Clinical Rehabilitation

To consolidate the evidence on the effect of physical exercise on fear of falling in individuals with stroke.

PubMed, CINAHL, Cochrane Database and MEDLINE

An extensive database search was conducted to identify the randomised controlled trials that examined the effect of physical exercise on fear of falling post-stroke. Grading of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence for each meta-analysis.

Fourteen trials totalling 1211 participants were included in this review. Thirteen of these (1180 participants) were included in the meta-analyses. In the primary analysis, very low-quality evidence suggested that exercise reduced fear of falling post-stroke (standardized mean difference (SMD) 0.48; 95% confidence interval (CI) 0.23 to 0.72). The effect was diminished at three- to six-month follow-up after exercise training ended (SMD −0.09; 95% CI −0.27 to 0.10; high-quality evidence). In the sensitivity analyses, the treatment effect was more pronounced in individuals with a lower baseline Berg balance score (BBS ≤45; SMD 0.53; 95%CI 0.17 to 0.88) and for those trials with exercise frequency of ≥3 sessions per week (SMD 0.70; 95%CI 0.39 to 1.01). Compared with circuit-based training consisting of a combination of walking, balance and strengthening exercises (SMD 0.27; 95% CI −0.09 to 0.63), walking programmes seemed to generate a larger effect on fear of falling (SMD 1.06; 95%CI 0.43 to 1.70).

Physical exercise was beneficial for reducing fear of falling in individuals with stroke, particularly those with poorer balance ability.

To determine the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for people with incomplete spinal cord injury.

PubMed, Embase, Web of Science, PEDro, CENTRAL and CINAHL were searched from inception until September 4, 2022. Randomized controlled trials that evaluated the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury were selected. Mean differences (MD) with 95% confidence interval (CI) were calculated. The methodological quality was evaluated by the Cochrane Risk of Bias 2.0 tool. Subgroup analyses were conducted according to the time since injury.

In total 19 studies involving 770 patients were eligible for analysis. Individuals with acute incomplete spinal cord injury in robotic-assisted gait training groups showed significantly greater improvements in 6-minute walking test (MD 53.32; 95% CI 33.49 to 73.15; P < 0.001), lower extremity motor scale (MD 5.22; 95% CI 3.63 to 6.80; P < 0.001) and walking index for spinal cord injury II (MD 3.18; 95% CI 1.34 to 5.02; P < 0.001). Robotic-assisted gait training improved peak oxygen consumption to a greater degree for chronic incomplete spinal cord injury patients (MD 4.90; 95% CI 0.96 to 8.84; P = 0.01).

Robot-assisted gait training may be a feasible and effective intervention in terms of cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury.

To examine the efficacy and safety of aquatic exercise for people with knee osteoarthritis.

PubMed, Web of Science, Embase, CENTRAL, CNKI and WanFang databases were searched from 1966 to September 2022.

Randomized controlled trials evaluating aquatic exercise for people with knee osteoarthritis compared with no exercise and land-based exercise were included. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the certainty of evidence.

Twenty-two studies with 1394 participants were included. Compared with no exercise (13 trials with 746 participants), low-to high-certainty evidence revealed that aquatic exercise yielded significant improvements in patient-reported pain (SMD −0.58, 95% CI −0.82 to −0.33), stiffness (SMD −0.57, 95% CI −1.03 to −0.11) and physical function (SMD −0.35, 95% CI −0.52 to −0.18) immediately postintervention. A sustained effect was observed only for pain at three months postintervention (SMD −0.48, 95% CI −0.91 to −0.06). The confidence intervals demonstrated that the pooled results do not exclude the minimal clinically important differences. There were no significant differences between the effects of aquatic exercise and land-based exercise (13 trials with 648 participants) on pain (SMD −0.12, 95% CI −0.29 to 0.04), stiffness (SMD −0.17, 95% CI −0.49 to 0.16) or physical function (SMD −0.13, 95% CI −0.28 to 0.02). No study reported a serious adverse event in relation to aquatic exercise.

Aquatic exercise provides a short-term clinical benefit that is sustained for at least three months postintervention in terms of pain in people with knee osteoarthritis.

This systematic review and meta-analysis aimed to evaluate the effect of respiratory muscle training on respiratory muscle strength, lung function, cardiopulmonary fitness, and quality of life for chronic kidney disease patients.

PubMed, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials published randomized controlled trials that evaluated the effect of respiratory muscle training for chronic kidney disease patients from inception to December 2021, and rerun on September 2022. The quality of included studies was evaluated according to the Cochrane Collaboration's risk of bias tool-2. The outcomes were analyzed as mean differences with a fixed/random effect model. The strength of evidence was evaluated with the Grading of Recommendation, Assessment, Development, and Evaluation approach.

Eleven randomized controlled trials were included. All but two of the studies were in hemodialysis patients. The follow-up time range was 4 to 12 weeks. Compared to controls, respiratory muscle training significantly improved maximal expiratory pressure (mean difference = 17.36, p = 0.013), maximal inspiratory pressure (mean difference = 18.26, p = 0.002), forced expiratory volume at 1 second (mean difference = 0.20, p= 0.020), forced vital capacity (mean difference = 0.26, p = 0.008), but not for 6-minute walk test (mean difference = 39.85, p= 0.138).

As a non-pharmacological therapy, respiratory muscle training can effectively improve maximal expiratory pressure, maximal inspiratory pressure, forced expiratory volume at 1 second, and forced vital capacity in patients with chronic kidney disease and is safe for such populations.

To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI).

Two-arm, parallel-group, randomized, double-blind, controlled trial.

60 patients with unilateral CAI.

integral physiotherapy (n = 30) or conventional physiotherapy (n = 30).

Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention.

The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (mean_integral = 20.14 (14.95–25.37), mean_Conventional = 29.46 (24.09–34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05).

Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients’ functional ability.

To estimate the cost-consequence of treating spasticity early with botulinum toxin in the acute stroke unit.

Secondary cost-consequence analysis, using data from a double-blind randomised-controlled trial.

Single-centre specialised stroke unit.

Patients with Action Research Arm Test grasp-score of <2 and who developed spasticity within six weeks of a first stroke were randomised to receive injections of: 0.9% sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment).

Resource use costs were calculated for the study. Mean contracture costs for each group were calculated. The Barthel Index and Action Research Arm Test were used to generate a cost per unit of improvement.

There were no significant differences associated with early treatment use. The mean contracture cost for the treatment group was £817 and for the control group was £2298 (mean difference = −£1481.1(95% CI −£2893.5, −£68.7) (p = 0.04). The cost per unit of improvement for the Barthel Index was −£1240 indicating that the intervention costs less and is more effective. The cost per unit of improvement for the Action Research Arm Test was −£450 indicating that the intervention costs less and is more effective.

Treating spasticity early in stroke patients at risk of contractures with botulinum toxin leads to a significant reduction in contracture costs. The cost per improvement of Barthel and Action Research Arm Test indicates that the intervention costs less and is more effective.

EudraCT(2010-021257-39) and ClinicalTrials.gov-Identifier:NCT01882556.

Investigate feasibility and acceptability of prism adaptation training for people with inattention (spatial neglect), early after stroke, during usual care.

Phase II feasibility randomised controlled trial with 3:1 stratified allocation to standard occupational therapy with or without intervention, and nested process evaluation.

Ten hospital sites providing in-patient stroke services.

Screened positive for inattention more than one-week post-stroke; informal carers. Occupational therapists participated in qualitative interviews.

Adjunctive prism adaptation training at the start of standard occupational therapy sessions for three weeks.

Feasibility measures included recruitment and retention rates, intervention fidelity and attrition. Outcomes collected at baseline, 3 weeks and 12 weeks tested measures including Nottingham Extended Activities of Daily Living Scale. Acceptability was explored through qualitative interviews and structured questions.

Eighty (31%) patients were eligible, 57 (71%) consented, 54 randomised (40:13, +1 exclusion) and 39 (74%) completed 12-week outcomes. Treatment fidelity was good: participants received median eight intervention sessions (IQR: 5, 12) lasting 4.7 min (IQR: 4.1, 5.0). All six serious adverse events were unrelated. There was no signal that patients allocated to intervention did better than controls. Twenty five of 35 recruited carers provided outcomes with excellent data completeness. Therapists, patients and carers found prism adaptation training acceptable.

It is feasible and acceptable to conduct a high-quality definitive trial of prism adaptation training within occupational therapy early after stroke in usual care setting, but difficult to justify given no sign of benefit over standard occupational therapy.

https://www.isrctn.com/ Ref ISRCTN88395268.

Stroke is a disabling, long-term condition that challenges the mental and physical health of stroke-survivors concurrently with their primary family-caregivers (dyad). However, there has been a lack of emphasis on this dyadic need. Thus, this study aims to investigate the impacts of two interventions on hope, self-esteem and hedonic wellbeing on depression among the stroke-survivor–caregiver dyad.

This randomized-controlled-trial applied the actor–partner interdependence model to 100 randomly-selected dyads (N = 200) of stroke-survivors, mean (SD) age was 73.63(7.22) and family-caregivers, mean (SD) age was 62.49(14.44) years, recruited from Hong Kong hospitals and rehabilitation centres. The intervention was eight-weekly two-hour narrative therapy group sessions (n = 54 dyads), compared with the current model of psychoeducational group to each dyad as needed. Outcomes were collected via questionnaires and interviews, at four time-points: baseline (T₁), during-intervention (T₂) (1-month), immediately post-intervention (T₃) (2-months) and follow-up (T₄) (6-months).

The results demonstrated that there are actor effects on stroke-survivors (β = −0.353, p < 0.05) and caregivers (β = −0.383, p < 0.05), where higher levels of hedonic wellbeing were associated with fewer depressive symptoms. Partner effects were observed as caregivers’ depressive symptoms were possessing a significant negative relationship with stroke survivors’ wellbeing (β = −0.387, p < 0.05). Those stroke survivors in the intervention group had a significantly higher level of self-esteem associated with lower levels of depression (β = −0.314, p < 0.05).

Improving hope, self-esteem and wellbeing through narrative therapy significantly mediates depressive symptoms, strengthening the dyadic support of stroke survivors and family caregivers.

To identify the best internal structure of the Tampa Scale for Kinesiophobia in chronic low back pain patients.

Questionnaire validation study was designed for this study.

This study was conducted in physical therapy facility.

Respondents reporting chronic low back pain (≥3 points on the 11-point Numerical Pain Rating Scale).

We included participants of both sexes, with a self-report of low back pain ≥3 months and with pain intensity ≥3 on the 11-point Numerical Pain Rating Scale; participants also answered the Roland–Morris Disability Questionnaire and the Pain-Related Catastrophizing Thoughts Scale for low back pain disability and catastrophizing, respectively. The dimensionality and number of items of the Tampa Scale for Kinesiophobia were evaluated using the confirmatory factor analysis. Criterion validity was assessed using Spearman’s correlation coefficient using the original version of the 17-item Tampa Scale for Kinesiophobia as the gold standard.

A total of 122 participants were included, with mean values of low back pain duration ≥48 months, pain intensity >5 and disability >8. Tampa Scale for Kinesiophobia structure with two domains and nine items was the most suitable, with adequate values in all fit indices (Chi-square/degree of freedom <3, Comparative Fit Index and Tucker–Lewis Index >0.90, and root mean square error of approximation <0.08) and lower Akaike information criterion and Bayesian information criterion values. We observed a high correlation between the 17-item Tampa Scale for Kinesiophobia and the activity avoidance domain (rho = 0.850, P < 0.001) and somatic focus domain (rho = 0.792, P < 0.001) of the nine-item Tampa Scale for Kinesiophobia.

Tampa Scale for Kinesiophobia structure with two domains (activity avoidance and somatic focus) and nine items is the most suitable for patients with chronic low back pain.

To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions.

Systematic review.

Individuals with neurological conditions.

Not applicable.

The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale.

From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as “sufficient” in a study with appropriate methodological quality (“very good” or “adequate”). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended.

The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated.

CRD42021257662.