Effects of virtual reality exercises and routine physical therapy on pain intensity and functional disability in patients with chronic low back pain.

Objectives: To compare the effects of Virtual Reality exercises and routine physical therapy on pain and functional disability in patients with chronic low-back pain. METHODS: The single-blind randomised controlled trial was conducted from April to October 2020 at the Physiotherapy Department of the Government Services Hospital, Lahore, Pakistan, and comprised patients of either gender, aged 25-50 years with chronic non-radiating low-back pain who were randomised into two equal groups. Group A received routine physical therapy, while group B received Virtual Reality exercises with routine physical therapy. Visual Analogue Scale and Modified Oswestry Disability Index were used to measure outcomes at baseline and after 4th, 8th and 12th sessions. Data was analysed using SPSS 24. RESULTS: Of the 84 patients, there were 42(50%) in each of the two groups. There were 28((33%) males and 56(66.6%) females. The mean age in group A was 37.5±12.5 years and in group B it was 38.2±11.8 years. Pain score at baseline was 6.62±1.04 in group A and 6.50±1.24 in group B which decreased to 3.32±0.81 and 1.00±0.60 respectively after the 12th session (p<0.05). Functional disability score at baseline was 65.08+8.94 in group A and 69.16±9.13 in Group B which decreased to 40.56±8.59 and 16.04±6.82 respectively after the 12th session (p<0.05). Group B showed significantly better results than group A (p<0.05). CONCLUSIONS: Virtual Reality exercises in combination with routine physical therapy had dominant effect on functional disability and low-back pain. Trial Registration Number (IRCTID): IRCT20200330046895N1.

The Effects of Spinal Manipulation Added to Exercise on Pain and Quality of Life in Patients with Thoracic Spinal Pain: A Randomized Controlled Trial.

Background: There are not enough reliable studies available in physiotherapy to determine the effects of spinal manipulative therapy added to exercise on thoracic spinal pain and quality of life. Objective: To investigate the effects of spinal manipulation on pain and quality of life in subjects with thoracic spinal pain. Study Design. It was an open-label "randomized controlled trial." Study Settings. Department of Physiotherapy, Services Hospital, Lahore, Pakistan. Participants. There were one hundred subjects with an age group between 18 and 60 years fulfilling the inclusion criteria. These subjects were divided equally into two groups; an experimental and a control group. Methods: In the experimental group (n = 50), thoracic spinal manipulation was applied along with thoracic muscle strengthening exercises. In the control group (n = 50) thoracic muscle exercises alone were given. Pain was measured by visual analogue scale (VAS) and quality of life with SF-36. Measurements were taken at baseline, immediately after session, after 8th session, and later as follow-ups at 12 weeks. Repeated measure ANOVA and independent sample T-test were used for within and between-group comparisons. Results: Mean age of subjects in control group was 38.56 ± 12.44 and in experimental group was 36.02 ± 11.32. Both groups demonstrated significant improvement in VAS score, and all domains of SF 36 but between-group comparison showed greater improvement in VAS of the experimental group compared to the baseline (P < 0.05), but between-group comparison of 8th session to follow-up has shown that effects of exercise persist while health-related quality of life in spinal manipulation group was significantly reduced after discontinuation of treatment. After the 8th session, spinal manipulation group showed notable results in terms of pain (mean diff 1.14 (0.62, 1.65) 95% CI and all aspects of SF 36 (P value <0.05). However, after week 12 of follow-up, no significant difference (P value >0.05) was observed among the study groups for pain and quality of life. Conclusion: Spinal manipulation added to thoracic exercise was more effective than thoracic exercise alone for improving pain and quality of life at the end of 8th session of care. However, the inclusion of spinal manipulation was not found effective at the 12-week follow-up. This trial is registered with IRCT20190327043125N1.

Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial.

OBJECTIVE: The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability. METHODS: It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons. RESULTS: There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05). CONCLUSIONS: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy. TRIAL REGISTRATION: RCT20190325043109N1.

Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial.

Purpose: Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy. Methods: A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used. Results: Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann-Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25. Conclusion: Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.