Clinical Rehabilitation

To evaluate the effect of Tai Chi on balance and reducing falls incidence in neurological disorders.

AMED, Embase, Web of Science, SCOPUS, EBSCO and Medline from inception until February 2018.

Randomized controlled trials of Tai Chi compared with active or no treatment control, measuring balance with the Berg Balance Scale or the Timed Up and Go Test and number of falls in neurological disorders were included. Methodological quality was assessed using PEDro and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

A total of 10 studies involving 720 participants were reviewed. Seven studies were in Parkinson’s disease and three in stroke. Seven studies were of high methodological quality and three were low. Meta-analyses of balance measured with the Timed Up and Go Test in Parkinson’s disease revealed a statistically significant effect of Tai Chi compared to no treatment (weighted mean difference (WMD), –2.13; 95% confidence interval (CI), −3.26 to −1.00; P < 0.001) and was insignificant (WMD, −0.19; 95% CI, −1.74 to 1.35; P = 0.81) when compared with active treatment. Tai Chi significantly reduced falls incidence in Parkinson’s disease (odds ratio (OR), 0.47; 95% CI, 0.29 to 0.77; P = 0.003) and stroke (OR, 0.21; 95% CI, 0.09 to 0.48; P < 0.001). Balance measured with the Timed Up and Go Test comparing Tai Chi and active treatment was insignificant (WMD, 0.45; 95% CI, –3.43 to 2.54; P = 0.77) in stroke.

Tai Chi is effective in reducing falls incidence in Parkinson’s disease and stroke. This systematic review did not find high-quality studies among other neurological disorders.

To review peer-reviewed literature relating to postoperative physiotherapy for degenerative cervical myelopathy (DCM), to determine efficacy in improving clinical outcome and recovery.

MEDLINE, EMBASE, CENTRAL, PEDro, ISRCTN registry, WHO ICTRP and Clinicaltrials.gov. References and citations of relevant articles were searched.

A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42016039511) from the origins of the databases till 15 February 2018. Included were all studies investigating physiotherapy as an intervention after surgical treatment of DCM to determine effect on clinical outcome and recovery. Study quality was determined using the Grades of Recommendation, Assessment, Development and Evaluation guidelines.

In all, 300 records were identified through tailored systematic searches, after removing duplicates. After screening, only one investigated postoperative rehabilitation using physiotherapy for DCM; however, this was retrospective with no controls. This study suggested that rehabilitation including physiotherapy improved postoperative recovery. There are currently two registered trials investigating the use of postoperative physiotherapy for DCM.

The literature provides insufficient evidence to make any evidence-based recommendations regarding postoperative physiotherapy use in DCM.

To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy.

Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier and Cochrane Library) before January 2018.

Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDRO score ≥ 5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes.

Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P < 0.001), and decreased cadence (SMD = –0.72, P < 0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD = 0.30, P = 0.004), E (SMD = 0.28, P = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD = 0.57, P < 0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.65, P < 0.001) and during swing (SMD = 1.34, P < 0.001), and decreased ankle power generation in stance (SMD = –0.72, P < 0.001) in children with equinus gait.

In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.

To determine the effects of different intradialytic exercise training modalities on physical functioning and health-related quality of life of maintenance hemodialysis patients.

We searched MEDLINE, Cochrane Trials Register and CINAHL for controlled trials that evaluated the effects of intradialytic exercise training for maintenance hemodialysis patients and published from the earliest available date to December 2017. Weighted mean difference and 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I² test.

Fifty-six studies met the study criteria, comprising a total of 2586 patients. Compared with no exercise, combined aerobic and resistance exercise resulted in significant improvement in peak VO₂ weighted mean difference (5.1 mL kg⁻¹ min⁻¹; 95% CI: 3.4, 6.8 mL kg⁻¹ min⁻¹), depression symptoms (−7.32; 95% CI −9.31, −5.33) and both physical function (10.67 points; 95% CI 1.08, 20.25 points) and vitality (10.01 points; 95% CI 4.30, 15.72 points) domains of health-related quality of life. Resistance exercise alone was significantly associated with improvement in the 6-minute walk test distance (30.2 m; 95% CI 24.6, 35.9 m), knee extensor strength (0.6 N; 95% CI 0.1, 1.0 N) and Physical Component Score of health-related quality of life (9.53 points; 95% CI −3.09, 22.15 points) when compared with control group. Aerobic exercise alone was not significantly associated with aerobic capacity and quality of life improvement.

The results provide support to interventions that combine intradialytic aerobic and resistance exercises to improve physical functioning and quality of life in end-stage renal disease patients undergoing hemodialysis.

To evaluate (1) the effectiveness of transcutaneous electrical nerve stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation parameters for TENS.

A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery in stroke survivors were assessed for inclusion. Outcomes of interest included plantar flexor spasticity, muscle strength, walking capacity and balance.

In all, 11 studies met the inclusion criteria which involved 439 stroke survivors. The meta-analysis showed that TENS improved walking capacity, as measured by either gait speed or the Timed Up and Go Test (Hedges’ g = 0.392; 95% confidence interval (CI) = 0.178 to 0.606) compared to the placebo or no-treatment control groups. TENS also reduced paretic plantar flexor spasticity, as measured using the Modified Ashworth Scale and Composite Spasticity Scale (Hedges’ g = –0.884; 95% CI = –1.140 to −0.625). The effect of TENS on walking capacity in studies involving 60 minutes per sessions was significant (Hedges’ g = 0.468; 95% CI = 0.201–0.734) but not in study with shorter sessions (20 or 30 minutes) (Hedges’ g = 0.254; 95% CI = –0.106–0.614).

The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors.

To evaluate the evidence for the use of virtual reality to treat balance and gait impairments in multiple sclerosis rehabilitation.

Systematic review and meta-analysis of randomized controlled trials and quasi-randomized clinical trials.

An electronic search was conducted using the following databases: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Database of Systematic Reviews (CDSR) and (CINHAL). A quality assessment was performed using the PEDro scale. The data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guideline statement. It was registered in the PROSPERO database (CRD42016049360).

A total of 11 studies were included. The data were pooled, allowing meta-analysis of seven outcomes of interest. A total of 466 participants clinically diagnosed with multiple sclerosis were analysed. Results showed that virtual reality balance training is more effective than no intervention for postural control improvement (standard mean difference (SMD) = −0.64; 95% confidence interval (CI) = −1.05, −0.24; P = 0.002). However, significant overall effect was not showed when compared with conventional training (SMD = −0.04; 95% CI = −0.70, 0.62; P = 0.90). Inconclusive results were also observed for gait rehabilitation.

Virtual reality training could be considered at least as effective as conventional training and more effective than no intervention to treat balance and gait impairments in multiple sclerosis rehabilitation.

To describe the use of periodized exercise prescription with patients in the context of rehabilitation.

The following databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, CINAHL, ScienceDirect, PEDro, Web of Science, SPORTDiscus, SAGE and Google Scholar. Databases were searched from inception to March 2018.

The literature search yielded 1772 articles with 1755 being excluded leaving 17 articles in total for the full review. Methodological quality and internal validity of the included papers were lacking. The included studies failed to indicate in which phase rehabilitation had occurred. Programme structure relating to the use of a familiarization phase, sequencing of exercises and structuring of specific phases (i.e. macrocycle, mesocycle and microcycle) was not present and lacked consistency across the board.

Periodization models of exercise prescription are being used within a variety of population groups in the rehabilitation setting. Integration of periodization principles into a rehabilitation programme still however remains a challenge. Although there is a lack of consistency with regard to the structure and implementation of a periodized model of exercise prescription in the rehabilitation context, it seems to be an alternative way in which to prescribe exercise within the rehabilitation setting.

To assess the effectiveness of 12 weeks of Pilates practice on disability, pain and kinesiophobia in patients with chronic non-specific low back pain.

This is a randomized controlled trial.

This study was conducted in the university laboratory.

A total of 64 participants with chronic non-specific low back pain were included.

Participants were randomly allocated to intervention group consisted in Pilates intervention during 12 weeks (n = 32) or control group who received no treatment (n = 32).

Disability, pain and kinesiophobia were assessed by Roland Morris Disability Questionnaire, visual analogue scale and Tampa Scale of Kinesiophobia, respectively. Measurements were performed at baseline, at 6 and 12 weeks after study completion.

There were significant differences between groups with observed improvement in Pilates intervention group in all variables after treatment (P < 0.001). Major changes on disability and kinesiophobia were observed at six weeks of intervention with no significant difference after 12 weeks (P < 0.001). Mean changes of the intervention group compared with the control group were 4.00 (0.45) on the Roland Morris Disability Questionnaire and 5.50 (0.67) in the Tampa Scale of Kinesiophobia. Pain showed better results at six weeks with a slightly but statistically significant improvement at 12 weeks with Visual Analogue Scale scores of 2.40 (0.26) (P < 0.001).

Pilates intervention in patients with chronic non-specific low back pain is effective in the management of disability, pain and kinesiophobia.

To explore how technologies are used and experienced in rehabilitation.

A qualitative study using a grounded theory approach within a randomized controlled trial investigating the effectiveness of tailored, affordable technologies to improve mobility and physical activity.

Aged care and neurological rehabilitation wards with community follow-up.

Twenty patients undergoing rehabilitation and randomized to the experimental arm of a trial (mean age 64 years (SD 23)) were recruited for interviews, plus 11 physiotherapists involved in technology prescription as part of the trial.

Two interviews per patient (one in hospital, one post-discharge) and four focus groups with physiotherapists were conducted. Transcribed data were coded and synthesized. Memo-writing and constant comparison methods guided data analysis.

A process of patient engagement with technology involving two stages: (1) initial patient engagement and (2) maintaining patient engagement was identified. Therapists used a series of steps and strategies to gain and maintain patient engagement. A positive first experience and continued input into patient programmes was needed. The level of patient engagement was not consistent across the duration of the trial, increasing or decreasing due to changes in the technologies prescribed or setting of use. Two conditions were key to optimizing patient engagement: sufficient support and perceived benefit from using technology.

Patients can engage with technology during rehabilitation when prescription is tailored by a therapist. Perceiving benefit from using technology, in addition to receiving the right support to enable use appears to influence the level of patient engagement.

This study aims to evaluate the prevalence and determinants of inadequate physical activity and excessive sedentary behaviour before and after total knee replacement.

Secondary analysis was performed on data from a cohort of 422 adults (45–74 years), drawn from 12 public or private hospitals, undergoing primary unilateral or bilateral total knee replacement surgery.

Questionnaires were used to determine the presence of inadequate physical activity and excessive sedentary behaviour before and 6  and 12 months after total knee replacement surgery. Knee pain, activity limitations, comorbidities, muscle strength, psychological well-being, fatigue, sleep and body mass index were measured/assessed as possible determinants of physical activity or sedentary behaviour.

Before surgery, 77% (n = 326) of the cohort participated in inadequate physical activity according to World Health Organization guidelines, and 60% (n = 253) engaged in excessive sedentary behaviour. Twelve months after surgery, 53% (n = 185) of the cohort engaged in inadequate physical activity and 45% (n = 157) in excessive sedentary behaviour. Inadequate physical activity before surgery (P = 0.02), obesity (P = 0.07) and comorbidity score >6 (P = 0.04) predicted inadequate physical activity 12 months after surgery. Excessive sedentary behaviour and activity limitations before surgery predicted excessive sedentary behaviour 12 months after surgery.

Although there were improvements after total knee replacement, 12 months after surgery about half the cohort did not meet World Health Organization recommendations for activity. Pre-surgery assessment of physical activity, activity limitations, sedentary behaviour and body mass index is essential to identify patients at risk for long-term inactivity.