Postoperative rehabilitation exercises with addition of blood flow restriction therapy following olecranon fracture: A case report.

BACKGROUND: The addition of blood flow restriction therapy (BFRT) to exercise in patients with olecranon fracture treated surgically has not been described in the literature. PURPOSE: To describe the effects and safety of BFRT exercises in the postoperative rehabilitation of a patient with olecranon fracture. CASE PRESENTATION: A 27-year-old male with a surgically treated olecranon fracture completed a 12-week postoperative physical therapy programme. The assessment was performed at the start of rehabilitation, 4 and 12 weeks. The patient had elbow pain, decreased active range of motion (AROM), reduced handgrip strength, and limited physical function. The patient was treated with low-intensity resistance exercises with BFRT. The BFRT was applied with three exercises per stage, at 50% of the limb occlusion pressure and 75 repetitions per exercise. At discharge from physical therapy, improvements were observed in pain intensity (5.9-1.4 cm), AROM of elbow flexion (88°-137°) and extension (-22°--2°), AROM of forearm pronation (18°-68°) and supination (34°-78°), handgrip strength (8 kg-47 kg), physical function (22.9%-89.6%), and disability (72.7%-13.6%). These changes reached the minimal clinically important difference at the time of discharge for all measures, except for extension, pronation, and supination AROM. CONCLUSION: The addition of BFRT to exercise was effective in improving pain, elbow, and wrist AROM, handgrip strength, function, and disability in a patient with surgically treated olecranon fracture. Despite the inherent limitations of our design, we believe these preliminary findings are compelling to warrant future investigations.

Effects of hypopressive exercise associated with aerobic and muscle strength training on the treatment of fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecologic cancer: A randomized clinical trial protocol.

Introduction: Therapeutic exercise has an important role in the population living with cancer as it improves function and quality of life and reduces the symptoms of cancer treatment. There is little clinical evidence on the effects of hypopressive exercise in women with gynecological cancer. Objective: Evaluate the effects of 4 weeks of hypopressive exercise associated with muscle strength training and aerobic exercises on fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecological cancer compared to a group that will perform conventional training. Methods: This randomized, single-blinded clinical trial study is set in the Clinical Research Laboratory, Department of Kinesiotherapy, at a Chilean University. Patients will be randomly assigned to an experimental group of hypopressive exercises associated with muscle strength training and aerobic exercises or a control group of muscle strength training and aerobic exercises. Twelve tele-rehabilitation sessions will be performed. Women over 18 years of age with gynecologic cancer who have been prescribed radiotherapy or chemotherapy will participate. Fatigue, quality of life, urinary incontinence symptoms, and sexual function will be assessed before and after the intervention. Expected results: The results of this clinical trial have important implications for specific treatment for the cancer population and generate new techniques in the practice of oncology-specialized kinesiologists. Hypopressive exercise is expected to reduce incontinence symptoms due to neuromuscular activation of the pelvic floor muscles. However, more studies are needed to confirm the beneficial effects of hypopressive exercises in face-to-face or remote rehabilitation.

Introducción: El ejercicio terapéutico juega un rol importante en la población con cáncer, ya que mejora la función, la calidad de vida y reduce los síntomas del tratamiento contra el cáncer. Hay poca evidencia clínica sobre los efectos del ejercicio hipopresivo en mujeres con cáncer ginecológico. Objetivo: Evaluar los efectos de cuatro semanas de ejercicio hipopresivo asociado con entrenamiento de fuerza muscular y ejercicios aeróbicos sobre la fatiga, los síntomas de incontinencia urinaria, la función sexual y la calidad de vida en mujeres tratadas por cáncer ginecológico, en comparación con un grupo que realizará entrenamiento convencional. Métodos: El escenario para este estudio de ensayo clínico aleatorizado y simple ciego es el Laboratorio de Investigación Clínica, Departamento de Kinesiología, en una Universidad Chilena. Las pacientes serán asignadas aleatoriamente a un grupo experimental de ejercicios hipopresivos asociados con entrenamiento de fuerza muscular y ejercicios aeróbicos, o a un grupo de control de entrenamiento de fuerza muscular y ejercicios aeróbicos. Se realizarán doce sesiones de telerehabilitación. Participarán mujeres mayores de 18 años con cáncer ginecológico a quienes se les haya indicado radioterapia o quimioterapia. Se evaluarán la fatiga, la calidad de vida, los síntomas de incontinencia urinaria y la función sexual antes y después de la intervención. Resultados: esperados Los resultados de este ensayo clínico tienen importantes implicaciones en términos del tratamiento específico para la población con cáncer y generan nuevas técnicas en la práctica de kinesiólogos especializados en oncología. Se espera que el ejercicio hipopresivo reduzca los síntomas de incontinencia debido a la activación neuromuscular de los músculos del suelo pélvico. Sin embargo, se necesitan más estudios para confirmar los efectos beneficiosos de los ejercicios hipopresivos, ya sea en rehabilitación presencial o a distancia.

Isolated bladder training or in combination with other therapies to improve overactive bladder symptoms: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Bladder training (BT), the maintenance of a scheduled voiding regime at gradually adjusted intervals, is a common treatment for overactive bladder (OAB). OBJECTIVES: To assess the effects of isolated BT and/or in combination with other therapies on OAB symptoms. METHODS: A systematic review of eight databases was conducted. After screening titles and abstracts, full texts were retrieved. Cochrane RoB 2 and the GRADE approach were used. RESULTS: Fourteen RCTs were included: they studied isolated BT (n = 11), BT plus drug treatment (DT; n = 5), BT plus intravaginal electrical stimulation (IVES; n = 2), BT plus biofeedback and IVES (n = 1), BT plus pelvic floor muscle training and behavioral therapy (n = 2), BT plus percutaneous tibial nerve stimulation, and BT plus transcutaneous tibial nerve stimulation (n = 1). In a meta-analysis of short-term follow-up data, BT plus IVES resulted in greater improvement in nocturia (mean difference [MD]: 0.89, 95% CI: 0.5, 1.20), urinary incontinence (UI; MD: 1.93, 95% CI: 1.32, 2.55), and quality of life (QoL; MD: 4.87, 95% CI: 2.24, 7.50) than isolated BT, while DT and BT improved UI (MD: 0.58, 95% CI: 0.23, 0.92) more than isolated BT. CONCLUSION: In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL. The limited number of RCTs and heterogeneity among them provide a low level of evidence, making the effect of BT on OAB inconclusive, which suggests that new RCTs should be performed.

Effects of hypopressive exercise associated with aerobic and muscle strength training on the treatment of fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecologic cancer: A randomized clinical trial protocol / Efectos del ejercicio hipopresivo asociado con el entrenamiento aeróbico y de fuerza muscular en el tratamiento de la fatiga, los síntomas de la incontinencia urinaria, la función sexual y la calidad de vida en mujeres tratadas por cáncer ginecológico: un protocolo de ensayo clínico aleatorizado

Introduction Therapeutic exercise has an important role in the population living with cancer as it improves function and quality of life and reduces the symptoms of cancer treatment. There is little clinical evidence on the effects of hypopressive exercise in women with gynecological cancer. Objective Evaluate the effects of 4 weeks of hypopressive exercise associated with muscle strength training and aerobic exercises on fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecological cancer compared to a group that will perform conventional training. Methods This randomized, single-blinded clinical trial study is set in the Clinical Research Laboratory, Department of Kinesiotherapy, at a Chilean University. Patients will be randomly assigned to an experimental group of hypopressive exercises associated with muscle strength training and aerobic exercises or a control group of muscle strength training and aerobic exercises. Twelve tele-rehabilitation sessions will be performed. Women over 18 years of age with gynecologic cancer who have been prescribed radiotherapy or chemotherapy will participate. Fatigue, quality of life, urinary incontinence symptoms, and sexual function will be assessed before and after the intervention. Expected results The results of this clinical trial have important implications for specific treatment for the cancer population and generate new techniques in the practice of oncology-specialized kinesiologists. Hypopressive exercise is expected to reduce incontinence symptoms due to neuromuscular activation of the pelvic floor muscles. However, more studies are needed to confirm the beneficial effects of hypopressive exercises in face-to-face or remote rehabilitation.

Introducción El ejercicio terapéutico juega un rol importante en la población con cáncer, ya que mejora la función, la calidad de vida y reduce los síntomas del tratamiento contra el cáncer. Hay poca evidencia clínica sobre los efectos del ejercicio hipopresivo en mujeres con cáncer ginecológico. Objetivo Evaluar los efectos de cuatro semanas de ejercicio hipopresivo asociado con entrenamiento de fuerza muscular y ejercicios aeróbicos sobre la fatiga, los síntomas de incontinencia urinaria, la función sexual y la calidad de vida en mujeres tratadas por cáncer ginecológico, en comparación con un grupo que realizará entrenamiento convencional. Métodos El escenario para este estudio de ensayo clínico aleatorizado y simple ciego es el Laboratorio de Investigación Clínica, Departamento de Kinesiología, en una Universidad Chilena. Las pacientes serán asignadas aleatoriamente a un grupo experimental de ejercicios hipopresivos asociados con entrenamiento de fuerza muscular y ejercicios aeróbicos, o a un grupo de control de entrenamiento de fuerza muscular y ejercicios aeróbicos. Se realizarán doce sesiones de telerehabilitación. Participarán mujeres mayores de 18 años con cáncer ginecológico a quienes se les haya indicado radioterapia o quimioterapia. Se evaluarán la fatiga, la calidad de vida, los síntomas de incontinencia urinaria y la función sexual antes y después de la intervención. Resultados esperados Los resultados de este ensayo clínico tienen importantes implicaciones en términos del tratamiento específico para la población con cáncer y generan nuevas técnicas en la práctica de kinesiólogos especializados en oncología. Se espera que el ejercicio hipopresivo reduzca los síntomas de incontinencia debido a la activación neuromuscular de los músculos del suelo pélvico. Sin embargo, se necesitan más estudios para confirmar los efectos beneficiosos de los ejercicios hipopresivos, ya sea en rehabilitación presencial o a distancia.

Affordable web-based foot-ankle exercise program proves effective for diabetic foot care in a randomized controlled trial with economic evaluation.

The aim of this study was to shed light on a crucial issue through a comprehensive evaluation of the cost-effectiveness and cost-utility of a cutting-edge web-based foot-ankle therapeutic exercise program (SOPeD) designed for treating modifiable risk factors for ulcer prevention in individuals with diabetes-related peripheral neuropathy (DPN). In this randomized controlled trial, 62 participants diagnosed with DPN were assigned to the SOPeD software or received usual care for diabetic foot. Primary outcomes were DPN symptoms and severity, foot pain and function, and quality-adjusted life years (QALYs). Between-group comparisons provided 95% confidence intervals. The study also calculated incremental cost-effectiveness and cost-utility ratios (ICERs), analyzed direct costs from a healthcare perspective, and performed a sensitivity analysis to assess uncertainty. The web-based intervention effectively reduced foot pain, improved foot function and showed favorable cost-effectiveness, with ICERs ranging from (USD) $5.37-$148.71 per improvement in different outcomes. There is a high likelihood of cost-effectiveness for improving DPN symptoms and severity, foot pain, and function, even when the minimum willingness-to-pay threshold was set at $1000.00 USD. However, the intervention did not prove to be cost-effective in terms of QALYs. This study reveals SOPeD's effectiveness in reducing foot pain, improving foot function, and demonstrating cost-effectiveness in enhancing functional and clinical outcomes. SOPeD stands as a potential game-changer for modifiable risk factors for ulcers, with our findings indicating a feasible and balanced integration into public health systems. Further studies and considerations are vital for informed decisions to stakeholders and the successful implementation of this preventive program on a larger scale.Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Multimodal therapeutic intervention program associated with photobiomodulation therapy for individuals with chronic nonspecific neck pain: protocol for a clinical trial.

BACKGROUND: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. METHODS: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. DISCUSSION: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. TRIAL REGISTRATION: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.

The Influence of Physical Exercises on the Flexibility of Older Individuals with Knee Osteoarthritis: A Systematic Review.

Background: Flexibility is a component of functional capacity and is relevant in maintaining the musculature and structures adjacent to the joints. Then, the improvement of the flexibility must be a critical goal in the rehabilitation programs. By improving flexibility in knee osteoarthritis (KOA) individuals, the pain is relieved, the risk of injury is reduced, and the need for surgical interventions is delayed. We aimed to summarize the available literature on the influence of different physical exercise modalities on flexibility in older KOA individuals. Methods: This study followed the PRISMA statement and registered in PROSPERO (CRD42020195786). Seven databases (MEDLINE/PubMed; PEDro; CINAHL; Scopus; Web of Science; Embase; and SPORTDiscus) were screened for papers published prior to Sep 6, 2022. The PEDro scale, Cochrane collaborations, and ROBINS-I tools were used to evaluate the methodological quality and risk of bias. Results: Ten studies (including 438 participants diagnosed with KOA) fulfilled the eligibility criteria, and nine concluded that flexibility was improved after a physical exercise program. Conclusion: Despite the modality, physical exercise improves flexibility in older KOA individuals, improving the functional capacity. Health professionals engaged in KOA rehabilitation should use physical exercise as a strategy to improve the flexibility of this population.

Exercise in cancer patients: assistance levels and referral pathways-a position statement from the Spanish Society of Medical Oncology.

There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient's needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients.

Effects of Therapies Involving Plyometric-Jump Training on Physical Fitness of Youth with Cerebral Palsy: A Systematic Review with Meta-Analysis.

The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were meta-analyzed by applying a random-effects model to calculate Hedges' g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed (I2 statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2-4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36-0.96, p < 0.001, I2 = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33-1.04, p < 0.001, I2 = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12-1.58, p = 0.023, I2 = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.

Patients' perspectives on planned interventions tested in the Otago MASTER feasibility trial: an implementation-based process evaluation study.

BACKGROUND: Patients are key stakeholders of clinical research, and their perspectives are relevant for researchers when planning and conducting clinical trials. Numerous aspects of trial process can influence participants' experiences. Their experiences within a trial can impact retention rates. Poor treatment adherence may bias treatment effect estimates. One way to improve recruitment and adherence is to design trials that are aligned with patients' needs and preferences. This study reports a process evaluation of the Otago MASTER feasibility trial. OBJECTIVES: Our aims were to investigate the patients' perceptions of the trial interventions through individual interviews. METHODS: Twenty-five participants were recruited for the feasibility trial and were allocated to two groups: tailored or standardised exercise. Sixteen participants agreed to take part in individual semi-structured interviews. Interviews were transcribed verbatim, and all interviews were analysed thematically using an iterative approach. RESULTS: Our key findings suggest participants: (1) took part in the study to access healthcare services and contribute to research; (2) valued interventions received; (3) reported certain barriers and facilitators to participate in the trial; and (4) highlighted areas for improvement when designing the full trial. CONCLUSION: Participants volunteered to access healthcare and to contribute to research. Participants valued the personalised care, perceived that their engagement within the trial improved their self-management and self-efficacy behaviour, valued the time spent with clinicians, and the empathetic environment and education received. Facilitators and barriers will require careful consideration in the future as the barriers may impact reliability and validity of future trial results.

Effectiveness of pilates-based exercises on the diastasis recti abdominis in climacteric women: a randomized controlled trial

INTRODUCTION: Recent studies have related the climacteric period with changes in connective tissue elasticity that may be related to diastasis recti abdominis. Mat Pilates is a method of exercise without impact that currently has more practitioners, due to its satisfactory results. However, there are no studies that evaluate the effectiveness of mat Pilates for women with diastasis recti abdominis. OBJECTIVE: To evaluate the effectiveness of the mat Pilates program in climacteric women with diastasis recti abdominis. METHODS: This randomized single-blinded clinical trial evaluated climacteric women with diastasis recti abdominis. The participants were randomized into the experimental group, which participated in 3 weekly sessions of mat Pilates for 12 weeks for a total of 36 sessions, and the control group (without exercises). The inter-rectus distance was measured with a digital caliper. The G*Power Version 3.1.9.2. software was used for the sample calculation, and the SPSS 20.0 program was used for statistical analysis. RESULTS: The study comprised 21 women, including 10 in the control group and 11 in the experimental group, with mean ages of 54.3 ± 7.1 and 55.3 ± 6.0 years and body mass index values of 28.8 ± 5.5 kg/m2 and 29.9 ± 4.48 kg/m2, respectively. In the experimental group, reductions were observed in all the measures related to diastasis recti abdominis (p<0.05) in the supraumbilical, umbilical, and infra-umbilical regions. CONCLUSION: The mat Pilates method is effective for reducing diastasis recti abdominis in the climacteric period.

Comparison of aquatic physiotherapy and therapeutic exercise in patients with chronic low back pain.

OBJECTIVE: To investigate and compare the effectiveness of aquatic physiotherapy and therapeutic exercise in the physical and functional performance of patients with chronic low back pain. METHODS: Twenty-six participants were randomized into 3 groups, namely an aquatic physiotherapy group (AG), a therapeutic exercise group (EG), and a control group (CG). The pain, disability, and quality of life were compared before and after the exercise protocols for 2 months, twice a week, on alternate days, for 60 min. For statistical analyses, the Kruskal-Wallis test was used to test the difference between the groups; the Wilcoxon test and the effect size were used for before-and-after comparisons. RESULTS: Twenty participants completed the study. There was a significant difference improvement in pain between the AG and the EG (p = 0.004), between the EG and the CG (p = 0.05), and in social role functioning between the groups (p = 0.02). No differences were observed in the other analyzed variables between the groups. Compared to the pre-treatment state, there were significant improvements in the AG in terms of pain (p = 0.02), functionality (p = 0.03), and general health status (p = 0.04). CONCLUSION: The AG group showed significant and clinical improvement in pain, disability, and quality of life. Improvements related to social aspects were found in the EG compared to the CG. The water provides a safe environment that facilitates the onset of exercise, so aquatic physiotherapy could be considered the first recommendation for patients with low back pain.

Evaluación y tratamiento kinésico de una atleta élite de CrossFit con lesión muscular del dorsal ancho: reporte de un caso / Evaluation and physical therapy treatment of an elite CrossFit athlete with latissimus dorsi muscle injury: a case report

RESUMEN Introducción: Las lesiones musculares del dorsal ancho (DA) son poco comunes y se producen casi exclusivamente en atletas de alto nivel competitivo. Hasta la fecha, no encontramos reportes de casos similares que describan de manera detallada el proceso de rehabilitación. El objetivo de este reporte de caso es describir la evaluación y el tratamiento kinésico de una atleta de élite de CrossFit en un consultorio privado de kinesiología. Presentación del caso: Una paciente femenina de 28 años, atleta de élite de CrossFit, sufrió una lesión muscular del DA durante una competencia. Se realizó una ecografía 72 h después, la cual confirmó la lesión. El tratamiento kinésico posterior fue activo y se basó principalmente en la progresión de diferentes ejercicios terapéuticos. Se realizaron diversas evaluaciones para monitorear la adaptación de la atleta (fuerza isométrica del DA, cuestionarios autorreportados y valoración funcional de la extremidad superior). Conclusión: La óptima progresión de los ejercicios durante el tratamiento, junto con una comunicación fluida entre la atleta, el entrenador y el kinesiólogo, permitió una vuelta a los entrenamientos diarios con el mismo nivel de cargas, intensidad y volumen que tenía previamente. La paciente regresó a la competencia a los 45 días del alta kinésica.

ABSTRACT Introduction: Latissimus dorsi (LD) muscle injuries are rare and primarily occur in high-level competitive athletes. To date, no similar case reports detailing the rehabilitation process have been found. The objective of this case report is to describe the assessment and physical therapy treatment of an elite CrossFit athlete at a private physical therapy clinic. Case presentation: A 28-year-old female patient, an elite CrossFit athlete, suffered an LD muscle injury during a competition. An ultrasound performed 72 h later confirmed the injury. Subsequent physical therapy treatment was active and primarily focused on the progression of various therapeutic exercises. Several assessments were conducted to monitor the athlete's adaptation (LD isometric strength test, self-reported questionnaires, and functional assessment to the upper extremity). Conclusion: The optimal progression of exercises during treatment, along with fluid communication among the athlete, coach, and physiotherapist, allowed a return to daily training with the same level of loads, intensity, and volume as before the injury. The patient returned to competition 45 days after discharge from physiotherapy.

High-flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an increasingly concerning global public health issue due to its high burden of morbidity and mortality. Pulmonary rehabilitation (PR) is a comprehensive intervention to improve patients' physical and psychological conditions, commonly involving oxygen supplementation. The potential benefits of high-flow nasal cannula (HFNC) have recently sparked interest as oxygen therapy. In this context, this study aims to assess the effects of HFNC during the exercise training component of a PR program in people with COPD. METHODS: Systematic review (CRD42022330929). We included randomised controlled trials (RCTs), including crossover RCTs with adults with stable COPD. We included trials using oxygen therapy with HFNC during the exercise training component of a PR programme. PRIMARY OUTCOMES: disease-specific health-related quality of life (HRQoL), exercise capacity (EC) and adverse events. SECONDARY OUTCOMES: treatment adherence, breathlessness and future exacerbations. RESULTS: We included five studies with 300 participants with moderate to severe COPD. The certainty of the evidence was primarily low or very low for all outcomes of interest due to risk of bias, inconsistency or imprecision. HFNC has little to no difference in HRQoL (4 studies, 129 participants, MD 0.17, 95% CI -1.20 to 1.54; I2 50%). HFNC may result in little to no difference in EC (3 studies, 212 participants, mean difference 18.73, 95% CI -20.49 to 28.94; I2 56%), and we are uncertain about the effect of HFNC on breathlessness (4 studies; 244 participants, MD of -0.07, 95% CI -0.4 to 0.26; I2 63%). Only one study with 44 participants reported a participant's withdrawal because of progressive dyspnoea during lower limb exercise. CONCLUSIONS: We are uncertain about the effect of HFNC during the exercise component of a PR programme in HRQoL, EC or dyspnoea compared to usual care or conventional supplementary oxygen. Non-domiciliary oxygen patients showed improvements in HRQoL, EC and dyspnoea.

Efficacy of diadynamic currents as an adjunct to exercise to manage symptoms of knee osteoarthritis in adults: A randomized controlled clinical trial.

OBJECTIVE: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. DESIGN: A randomized-controlled trial. SETTING: Special Rehabilitation Services in Taboão da Serra. PARTICIPANTS: Patients with bilateral knee osteoarthritis. INTERVENTION: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). RESULTS: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was -3.08 points (95% confidence interval -4.13; -2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was -2.40 points (95% confidence interval -3.34; -1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was -4.08 points (95% confidence interval -5.89; -2.26), p < 0.01 with an effect size of 1.04. CONCLUSION: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months.

Exercise-induced hypoalgesia in chronic neck pain: A narrative review.

Chronic neck pain (CNP) is a worldwide health problem with several risk factors. One of the most widely used treatments for managing this condition is therapeutic exercise, which could generate a response called exercise-induced hypoalgesia (EIH). There is no consensus on the best exercise modality to induce hypoalgesia. Therefore, this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP. We included articles on EIH and CNP in patients older than 18 years, with pain for more than three months, where the EIH response was measured. Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded. The studies reviewed reported variable results. Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity; however, in people with chronic pain, the response is variable. Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity, others found no clinical response, and some even reported EIH with decreased pain and increased sensitivity. EIH is an identifiable, stimulable, and helpful therapeutic response in people with pain. More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon. In addition, it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.

Rotator cuff isometric exercises in combination with scapular muscle strengthening and stretching in individuals with rotator cuff tendinopathy: A multiple-subject case report.

BACKGROUND AND PURPOSE: To assess the effects of a rehabilitation protocol of rotator cuff (RC) isometrics coupled with traditional shoulder exercises on patient-rated outcomes, muscle strength, and electromyographic activity in individuals with RC tendinopathy. METHODS: Eleven individuals (8 women and 3 men, 37.9 ± 5.6 years) with RC tendinopathy performed isometric RC exercises in combination with scapular muscle stretching and strengthening for 6 weeks. Treatment effects were assessed with patient-rated pain and shoulder function, isometric muscle strength, electromyographic activity during arm elevation and internal and external shoulder rotation, and pain during arm elevation before and at the end of the first session, and after 6 weeks of intervention. RESULTS: There were improvements in pain and shoulder function, increased isometric muscle strength for arm elevation and internal rotation, increased muscle activity of the infraspinatus and serratus anterior, and reduced pain during arm elevation after 6 weeks of intervention. DISCUSSION: This case report showed improvements on pain and function, increases on isometric strength of the shoulder and on electromyographic activity of the serratus anterior and infraspinatus muscles, as well as decreases on pain during arm elevation, after a 6-week intervention of RC isometric exercises associated with scapular muscle stretching and strengthening in patients with RC tendinopathy.

Multiprofessional perceptions and barriers to early mobilization in intensive care: a study at a university hospital / Percepções multiprofissionais e barreiras à mobilização precoce na terapia intensiva: um estudo em um hospital universitário

INTRODUCTION: Hospitalization often causes mobility difficulties and hinders daily activities. Progressive mobilization of patients in intensive care units (ICUs) is safe and linked to better clinical and functional outcomes. OBJECTIVE: To assess the perception of a multidisciplinary team in the ICUs of a university hospital regarding early mobilization (EM). METHODS: A prospective observational study was conducted using data collected from professionals and students in the ICU of Clementino Fraga Filho University Hospital at the Federal University of Rio de Janeiro between June and December 2019. Data on EM perception were collected using a questionnaire. Descriptive statistics and Fisher's exact tests were used to analyze the differences between the professional categories. RESULTS: In comparison to physiotherapists (88%), a smaller percentage of physicians (37.5%) and nurses (50%) reported that patients on mechanical ventilation (MV) are mobilized within 48 hours (P80%), with the main perceived barriers being the availability of professionals (58%), the clinical condition of patients (55%), and patients undergoing procedures (45%). CONCLUSION: In a university hospital without an established EM protocol, the multidisciplinary team showed satisfactory knowledge and perceptions of EM. However, creating institutional protocols and guidelines is essential to engage multidisciplinary teams in implementing EM and overcoming barriers.

INTRODUÇÃO: A hospitalização frequentemente causa dificuldades de mobilidade e compromete as atividades da vida diária. A mobilização progressiva de pacientes em unidades de terapia intensiva (UTI) é segura e está associada a melhores resultados clínicos e funcionais. OBJETIVO: Avaliar a percepção da equipe multiprofissional das UTIs de um hospital universitário quanto à mobilização precoce (MP). MÉTODOS: Foi realizado um estudo prospectivo e observacional com dados coletados de profissionais e estudantes da UTI do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro entre junho e dezembro de 2019. Os dados sobre a percepção da MP foram coletados por meio de questionário. A estatística descritiva e o teste exato de Fisher foram utilizados para analisar as diferenças entre categorias profissionais. RESULTADOS: Em comparação aos fisioterapeutas (88%), um percentual menor de médicos (37,5%) e enfermeiros (50%) relataram que os pacientes em ventilação mecânica (VM) são mobilizados em 48 horas (P80%), sendo as principais barreiras percebidas a indisponibilidade de profissionais (58%), a condição clínica (55%) e pacientes submetidos a procedimentos (45%). CONCLUSÃO: Em um hospital universitário sem protocolo de MP estabelecido, a equipe multidisciplinar apresenta percepção satisfatória sobre a MP. Contudo, a criação de protocolos e diretrizes institucionais é essencial para engajar a equipe na implementação da MP e na superação de barreiras.

Effects of lower limb muscle strengthening on interface pressure in older adults undergoing inelastic compression: Randomized controlled clinical trial.

OBJECTIVE: To analyze the effects of lower limb muscle strengthening on interface pressure (IP), static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) in older adults undergoing inelastic compression therapy. METHOD: Forty-three healthy older adults of both sexes (Age: 66.2 ± 4.4 years) met the eligibility criteria and completed all stages of the study (Resistance Training - RT: N = 20; Control - CONT: N = 23). Body composition, strength and functional mobility of lower limbs, IP, SSI, DSI, and WPA were evaluated before and after intervention. RESULTS: The two-way ANOVA with repeated measures demonstrated a significant time-group interaction effect on muscular strength for 1-RM [F (1, 41) = 21.091; p ≤ 0.001], IP in the orthostatic position [F (1, 41) = 5.124; p ≤ 0.05], minimum WPA [F (1, 41) = 10.999; p ≤ 0.05], maximum WPA [F (1, 41) = 8.315; p ≤ 0.05], DSI minimum (F (1, 41) = 4.608; p ≤ 0.05), DSI maximum (F (1, 41) = 8.926; p ≤ 0.05), and on the delta DSI (F (1, 41) = 7.891; p ≤ 0.05). CONCLUSIONS: In RT group, the increase in lower limb muscle strength was accompanied by an increase in IP in foot dorsiflexion and plantar flexion maneuvers, both in the standing position (DSI) and during gait (WPA).

Therapeutic Interventions to Improve Static Balance in Type 2 DiabetesMellitus: A Systematic Review and Meta-Analysis.

INTRODUCTION: Diabetes mellitus (DM) is a metabolic disorder characterized by an abnormal increase in blood glucose levels resulting from insulin secretion and/or dysfunctional activity that can lead to several serious complications in addition to decreased postural balance. OBJECTIVE: This study aimed to identify and analyze the main interventions used to improve static balance in patients with DM. METHODS: For the selection of articles, a bibliographic search was performed using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only clinical trials that investigated the effect of training on static balance in adults with type 2 DM were selected, and 34 studies were included. RESULTS: The search resulted in the identification of 2681 articles, and of these, 31 were eligible for the study. The identified interventions were proprioceptive, aerobic, resistance training on platforms, in virtual reality, and Tai Chi. The main results obtained were an increase in time in the one-leg stance, Romberg test, and tandem position, a significant increase in the Berg Balance Scale score and balance index, and a reduction in the variables of postural sway. CONCLUSION: There are a variety of effective training methods for improving static balance, and the choice of intervention to be applied goes beyond proven effectiveness, depending on reproducibility and/or financial cost.