Comparing selective and general hamstring stretching and strengthening for pain, disability, and quality of life in patients with primary knee osteoarthritis and varus deformity: A randomized clinical trial.

BACKGROUND: A combination of hamstring stretching and strengthening exercises may benefit patients with knee osteoarthritis by promoting pain relief and disability improvement. PURPOSE: The current study aimed to compare the effects of lateral hamstring strengthening and medial hamstring stretching with general hamstring stretching and general hamstring strengthening on pain, disability, and quality of life in patients with primary knee osteoarthritis and varus deformity. METHODS: Forty patients with knee osteoarthritis were randomly assigned to two groups: a general hamstring strengthening group (14 women, 6 men) and a selective hamstring strengthening group (16 women, 4 men). In the general hamstring strengthening group, participants performed hamstring stretching and strengthening exercises broadly. In contrast, the selective hamstring strengthening group specifically targeted lateral hamstring strengthening and medial hamstring stretching. The treatment program was conducted three times a week for 4 weeks. Pain and disability levels were evaluated before and after treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), quality of life was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire, and physical activity levels were determined using the Tegner activity scale. RESULTS: Both groups demonstrated significant improvement in all outcomes except for the quality of life subscale of the KOOS questionnaire (p = .98) in the general hamstring strengthening group. However, the selective hamstring strengthening group exhibited greater improvements in symptoms (p = .02, effect size (d) = 0.92) and pain subscales (p = .01, d = 0.80) according to the KOOS questionnaire. Additionally, the pain subscale (p = .02, d = 0.79) of the OAKHQOL questionnaire exhibited greater improvements in the selective hamstring strengthening group. Tegner activity scale scores significantly improved in both groups. CONCLUSION: Strengthening the lateral hamstring and stretching the medial hamstring muscles seem to be beneficial for reducing pain in patients with primary knee osteoarthritis and varus deformity. Attention to stabilization in frontal and horizontal planes in the knee joint might be better than simply evaluating the joint in the sagittal plane.

Prescribing strength training for stroke recovery: a systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024. ELIGIBILITY CRITERIA: Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery. RESULTS: Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as 'critical for decision-making' by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34-1.56)), balance (SMD=1.13 (0.51-1.75)), functional ability and mobility (SMD=0.61 (0.09-1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02-0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01-0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed. CONCLUSION: Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery. PROSPERO REGISTRATION NUMBER: CRD42023414077.

Scientific Exercise Approach to Scoliosis in Adolescents With Mild Idiopathic Scoliosis: A Controlled Clinical Trial.

OBJECTIVE: This study aimed to investigate the effectiveness of Scientific Exercise Approach to Scoliosis (SEAS) protocol for patients with mild adolescent idiopathic scoliosis (AIS). METHOD: (A controlled clinical trial) This preliminary study included 32 patients with AIS, aged 10 to 16 years, with Cobb angles ranging from 12° to 25°. The participants were divided into 2 groups: the SEAS group (n = 21) and standard care (n = 11). We assessed Cobb angles via radiographs, axial trunk rotation using the Adams test, spinal deformity from various perspectives with the Spinal Appearance Questionnaire (SAQ), and health-related quality of life with the Scoliosis Research Society-22 (SRS-22) questionnaire, both before and after 1 year of treatment. RESULTS: Repeated measure-ANOVA revealed significant group x time interactions for various parameters: Cobb angle (F1,30 = 35.757; P < .001), axial trunk rotation (F1,30 = 39.595; P < .001), SAQ appearance domain for the physiotherapist (F1,30 = 53.943; P < .001), SAQ appearance (F1,30 = 14.054; P = .001), expectations (F1,30 = 9.103; P = .005) domains, the total score (F1,30 = 23.574; P < .001) for the child, and the SAQ appearance domain for the parent (F1,29 = 5.412; P = .027). There were no significant differences in SRS-22 scores between the 2 groups. The success rates for the SEAS group and the standard care group were 100% and 72.7%, respectively. CONCLUSION: After 1 year, the group of patients with mild AIS who received the SEAS method showed greater improvements in the Cobb angle, axial trunk rotation, and spinal appearance than those who received standard care. This preliminary study suggests that larger trials should be completed.

Efficacy of Sensor-Based Training Using Exergaming or Virtual Reality in Patients with Chronic Low Back Pain: A Systematic Review.

In its chronic and non-specific form, low back pain is experienced by a large percentage of the population; its persistence impacts the quality of life and increases costs to the health care system. In recent years, the scientific literature highlights how treatment based on assessment and functional recovery is effective through IMU technology with biofeedback or exergaming as part of the tools available to assist the evaluation and treatment of these patients, who present not only with symptoms affecting the lumbar spine but often also incorrect postural attitudes. Aim: Evaluate the impact of technology, based on inertial sensors with biofeedback or exergaming, in patients with chronic non-specific low back pain. A systematic review of clinical studies obtained from PubMed, Scopus, Science Direct, and Web of Science databases from 1 January 2016 to 1 July 2024 was conducted, developing the search string based on keywords and combinations of terms with Boolean AND/OR operators; on the retrieved articles were applied inclusion and exclusion criteria. The procedure of publication selection will be represented with the PRISMA diagram, the risk of bias through the RoB scale 2, and methodological validity with the PEDro scale. Eleven articles were included, all RCTs, and most of the publications use technology with exergaming within about 1-2 months. Of the outcomes measured, improvements were reported in pain, disability, and increased function; the neuropsychological sphere related to experiencing the pathology underwent improvements. From the results obtained, the efficacy of using technology based on exergames and inertial sensors, in patients with chronic non-specific low back pain, was increased. Further clinical studies are required to achieve more uniformity in the proposed treatment to create a common guideline for health care providers.

Cross-cultural adaptation and test-retest reliability assessment of a Swedish version of the exercise adherence rating scale in patients after shoulder surgery.

BACKGROUND: Adherence to prescribed home exercise is an important predictor for the long-term effectiveness of exercise therapy and therefore important to evaluate. The Exercise Adherence Rating Scale (EARS) is a valid and reliable tool to assess exercise adherence behavior, but it is not translated into Swedish. This study aimed to translate EARS into Swedish and to explore the psychometric properties in terms of test-retest reliability, internal consistency as well and possible floor-/ceiling effects. MATERIALS AND METHODS:   A translation and cultural adaptation process followed international guidelines and resulted in EARS-Sv. A total of 30 patients who had undergone shoulder surgery were included in the study and filled out EARS-Sv at two different time points. The test-retest reliability was evaluated through the weighted kappa coefficient and Intraclass Correlation Coefficient (ICC). Cronbach's alpha was used to assess internal consistency. Floor-/ceiling effects were calculated. RESULTS: The test-retest reliability of the questionnaire was good with ICC (0.79, CI 95%) and moderate with weighted kappa-coefficient (MD= 0.58). Cronbach's alpha was considered good (0.88). A ceiling effect was registered in all 6 items of EARS-Sv. CONCLUSION: EARS-Sv has moderate to good test-retest reliability and good internal consistency in patients who have undergone shoulder surgery.

The postoperative results in orthopaedic patients are often dependent on adherence to postoperative home rehabilitation programs.Exercise Adherence Rating Scale (EARS) is a questionnaire assessing adherence to prescribed home exercise and the Swedish version has an acceptable test-retest reliability and good internal consistency for patients who have undergone shoulder surgery.The Swedish version of EARS could be used as a tool to identify patients having difficulties adhering to the prescribed home exercises.

Efficacy of the Otago-Exercise-Programme to reduce falls in community-dwelling adults aged 65-80 when delivered as group or individual training: Non-inferiority-clinical-trial.

BACKGROUND: The Otago Exercise Programme is an effective intervention for falls prevention. However, there is limited evidence in relation to studies that compare efficacy for falls prevention when delivered Otago Exercise Programme in a group or individual format in a primary care context. OBJECTIVE: To compare the Otago Exercise Programme delivered as a group vs. individual format for community dwelling older adults, over a one year period. The hypothesis was that neither format would be inferior to the other. METHODS: DESIGN: A four-year multicentre, randomized, non-inferiority clinical trial, with two arms- Otago Exercise Programme group training and individual Otago exercise training. SETTING(S): 21 primary healthcare centers. PARTICIPANTS: A sample size of 728 participants was established. Participants were aged between 65 and 80 years; living in the community; able to walk independently; and agreed to take part in the study and provided signed informed consent. INTERVENTION: The Otago Exercise Programme was delivered mainly by nurses in primary care, with five face to face sessions, and a reinforcement 6 months later. Participants were encouraged to exercise at home between face to face sessions. DATA COLLECTION: at baseline and after 6 and 12 months from October 2017 to 2020. PRIMARY OUTCOME: people who reported at least one fall. SECONDARY OUTCOMES: number of falls, cause of falls, consequences and assistance, adherence and satisfaction. Group allocation was blinded to the researchers involved in analysis. Reporting: Consolidated Standards of Reporting Trials recommendations for the Statement for Randomized Trials of Nonpharmacologic Treatments. RESULTS: Eight hundred twenty-seven participants were randomized (226 were allocated in group training and 272 in individual training). The analysis of the proportion of people who reported at least one fall and number of falls showed no differences between individual and group training. Assessment of the equivalence between the interventions at 12 months showed that the confidence interval for the difference of people who reported at least one fall was found to be within the equivalence limit of 10% considered. However, in those participants with a previous history of falls, group format showed potentially greater benefit. The participants in individual training presented higher scores on the Exercise Adherence Rating Scale test. No differences were found in satisfaction between the groups. CONCLUSIONS: The group Otago Exercise Programme is equivalent to individually delivered Otago Exercise Programme in terms of prevention of falls over a 12-month follow up. Adherence was higher in individual training. IMPLICATIONS: Healthcare professionals could offer either Otago Exercise Programme format dependent on patient preference and be confident that that standardized intervention provides patient benefit. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03320668). Data registration 31/10/2017.

Patient preferences for conservative treatment of shoulder pain: a discrete choice experiment.

BACKGROUND: Shoulder pain is common amongst adults, but little is known about patients' preferences. OBJECTIVE: The aim of this study was to determine patients' preferences for treatment options offered for shoulder pain in primary care. METHODS: A discrete choice experiment was used to investigate these preferences. Adults with shoulder pain were asked to make 12 choices between two treatment options, or to opt-out. The attributes of the 12 treatment options were presented as varying in: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), prevention of relapse (yes/no), requiring injection (yes/no), and including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model. RESULTS: Three hundred and twelve participants completed the questionnaire with mean age of 52 ±â€…15.2 years. Latent class analysis revealed three groups. Group 1 preferred to opt-out, unless the attributes were highly favorable (90% effectiveness). Group 2 preferred treatment, but not an injection. Group 3 preferred to opt-out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again. CONCLUSION: This study showed that most patients with shoulder pain prefer to opt-out, unless treatment attributes are highly favorable. Characteristics of influence on this decision was whether the patient had received an injection or physiotherapy before.

Acute and long-term effect of specific and non-specific exercises in patients with chronic neck pain: A protocol for a randomized controlled trial.

Exercise therapy is the most common approach for people with chronic neck pain (CNP). Although well-established, it remains unknown which type of exercise is the best for treating this condition. Moreover, pain processing can play a role in the persistence of pain and in the response to interventions. Thus, the aim of this randomized controlled trial is to compare the acute and long-term effects of two exercise protocols (specific and non-specific) on pain and pain processing in individuals with CNP. One hundred and ten participants aged between 18 and 65 years who have had non-specific neck pain for more than 3 months will be recruited. They will be randomized and allocated into two groups (specific exercises and non-specific exercises) and both groups will perform an exercise programme twice a week for 8 weeks. Both programmes are divided into two progressive and individualized phases. The primary outcomes are change in pain intensity after 8 weeks of exercise and exercise-induced hypoalgesia, and secondary outcomes are pressure pain threshold, temporal summation of pain, conditioned pain modulation, the Neck Disability Index, the Baecke Physical Activity Questionnaire, and the Global Perception of Change Scale. Outcomes will be assessed at baseline, after 8 weeks of intervention, and at 6-month follow-up.

Prevalence of concerns about falling in people with knee or hip osteoarthritis and the association with pain, function, and psychological factors-a cross-sectional study of 7442 patients treated in primary care.

BACKGROUND: Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA. METHODS: This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression. RESULTS: In total, 7442 patients were included [mean age 67 years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [ß-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex. CONCLUSIONS: CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant.

Individualized Versus General Exercise Therapy in People with Subacromial Pain Syndrome: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of individualized exercises based on movement fault (MF) control on pain intensity and disability in subjects with chronic subacromial pain syndrome (SAPS). DESIGN: Randomized Controlled Trial (IRCT20221126056621N1) SETTING: Rehabilitation clinics PARTICIPANTS: Thirty-eight participants with chronic SAPS (aged 52.23(8.47), 60 %woman). INTERVENTIONS: The participants were randomly allocated to one of the intervention groups (individualized exercises based on MFs control test designed to target specific movement faults) or the control group (commonly prescribed general scapular stabilization exercises). Both groups received exercise sessions twice a week for four weeks. MAIN OUTCOME MEASURES: The primary outcome measures were pain intensity at rest (PR) and during arm raising (PAR) using a visual analog scale. Disability was assessed as a key secondary outcome, including the disabilities of the arm, shoulder, and hand (DASH) questionnaire and the Shoulder Pain and Disability Index (SPADI). RESULTS: Following completion of all exercise sessions, PAR was significantly lower in the intervention group compared to the control group (mean [CI]: 9.17 [0.31 to 18.03], p=0.04), with a large effect size [0.68]. The reduction of PAR remained significantly lower in the intervention group than in the control group after four months of follow-up (mean [CI]: 18.29 [9.09 to 27.48], p=0.00) with a large effect size [1.27]. Disability significantly decreased at two month (mean=14.58, p=0.002 on SPADI index; mean=10.26, p=0.006 on DASH index) and four month (mean=19.85, p=0.00 on SPADI index; mean=12.09, p=0.001 on DASH index) follow ups in the intervention group compared to the control group. CONCLUSION: Individualized exercises based on MFs control of the shoulder region was accompanied by decreased PAR and disability in subjects with SAPS.

Effectiveness of an exercise therapy program based on sports in adults with acquired brain injury: a randomized controlled trial.

OBJECTIVE: To examine the effects of a sport-based exercise therapy program combined with usual care (sET+UC) compared with usual care alone (UC) on health-related quality of life, upper limb motor control, functional capacity, mobility, balance, and physical activity participation in ambulant adults with acquired brain injury (ABI). DESIGN: Single-blind, parallel-group, randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Twenty-three adults with ABI (82.6% stroke; 17 males; mean age of 59.6±10.3 yr) INTERVENTION: Participants received either sET+UC (n=11) or UC (n=12). The sET+UC group received sixteen 60-minute sessions of a sport-based ET program in addition to sixteen 60-minute sessions of usual care, whereas the UC group attended usual care only. MAIN OUTCOME MEASURES: Primary outcome measures were health-related quality of life (Short Form-36, SF-36) and upper limb motor control (Fugl Meyer-Upper Extremity; FM-UE), while the secondary included functional capacity (6-Minute Walk Test, 10-Meter Walk Test), mobility (Timed Up and Go Test), balance (Berg Balance Scale) and physical activity participation (Global Physical Activity Questionnaire). RESULTS: Significant differences were found in all outcome analyses at post-intervention when comparing between groups. The sET+UC group showed significant improvements in both the physical (p=.027, r=.46) and mental component summary (p=.001, r=.71) of the SF-36 as well as FM-UE (p=.004, r=.60), with large effect sizes. In turn, all secondary outcomes were also significantly improved in this group (all p<.05 r>.05). In contrast, the UC group showed slight improvements in post-intervention scores but did not reach significance in any of these measures. CONCLUSIONS: This study shows that a sport-based exercise therapy program combined with usual care can effectively improve all the aforementioned outcomes measures in ABI population. Further research with larger sample sizes and follow-up assessments is crucial to gain a more comprehensive understanding of the long-term effects of the intervention in this specific population.

Association between depression and adherence to upper limb exercises among community-dwelling stroke survivors: A cross-sectional study.

Background and Aims: Upper limb recovery after stroke tends to be slower and incomplete. Participation in motor rehabilitation and exercise adherence are crucial to improve motor recovery. However, post-stroke depression (PSD) could impede active participation in exercises. Therefore, this study investigates the association between depression and exercise adherence among community-dwelling stroke survivors. Methods: This cross-sectional study was conducted among 215 stroke survivors undergoing motor rehabilitation between February 2021 and January 2023. Patient Health Questionnaire-9 (PHQ-9) and Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) were measured to assess depression symptoms and exercise adherence, respectively. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was administered to identify the influence of impairment on these factors. Chi-square and multinomial and binary logistic regression analyses were applied to determine the relationships between these measurements. Results: Using the Chi-square test, the PHQ-9 was significantly associated with SS-MAHE (p < 0.05). Logistic regression analysis revealed that patients with moderate depression had lower odds of exercise adherence (OR:0.69, 95%CI:0.56, 0.85, p < 0.01) compared to those with no depression. Type of exercises such as movement-based (OR:2.00, 95%CI:1.80, 2.24, p < 0.001) and task-based exercises (OR:1.80, 95%CI:1.53, 2.13, p < 0.001), had higher adherence odds compared to those not exercising. Severe impairment (FMA-UE) was significantly associated with lower exercise adherence (OR:0.71, 95%CI:0.54, 0.94, p < 0.05) and an increased risk of minimal depression (RR:11.09, 95%CI:1.17, 105.04, p < 0.05) compared to mild impairment. Conclusions: PSD significantly impacts exercise adherence, with moderate depression notably reducing adherence rates. Incorporating mental health support into stroke rehabilitation could improve exercise adherence and potentially enhance upper limb motor recovery outcomes.

Effect of lower-limb isokinetic muscle strengthening on knee function and joint contact force in knee osteoarthritis patients awaiting total knee arthroplasty: study protocol for a randomized controlled trial.

BACKGROUND: Knee osteoarthritis (OA) is a common and serious joint disease and patients mainly suffer from knee pain and dysfunction, significantly impacting their quality of life and daily activities. Non-pharmacological treatments and total knee arthroplasty (TKA) are the two major treatments for knee OA. TKA is the primary treatment for severe knee OA patients, however, the postoperative rehabilitation results are not entirely satisfactory. To enhance postoperative rehabilitation outcomes, preoperative lower-limb muscle strengthening has aroused attention and demonstrated significant results on functional recovery after TKA. Specifically, isokinetic muscle strengthening (IMS) has been highly anticipated as an efficient training method. Nevertheless, its effects in perioperative and long-term periods of TKA require further investigation. This study aims to evaluate the impact of preoperative lower-limb IMS during the 4 weeks before TKA on the perioperative and postoperative outcomes, with particular attention on knee function, pain, and inflammatory response. METHODS: In this study, 104 patients awaiting TKA will be randomized to 2 groups: the IMS and health education groups. All patients will be evaluated at baseline, post-intervention, discharge day, and postoperative day 14, with follow-up assessments at 6 weeks, 3, 6, and 12 months after discharge. The primary outcome will be the Knee Injury and Osteoarthritis Outcome Score 3 months after TKA and the medial-to-lateral knee contact force ratio. The secondary outcomes will be changes in lower-limb muscle strength, knee pain, inflammation response, active range of motion, performance-based function (5-times Sit-to-Stand Test, Time Up-and-Go Test, 3 m walking speed), Berg Balance Scale, and surgical need. DISCUSSION: Lower-limb IMS can improve muscle strength, pain, and function for early knee OA patients. However, the effects of different doses of IMS on perioperative and postoperative knee pain, inflammation response, and function after TKA are inconclusive. This study will provide high-quality evidence to assess the efficacy of IMS in end-stage patients who will undergo TKA. Understanding IMS in end-stage knee OA patients will help guide future surgical management for this population. Trial Registration Chinese Clinical Trial Registry ChiCTR2400088136.

Increasing or decreasing load during resistance training is not associated with changes in pain among individuals with patellar tendinopathy: a randomized crossover study.

OBJECTIVES: This study investigated whether exercising with different relative loads would be associated with different experienced pain intensities in individuals with patellar tendinopathy. MATERIALS AND METHODS: We recruited 14 individuals with patellar tendinopathy for this randomized crossover study. In a randomized order, participants performed one set of single-legged leg presses during one session with three relative loads (6 repetition maximum (RM), 10RM, and 14RM). The primary outcome was pain during exercise measured on a 0-10 Numerical Rating Scale (NRS) (0 = no pain, 10 = worst pain), which participants rated after performing the exercise set with each relative load. RESULTS: No differences in pain during either of the three relative loads were observed (F(2, 26) = 0.06, p = 0.942). The participants' experienced pain was 4.5 NRS (SD1.7), 4.5 NRS (SD1.7), and 4.6 NRS (SD2.0) during the 6RM, 10RM, and 14RM loads, respectively. A secondary analysis revealed no statistically significant difference in pain intensity between the performance of the first, second, or third exercise set regardless of the load (F(2, 26) = 1.06, p = 0.367). CONCLUSIONS: There was no difference in pain intensity during either relative load among individuals with patellar tendinopathy. Therefore, higher loads may be applied, associated with enhanced tendon adaptation.

Clinicians may tend to decrease the load if the patient suffering from patellar tendinopathy expresses pain despite no evidence supporting that reducing the load will change the pain intensity during exercise.This study found that all loads (6RM, 10RM, and 14RM) were associated with the same pain experience.Pain did not vary with different exercise loads and, therefore, should not be used as the primary guide for load selection.

Clinical Effects of Additional Platelet-Rich Plasma Application to Exercise Therapy in Patients with Subacromial Impingement Syndrome: A Double-Blind Randomized Controlled Trial.

Background: Exercise therapy (ET) is the main and initial treatment modality for treating subacromial impingement syndrome (SIS). The isolated or combined use of platelet-rich plasma (PRP) applications in treating SIS is increasing and promising. A comparison was made on the effectiveness of ET alone and in combination with PRP on pain, functionality, and quality of life (QoL) in patients with SIS. Purposes/Hypothesis: The purposes of this study were to (1) investigate the possible positive effects of PRP injections combined with ET in treating SIS on pain, functionality, and QoL and (2) propose an alternative treatment protocol. It was hypothesized that the group receiving PRP applications in addition to ET would have a better QoL due to less pain and higher functionality 6 months after treatment. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Volunteer patients diagnosed with SIS were included based on history and physical examination findings. All participants underwent magnetic resonance imaging to confirm the diagnosis and exclude possible accompanying pathologies. The patients were randomly divided into 2 groups. The first group underwent ET at home for 8 weeks (ET group), and the second group received the same ET program and an additional 2 PRP injections, at the beginning of the study and the end of the fourth week (PRP group). Patients were evaluated initially and 6 months after the treatment using the visual analog scale (VAS) for pain score, Constant-Murley Score (CMS), and the 36-Item Short Form Health Survey (SF-36). The Kolmogorov-Smirnov test determined the conformity of the data to a normal distribution, chi-square analysis was used to compare categorical variables between groups, and the Mann-Whitney U test was used to compare continuous and intergroup variables. Intragroup changes before and after treatment were evaluated with the Wilcoxon signed-rank test. P < .05 was considered statistically significant. Results: A total of 67 patients were initially enrolled; 5 were excluded and 6 were lost to follow-up (1 because of a COVID diagnosis). Thus, 56 patients (56 shoulders) were included for analysis. There were 28 patients in the ET group and 28 patients in the PRP group. There were no statistical differences between groups regarding participant characteristics and clinical evaluations before treatment. A statistically significant improvement was observed in pain (VAS subgroups), functionality (CMS subgroups), and QoL (SF-36 subgroups) evaluations of patients in both the ET and the PRP groups compared with before the treatment and 6 months after treatment (P < .05). At the 6-month posttreatment evaluation, the PRP group was statistically significantly superior to isolated ET in terms of VAS rest (P = .001) and night (P = .004) scores. This superiority was also in favor of the PRP group in flexion strength (P = .001), abduction strength (P = .046), and abduction degree (P = .041) measurements. There was no significant difference between ET and PRP groups regarding VAS activity, CMS, and SF-36 scores (P > .05) at 6 months. Conclusion: Our study showed that both isolated ET and additional PRP application to ET are effective methods in SIS treatment regarding pain, function, and QoL. Combining ET with PRP was superior in reducing pain and improving abduction degree and strength.

Effects of Exercise in Adults With Cancer Pain: A Systematic Review and Network Meta-Analysis.

CONTEXT: Pain is one of the most common symptoms of cancer patients, affecting the patient's physical, psychological, behavioral, social relations and other aspects. Previous studies have demonstrated that exercise is effective for cancer pain, and the optimal exercise is still unknown. OBJECTIVES: This study aimed to compare the effects of different exercise interventions on cancer pain in adults. METHODS: Randomized control trials identified from medical literature databases that reported effects of exercise in adults with cancer pain were included in this study. Literature screening and data extraction were conducted independently by 2 researchers. Cochrane Bias Assessment 2.0 was used to assess the quality of the literature, and Stata 15.0 software was used for Network meta-analysis. RESULTS: Forty-one studies were included, involving 3537 patients with cancer pain. The types of exercise involved included aerobic exercise, medium intensity continuous training, high-intensity interval training, resistance exercise, mind-body exercise and comprehensive exercise program (CEP). The results suggested that CEP was more effective than the usual care in relieving pain intensity in cancer patients [SMD = -1.96,95% CI (-3.47, -0.44)] (SUCRA = 97.9%). Mind-body exercise outperformed usual care in reducing pain interference in cancer patients [SMD = -0.65, 95% CI (-1.21, -0.09)] (SUCRA = 83.8%). CONCLUSION: Current evidence shows that CEP is the best way to relieve the pain intensity of cancer patients, and mind-body exercise is the best way to reduce pain interference of cancer patients. Due to the limited number and quality of the included studies, the above conclusions need to be further verified by more high-quality studies.

Combined Treatment of Face-to-Face Physical Therapy and Telerehabilitation in Workers with Whiplash Syndrome.

Objective: Interventions through telerehabilitation have shown positive effects in various clinical conditions, facilitating the return to work of the working population. This study aimed to compare conventional, center-based physiotherapy versus an intervention combining home- and center-based treatment for whiplash syndrome in workers enrolled in a mutual insurance company, evaluating differences in the number of face-to-face sessions and the duration of sickness absence. The secondary aim was to assess the acceptability and usability of the telerehabilitation intervention. Methods: The study population (n = 387) comprised workers aged 16 to 65 years who required physiotherapy due to whiplash (ICD-9 847.0). The main outcome variable was the number of face-to-face sessions. The duration of sickness absence was also calculated. A survey was also conducted to determine patient acceptance and usability of the platform. The analyses were adjusted for sex, age, occupation, and the center where the physiotherapy treatment was administered. Results: The number of face-to-face physiotherapy sessions dropped significantly, from 9 to 7, due to the implementation of telerehabilitation. This decrease was not associated with a longer duration of sickness absence. The difference in the median duration of sickness absence between patients who had not undergone telerehabilitation and those who had undergone telerehabilitation was -1 [95% CI= (-6 to 2)]. Conclusion: Telerehabilitation reduces the number of face-to-face physiotherapy sessions needed, which can reduce the care burden in physiotherapy centers and avoid the need for patients to travel (with a corresponding reduction in transportation costs), without increasing the duration of sickness absence.

Comparison of effectiveness of extracorporeal shock wave therapy and peloidotherapy in patients with plantar fasciitis: a prospective, randomized, controlled study.

Although peloidotherapy and ESWT are effective treatments for plantar fasciitis, there is no comprehensive research that directly compares their effectiveness. Our study aimed to compare the effectiveness of ESWT and peloidotherapy on pain, quality of life and functional status in individuals diagnosed with plantar fasciitis (PF). A total of 78 patients, aged between 18 and 65 years, diagnosed with PF after a thorough anamnesis and physical examination and experiencing heel pain for at least 3 months or longer and who presented to the Clinic between January 2021 and January 2023, were included in the study. Patients were randomly allocated to two groups. The peloidotherapy group received 15 sessions of peloid therapy five days a week for three weeks, while the ESWT group received three sessions of radial-type ESWT once a week for three weeks. Additionally, all patients were given a home exercise program. All patients were evaluated three times for treatment efficacy. Pain levels were assessed using the Visual Analog Scale (VAS) and Heel Tenderness Index (HTI), functional status and quality of life were assessed using the Foot Ankle Outcome Score (FAOS) and Short Form 36 (SF-36), respectively. In both treatment groups, there was a statistically significant improvement in VAS, HTI, FAOS and SF-36 scores at the end of treatment and during the one-month follow-up, compared to the initial baseline values. A statistically significant difference in favor of peloidotherapy was observed in post-treatment symptom and pain scores (p = 0.046). However, this difference did not persist at the one-month follow-up. Both active treatment methods were similarly effective and no superiority was observed between them (p > 0.05). Peloidotherapy and ESWT treatments, along with a home exercise program, were found to be effective for patients with plantar fasciitis. In the conservative treatment of PF, both peloidotherapy and ESWT can be recommended as effective and reliable options.