Comparison of Muscle Energy Technique, Myofascial Release, and Combined Techniques for Glenohumeral Internal-Rotation Deficit. An Interventional Study / Comparación de Técnica de Energía Muscular, Liberación Miofascial y Técnicas Combinadas para el Déficit de Rotación Interna Glenohumeral. Un Estudio Intervencionista

SUMMARY: This study aimed to determine the benefits of a combined technique of muscle energy with and myofascial release more effective than using each in isolation in glenohumeral internal rotator deficits. An interventional study was designed for this study. Thirty-eight patients were diagnosed with painful shoulder syndrome. Patients were randomly allocated into 4 groups where Group A was treated with combined muscle energy and myofascial release; Group B with muscle energy technique; Group C with myofascial release and Group D used as control. The evaluation of the passive joint range of the glenohumeral internal rotation and sociodemographic data for each of the groups were measured, before and after interventions. Despite the use of myofascial release and muscle energy techniques being significantly beneficial in their respective groups, when both were combined; it outcomes were highly successful. A combination therapy treatment applied with the Muscle Energy and Myofascial Release Techniques in patients with painful shoulder syndrome will be more effective in increasing the range of motion of the glenohumeral internal rotation joint than any of the techniques applied individually.

Este estudio tuvo como objetivo determinar los beneficios de una técnica combinada de energía muscular con liberación miofascial más efectiva que usar cada una de manera aislada en los déficits de los músculos rotadores internos glenohumerales. Para este estudio se diseñó un protocolo de intervención. En 38 pacientes se diagnosticó síndrome de hombro doloroso. Los pacientes fueron asignados aleatoriamente a 4 grupos; el grupo A fue tratado con energía muscular combinada y liberación miofascial; Grupo B con técnica de energía muscular; Grupo C con liberación miofascial y Grupo D utilizado como control. Se midió la evaluación del rango articular pasivo de la rotación interna de la articulación glenohumeral y datos sociodemográficos de cada uno de los grupos, antes y después de las intervenciones. A pesar de que el uso de técnicas de liberación miofascial y energía muscular resultó significativamente beneficioso en sus respectivos grupos, cuando ambas se combinaron; Sus resultados fueron muy exitosos. Un tratamiento de terapia combinada aplicado con las Técnicas de Energía Muscular y Liberación Miofascial en pacientes con síndrome de hombro doloroso será más efectivo para aumentar el rango de movimiento de la articulación de rotación interna glenohumeral que cualquiera de las técnicas aplicadas individualmente.

Myofascial pain - A major player in musculoskeletal pain.

Myofascial pain is a soft tissue pain syndrome with local and referred musculoskeletal pain arising from trigger points. Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Myofascial pain can exist independently of other pain generators or can coexist with or is secondary to other acute and chronic painful musculoskeletal conditions. Myofascial pain is most effectively treated with a multimodal treatment plan including injection therapy (known as trigger point injections, physical therapy, postural or ergonomic correction, and treatment of underlying musculoskeletal pain generators. The objectives of this review are to outline the prevalence of myofascial pain, describe the known pathophysiology of myofascial pain and trigger points, discuss the clinical presentation of myofascial pain, and present evidence-based best practices for pharmacologic, non-pharmacologic, and interventional treatments for myofascial pain.

Observations on the Therapeutic Efficacy of Biomimetic Physiotherapy Combined with Manipulation Therapy in Managing Myofascial Pelvic Pain Syndrome in Women.

Objective: This study aims to investigate the clinical efficacy of biomimetic physiotherapy combined with manipulation therapy in the management of female myofascial pelvic pain syndrome (MPPS). Methods: A total of 120 patients diagnosed with MPPS at our hospital from June 2018 to June 2021 were included. All patients had a history of sexual activity, met the diagnostic criteria for female chronic pelvic pain, and exhibited pelvic floor muscle and myofascial trigger points in gynecological examinations. Based on treatment methods, patients were categorized into a control group (n=64, treated with biomimetic physiotherapy) and an experimental group (n=56, treated with biomimetic physiotherapy plus manipulation therapy). Pre- and post-treatment assessments in both groups included pelvic floor muscle surface electromyogram, Visual Analogue Scale (VAS) score, pelvic floor muscle tenderness score, and pelvic floor muscle strength. Results: After treatment, in the control group, the mean values of pre-resting potential and post-resting potential declined significantly, from (9.58±2.22) to (4.06±0.77) and from (8.18±1.78) to (3.56±0.61), respectively. In the experimental group, these values decreased from (9.61±2.77) to (3.15±0.58), and from (8.16±1.78) to (2.79±0.59). The VAS score exhibited a noteworthy decrease from (6.18±1.00) to (3.15±0.56) in the control group and from (6.20±1.13) to (2.04±0.68) in the experimental group. The pelvic floor muscle tenderness score decreased from (8.14±0.86) to (3.78±0.77) in the control group and from (7.91±1.03) to (1.93±0.80) in the experimental group. Furthermore, the percentage of patients whose pelvic floor muscle strength increased from

Treatment of shoulder impingement syndrome: a survey of physical therapists in Saudi Arabia.

OBJECTIVE: Shoulder impingement syndrome (SIS) is one of the most frequent causes of shoulder pain. Evidence supported the use of conservative treatment for SIS. Clinical practice guidelines (CPGs) indicated that physical therapy interventions, including therapeutic exercises, manual therapy, patient education, and advice, were recommended for the treatment of SIS. This study's purpose was to investigate physical therapists' adherence to the CPGs for treating SIS. SUBJECTS AND METHODS: Physical therapists in Saudi Arabia were invited to participate in an online survey via the Saudi Physical Therapy Association between May and December 2022. The developed online survey consisted of 36 questions, divided into five sections: eligibility, demographics, clinical practice regarding the treatment of SIS, barriers, and facilitators for the use of CPGs. Descriptive and logistic regression analysis were employed to analyze study data. RESULTS: A total of 313 physical therapists completed the entire survey. In general, physical therapists were aligned with CPGs. Physical therapists advised their patients, utilized therapeutic exercises and manual therapy techniques, and used electrotherapy modalities despite being not recommended. Key challenges indicated by physical therapists for the use of CPGs include low patient adherence to therapists' instructions, lack of adequate knowledge, and limited clinical time. CONCLUSIONS: Overall, physical therapists in Saudi Arabia followed the CPGs for treating SIS. Therapeutic exercises combined with manual therapy were the most common treatment options. However, further research should consider exploring adherence to such guidelines over time.

The effect of clay therapy on hopelessness and depression levels in chronic stroke patients in addition to physical therapy.

BACKGROUND: Clay art therapy can be used as part of rehabilitation for chronic stroke patients. OBJECTIVE: The objective of this study is to examine the effect of clay therapy on hopelessness and depression levels in chronic stroke patients who receive physical therapy and compare them to patients who only receive physical therapy. METHODS: This randomized controlled study was conducted between August 1st - September 28th, 2022 in Turkiye, with 60 patients who agreed to participate in the study and met the inclusion criteria, which were chronic stroke patients who received physical therapy. The patients were divided into two groups (30 in the experimental group, 30 in the control group) with the control group receiving only their routine physical therapy and rehabilitation (5 days a week, 40 sessions in total), while the experimental group received their routine physical therapy and rehabilitation program as well as clay therapy twice a week, 60 min per session, for 8 weeks. Demographic information of all the participants was recorded, and the Beck Depression Inventory and Beck Hopelessness Scale were administered before and after treatment. RESULTS: The patients' depression posttest scores (t(58) = -11.386; p = 0.000 < 0,05), and hopelessness posttest scores (t(58) = -10.247; p = 0.000 < 0,05) differed significantly based on their groups. The control group's depression posttest scores (x¯ =25,033) and hopelessness posttest scores (x¯ =15,000) were higher than the experimental group's depression posttest scores (x¯ =9,067) and hopelessness posttest scores (x¯ =8,000). The control group's feeling about the future posttest scores (x¯ =2,967) were higher than the experimental group's posttest scores (x¯ =0,967). The control group's loss of motivation posttest scores (x¯ =6,400) were higher than the experimental group's posttest scores (x¯ =2,667). CONCLUSION: It was seen that clay therapy, in addition to physical therapy, was effective in reducing depression and hopelessness in chronic stroke patients.

Which Portion of Physiotherapy Treatments' Effect Is Not Attributable to the Specific Effects in People With Musculoskeletal Pain? A Meta-Analysis of Randomized Placebo-Controlled Trials.

OBJECTIVE: We aimed to quantify the proportion not attributable to the specific effects (PCE) of physical therapy interventions for musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. STUDY SELECTION CRITERIA: Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. DATA SYNTHESIS: Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (RoB 2). The proportion of physical therapy interventions effect that was not explained by the specific effect of the intervention was calculated, using the proportion not attributable to the specific effects (PCE) metric, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). RESULTS: Sixty-eight studies were included in the systematic review (participants: n = 5238), and 54 placebo-controlled trials informed our meta-analysis (participants: n = 3793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy, and dry needling. Placebo interventions included manual, nonmanual interventions, or both. The proportion not attributable to the specific effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE = 0.88, 95% confidence interval [CI]: 0.57, 1.20). In exercise therapy, this proportion accounted for 46% of the overall treatment effect for pain intensity (PCE = 0.46, 95% CI: 0.41, 0.52). The PCE in manipulation excelled in short-term pain relief (PCE = 0.81, 95% CI: 0.62, 1.01) and in mobilization in long-term effects (PCE = 0.86, 95% CI: 0.76, 0.96). In taping, the PCE accounted for 64% of disability improvement (PCE = 0.64, 95% CI: 0.48, 0.80). CONCLUSION: The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by factors not attributable to the specific effects of the interventions. Boosting these factors consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients. J Orthop Sports Phys Ther 2024;54(6):391-399. Epub 11 April 2024. doi:10.2519/jospt.2024.12126.

Procedural skills workshops for primary care physicians in Israel: a comprehensive analysis.

BACKGROUND: Some of the most common complaints addressed by primary care physicians (PCPs) require manual procedures, such as lacerations repair, abscesses drainage, ingrown toenails removal, dry needling for myofascial pain syndrome, and Epley maneuver for treating benign paroxysmal positional vertigo (BPPV). The aim of this study was to describe the procedural skills workshops program for PCPs implemented in Maccabi Healthcare Services and to investigate how many PCPs have participated and used the skills since the program's inception in 2017. METHODS: In this observational study, we followed all participants in courses from 2017 to 2021. We extracted all procedures performed during these years by PCPs who learned the skill in MHS. RESULTS: During the study period, 620 PCPs participated in workshops for dry needling, soft-tissue and joint injections, BPPV treatment, minor surgical procedures, and spirometry. Most procedures performed were dry needling (average annual number 3,537) and minor surgical procedures (average annual number 361). The average annual use per physician was highest for dry needling (annual average use per physician who used the learned skill was 50.9), followed by soft tissue and joint injections (16.8), minor surgical procedures (14.8), and BPPV treatment (7.5). CONCLUSION: procedural skills workshops may expand PCPs' therapeutic arsenal, thus empowering PCPs and providing more comprehensive care for patients. Some manual skills, such as dry needling, soft tissue injections, and the Epley maneuver, were more likely to be used by participants than other skills, such as spirometry and soft tissue injections.

Efficacy of Rehabilitative Techniques on Pain Relief in Patients With Vulvodynia: A Systematic Review and Meta-Analysis.

OBJECTIVE: Vulvodynia is a chronic clinical condition characterized by provoked or non-provoked vulvar pain for at least 3 months of unknown etiology. The onset of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, such as pelvic floor muscle and autonomic dysfunction, and interpersonal factors. A stepwise approach of pelvic floor physical therapy as medical management is suggested. In this scenario, by this meta-analysis of randomized controlled trials, we aimed to evaluate the efficacy of rehabilitation interventions in patients with vulvodynia. METHODS: On October 13, 2022, PubMed, Scopus, and Web of Science were systematically searched for randomized controlled trials that assessed the efficacy of the rehabilitative approach to pain during intercourse in patients with vulvodynia. The quality assessment was performed with the Cochrane risk-of-bias tool for randomized trials. The trial registration number is CRD42021257449. At the end of the search, 9 studies were included for a total of 332 patients. A pairwise meta-analysis was performed to highlight the efficacy of rehabilitative approaches for reducing pain during intercourse, as measured with a visual analog scale or a numerical rating scale. RESULTS: Meta-analysis showed that all these rehabilitative approaches had an overall effect size of -1.43 (95% CI = -2.69 to -0.17) in decreasing vulvodynia pain in terms of the visual analog scale. In the subgroup analysis, a significant effect size in acupuncture (effect size = -2.36; 95% CI = -3.83 to -0.89) and extracorporeal shockwave therapy (effect size = -2.94; 95% CI = -4.31 to -1.57; I2 = 58%) was observed. According to the Cochrane risk-of-bias tool, a low risk of bias for outcome selection in 89% of studies. CONCLUSION: Findings from this meta-analysis suggested that the physical agent modalities and complementary medicine techniques in people with vulvodynia appear to be more effective than placebo, sham, or waiting list. Further evidence on physical agent modalities and complementary therapies are warranted in the future. IMPACT: This was the first systematic review and meta-analysis of randomized controlled trials to provide evidence on the efficacy of rehabilitation interventions in patients with vulvodynia.

Physical therapy interventions for people experiencing homelessness to improve pain and self-perceived health status.

BACKGROUND: Homeless shelters have emerged as components of the social services network, playing an important role in providing health care to the homeless population. The aim of this study was to evaluate an individualized physical therapy intervention for people experiencing homelessness and to determine the relationship between self-perceived variables. METHODS: Pre and post study, setting at the "Santa y Real Hermandad de Nuestra Señora del Refugio y Piedad" homeless shelter in Zaragoza, Spain. Participants were people experiencing homelessness with musculoskeletal disorders who attended a physical therapy service at shelter facilities. A physical therapy program was implemented including health education, exercise and manual therapy, electrotherapy, thermotherapy and bandaging. Demographic variables (age and gender), nationality, employment situation, educational level, pain location, number of painful areas, feeling of loneliness (3-Item Loneliness Scale; values from 3 to 9), pain intensity (Numerical Pain Rating Scale [NPRS]; from 0 to 10) and self-perceived health (Clinical Global Impression [CGI]; from 1 to 7). RESULTS: Sixty-four homeless people (age of 46.4 ± 10.9 years) participated in the study. Musculoskeletal pain was reported by 98.4% of subjects, with moderate pain intensities (6.1), and 48.4% presenting with pain at multiple sites. Perceptions of loneliness were low (3.7 ± 2.5) and self-perceived health status was moderately ill (3.5 ± 1.7). Positive significant correlations were identified between pain intensity and self-perceived health. The average number of sessions was 1.5 (± 0.8), with manual therapy (35.6%) followed by health education (23.5%) being the most frequently used techniques. Both pain and self-perceived health improved after treatment, even following a brief intervention. CONCLUSIONS: This study demonstrates the potentially negative impact of untreated pain on the self-perceived health of homeless individuals with musculoskeletal disorders that should be targeted for consideration. The findings suggest that a paradigm shift in pain management, including a physical therapy service in shelters, is needed to address the rehabilitation demands of these individuals in a real-life context. This study was approved by the Aragon Ethics Committee (PI19/438) and performed according to the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial.

OBJECTIVE: To determine the efficacy of two physiotherapeutic interventions - aquatic therapy (AT) and land-based therapy (LBT) - for reducing pain in women with fibromyalgia. DESIGN: Single-blind, randomised controlled, equivalence trial. SETTING: Fibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity Association in A Coruña, Spain. PARTICIPANTS: Forty women with fibromyalgia were assigned at random in a 1:1 manner to two groups: AT (n = 20) and LBT (n = 20). INTERVENTIONS: Two therapeutic exercise programmes, with 60-min sessions, were undertaken three times per week for 12 weeks. Sessions were carried out in groups by a trained physiotherapist. OUTCOME: The primary outcome was pain intensity (visual analogue scale). The secondary outcomes were pressure pain threshold (algometer), quality of life (Revised Fibromyalgia Impact Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory) and physical ability (6-Minute Walk Test). Patients were evaluated at baseline, 12 weeks (post-treatment) and 18 weeks (follow-up). The statistical analysis was per-protocol. P < 0.05 was considered to indicate significance. Effect size was calculated. RESULTS: The mean age was 50 [standard deviation (SD) 9] years, with median body mass index of 27 [interquartile range (IQR) 25-30] kg/m2 and median symptom duration of 11 (IQR 6-15) years. No differences were observed between the groups post-treatment, but differences in favour of AT were found in pain intensity [2.7 (IQR 1.5-4.9) vs 5.5 (IQR 3.3-7.6); p= 0.023; large effect, Cohen's d= 0.8; 95% confidence interval (CI) 0.1-1.5] and sleep quality [12.0 (IQR 7.3-15.3) vs 15.0 (IQR 13.0-17.0); p= 0.030; large effect, Cohen's d= 0.8; 95% CI 0.1-1.5] at follow-up. CONCLUSIONS: The results suggest that AT is better than LBT for reducing pain intensity and improving sleep quality after 6 weeks of follow-up. AT may be a good treatment option for women with fibromyalgia. CLINICAL TRIALS REGISTRATION NUMBER: ClinicalTrials.gov NCT02695875 CONTRIBUTION OF THE PAPER.

Exploring the feasibility and acceptance of an optimised physiotherapy approach for lateral elbow tendinopathy: a qualitative investigation within the OPTimisE trial.

OBJECTIVES: To explore the acceptability of an optimised physiotherapy (OPTimisE) intervention for people with lateral elbow tendinopathy (LET) and feasibility of comparing it to usual care in a randomised controlled trial. DESIGN: Semistructured interviews, analysed using thematic analysis and mapped onto the COM-B model of behaviour change. SETTING: Conducted as part of the OPTimisE Pilot & Feasibility randomised controlled trial within physiotherapy departments in the United Kingdom National Health Service. PARTICIPANTS: 17 patients with LET (purposively sampled to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation) and all 8 physiotherapists involved as treating clinicians or site principal investigators. RESULTS: Four themes were identified. First, participants reported the OPTimisE intervention as acceptable. Second, differences between the OPTimisE intervention and usual care were identified, including the use of an orthosis, holistic advice/education including modifiable risk factors, forearm stretches, general upper body strengthening and a more prescriptive exercise-dosing regimen. Third, participants provided feedback related to the trial resources, which were viewed positively, but identified language translation as a need. Fourth, feedback related to trial processes identified the need for changes to outcome collection and reduction of administrative burden. From the perspective of adopting the OPTimisE intervention, we found evidence that participants were able to change their behaviour. Considering the findings through the lens of the COM-B model, the intervention is likely to be deliverable in practice and the trial can be delivered at scale with some additional support for physiotherapists. CONCLUSIONS: Overall, the OPTimisE intervention was found to be different to usual care and acceptable to patients and physiotherapists. The study highlighted the need to refine trial processes and resources prior to a full-scale trial, to reduce administrative burden, increase support for physiotherapists, improve return rate of outcome questionnaires and provide language translation. TRIAL REGISTRATION NUMBER: ISRCTN database 19 July 2021. https://www.isrctn.com/ISRCTN64444585.

Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: A Prospective Open-Label Study.

The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.

Optimization of the cosmetic appearance of skin scar after caesarean section - part II physiotherapy practice.

Scar formation is a natural part of the healing process after CS. This process, lasting up to two years, depends on the number of factors including type of incision, wound size, the person's age, body weight, health condition, and many others. Abnormal scarring should not be treated only as a cosmetic defect or superficial tissue defects. Functional and anatomical considerations must also be considered. Large varieties of non-invasive treatment modalities have been used to enhance wound healing and scar treatment. The article proposes a comprehensive approach to scar prevention and remodeling. The role of manual techniques, dry needling, cupping therapy, compression therapy, Kinesio taping, and physical agents is highlighted.

Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus.

OBJECTIVE: To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES: A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS: Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS: Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS: The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

Action observation with motor simulation improves reactive stepping responses following strong backward balance perturbations in healthy young individuals.

BACKGROUND AND OBJECTIVE: Adequate reactive steps are critical for preventing falls following balance perturbations. Perturbation-based balance training was shown to improve reactive stepping in various clinical populations, but its delivery is labor-intensive and generally uses expensive equipment. Action observation of reactive steps with either motor imagery (AOMI) or motor simulation (AOMS) are potential alternative training modalities. We here aimed to study their effects on reactive stepping performance. METHODS: Sixty healthy young subjects were subjected to forward platform translations that elicited backward reactive steps. The AOMI group (n = 20) was tested after AOMI of an actor's reactive steps, while the AOMS group (n = 20) additionally stepped along with the actor. The control group (n = 20) was tested without any prior observation. Our primary outcome was the step quality of the first trial response, as this best represents a real-life loss-of-balance. Step quality was quantified as the leg angle with respect to the vertical at stepping-foot contact. We also studied single step success rates and reactive step quality across repeated trials. RESULTS: Reactive step quality was significantly better in the AOMI and AOMS groups than in the control group, which differences coincided with a twofold higher single step success rate. Reactive step quality improved upon repeated trials in all groups, yet the AOMS group needed the fewest repetitions to reach plateau performance. SIGNIFICANCE: The present results demonstrate that both AOMI and AOMS improved first and repeated trial reactive stepping performance. These findings point at the potential applicability of these concepts for home-based reactive balance training, for instance in serious games, with overt movements (AOMS) possibly having some benefits over mental imaginations (AOMI). Whether similar beneficial effects also emerge in the target populations of balance-impaired individuals remains to be investigated.

A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction.

OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review.

This article aims to provide a concise overview of the best available evidence for managing post-stroke spasticity. A modified scoping review, conducted following the PRISMA guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR), involved an intensive search on Medline and PubMed from 1 January 2000 to 31 August 2023. The focus was placed on high-quality (GRADE A) medical, rehabilitation, and surgical interventions. In total, 32 treatments for post-stroke spasticity were identified. Two independent reviewers rigorously assessed studies, extracting data, and evaluating bias using GRADE criteria. Only interventions with GRADE A evidence were considered. The data included the study type, number of trials, participant characteristics, interventions, parameters, controls, outcomes, and limitations. The results revealed eleven treatments supported by GRADE A evidence, comprising 14 studies. Thirteen were systematic reviews and meta-analyses, and one was randomized control trial. The GRADE A treatments included stretching exercises, static stretching with positional orthosis, transcutaneous electrical nerve stimulation, extracorporeal shock wave therapy, peripheral magnetic stimulation, non-invasive brain stimulation, botulinum toxin A injection, dry needling, intrathecal baclofen, whole body vibration, and localized muscle vibration. In conclusion, this modified scoping review highlights the multimodal treatments supported by GRADE A evidence as being effective for improving functional recovery and quality of life in post-stroke spasticity. Further research and exploration of new therapeutic options are encouraged.

Acupuncture and dry needling for physical therapy of scar: a systematic review.

BACKGROUND: There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment. OBJECTIVE: The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture. SEARCH STRATEGY: The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023. INCLUSION CRITERIA: The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included. DATA EXTRACTION AND ANALYSIS: The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results. RESULTS: As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous. CONCLUSIONS: The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation. SYSTEMATIC REVIEW REGISTRATION: INPLASY no. 202310058.