Does backward gait require more proprioception and balance in older adults after total knee arthroplasty?

Objectives: Some basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA). Methods: A prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals. Results: TUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1 = 0.386, r2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1 = 0.293, r2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1 = -0,693, r2 = -0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1 = -0.642, r2 = -0.645, p < 0.01). Conclusion: The study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.

Opinions, satisfaction and expectations of individuals with multiple sclerosis about telerehabilitation services.

OBJECTIVE: The opinions, satisfaction, and expectations of telemedicine can provide essential data for remote health services in individuals with Multiple Sclerosis (MS). The study aimed to demonstrate the views (barriers-benefits), satisfaction, and expectations of individuals with MS about telerehabilitation services. METHODS: A prospective cross-sectional was conducted with 82 individuals with MS who received telerehabilitation services for at least one year. The participants have completed SymptoMScreen, Beck Depression Inventory (BDI), Telehealth Usability Questionnaire (TUQ), Telemedicine Satisfaction Questionnaire (TSQ), Telehealth Barriers Questionnaire (TBaQ and Telehealth Benefits Questionnaire (TBeQ). RESULTS: As the age of individuals with MS increased, TUQ (r: -0.517, p < 0.001) and TBeQ (r: -0.383, p < 0.001) decreased, while TSQ (r: 0.405, p < 0.001) and TBaQ (r: 0.390, p < 0.001) increased. SymptoMScreen score (r: -0.288, p < 0.05) was weakly associated with TUQ. In addition, TUQ, TSQ, TBeQ, and TBaQ were strongly correlated (p < 0.001). CONCLUSION: In order to improve usability and satisfaction in telerehabilitation services, the age, symptom severity, and education levels of individuals with MS should be considered. Telehealth methods with high usability should be preferred to increase patient satisfaction.

The effect of visual feedback-based clinical monitoring application in patients with chronic low back pain: a randomized controlled trial.

PURPOSE: No study has addressed the effect of patient-reported outcomes as a visual feedback tool during telerehabilitation. This study aimed to investigate the effect of a visual feedback-based monitoring application PhysioAnalyst on pain, pain catastrophizing, physical functions, quality of life, usability, satisfaction, and exercise adherence in individuals with chronic low back pain (CLBP). METHODS: A single-blind, randomized controlled trial was conducted with 44 CLBP patients. Participants were randomized into two groups: the tele-assessment feedback group (TAFG) (n = 22) and the control group (CG) (n = 22). Participants were assessed before the intervention, at the 4th week and after the intervention. Individuals were assessed using the Visual Analog Scale (VAS), Nottingham Health Profile (NHP), Pain Catastrophizing Scale (PCS), Oswestry Disability Index (ODI), Telehealth Usability Questionnaire (TUQ), Telemedicine Satisfaction Questionnaire (TSQ), and Exercise Adaptation Rating Scale (EARS) via PhysioAnalyst. Individuals in the TAFG group received graph-based visual feedback on assessment data in week 4. RESULTS: The improvement in VAS, NHP, ODI, TUQ, TSQ, and EARS of individuals in TAFG was statistically significant (p < 0.05). Only ODI and PCS scores in CG showed significant improvement (p < 0.05). After the graphics-based visual feedback presented to the TAFG, the VAS, NHP-Emotional, NHP-Sleep, NHP-Total, PCS, TUQ, TSQ, ODI, and EARS scores gained more than CG (p < 0.05). CONCLUSION: The results confirmed the additional contribution of telerehabilitation's graphics-based visual feedback in pain, pain catastrophizing, disability, quality of life, and exercise participation. Since the importance of continuity in long-term rehabilitation in patients with CLBP is comprehended, feedback to increase patient motivation can be added to telerehabilitation applications.

Effect of Telerehabilitation-Based Exercise and Education on Pain, Function, Strength, Proprioception, and Psychosocial Parameters in Patients With Knee Osteoarthritis: A Randomized Controlled Clinical Trial.

OBJECTIVE: In middle-aged individuals with early-stage knee osteoarthritis, follow-up with remote rehabilitation methods may provide effective clinical outcomes. The present study aimed to investigate the effect of telerehabilitation on pain, function, performance, strength, proprioception, and psychosocial parameters in patients with knee osteoarthritis. DESIGN: A randomized controlled study was conducted with 54 participants with knee osteoarthritis. All patients were randomized into two groups: the home-based telerehabilitation group ( n = 29) and the home-based paper group ( n = 28). The home exercise program and training were provided with an instruction manual to paper group. The same home exercise and education prescriptions were given to individuals in telerehabilitation group via an online platform. Pain, function, quality of life, physical performance, muscle strength, and proprioception were evaluated at baseline and after 8 wks of intervention. In addition, satisfaction and usability were evaluated at week 8. RESULTS: Telerehabilitation group demonstrated better improvement in terms of pain, function, quality of life index score, and left extremity proprioception ( P < 0.05). Telerehabilitation group was not superior to paper group in terms of muscle strength and performance tests (except the Five Times Sit to Stand Test) ( P > 0.05). CONCLUSIONS: The home-based telerehabilitation program was superior to the home-based paper group program for pain, function, quality of life, and proprioception in patients with knee osteoarthritis.

The effectiveness of dual task exercise training on balance, mobility, physical performance, and quality of life in children with cerebral palsy: a single-blind randomized controlled trial.

BACKGROUND: Most activities of daily living require more than one activity, including motor-motor or motor-cognitive task. Few studies have investigated the effects of dual-task training in children with cerebral palsy (CP). AIMS: This study was aimed at investigating the effectiveness of motor-cognitive dual-task exercise training in children with cerebral palsy (CP). METHODS: A single-blind randomized controlled trial was conducted with thirty children with CP. Participants were randomized into dual group training group (DTG) and control group (CG). Children were evaluated before the intervention and after 12 weeks of treatment with Gross Motor Function Classification Scale (GMFCS), Pediatric Berg Balance Test (PBBS), Single Leg Stance Test (SLST), Timed Up and Go Test (TUG), 3 Meter Backwards Walk Test (3-MBWT), 6 Meter Walk Test (6-MWT), and General Children's Quality of Life Measure (KINDL). RESULTS: DTG demonstrated significantly improved all KINDL scores (p < 0.01). In comparisons between groups adjusted analysis, results showed a better improvement of all KINDL scores in-favor-of DTG (p < 0.01). Significant improvements were found in all SLST scores and PBS in DTG (p < 0.01). Adjusted analysis results proved there was a significant improvement in all balance scores on behalf of DTG (p < 0.01). Significant improvement was observed in DTG for TUG, 3MBWT, and 6MWT scores (p = 0.001). An improvement in-favor-of DTG was found for all performance tests in the adjusted analysis (p < 0.001). CONCLUSION: The results of this randomized controlled trial highlighted the advantage of dual-task training on balance, physical performance, and quality of life in children with CP.

Investigation of Reaction Time, Proprioception, and Shaped Pathway Walking Performance in Older Patients with Total Knee Arthroplasty.

OBJECTIVES: The existing literature on total knee arthroplasty (TKA) does not provide clear data on step reaction time and proprioception and gait in shaped pathways. This study investigated the relationship between proprioception and reaction time with walking performance in shaped pathways in older patients undergoing TKA. DESIGN: A cross-sectional observational study. SETTING AND PARTICIPANTS: An orthopedic outpatient clinic with 103 older patients with TKA after a minimum of 6 months after surgery. METHODS: Participants were evaluated with Figure-of-8 Walk Test (F8WT), L Test, Tinnetti Gait Test (TGT), proprioception measurement with an app-based inclinometer, and step reaction time (SRT) test. The same assessor carried out all evaluations. RESULTS: F8WT showed a strong correlation with SRT-right, SRT-left, and Tinetti Gait Test (TGT), respectively (r1 = 0.628, r2 = 0.619, r3 = -0.615, P < .01). In addition, F8WT was moderately correlated with Right Leg Proprioception Test (RLPT) and Left Leg Proprioception Test (LLPT), respectively (r1 = 0.487, r2 = 0.439, P < .01). There was a moderate correlation between L Test with RLRT, LLRT, and TGT, respectively (r1 = 0.597, r2 = 0.584, r3 = -0.542, P < .01). Besides, there was a weak positive correlation between L Test with RLPT and LLPT, respectively (r1 = 0.394, r2 = 0.335, P < .01). A regression model showed that the L test was related to RLRT, LLRT, and TGT (R2 = 0.432, P < .001). The higher ability of the L test was weakly associated with higher levels of TGT (standardized ß = -0.28, P = .0012). Besides, regression analysis also proved that F8WT was related to RLRT, LLRT, and TGT (R2 = 0.522, P < .001). The most highly associated parameter was LLRT (standardized ß = 0.958, P = .003). CONCLUSIONS AND IMPLICATIONS: Gait in shaped pathways is associated with proprioception, reaction time, and balance ability in older patients with TKA. Therefore, proprioception, reaction time, and balance should be considered to improve the shaped pathway walking performance of patients after bilateral, right, or left TKA surgery.

The effect of exercise and education combination via telerehabilitation in patients with chronic neck pain: A randomized controlled trial.

BACKGROUND: A limited number of studies have investigated the effect of telerehabilitation in individuals with chronic neck pain (CNP). OBJECTIVE: The study aimed to evaluate the effectiveness of holistic exercise and education combination via telerehabilitation on pain, disability, kinesiophobia, exercise adherence, quality of life and patient satisfaction in individuals with CNP. METHODS: A two-armed, randomized controlled study was conducted with 40 participants with CNP. Patients were randomized into two groups: Telerehabilitation (TR) (n = 20) and Standard Rehabilitation (SR) (n = 20). The TR group was provided with exercise and education videos online. The same protocol was given to the SR group in the clinical setting. Patients were evaluated at baseline and after eight weeks of intervention. Satisfaction and usability levels of the TR group were assessed at week 8. RESULTS: TR group demonstrated better improvement in function, quality of life (including bodily pain, general health, social function), kinesiophobia and exercise adherence. The TR group was not superior to the SR group in pain and other quality-of-life subscores. A vast majority of the TR group had high satisfaction and usability. CONCLUSION: Comprehensive rehabilitation via TR increases satisfaction and participation in patients with CNP. Besides, TR provides more positive effects on function and kinesiophobia. Further studies should focus on the impact of telerehabilitation on pain and quality of life in CNP with a long-term follow-up.

Comparison of physical performance, gait, balance, falls efficacy, and step reaction time in individuals with multiple sclerosis.

OBJECTIVE: The study aimed to investigate the physical performance, gait, balance, falls efficacy, and step reaction time in individuals with MS. METHODS: A total of 60 individuals (30 individuals with MS and 30 age and sex-matched healthy controls) were enrolled. Individuals' physical performance was evaluated with the Timed Up and Go Test (TUG) and Five-Times-Sit-to-Stand Test (FTSTS). Activities-specific Balance Confidence (ABC) Scale, 12-item Multiple Sclerosis Walking Scale (MSWS-12v2) and Falls Efficacy Scale International (FES-I) were used to assess the balance, gait and fall efficacy of the participants. Individuals' step reaction time (SRT) was calculated with video-based software. The time between the step command and the first contact of the foot with the ground in the first step was recorded. RESULTS: The mean age of the individuals with MS and the control group was 38.5 ± 9.4 years and 33.9 ± 11.7 years, respectively. Significant differences existed between the groups in SRT, FES-I, ABC, and FTSTS (p < 0.05). There was no significant correlation between SRT with any other parameter (p > 0.05). TUG was moderately correlated with MSWS-12 and FES-I (r1 =0.426, r2 =0.495, p < 0.05). Besides, there was a moderate correlation between ABC with TUG and FTSTS (r1 =-0.605, r2 =-0.468, p < 0.05). A high degree correlation was found between MSWS-12 with FES-I and ABC (r1 =0.843, r2 =-0.834, p < 0.05). CONCLUSION: Individuals with MS have decreased SRTs. However, this condition was not found to be related to physical performance. Further studies should focus on the association of SRT with cognitive and psychosocial parameters.

Investigation of Motor Activity, Movement Kinematics and Forward-Backwards Gait in Children with Cerebral Palsy.

Our aim in this study was to examine relationships between the motor activity ability, sensor-based kinematics and forward-backwards gait characteristics of children with cerebral palsy (CP). In this prospective cross-sectional study we studied 40 children with CP. We used the Pediatric Motor Activity Log Revised (PMAL-R) to assess motor activity, evaluated motion kinematics (acceleration and angular velocity) with a sensor-based application, applied the Edinburgh Visual Gait Score (EVGS) and the Timed Up and Go Test (TUG) to observe gait performance, and used the Three Meter Backward Walk Test (3MBWT) to assess backward gait. We found moderately positive significant correlations (r1 = 0.416, r2 = 0.418, p < 0.05) between the chilidren's minimum angular velocity on PMAL-R motor activity frequency (how often) and quality (how well) scores, respectively. We also found moderately negative significant correlations (r1 = -0.529, r2 = -0.521, p < 0.05) between PMAL-R frequency (how often) and quality (how well) scores with TUG, respectively. There were moderately high positive correlations (r1 = 0.415, r2 = 0.726, p < 0.05) between EVGS scores and 3MBWT and TUG scores, respectively. We concluded that angular velocity ability was moderately related to children's motor activity and showed that physical performance tests (TUG and 3MBWT) could monitor gait function and upper extremity motor activity level, including both forward and backward walking tasks, in children with CP.

The investigation of cognition, proprioception, sensory and physical function in stroke patients with urinary incontinence.

PURPOSE: This study aimed to investigate cognition, proprioception, and sensory/physical function in stroke patients with urinary incontinence (UI). METHODS: A prospective cross-sectional study was conducted on 53 individuals with stroke (23 had UI and 21 matched controls). The Incontinence Impact Questionnaire Short Form (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to assess the patients' UI symptoms. Participants were also evaluated with Mini-Mental State Examination (MMSE), Barthel Index (BI), Fugl-Meyer Sensory Assessment (FMA-S), Five Times Sit to Stand Test (FTSST), Functional Reach Test (FRT) and Proprioception Test. RESULTS: FTSST, FRT and FMA-S were better in stroke subjects without UI (p < 0.05). There was a moderate correlation between IIQ-7 with FMA-S, FTSST and proprioception (left extremity) (r1: - 0.415, r2: 0.440, r3: 0.430, p < 0.05) and a low correlation with BI (r: - 0.356, p < 0.05). CONCLUSION: Individuals with UI had worse sensory/motor function and static balance. Stroke patients with UI were more dependent, had less sensory function, and had worse lower extremity muscle strength and proprioception as the level of urinary incontinence increased. To reduce urinary incontinence, emphasis on motor/sensory function, balance, and proprioception should be considered.

The effect of pelvic floor muscle training on urinary incontinence in patients with stroke: a systematic review and meta-analysis.

BACKGROUND: No other systematic review presented the effectiveness of pelvic floor muscle training (PFMT) in individual with stroke. AIMS: The purpose of this systematic review and meta-analysis was to demonstrate the effectiveness of PFMT for urinary incontinence in patients with stroke. METHODS: "Web of Science (WoS), Cochrane Library, PubMed and Scopus" databases were searched. "Revised Cochrane risk-of-bias tool randomized trials (RoB 2)" and "PEDro" were used to assess the risk of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were conducted to present the results. RESULTS: A total of 8 articles were included in the review. Seven articles were classified as "good" level evidence. Four articles were considered to have "high risk" of bias for the overall score. Regarding two homogenous studies, PFMT-based rehabilitation was not superior standard urinary incontinence therapy on SF-36-Social Function score at 12-week follow-up (ES 0.47, 95% CI - 0.16-0.96). Data pooling of two studies did not provide an additional advantage of pelvic muscle training on 3 days voiding diary (night, total day) score at 12-week follow-up (ES 28, 95% CI - 0.61-0.48; ES 0.30, 95% CI - 0.23-0.95). On the other hand, low-quality evidence demonstrated that pelvic muscle training yielded better results on daytime voiding (ES 0.28, 95% CI 0.04-1.16). CONCLUSIONS: The results demonstrated that PFMT had positive effects in terms of daytime urination frequency and incontinence. Although some studies have reported positive effects on symptoms, function, strength, and endurance, the generalizability of these results is controversial. Further studies should assess the quality-of-life and function with urinary incontinence and stroke-specific tools.

Psychometric properties of the Facial Disability Index in patients with facial palsy: a systematic review and meta-analysis.

PURPOSE: The aim of the study was to present the systematic review and meta-analysis of the psychometrical analysis of Facial Disability Index (FDI) studies. METHODS: A literature search was conducted in the relevant electronic databases "PubMed, Scopus, Web of Science (WoS), and Cochrane Library." A total of 621 articles were obtained by searching the relevant keywords (PubMed: 384, Cochrane Library: 14, Web of Science: 132, Scopus: 91). A total of 8 papers were included. The four-point classification and rating-based "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" tools were used to evaluate the bias risk and evidence levels. RESULTS: Cronbach's alpha pooling of FDI total score was (ES): 0.803 (95% CI: 0.73-0.86). Heterogeneity for the Facial Disability Index-Physical Function (FDI-PF) and Facial Disability Index-Social Function (FDI-SF) subscore based on intraclass correlation coefficient (ICC) were I2 = 84.2% (ICC: 0.88, 95% CI: 0.81-0.92) and I2 = 73.7% (ICC: 0.87, 95% CI: 0.81-0.90), respectively. Correlational results between Sunnybrook Facial Grading System (SFGS) with FDI-PF and FDI-SF were 0.38 and 0.22, respectively. The correlations of FDI-PF with Short Form-12 Physical Component Summary (SF-12-PCS) and Short Form-12 Mental Health Component Summary (SF-12-MCS) were 0.43 and 0.28, respectively. Correlation results of FDI-SF with SF-12-PCS and SF-12-MCS were 0.23 and 0.57. The relationship results of Facial Clinimetric Evaluation with FDI-PF and FDI-SF were 0.71 and 0.57, respectively. CONCLUSION: FDI is a psychometrically valuable questionnaire, especially for the internal consistency, reliability, and validity. In clinical practice, the use of FDI would be valuable, in addition to clinician-based grading, to see more of patients' social influences precisely.