A controlled randomized trial with a 12-week follow-up investigating the effects of medium-frequency neuromuscular electrical stimulation on pain, VMO thickness, and functionality in patients with knee osteoarthritis.

BACKGROUND: One of the major contributors to disability in Knee osteoarthritis (KOA) patients is weakness in the Quadriceps Femoris muscle. Neuromuscular electrical stimulation (NMES) has been used in rehabilitation for patients suffering from muscle weakness. Thus, the purpose of the study was to assess the effectiveness of NMES and exercise therapy, for improving pain, muscle weakness and function among patients with KOA. METHODS: A randomized controlled trial was conducted with 75 female patients diagnosed with KOA. Participants were divided into three intervention groups: NMES-only, exercise therapy (Exs) alone, and a combination of NMES and exercise (NMES + Exs). All patients underwent 12 supervised treatment sessions, three times a week. Outcome measures included pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), thigh muscle girth (TG), thickness of the Vastus Medialis Oblique (VMO), timed up and go test (TUG), six-minute walk test (6MWT), and WOMAC scores. Statistical analyses (ANOVA and Kruskal-Wallis) methods were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. RESULTS: The NMES group exhibited a significant reduction in pain at the 12-week follow-up compared to the other groups(p = 0.022). The NMES + Exs group showed better outcomes in terms of FROM, TG, and VMO thickness post-intervention (p < 0.0001, p < 0.004, p = 0.003, respectively) and at the 12-week follow-up (p < 0.0001, p < 0.0001, p < 0.0001, respectively). Additionally, NMES was superior in improving TUG and 6MWT post-intervention (p < 0.0001, p = 0.038, respectively) and during the follow-up assessments (p < 0.0001, p = 0.029, respectively). The NMES + Exs group achieved better WOMAC stiffness scores at both post-intervention and follow-up evaluations (p < 0.0001, p < 0.0001, respectively). Furthermore, at the 12-week follow-up, NMES + Exs group outperformed the others in WOMAC pain and function subscales (p = 0.003, p = 0.017, respectively), while the NMES group demonstrated better WOMAC total scores compared to the other groups (p = 0.007). CONCLUSION: The combination of NMES and exercise seems to be an efficient approach for managing KOA, as it enhances knee flexion range and TG, increases VMO thickness, and improves WOMAC scores. On the other hand, NMES alone was found to be effective in improving the physical function of KOA patients. TRIAL REGISTRATION: IRCT20101228005486N7 (06-02-2020).

Therapy-based expert system on function and postural stability after anterior cruciate ligament reconstruction: a pilot study.

PURPOSE: Wii Fit exergames have been less commonly used for the rehabilitation of athletes after Anterior Cruciate Ligament Reconstruction (ACLR). This study aims to investigate the effects of an expert system using Wii Fit exergames compared to conventional rehabilitation following ACLR. A forward-chaining rule-based expert system was developed which proposed a rehabilitation program that included the number and type of exercise in terms of difficulty and ease and the duration of each exercise in a progressive manner according to the patient's physical condition. MATERIALS AND METHODS: Twenty eligible athletes aged 20-30 who underwent ACLR were enrolled in this study and randomly assigned to two groups; and received 12 sessions of either Wii Fit exergames as Wii group (n = 10) or conventional rehabilitation as CL group (n = 10). RESULTS: The main outcomes consisted of pain (Visual Analogue Scale (VAS)), knee effusion, knee flexion range (KFR), thigh girth (TG), single-leg hop for distance (SLHD), and for time (SLHT), static and dynamic balance tests. Both groups had considerable improvement in all outcomes, also there were significantly differences between Wii and CL groups as follows; VAS (P < 0.001), knee effusion (P < 0.001), TG (P = 0.001), KFR (P = 0.012), static balance in stable position (P < 0.001) and in unstable position (P = 0.001), dynamic balance in the anterior (P < 0.001), posteromedial (P < 0.001), posterolateral (P = 0.004) directions, symmetry index of SLHD (P < 0.001) and symmetry index of SLHT (P = 0.013). CONCLUSIONS: The findings showed that using Wii Fit exergames in post-ACLR patients reduced pain and effusion while also improving function and balance significantly. Iranian Registry of Clinical Trials registration number is IRCT20191013045090N1, and the registration date is 03-03-2020.

Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up.

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders causing pain and functional impairment. The purpose of the study is to compare the effects of high-intensity laser therapy (HILT), conventional physical therapy (CPT), and exercise therapy (ET) on pain and function in patients with KOA. The study was designed as an assessor-blind randomized controlled trial. Ninety-three patients (aged between 50 and 75 years) with proved KOA were included and randomly allocated into three groups, and received 12 sessions of HILT, CPT, or ET. The outcomes were pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), timed up and go test (TUG), 6-min walk test (6MWT), and functionality of knee measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Statistical analyses were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. HILT was significantly more effective than the other groups in decreasing the VAS, increasing FROM and improving the scores of WOMAC (total and function subscale) both after treatment and after 12 weeks. The effect of HILT and CPT on the TUG, 6MWT, and WOMAC pain subscale was not significantly different after treatment, and both were better than ET. HILT was significantly better than the others after follow-up, particularly more effective on the stiffness subscale of WOMAC. HILT combined with exercise therapy, as a useful therapeutic approach, could have positive influences on KOA patients.

Downhill walking influence on physical condition and quality of life in patients with COPD: A randomized controlled trial.

Background: Chronic Obstructive Pulmonary Disease (COPD), in addition to its respiratory problems, is accompanied by several musculoskeletal consequences. The aim of this study is to investigate the effectiveness of eccentric exercise in the form of downhill walking (DW) on respiratory capacity, physical function and quality of life (QOL) in patients with COPD. Methods: The randomized controlled trial was carried out during 2014 - 2015 in Hazrat-e-Rasool Hospital in Tehran, Iran. The study design was as an assessor blind RCT on 32 patients with COPD that randomly assigned to the eccentric training (ET) and control (CON) groups. Patients in ET group received a 12-week DW exercise on the treadmill while the patients in the control group were only treated by COPD conventional medications and walked on paved surfaces. Functional tests, FEV1, FEV1 to FVC and St. George's Respiratory Questionnaire (SGRQ) were used to assess the subject's physical status and QOL pre and post-intervention. Results: The FEV1 (p=0.008), FEV1/FVC (p=0.002), six-minute walk test (p=0.029), timed up & go test (p=0.023), SGRQ symptom (p=0.022), SGRQ activity (p=0.007), SGRQ impact (p=0.033) and total score of SGRQ (p=0.013) improved significantly in the ET group compare to the CON group. Conclusion: DW could have positive influence on physical status and QOL of patients with COPD.

Does Downhill Walking on Treadmill Improve Physical Status and Quality of Life of A Patient With COPD?

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is accompanied by several extra-pulmonary consequences, such as skeletal muscle weakness and atrophy which will have a negative impact on daily life in patients and lead to their debilitation; therefore, when treating COPD patients, protocols should be taken into account to improve function and quality of life (QoL). CASE PRESENTATION: The case was a 71- year-old woman suffering from chronic bronchitis and bronchiectasis for 30 years that has been faced with increased musculoskeletal disorders in recent months. The case was managed by downhill treadmill walking for four months with the aim of improving her functional ability and QoL. Functional tests, thigh girth measurement and St. george's respiratory questionnaire (SGRQ) were used to assess the physical status and QoL of the patient. The outcomes measures confirmed the improvement of the studied case. The improvements continued three months after the beginning of the treatment. CONCLUSIONS: The eccentric exercise therapy in the form of downhill walking had positive effects on functions and QoL of studied case, especially had an augmenting effect on the thigh muscles size.

The study of correlation between forward head posture and neck pain in Iranian office workers.

INTRODUCTION: Factors such as prolonged sitting at work or improper posture of head during work may have a great role in neck pain occurrence among office employees, particularly among those who work with computers. Although some studies claim a significant difference in head posture between patients and pain-free participants, in literature the forward head posture (FHP) has not always been associated with neck pain. Since head, cervical and thoracic postures and their relation with neck pain has not been studied in Iranian office employees, the purpose of this study was to investigate the relationship between some work-related and individual factors, such as poor posture, with neck pain in the office employees. MATERIAL AND METHODS: It was a cross-sectional correlation study carried out to explore the relationship between neck pain and sagittal postures of cervical and thoracic spine among office employees in forward looking position and also in a working position. Forty-six subjects without neck pain and 55 with neck pain were examined using a photographic method. Thoracic and cervical postures were measured using the high thoracic (HT) and craniovertebral (CV) angles, respectively. RESULTS: High thoracic and CV angles were positively correlated with the presence of neck pain only in working position (p < 0.05). In forward looking position, there was no statistically significant difference between the 2 groups (p > 0.05). CONCLUSIONS: Our findings have revealed that office employees had a defective posture while working and that the improper posture was more severe in the office employees who suffered from the neck pain.

A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women's Stress Urinary Incontinence: Three- Month Follow- Up.

OBJECTIVE: To determine whether Whole Body Vibration Training (WBVT) is effective at improving pelvic floor muscles strength in women with Stress Urinary Incontinence (SUI). MATERIALS AND METHODS: The study was designed as a randomized clinical trial. 43 women with SUI were randomly assigned in two groups; WBVT and Pelvic Floor Muscle Training (PFMT) and received interventions for four weeks. Pelvic floor muscle (PFM) strength, quality of life and incontinence intensity were evaluated. All measurements were conducted pre and post intervention and also after 3 months in all participants. The ANOVA and the independent sample t test were applied respectively to determine the differences in each group and between the groups. RESULTS: This study showed the WBVT protocol in this study was effective in pelvic floor muscles strength similar to PFMT, and also in reducing the severity of incontinence and increasing I-QOL questionnaire score. We found significant differences in each group pre and post intervention (p = 0.0001); but no significant difference in comparison of two groups' outcomes. Also after three-month follow up, there was no significant difference between groups. CONCLUSION: The findings of this study showed the beneficial effects of WBVT in improving pelvic floor muscles strength and quality of life in patients with urinary incontinence in four-week treatment period and after three months follow up.

The relationship of forward head posture and rounded shoulders with neck pain in Iranian office workers.

UNLABELLED: Background Office workers spend a long period of time behind a computer during working hours. The relation between the posture of sitting during work with computer and neck pain is still debatable. Even though some researchers claim a significant difference in head posture between patients with neck pain and pain-free participants, the FHP (forward head posture) has not always been associated with neck pain in literature. So, the purpose of this study was to discover the relationship between neck pain and improper posture in the head, cervicothoracic spine and shoulders. METHODS: This was a cross-sectional study to explore the relationships between neck pains, sagittal postures of cervical and thoracic spine and shoulders among office workers in two positions, straight looking forward and working position. 46 subjects without neck pain and 55 subjects with neck pain were evaluated using a photographic method. Thoracic and cervical postures were measured by the HT (High Thoracic), CV (Craniovertebral) angles respectively. Shoulder's posture was evaluated in the sagittal plane by the acromion protrusion. RESULTS: HT and CV angles were positively correlated with the presence of neck pain only in working position (p< 0.05). In straight looking forward position there was no significant difference between the two groups statistically (p>0.05). The difference of shoulder protrusion between symptomatic and asymptomatic groups was not significant. CONCLUSION: FHP and thoracic kyphosis were accompanied with neck pain. But shoulder posture was not correlated with neck pain.

The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial.

BACKGROUND: Dysfunction in the kinetic chain caused by poor scapula stabilization can contribute to shoulder injuries and Shoulder Impingement Syndrome (SIS). The purpose of this study was to compare the effectiveness of two treatment approaches scapular stabilization based exercise therapy and physical therapy in patients with SIS. METHODS: The study is a randomized clinical trial in which 68 patients with SIS were randomly assigned in two groups of exercise therapy (ET) and physical therapy (PT) and received 18 sessions of treatment. Pain, shoulders' range of abduction and external rotation, shoulder protraction, scapular rotation and symmetry as well as postural assessment and Pectoralis minor length were evaluated pre and post intervention. The paired-sample t test and the independent sample t test were applied respectively to determine the differences in each group and between two groups. RESULTS: Our findings indicated significant differences in abduction and external rotation range, improvement of forward shoulder translation and increase in the flexibility of the involved shoulder between the two groups (respectively ; p=0.024, p=0.001, p<0/0001, p<0/0001). No significant difference was detected in pain reduction between the groups (p=0.576). Protraction of the shoulder (p<0.0001), forward head posture (p<0/0001) and mid thoracic curvature (p<0.0001) revealed a significant improvement in the ET group. Apparent changes occurred in scapular rotation and symmetry in both groups but no significant differences were observed between the two groups (respectively; p=0.183, p=0.578). CONCLUSION: The scapular stabilization based exercise intervention was successful in increasing shoulder range, decreasing forward head and shoulder postures and Pectoralis minor flexibility.