Exploring Pelvic Symptom Dynamics in Relation to the Menstrual Cycle: Implications for Clinical Assessment and Management.

BACKGROUND: Pelvic floor dysfunctions (PFDs) encompass an array of conditions with discrepant classification systems, hampering accurate prevalence estimation. Despite potentially affecting up to 25% of women during their lifetime, many remain undiagnosed, underestimating the true extent. OBJECTIVES: This cross-sectional study aimed to examine the impacts of the menstrual cycle on PFDs and dysfunctions. Secondary objectives included investigating differences between athletic and nonathletic women. METHODS: An online questionnaire examined the effects of the menstrual cycle (MC) on 477 women's pelvic symptoms (aged 16-63 years), stratified by athletic status. This ad hoc instrument built upon a validated screening tool for female athletes. RESULTS: Most participants reported symptom fluctuations across menstrual phases, with many modifying or reducing exercise participation. A concerning number experienced daily undiagnosed pelvic floor symptoms, emphasizing needs for comprehensive medical evaluation. CONCLUSIONS: Exacerbated pelvic symptoms showed complex relationships with menstruation, highlighting the importance of considering the MC in customized clinical management approaches. Symptoms demonstrated differential links to menstruation, indicating needs for individualized evaluation and tailored treatment plans based on symptom profiles and hormonal interactions. Educating professionals and patients remains essential to enhancing awareness, detection, and therapeutic outcomes. Further controlled longitudinal research should elucidate intricate relationships between menstrual cycles and pelvic symptom variability.

Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain-A Case Series.

(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p < 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.

Assessing the Quality of YouTube's Incontinence Information after Cancer Surgery: An Innovative Graphical Analysis.

BACKGROUND: Prostate and colorectum cancers rank among the most common cancers, and incontinence is a significant postsurgical issue affecting the physical and psychological well-being of cancer survivors. Social media, particularly YouTube, has emerged as a vital source of health information. While YouTube offers valuable content, users must exercise caution due to potential misinformation. OBJECTIVE: This study aims to assess the quality of publicly available YouTube videos related to incontinence after pelvic cancer surgery. METHODS: A search on YouTube related to "Incontinence after cancer surgery" was performed, and 108 videos were analyzed. Multiple quality assessment tools (DISCERN, GQS, JAMA, PEMAT, and MQ-VET) and statistical analyses (descriptive statistics and intercorrelation tests) were used to evaluate the characteristics and popularity, educational value, quality, and reliability of these videos, relying on novel graphical representation techniques such as Sankey and Chord diagrams. RESULTS: Strong positive correlations were found among quality rating scales, emphasizing agreement. The performed graphical analysis reinforced the reliability and validity of quality assessments. CONCLUSIONS: This study found strong correlations among five quality scales, suggesting their effectiveness in assessing health information quality. The evaluation of YouTube videos consistently revealed "high" quality content. Considering the source is mandatory when assessing quality, healthcare and academic institutions are reliable sources. Caution is advised with ad-containing videos. Future research should focus on policy improvements and tools to aid patients in finding high-quality health content.

Associations between Preoperative Patient Socioeconomic Status and Pain-Related Outcomes with Pain and Function in Patients Undergoing Rotator Cuff Repairs.

BACKGROUND: Patients undergoing rotator cuff repairs commonly experience postoperative pain and functional limitations. Various socioeconomic and pain-related factors have been recognized as influential in the prognosis of such patients. This study aims to investigate the associations between postoperative pain and functionality and preoperative pain-related outcomes and socioeconomic status in patients undergoing rotator cuff repairs. METHODS: This cross-sectional study examines the relationship between the outcomes of rotator cuff repairs and participants' socioeconomic status and pain-related measures. Socioeconomic status was assessed through indicators such as educational level, monthly household income, and occupation. Pain-related outcomes included measures of kinesiophobia and pain self-efficacy. RESULTS: A total of 105 patients (68 male, 37 female) were included in the analysis. The findings revealed no significant association between postoperative pain or functionality and the patients' socioeconomic status (p > 0.05). However, postoperative pain levels demonstrated a significant association with preoperative kinesiophobia (p < 0.05) and pain self-efficacy (p < 0.013). In contrast, functionality did not exhibit a significant association with these measures (p < 0.072 and 0.217, respectively). CONCLUSIONS: Preoperative pain-related outcomes play a role in postoperative pain levels among patients undergoing rotator cuff repairs. However, they do not appear to be related to functionality. Additionally, socioeconomic status does not significantly impact either pain or functionality.

Effectiveness of Conservative Treatments in Positional Plagiocephaly in Infants: A Systematic Review.

OBJECTIVE: The objective of this study is to analyze conservative treatments implemented to manage positional plagiocephaly in infants. METHODS: This is a systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, performed in the Medline (PubMed), Scopus, Web of Science, and Cochrane databases. Articles were selected according to the eligibility criteria, regarding the effectiveness of conservative treatments in positional plagiocephaly in infants, published in the last 10 years with a score ≥3 in the PEDro Scale. RESULTS: A total of 318 articles were identified and 9 of them were finally selected. CONCLUSIONS: Physical therapy treatment is considered as the first line of intervention in plagiocephaly with non-synostotic asymmetries and manual therapy is the method that obtains the best results within this intervention. In cases of moderate or severe plagiocephaly, helmet therapy can be an effective second-line intervention; however, the best way to prevent this condition is through counseling of parents or caregivers, and early treatment is essential for optimal therapeutic outcomes. The review was registered in PROSPERO (CDR42022306466).

Psychometric properties of the translated Spanish version of the Pain Self-Efficacy Questionnaire.

Introduction: Some patients with rotator cuff injuries do not report significant changes in pain-related outcomes. Pain self-efficacy, which is commonly assessed using the Pain Self-Efficacy Questionnaire, may contribute toward this outcome. However, a Spanish adaptation of this questionnaire is currently lacking. Therefore, this study's purpose was developing the Spanish version of this questionnaire, and assess its psychometric properties. Methods: The Spanish version of the Pain Self-Efficacy Questionnaire was translated and culturally adapted, and a sample of 107 patients with rotator cuff injuries completed the questionnaire to examine its convergent validity (analyzing its correlation with the Tampa Scale of Kinesiophobia), its test-retest reliability, for which a subset of 40 participants completed again the questionnaire, and its internal consistency. Results: Translation was conducted without any problems, and 107 participants completed the study. Mean scores for the Pain Self-Efficacy Questionnaire were 45.2 points (standard deviation, 11.4). The Pain Self-Efficacy Questionnaire showed a moderate negative correlation with the Tampa Scale of Kinesiophobia (Pearson's correlation index r = -0.48) supporting its convergent validity. High test-retest reliability (Intraclass Correlation Coefficient of 0.90) and excellent internal consistency (Cronbach's α value of 0.92) were also found. Discussion: The Spanish version of the Pain Self-Efficacy Questionnaire presents high validity, test-retest reliability, and internal consistency to assess pain self-efficacy in patients suffering rotator cuff injuries in Spanish-speaking settings.

Effects of resistance training on patients with End-Stage Renal Disease: an umbrella review with meta-analysis of the pooled findings.

OBJECTIVES: This umbrella review aimed to review the effects of resistance training on patients with end-stage renal disease and assess the methodological quality of the available literature. METHODS: An umbrella review and meta-meta-analysis was performed. A systematic search was conducted until May 2022. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The meta-meta-analyses were performed with a random-effects model and the summary statistics were presented in the form of a forest plot with a weighted compilation of all standardized mean differences and corresponding 95% confidence interval. Twenty-four reviews were eventually included. The protocol was registered in the international registry PROSPERO (CRD42022321702). RESULTS: Resistance training showed positive effects on functional capacity (g = 0.614), aerobic capacity (g = 0.587), health-related quality of life (g = 0.429), and peak force (g = 0.621). Fifteen of the included studies (63%) presented low risk of bias, and the remaining studies (37%) showed unclear risk of bias. CONCLUSION: Resistance training in patients undergoing hemodialysis is an intervention that shows positive results regarding physical and functional outcomes. The quality level of the literature is inconclusive, but the included studies present low risk of bias.

Psychometric Properties of the Translated Spanish Version of the Vaginal Penetration Cognition Questionnaire: A Preliminary Work for Validation.

(1) Background: To develop an instrument in Spanish to assess beliefs and feelings about vaginal penetration and assess its psychometric properties. (2) Methods: This study translated and adapted the Vaginal Penetration Cognition Questionnaire into Spanish, and a total of 225 women who suffered from Genito-Pelvic Pain/Penetration Disorder were included in the study. The psychometric properties, including construct, convergent and discriminant validity, test-retest reliability, and internal consistency of the translated version were assessed. (3) Results: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess beliefs and thoughts about vaginal penetration in women suffering from Genito-Pelvic Pain/Penetration Disorder. The exploratory factor analysis yielded four domains that explained 62.5% of the variance. Convergent and discriminant validity was also confirmed. Test-retest reliability was high, with an intraclass correlation coefficient value of 0.90, a standard error of measurement of 4.21, and a minimal detectable change of 11.66 points. Every domain also showed good internal consistency levels, with Cronbach's α values ranging from 0.84 to 0.89. (4) Conclusion: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess vaginal penetration cognition in women suffering from Genito-Pelvic Pain/Penetration Disorder.

A dataset of the measurement of lower limb muscle strength with handheld dynamometry in patients undergoing hemodialysis.

The dataset presented in this article belongs to a test-retest reliability study of the assessment of lower limb muscle strength through handheld dynamometry in patients with End-Stage Renal Disease undergoing hemodialysis. The intervention was carried out at the Hospital de Manises, in Manises (Spain). The strength of different muscle groups in the lower limbs of participants undergoing hemodialysis was assessed at different points. The same researcher was in charge of doing all of the assessments, and a standardized protocol was followed to conduct the assessment. Data was collected during the dialysis sessions at different points of time. This dataset contains raw data obtained from those assessments. The analysis consisted in assessing the test-retest reliability, through the Intraclass Correlation Coefficient (ICC), of the measurement of strength in the lower limbs through handheld dynamometry. Further analysis for this raw data could be to compare results obtained in this sample with results obtained in the assessment of similar samples, or to supply relevant scientific evidence to include the measurement of lower limb strength in patients undergoing hemodialysis in experimental studies conducted in this population, such as interventions that include resistance training for the lower limbs as the intervention.

Socioeconomic status and treatment outcomes in women with genito-pelvic pain penetration disorder: A longitudinal study of a therapeutic educational program dataset.

Sexual health is crucial for overall well-being, and dyspareunia (genito-pelvic pain/penetration disorder) is a common sexual disorder that can be addressed through multimodal physiotherapy approaches, including education. However, it's unclear whether socioeconomic factors influence the effectiveness of educational therapies for dyspareunia. The dataset presented in this article was used in a pilot randomized controlled trial that aimed to investigate any potential correlation between socioeconomic status and the outcomes of a therapeutic educational program for dyspareunia, evaluating the impact of a therapeutic educational program on 69 women. The data measured pain intensity, pain-related outcomes, and sexual functioning over time. In February 2022, socioeconomic status measurements (age, educational level, household monthly income, and job rank) were collected. The analysis used Pearson's correlation index and Spearman's rho statistic to assess any correlations between these variables. The results of the correlation analysis indicated that there was no significant correlation between any of the outcomes of the intervention and the socioeconomic status measurements. The data analysis findings suggest that a therapeutic educational program can effectively improve pain intensity, pain-related outcomes, and sexual functioning in patients with persistent pelvic pain, regardless of their socioeconomic status. These findings have policy implications, as they suggest that education is a powerful tool that can improve sexuality outcomes for patients with dyspareunia, regardless of their socioeconomic background. The dataset contains the collected raw data, including partial participant demographics data and scores categorized by question group, as well as scores for each participant at each time point (before and after the intervention). This dataset can be used to further analyze the results and the study can be potentially replicated.

Dynamic balance and explosive strength appears to better explain single leg hop test results among young elite female basketball athletes.

To analyze the impact of balance, lower-limb explosive strength and anthropometric variables on the result of the hop test in young elite female basketball athletes. Ninety young elite female basketball athletes (13-17 years), without current or recent lower-limb injury, were assessed in the off-season period of July 2021. Single leg hop test, countermovement jump, Y balance test and anthropometric outcomes were assessed. A correlation study and a regression model were performed to investigate the influence of such outcomes and the value of their participation on the hop test results. It was found a low-to-moderate correlation effect size for both countermovement jump (distance and power flight) and Y balance test values (except interlimb outcomes) with the single leg hop test results. Anthropometric outcomes did not show significant correlation (p > 0.05). Regression model revealed that for right hop test, countermovement jump values exhibited an adjusted determination coefficient of 0.408, (ß = 0.249, p = 0.013), For left hop test, again the countermovement jump values (ß = 0.229, p = 0.025), and left Y balance test values (ß = 0.331, p = 0.011) jointly obtained an adjusted determination coefficient of 0.263 significant predictive value for countermovement jump outcomes in both right (ß = 0.249, p = 0.013; ß = 0.301; p = 0.031) and left leg (ß = 0.229, p = 0.025; ß = 0.365, p = 0.040), as well as certain Y balance outcomes values. Explosive strength, and dynamic balance although to a lesser extent, appear to be the most relevant physical-functional factors influencing the single leg hop test results among young elite female basketball athletes. These findings may a serve as a basis to implement targeted interventions, such as plyometric and balance training, for an enhancement on functional rehabilitation and reducing the risk of injury related to the hop test results.

A dataset of the effects of therapeutic exercise programs on physical function in patients undergoing hemodialysis.

The dataset presented in this article belongs to a randomized controlled trial, conducted between November 2015 and May 2016, where therapeutic exercise interventions were implemented in patients with End-Stage Renal Diseases undergoing hemodialysis. The intervention was carried out at the Hospital de Manises, in Manises (Spain). Participants performed a 16-week exercise program either during dialysis (intradialytic) or at home, combining resistance and aerobic training. Tests were assessed prior to the dialysis session, and include several dimensions of the patient's functional status, such as functional capacity, physical performance, balance, lower limb strength and endurance, and handgrip strength. Data was collected prior to and after the implementation of an intervention. The dataset contains the raw data obtained in this data collection. The analysis consisted in the improvement of these outcomes when a therapeutic exercise intervention is implemented. Further analysis could potentially include the stratification of the sample in several subgroups according to demographic characteristics of the participants, according to levels of compliance to the intervention and according to even more specific changes within the tests performed. For instance, the improvement of the overall assessment of the Short Performance Physical Battery Test might differ from the improvement of any of the components that build this "battery" of tests, such as gait speed, balance, or the Sit-to stand-to sit 5 tests.

Movement Representation Strategies as a Tool for Educational Innovation in Physiotherapy Students: A Randomized Single-Blind Controlled-Pilot Trial.

Physiotherapy has a strictly theoretical body of knowledge, but for the most part, the physiotherapist's learning is practical. The practical part is fundamental to acquire clinical skills that the physiotherapist will later use in professional practice. The main aim of this study was to assess the effectiveness of movement representation strategies (MRS) in the improvement of manual skills of physiotherapy students as an educational innovation strategy. We randomly assigned 30 participants to an action observation practice (AOP), motor imagery practice (MIP), or sham observation (SO) group. A high velocity, low amplitude lumbar manipulation technique that is widely used in clinical physiotherapy practice was taught in one session. The primary outcomes were required time and test score. The secondary outcomes were perceived mental fatigue and perceived difficulty for learning. The outcomes were assessed preintervention and immediately after the intervention (postintervention). The main results showed that both AOP and MIP improved the total time required and the test score, as well as entailed less perceived difficulty for learning. However, both strategies showed a higher level of mental fatigue after the intervention, which was higher in the MIP group. Based on the results obtained, it seems that the application of MRS promotes greater learning of manual motor tasks in physiotherapy students and could be used as educational innovation strategies.

Assessing the outcomes of manual physical therapy and conventional treatment for chronic pediatric constipation: A dataset analysis of quality of life.

The dataset presented in this article was used in a pilot randomized and controlled trial that evaluated the effectiveness of manual physical therapy (MPT) compared to conventional pharmacologic treatment (CPT) for treating chronic pediatric functional constipation (CPC). The pilot trial was carried out at the Central University Hospital of Asturias in Oviedo, Spain, with 47 children between 2 and 12 years old being evaluated by a Pediatric Gastroenterologist. Participants received 9 sessions of MPT which were spaced out weekly for the first two months and bi-weekly for the third month. The Pediatric Quality of Life questionnaire (PedsQLTM) scores were assessed at the start of the trial (Time 1), its end (Time 2), and 5 years later (Time 3). The dataset contains the collected raw data, including participant demographics data and PedsQLTM scores categorized by question group, as well as total scores for each participant at each time point. This dataset can be used to further analyze the results and the study can be potentially replicated.

Differences between Sexes and Speed Levels in Pelvic 3D Kinematic Patterns during Running Using an Inertial Measurement Unit (IMU).

This study aimed to assess the 3D kinematic pattern of the pelvis during running and establish differences between sexes using the IMU sensor for spatiotemporal outcomes, vertical acceleration symmetry index, and ranges of motion of the pelvis in the sagittal, coronal, and transverse planes of movement. The kinematic range in males was 5.92°-6.50°, according to tilt. The range of obliquity was between 7.84° and 9.27° and between 9.69° and 13.60°, according to pelvic rotation. In females, the results were 6.26°-7.36°, 7.81°-9.64°, and 13.2°-16.13°, respectively. Stride length increased proportionally to speed in males and females. The reliability of the inertial sensor according to tilt and gait symmetry showed good results, and the reliability levels were excellent for cadence parameters, stride length, stride time, obliquity, and pelvic rotation. The amplitude of pelvic tilt did not change at different speed levels between sexes. The range of pelvic obliquity increased in females at a medium speed level, and the pelvic rotation range increased during running, according to speed and sex. The inertial sensor has been proven to be a reliable tool for kinematic analysis during running.

Test-Retest Reliability, Validity, and Minimal Detectable Change of the Measurement of Lower Limb Muscular Strength with Handheld Dynamometry in Patients Undergoing Hemodialysis.

Background: Chronic kidney disease is an exponentially growing medical and economic worldwide problem. There are specific elements used to assess patient's functional capacity loss and overall deterioration in order to determine the patient's clinical status, and muscle impairment is one of the most common. It is therefore necessary to develop reliable and applicable methods to determine muscle impairment in patients with chronic kidney disease. Methods: This is a prospective, nonexperimental, descriptive methodological investigation performed in patients undergoing hemodialysis. This study analyzes the reliability and validity of muscle strength assessments performed with handheld dynamometry in patients with chronic kidney disease undergoing hemodialysis. Results: Results show overall high reliability and validity in the assessment of muscle strength of the lower limbs. Conclusion: To our knowledge, this is the first study to assess handheld dynamometry in patients undergoing hemodialysis, presenting promising results with a relatively affordable and easily applicable method.

Effect of an aerobic and strength exercise combined program on oxidative stress and inflammatory biomarkers in patients undergoing hemodialysis: a single blind randomized controlled trial.

BACKGROUND: Chronic kidney disease patients on hemodialysis treatment are characterized by increased levels of inflammatory markers and oxidative stress, in addition to a significant deterioration in physical function. The benefits of physical exercise on the functional capacity of this patients are well known; however, it can also improve the endogenous antioxidant defense system and the inflammatory state, but still very few studies have been carried out. This is the first study to analyze the effect of a 4-month exercise program with combined aerobic and strength training in patients undergoing hemodialysis, under two modalities. METHODS: Seventy-one patients undergoing hemodialysis were enrolled and randomized in two groups, one of them performing an intra-dialysis exercise program (n = 36), and the other carrying out a home-based exercise program (n = 35). Serum levels of oxidative stress and inflammation biomarkers were determined before and after the intervention. RESULTS: IL-6 plasma levels showed a significant decrease in the intra-dialysis group after exercise (42.61 ± 9.21 to 26.40 ± 7.84, p = 0.03), while CRP levels decreased significantly in the home-based group (16.12 ± 24.18 to 8.50 ± 11.28, p = 0.03). MCP-1, TNF-α, ICAM-1 and the oxidative stress markers MDA, GSH and GSSG, did not undergo significant changes after the intervention. CONCLUSION: Four months of combined strength and aerobic endurance exercise improve the inflammatory status of hemodialysis patients by significantly reducing IL-6 levels in those subjects who perform intra-dialysis exercise and CRP levels in those who do it at home.

Niveles de adherencia en una intervención de ejercicio guiada por enfermería en pacientes en diálisis / Levels of adherence of dialysis patients to an exercise program run by nursing

Resumen Introducción: Todavía existen numerosas barreras al momento de implementar rutinas de ejercicio en el tratamiento habitual de diálisis, a pesar de que los beneficios sean conocidos. Desarrollar estrategias costo-efectivas resulta necesario para solventar estas barreras e incluir el ejercicio como un complemento terapéutico en diálisis. El personal de enfermería tiene un rol de vital importancia en estas unidades, por lo tanto, explorar la adherencia podría ser interesante para facilitar el ejercicio. Material y métodos: Fueron asignados 71 participantes, tanto a un programa intradialítico como a un programa domiciliario de ejercicio. Realizaron ejercicio durante 16 semanas. Las enfermeras guiaron el programa intradialítico y los domiciliarios fueron autónomos. Se registró el número total de sesiones realizadas para obtener los niveles de adherencia al ejercicio. Resultados: En el grupo de ejercicio intradialítico un 25% de los participantes mostraron adherencia baja, un 50% adherencia media y un 25% adherencia alta. En el grupo domiciliario un 49% mostró adherencia baja, un 9% adherencia media y un 42% adherencia alta. Conclusiones: Existen mayores niveles de adherencia en el grupo intradiálisis frente al domiciliario y los niveles de alta adherencia fueron mayores en el grupo domiciliario, mostrando un mayor impacto en los de adherencia baja.

Abstract Introduction: There are still several barriers against establishing exercise routines in regular dialysis treatments despite their well-known benefits. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complement to dialysis treatment. Nurses play a central role in these units; therefore, examining adherence may be interesting to make exercise implementation easier. Methods: 71 subjects were randomized either into an intradialytic or a home exercise program. They did exercise for 16 weeks. Nurses ran the intradialytic exercise program and the home exercise program was autonomous. The total number of sessions carried out was recorded in order to obtain the levels of adherence to the exercise. Results: In the intradialytic exercise group, 25% of participants showed low adherence; 50% had medium adherence, and 25%, high adherence. In the home group, 49% showed low adherence; 9% exhibited medium adherence, and 42%, high adherence. Conclusions: There are higher levels of adherence in the intradialytic group when compared to the home group, but the levels of high adherence were more significant in the home group, showing a greater impact in those with low adherence.

Effects of exercise programs on physical function and activity levels in patients undergoing hemodialysis: a randomized controlled trial.

BACKGROUND: There are still many barriers when implementing exercise routines within daily dialysis care, even though benefits are well-known. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complementary therapy in dialysis. AIM: To compare several exercise programs on hemodialysis patient's functional capacity and health-related quality of life. DESIGN: This study was a 16-week follow-up, two-parallel group trial with balanced randomization. SETTING: Participants in this study belonged to a private hospitalized care center. POPULATION: Referred sample of 71 patients that suffered end-stage chronic kidney disease who underwent hemodialysis for at least 3 months and had a medical stable condition. METHODS: Thirty-six participants performed for 16 weeks an intradialytic exercise program lead by the nursing staff of the hemodialysis unit and 35 a home-based program supervised by physical therapists of the hospital. RESULTS: The main researcher and the data analyst were both blinded to participant allocation. There was a significant effect in time for both groups. Participants improved significantly in the Short Performance Physical Battery (SPPB), One-Leg Heel-Rise (OLHR) and 6 Minute-Walk Test (6MWT), and in the Physical Activity Scale for the Elderly (PASE) and Short Survey Form 36 (SF-36) questionnaires. CONCLUSIONS: Nurse-led and home-based exercise interventions produce beneficial effects involving physical function, activity levels and health-related quality of life in patients undergoing hemodialysis. CLINICAL REHABILITATION IMPACT: The study emphasizes the importance of exercise rehabilitation routines in fragile populations such as dialysis patients, and the potential to overcome barriers for its daily implementation.

The effects of a combined physical therapy approach on Morton's Neuroma. An N-of-1 Case Report.

INTRODUCTION: There is a lack of supporting evidence for conservative treatments involving Morton's Neuroma, which has often a clinical presentation with many associated complications such as functional impairment and chronic pain. This case study assessed the effects of a combined physical therapy treatment for Morton's Neuroma, an injury often referred for surgery. METHODS: The patient suffered a long-standing Morton's Neuroma and received 6 combined physical therapy sessions that included soft-tissue massage, joint mobilization, strengthening therapeutic exercises and pain education. Values for pain with deep pressure, pain maladaptive beliefs and functionality were taken using clinical testing and questionnaires. RESULTS: After the intervention was successfully completed, pain when applying deep pressure resolved. Functionality involving the toe-to-wall test showed an improvement in ankle dorsiflexion and better results were found in both the LEFS and FAAM questionnaires. Pain maladaptive beliefs, assessed with the Pain Catastrophizing Scale and the Pain Awareness Questionnaire also reflected an improvement. CONCLUSION: A combined physical therapy approach shows encouraging results in the treatment of Morton's Neuroma.