Clinical outcomes of conservative versus surgical treatment for patients with proximal humeral fracture before physiotherapy.

Fear of movement, pain, and loss of shoulder function are the most common problems irrespective of their approach to management after proximal humeral fracture (PHF). However, it has been unclear whether there could be differences between both treatments in early clinical outcomes. It can help physiotherapists to guide in choosing treatment approaches. This study aimed to compare kinesiophobia, pain, range of motion (ROM), shoulder function, and Quality of life (QoL) in patients treated with either conservative (CT) versus surgical (ST) after PHF. In addition, it aimed to determine correlations between fear of movement and seconder outcome measures. This cross-sectional study enrolled the patients having 5-6 weeks (being permitted active movement) after being treated either CT or ST and receiving no physical therapy. Pain, passive and active ROMs, shoulder function, fear of movement, and QoL were evaluated. 42 patients were recruited. Kinesiophobia scores were similar (p=0.55) and moderate in both groups. There was a significant difference in degrees of shoulder active flexion, active and passive abduction in favor of the CT group (p=0.05, p=0.02, p=0.04, respectively). However, there was no difference between groups regarding the remaining clinical outcomes. Furthermore, kinesiophobia showed a moderate negative correlation with energy/fatigue, social functioning, and general health. These findings showed that patients treated surgically did not have more kinesiophobia, less function, and QoL before starting physiotherapy, despite having soft tissue damage and different types of fractures. However, surgically treated patients had significantly less range of motion.

Effectiveness of Pilates-based exercises on upper extremity disorders related with breast cancer treatment.

Breast cancer treatment causes upper extremity (UE) impairments. This study aims to assess the efficacy of Pilates-based exercises (PE) in comparison with combined exercise (CE) and home exercise (HE) groups, in the rehabilitation of UE disorders related with breast cancer treatment. Fifty-five patients were randomly allocated to PE, CE (consisting of strengthening, stretching and range of motion [ROM] exercises) and HE groups (consisting of CE group exercises). Pain (using visual analogue scale), ROM (using digital goniometer), muscle strength (using dynamometer and pinch gauge), functional status (using Constant-Murley scale and Disabilities of the Arm, Shoulder and Hand scale) were evaluated before and after intervention. For data analyses (using spss 21 version), one-way ANOVA, paired samples t-test and Kruskal-Wallis test were performed (p ≤ .05 was considered statistically significant). The data obtained in this study revealed significant improvements in almost all the parameters measured in the PE and CE groups, and some improvements were superior to HE group. PE seemed to have resulted similar improvements in pain, muscle strength and functional status when compared to CE group. Therefore, PE seems to be an effective method of rehabilitation of patients with UE disorders related with breast cancer treatment, and might be considered for use as an alternative to CE in this population.