Respiratory Support Effects over Time on Regional Lung Ventilation Assessed by Electrical Impedance Tomography in Premature Infants.

Background and objectives: Respiratory distress syndrome (RDS) frequently necessitates respiratory support. While non-invasive methods are typically the preferred approach, mechanical ventilation becomes necessary for patients with insufficient response. Our study aimed to compare two common respiratory support modes, volume-targeted mechanical ventilation and non-invasive ventilation continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC), using electrical impedance tomography. Materials and Methods: Infants with very low birth weight and gestational ages of less than 32 weeks were eligible for inclusion in the study. All enrolled infants were beyond the transitional period (>72 h of age). The infants were divided into two groups: infants receiving invasive respiratory support through an endotracheal tube and infants receiving non-invasive respiratory support. We used electrical impedance tomography to assess end-expiratory lung impedance (EELZ), DeltaZ, heterogeneity, and regional ventilation distribution. Patients were evaluated at 0, 30, and 60 min after assuming the supine position to examine potential time-related effects. Results: Our study initially enrolled 97 infants, and the final analysis included a cohort of 72 infants. Ventilated infants exhibited significantly larger EELZ compared to their non-invasive counterparts (p = 0.026). DeltaZ was also greater in the invasive respiratory support group (p < 0.001). Heterogeneity was higher in the non-invasive group and did not change significantly over time. The non-invasive group demonstrated significantly greater ventilation in the dependent lung areas compared to intubated patients (p = 0.005). Regional distribution in the left lung was lower than in the right lung in both groups; however, this difference was significantly more pronounced in intubated patients (p < 0.001). Conclusions: Our study revealed that volume-targeted mechanical ventilation results in higher EELZ and DeltaZ compared to spontaneously breathing infants receiving non-invasive respiratory support. However, lung heterogeneity was lower during mechanical ventilation. Our study also reaffirmed that spontaneous breathing promotes greater involvement of the dependent lung compared to mechanical ventilation.

The Impact of Previous Comorbidities on New Comorbidities and Medications after a Mild SARS-CoV-2 Infection in a Lithuanian Cohort.

This cross-sectional study investigates new comorbidities and new medications after a mild SARS-CoV-2 infection. Data were collected after an acute SARS-CoV-2 infection by online survey in a Lithuanian cohort. Sociodemographic data, SARS-CoV-2-related symptoms, previous and new comorbidities, and medications were analysed. The results of 895 participants (mean age: 44 years) show that 91% were women, 58% had higher education, and 84% were working. Among those, 473 (52.8%) answered being "healthy" before infection; 823 (92%) indicated being positive on diagnostic tests; and 841 (94%) were non-hospitalized. Asymptomatic infection was reported by 17 participants (1.9%). Participants reporting any comorbidity before a SARS-CoV-2 infection reported more frequently having remaining symptoms compared to those who were "healthy", particularly in relation to neurological symptoms. Thirteen percent of participants reported new comorbidities, and thirty-five percent started new medication. Among new medications, an intake of vitamins/supplements (21%) and anti-inflammatory drugs (4%) was more often reported by "unhealthy" participants. Regression analysis revealed that new cardiovascular and pulmonary diagnoses predicted each other. Participants reporting prior neurological disorders tended to have an increased risk of intaking new vitamins/supplements and anti-inflammatory drugs after infection. The results indicate a significantly increased consumption of medication, particularly unprescribed substances, after SARS-CoV-2, indicating a need of more research in this area.

High-Frequency Ipsilesional versus Low-Frequency Contralesional Transcranial Magnetic Stimulation after Stroke: Differential Effects on Ipsilesional Upper Extremity Motor Recovery.

Background and Objectives: Stroke is a major cause of death and disability worldwide; therefore, transcranial magnetic stimulation (TMS) is being widely studied and clinically applied to improve motor deficits in the affected arm. However, recent studies indicate that the function of both arms can be affected after stroke. It currently remains unknown how various TMS methods affect the function of the ipsilesional upper extremity. Materials and Methods: Thirty-five subacute stroke patients with upper extremity motor deficits were enrolled in this study and randomly allocated into three groups, receiving either (1) low-frequency rTMS over the contralesional hemisphere; (2) high-frequency rTMS over the ipsilesional hemisphere; or (3) no stimulation. Experimental groups received 10 rTMS sessions over two weeks alongside standard rehabilitation, and the control group received the same procedures except for rTMS. Both affected and unaffected upper extremity motor function was evaluated using hand grip strength and Functional Independence Measure (FIM) tests before and after rehabilitation (7 weeks apart). Results: All groups showed significant improvement in both the affected and unaffected hand grip and FIM scores (p < 0.05). HF-rTMS led to a notably higher increase in unaffected hand grip strength than the control group (p = 0.007). There was no difference in the improvement in affected upper extremity motor function between the groups. The FIM score increase was lower in the control group compared to experimental groups, although not statistically significant. Conclusions: This study demonstrates the positive effect of ipsilesional HF-rTMS on the improvement in unaffected arm motor function and reveals the positive effect of both LF- and HF-rTMS on the affected upper extremity motor function recovery.

Association between greenery and health indicators in urban patients with symptomatic heart failure: a retrospective cohort study in Lithuania.

Urban green spaces benefit physical, mental health, and reduses the risk of cardiovascular disease. A study in Kaunas, Lithuania collected health data from 100 patients with symptomatic heart failure (HF) during 2006-2009. Residential greenness was measured by the normalized difference vegetation index (NDVI). We assessed the impact of greenness on health indicators and on changes in health markers after 6 months. Higher greenness levels based on the NDVI 1-km radius were related to higher mean values of heart rate (HR) and ejection fraction and lower left ventricular (LV) end-diastolic diameter index (LV EDDI), LV end-systolic volume (ESV), left atrium size (LAS), and right atrium size (RAS) at baseline. After 6 months, a decrease in DBP and HR and an improvement in spiroergometric parameters were associated with exposure to high levels of greenness. The long-term rehabilitation group experienced significant changes in spiroergometric indicators. The results confirm that the greenness of the residential environment can improve health indicators in patients with HF.

The role of nutraceuticals in heart failure muscle wasting as a result of inflammatory activity. The International Lipid Expert Panel (ILEP) Position Paper.

Muscle wasting is one of the main causes for exercise intolerance and ventilatory inefficiency in patients with heart failure and a strong predictor of frailty and reduced survival. The prevalence of sarcopenia is at least 20% in patients with heart failure. Patients with heart failure often have subclinical systemic inflammation, which may exert sustained effects on skeletal muscle. Besides exercise, nutrition should also be carefully evaluated as an appropriate diet with selected nutraceuticals may be able to stimulate muscle anabolism and inhibit muscle catabolism. This review summarizes the epidemiological and clinical trial evidence supporting the recommendations for the use of nutraceuticals with anti-inflammatory properties in heart failure and provides an overview of the state of the evidence for nutraceutical supplementation to prevent and/or mitigate heart failure muscle wasting.

Wearable-based Assessment of Heart Rate Response to Physical Stressors in Patients After Open-Heart Surgery With Frailty.

Due to frailty, cardiac rehabilitation in older patients after open-heart surgery must be carefully tailored, thus calling for informative and convenient tools to assess the effectiveness of exercise training programs. The study investigates whether heart rate (HR) response to daily physical stressors can provide useful information when parameters are estimated using a wearable device. The study included 100 patients after open-heart surgery with frailty who were assigned to intervention and control groups. Both groups attended inpatient cardiac rehabilitation however only the patients of the intervention group performed exercises at home according to the tailored exercise training program. While performing maximal veloergometry test and submaximal tests, i.e., walking, stair-climbing, and stand up and go, HR response parameters were derived from a wearable-based electrocardiogram. All submaximal tests showed moderate to high correlation ( r = 0.59-0.72) with veloergometry for HR recovery and HR reserve parameters. While the effect of inpatient rehabilitation was only reflected by HR response to veloergometry, parameter trends over the entire exercise training program were also well followed during stair-climbing and walking. Based on study findings, HR response to walking should be considered for assessing the effectiveness of home-based exercise training programs in patients with frailty.

Do Comorbidities and Daily Medication before SARS-CoV-2 Infection Play a Role in Self-Reported Post-Infection Symptoms?

This study investigated the associations between health status before SARS-CoV-2 infection and persistent symptoms after acute infection. Data were collected from participants older than 18 years and more than 28 days after acute SARS-CoV-2 infection using an online survey. Sociodemographic data, comorbidities, and daily medication before infection, as well as acute and persistent symptoms were analysed. Among the 1050 participants (mean age 41 years, 88% women, 56% with higher education, 93% working), 538 (51%) reported being healthy and 762 (73%) reported not taking any daily medication prior to infection. Positive laboratory testing was reported by 965 (92%) participants; asymptomatic infection was reported by 30 (3%); and 999 (95%) stayed at home during their acute infection. Reduced physical capacity (40%), fatigue (39%), cognitive difficulties (30-34%), altered sense of smell (24%), headache (20%), tachycardia (20%), unstable mood (19%), hair loss (17%), and insomnia (17%) were the most often reported symptoms. Those taking daily medication before infection reported increased frequency of both acute and persistent symptoms, except for decreased frequency of persistent altered smell and taste. The presence of persistent symptoms was predicted by taking daily medication before infection and by the total number of acute symptoms. Comorbidities before infection did not predict persistent symptoms. Therefore, the role of medication needs further investigation in both acute SARS-CoV-2 infection and post-COVID-19 condition.

Wearable-Based Assessment of Frailty Trajectories During Cardiac Rehabilitation After Open-Heart Surgery.

Frailty in patients after open-heart surgery influences the type and intensity of a cardiac rehabilitation program. The response to tailored exercise training can be different, requiring convenient tools to assess the effectiveness of a training program routinely. The study aims to investigate whether kinematic measures extracted from the acceleration signals can provide information about frailty trajectories during rehabilitation. One hundred patients after open-heart surgery, assigned to the equal-sized intervention and control groups, participated in exercise training during inpatient rehabilitation. After rehabilitation, the intervention group continued exercise training at home, whereas the control group was asked to maintain the usual physical activity regimen. Stride time, cadence, movement vigor, gait asymmetry, Lissajous index, and postural sway were estimated during the clinical walk and stair-climbing tests before and after inpatient rehabilitation as well as after home-based exercise training. Frailty was assessed using the Edmonton frail scale. Most kinematic measures estimated during walking improved after rehabilitation along with the improvement in frailty status, i.e., stride time, cadence, postural sway, and movement vigor improved in 71%, 77%, 81%, and 83% of patients, respectively. Meanwhile, kinematic measures during stair-climbing improved to a lesser extent compared to walking. Home-based exercise training did not result in a notable change in kinematic measures which agrees well with only a negligible deterioration in frailty status. The study demonstrates the feasibility to follow frailty trajectories during inpatient rehabilitation after open-heart surgery based on kinematic measures extracted using a single wearable sensor.

Correction: Vabalaite et al. Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review. Medicina 2021, 57, 1215.

In the original publication [...].

Effectiveness of additional resistance and balance training and telephone support program in exercise-based cardiac rehabilitation on quality of life and physical activity: Randomized control trial.

OBJECTIVES: To evaluate 20 days and 3 months follow-up effectiveness of cardiac rehabilitation (CR) enhanced by resistance/balance training and telephone-support program compared to usual CR care in improving quality of life, clinical course and physical activity behavior. DESIGN: Single-centre randomized controlled trial. SETTING: Inpatient CR clinic. SUBJECTS: 116 (76.1 ± 6.7 years, 50% male) patients 14.5 ± 5.9 days after valve surgery/intervention were randomized to intervention group (IG, n = 60) or control group (CG, n = 56). INTERVENTION: Additional resistance/balance training (3 days/week) during phase-II CR and telephone-support program during 3-month follow-up. CG patients were provided with usual CR care. MAIN MEASURES: Short Form 36 Health Survey scales, European Quality of Life 5 Dimensions 3 Level Version QoL index, visual analog scale, clinical course, and physical activity behavior assessed with standardized questionnaires. RESULTS: IG reported statistically significant higher mental component score (48.5 ± 6.91 vs. 40.3 ± 11.21 at the baseline, 50.8 ± 9.76 vs. 42.6 ± 9.82 after 20 days, 49.4 ± 8.45 vs. 40.5 ± 8.9 after 12 weeks follow up), general health (48.6 ± 3.17 vs. 45.0 ± 2.95 at the baseline, 53.6 ± 3.02 vs. 43.8 ± 2.55 after 20 days, 53.2 ± 3.11 vs. 44.2 ± 3.07 after 12 weeks) and role limitations due to emotional problems (48.5 ± 15.2 vs. 27.7 ± 11.5 at the baseline, 72.7 ± 12.6 vs. 30.5 ± 11.2 after 20 days, 66.6 ± 14.2 vs. 36.1 ± 11.2 after 12 weeks) in all three assessments (p < 0.05). CG patients had more documented hospital admissions (4 (8%) vs 10 (25%), p = 0.027), atrial fibrillation paroxysms (3 (6.0%) vs. 10 (35.0%), p = 0.011) and blood pressure swings (13 (26%) vs. 20 (50%), p = 0.019). IG patients chose more different physical activities (1.7 ± 0.7 vs. 1.25 ± 0.63, p = 0.002), spent more time being physical active every day (195.6 ± 78.6 vs. 157.29 ± 78.8, p = 0.002). CONCLUSIONS: The addition of resistance/balance exercises and telephone-support program 12 weeks after to the CR could linked to higher physical activity levels and fewer clinical complications but did not lead to a significant improvement in quality of life.

Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome.

Background and Objectives: The world's population is rapidly aging, and it is estimated that, by 2050, every sixth person on earth will be older than 65 years. Around 30% of older adults entering cardiac rehabilitation (CR) meet the criteria of frailty. Frailty identification has not been included in the routine evaluation of CR patients yet, and there is a lack of evidence on what training regimen for improving physical performance in frail people is optimal. Therefore, the aim of our study was to determine the prevalence of frailty and to evaluate the effect of two different complementary training programs on the gait speed of older vulnerable and frail patients with acute coronary syndrome and mid-range-to-preserved left ventricular ejection fraction (≥40%) during short-term CR. Materials and Methods: This randomized controlled trial was conducted from January 2020 to September 2021. CR participants (n = 97) with a mean age of 73.1 ± 5.3 years were randomly allocated into three groups: control (CG, n = 32), intervention-1 (IG-1, n = 32) and intervention-2 (IG-2, n = 33). The patients of all three groups attended a usual inpatient CR program, and two intervention groups additionally received different resistance and balance training programs 3 days a week: the IG-1 underwent complementary training with traditional means of physical therapy, while the IG-2 underwent complementary training with mechanical devices. The mean CR duration was 18.9 ± 1.7 days. Frailty was assessed with the Edmonton Frail Scale, and the 5 m walk test was used to evaluate gait speed. Results: Frailty was determined in 37.1% of participants, and 42.3% met the criteria of being vulnerable. After CR, the gait speed of frail and vulnerable patients significantly improved in all three groups (p < 0.05). In the IG-2, slow gait speed was reversed to normal in the overwhelming majority of patients (p < 0.05), while the CG had the greatest proportion of patients who remained to be slow after CR (p < 0.05). Conclusions: A considerable part of patients entering CR are frail or vulnerable; therefore, it is of crucial importance to assess frailty status in all older people. All three CR programs improved gait speed in frail and vulnerable older patients with ischemic heart disease. Complementary resistance and balance training with mechanical devices more effectively reversed slow gait speed to normal during short-term CR.

Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review.

Background and Objectives: Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. Materials and Methods: This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. Results: A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.

Analysis of Functional Recovery and Subjective Well-Being after Arthroscopic Rotator Cuff Repair.

Background: Rotator cuff tears are common causes of functional shoulder instability and often lead to arthroscopic rotator cuff repair. A well-programmed rehabilitation leads to successful tendon healing, positive functional recovery and subjective well-being (SWB). Objective: To evaluate the changes in shoulder functioning and SWB pre-, post-outpatient rehabilitation and after one-month follow-up. Materials and Methods: A total of 44 patients were assessed three times: at the beginning (six weeks' post-surgery), at the end of outpatient rehabilitation (2-3 weeks) and one month after rehabilitation. The outcome measures were the Disabilities of the Arm, Shoulder and Hand score (DASH), active range of motion (ROM), manual muscle testing (MMT), hand dynamometry (HD) and pain level by a Visual Analogue Scale (VAS). SWB was assessed by Rosenberg self-esteem scale (RSES), Positive and Negative Affect Schedule (PANAS) and the Lithuanian Psychological Well-Being Scale (LPWBS). Results are presented as a difference between periods. Results: Affected shoulder motor function (MMT, HD and ROM) significantly improved in three periods (p < 0.05); however, major recovery was observed in the follow-up period. VAS scores meaningfully decreased over all stages and negatively correlated with motor function recovery (p < 0.05). DASH rates exhibited significant retrieval in all phases, especially in follow-up. SWB results demonstrated the larger effects of self-evaluation in follow-up, improved daily functions and psychological wellness, then negative emotions significantly decreased (p < 0.05). Conclusions: The experienced pain and psychosocial factors significantly influence functional recovery of the shoulder during rehabilitation. The improvement in motor function, ability and pain relief during rehabilitation increases level of SWB, psychological wellness and positive emotional affect in long-term context.

Cardiac Rehabilitation and Complementary Physical Training in Elderly Patients after Acute Coronary Syndrome: A Pilot Study.

Background and Objectives: Nearly 23% of elderly patients hospitalized due to acute coronary syndrome have reduced muscle strength. It is assumed that these patients would better benefit from a complex training-a combination of endurance, strength, balance, coordination, and flexibility-in order to reduce the loss of muscle strength and mass and improve functional capacity. The aim of this study was to assess the effectiveness and safety of two different complementary resistance and balance training programs during short-term cardiac rehabilitation (CR) in elderly patients after a percutaneous or surgical intervention due to acute coronary syndrome. Materials and Methods: This randomized controlled trial was conducted from January 2020 to February 2021 in one Lithuanian rehabilitation hospital. A total of 63 participants who met the inclusion criteria were randomly assigned to three groups (at the ratio of 1:1:1): control (CG, n = 19), intervention 1 (IG-1, n = 26), and intervention 2 (IG-2, n = 18). All the patients attended a usual inpatient CR program of a mean duration of 18.7 ± 1.7 days, while the patients assigned to the intervention groups (IG-1 and IG-2) additionally received different resistance and balance training programs three days a week. Functional capacity, with 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET), as well as physical performance, with the short physical performance battery (SPPB) test and one repetition maximum test (1RM) for leg press, were assessed at baseline and after CR. Results: The mean age of the participants was 72.9 ± 5.5 years; 73% were men. All parameters of functional capacity and physical performance improved significantly after CR (p < 0.05), except for peak VO2 that improved only in the IG-1. Comparison of CR effectiveness among the groups revealed no significant differences. Conclusions: All three rehabilitation programs were safe and well tolerated by elderly patients aged ≥65 years as well as improved functional capacity (6-minute walk distance and peak workload) and physical performance (SPPB and 1RM). Complementary resistance and balance training with traditional physical therapy means and exercises with mechanical devices did not show greater benefits for the results of physical performance compared with the usual CR program.

Healthcare professional-led interventions on lifestyle modifications for hypertensive patients - a systematic review and meta-analysis.

BACKGROUND: About 0.9 billion people in the world have hypertension. The mortality due to hypertension increased dramatically over the last decades. Healthcare professionals should support patients with hypertension to modify their lifestyle to decrease blood pressure, but an overview of effective lifestyle interventions is lacking. The aim of this study was to determine whether healthcare professional-led interventions on lifestyle modifications are effective in lowering blood pressure in patients with hypertension. METHODS: A systematic literature review following the PRISMA guidelines was conducted. PubMed, EMBASE and CINAHL databases were searched for randomized control trials (RCTs) of interventions on lifestyle modifications of hypertensive patients which were performed by healthcare professionals (physician, nurse, pharmacist) and which reported blood pressure measurements. Papers were reviewed by two reviewers and analysed using Cochrane software Revman 5.4. In a meta-analysis difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and the percentage of patients with controlled blood pressure (BP) was analysed. RESULTS: In total, 34 clinical trials reporting on 22,419 patients (mean age 58.4 years, 49.14% female, 69.9% used antihypertensive medications) were included. The mean difference SBP was - 4.41 mmHg (95% CI, - 5.52to - 3.30) and the mean difference DBP was - 1.66 mmHg (95% CI - 2.44 to - 0.88) in favor of the intervention group vs usual care. Fifty-six percent of patients achieved BP control in the intervention group vs 44% in usual care, OR = 1.87 (95% CI, 1.51 to 2.31). CONCLUSION: Healthcare professional-led interventions were effective. Patients achieved almost 5 mmHg decrease of SBP and more patients achieved BP control. The results suggest that efforts are needed for widespread implementation.

The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial.

BACKGROUND: To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention. METHODS: Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5 ± 5.9 days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6 min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT). RESULTS: One hundred sixteen patients (76.1 ± 6.7 years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n = 60) or CG (n = 56) and participated in CR (18.6 ± 2.7 days). As a result, 6MWT (IG 247 ± 94.1 vs. 348 ± 100.1, CG 232 ± 102.8 vs. 333 ± 120.7), SPPB (IG 8.31 ± 2.21 vs. 9.51 ± 2.24, CG 7.95 ± 2.01 vs. 9.08 ± 2.35), 5MWT (IG 0.847 ± 0.31 vs. 0.965 ± 0.3, CG 0.765 ± 0.24 vs 0.879 ± 0.29) all other outcome variables and physical frailty level improved significantly (p < 0.05) in both groups with no significant difference between groups. Improvements were sustained over the 3-month follow-up for 6MWT (IG 348 ± 113 vs. CG 332 ± 147.4), SPPB (IG 10.37 ± 1.59 vs CG 9.44 ± 2.34), 5MWT (IG 1.086 ± 0. 307 vs CG 1.123 ± 0.539) and other variables. Improvement in physical frailty level was significantly more pronounced in IG (p < 0.05) after the 3-month follow-up. CONCLUSION: Exercise-based CR improves functional and exercise capacity, physical performance, and muscular strength, and reduces physical frailty levels in patients after valve surgery/intervention in the short and medium terms. SPPB score and 5MWT were useful for physical frailty assessment, screening and evaluation of outcomes in a CR setting. Additional benefit from the resistance and balance training could not be confirmed. TRIAL REGISTRATION: NCT04234087 , retrospectively registered 21 January 2020.

The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: randomized participant blind controlled trial.

OBJECTIVES: To evaluate and compare the efficacy of high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) for plantar fasciitis. DESIGN: A participant blind randomized controlled trial with parallel group design and an active comparator with follow-up at four weeks. SETTINGS: Outpatient, University hospital. SUBJECTS: Unilateral plantar fasciitis participants (n = 102) were randomly assigned into two groups. Recruitment period was from January 2017 to April 2019. INTERVENTIONS: Interventions included eight sessions of laser therapy over three weeks and single session of patient education. The HILT group (n = 51) received HILT and the LLLT group (n = 51) received LLLT. MAIN MEASURES: Primary outcomes: visual analogue scale; secondary outcomes: pressure algometry, sonography of plantar fascia thickness (time frame: baseline to three-week and four-week follow-up) and numeric rating scale (0%-100%) for opinion of participants on effect of treatment (time frame: three weeks). Data presented: mean (SD) or n (%). RESULTS: There was no statistically significant difference between the groups according to visual analogue scale (pain in general reduction in three weeks: 2.57(3.45) vs. 2.88(3.28) cm), pressure algometry (pain threshold difference between healthy and affected heel reduction in three weeks: 1.80(6.39) vs. 1.77(2.85) kg) and sonography measurements (plantar fascia thickness difference between healthy and affected heel reduction in three weeks: 0.19(0.56) vs. 0.30(0.57) mm). There was a statistically significant difference between the groups in participants' opinion in favor to HILT group (efficacy of treatment better than 50%: 26(51%) vs. 37(73%)). CONCLUSION: No statistically significant difference between groups was observed.

The effectiveness of Kinesio Taping® for mobility and functioning improvement in knee osteoarthritis: a randomized, double-blind, controlled trial.

OBJECTIVE: To evaluate the effectiveness of the Kinesio Taping® method for mobility and functioning improvement for patients with knee osteoarthritis (KO). DESIGN: Randomized, double-blinded, controlled trial. SETTING: Outpatient rehabilitation department. SUBJECTS: A total of 187 subjects with symptomatic I-III grade KO participated; of these, 157 subjects were included in the analyses (intervention group, n = 81 (123 knees); control group, n = 76 (114 knees). INTERVENTION: The intervention group received a specific Kinesio Taping application, and the control group received non-specific knee taping for a month. MAIN MEASURES: Changes in Knee injury and Osteoarthritis Outcome Scores (KOOS), knee active range of motion, 10-Meter Walk, and the five times sit to stand tests (5xSST) were assessed at baseline, after four weeks of taping, and a month post taping intervention. Subjective participants' experiences and opinions on the effect of knee taping were evaluated. The chosen level of significance was p < 0.05. RESULTS: The mean age of participants was 68.7 ± 9.9 in intervention group and 70.6 ± 8.3 in control group (p > 0.05). The change from baseline in gait speed in the intervention group after taping month was +0.04 ± 0.1 m/s, at follow-up +0.06 ± 0.1 m/s; in control group +0.07 ± 0.1 m/s, and +0.09 ± 0.1 m/s; the change in time needed to accomplish 5xSST was -2.2 ± 3.2 seconds, at follow-up -2.4 ± 3.1 seconds; in control group -2.8 ± 3.6 seconds, and -2.4 ± 4 seconds. Improved knee flexion and enhancement in functioning assessed by KOOS were noticed in both groups, with lasting improvement to follow up. No difference in the change in the above-mentioned outcomes was found between groups (p > 0.05). Fewer subjects (6.2% (5) vs. 21.1% (16), χ2 = 7.5, df = 2, p = 0.024) from Kinesio Taping group were unsure if taping alleviated their mobility and more intervention group patients indicated higher subjective satisfaction with the effect of knee taping to symptom and mobility alleviation than control group (p < 0.005). CONCLUSION: Investigated Kinesio Taping technique did not produce better results in mobility and functioning improvement over non-specific knee taping; however, it had higher patient-reported subjective value for symptom attenuation and experienced mobility enhancement.

The effect of balneotherapy and peloid therapy on changes in the functional state of patients with knee joint osteoarthritis: a randomized, controlled, single-blind pilot study.

The treatment of OA using pharmaceutical and non-pharmaceutical measures remains a topical subject. The purpose of this study is to assess the effect of natural factors (mineral water and mud) on changes in the functional state of patients with knee joint OA. Ninety-two adult people with grade I-III knee joint OA according to the Kellgren and Lawrence scoring system participated in the study. The subjects received 10 mineral water bath plus physical therapy or mud application procedures plus physical therapy or physical therapy alone every other day. The effectiveness of the treatment was assessed on the basis of anthropometric changes of data, VAS, SF-36, KOOS questionnaire indicators. Significantly greater walking speed, test of 5 sit downs/stand ups, circumference of a knee joint, flexion and extension range, flexor and extensor strength after treatment lasting 1 month were obtained in the intervention group. After 1 month after treatment pain intensity scores over the past month and when changing position were significantly higher in the control group. The positive changes in SF-36 were identified after 1 month after treatment: physical activity increased and pain decreased in the intervention groups. There was no significant difference between the averages of any KOOS subscale in groups. However, average percentages of symptoms, stiffness, and pain in the intervention groups were significantly better after treatment and lasting 1 month after treatment. Balneotherapy and peloid therapy effectively reduce pain and improve the functional state of patients with OA of a knee joint.

The effectiveness of Kinesio Taping® for pain management in knee osteoarthritis: a randomized, double-blind, controlled clinical trial.

BACKGROUND: Kinesio Taping® method is a nonpharmacological alternative for pain management in musculoskeletal disorders. However, the existing evidence is insufficient to assess its full effectiveness for pain management in knee osteoarthritis (KO). Our aim was to evaluate the effectiveness of the Kinesio Taping method in reducing knee pain for KO patients. METHODS: In this randomized, double blind, controlled trial, we recruited 187 patients with grade I-III KO who were allocated to either the Kinesio Taping or control group. The study was carried out in outpatient facility. Either Kinesio Taping or nonspecific taping was applied on the affected knee area for 4 weeks. Pain evaluation was performed at baseline, after 1 month of taping and after 1 further month without taping. The data on usage of painkillers were collected; Numeric Pain Rating Scale; an algometer, and Knee injury and Osteoarthritis Outcome Scores (KOOS) pain subscale were used to assess pain. Tolerance and subjective opinions toward the effectiveness of taping were evaluated. The chosen level of significance was p < 0.05, ß â©½ 0.2. RESULTS: The majority (>70%) of both groups' patients indicated that tapes reduced the knee pain. The reported use of painkillers decreased, in addition to self-reported increase in the KOOS subscale, thereby indicating pain alleviation. All self-reported improvement remained at the 1-month follow up (p < 0.05). Significantly higher and clinically meaningful reduction of pain intensity was found in the Kinesio Taping group after the treatment month, in comparison with the control group (p < 0.05). More pain reduction was reported in the daytime for participants in the Kinesio Taping group at the follow up (p = 0.022). No changes in algometry results were observed. CONCLUSIONS: Elastic taping can safely relieve knee pain and reduce the need for pharmacological management in KO. A specific Kinesio Taping technique is clinically more beneficial for knee-pain alleviation in comparison with nonspecific taping.[ClinicalTrials.gov identifier: NCT03076177.].