Clinical Rehabilitation

The purpose of this study was to determine the benefits and harms of low-level laser therapy for Achilles tendinopathy.

Search strategies were conducted (from inception to February 2020) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino Americana em Ciências da Saúde e do Caribe (LILACS), Physiotherapy Evidence Database (PEDro), SPORTDiscus, ClinicalTrials.gov, World Health Organization (WHO)-ICTRP and OpenGrey databases, to retrieve all randomized controlled trials that compared laser therapy with inactive/active interventions.

This study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk of bias was assessed using the Cochrane Risk of bias table. Meta-analyses were performed on dependence of homogeneity, otherwise results were reported narratively. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Four trials (119 participants) were analyzed. Laser therapy associated to eccentric exercises when compared to eccentric exercises and sham had very low to low certainty of evidence in pain and function assessment. Despite one trial favored laser therapy at two months (mean difference (MD) −2.55, 95% confidence interval (95% CI) −3.87 to −1.23), the CIs did not include important differences between groups at 3 and 13 months. The function assessment showed an improvement favoring the placebo group at one month (MD 9.19, 95% CI −16.16 to −2.23) and non-significant difference between groups at 3 and 13 months. Adverse events were poorly reported but restricted to minor events related to the exercises.

The certainty of evidence was low to very low, and the results are insufficient to support the routine use laser therapy for Achilles tendinopathy.

To evaluate the effects of kinesio taping on shoulder disorders, as a single treatment modality or as conjunction to other treatments.

MEDLINE, PEDro (Physiotherapy Evidence Database), The Cochrane Library, Web of Science, Embase and OpenGrey databases were searched for trials published before 5 February 2020.

This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Randomized controlled trials published in English or Turkish were included. The methodological quality of the studies was assessed with the Physiotherapy Evidence Database scale. For analysis of continuous data, mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used. The I² statistics was used to measure the heterogeneity.

Fourteen studies were included with 680 participants. Kinesio taping did not produce better results on pain compared to sham (MD by –0.77 (95% CI = –1.77, 0.22), P = 0.13), exercises (MD by –0.51 (95% CI = –1.41, 0.39), P = 0.27), or passive treatments (MD by –0.29 (95% CI = –0.77, 0.19), P = 0.24). Similarly, kinesio taping did not found superior to sham kinesio taping (SMD by –0.01 (95% CI = –0.31, 0.29), P = 0.94), exercises (SMD by 0.41 (95% CI = –0.25, 1.07), P = 0.22), or passive treatments on function (SMD by –0.02 (95% CI = –0.19, 0.15), P = 0.82). There was no significant SMD on range of motion (ROM) by –0.07 (95% CI = –0.47, 0.33, P = 0.74) compared to sham kinesio taping and –0.06 (95% CI = –0.20, 0.09, P = 0.46) compared to passive treatment. Overall, effect size was found small to moderate.

Despite reported positive effects in some studies, there is no firm evidence of any benefit of kinesio taping on shoulder disorders.

To review the literature that has explored conservative treatments for the management of shoulder pain in manual wheelchair users.

Five databases were systematically searched in february 2020 for terms related to shoulder pain and manual wheelchair use. Articles were screened and included if they investigated the conservative treatment of shoulder pain in wheelchair users. Participants’ physical characteristics, experimental design and primary and secondary outcome measures were extracted from studies. Studies were grouped according to treatment type to identify gaps in the literature and guide future research.

The initial search identified 407 articles, of which 21 studies met the inclusion criteria. Exercise-based treatment interventions were most prevalent (n = 12). A variety of exercise modalities were employed such as strengthening and stretching (n = 7), ergometer training (n = 3), Pilates classes (n = 1) and functional electrical stimulation (n = 1). Only three studies supplemented exercise with an additional treatment type. The Wheelchair Users Shoulder Pain Index was used by 18 studies as the primary measure of shoulder pain. Only seven of these included an objective measure of shoulder function. Participant characteristics varied among studies, and physical activity levels were frequently not reported.

Despite the high prevalence of shoulder pain in manual wheelchair users, the number of studies to have explored conservative treatment types is low. Exercise is the most commonly used treatment, which is encouraging as physical inactivity can exacerbate other health conditions. Few studies have adopted interdisciplinary treatment strategies or included objective secondary measures to better understand the mechanisms of pain.

The aim of this study is to determine the effectiveness of an extended cognitive rehabilitation program in group’s sessions in multiple sclerosis.

Double-blind multicenter randomized trial.

People with multiple sclerosis of 18 to 60 years, Expanded Disability Status Scale ⩽6.0, mild to moderate cognitive impairment.

They were randomized into cognitive rehabilitation program (ProCog-SEP) or in a placebo program. ProCog-SEP comprises 13 group’s sessions over 6 months and includes psychoeducational advices and cognitive exercises. Placebo program included non-cognitive exercises. No strategy and no cognitive advice were provided.

The primary endpoint was the percentage of verbal memory learning measured by the Selective Reminding Test. A comprehensive neuropsychological assessment is carried out before and after interventions by a neuropsychologist blinded to intervention. Effectiveness of the ProCog-SEP versus Placebo has been verified using linear regression models.

In total, 128 participants were randomized and 110 were included in the study after planning session in groups; 101 completed this trial (77.2% females); mean age: 46.1 years (±9.6); disease duration: 11.8 years (±7.5). ProCog-SEP was more effective in increasing in learning index (9.21 (95% confidence interval (CI): 1.43, 16.99); p = 0.02) and in working memory on manipulation (0.63 (95% CI: 0.17, 1.09); p = 0.01), and updating capacities (–1.1 (95% CI: –2.13, –0.06); p = 0.04). No difference was observed for other neuropsychological outcomes. Regarding quality of life outcomes, no change was observed between the two groups.

These findings suggest that ProCog-SEP could improve verbal learning abilities and working memory in people with multiple sclerosis. These improvements were observed with 13 group sessions over 6 months.

To explore the effects of an eight-week core stability program on balance ability in persons with Parkinson’s disease.

Randomized controlled trial.

A local Parkinson’s association.

A total of 44 participants with a clinical diagnosis of Parkinson’s disease were randomly assigned to an experimental (n = 22) or control group (n = 22).

The experimental group received 24 sessions of core training, while the control group received an intervention including active joint mobilization, muscle stretching, and motor coordination exercises.

The primary outcome measure was dynamic balance evaluated using the Mini-Balance Evaluation Systems Test. Secondary outcomes included the balance confidence assessed with the Activities-specific Balance Confidence Scale and standing balance assessed by the maximal excursion of center of pressure during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test.

After treatment, a significant between-group improvement in dynamic balance was observed in the experimental group compared to the control group (change, 2.75 ± 1.80 vs 0.38 ± 2.15, P = 0.002). The experimental group also showed a significant improvement in confidence (change, 16.48 ± 16.21 vs 3.05 ± 13.53, P = 0.047) and maximal excursion of center of pressure in forward (change, 0.86 ± 1.89 cm vs 0.17 ± 0.26 cm, P = 0.048), left (change, 0.88 ± 2.63 cm vs 0.07 ± 0.48 cm, P = 0.010), and right (change, 1.63 ± 2.82 cm vs 0.05 ± 0.17 cm, P = 0.046) directions of limits of stability compared to the control group.

A program based on core stability in comparison with non-specific exercise benefits dynamic balance and confidence and increases center of mass excursion in patients with Parkinson’s disease.

The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment.

The design of this study was an assessor-blinded, randomized controlled trial.

The setting for this study is the community from Manila, Philippines.

In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60–83) were randomly allocated to three intervention groups and one waitlist control group.

The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up.

Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength.

No significant difference was observed across time and groups on fall incidence rate at 12 weeks (P = 0.152) and at 36 weeks (P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks.

There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.

The aim of this study was to compare the effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease (CVD).

This is a prospective, randomized, controlled, single-blind clinical trial.

The study was conducted in a physiotherapy and rehabilitation unit of a university hospital.

A total of 62 patients with early-stage CVD were allocated to either an experimental group or a control group.

Experimental group (n = 29) received Kinesio Taping intervention once a week for four weeks, while control group (n = 29) received compression stockings for four weeks. All patients additionally undertook an exercise training programme including calf muscle pump exercises, flexibility exercises and diaphragmatic breathing.

Visual analogue scale, lower limb circumference measurements, 6-minute walk test and Short Form 36 questionnaire were applied before and after four weeks of treatment.

Control group showed statistically significant improvements in pain (P < 0.001), ankle circumferences (right, P = 0.002; left, P = 0.037), calf circumferences (right, P = 0.020; left, P = 0.022), knee circumference (left, P = 0.039) and thigh circumferences (right, P = 0.029; left, P = 0.002) compared with experimental group. There were no significant differences between groups with respect to functional capacity and quality of life (P > 0.05). Both groups significantly improved 6-minute walk distance (P < 0.001) and Short Form 36 physical component summary (experimental group, P = 0.002; control group, P = 0.006).

This study demonstrated that Kinesio Taping and compression stockings revealed similar improvements of functional capacity and quality of life in patients with CVD. The symptoms of pain and edema caused by CVD can be decreased more efficiently with compression stockings than Kinesio Taping intervention.

To determine the effect of a supportive educational intervention based on the Orem self-care model on women with type 2 diabetes and diabetic peripheral neuropathy.

A randomized controlled trial.

Hospital outpatient diabetes clinic.

Adult women with type 2 diabetes and mild-to-moderate diabetic peripheral neuropathy. Out of 410 patients, 120 diabetic patients were recruited and randomly assigned to trial group (N = 60) and control group (N = 60).

The trial group received a designed intervention consist of one-month supportive educational program with three months of follow-up (totally four months), based on self-care requisites according to the Orem self-care regarding diabetic peripheral neuropathy. The control group only received a routine care program in the diabetes clinic.

The main outcomes were symptoms and severity of diabetic neuropathy. Further outcomes were fasting blood sugar and glycosylated hemoglobin.

By the end of the intervention, the number of participants reduced from 60 to 58 in the trial group and to 57 in the control group (totally 115). The intervention significantly decreased mean score of diabetic neuropathy symptoms (trial group: 3.26 vs. control group: 9.57, P = 0.001), severity (trial group: 5.86 vs. control group: 9.02, P = 0.001), fasting blood sugar (trial group: 151 vs. control group: 204, P = 0.001), and glycosylated hemoglobin (trial group: 7.85 vs. control group: 8.62, P = 0.004).

Delivering a supportive-educational intervention based on the Orem self-care model on outpatient diabetes clinic can decrease the symptoms and severity of diabetic peripheral neuropathy.

It was registered in the Iranian Registry of Clinical Trials (IRCT2015021521095N1).

The aim of this study is to evaluate a novel composite measure of active range of motion (X_A) and determine whether this measure correlates with active function.

Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA.

Tertiary rehabilitation centers in Australia, Europe, and the United States.

Adults with upper (n = 254) or lower (n = 345) limb spastic paresis following stroke or brain trauma.

AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb.

X_A was used to calculate a novel composite measure (CX_A), defined as the sum of X_A against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CX_A and active function at Weeks 4 and 12 of open-label cycles were explored.

CX_A and active function were moderately correlated in the upper limb (P < 0.0001–0.0004, r = 0.476–0.636) and weakly correlated in the lower limb (P < 0.0001–0.0284, r = 0.186–0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CX_A and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, P = 0.0160, r = 0.213; Cycle 3 Week 4, P = 0.0031, r = 0.296). Across cycles, CX_A improvements peaked at Week 4, while functional improvements peaked at Week 12.

CX_A is a valid measure for functional impairments in spastic paresis. CX_A improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.

The aims of this study were to describe patterns and dose of rehabilitation received following stroke and to investigate their relationship with outcomes.

This was a prospective observational cohort study.

A total of seven public hospitals and all subsequent rehabilitation services in Queensland, Australia, participated in the study.

Participants were consecutive patients surviving acute stroke between July 2016 and January 2017.

We tracked rehabilitation for six months following stroke and obtained 90- to 180-day outcomes from the Australian Stroke Clinical Registry.

Dose of rehabilitation – time in therapy by physiotherapy, occupational therapy and speech pathology; modified Rankin Scale (mRS)- premorbid, acute care discharge and 90- to 180-day follow-up.

We recruited 504 patients, of whom 337 (median age = 73 years, 41% female) received 643 episodes of rehabilitation in 83 different services. Initial rehabilitation was predominantly inpatient (260/337, 77%) versus community-based (77/337, 21%). Therapy time was greater within inpatient services (median = 29 hours) compared to community-based (6 hours) or transition care (16 hours). Median (Quartile 1, Quartile 3) six-month cumulative therapy time was 73 hours (40, 130) when rehabilitation commenced in stroke units and continued in inpatient rehabilitation units; 43 hours (23, 78) when commenced in inpatient rehabilitation units; and 5 hours (2, 9) with only community rehabilitation. In 317 of 504 (63%) with follow-up data, improvement in mRS was most likely with inpatient rehabilitation (OR = 3.6, 95% CI = 1.7–7.7), lower with community rehabilitation (OR = 1.6, 95% CI = 0.7–3.8) compared to no rehabilitation, after adjustment for baseline factors.

Amount of therapy varied widely between rehabilitation pathways. Amount of therapy and chance of improvement in function were highest with inpatient rehabilitation.

Given the characteristic of high disability rates, the successful return of stroke patients to society is increasingly becoming a serious challenge. This study aimed developing a theory to reveal the development and transformation process of social participation among stroke survivors as a foundation for creating strategies to improve their social participation.

A constructivist grounded theory approach using data from in-depth semi-structure interviews.

The settings were various, including the stroke follow-up clinic, rehabilitation institutions, subjects’ homes, park, work unit, and rest home in Shanghai, China.

In all, 36 stroke survivors who have passed through the acute phase and returned home participated in this study to share their experiences of social participation and processes of changes from September 2017 to January 2019.

A substantive theory on the development and transformation process of social participation among stroke survivors was generated, which included four process ingredients: “in-orbit,” “off-orbit,” “returning orbit,” and “in-orbit again.” The core concept “hard return” revealed not only the tough development process but also the unsatisfactory change results. Both participation abilities and participation willingness had an important impact on social participation and also played a significant role in driving its development.

This study has identified the development process of social participation in stroke survivors and “hard-return” suggests not only the tough process but also unsatisfactory results. Interventions targeted process ingredients seem to be potentially promising to improve stroke survivors’ social function outcomes.

(1) To determine associated factors of improved balance performance after a 10-week HiBalance intervention period, and (2) to determine effects of the programme on modifiable factors found above, considering both groups.

Pre-posttest substudy founded on the outcomes evaluation of an effectiveness-implementation trial.

Sixty-one participants were allocated the HiBalance training, while 56 were controls.

Participants received a 10-week, two times weekly, progressive balance training, that is, HiBalance intervention, led by physical therapists. The intervention was group based and gradually incorporated dual-tasking over the training period. Participants also performed, unsupervised, a 1×/week home exercise programme.

The Mini-Balance Evaluation Systems Test (Mini-BESTest) assessed balance performance, and those having improved by ⩾2 points were classified as positive responders. Balance confidence was the secondary outcome.

Fifty-three (87%) participants completed the intervention and 32 (60%) improved their balance scores by ⩾2 points in the intervention group, with 11 (24%) in the control group. The multivariable logistic regression analysis revealed two independently associated factors of improved balance, which included balance confidence (odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90–0.99) and attendance of ⩾80% of training sessions (OR = 10.10; 95% CI = 1.71–59.60). The final model demonstrated good fit and acceptable discrimination (area under the curve = 0.84). Secondary analysis revealed a fair relationship (Rho = 0.30; P = 0.044) between improvements in balance confidence and balance performance in the intervention but not control group.

Two personal factors were significantly associated with a higher likelihood of improvement in clinically measured balance performance. The HiBalance intervention appears to benefit those with lower balance confidence.