Effects of low-intensity pulsed ultrasound on pain and functional disability in patients with early-stage lumbar spondylolysis: A randomized controlled trial.

BACKGROUND: Low Intensity Pulsed Ultrasound (LIPUS) is beneficial in accelerating fracture recovery, enhancing their capacity to execute tasks of daily life and, as a result, their autonomy. OBJECTIVE: To compare the outcomes of routine physical therapy and routine physical therapy along with LIPUS in patients with early-stage lumbar spondylolysis. METHODS: Thirty-four (29 males and 5 females) patients exhibiting symptomatic low back pain for at least four weeks were recruited and randomly divided into control group (CG) and intervention group (IG) group. Randomization was done by using goldfish bowl method and allocation was done by using sealed envelope method. Parallel assignment was done. Numeric Pain Rating Scale (NPRS) was utilized for the measurement of pain and Oswestry Disability Index (ODI) for functional disability. Patients were assessed at baseline, at the end of 12th and 20th week. Interventions were applied by two physical therapists (one male and one female) having more than eight years of clinical experience for 10 weeks on alternate days. RESULTS: Intervention group reported significant percentage change of 47% at 12th week and 65% at 20th week for pain and 42% at 12th week and 81% at 20th week for functional disability compared with 40% at 12th week and 37% at 20th week for pain and 3% at 12th week and 25% at 20th week follow-up for functional disability from baseline in control group. CONCLUSION: Low-intensity pulsed ultrasound has significantly reduced pain and functional disability in patients with early-stage lumbar spondylolysis by using following parameters; 1.1-MHz oscillation frequency, 1-kHz pulsed frequency, 100-mW/cm2 spatial intensity, 2 ms pulse duration, 100Hz pulse repetition rate, 20% pulse duty cycle, and 20-min duration on alternate days.

Role of low-intensity pulsed ultrasound on lumbar spondylolysis: A systematic review.

OBJECTIVE: To systematically review the role of low-intensity pulsed ultrasound on lumbar spondylolysis. METHODS: Literature search was conducted on PubMed, Embase, CINAHL, Web of Science, PEDro and Scopus databases to identify relevant studies published between 2010 and 2020 by using medical subject headings and applying Booleans, such as low-intensity pulsed ultrasound OR interventional ultrasound AND lumbar spine OR lumbar region AND spondylolysis OR stress fracture. Unpublished studies were hand-searched in the journals, abstracts of conferences were reviewed, and citation index was used for searching experts in the field and then contacting them for information. Studies included were the ones that had at least one of the following outcomes: bone union rate, treatment period to bone union and time to return to previous activities. RESULTS: Of the 243 studies identified, 228(94%) were full text articles and only 2(0.8%) studies were critically appraised for qualitative synthesis based on bone union rate, treatment period to bone union, and time to return to previous activities. CONCLUSIONS: Low-intensity pulsed ultrasound was found to be effective for bone union and a useful therapy for quick return to playing sports in patients with lumbar spondylolysis.

Effects of High-Energy Extracorporeal Shockwave Therapy on Pain, Functional Disability, Quality of Life, and Ultrasonographic Changes in Patients with Calcified Rotator Cuff Tendinopathy.

Objective: The current trial was designed to evaluate the effects of high-energy shockwave therapy on objective and subjective outcomes among participants with calcified rotator cuff tendinopathy. Methods: This parallel-group, randomized trial consists of 42 patients affected by calcific tendinopathies divided into two groups of 21 participants. Patients having calcified tendinopathy aged between 30 and 65 years with type A or B calcification were selected in the trial after signing the written consent form. Participants in the ESWT+RPT group received eight sessions of shockwaves, while the RPT group was treated by routine physical therapy. About 2000 shockwaves of 0.32 mJ/mm2, 120 Hz per treatment, were given as 12 sessions for the first six weeks (2 sessions/week). Pain intensity and shoulder functional ability, ultrasonographic changes, and quality of life were assessed with the numeric pain rating scale (NPRS), Constant-Murley score (CMS), ultrasonography, and Western Ontario rotator cuff index (WORC). Results: There were significant differences regarding NPRS and CMS between the two groups, at baseline and 6th and 12th weeks after intervention (p < 0.05). Within-group differences also showed statistically significant results after treatment (all p < 0.05). Significant results were seen in the WORC and ultrasonographic results pre- and posttreatment; more significant findings were found in the experimental group as compared to others. Conclusion: High-energy shockwave therapy has been proved to be effective and thus strongly recommended for the management of calcified rotator cuff tendinopathy, improving the pain, functionality, and quality of life of these participants and decreasing the size of calcified deposits. Shockwave therapy is proved to be superior to routine physiotherapy.

Obstetric Outcomes of Women Who Sustained Traumatic Spinal Injury during Pregnancy: A Systematic Review.

Literature regarding pregnant women who sustained traumatic spinal injury during pregnancy is limited. Existing papers are mainly case reports, and this indicates a need for more high-quality research evidence in this area. Therefore, this study was designed to systematically review available literature that reported demographic information, clinical characteristics, and obstetric outcomes of women who sustained spinal injury during pregnancy. Studies published from the earliest record to January 2019, which reported traumatic spinal injury during pregnancy, were included. Studies that have reported pregnancy in patients with pre-existing spinal injury, review articles, commentaries, letter to editors, conference papers, and studies published in languages other than English were excluded. Sixteen studies reporting on 26 women were included. Their mean age was 26.7±5.5 years. Motor vehicle accidents were the main cause of spinal injury (n=15, 58%). Of the cases, four women sustained spinal injury during the 1st trimester of pregnancy, of which one had a spontaneous abortion, one delivered a baby with arthrogryposis multiplex congenital disorder, and the third one delivered a premature baby who died shortly after the delivery. Fifteen women sustained injury during their 2nd trimester, of which 14 delivered normal babies, while six sustained spinal injury during the 3rd trimester. Of these women, five delivered normal babies at term. Outcomes of pregnancy appear significantly affected if a spinal injury occurs during the 1st trimester of pregnancy; however, injuries sustained during the 2nd and 3rd trimesters can have good obstetric outcomes.

Reliability of modified functional reach test in the assessment of balance function in people with spinal cord injury: A systematic review.

OBJECTIVE: To systematically review studies reporting reliability of modified functional reach test for the assessment of sitting balance function in people with spinal cord injury. METHODS: The systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and comprised research studies published in English language from the earliest record till October 2019 on the subject of reliability of modified functional reach test in assessing balance function in adult spinal cord injury patients.. Prominent databases were searched with relevant key words to shortlist the targeted studies. RESULTS: Of the 108 studies retrieved initially, 6(5.55%) were included in the current systematic review. All the 6(100%) studies reported only test-retest reliability of modified functional reach test. Of them, 4(66.6%) studies measured only forward reach, while 2(33.3%) measured reach in different directions. All 6(100%) studies reported good to excellent reliability of modified functional reach test with interclass coefficient values ranging from 0.78 to 0.99. CONCLUSIONS: Modified functional reach test was found to be a reliable tool for assessing sitting balance function in individuals with spinal cord injury.

Effectiveness of proprioceptive training and conventional physical therapy in treating adhesive capsulitis.

OBJECTIVE: To determine effectiveness of proprioceptive training and conventional physical therapy in managing patients with adhesive capsulitis. METHODS: A pre-test post-test control group study was conducted at Rehman Medical Institute from June to December 2019. Thirty-eight patients, aged 30 to 60 years, with diagnosis of adhesive capsulitis for more than four months were divided into two groups. Subjects in Group-I (conventional group; n=19) received conventional physical therapy protocols for one month while subjects in Group-II (proprioceptive group; n=19) received proprioceptive training along with conventional physical therapy for one month. Disability of Arm Shoulder & Hand questionnaire, Shoulder Pain & Disability Index and goniometer were used at baseline and post-treatment to assess functional activity level, pain & disability and range of motion respectively. Data was analyzed using SPSS version 20. RESULTS: The mean age of the participants was 53.13 ± 9.12 years. Baseline characteristics were balanced between the two groups. After the treatment, all measures (functional activity level, pain, disability, ROM) improved in both groups. Post treatment, between group analysis showed that functional activity (DASH) and pain (SPADI pain) significantly (P-value <0.05) improved in proprioceptive group as compared to conventional group. However, there were no significant differences (P-value≥ 0.05) in post treatment SPADI disability, SPADI total and ROM (flexion, abduction, external rotation) scores of both groups. CONCLUSION: Proprioceptive exercises along with conventional physical therapy are more effective in managing pain and improving functional activities in adhesive capsulitis patients as compared to conventional physical therapy alone.

Role of extracorporeal shockwave therapy in patients with rotator cuff tendinopathy: synthetic analysis of last two decades.

OBJECTIVE: To explore current evidence on the effectiveness of shockwave therapy in patients with rotator cuff tendinopathy. METHODS: The meta-analysis study was conducted at University of Lahore from May 2019 to December 2019 and comprised search on Cochrane, Medline, Embase, Physiotherapy Evidence Databasedatabases and other sources as well as unpublished grey literature related to shockwave therapy in patients with rotator cuff tendinopathy published between 2000 and 2019. Methodological quality assessment was performed using Cochrane risk of bias tool and the included studies were critically appraised using the Physiotherapy Evidence Databasescale. RESULTS: Of the 11 studies shortlisted, data was not extractable from 2(18%). Of the 9(82%) studies analysed, 8(89%) were randomised trials and 1(11%) was randomised pilot study. Overall, 4(44.4%) studies had high quality and 5(55.6%) fell in the fair category. CONCLUSIONS: There was no consensus found on the efficacy of extracorporeal shockwave therapy compared to traditional rehabilitation among patients with rotator cuff tendinopathy.

Reliability of Hand-Held Dynamometer for assessing Isometric Lumbar Muscles Strength in Asymptomatic Healthy Population.

OBJECTIVE: To determine intra-rater and inter-rater reliability of hand-held dynamometer for assessing isometric lumbar muscle strength in asymptomatic healthy population. METHODS: It was a cross-sectional study conducted at the department of physiotherapy, University of Lahore Teaching Hospital, Lahore, Pakistan, from July 2020 to August 2020 through non probability-purposive sampling technique. Thirty healthy subjects were tested at thirty-degree lumbar flexion and zero-degree lumbar extension positions. Two raters assessed isometric strength of lumbar flexor and extensor muscles, by a hand-held dynamometer. Strength was measured and recorded by each of the two raters and re-assessed after a week. Correlation and pairwise comparison were done between readings. ICC values were calculated for the assessment of isometric lumbar muscle strength using handheld dynamometer. RESULTS: A total of 30 healthy subjects had participated with mean age of 22.84±1.21 years, height 174.33±6.83 cm, weight 68.58±5.08 kg and BMI 22.52±0.35. Findings showed an excellent intra-rater (ICC 2, k = 0.95 to 0.97) and inter-rater (ICC 2, k = 0.94 to 0.95) reliability. CONCLUSIONS: Hand held dynamometer demonstrated an excellent intra- and inter-rater reliability for assessment of isometric lumbar muscles strength of healthy subject at clinical setting as it is simple to use, portable and cost-effective for the precise measurement of lumbar muscles strength.

Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Exercise is considered a cornerstone in achieving an optimized blood glucose level and reducing body weight, body mass index (BMI), and waist circumference. This study aimed to investigate and quantitatively summarize the literature regarding the therapeutic effects of exercise and general physical activity on glycemic control. METHODS: A systematic review and meta-analysis of the literature on the therapeutic effects of exercise on glycemic control in patients with type 2 diabetes mellitus (type 2 DM) were conducted using electronic databases. Studies with an exercise intervention lasting more than 8 weeks were included. Both qualitative and quantitative analyses were performed. Qualitative data were presented narratively in table form. Quantitative analysis was performed using a random-effects model with a 95% confidence interval and a significance level of 0.05. The Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias 2 (RoB2) tool were used to assess the quality of evidence and the risk of bias. RESULTS: A total of 21,559 articles were identified through different databases. Out of 21559 studies, only 32 randomized controlled trials were deemed eligible for inclusion in this study. The average exercise session was 45.15 min, while the average follow-up duration was 21.94 weeks. The mean exercise frequency according to our findings was 3.25 days/week. Almost all the studies reported decreases in glycated hemoglobin (HbA1c; P < 0.0001), fasting blood glucose (P = 0.03), BMI (P = 0.04), and waist circumference (P = 0.007) after the exercise intervention. CONCLUSION: Exercise plays an important role in optimizing glycemic control and improving quality of life (QoL), BMI, and waist circumference in type 2 DM patients. Exercise could be a safe adjunct therapy to medical treatments in these patients. REGISTRATION: PROSPERO: CRD42020210816.

Diagnostic tests to assess balance in patients with spinal cord injury: a systematic review of their validity and reliability.

Background: Sophisticated biomechanical instruments can assess balance in patients with spinal cord injury (SCI) with accuracy and precision; however, they are costly and time consuming to use. Clinical diagnostic tests to assess balance in patients with SCI are less costly and easier to use, but there is limited literature available regarding their reliability and validity. Objectives: To review systematically articles reporting the validity and reliability of diagnostic tests used to assess balance function in patients with SCI. Methods: We searched for articles in the English language from the earliest record to December 15, 2020, which reported validity or reliability of any clinical instrument or diagnostic test used to assess balance in patients with SCI. Articles assessing balance in paraplegic patients with causes other than SCI were excluded. Databases included MEDLINE, AMED, EMBASE, HMIC, PsycINFO, CINAHL, Scopus, and Google Scholar. The COSMIN Risk of Bias checklist was used to assess the studies included and PRISMA-DTA guidelines were applied. Results: We included 16 articles that assessed the validity or reliability of 10 diagnostic tests. The Functional Reach Test (FRT), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest) were assessed by more than 1 study, while the remaining 7 diagnostic tests including the Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure were assessed by 1 study each. The FRT has good-to-excellent test-retest reliability, excellent inter-rater reliability, and good construct, concurrent, and convergent validity. The BBS has excellent inter-rater and intra-rater reliability, high internal consistency, and good concurrent and construct validity. The Mini-BESTest has excellent test-retest reliability, excellent inter-rater reliability, high internal consistency, and good concurrent, convergent, and construct validity. Conclusions: The FRT, BBS, and Mini-BESTest appear to be valid and reliable clinical instruments to assess balance function in patients with SCI.

Effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain; a randomized controlled trial.

OBJECTIVES: To compare the effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain. METHODS: The randomized controlled trial was conducted at 3 different hospitals in Peshawar, Pakistan, from October 2016 to January 2017, and comprised patients suffering from non-specific neck pain aged 25-60 years. The control group received cervical manual therapy alone while the experimental group received cervical along with thoracic manual therapy for 2 weeks. Data was analysed using SPSS 20. RESULTS: Of the 37 subjects, 20(54%) were cases and 17(46%) were controls.The overall mean age was 35.9±9.6 years. There was no significant difference between the groups at baseline in terms of the levels of pain (p=0.125) and disability (p=0.392). The experimental group showed greater reduction in pain (p=0.02) and disability (p=0.03) compared to the control group. CONCLUSIONS: Cervical along with thoracic manual therapy reduced neck pain and associated neck disability more effectively than cervical manual therapy alone.

Comparison of dual task specific training and conventional physical therapy in ambulation of hemiplegic stroke patients: A randomized controlled trial.

OBJECTIVE: To compare the effectiveness of dual task specific training and conventional physical therapy in ambulation of patients with chronic stroke. METHODS: The randomised controlled trial was conducted at the Habib Physiotherapy Complex, Peshawar, Pakistan, from January to August 2017, and comprised patients with chronic stroke. The patients were randomly assigned to two treatment groups. Group A received dual task training, while Group B received conventional physiotherapy. Dual task training included activities such as slowlywalking backward, sideways, and forward on a smooth surface while holding a 100gm sandbag. The conventional physiotherapy included mat activities, stretching and strengthening exercises and gait training. Pre-test and post-test data was taken for both spatial and temporal variables for both groups using Time Up and Go Test and 10-meter walk test. Step length, stride length, cycle time and cadence were also calculated before and after treatment. SPSS 23 was used to analyse the data. RESULTS: Of the 64 patients, there were 32(50%) in each of the two groups that both had 17(53%) males and 15(47%) females. Mean age in Group A was 58.28 ± 7.13 years, while in Group B it was 58.87 ± 6.13 years. Baseline parameters had no significant differences between the groups (p>0.05). Post-treatments scores revealed significant improvement of spatial and temporal variable of gait, 10-meter walk, cadence, step length, stride and cycle time in Group A compared to Group B (p<0.05 each). CONCLUSIONS: Conventional physical therapy and dual task training effectively improved gait ability of chronic stroke patients, and the latter showed significant improvement in all spatial and temporal gait variables compared to former.

Employment status of person with disability in Government Departments in Khyber Pakhtunkhwa Pakistan.

OBJECTIVE: The objective of the study was to determine whether anticipated number of person with disabilities was employed in different government departments of Khyber Pakhtunkhwa (KPK), Pakistan. METHODS: Using across sectional survey, data from 16 different departments of provincial government of KPK was collected by volunteers of 'Friends of Paraplegics. RESULTS: Out of total 1, 71,137 Govt. employees, only 1151 (0.67%) were person with disabilities. None of the included departments fulfilled 2% allocated job quota for person with disabilities. Majority of the employees included in study were from Elementary & Secondary Education Department (n=140345) and Agriculture, Livestock & Cooperation Department (n=14315). The number of person with disabilities in these departments were 960 (0.68%) and 68 (0.48%) respectively. The highest percentage of person with disabilities were working in Higher Education Archives & Libraries Department (1.65%)followed by Law, Parliamentary Affairs & Human Rights Department (1.42%), Planning & Development Department (1.39%) and Administration & Establishment Department (1.16%). CONCLUSION: It is concluded that a small number of person with disabilities are employed in different Govt. Departments. Moreover, these departments has not ensured providing 2% job quota for person with disabilities.

A randomized control trial comparing the effects of motor relearning programme and mirror therapy for improving upper limb motor functions in stroke patients.

OBJECTIVE: To compare the effectiveness of motor relearning programme with mirror therapy in upper limb motor functions of stroke patients. METHODS: The randomised control trial was conducted in Rafsan Neuro Rehabilitation Centre, Peshawar, Pakistan, from June to December 2017, and comprised stroke patients who had Mini Mental State Examination score over 24. Participants were randomly allocated into treatment and control groups. The treatment group underwent a Motor Relearning Programme, while the control group received Mirror therapy. Upper limb sub-scales of the motor assessment scale were used as data collection tool. SPSS 20 was used for data analysis. RESULTS: Of the 66 subjects, 46(69.7%) were males and 20(30.3%) were females. The overall mean age was 55.44±9.21 years. Left hemiplegia was found in 31(47%) subjects, while 35(53%) had right hemiplegia. Each of the two groups had 33(50%) subjects. There were significant differences between pre-treatment and post-treatment mean scores of upper arm functions, hand function and advance hand activities of the two groups (p<0.05 each). All the three variables significantly improved in the treatment group compared to the control group (p<0.001). CONCLUSIONS: Motor Relearning Programme and Mirror therapy were found to be effective in improving upper limb motor functions of stroke patients, but the former was found to be more effective than the latter.

Factors influencing the community integration of patients following traumatic spinal cord injury: a systematic review.

BACKGROUND: Spinal cord injury (SCI) is a high-cost disabling condition, which brings a huge number of changes in individual's life. The emphasis of rehabilitation has moved from medical administration to issues that affect quality of life and community integration. This systematic review was conducted to identify the factors associated with community reintegration of patients with spinal cord injury. . METHODS: Google Scholar, PEDro, Pakmedinet, AMED, BIOMED central, Cochrane Library, MEDLINE, PsychoINFO, PUBMED, ScienceDIRECT, Scirus and Wiley Online Library databses were searched by using key words 'Spinal cord injury' 'Paraplegia' or 'Spinal Cord Lesion' or Tetraplegia. They were cross-linked with 'Community reintegration', 'Community participation' and 'Community access'. The methodological quality of the studies included was analysed by using McMaster University Tool and Thomas Tool. The data extracted included sample size, intervention, duration, results, outcome measures, and follow-up period. RESULTS: A total of 11 relevant studies were located. The evidence extracted was classified into four groups; health-related barriers or facilitators, environment-related barriers or facilitators, psychological barriers and social barriers that are associated with community reintegration of such individuals. CONCLUSIONS: The review revealed that there were more barriers in the form of health-related issues, personal and environmental, psychological and social issues that hinder the community reintegration of individuals with spinal cord injury compared to facilitators. Most studies identified special challenges related to environment in the sense of accessibility of home and public buildings and transportation. Removing barriers related to health, environment, and psychological and social factors can enhance community reintegration of such patients.

Epidemiology, Clinical Features and Consequences of Spinal Cord Injury in Children.

OBJECTIVE: To describe epidemiology, clinical features and clinical consequences of Spinal Cord Injury (SCI) in children. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Paraplegic Centre, Hayatabad, Peshawar, from July 2011 to March 2017. METHODOLOGY: SCI patients having age up to 15 years, admitted to Paraplegic Centre, were inducted in 2017. Exclusion criteria was foreign-national SCI patients, and/or SCI patients re-admitted to paraplegic centre. List of all SCI patients admitted to the centre was retrieved and 102 patients were identified. Data of these patients was evaluated for demographic information, physiological intactness (complete SCI/incomplete SCI), neurological level and complications. RESULTS: A total of 102 patients (66 males and 36 females) with mean age 10.9 ±3.7 years were included in this study. Firearm injury was the most common cause (n=39, 38.2%) of SCI in these patients, followed by fall from height (n=23, 22.5%), road traffic accidents (n=14, 13.7%), and weight fallen over (n=14, 13.7%). Bomb blast injury (n=7, 6.9%), diving accident (n=3, 2.9%), and sports related injuries (n=2, 2.0%). Majority of the patients (n=82, 80.4%) had complete SCI (ASIA A); the commonest SCI level was thoracic region (n=59, 57.8%) and the least reported region was (n=14, 13.7%) cervical. Out of the total, 50 (49.0%) patients had pressure ulcer in which 15 (30.0%) patients were having grade IV pressure ulcer, 9 (18.0%), 15 (30.0%) and 11 (22.0%) patients were had grade I, grade II and grade III pressure ulcer, respectively. CONCLUSION: Majority of causes of SCI in children are similar to those reported in adult population. However, the commonest causes of SCI in children in Pakistan were firearm injury and bomb blast, which are rarely reported in other countries. Like adult population, these children with SCI are prone to developing pressure ulcer.

Consequences of traumatic spinal cord injury during pregnancy in Pakistan.

INTRODUCTION: Traumatic spinal cord injury (SCI) is one of the major causes for poor outcomes of pregnancy. Injury during pregnancy is uncommon; therefore, outcome data are scarce. This case series presents outcomes of pregnancy in five women who sustained SCI during their pregnancies. CASE PRESENTATION: Five women who sustained SCIs during pregnancy (age range: 24-38 years) were identified and included in this case series. The causes of SCI in this population were fall from heights (cases 1 and 2), road traffic accidents (cases 3 and 4) and firearm injury (case 5). Two of the females were managed conservatively (cases 1 and 5) and the rest underwent surgical procedures for fixing their spine. Out of these patients, four patients delivered normal healthy babies, while the baby of one patient died within 1 hour after delivery. DISCUSSION: Limited data about the outcomes of pregnancy in women who sustained SCIs during pregnancy are available in the literature. The outcomes of pregnancy in women who sustained SCIs during the first trimester are not satisfactory, and special attention may be needed to improve the expected outcomes. Data from our study show similar findings to developed countries.

Effect of progressive resistive exercise training in improving mobility and functional ability of middle adulthood patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) in their middle adulthood are more prone to reduced mobility than younger patients having the same medical condition. Progressive resistive exercise training (PRT) is deemed an effective treatment approach for the management of muscular weakness in patients with CKD. The present review is an attempt to understand the effectiveness of PRT in the mobility and functional ability of patients suffering from CKD. We systematically searched electronic databases, including Medline, Scopus, PubMed, CINAHL, PEDRo and Cochrane, to review the published literature on this subject. Electronic searches were limited to training programs carried out on resistive, aerobic, endurance and therapeutic exercises reporting outcome measures including muscular strength, size, physical function and functional capacity in the clinical population with CKD aged > 40 years. Studies with a minimum duration of eight weeks of exercise training or more were considered eligible for review. The methodological criteria of the included studies were assessed with the PEDro scale. A total of 80 articles were identified using the keywords in the above-mentioned databases. However, based on the study's inclusion and exclusion criteria, only 11 articles were finally included. The results of this review substantiate the effectiveness of PRT in patients with CKD. However, further research is warranted in this area due to the limited availability of high-quality published evidence.

Antecedent anterior cruciate ligament reconstruction surgery and optimal duration of supervised physiotherapy.

A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6th, 12th and 24th week post-surgery). The patient scored 30, 56, 60 and 85 on IKDC (maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6th, 12th and 24th week following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12th and 24th week post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session (verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury, immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the patient during the 24 week rehabilitation period. The latter number of physiotherapy sessions was substantially less than the average supervised physiotherapy sessions reported in the literature.