitation intervention (GREAT Strides) and a future trial. MethodsThis was a mixed methods feasibility study with embedded qualitative components. People with early (<2 years) rheumatoid arthritis (RA) and foot pain were eligible. Intervention acceptability was evaluated using a questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Participants and therapists were interviewed to explore intervention acceptability. Deductive thematic analysis was applied using the Theoretical Framework of Acceptability. For fidelity, audio recordings of interventions sessions were assessed using the Motivational Interviewing Treatment Integrity (MITI) scale. Measurement properties of four candidate primary outcomes, rates of recruitment, attrition and data completeness were evaluated.Results35 participants (68.6% female) with median age (inter-quartile range [IQR]) 60.1 [49.4-68.4] years and disease duration 9.1 [4.0-16.2] months), were recruited and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent; 21/23 were confident that it could help and would recommend it; 22/23 indicated it made sense to them. Adherence was good, with a median [IQR] EARS score of 17/24 [12.5-22.5]. One serious adverse event that was unrelated to the study was reported. Twelve participants’ and 9 therapists’ interviews confirmed intervention acceptability, identified perceptions of benefit, but also highlighted some barriers to completion. Mean MITI scores for relational (4.38) and technical (4.19) aspects of motivational interviewing demonstrate good fidelity. The Foot Function Index disability subscale performed best in terms of theoretical consistency and was deemed most practical. ConclusionGREAT Strides was viewed as acceptable by patients and therapists, and we observed high intervention fidelity, good patient adherence and no safety concerns. A future trial to test the additional benefit of GREAT Strides to usual care will benefit from amended eligibility criteria, refinement of the intervention and strategies to ensure higher follow-up rates. The Foot Function Index disability subscale was identified as the primary outcome.Trial registrationISRCTN14277030

Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial

Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl–Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.

Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials

Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method able to modulate neuronal activity after stroke. The aim of this systematic review was to determine if tDCS combined with robotic therapy (RT) improves limb function after stroke when compared to RT alone. Methods A search for randomized controlled trials (RCTs) published prior to July 15, 2021 was performed. The main outcome was function assessed with the Fugl-Meyer motor assessment for upper extremities (FM/ue) and 10-m walking test (10MWT) for the lower limbs. As secondary outcomes, strength was assessed with the Motricity Index (MI) or Medical Research Council scale (MRC), spasticity with the modified Ashworth scale (MAS), functional independence with the Barthel Index (BI), and kinematic parameters. Results Ten studies were included for analysis (n = 368 enrolled participants). The results showed a non-significant effect for tDCS combined with RT to improve upper limb function [standardized mean difference (SMD) = − 0.12; 95% confidence interval (CI): − 0.35–0.11)]. However, a positive effect of the combined therapy was observed in the lower limb function (SMD = 0.48; 95% CI: − 0.15–1.12). Significant results favouring tDCS combined with RT were not found in strength (SMD = − 0.15; 95% CI: − 0.4–0.1), spasticity [mean difference (MD) = − 0.15; 95% CI: − 0.8–0.5)], functional independence (MD = 2.5; 95% CI: − 1.9–6.9) or velocity of movement (SMD = 0.06; 95% CI: − 0.3–0.5) with a “moderate” or “low” recommendation level according to the GRADE guidelines. Conclusions Current findings suggest that tDCS combined with RT does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.

The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients

Objective: This study aimed to research the effect of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on the lower limb function of post-convalescent stroke patients.Methods: A total of 122 patients in the stroke recovery stage who suffered from leg dysfunction were randomly divided into two groups: a tDCS group (n = 61) and a FES group (n = 61). All patients received same routine rehabilitation and equal treatment quality, the tDCS group was treated with tDCS, while the FES group received FES. The lower limb Fugl-Meyer assessment (FMA), modified Barthel index (MBI), functional ambulatory category (FAC), and somatosensory evoked potential (SEP) were used to assess the patients at three different stages: prior to treatment, 4 weeks after treatment, and 8 weeks after treatment.Results: The assessment scores for FMA, MBI, and FAC for the lower extremities after treatment (P &gt; 0.05) were compared with those before treatment. The FMA, MBI, and FAC scores of the tDCS group were significantly higher than those of the FES group in all three stages (P &lt; 0.05). The FMA, MBI, and FAC assessment scores of both groups were significantly higher after 4 weeks of treatment than that before treatment, and the scores after 8 weeks of treatment were significantly higher than those after 4 weeks after treatment (P &lt; 0.05). The P40, N45 latencies decreased and the P40, N45 amplitudes increased, but there was no significant difference before treatment and after treatment (P &gt;0.05), and there was no significant difference of the tDCS and FES groups before treatment and after treatment.Conclusion: In conclusion, FMA, MBI, and FAC indicate that both tDCS and FES can significantly promote the recovery of a patient’s leg motor function and tDCS is more effective than FES in the stroke recovery stage. The application value of SEP in stroke patients remains to be further studied.

Effect of Oculus Guided Physical Therapy in Adjunct to Conventional Therapy in Knee Osteoarthritis Patients-A Research Protocol

Background: Osteoarthritis is the most prevalent disorder affecting the quality of life of older people. Eventually, the protecting tissue at the ends of bones degrades. One of the commonest type is osteoarthritis of knee. Knee osteoarthritis is linked to three main symptoms: knee pain, swelling, and decreased quadriceps mobility. Knee osteoarthritis can be treated with various physical therapy interventions, physiotherapy shows effective results. Visual reality can be used for the physical rehabilitation. In this study an attempt is been made to use the oculus quest for rehabilitation of knee osteoarthritis patients in adjunct to the conventional treatment. Objectives: To demonstrate the effect of a conventional treatment regimen on lower limb function in patients with knee osteoarthritis. To demonstrate the influence of virtual reality-based games on lower limb function in individuals with knee osteoarthritis. In patients with knee osteoarthritis, the effect of virtual reality physical therapy in addition to traditional therapy was compared to the effect of simply conventional therapy. Methods: The aim of this study is to look at the effects of VR-based exercise as an adjunct to conventional therapy. To that aim, a pre and post experimental design will be used, with a control group receiving just conventional therapy (strengthening, ultrasound, Maitland mobilization) and an experimental group receiving conventional treatment as well as the VR-based exercise. Data collected will be examined using the SPSS variant. Conclusion: Conclusion will be drawn based on the effect of virtual reality based exercises and conventional exercises. Which will help the therapist as well as patient in better treatment approach towards knee osteoarthritis.

Effect of non-invasive brain stimulation on lower limb function in patients after stroke: A PRISMA-compliant systematic review and meta-analysis

Background: In recent years, it is reported that non-invasive brain stimulation [including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS)] could improve lower limb function in patients after stroke. However, some studies showed no effect. In the present study, we aimed to make a meta-analysis to assess effect of non-invasive brain stimulation on lower limb function in patients after stroke. Methods: Studies exploring the effect of tDCS or rTMS on lower limb function in patients after stroke were searched on the PubMed, Web of Science, EMBASE, Medline, Google Scholar before March 2021. Meta-analysis was made to summarize results of these studies. Results: The present study showed significantly better walking speed, mobility and muscle strength increase effect in tDCS group compared to sham tDCS group [walking speed: standard mean difference (SMD) = 1.14, 95% CI = 0.48 to 1.80, I2 = 74.0%, p value for Q test < 0.001; mobility: SMD = 0.79, 95% CI = 0.21 to 1.36, I2 = 53.8%, p value for Q test = 0.043; muscle strength: SMD = 2.79, 95% CI = 0.61 to 4.98, I2 = 93.9%, p value for Q test < 0.001]. In addition, meta-analysis showed significantly better walking speed, balance and motor function increase effect in rTMS group compared to sham rTMS group [walking speed: SMD = 3.31, 95% CI = 1.38 to 5.24, I2 = 92.1%, p value for Q test < 0.001; balance: SMD = 3.54, 95% CI = 1.45 to 5.63, I2 = 95.4%, p value for Q test < 0.001; motor function: SMD = 1.65, 95% CI = 0.53 to 2.76, I2 = 90.3%, p value for Q test < 0.001]. Conclusions: This meta-analysis suggested that non-invasive brain stimulation improved lower limb function in patients after stroke. More large scale, blinded RCTs were necessary to confirm the effect of rTMS and tDCS on lower limb function in patients after stroke.

Effectiveness of a 3-month antifalling program in the mobility, balance confidence, and muscle performance of older adults

This study determined the effectiveness of a 3-month group-based multicomponent exercise program in the mobility, balance confidence, and muscle performance of older adults. A total of 40 participants (mean age=70.60±6.25 years completed pre- and posttest clinical intervention measures of mobility using the Timed Up and Go (TUG) test, balance confidence using the Activities-specific Balance Confidence scale, upper limb strength (handgrip dynamometer), and lower limb function (30-sec chair rise test). Data were analyzed using paired t-test and based on TUG criteria for risk of fall (low- and high-risk groups). Significant improvements were found in all measures (All P<0.05) following the 3-month program. Measures according to the risk of fall categories were also significantly improved (P<0.01), except the left handgrip strength (P>0.05). The low-risk group showed a higher improvement in mobility (14.87% vs. 11.74%), balance confidence (34.21% vs. 26.08%), and lower limb function (96.87% vs. 21.20%) but was not significantly different from the high-risk group (P>0.05). A group-based multicomponent exercise program benefited the physical functions of older adults at low- or high risk of falls.