Synchronous and asynchronous telerehabilitation methods produce similar benefits in individuals with non-specific neck pain.

INTRODUCTION: Evidence exists on clinical benefits of synchronous and asynchronous telerehabilitation for patients with non-specific neck pain (NSNP); however, limited studies are comparing synchronous and asynchronous telerehabilitation (TR) programs in this population. The aim of this study was to estimate the relative effectiveness of an 8-week synchronous or asynchronous TR in improving pain, functional disability, kinesiophobia, and mobility in patients with NSNP. MATERIALS AND METHODS: This was a randomized, controlled clinical trial carried out on 60 individuals with NSNP. Participants were randomly assigned to synchronous TR group (n = 30) or asynchronous TR group (n = 30) that received the same exercise program for 8 weeks. Pain measured by Numeric Pain Rating Scale (NPRS), disability measured by Neck Disability Index (NDI), kinesiophobia measured by Tampa Scale of Kinesiophobia (TSK), and cervical range of motion were used as outcome measures. Assessments were performed at baseline, 4th week, 8th week, and 16th week. RESULTS: The analysis showed a significant effect of time and significant interaction between group and time in NPRS, NDI, TSK, and cervical mobility scores (p < 0.05), yet the group effect was not significant (p > 0.05). There were no significant differences between the groups at all time points (p > 0.05) except for cervical right lateral flexion at 8th week (p = 0.036). CONCLUSION: Telerehabilitation technologies are expanding at a rapid rate, and it is essential to understand the outcomes produced using these technologies in health conditions. This study showed that synchronous and asynchronous telerehabilitation produces similar results in patients with NSNP, supporting that either method can be used interchangeably.

Extracorporeal Shock Wave Therapy Versus Low Level Laser Therapy in The Treatment of Plantar Fasciitis: A Randomized Controlled Trial.

BACKGROUND: Plantar fasciitis (PF) is predominantly treated conservatively through some modalities such as extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT), yet the short effect of these modalities on pain and function is still ambiguous. This study aims to compare the short-term effectiveness of ESWT and LLLT on pain and function in patients with PF. METHODS: Participants (n=47) were randomly assigned into 2 groups as ESWT (n=27) and LLLT (n=20). ESWT (once a week) and LLLT (three times a week) were administered to the participants for 3 weeks. Foot function index (FFI) including pain, disability, and activity limitation subscales was administered at baseline and post-treatment. A reduction of one point in total scores was considered as a minimum clinically important difference. Repeated measures of ANOVA were used to analyze the changes in outcomes and compare the groups. RESULTS: There were significant main effects of time, and significant interaction effects between group and time on pain (P<0.001), disability (P<0.001), and activity limitation (P<0.05). The main effect of the group was not significant for all subscales (P=0.811, P=0.481, P=0.865, respectively). The LLLT group showed a significant decline in pain (P<0.001), disability (P<0.001), and activity limitation (P<0.001) while there was no change in the ESWT group over time (P=0.319, P=0.711, P=1.0 respectively). Consistently, 95% of participants in the LLLT had CID in the pain subscale whereas 48% of the ESWT group had. CONCLUSIONS: LLLT was found to be superior to ESWT as an effective approach in the short-term management of PF.

A mobile application tool for standing posture analysis: development, validity, and reliability.

BACKGROUND: Using mobile application for postural assessments has been drawing a rising interest due to widespread use of smartphones. Although there are some mobile applications in use, validated mobile tools for accurate postural assessment are still warranted. AIMS: This study aimed to develop Fizyoprint mobile application tool to assess standing posture and investigate the validity and reliability of the application in young adults. METHODS: A convenience sample of 20 young adults (12 men and 8 women with a mean age of 21.3 ± 2.2 years) and 2 physiotherapists as raters participated in the study. The participant's digital images were obtained from the anterior, posterior, and right lateral sides. The raters selected the anatomic reference points by using digital markers in the app screen, and the Fizyoprint application, with Turkish language option, calculated a total of 26 posture variables, including 11 distance and 15 angle variables. Each participant was assessed twice (1-week interval) by 2 raters with Fizyoprint. Inter- and intra-rater reliabilities were estimated using the intraclass correlation coefficient. The BioTonix™ posture analysis system was used for validation. RESULTS: A total of 80.7% (21 variables) indicated acceptable to excellent intra-rater reliability results. A total of 57.7% (15 variables) were found to be acceptable to excellent for inter-rater measurements. The results confirmed the validity of the Fizyoprint application for testing the standing posture. CONCLUSIONS: Fizyoprint application is a new, valid, free mobile tool with acceptable concordance with BioTonix™ postural analysis system for assessing standing posture. Further studies are warranted to test the current application in different populations and musculoskeletal conditions.

Functional hip joint centre determination in children with cerebral palsy.

BACKGROUND: Although functional methods determining the hip joint center (HJC) are becoming increasingly popular, no systematic investigation has been conducted yet to assess the reliability of functional hip joint calibration in patients with cerebral palsy (CP). RESEARCH QUESTION: What is the most reliable way to conduct functional calibration motions for estimating HJC location in children with CP and movement disorders? METHODS: Twenty-two patients with CP were included in the study. A marker set for Plug-in Gait with additional cluster markers was used. Two functional calibration movements, including a new movement, were proposed and tested with one and three repetitions each. Functional HJCs were determined using the SCoRE approach and compared to results obtained by applying the conventional regression method for assessing face validity. RESULTS: The choice of calibration movement had significant impact on SCoRE residuals and HJC location. Increasingly repeating calibration movements did not improve results. A modified star movement by allowing the toes to tip the ground provided the most reliable data and is feasible for children with GMFCS level I-III. The feasibility of the method is further improved by analyzing hip motion in the contralateral stance limb and, among the calibration movements, gave the most precise HJC estimation. SIGNIFICANCE: Type and performance of the functional calibration movement is one key factor for determining a robust HJC. Analyzing the data in the stance leg via the modified star motion yielded robust and reasonable results for the HJC location, which should be validated in further studies that include imaging methods. Using one repetition instead of three seems promising in terms of feasibility for patients with movement disorder.

A Better Way to Decrease Knee Swelling in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial.

Objective: In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis. Methods: Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week. Results: We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups (p < 0.05). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling (p=0.028). Conclusions: According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322.

Effects of chemotherapy process on postural balance control in patients with breast cancer.

BACKGROUND: Breast cancer (BC) is the most common type of cancer among women in the world. Patients can face musculoskeletal disorders due to treatment side effects that result in failure to walk, falling, or fractures associated with balance problems. PURPOSE: The aim of this study was to determine whether postural balance would be affected during chemotherapy (CT) in people with BC. MATERIALS AND METHODS: A total of 32 women who consulted the medical oncology department, between 31 and 63 years of age, were admitted to the study. For fear of falling, fall efficiacy scale; for static balance, double-leg, single-leg, and tandem stance tests with eyes opened and eyes closed; Romberg test; for dinamic balance, Sit To Stand (STS) test, and Time Up and Go (TUG) tests were performed in the patients. RESULTS: Reduced fear of falling between CT cycles (P < 0.0125), no change in postural sway in double-leg stance test with eyes opened (P = 0.734) and eyes closed (P = 0.127), significantly increased postural instability in single-leg and tandem stance test with eyes opened and eyes closed (P = 0.000), no change in postural stability in Romberg test (P > 0.05), significantly increased postural instability in STS (P = 0.000) and TUG tests (P = 0.000), and significantly increased time of finishing the STS (P = 0.021) and TUG tests (P = 0.010) were noted. CONCLUSION: Patients demonstrated postural instability which can ruin the daily life activities in many parameters of measurements. Postural balance exercises should be performed by BC survivors undergoing CT.

Gender and age impact on plantar pressure distribution in early adolescence.

OBJECTIVE: The aim of the study was to investigate gender and age effect on dynamic plantar pressure distribution in early adolescence. METHODS: A total of 524 adolescents (211 women and 313 men; mean age: 12.58 ± 1.11 years (range: 11-14 years)) participated in pedobarographic measurements during gait at self-selected speed. Data of peak pressure (PP), maximum force (MaxF-Newton), body weight corrected maximum force (BW_MaxF), contact area (CA-cm2) were analyzed for total foot and four plantar regions (hindfoot, midfoot, forefoot and toes). RESULTS: Higher toes PP was found in the ages of 12-14 years in females compared to males (253.79 ± 104.93 vs 216.00 ± 81.12 for the age of 12, p = 0.011, 264.40 ± 65.02 vs 227.21 ± 83.4 for the age of 13, p = 0.044, 299.75 ± 140.60 vs 238.75 ± 103.32 for the age of 14, p = 0.005). Females' higher MaxF especially for toes (136.24 ± 48.54 vs 115.33 ± 46.03, p = 0.008) and smaller CA especially for forefoot (50.12 ± 5.79 vs 54.4893 ± 6.80, p = 0.001) were considerable in the late of early adolescence. Forefoot (305.66 ± 82.14 females p = 0.001, 281.35 ± 79.59 males p < 0.001) and total foot PP (374.08 ± 113.93 females, p = 0.035, 338.61 ± 85.85 males p = 0.009) at the age of 14 was significantly higher than in younger ages in both gender groups. CONCLUSION: The results indicate that especially the age of 14 years in early adolescence is a critical age for alteration in plantar pressure distribution. Interestingly females tended to increase their toe and forefoot plantar pressures compared to males by increasing age. We suggest that gender and age impact on toes plantar pressure alterations in early adolescence may be a possible risk factor for further foot impairments. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

The relationship between objective balance, perceived sense of balance, and fear of falling in stroke patients.

OBJECTIVE: The objective of our study was to investigate the relationship between objective balance, fear of falling, and perceived sense of balance (PSB) in stroke patients. METHODS: Seventy patients aged 18-65 years with chronically developed hemiplegia or hemiparesis were enrolled in the study. Patients' objective balance scores, fear of falling, and PSB were obtained using the berg balance scale (BBS), the falls efficacy scale (FES), and a visual analog scale, respectively. The Standard Mini-Mental Examination was performed to exclude patients with mental disorders from the study. RESULTS: There was a moderate negative correlation between PSB and BBS scores (p = 0.001, ρ = -0.588); a strong negative correlation between BBS and FES scores (p = 0.001, ρ = -0.808); and a strong positive correlation between PSB and FES scores (p = 0.001, ρ = 0.714). We found that BBS scores had negative correlation with PBS scores in left hemiplegic patients while there was no any relationship between BBS and PBS scores in right hemiplegic patients. CONCLUSION: PSB assessment, besides the BBS, should be considered among the routine assessment methods that enable the rehabilitation team to be aware of patients' balance capacities.

The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises.

The aim of the study was to compare the effects of low-intensity exercise programs for lower extremities, either supervised or at home, on pain, muscle strength, balance and the hemodynamic parameters of knee osteoarthritis (OA) patients. This randomized study included 78 patients with knee OA in 2 groups of supervised and home-based exercise program. Exercises were applied to the first group in the clinic as a group exercise program and were demonstrated to the second group to be performed at home. Before and after the 6-week exercise program, assessment was made of pain, quadriceps and hamstring muscle strengths, 6-min walk test (6MWT), and non-invasive hemodynamic parameters. Results of the 78 patients, 56 completed the study. Pain, muscle strength, and 6MWT scores showed significant improvements in both groups. There were also significant differences in the amount of change in pain and muscle strength (pain: p = 0.041, Rqdc: 0.009, Lqdc: 0.013, Rhms: 0.04) which indicated greater improvements in the supervised group. The balance scores of supervised group showed a significant improvement (p = 0.009). No significant change was determined in hemodynamic parameters of either group. Conclusion according to the results of this study showed that low-intensity lower extremity exercises conducted in a clinic under the supervision of a physiotherapist were more effective than home-based exercises in reducing post-activity pain levels and improving quadriceps and right hamstring muscle strength. Both the supervised and home exercise programs were seen to be effective in reducing rest pain and increasing 6 MW distance in knee osteoarthritis patients.

Association between the physical activity level and the quality of life of patients with type 2 diabetes mellitus.

[Purpose] Physical activity and regular exercise play an important role in glycemic control, which is considered an important part of the treatment of type 2 diabetes mellitus. This study evaluated physical activity level and its relationship with quality of life in patients with type 2 diabetes mellitus. [Subjects and Methods] We evaluated 129 subjects with type 2 diabetes mellitus through a face-to-face interview using the short version of the International Physical Activity Questionnaire and Diabetes-39. Demographic data, diabetes symptoms, time of initial diagnosis, and treatment procedure/approaches were recorded. [Results] Of the study subjects, 51 (39.5%) had low, 67 had moderate (51.9%), and 11 (8.5%) had high activity levels. The mean weekly sitting duration was 302 minutes. The mean weekly walking time was 231.7 minutes. Except for the "diabetes control" domain, scores for all the subgroups and the total score in the quality-of-life assessment had a statistically significant negative correlation with physical activity level. [Discussion] Physical inactivity negatively affects the quality of life of diabetic patients. A planned exercise education program and incorporation of exercise into the lifestyle can improve the quality of life of patients with type 2 diabetes mellitus.

Kinesiophobia in relation to physical activity in chronic neck pain.

BACKGROUND: Little research is available concerning physical activity and its determinants in people with chronic neck pain. OBJECTIVE: To explore the relation between kinesiophobia and physical activity and gender effect on these relations in people with chronic neck pain. METHODS: Ninety-nine subjects (34 men and 65 women) with chronic neck pain were participated in the study. Pain intensity was assessed with Visual Analog Scale and kinesiophobia degree was determined by using Tampa Scale of Kinesiophobia. Level of physical activity was assessed with short form of the International Physical Activity Questionnaire. RESULTS: There was no statistically correlation between neck pain intensity and kinesiophobia degree (p= 0.246, r= 0.123) and physical activity level (p= 0.432, r= -0.083). It was also found that kinesiophobia degree was not correlated to physical activity level (p= 0.148, r= -0.153). There was a negative correlation between kinesiophobia degree and physical activity level only for women, not for men (p= 0.011, r= -0.318). CONCLUSIONS: Our results showed that although people with chronic neck pain reported higher pain intensity and fear of movement, pain intensity and kinesiophobia degree did not associate to their physical activity levels. It can be speculated that high kinesiophobia degrees cause low physical activity levels for women, but not for men.

The immediate effect of patellar tendon strap on weight-bearing asymmetry during squatting in patients with unilateral knee osteoarthritis: A pilot study.

BACKGROUND: Knee osteoarthritis has commonly been associated with a symptom of pain resulting in an inter-limb weight-bearing asymmetry during functional tasks. Patellar tendon strap is one of the non-pharmacologic interventions to alleviate knee pain. OBJECTIVES: To investigate the immediate effect of a patellar tendon strap on weight-bearing asymmetry during squatting in people with unilateral knee osteoarthritis. STUDY DESIGN: Cross-sectional study. METHODS: Ten patients with unilateral knee osteoarthritis and 10 healthy subjects were included in the study. Weight-bearing asymmetry of patients was assessed using a weight-bearing squat test during squatting at 30° and 60° both with and without patellar tendon strap. Pain intensity was assessed during squatting in unstrapped and strapped conditions with Visual Analog Scale. RESULTS: The decrease in weight-bearing asymmetry values immediately after wearing patellar tendon strap during 30° (p = 0.006) and 60° (p = 0.011) of squatting tests was significantly higher in knee osteoarthritis patients than in healthy subjects. Reported pain intensity was similar in unstrapped and strapped conditions (p = 0.066). CONCLUSION: The results of this study showed improved inter-limb weight-bearing symmetry during squatting. Further research with larger sample sizes investigating the effect of patellar tendon strap on weight-bearing asymmetry during functional activities in people with knee osteoarthritis is warranted. CLINICAL RELEVANCE: Patellar tendon straps (easily fit and cheap unlike knee braces) had more improvements in inter-limb weight-bearing symmetry during squatting in people with knee osteoarthritis compared to healthy subjects. This study is a new insight for future studies to investigate clinical benefits of wearing patellar tendon straps in this population.

Beliefs towards mental illness in Turkish physiotherapy students.

Mental health is a new area of specialization for physiotherapists. However, they usually meet patients with psychiatric co-morbidities secondary to other chronic diseases. It is important to explore the beliefs of future physiotherapists regarding mental illness in order to implement effective strategies to avoid possible stigmatizing attitudes that may interfere with the rehabilitation process. Moreover, the psychiatric field should be introduced to physiotherapists as a clinical and research area. Therefore, we aimed to question the beliefs of physiotherapy students regarding mental illness using the Beliefs towards Mental Illness Scale in two different universities in Turkey. The total score of 524 students was 46.5 ± 14.5 out of 105 while the Dangerousness Subscale score was 21.2 ± 5.8/40; Incurability and Poor Social and Interpersonal Skills Subscale score was 24.2 ± 9.3/55 and Shame Subscale score was 1.1 ± 1.9/10. Students who had a relationship with an individual having a mental problem and students who had consulted a psychiatrist/psychologist for any mental problem showed more positive beliefs. Future physiotherapists should be informed and trained regarding people with mental illness both to avoid stigma and to be aware of this area in physiotherapy settings. Therefore, it is important to implement new curricula for schools providing physiotherapy education including courses, lectures and clinical practices in the psychiatry field.

Is hypertension a risk factor for poor balance control in elderly adults?

[Purpose] The aim of this study was to investigate whether hypertension negatively affects the postural balance control of elderly adults under different sensory conditions. [Subjects and Methods] Fifty-four healthy elderly adults who were residents in a Geriatric Home Care Center were recruited for this study. Height, weight, body mass index and age of the volunteers were recorded. After applying the exclusion criteria, the final study group included 16 hypertensive (HT) and the control group included 10 non-hypertensive (Non-HT) healthy elderly adults. To evaluate postural balance control objectively, the modified Clinical Test of Sensory Interaction on Balance (modified CTSIB) test was performed under four different conditions: 1) eyes open on a stable surface; 2) eyes closed on a stable surface; 3) eyes open on an unstable surface; and 4) eyes closed on an unstable surface. [Results] The postural balance scores (center of gravity sway) of the HT group were slightly higher than those of the Non-HT group under conditions 1 (HT group=0.3°/sec, Non-HT group=0.2°/sec), 2 (HT group=0.8°/sec, Non-HT group=0.4°/sec) and 4 (HT group=4.5°/sec, Non-HT group=3.5°/sec), but no statistically significant differences were found between the HT and Non-HT groups under any sensory condition. [Conclusion] The result of this study indicate that controlled hypertension in elderly adults is not a cause of worse balance performance than controls on stable or unstable surfaces with the eyes open or closed.

Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors.

AIM OF THE STUDY: There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors. MATERIAL AND METHODS: Eighteen females 38-60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL). RESULTS: The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions. CONCLUSIONS: These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance.

Altered movement strategies in sit-to-stand task in persons with transtibial amputation.

BACKGROUND: Sit-to-stand movement is an essential function for participation in many activities of daily living. Although this movement is one of the most important functional tasks, there is limited research investigating strategies of sit-to-stand movement in transtibial amputees. OBJECTIVES: To examine movement strategies of the sit-to-stand task in persons with transtibial amputation and healthy non-amputated individuals. STUDY DESIGN: Cross-sectional study. METHODS: A total of 12 male unilateral transtibial amputees and 19 healthy male subjects participated in this study. Sit-to-stand movement was evaluated in terms of weight transfer time, weight-bearing symmetry, sway velocity, and rising index by using Balance Master System. RESULTS: Participants in both groups exhibited similar weight-bearing transfer time (p > 0.05). Transtibial amputees demonstrated significantly greater weight-bearing asymmetry, higher sway velocity, and lower rising index than healthy subjects during the sit-to-stand transfer movement (p < 0.05). CONCLUSIONS: Transtibial amputees were unable to use the same movement strategies during a sit-to-stand task as healthy individuals; therefore, they had to develop new strategies to perform this task. CLINICAL RELEVANCE: Little is known about the altered movement strategies during sit-to-stand task in transtibial amputees. The results of the study might provide some new insight into the motor components of the sit-to-stand movement in persons with transtibial amputation for both clinicians and researchers.

Gender specific strategies in demanding hopping conditions.

Difference in leg stiffness between females and males is considered to be a cause of higher rates of Anterior Cruciate Ligament injury in female athletes. Females are believed to have lower stiffness and as a consequence different recruitment strategies to adapt functional tasks. The aim of the current study was to evaluate how leg stiffness is tuned to demanding conditions. 22 healthy subjects (11 Male-11 Female; age: 20-43 years) participated in this study. Subjects performed two-legged hopping tasks (at their preferred rate, as fast as possible and with added mass of 10% bodyweight) on a force platform. Leg stiffness was calculated for each condition as the ratio between peak ground reaction force and vertical displacement of center of mass. In the preferred and added mass conditions males showed substantially higher leg stiffness than females (p= 0.006 and p = 0.002, respectively). When hopping as fast as possible the gender bias in leg stiffness disappeared (p = 0.880). Added mass had no significant effect on change in leg stiffness. Results have shown that females increased their leg stiffness more than males indicating they have no gender limiting capacity to reach objectives of higher demanding tasks (i.e.fastest hopping).The relationship between observed gender differences in leg stiffness and increased Anterior Cruciate Ligament injury rate in females requires further study. Key pointsLeg stiffness is an adaptable property of neuro musculoskeletal system to different functional loading conditions.Females can increase their leg stiffness more than males indicating they have no gender limiting capacity to reach objectives of higher demanding tasks as fastest hopping.