Prospective comparative study between knee alignment-oriented static and dynamic balance exercise in patellofemoral pain syndrome patients with dynamic knee valgus.

Exercise therapy has been reported as an effective treatment method for patellofemoral pain syndrome (PFPS). However, there is a lack of studies regarding the effectiveness of balance exercise in the treatment of patients with PFPS. This study aimed to prospectively compare changes in proprioception, neuromuscular control, knee muscle strength, and patient-reported outcomes between patients with PFPS treated with knee alignment-oriented static balance exercise (SBE) and dynamic balance exercise (DBE). The participants were divided into 2 groups: 17 knee alignment-oriented SBE group and 19 knee alignment-oriented DBE group. Proprioception was assessed by dynamic postural stability using postural stabilometry. Neuromuscular control and knee muscle strength were measured for acceleration time and peak torque in quadriceps muscle using an isokinetic device. Patient-reported outcomes were evaluated using a visual analog scale for pain and the Kujala Anterior Knee Pain Scale. There was greater improvement in dynamic postural stability (0.9 ±â€…0.3 vs 1.2 ±â€…0.5; 95% confidence interval [CI]: 0, 0.6; Effect size: 0.72; P = .021) and quadriceps AT (40.5 ±â€…14.3 vs 54.1 ±â€…16.9; 95% CI: 2.9, 24.2; Effect size: 0.86; P = .014) in the DBE group compared to the SBE group. Knee alignment-oriented DBE can be more effective in improving dynamic postural stability and quadriceps muscle reaction time compared with the knee alignment-oriented SBE in PFPS patients with dynamic knee valgus.

Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial.

Background: Shoulder subluxation occurs in 17−64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing.

Supervised Rehabilitation May Lead to Better Outcome than Home-Based Rehabilitation Up to 1 Year after Anterior Cruciate Ligament Reconstruction.

Background and objectives: Previous studies consistently found no significant difference between supervised and home-based rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the function of the nonoperative knee, hamstring strength at deep flexion, and neuromuscular control have been overlooked. This prospective observational study was performed to investigate the outcomes after ACLR in operative and nonoperative knees between supervised and home-based rehabilitations. Materials and Methods: After surgery, instructional videos demonstrating the rehabilitation process and exercises were provided for the home-based rehabilitation group. The supervised rehabilitation group visited our sports medicine center and physical therapists followed up all patients during the entire duration of the study. Isokinetic muscle strength and neuromuscular control (acceleration time (AT) and overall stability index (OSI)) of both operative and nonoperative knees, as well as patient-reported knee function (Lysholm score), were measured and compared between the two groups 6 months and 1 year postoperatively. Results: The supervised rehabilitation group showed higher muscle strength of hamstring and quadriceps in nonoperative knees at 6 months (hamstring, p = 0.033; quadriceps, p = 0.045) and higher hamstring strength in operative and nonoperative knees at 1 year (operative knees, p = 0.035; nonoperative knees, p = 0.010) than the home-based rehabilitation group. At 6 months and 1 year, OSIs in operative and nonoperative knees were significantly better in the supervised rehabilitation group than in the home-based rehabilitation group (operative knees, p < 0.001, p < 0.001; nonoperative knees, p < 0.001, p < 0.001, at 6 months and 1 year, respectively). At 1 year, the supervised rehabilitation group also demonstrated faster AT of the hamstrings (operative knees, p = 0.016; nonoperative knees, p = 0.036). Lysholm scores gradually improved in both groups over 1 year; however, the supervised rehabilitation group showed higher scores at 1 year (87.3 ± 5.8 vs. 75.6 ± 15.1, p = 0.016). Conclusions: This study demonstrated that supervised rehabilitation may offer additional benefits in improving muscle strength, neuromuscular control, and patient-reported knee function compared with home-based rehabilitation up to 1 year after ACLR.

Effectiveness of modeling videos on psychological responses of patients following anterior cruciate ligament reconstruction: A pilot randomized trial.

BACKGROUND: To date, much of the rehabilitation following anterior cruciate ligament reconstruction (ACLR) has centered on physical components. However, clinical outcomes including return to sport after ACLR depends on not only physical recovery but also psychological components. This study was performed to assess the feasibility of 6-month modeling video intervention on psychological responses following ACLR. METHODS: Following the baseline assessment of psychological measures through Knee Self Efficacy Scale (K-SES), ACL-Return to Sport after Injury (ACL-RSI), and Tampa Scale of Kinesiophobia-11 (TSK-11), 32 patients scheduled for ACLR were randomly assigned to intervention (n = 10), placebo (n = 11), or control (n = 11) group. Six modeling videos and placebo videos were developed by the investigators. Intervention and placebo groups watched their respective videos during their follow-up visits while control group did not. All groups completed psychological assessments during hospitalization, at 2 weeks, at 6 weeks, at 3 months, and at 6 months following ACLR. Also, Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to evaluate symptoms and function of the knee at 3 and 6 months after surgery. RESULTS: No significant changes in K-SES, ACL-RSI, and TSK-11 scores over 6-month period were observed among groups (P = .808, P = .574, P = .888, respectively). Compared with baseline, only the scores of K-SES improved with statistical significance in the intervention, placebo, and control groups (P = .05, .01, .00) at 6 months after ACLR. The KOOS subscale scores were not significantly different among the intervention, placebo, and control groups at 3 and 6 months. CONCLUSION: A modeling video intervention, although feasible, was not effective in addressing the psychological risk factors in patients undergoing ACLR.