Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5 años de edad. Revisión sistemática / Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5 years of age: Systematic review

La intervención motora temprana es esencial en niños con parálisis cerebral; sin embargo, se desconoce su efectividad entre los 3 y los 5años. El objetivo fue determinar la efectividad de la intervención motora temprana en el desarrollo motor de dicha población. Se realizó una revisión sistemática de literatura acerca de intervenciones motoras tempranas realizada en diferentes bases de datos como Pubmed/Medline, PEDro, OTSeeker, Embase y LILACS. Finalmente se seleccionaron 18 artículos, de los cuales 4 presentaron cambios a favor del grupo experimental en los desenlaces desarrollo motor global y función motora manual, con la terapia de integración sensorial y la terapia de movimiento inducido por restricción, respectivamente; no obstante, los resultados no fueron estadísticamente significativos y el nivel de evidencia fue bajo. La intervención motora temprana podría incluirse con precaución para la mejoría del desarrollo motor global y la función manual. Es necesario realizar estudios de mayor calidad metodológica. (AU)

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary. (AU)

Interdisciplinary collaborative eye examinations to protect preterm infant neurodevelopment: a quality improvement project.

Introduction: Infants born <31 weeks gestational age with birth weight ≤ 1,500 grams receive routine eye examinations to screen for Retinopathy of Prematurity (ROP) while in the Neonatal Intensive Care Unit (NICU) to help prevent vision threatening complications; however, preterm infants' sensory systems are underdeveloped, and repeated exposure to painful stimuli is associated with worse developmental outcomes. Methods: An interdisciplinary NICU team designed a collaborative eye exam model (CEEM) incorporating best practice recommendations for infant pain control during exams. Pain scores and vital signs were recorded before, during, and after exams. Two sets of mixed-effects regression models with a random intercept on infants were established to investigate relationships between the intervention, birth gestational age (BGA), postmenstrual age (PMA), and outcomes associated with painful stimuli. Survey feedback was elicited from NICU stakeholders about the CEEM. Results: Thirty standard of care (SC) and 35 CEEM exams of 37 infants were included in final analysis. In infants of the same BGA, the number of desaturation events was significantly reduced in the CEEM group (p = 0.003) and became 1.53 times smaller with each additional week of BGA (p = 0.009). Probability of heart rate recovery within 15 min lowered significantly in the CEEM group (p = 0.04). In SC or CEEM or between infants of the same PMA, no differences were observed for bradycardia, heart rate range, chance of heart rate recovery, or pain scores. Increases in tachycardia (p < 0.001) events and desaturations p = 0.006 were discovered in the CEEM group. When considering interaction effects, the CEEM appeared to reduce the number of desaturations to a greater degree for infants at earliest BGAs with attenuation of this effect with greater BGA. Regarding PMA, bradycardia and tachycardia events were reduced for infants across PMAs in the CEEM, but the effect for tachycardia improves with age, while the effect for bradycardia diminishes with age. Stakeholders agreed that the infant's eye exam experience and the staff experience was "very much" improved by the CEEM. Discussion: Despite variable findings in selected outcome measures, the CEEM was positively viewed by staff. Infants may benefit from the CEEM differently based on BGA and PMA.

An Integrated Approach to Chronic Low Back Pain: Evaluating the Impact of Consecutive Loop TheraBand Training Combined With Proprioceptive Neuromuscular Facilitation and Conventional Physiotherapy.

Chronic low back pain (CLBP) is a prevalent musculoskeletal condition characterized by persistent discomfort in the lumbosacral region lasting beyond 12 weeks. Individuals with CLBP often experience limitations in range of motion and compromised performance of affected body parts. Core muscle weakness/delayed activation and impaired lumbar proprioception are established contributors to CLBP. And influence balance dysfunction in CLBP patients. Exercise therapy is a cornerstone in the management of CLBP, aimed at enhancing muscular endurance, strength, and flexibility of the back muscles and soft tissues. However, the efficacy of exercise interventions depends on various factors including the type, intensity, frequency, and duration of exercises. This case report presents the rehabilitation of a corporate employee with a non-specific CLBP. The rehabilitation goals focused on improving balance, reducing disability, and alleviating pain. An integrated approach combining proprioceptive neuromuscular facilitation (PNF) with Consecutive Loop TheraBand (CLX) (The Hygenic Corporation, Akron, USA) along with traditional physical therapy techniques was implemented. PNF, a well-established technique, was chosen for its effectiveness in reducing disability and LBP while enhancing balance. The integration of PNF alongside conventional physiotherapy resulted in notable improvements, including increased lumbar flexion range following the rehabilitation period. This case underscores the importance of early initiation of comprehensive rehabilitation in CLBP patients to preserve strength, alleviate pain, reduce functional disability, and enhance balance. By addressing both the muscular and proprioceptive aspects of CLBP, this integrated approach aims to optimize outcomes in CLBP management.

Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes.

OBJECTIVE: To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated with improved clinical outcomes. METHODS: We retrospectively analysed all previously ambulatory adults admitted with hip fracture to our tertiary hospital, comparing 'usual' ('control') care (09/19-03/20) to EWP (09/20-03/21). Outcomes included Day-7 mobility ≥20 m (primary), additional mobility measures, specified postoperative complications, new residential facility placement, acute length-of-stay (LOS) and 30-day death. RESULTS: Amongst 235 eligible patients (128 control, 107 EWP), 66% were female, mean age was 80.4 years (SD 10.5), 20% from residential care and 49% (114/235) were mobilising without aid at baseline (no between-group differences; all p ≥ .20). Median acute LOS was 10 days (IQR 6-15), total hospital LOS was 21 days (IQR 12-37) and 3% (n = 6) died by Day 30. Median Day-7 distance mobilised was 25 m (IQR 7-50) with EWP versus 10 m (3-40) (p = .06). No EWP patients developed pressure injury (0 vs. 6, p = .02); other outcomes were similar between groups. Adjusting for age, residence, baseline cognitive impairment, American Society of Anesthesiologist score and preadmission mobilisation without aids, EWP was independently associated with increased likelihood of mobilising ≥20 m at Day 7 (aOR 1.83, 95% CI 1.04-3.23, p = .03). CONCLUSIONS: Enhanced daily weekend physiotherapy was associated with improvement in early mobility, but not other outcomes assessed. These data would be strengthened by randomised controlled trial data exploring more intense physiotherapy, cost-benefit analysis and patient experience measures.

Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

[Multidisciplinary Complex Treatment of Parkinson's disease : Cornerstone of an individualized treatment]. / Multidisziplinäre Komplextherapie der Parkinson-Krankheit : Eckpfeiler einer individualisierten Behandlung.

BACKGROUND: The inpatient Parkinson's disease multimodal complex treatment (PD-MCT) was applied more than 15,000 times in 2022, in Germany. This number is increasing as is Parkinson's disease (PD), which affects more than 400,000 people in Germany and leads to 100,000 disability-adjusted life years. In recent years, several observational studies have been conducted on the effectiveness of this kind of multidisciplinary care. OBJECTIVE: To summarize and discuss the evidence on the nature, benefits and potential of PD-MCT. METHODS: A narrative review of selected empirical findings was carried out. RESULTS: The PD-MCT frequently lasts for 2-3 weeks and aims to maintain the quality of life of people with PD. Disease symptoms and activities of daily living are jointly improved by pharmacological strategies and activating therapies (physiotherapy, occupational therapy, speech and language therapy, physical training, art therapy). The PD-MCT is a useful measure to avoid or mitigate crisis situations in the course of the disease. A total of eight observational studies (n = 1246) have shown good effectiveness with a total mean improvement of the International Parkinson and Movement Disorder Society unified Parkinson's disease rating scale III (MDS-UPDRS III) by 7.8 points. The transfer of effects into everyday life through intensive and specialized community-based care must be ensured in order to achieve sustained effects on the quality of life. Ideally, this transfer can be supported by integrated PD networks and digital technologies in the future. CONCLUSION: There is potential for development in the standardization, patient selection and quality assurance of PD-MCT as well as in the embedding in care structures such as PD networks. Open research questions include a precise definition of the target group and higher quality evidence of short-term and long-term effectiveness.

Unveiling Timetable for Physical Therapy after Single-Level Lumbar Surgery for Degenerative Disc Disease: Insights from a Systematic Review and Meta-Analysis.

Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether to initiate physical therapy immediately or to wait weeks is of particular interest. The aim of this study is to review the available literature regarding the optimal timing of physical therapy initiation and the outcomes obtained. Methods: This review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This search was carried out in February 2024. Only peer-reviewed articles were considered for inclusion. Results: Fourteen studies were included. The primary outcomes assessed in the included studies were the following: 12-week and 12-month low back pain, return to work, function and disability, psychological status, patient satisfaction, and complications associated with early physical therapy. A meta-analysis was performed concerning low back pain after lumbar discectomy at 12 weeks and 12 months and complications after early physical therapy after lumbar discectomy and lumbar interbody fusion. A significant difference was found between early and standard physical therapy in terms of low back pain at 12-18 months (p = 0.0062); no significant differences were found in terms of complications, both for discectomy and arthrodesis. Conclusions: This review indicates that employing early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications.

Physical Modalities for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023.

Introduction: Localized provoked vulvodynia (LPV) is a prevalent sexual health condition with significant negative impacts on quality of life. There is a lack of consensus regarding effective management. Methods: We used Arksey and O'Malley's five-step method to identify, collate, and evaluate literature published between 2010 and 2023. The scoping review investigated the efficacy or effectiveness of interventions in the management of LPV. The aim of this paper is to map the literature on the efficacy or effectiveness of physical interventions. Results: The review produced 19 primary studies of physical interventions for LPV. These include acupuncture, laser therapy, physiotherapy, transcutaneous electrical nerve stimulation, low-intensity shockwave therapy, transcranial direct current stimulation, and vestibulectomy. Conclusion: Published studies that investigated a range of physical treatments for LPV showed some positive effects, except for transcranial direct-current stimulation. The remaining modalities demonstrated improved sexual pain and treatment satisfaction, when measured. Findings were mixed for non-sexual pain. There was insufficient evidence to draw conclusions regarding other outcomes. Researchers are encouraged to conduct larger, high-quality studies that sample more diverse patient populations and use patient-oriented outcomes to assess effectiveness of physical modalities.

Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials.

In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.

Neurooncological Rehabilitation in Diffuse Gliomas.

BACKGROUND: With the further advancement of surgical technology and modern tumor-targeted treatment strategies, longer survival rates can be achieved in diffuse gliomas. Pre- and post-therapeutic physical and cognitive deficits are frequently associated with gliomas. The clinical impact of physical therapy and rehabilitation on neurooncological disorders has not been analyzed consecutively. This study investigates the clinical effect of rehabilitation in patients with diffuse gliomas. METHODS: Patients with surgically and radio-/oncologically treated diffuse gliomas were recruited into this study. They were admitted to an inpatient program for three weeks. The patients underwent physical and occupational therapy, exercise programs, and psychooncological support. The outcome measures included motor strength, mobility, neuropsychological deficits, and tumor localization-dependent symptoms for the statistical determination and comparison of the respective Eastern Cooperative Oncology Group (ECOG) scores on admission and discharge by a two-tailed t-test. RESULTS: A total of 25 patients (f/m: 11/14) with diffuse gliomas were recruited into the program. Four patients (16%) had CNS WHO grade 2, seven patients (28%) had grade 3, and 14 patients (56%) had grade 4 tumors. Major improvement in motor, cognitive, and functions of the daily activities was achieved in the examined population. Major improvement in motor, cognitive, and neurological functions of the daily activities screened in the admission of all patients was achieved. The comparison of the ECOG scores determined on admission and on discharge showed a statistical significance derived from the undertaken t-test with a p-value <0.05. CONCLUSION: We herein show that a clearly defined inpatient rehabilitation protocol significantly enables the improvement of the quality of life of patients with diffuse gliomas. The effectiveness of the exercise program and psychooncological assistance was confirmed by the course of patient-reported functions. Based on the limited number of our patient collective, multicenter studies with broader patient sizes should be performed to confirm our significant results.

Exercise Responses During Outdoor Versus Virtual Reality Indoor Arm+FES-Leg Cycling in Individuals with Spinal Cord Injury.

Background: Virtual reality (VR)-enhanced indoor hybrid cycling in people with spinal cord injury (SCI) can be comparable to outdoor hybrid cycling. Method: Eight individuals with chronic thoracic-lesion SCI performed voluntary arm and electrically assisted leg cycling on a hybrid recumbent tricycle. Exercises were conducted outdoors and indoors incorporating VR technology in which the outdoor environment was simulated on a large flat screen monitor. Electrical stimulation was applied bilaterally to the leg muscle groups. Oxygen uptake (VO2), heart rate, energy expenditures, and Ratings of Perceived Exertion were measured over a 30-minute outdoor test course that was also VR-simulated indoors. Immediately after each exercise, participants completed questionnaires to document their perceptual-psychological responses. Results: Mean 30-minute VO2 was higher for indoor VR exercise (average VO2-indoor VR-exercise: 1316 ± mL/min vs. outdoor cycling: 1255 ± 53 mL/min; highest VO2-indoor VR-exercise: 1615 ± 67 mL/min vs. outdoor cycling: 1725 ± 67 mL/min). Arm and leg activity counts were significantly higher during indoor VR-assisted hybrid functional electrical stimulation (FES) cycling than outdoors; 42% greater for the arms and 23% higher for the legs (P < 0.05). Similar responses were reported for exercise effort and perceptual-psychological outcomes during both modes. Conclusion: This study proposes that combining FES and VR technology provides new opportunities for physical activity promotion or exercise rehabilitation in the SCI population, since these modes have similar "dose-potency" and self-perceived effort. Human Research Ethics Committee of the University of Sydney Ref. No. 01-2010/12385.

An opportunity for management of fatigue, physical condition, and quality of life through asynchronous telerehabilitation in post-acute COVID-19 patients: a randomized controlled pilot study.

OBJECTIVE: to compare the preliminary efficacy of asynchronous telerehabilitation in post-acute COVID-19 on fatigue, physical condition, quality of life, and feasibility of this pilot study, versus a booklet format. DESIGN: Randomized pilot study with two intervention arms: asynchronous telerehabilitation group (ATG), and booklet-based rehabilitation group (BRG), with two follow-ups at 3-and 6-months. SETTING AND PARTICIPANTS: Patients discharged after COVID-19 were recruited and evaluated at Hospital. INTERVENTION: The intervention consisted of a 12-week multimodal rehabilitation program, via telerehabilitation or by a booklet. MAIN OUTCOME MEASURES: Fatigue as main outcome, and functional status, quality of life, and feasibility as secondary outcomes were evaluated. RESULTS: After the intervention, there was no significant difference between groups in fatigue but there were significant differences in favor of the ATG 6MWT (p=0.008), the 30" STST (p=0.019), and physical quality of life (p=0.035). These improvements were maintained throughout the 6-month follow-up. Telerehabilitation was shown to be a viable option, without incidents and with a higher adhesion (p=0.028) than the booklet format. CONCLUSION: A multimodal rehabilitation program by means of asynchronous telerehabilitation appears as a more effective option than traditional formats in improving post-acute COVID-19 sequelae.

Characterizing clinical patterns of physical therapy activities for post-stroke spasticity in stroke rehabilitation: looking into the "Black Box".

Physical therapy is considered to be an adjunctive therapy for the management of post-stroke spasticity. The insight of this study is to observe the current clinical practices of rehabilitation for post-stroke spasticity. For this purpose, an observational cross-sectional study was conducted. Data was collected by a standardized therapy documentation form for spasticity management. Fifty physiotherapists filled out that form. Almost all of them used subjective measures (modified Ashworth scale) for spasticity assessment and functional independence measure for level of independence. Readings were taken in the first, second, and third blocks of six-hour duration. Results showed that 42 (83.5%) physiotherapists measured spasticity at the initial session, while 47(94.6%) reported various multiple rehabilitation treatment preferences for spasticity management. Disparities exist in therapeutic management for post-stroke spasticity throughout rehabilitation which are mainly based on physiotherapists' clinical expertise. However, a better understanding of current trends in physical therapy clinical practices will assist in tailoring strategies to upgrade management for post-stroke spasticity.

Assessing the factors that influence the utilization and delivery of rehabilitation services among persons with Parkinson's disease: A scoping review.

RATIONALE: Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation. AIMS AND OBJECTIVES: This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD. METHODS: A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa-wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate. RESULTS: Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization. CONCLUSION: Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD.

Cracking the Code of Digital Discomfort Through the Dynamic Fusion of Matrix Rhythm Therapy and Physiotherapy Exercises for Text Neck Syndrome.

Text neck syndrome refers to the excessive use of electronic devices such as laptops, mobile phones, and so on, which causes prolonged and continued forward bending of the neck, leading to a strain in the muscle, causing muscle imbalance, and leading to poor posture. In this article, we focus on a case of a 22-year-old female who has a daily average screen time of around four to five hours, which leads to stress on cervical muscles that further develop into tightness and cause poor posture. She is managed with physiotherapy treatment that focuses on reducing pain and increasing the strength of the individual. The physiotherapy treatment focuses on the prevention of further damage to the cervical muscles and educating the individual to perform minimum forward bending by providing ergonomic advice, reducing pain, and improving range of motion.

A Structured Literature Review on the Research and Design of Rehabilitation Environments.

AIM: This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. BACKGROUND: Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. METHOD: We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. RESULT AND CONCLUSION: Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.

The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review.

BACKGROUND: Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution. OBJECTIVE: This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes. RESULTS: Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise. CONCLUSIONS: Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.

Provider Opinions on Effectiveness of Physical Therapy as Treatment for Glenohumeral Arthritis.

INTRODUCTION: Physical therapy (PT) is a described first-line treatment option for glenohumeral arthritis, but its efficacy for treating this spectrum of disease is not well understood. The purpose of this study is to evaluate the opinions of expert providers-orthopedic surgeons and physical therapists-regarding the utility of PT in treating glenohumeral arthritis in different stages of radiographic severity. Our goal is to identify areas of interprofessional majority agreement as well as areas without agreement that warrant further investigation. METHODS: A 35-question survey was created and distributed via email to members of the American Shoulder and Elbow Surgeons and the American Society of Shoulder and Elbow Therapists, collecting information on demographics, professional experience, and the perceived benefit of PT for patients with different stages of glenohumeral arthritis based on radiographic severity. Survey responses were analyzed for inter-professional differences in distribution of answer choices as well as for majority agreement statements. Items with > 50% agreement from a professional group were considered statements of majority agreement. RESULTS: 190 surgeons and 39 physical therapists completed the survey. Surgeons and therapists demonstrated different distribution of answer choices in 25 of the 29 non-demographic related questions (86%). Surgeons and therapists reached the same majority statement in eight items (28%) and reached disagreeing majority statements in four items (14%). They agreed on the benefits of PT for mild arthritis, the benefits of corticosteroid injections, the frequency of strengthening exercises, and that PT failure should not be required for surgical approval in patients with severe arthritis. They disagreed on the whether PT exacerbates symptoms in patients with moderate arthritis, and whether preoperative PT influences postoperative outcomes. CONCLUSION: Both surgeons and therapists agreed that PT may be less beneficial for patients with more advanced radiographic arthritis and that PT failure should not be required for insurance approval for surgical intervention in patients with severe glenohumeral arthritis. Further research is needed to determine the efficacy of PT for patients with moderate arthritis as well as the utility of preoperative PT for improving postoperative outcomes.

Musculoskeletal disorders of the upper and lower limb: Prevalence among patients in Eastern province, Saudi Arabia.

OBJECTIVES: To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy. METHODS: Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb). RESULTS: A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, p<0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, p<0.001). CONCLUSION: This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.