Neck pain is the third musculoskeletal condition that causes the most days lived with disability and is considered an important public health problem with a significant economic impact, decreased ...productivity and work absenteeism. In addition to pain, these individuals also present psychosocial symptoms such as kinesiophobia, catastrophizing, anxiety, and depression. Although exercise is an effective approach in the treatment of chronic neck pain, physiotherapists face barriers to the success of therapy, such as lack of patient adherence. Additionally, due to costs, distance and lack of adequate information, patients do not have access to physiotherapy treatment. Therefore, telerehabilitation is an emerging tool to overcome these barriers. However, despite the literature supporting the effectiveness of telerehabilitation in chronic musculoskeletal conditions, there are no studies on its efficacy in neck pain regarding pain, disability and psychosocial symptoms when compared to face-to-face treatment.
To investigate the efficacy of a telerehabilitation exercise program compared to face-to-face exercise program in patients with chronic neck pain.
The study is a single-blinded randomized controlled trial. Ninety-eight individuals of both sexes, between 18-65 years old, with non-specific neck pain lasting longer than 3 months will be recruited. They will be randomly allocated to one of two groups (telerehabilitation and face-to-face). The telerehabilitation group will perform the intervention at home through videos sent beforehand and weekly call will be made to follow-up the participants. The face-to-face group will perform the intervention with the therapist. The primary outcomes will be pain intensity and disability. Secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, symptoms of anxiety and depression, pain self-efficacy and global perceived effect. All participants will be evaluated before and after treatment. Both groups will perform the same exercise protocol, twice a week for six weeks. The protocol consists of 8 exercises (two stretching exercises, two mobility exercises and four strengthening exercises) with an approximate duration of 40 minutes and these will be progressed every two weeks. The statistical analysis will follow the principles of intention-to-treat analysis and the effects of treatment will be calculated using mixed linear models, using interactions terms (group versus time interactions).
This is the first study to investigate whether an exercise program applied via telerehabilitation is effective in reducing pain, disability, and psychosocial symptoms in individuals with chronic neck pain when compared to the same exercise program applied face-to-face.
The results of this study may contribute to a better understanding of the efficacy of telerehabilitation in biopsychosocial outcomes, as well as support future remote intervention research to reduce physical, temporal, financial and treatment adherence barriers that professionals face. In addition, remote treatment may also be able to reduce waiting lists and public spending on chronic neck pain.
To compare scapular kinematics and muscle activity among various scapular muscle exercises.
A cross-sectional study.
A university research laboratory.
Eighteen healthy men participated in this study.
...Three-dimensional scapular kinematics was measured with an electromagnetic motion capture system. Activities of the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) were measured by using surface electromyography (EMG). In addition, the ratio of LT to the UT (LT/UT) and SA to the UT (SA/UT) was calculated. A repeated one-way analysis of variance and Shaffer's post-hoc analysis were used to detect the differences in each outcome during five exercises.
The scapula was rotated upwardly during all exercises except push-up plus. The LT/UT ratio during side-lying external rotation and side-lying flexion were significantly higher than that for scapular plane elevation (P < .05), although the highest activity of the lower trapezius was produced during scapular plane elevation. The activities of the serratus anterior and SA/UT ratio during horizontal adducted elevation and push-up plus were significantly higher than that during scapular plane elevation (P < .05).
Horizontal adducted elevation might be more appropriate for increasing scapular upward rotation with high serratus anterior activity and SA/UT ratio than push-up plus.
•Scapular kinematics/muscle activity were analyzed while performing exercises.•Horizontal adducted elevation facilitated upward rotation/serratus anterior.•Side-lying flexion facilitated upward rotation/lower trapezius.•Push-up plus facilitated downward rotation/serratus anterior.•Horizontal adducted elevation/side-lying flexion may increase upward rotation.
The aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) ...compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone.
A total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches.
Compared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP.
This RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs.
NCT04571528.
•Two video-based virtual treatments (i.e., FIBROWALK and MPP) were found to be efficacious for treating fibromyalgia.•More generalized clinical benefits were observed in the FIBROWALK intervention.•Additional evidence regarding the increased benefits of combining physical therapy and psychological techniques is provided.•FIBROWALK and MPP might be highly scalable, affordable and effective therapeutic alternatives to face-to-face treatments.
In western society an internal health locus of control (perception that health outcomes are due to one's own behavior) is related to perceived sports knee function following anterior cruciate ...ligament reconstruction. This prospective cohort study was performed to determine if similar health beliefs exist among athletically active Hindu patients from Nepal following primary anterior cruciate ligament reconstruction.
Twenty-five consecutive patients (21 men, 4 women) of 26.7 ± 7.7 years of age participated in this study at 4.2 ± 2 months post-surgery. All subjects had undergone primary anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft, with anteromedial portal use for femoral tunnel drilling and interference screw fixation. Subjects completed the Knee Outcome Survey - Sports Activities Scale symptoms and functional limitations during sports subscales and Form C of the Multidimensional Health Locus of Control scales. Descriptive and correlational statistical analysis was performed. An alpha level of p < 0.05 was selected to indicate statistical significance.
Knee Outcome Survey - Sports Activity Scale symptoms scores were 71.3 ± 18 (range = 43-97) and functional limitations scores were 42.4 ± 34 (range = 10-95). Multidimensional Health Locus of Control subscale scores were Internal (27.8 ± 4.6), Chance (21.5 ± 6.3), Doctors (16.1 ± 1.9) and other people (14 ± 3.5). Significant relationships were not observed between symptoms or functional limitations subscale scores and Multidimensional Health Locus of Control internal, doctors or powerful others subscale scores. However, strong (r = 0.72) and moderately strong (r = 0.48) relationships were observed between the Multidimensional Health Locus of Control chance subscale score and Knee Outcome Survey - Sports Activities Scale functional limitations and symptoms subscales, respectively.
Following primary anterior cruciate ligament reconstruction, Hindu patients from Nepal displayed strong relationships between perceived knee function and symptoms and the Multidimensional Health Locus of Control chance subscale. Identification and targeting the beliefs of patients may be clinically important to facilitating positive treatment progression and behavioral changes during post-surgical rehabilitation programs. Further studies are needed to determine how medical and rehabilitation clinicians who provide care to patients from eastern, collectivist cultures can optimize healthcare strategies for patients with sociocultural or religious/spirituality influences that possess strong chance or luck beliefs.
Implications for Rehabilitation
Following primary anterior cruciate ligament reconstruction, Hindu patients from Nepal displayed strong relationships between perceived knee function and chance health locus of control beliefs.
Identification and targeting the health locus of control beliefs of patients may be clinically important to facilitating positive treatment progression and behavioral changes during post-surgical rehabilitation programs.
Medical and rehabilitation professionals need to become more aware of how a patient's religious or spiritual beliefs may conflict with healthcare instructions, or, alternatively, could be better harnessed to facilitate improved program adherence.
The design and control of a cable-driven rehabilitation robot, which can be configured easily for exercising different articulations such as elbows, shoulders, hips, knees and ankles without ...requiring any orthosis, are introduced. The passive, active-assisted and active-resisted exercises were designed and implemented using impedance control. The controller could switch between exercises according to the force feedback. The effectiveness of the proposed controller was demonstrated by experimental studies. The robot was tested first with a dummy extremity and then with a healthy subject mimicking various types of patients during the tests. Experimental results showed that satisfactory closed-loop performances were achieved.
The purpose of this study was to evaluate the effectiveness of a 12-week multicomponent treatment based on pain neuroscience education, therapeutic exercise, cognitive behavioral therapy, and ...mindfulness-in addition to treatment as usual-compared with treatment as usual only in patients with fibromyalgia.
This randomized controlled trial involved a total of 272 patients who were randomly assigned to either multicomponent treatment (n = 135) or treatment as usual (n = 137). The multicomponent treatment (2-hour weekly sessions) was delivered in groups of 20 participants. Treatment as usual was mainly based on pharmacological treatment according to the predominant symptoms. Data on functional impairment using the Revised Fibromyalgia Impact Questionnaire as the primary outcome were collected as were data for pain, fatigue, kinesiophobia, physical function, anxiety, and depressive symptoms (secondary outcomes) at baseline, 12 weeks, and, for the multicomponent group only, 6 and 9 months. An intention-to-treat approach was used to analyze between-group differences. Baseline differences between responders (>20% Revised Fibromyalgia Impact Questionnaire reduction) and nonresponders also were analyzed, and the number needed to treat was computed.
At posttreatment, significant between-group differences with a large effect size (Cohen d > 0.80) in favor of the multicomponent treatment were found in functional impairment, pain, kinesiophobia, and physical function, whereas differences with a moderate size effect (Cohen d > 0.50 and <0.80) were found in fatigue, anxiety, and depressive symptoms. Nonresponders scored higher on depressive symptoms than responders at baseline. The number needed to treat was 2 (95% CI = 1.7-2.3).
Compared with usual care, there was evidence of short-term (up to 3 months) positive effects of the multicomponent treatment for fibromyalgia. Some methodological shortcomings (eg, absence of follow-up in the control group and monitoring of treatment adherence, potential research allegiance) preclude robust conclusions regarding the proposed multicomponent program.
Despite some methodological shortcomings in the design of this study, the multicomponent therapy FIBROWALK can be considered a novel and effective treatment for patients with fibromyalgia. Physical therapists should detect patients with clinically relevant depression levels prior to treatment because depression can buffer treatment effects.
Fibromyalgia is prevalent and can be expensive to treat. This multicomponent treatment could significantly improve the core symptoms of fibromyalgia compared with usual treatment.
The COVID-19 pandemic pushed physicians to modify conventional practices to reduce the exposure and risk of infection among patients and health workers. Telemedicine is one of the safest methods, and ...telerehabilitation could prevent the sequelae of COVID-19. A quasi-experimental study with randomized sampling without masking/blinding was conducted. The study was conducted from August 2021 to March 2022 at Hospital A in Pekanbaru, Hospital B in Jayapura, and Hospital C in Jakarta, Indonesia. A total of 27 patients were recruited and divided into control and intervention groups. The control group was given conventional education on therapeutic exercise at home, while the intervention group was shown educational videos about therapeutic exercise at home. The comparison of all functional outcomes between the two groups after the intervention showed a significant difference. The intervention group improved more than the control group, except for the fatigue severity scale. Most of the responses showed that this video was feasible and useful and did not need to be supervised by health workers. Therapeutic exercise educational videos can be an option to deliver rehabilitation programs for post-COVID-19 hospitalized patients.
To evaluate the effects of exercise therapy on neuropathic symptoms, signs, psychosocial aspects, and physical function in people with diabetic neuropathy (DN).
A search in PubMed, Web of Science, ...Physiotherapy Evidence (PEDro), and Cochrane databases was performed from inception to Invalid Date NaN, . Randomized clinical trials (RCTs) were selected in patients with DN comparing exercise therapy with a control group. The studies' methodological quality was assessed with the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall quality.
Eleven RCTs (n = 517 participants) were included. Nine studies showed high methodological quality. Mean (MD) and standardized mean differences (SMD) were observed in favor of exercise therapy for symptoms (MD = −1.05; confidence interval 95% = −1.90 to −0.20), signs (SMD = −0.66; confidence interval 95%= −1 to −0.32), and physical function (SMD = −0.45; confidence interval 95% = −0.66 to −0.24). No changes were found in psychosocial aspects (SMD = −0.37; confidence interval 95% = −0.92 to 0.18). The overall quality of evidence was very low.
The quality of evidence suggesting that exercise therapy provides short-term benefits in neuropathic symptoms, signs, and physical function in patients with DN is very low. Furthermore, there were no effects found on psychosocial aspects.
Therapeutic exercises play an important role in the physical therapy and the rehabilitation. The exercises that can be assisted by a physiotherapist are increasingly being performed by the ...rehabilitation robots partially or fully due to their various merits. This study aims to develop a complete rehabilitation system, which consists of a rehabilitation robot, an HMI and a hybrid impedance controller that can model all the therapeutic exercises for an upper limb rehabilitation. The 3-DOF upper limb rehabilitation robot is able to perform the movements of flexion–extension and ulnar–radial deviation for the wrist, and the movement of pronation–supination for the forearm. The experimental studies were conducted with healthy subjects and patients. First, the experiments were done with the healthy subjects to prove the control performance of the robotic system. The results showed that the hybrid impedance controlled robot can perform the therapeutic exercises very successfully. Then, the experimental studies were carried out with the real patients in a clinical environment. At the end of the treatment process, remarkable improvements were observed in terms of the limb force in all of the patients.
