Physiotherapy Practice and Research

Clinical gait analysis of sagittal plane lower-limb kinematics using video images is a quantitative tool for clinicians. However, the reliability and validity of limb kinematics after stroke using video images has not been fully investigated.

This study aimed to examine the within-session inter-rater reliability and criterion-related validity of lower limb angles measured in sagittal plane images captured using a smartphone for assessing post-stroke gait and to determine which asymmetric parameters are associated with faster gait velocity.

Thirty-two patients with stroke were included; video images were recorded as they walked at their preferred pace for 1–3 cycles. Lower limb angles (contact, push-off, and excursion angles) and degree of asymmetry were determined based on video images using markers of acromion, greater trochanter, and fifth metatarsal head. Measurement reliability was calculated using the two-way random effects model of intraclass correlation coefficients and minimal detectable change. The criterion validity investigated Pearson’s correlation between lower limb angles and their asymmetry and gait velocity.

The lower value of the 95% confidence interval of intraclass correlation coefficients (2.3) of the lower limb was 0.891, and the maximum minimal detectable change was 9.6 degrees. Push-off angle showed a moderate-to-strong correlation with gait velocity, whereas the asymmetry of the push-off angle showed a weak correlation with gait velocity.

Assessing post-stroke gait utilizing video images using a smartphone is feasible. The push-off angle, in particular, may provide insight into the clinical assessment of post-stroke gait.

Although proprioceptive impairment is observed in about half of patients with stroke and is a factor affecting functional recovery and length of hospital stay, there is a discrepancy in terms of its measurement methods between physiotherapy research and the clinical field. This study aimed to examine the concurrent validity and reliability of knee proprioception using an electrogoniometer and a mobile app in patients with stroke.

In this cross-sectional study, we conducted proprioception tests with an electrogoniometer (custom-made device; Unimec, Japan) and an app (Goniometer Pro; 5fuf5, Bloomfield, NJ) in 28 hospitalized patients with stroke, with an average of 11.21 days (range 2–4 days) from the onset of stroke. Threshold to detect passive motion (TDPM), TDPM+muscle tendon vibration (MTV), and joint position sense (JPS) were used for proprioception tests. These tests were performed three times each in a random order, and the intraclass correlation coefficient, correlation, and absolute reliability for the electrogoniometer and the app were analyzed.

Both TDPM and TDPM+MTV measured by the electrogoniometer and the app showed high correlation and “good” to “excellent” reliability regarding the variation in measured values, indicating that the two instruments are compatible, while JPS showed “poor” to “moderate” reliability and weak correlation for the electrogoniometer and the app.

In conclusion, in patients with stroke, TDPM and TDPM+MTV measurements using the Goniometer Pro app can replace measurements with an electrogoniometer.

Motor impairments are common consequences in people with multiple sclerosis (PwMS). These impairments limit function independence and decrease activities of daily living. Focal muscle vibration (FMV) produces vibration signals affecting the central nervous system. No systematic review has been published investigating the effects of FMV on motor impairments in people with MS.

This review was conducted to investigate the effects of FMV in motor rehabilitation in PwMS.

PubMed, SCOPUS, REHABDATA, PEDro, CINAHL, EMBASE, MEDLINE, and Web of science were searched from their inception until May 2023. Studies were included if they were experimental studies, used FMV in PwMS, and evaluated motor impairments. Studies were excluded if they used other forms of vibration application (e.g., whole-body vibration) or used pharmacological treatments as a primary intervention. We evaluate the risk of bias using the Physiotherapy Evidence Database (PEDro) scale.

Five studies met our eligibility criteria. Three studies were randomized controlled trials, a clinical controlled trial (n = 1), and a pilot study (n = 1). A total of 123 participants were included in this review (Mean age = 47), 42.28% of whom were men. The PEDro scale scores ranged from three to eight. The findings revealed beneficial and non-beneficial effects of FMV on motor function in PwMS.

The FMV application is safe and well-tolerated in PwMS. The evidence for the impacts of FMV on motor impairments in PwMS was limited. Additional studies with long-term follow-ups are encouraged.

Physical activity plays an important role in management and preventing complications of type 2 diabetes mellitus (DM). Effectiveness of Pilates on DM showed that there was improvement in glucose control. Presently, resistance training forms are becoming very popular for weight loss and DM. Calisthenics is a relatively new form of resistance exercise training that has been less studied in obese and diabetic individuals.

To evaluate and compare the effect of Calisthenics and Pilates training approaches on percentage body fat and glycemic control (HbA1C, Post Prandial Blood Glucose (PPBG)) in overweight individuals with type 2 Diabetes mellitus (DM).

Thirty (n = 30) over weight individuals with type 2 DM with HbA1C levels >6.5% were recruited for the study. The participants were randomly allocated to calisthenics (CG) and Pilates (PG) study groups who received respective exercise interventions for 12 weeks. The outcome measures were HbA1C, PPBG and percentage body fat assessed at pre and post intervention.

Both CG and PG study groups showed statistically significant difference for glycemic control (HbA1C, PPBG) post 12 week intervention. However, significant improvement was noted in CG than PG in terms of HbA1c (p = 0.03), PPBG (P = 0.01) and body fat percentage (p < 0.0001).

Calisthenics exercise training was more effective than the Pilates training in achieving long term (HbA1c) and post meal (PPBS) glycemic control with significant reduction in body fat percentage in overweight individuals with type 2 DM.

The distortion of truth or “spin” has become a major concern in various fields as it can affect the accuracy of research dissemination. Recognizing the extent of this issue in physiotherapy research is essential for promoting good-quality research and raising awareness.

This study aimed to determine the prevalence of spin in randomized controlled trials (RCTs) published by Indian physiotherapists.

A Medline search was conducted to identify RCTs published by Indian physiotherapists from January 2000 to November 2018. We included studies with nonsignificant primary outcomes and reviewed them for spin in both abstracts and full texts using the Boutron checklist. Three reviewers were involved in the process.

Of the 44 RCTs with nonsignificant outcomes, 40 (90%) showed spin in their abstracts and 39 (88%) in their main text conclusions.

Our findings reveal a significant prevalence of spin in nonsignificant RCTs published by physiotherapy researchers. Improving research knowledge, enhancing scientific writing skills, and providing mentorship may help reduce spin in result reporting.

Hip fractures are a life changing injury for many; often patients sustaining a hip fracture do not regain their pre-injury function. Early rehabilitation improves patient outcomes (e.g. Mobility, independence & function).

The aim of this study was to investigate whether patients with hip fracture progressed differently depending on their surgery type, specifically whether arthroplasty or internal fixation (IF) was employed as part of the surgical management.

A prospective audit was completed on hip fracture patients presenting to our unit between October 2019 and October 2020 who received surgical intervention for their fracture. The audit collected data on patient outcomes, specifically Timed Up and Go scores (TUG), Discharge destination and Cumulative Ambulatory Scores. The study group comprised 89 patients with femoral neck fractures (60 females, 29 males). The average age was 77 (range 50–96) years. Sixty-nine patients were managed with an arthroplasty, 20 patients were managed with IF.

Results from this audit highlighted that at discharge, TUG scores had improved in both groups with the arthroplasty group completing their TUG in a mean of 46 seconds (median 39 seconds) and the IF group in a mean of 55.7 seconds (median 46 seconds). Eleven (55%) of the patients treated with IF were discharged home directly, while 26 (38%) of the patients treated with an arthroplasty were discharged home directly. Hip fracture patients treated with arthroplasty had lower functional ability on day one post-operatively based on the CAS. Patients treated with arthroplasty showed greater improvement in function and mobility at the time of discharge when compared to the IF group. A greater proportion of the IF group were discharged directly home (55% vs 38%) and able to receive any ongoing rehabilitation as an outpatient while a greater portion of the arthroplasty group required further inpatient rehabilitation (35% vs 48%).

This audit indicated that irrespective of surgical intervention (Arthroplasty or IR) there is little difference in patient outcomes in the post-operative period.

Muscle energy technique (MET) is a voluntary contraction of a patient’s muscle in a predetermined direction, at varying levels of intensity. Its commonly used as a treatment option in musculoskeletal rehabilitation. This study aims to investigate the effectiveness of MET in the treatment of people with musculoskeletal injuries with particular emphasis on flexibility, range of motion (ROM), and function.

Scopus (via Science Direct), CINAHL via (EBSCO), Embase (via OvidSP), PubMed, and PEDro were searched using specified keywords to select randomized controlled trials that assessed the effect of MET on flexibility, ROM, or function in patients with musculoskeletal disorders. Two authors extracted all related information from the included trials and presented them in an excel spreadsheet. Two other authors independently conducted the quality assessment. Meta-analysis was performed where homogeneity (similirty regarding population and outcomes) was sufficient and required data were available.

A total of 42 studies were included. Yet, twelve joined the meta-analysis where six comparisons were conducted. Of them, four comparisons were composed of two trials, one comparison consisted of six, and another one was composed of four. No statistically significant differences were observed between MET and other comparators regarding function and ROM, especially in patients with low back or neck pain. MET was statistically significantly better than control or sham interventions on the flexibility of patients with sacroiliac joint (SIJ) problems.

MET can produce better flexibility than placebo and control interventions in patients with SIJ problems. MET is not better than other interventions regarding function and ROM. Although the existence of multiple trials testing the effectiveness of MET, there is obvious heterogeneity. There is no sufficient evidence to reliably determine the clinical effect of MET in practice.

The trapeziometacarpal or first carpometacarpal (CMC) joint is the second most common joint affected in osteoarthritis (OA) of the hand. Surgical intervention may be required when conservative measures fail to alleviate symptoms.

To investigate operative and post-operative management of trapeziometacarpal osteoarthritis in Ireland.

An on-line Qualtrics survey was used to determine practice patterns of hand surgeons and therapists including surgical technique, patterns of referral to therapy, treatment protocol and perceived pain impact.

Twenty surgeon’s responses were received. Trapeziectomy with Ligament Reconstruction and Tendon Interposition (LRTI) was the most common procedure for all stages of arthritis for sedentary and manual patients. Sixty seven percent (n = 18) stated they perform an additional procedure if stage IV arthritis is present. Eighty percent (n = 16) stated they would perform an additional procedure for MCP joint hyperextension.

There were 28 therapist responses. Almost all respondents indicated that patients are initially casted post-surgery with 88% (n = 24) indicating they remain casted for 1-2 weeks. A rigid long thumb spica and neoprene splint are most commonly used. The commencement of exercises differed between respondents and surgical procedures. All participants stated that pain is an issue in the rehabilitation of these patients.

There was consistency in the surgical procedure choice. The stage of arthritis and functional level of the patient was not found to be an important factor for choosing this procedure. There is some consensus for post-operative casting and splinting but more variability in terms of exercise prescription. Pain is a factor to consider post-operatively.

Running-related injuries (RRI) are common among recreational runners, but research exploring lived experiences of a RRI is limited.

This study aimed to explore the psychosocial aspects experienced by recreational runners hindered in usual running because of RRI.

Individual semi-structured interviews based on a qualitative phenomenological methodology explored injured recreational runners experiences, reactions, thoughts, and feelings. Systematic text condensation was used as the analysis method.

Three main codes were identified: Reasons for running: ‘Calm for me is a feeling of my body just relaxing. It may sound a bit weird because you run, but it is kind of a feeling of just being able to unplug‘, Daily life during an injury - besides running: ‘When I couldn’t run at all, it was super annoying. Several months it was completely empty. It was like there was a hole. There seemed to be missing something because I usually ran‘, Running while injured: ‘Do I feel pain? Or is it something else? And should I navigate regarding the length of the route and where I run, how fast I run, and with whom I run? ‘.

The recreational runners experiences explored in this study support the importance of bio-psycho-social awareness when physiotherapists meet runners hindered in usual running because of RRI.

The evaluation and treatment of patients with low back pain (LBP) often involve categorization based on movement direction. However, it is not certain whether the lumbar spine and hip motion angles are associated with movement direction in individuals with LBP.

The purpose of this study was to verify whether the motion angles of the lumbar spine and hip joint are associated with the movement direction in individuals with LBP.

Participants were recruited as volunteers at the authors’ institutions. In this cross-sectional observational study, participants were divided into two groups: those without LBP and those with LBP. To measure lumbar spine and hip motion angles in clinical movement tests (trunk forward bending and prone hip extension), those with LBP were divided into a flexion LBP group and an extension LBP group. Wearable sensors were used to measure lumbar spine and hip motion angles.

Participants with LBP had a greater hip motion angle in the early stages of movement than that of those without LBP; this was associated with the movement direction in which pain appeared.

In individuals with LBP, the motion angles of the lumbar spine and hip joint are associated with the movement direction. Therefore, this pain subgroup and associated movement direction should be considered when evaluating and treating individuals with LBP.

Low back pain (LBP) is a leading cause of disability worldwide. A spectrum of psychological conditions such as anxiety, fear, stress and low mood are often reported to co-occur in individuals with persistent back pain and are cited as reasons for the continued experience of pain. However, any potential causal effect of emotional distress on new onset LBP is understudied. Therefore, the aim of this review is to examine the impact of emotional distress as a risk factor for new presentations of acute low back pain.

A systematic review was performed in accordance with the PRISMA guidelines. The Medline, Embase and APA databases were searched for primary research articles exploring emotional distress and low back pain. Prospective studies that investigated subjects initially free from back pain, who also undertook some form of psychometric testing at baseline, were included in the review. In total, 6 studies were identified with a broad geographical spread and diverse population cohorts including pregnant women, forestry workers, nursing students, adolescents, individuals with medical comorbidities and adult population studies.

The results from all six studies found a significant relationship between an initial presence of emotional distress and subsequent onset of acute low back pain.

This review encourages the acknowledgement of underlying emotional distress as a risk factor in acute low back pain, and to address it as part of the overall management plan.

The study aimed to determine the clinical and functional status of patients with chronic low back pain (CLBP) due to facet joint arthrosis (FJA) and to examine the relationship, if any, between pain beliefs and clinical and functional status.

This descriptive, cross-sectional study involved patients who had been diagnosed with CLBP due to mild to moderate FJA. The participants were evaluated using the Numeric Pain Rating Scale (NPRS rest and activity), the Oswestry Disability Index (ODI), the Short-Form Quality of Life Index 12 version 2 (SF-12v2; PCS and MCS) and the Pain Beliefs Questionnaire (PBQ). Statistical analyses were performed using SPSS.

This study involved 58 patients (28 females and 30 males) with a mean age of 52.12±4.64 years. The reported pain intensity was 1.93±1.52 at rest and 5.10±1.10 during activity, while the ODI was 24.59±6.61. The MCS was higher than the PCS, with mean scores of 43.52±5.86 and 38.97±5.01, respectively. The participants had higher scores for organic pain beliefs (3.81±0.51) than for psychological pain beliefs (3.35±0.69). A weak positive correlation was found between psychological pain beliefs and functional status (r = 0.336; p = 0.010).

Patients with CLBP due to FJA experienced mild pain at rest, moderate pain during activity, and moderate functional disability. Participants with stronger psychological pain beliefs exhibited a higher level of functional disability. Addressing pain beliefs may help to improve functional outcomes.

The pathophysiology of adhesive capsulitis may be associated with increased neural mechanosensitivity in upper limb neurodynamic test.

To investigate the findings of neurodynamic assessment in patients with more than four month history of adhesive capsulitis.

Thirty-five patients with more than four month history of adhesive capsulitis were participated in this study. A physiotherapist performed the Upper Limb Neurodynamic test 1 procedure on the participant’s upper limb. Elbow extension range of motion at the end of the Upper Limb Neurodynamic test 1 was compared with the participant’s elbow extension at the end of Upper Limb Neurodynamic test 1 performed on the opposite upper limb and to elbow extension on the symptomatic side performed with the arm by the side.

The intensity of pain in Upper Limb Neurodynamic test 1 increased with lateral flexion of the neck to the unaffected side and eased with lateral flexion to the affected side in all participants. A marked restriction of the elbow passive extension range of motion in Upper Limb Neurodynamic test 1 on the affected side (–54.6±17.8°) compared to the unaffected side was found (–7.3±10.7°) (p < 0.001).

Restriction of elbow passive extension range of motion at the end of the Upper Limb Neurodynamic 1 test reproduced patients’ familiar adhesive capsulitis associated pain and the pain changed with structural differentiation using cervical lateral flexion. Neurodynamic assessment may need to be considered to assess neural mechanosensitivity in patients with adhesive capsulitis.

To investigate the test-retest reliability, side-to-side difference, responsiveness, and concurrent validity of skin blood flow (SkBF) measured by laser Doppler flowmetry (LDF) in individuals with acute or subacute lateral elbow tendinopathy (LET).

Eighteen individuals with acute or subacute LET were recruited for this study. SkBF was measured over the lateral epicondyle and common extensor origin on both ipsilateral and contralateral sides. The intraclass correlation coefficient (ICC_3,1) was used to evaluate test-retest reliability. A paired t-test was used for comparing the side-to-side difference. Responsiveness was reported with a change score, paired t-test, effect size (ES), and standardized response mean (SRM). The concurrent validity of SkBF was investigated by correlating with a visual analog scale (VAS) pain intensity during resisted wrist extension isometric contraction using the Spearman correlation coefficient.

Test-retest reliability was good at lateral epicondyle (ICC_3,1 = 0.899), and at common extensor origin (ICC_3,1 = 0.803). A side-to-side difference was found between the two sides (p < 0.001). For responsiveness, the change score for SkBF at the lateral epicondyle was – 8.04, and the common extensor origin was – 3.54. The ES and SRM ranged from – 0.71 to – 0.78. Concurrent validity was reported with a strong correlation with pain intensity (r = – 0.637).

SkBF is a reliable and responsive variable for investigating the elbows with acute or subacute LET providing clinical information according to its inflammatory responses. However, the concurrent validity can be found only for SkBF at common extensor origin, which correlates with pain during resisted wrist extension isometric contraction.

Knee Osteoarthritis is a common degenerative joint disease associated with significant walking-related disability. Impaired gait mechanics can lead to an increase in energy expenditure and impaired energy recovery, causing an increase in perceived fatigue resulting in functional decline. However, despite the association of performance fatigability with negative health outcomes and walking-related disability, it is still not well understood in patients with knee osteoarthritis.

The study conducted a cross-sectional comparison between 20 participants with knee osteoarthritis (OA) classified as grade III or less on the Kellgren classification, and a control group of 20 healthy individuals matched in age, weight, height, body mass index (BMI) and gender. A six-minute walk test (6MWT) was used as an outcome measurement tool, and distance, gait velocity, and walking-related performance fatigability were calculated. SPSS version 21 was used to analyze the data, and the normality of the data was determined using the Shapiro-Wilk test. For normally distributed data, the independent t-test was employed, while the non-normally distributed data was analyzed using the Mann-Whitney U test.

No significant differences (p > 0.05) were observed between healthy controls and participants with knee OA in terms of age, weight, height, and BMI. However, significant differences (p < 0.05) were observed in total distance covered in 6 minutes, distance covered in each minute, gait velocity and walking-related performance fatigability. Persons with knee OA demonstrated greater fatigability and lesser gait velocity and distance covered during the 6MWT.

Individuals with knee OA exhibited greater fatigability and lower gait velocity and distance covered during the 6MWT.

Cervical spine dysfunction has been shown to cause symptoms of dizziness and vertigo in patients, due to its connection to the vestibular system. There is a sparsity of prospective studies describing the prevalence of cervical involvement in these patients.

To identify the prevalence of cervical mobility restrictions in patients with symptoms of dizziness and vertigo prospectively.

Eighty-two subjects referred to physical therapy were assessed for mobility restrictions from the Atlanto-occipital joint to the level of C5 using evidenced-based manual techniques. These techniques included the seated and supine cervical flexion rotation tests and posterior to anterior joint mobility assessments.

The prevalence of cervical mobility restrictions was 72% overall. Restrictions were found in 70% of those referred for dizziness/vertigo, 64% with benign paroxysmal positional vertigo (BPPV) and 90% of those referred for concussion. None of the referring providers had considered cervical involvement prior to making the referral.

Afferent input from the muscles, joint and connective tissues in the cervical spine can cause the symptoms associated with dizziness, vertigo and concussion. This prospective study demonstrates the high prevalence of cervical mobility restrictions in these patients. This study provides much needed evidence for the need for early manual assessment of the cervical spine and surrounding structures if an appropriate rehabilitation program is to be designed. Physical therapists, athletic trainers and those who care for patients with complaints of dizziness, vertigo, BPPV or concussion should assess their patient for mobility restrictions early on in the evaluation process and treat accordingly.