Effectiveness of exercise intervention on physical and health outcomes in patients admitted to an acute medical ward: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of inpatient medical ward exercise on physical and health outcomes in adults compared with usual care. DATA SOURCES: Medline, CINAHL and EMBASE were searched from inception to 20 April 2023. REVIEW METHODS: Randomised-controlled trials in English that reported physical and health outcomes of adults who received an exercise intervention on an acute medical ward were included. Two reviewers independently extracted data. Methodological quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed the quality of evidence to evaluate the certainty of effect. Meta-analyses were performed where possible. RESULTS: Thirteen studies were included, with 1273 unique participants (mean [SD] age, 75.5 [11] years), which compared exercise intervention with usual care. Low quality evidence demonstrated a significant improvement in aerobic capacity ([MD], 1.39 m [95% CI, 0.23, 2.55], p = 0.02) and maximum isometric strength ([MD], 2.3 kg [95% CI, 2.2, 2.4], p < 0.001) for the exercise intervention compared with usual care. Low quality evidence demonstrated no difference for in-hospital falls count ([OR], 1.93 [95% CI, 0.61, 6.12] p = 0.27) or mortality ([OR], 0.77 [95% CI, 0.48, 1.23], p = 0.27). Moderate quality evidence demonstrated no difference for length of stay ([MD], -0.10 days [95% CI, -0.31, 0.11] p = 0.36). CONCLUSION: Exercise prescribed during an acute medical ward stay improves aerobic capacity and maximum isometric strength but may not reduce length of stay, in-hospital falls or mortality.

The immediate and lasting balance outcomes of clinical falls-prevention programs: A non-randomised study.

PURPOSE: Exercise-based falls-prevention programs are cost-effective population-based approaches to reduce the risk of falling for older adults. The aim was to evaluate the short-term and long-term efficacy of three existing falls-prevention programs. METHODS: A non-randomized study design was used to compare the immediate-post and long-term physical outcome measures for three falls prevention programs; one high-level land-based program, one low-level land-based program and a water-based Ai Chi program. Timed-up-and-go (TUG), five-times sit-to-stand (5xSTS), six-minute walk test (6MWT) and six-meter walk test were assessed at baseline, post-program, and at six-months follow-up. Linear mixed models were used to analyze between- and within- group differences, with the high-level land-based program used as the comparator. RESULTS: Thirty-two participants completed post-program assessment and 26 returned for follow-up. There was a difference in the age (years) of participants between programs (p = 0.049). The intercept for TUG and six-meter walk test time was 47.70% (23.37, 76.83) and 32.31s (10.52, 58.41), slower for the low-level group and 40.49% (17.35, 69.89) and 36.34s (12.75, 64.87), slower for the Ai Chi group (p < 0.01), compared with the high-level group. Mean time taken to complete the TUG was less both immediately post-program and at 6-month follow-up (p = 0.05). Walking speed for the six-meter walk test was only faster at six-months (p < 0.05). The 5xSTS duration was significantly reduced only at post-intervention (p < 0.05). CONCLUSION: These results indicate land-based and water-based falls-prevention programs improve physical outcome measures associated with falls-risk and many improvements are maintained for six months after the completion of the program. (Retrospective trial registration: ACTRN1262300119069).

The effect of manual therapy on ankle dorsiflexion range of motion: A pilot crossover randomized trial.

INTRODUCTION: Restricted ankle dorsiflexion is common after lower limb injury. The aim of this pilot study was to investigate the effect of passive ankle joint mobilization and calf muscle massage on ankle dorsiflexion range of motion in adults with residual restricted dorsiflexion. The secondary aim was to assess the methodology of the pilot study to inform a larger clinical trial. METHOD: The study design was a randomized crossover trial with assessor blinding. Twenty-five healthy participants with a history of lower limb injury were included in the study. Ankle joint mobilization and calf muscle massage were applied for 5 min in a random order, one to two weeks apart. Ankle dorsiflexion was measured by using the weight-bearing lunge pre- and post-intervention (cm). Paired t-tests were used to analyze the effect of the manual therapy interventions on restricted ankles. A minimal detectable difference 95% (MMD95) was calculated. The pilot study was analyzed for suitability of inclusion criteria, blinding of assessors and the manual therapist, and the washout period. RESULTS: A significant increase in dorsiflexion was demonstrated for ankle joint mobilization (change score = 0.51 ± 0.76, p = 0.003) and calf muscle soft tissue massage (change score = 0.91 ± 1.07, p < 0.001). There was no difference in change scores between manual therapy techniques (mobilization 0.51 ± 0.76, massage 0.91 ± 1.07, p = 0.12). Evaluation of the pilot study revealed limitations to be modified in future studies. CONCLUSION: These preliminary data indicate ankle joint mobilization and calf muscle soft tissue massage had similar effects on increasing ankle dorsiflexion range of motion in ankles with residual dorsiflexion restriction.

Groin pain and hip range of motion is different in Indigenous compared to non-indigenous young Australian football players.

OBJECTIVES: Hip and groin pain are common problems in Australian football. Although indigenous (I) players are at greater risk of soft tissue injury than their non-indigenous (non-I) counterparts, Aboriginal descent has not previously been identified as a risk factor for hip and groin injury. The aim of this study was to investigate if hip and groin screening tests would demonstrate differences between indigenous and non-indigenous junior elite AF players. DESIGN: Cross-sectional study. METHOD: Two hundred and seventy elite junior Australian football players were screened using five hip and groin musculoskeletal tests. RESULTS: Thirty-three players (12%) were indigenous. Differences were demonstrated between the two groups for right prone hip internal rotation (I X = 27.60 ± 9.16, non-I X = 33.39 ± 8.88, p < 0.001) and left prone hip internal rotation (I X = 25.83 ± 10.25, non-I X = 31.36 ± 8.75, p < 0.001), pressure on squeeze test with knees at 90° (I X = 165.71 ± 40.32, non-I X = 188.17 ± 62.32, p = 0.001) and pressure on squeeze tests with knees at 0° (I X = 172.57 ± 35.98, non-I X = 202.57 ± 49.14, p = 0.049), and pain provocation during squeeze test with knees at 90° (I X = 3.19 ± 2.26, non-I X = 1.03 ± 1.78, p > 0.001). CONCLUSIONS: The indigenous players displayed less range of passive hip internal rotation with the hip in neutral, reduced adductor squeeze force and higher levels of groin pain with the squeeze test at 90°. The differences observed between indigenous and non-indigenous players suggest indigenous players are at greater risk of hip and groin injuries in Australian football.