Structured guideline-based physiotherapy reduces difficulties in activities of daily living in Parkinson's disease.

BACKGROUND: In the long term, Parkinson's disease (PD) leads to the development of difficulties in daily functional tasks. There remains a paucity of evidence on the effectiveness of physiotherapy on patient-perceived difficulties regarding basic activities of daily living (ADL). OBJECTIVES: To assess an effect of a versatile physiotherapy intervention on patient-perceived difficulties in basic ADL. METHODS: The study sample included 24 patients (10 men and 14 women) with PD. Participants were randomly assigned into intervention (IG) and control groups (CG). Two assessments were performed with a gap of 10 weeks. Following first assessment, during an 8-week period, IG participants attended sixteen physiotherapy 60-minutes sessions in groups that were divided into five parts to address the core areas recommended by the European Physiotherapy Guideline for PD (EPGPD): gait, transfers, balance, physical capacity, and manual activities. The main assessment tool was the Modified Patients Specific Functional Scale (ModPSFS), which represents a self-assessment rating on difficulties perceived in 17 different commonly occurring activities. RESULTS: IG members reported a significant reduction in self-perceived difficulties as assessed by ModPSFS (effect size 1.39; 95%CI 5.1, 26.6 points, p = 0.005). CONCLUSIONS: 2-months conventional physiotherapy with incorporated core areas recommended in EPGPD for PD reduced patient-perceived difficulties in basic ADL.

Versatile guideline-based physiotherapy intervention in groups to improve gait speed in Parkinson's disease patients.

BACKGROUND: Gait function is known to be impaired by Parkinson's disease (PD). The effect of exercise to improve gait has been widely examined, often with special intervention. However, in clinical settings, physiotherapy rarely consists only of gait training. OBJECTIVE: To examine whether versatile physiotherapy intervention conducted in accordance with European Physiotherapy Guideline for Parkinson's Disease (EPGPD) is sufficient to increase gait speed (GS). METHODS: Participants (24) with idiopathic PD were randomly enrolled into intervention (IG) and control groups (CG) (n = 12, 7 females and 5 males in each group). Sixteen one-hour therapy sessions (twice per week) were conducted for IG. Each session focused on core areas recommended in EPGPD. Participants were assessed twice with 10 weeks between assessments. GS was calculated based on a gait test of Short Physical Performance Battery. Dominant side hip flexion and abduction range of motion (HFLEX & HABD) were measured and Freezing of Gait questionnaire (FOG) was administered. RESULTS: Versatile intervention in groups resulted in increase of GS (ES -0.9 [CI{0.1}-{0.4}] m/s) and HFLEX (ES-0.6 [CI{5.9}-{16.6°}]. FOG was reduced (ES -0.41 [CI {-2.8}{-5.5}]). Re-evaluation HABD differed between groups and indicated large ES (r = -0.5). CONCLUSIONS: Versatile physiotherapy is sufficient to improve GS, range of motion and reduce FOG.

The approach of physiatrists to low back pain across Europe.

BACKGROUND: Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists. OBJECTIVE: The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study. METHODS: The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey. RESULTS: The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain. CONCLUSION: The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with respiratory conditions. The European PRM position (UEMS PRM Section).

Chronic respiratory conditions are among the top causes of death and disability. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with chronic respiratory conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with twenty-three recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of chronic respiratory conditions is to lead pulmonary rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with chronic respiratory conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with respiratory conditions.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with cardiovascular conditions. The European PRM position (UEMS PRM Section).

Cardiovascular conditions are significant causes of mortality and morbidity leading to substantial disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with cardiovascular conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of cardiovascular conditions is to lead cardiac rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with cardiovascular conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cardiovascular conditions.

Functional Performance and Associations between Performance Tests and Neurological Assessment Differ in Men and Women with Parkinson's Disease.

BACKGROUND: Neurological assessment of a patient with Parkinson's disease (PD) is expected to reflect upon functional performance. As women are known to report more limitations even for same observed functional performance level, present study was designed to examine whether associations between neurological assessments and functional performance differ across genders. METHODS: 14 men and 14 women with PD participated. Functional performance was assessed by measuring walking speeds on 10-meter walk test (10MWT) and by performing timed-up-and-go-test (TUG). Neurological assessment included Hoehn and Yahr Scale (HY), Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Schwab and England Activities of Daily Living Scale (S-E), and Mini Mental State Examination (MMSE). RESULTS: In women with PD, Kendall's tau-b correlation analyses revealed significant correlations between functional performance tests and neurological assessment measures, with the exception in MMSE. No corresponding associations were found for men, although they demonstrated better functional performance, as expected. CONCLUSION: Men in similar clinical stage of the PD perform better on functional tests than women. Disease severity reflects upon functional performance differently in men and women with PD. Results indicate that when interpreting the assessment results of both functional performance and neurological assessment tests, the gender of the patient should be taken into consideration.

Oxidative stress before and after exercise conditioning in patients following surgical revascularization of the myocardium.

The main purpose of the study was to evaluate changes in the extent of oxidative stress and its associations with the indices of cardiorespiratory reserve and functional capacity in 35 patients enrolled in a 12-week exercise conditioning programme 2-4 weeks after surgical revascularization of the myocardium. The following markers of oxidative stress were measured spectrophotometrically before and after the programme: lipid peroxidation products (thiobarbituric acid reactive substances, diene conjugates and lipid hydroperoxide) and markers of blood antioxidant status (blood glutathione markers, blood antioxidative capacity and lag phase of low-density lipoprotein (LDL)). To evaluate the functional indices of the cardiorespiratory system the patients underwent bicycle cardiopulmonary testing before entering and after completing the programme. On the basis of peak oxygen consumption (peak VO2) +/- 1 SD, three subgroups with different aerobic capacity were identified: >/=19 ml/min per kg (GR I, n = 7), 11-19 ml/min per kg (GR II, n = 24) and