Chronic pain is a leading global cause of disability. There is evidence supporting the efficacy of virtual reality (VR) interventions for improving pain and function in patients with chronic pain. However, use of VR in physiotherapy practice remains limited. This study examined the pre-implementation barriers and facilitators experienced by physiotherapists working in Germany when implementing VR for chronic pain management in outpatient settings. Physiotherapists participating in a VR implementation study were interviewed using semi-structured interviews. The interviews were transcribed and analyzed using qualitative content analysis. The identified barriers and facilitators were categorized into domains of the Theoretical Domains Framework. Based on the interviews with nine physiotherapists, the pre-implementation key barriers included environmental barriers, such as time limitations and lack of insurance reimbursement, knowledge barriers in relation to chronic pain management and VR content, professional role barriers, such as VR being perceived as outside the scope of physiotherapy and decision-making barriers, such as patient selection. The primary facilitators were environmental opportunities, such as VR being a unique asset of the practice or a dedicated area for VR therapy. Additional facilitators included positive expectations for the rehabilitation process and the belief that VR is an opportunity of growth for physiotherapy as a profession. Physiotherapists recognize the therapeutic potential of VR, but anticipate significant implementation challenges related to environmental restrictions, knowledge gaps, and professional role conflicts. However, they also identified potential facilitators, such as VR's unique assets for practices and its benefits for patient empowerment and professional advancement. Successful adoption requires multifaceted strategies that address reimbursement policies, provide enhanced training in areas such as pain neuroscience and VR applications, and facilitate workflow integration. Future research should validate these findings across diverse healthcare systems to support the integration of VR in chronic pain care. The study was registered with the German Clinical Trials Register on April 14, 2023 (ID: DRKS00030862).
Frozen shoulder (FS) is characterized by a multifactorial progression, often worsened by metabolic factors such as diabetes. Effective management may require a multidisciplinary approach that includes therapeutic exercise, physiotherapy, metabolic control, psychological support, and healthy lifestyle interventions. However, current evidence remains fragmented and predominantly focused on isolated domains, with limited integration of these factors within a biopsychosocial framework. The aim of this study was to comprehensively evaluate the influence of exercise-based interventions, as well as metabolic, psychological, and lifestyle-related factors, on clinical outcomes, including pain, function, range of motion, and quality of life, in patients with FS. This systematic review with meta-analysis, reported following the PRISMA guidelines, included 31 studies published between 2010 and 2024, comprising randomized controlled trials, observational studies, Mendelian randomization studies, and qualitative studies. MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Scopus were searched until April 2025. The risk of bias was assessed according to study design. The Cochrane Risk of Bias tool (RoB 1) was used for randomized controlled trials. Observational studies (including cross-sectional, case-control, and cohort studies) were assessed using the Newcastle-Ottawa scale (NOS). Mendelian randomization studies were evaluated using established methodological quality criteria for MR studies, including the assessment of instrument validity, pleiotropy, and heterogeneity. Qualitative studies were appraised using appropriate qualitative assessment criteria. The certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Twelve studies evaluated physical interventions. Global effect summary of exercise versus control showed a small but statistically significant benefit favoring exercise (standardized mean difference [SMD], Hedges' g = 0.10; 95% CI 0.05-0.15) across clinical outcomes, particularly pain, function, and range of motion. Associations between FS and metabolic parameters (e.g., triglycerides, glucose, and HbA1c) were identified in 12 studies, although these results were synthesized narratively and no pooled effect estimates (e.g., odds ratios) were calculated due to heterogeneity. Seven studies showed that anxiety was consistently associated with FS severity, with potential impact on pain, functional outcomes, and quality of life, although this relationship may depend on sample characteristics. The risk of bias was low in exercise-related studies, unclear in those on quality of life, and high in metabolic studies. Overall, the certainty of evidence was rated as very low due to the risk of bias, heterogeneity, and imprecision. Evidence supports a multifactorial, biopsychosocial model for FS. Exercise-based interventions were associated with small improvements in pain, function, and range of motion, while metabolic dysfunction and anxiety were identified as factors associated with FS severity. However, the certainty of evidence was very low and findings should be interpreted with caution due to high heterogeneity and methodological variability across studies. Future research should prioritize integrated, multidisciplinary strategies to improve FS treatment.
Diabetic Peripheral Neuropathy (DPN) is a multifaceted complication characterized by pain, numbness, tingling, gait and balance impairments, and autonomic dysfunction, all of which compromise functional independence and quality of life. Existing quantitative tools, though widely used, often fail to capture the complexity of patients' lived experiences and the nuanced effects of therapeutic interventions. To address this gap, this study aimed to develop and validate a semi-structured interview guide that explores the functional and psychosocial domains most affected in individuals with DPN, with a particular emphasis on physiotherapy advancements. A six-domain interview guide was constructed using a Delphi survey method. The identified domains were: (1) Pain and Other Symptoms, (2) Activities of Daily Living, (3) Balance, (4) Walking, (5) Autonomic Changes, and (6) Social Participation. Each domain comprised an open-ended lead question supported by probes to facilitate rich, detailed narratives. Content validation was undertaken by a panel of seven experts using a structured validation form. Based on expert feedback, iterative refinements were made until consensus was achieved. The finalized interview guide demonstrated excellent content validity, with a Scale-Level Content Validity Index (S-CVI/Ave) of 0.975 and Item-Level Content Validity Index (I-CVI) scores ranging from 0.85 to 1.0, indicating strong agreement on relevance and clarity across all domains. This interview guide offers a culturally sensitive and scientifically sound tool for capturing patient perspectives on physiotherapy in DPN. By bridging the limitations of quantitative measures, it provides valuable insights for clinical practice, research, and policy, advancing person-centered and holistic care. CTRI/2023/12/060929 (Registered on: 29/12/2023).
As a part of the Irish Comparative Outcome national cohort study of childhood CF, this cross-sectional study investigated challenges faced by parents of children with CF (CWCF) in the Republic of Ireland using a newly validated modified tool. Parents completed the modified "Challenge of Living with Cystic Fibrosis-Short Form" (CLCF-SF), developed to determine caregiver burden for parents of CWCF, with limited items (N = 15) to complete. Linear regression examined associations between CLCF-SF scores and demographic and clinical factors. 263 of 357 (73.6%) responded. Parents reported marginal to great difficulty in balancing daily lives and CF care (31%), managing extra expenses (46.8%), and establishing care routines (76.5%). Parents felt supported by medical teams. Parents of younger children reported more difficulties juggling CF demands with family needs (39.3% vs 25.0%), a more stressful family lifestyle (51.4% vs 39.1%). A greater proportion of parents of older CWCF (48.1% vs 28%) and of CWCF on CFTR modulator therapy (45% vs 27%) reported moodiness. Cronbach's α was 0.87, indicating very good internal consistency. This was the first use of the modified CLCF-SF in a population setting. High response rates indicate ease of completion. This study provides an assessment of internal consistency, usability, and performance of the modified version of the new tool; the need for age-adequate financial and psychological support is highlighted.
Major depressive disorder (MDD) is a prevalent mental illness characterised by persistent sadness, loss of interest in activities and cognitive impairment. While pharmacological and psychotherapeutic treatments remain the standard for MDD management, non-pharmacological interventions, such as aerobic exercise, have gained attention for their potential benefits in reducing depressive symptoms and improving quality of life. Although several studies have explored the effectiveness of aerobic exercise in managing MDD, there is still no comprehensive synthesis of the existing evidence. This study aims to synthesise existing evidence on the effects of aerobic exercise interventions in the management of individuals diagnosed with MDD. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive search will be conducted across Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science and BioMed Central databases. Search terms will be developed using the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework, incorporating keywords and Medical Subject Headings related to 'Major Depressive Disorder', 'Aerobic Exercise', 'Depression', and 'Quality of Life'. Only intervention studies, including randomised controlled trials, quasi-experimental and pre-post intervention studies, will be included involving adults aged 18 years or older diagnosed with MDD according to standardised criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Statistical Classification of Diseases and Related Health Problems -10 (ICD-10)). For included intervention studies, the comparator will be standard care, placebo or no-exercise control groups. The primary outcome is change in depressive symptoms, and secondary outcomes include quality of life, anxiety and stress-related biomarkers. Three independent reviewers will screen studies, extract data using Covidence software (Veritas Health Innovation in partnership with Cochrane) and assess study quality using the updated Cochrane Risk of Bias 2.0 (Rob-2) tool alongside the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. If feasible, a meta-analysis will be conducted using RevMan V.5.4 (Cochrane's Review Manager), with effect sizes determined by mean differences, standardised mean differences or ORs, depending on the outcome type. This study is currently at the proposal stage, with article searches expected to begin in November 2025 and data extraction anticipated to be completed by January 2026. No ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences. CRD420251151897.
Accurate assessment of shoulder range of motion is essential for clinical decision-making in physiotherapy. While visual estimation of joint angles is commonly used in practice, its agreement with objective reference measurements under clinically relevant conditions remains unclear. This study aimed to assess the agreement between video-based expert visual estimation of shoulder abduction and three-dimensional (3D) motion capture as a reference standard. A cross-sectional method comparison study was conducted. Shoulder abduction movements of four healthy participants were recorded using a 3D motion capture system. Twenty-four video recordings were presented to experienced physiotherapists (≥ 10 years of clinical experience), who visually estimated joint angles via an online questionnaire. Differences between estimated and reference values were analysed using descriptive statistics, Bland-Altman analysis, and cross-classified mixed-effects modelling to account for repeated measurements across raters and video stimuli. A total of 923 paired observations from 33 experts were analysed. Visual estimation showed a consistent tendency toward overestimation, with a mean difference of 14.7° (SD 11.6°) and limits of agreement ranging from - 8.0° to 37.5°. A cross-classified mixed-effects model estimated a mean bias of 14.5° (95% CI 11.8° to 17.3°), confirming systematic overestimation. Most estimates (89.9%) exceeded the reference value. Variability was substantial, with 27.3% of variance attributable to differences between video stimuli and 10.5% to differences between raters. Visual estimation of shoulder abduction angles by experienced physiotherapists showed limited agreement with a 3D motion capture reference and a consistent tendency toward overestimation. Given the observed variability, visual estimation alone may be insufficient for accurately detecting small changes in joint angle. The use of objective measurement tools may support more reliable assessment in clinical practice.
The increasing frequency of emergencies, disasters, and humanitarian crises underscores the need for a health workforce adequately prepared to respond across disaster management continuum. Within this context, physiotherapists play an essential role in post-disaster care, yet evidence on students' readiness for emergency, disaster, and humanitarian action (EDHA) remains limited. This study aimed to develop and content-validate an assessment tool and examine physiotherapy students' predisposition, perceived competence, and readiness to assume functional roles in EDHA contexts. A two-phase study was adopted. Phase 1 comprised instrument development, including a 12-item questionnaire organized into three conceptual domains assessing predisposition, perceived competence, and readiness to assume functional roles in EDHA contexts. Content validation was performed using a two-round expert panel process with 12 experts, and pre-testing. Phase 2, a cross-sectional design, involved administering the final questionnaire to 126 undergraduate physiotherapy students from six Portuguese higher education institutions. The instrument demonstrated excellent content validity (S-CVI/Ave = 0.98). Although a majority of students reported interest in EDHA contexts (61.9%), only 35.7% felt adequately prepared. Results from the assessment tool showed high self-reported interpersonal preparedness, with 96.8% of students rating empathy and 92.9% collaboration as "good" or "very good." In contrast, 57.2% reported positive ratings for leadership. A substantial competence gap was observed in technical domains: 60.3% of participants considered themselves not or only slightly capable of delivering specialized rehabilitation training, and 42.1% reported low confidence in training peers to identify rehabilitation needs. Similarly, low perceived competence was reported in psychological first aid and burn management. Predisposition to work in disaster contexts did not differ significantly across academic years [ESSAlcoitão: χ2(2) = 0.287, p = 0.866; other institutions: χ2(2) = 0.200, p = 0.905]. Furthermore, 64.3% of students considered curricular preparation insufficient. By providing a validated instrument that captures a composite construct of predisposition, perceived competence, and functional role readiness, this study offers a tool for monitoring educational needs and evaluating the impact of curricular reforms. The identified readiness-competence gap reinforces the urgency of integrating structured, competency-based EDHA training within undergraduate physiotherapy curricula, thereby strengthening public health preparedness and contributing to more resilient health systems in the face of increasingly frequent emergencies and disasters.
Impairment in blood supply to the brain deprives its cells of the much-needed nutrients and molecules such as oxygen and glucose necessary for its development, growth and survival. This will set up a host of pathological processes such as impaired homeostasis, energy failure, excitotoxicity, oxidative stress, impaired protein synthesis, inflammation, cytokine-mediated toxicity and impairment of blood-brain barrier. These pathological processes will result in the damage or death of the cells depending on the extent of the deprivation. Similarly, they will impair synthesis of acetylcholine (Ach) and norepinephrine (NE), which are important neurotransmitters in the cholinergic and adrenergic systems responsible for cellular communication and functions. Thus, interventions to help arrest and/or modulate the initial and subsequent pathological states and help recover the functions of the brain are needed. One of such interventions is vagus nerve stimulation, which helps activate the cholinergic and the adrenergic systems via projections of the afferent fibers of the vagus nerve to the nucleus of the solitary tract (NTS). Activation of the cholinergic and the adrenergic systems results in reduction in pro-inflammatory factors such as tumor necrosis α, increase in pro-angiogenic factors and increase in firing of adrenergic neurons in the central nervous system (CNS).
Core outcome measurement sets (COMS) enhance the consistency and comparability of outcome reporting in clinical research. However, their effectiveness depends on the selection of valid, reliable, and feasible measurement instruments. Core outcome sets (COS) and COMS have been developed for specific intensive care unit (ICU) patient subgroups. The aim of this study is to establish a standardised approach to outcome measurement and operationalisation for adults acutely admitted to the ICU who are participating in clinical trials and other clinical research. This protocol describes the development of a COMS for adults acutely admitted to the ICU, the CoreMS-ICU, consisting of six core outcomes: survival, free of life support, free of delirium, out of hospital, health-related quality of life, and cognitive function. We will follow the Consensus-based Standards for the Selection of Health Measurement Instruments guideline and report according to the Core Outcome Set-STAndardised Protocol Items guideline. The development of the CoreMS-ICU will follow five predefined steps: (1) conceptual considerations for the six core outcomes; (2) systematic searches for outcome measurement instruments, including consideration of existing COMS; (3) quality assessment of relevant outcome measurement instruments; (4) consensus-based selection of outcome measurement instruments; and (5) recommendations and guidance on how to operationalise and report the measurement of the six core outcomes. We will involve research panels consisting of key stakeholders: patients, family members, healthcare professionals, and researchers in steps 1 and 4. We aim to develop a COMS for adults acutely admitted to ICU patients to facilitate the consistent use of outcomes in trials and enhance the translation of research findings into clinical practice.
Background Rehabilitation services are vital in improving the quality of life for people with disabilities in Nepal, where there is a prolonged effect of civil conflict and frequent natural disasters. To refer patients to rehabilitation specialists, health professionals should be equipped with knowledge and should have a positive attitude towards multidisciplinary rehabilitation. However, information on the knowledge, attitude, and practice (KAP) of health professionals in Nepal regarding multidisciplinary rehabilitation is limited. Objective To determine the level of knowledge, attitude, and practice of multidisciplinary rehabilitation among health professionals. Method A cross-sectional study was conducted across three hospitals in the Kavre district involving 118 various health professionals. A self-administered questionnaire was used to measure knowledge, attitude, and practice. Knowledge scores ranged from 0 to 24 (≤ 8: low, 9-16: moderate, > 16: high) and attitude scores from 0 to 20 (≤ 6: low, 7-14: moderate, > 14: high). Data were analyzed using SPSS version 26, employing descriptive statistics and non-parametric tests. Result The mean knowledge score was 17.77 ± 4.91, with 72% of participants demonstrating a high level of knowledge in multidisciplinary rehabilitation. The mean attitude score was 16.22 ± 3.23, with 74% rating high positive attitudes. Regarding practice, 50% of participants referred more than five patients to physiotherapists monthly, while 79.4% did not refer any patients to physiatrists monthly. Conclusion Health professionals in the Kavre district exhibit generally high knowledge and positive attitudes towards multidisciplinary rehabilitation. Nonetheless, referral patterns indicate underutilization of physiatrists and speech therapists, suggesting areas for targeted interventions to improve multidisciplinary rehabilitation services accessibility in Nepal.
Crohn's disease (CD) is primarily characterised by chronic gastrointestinal inflammation; however, its systemic nature frequently leads to musculoskeletal complications. Among these, clinically significant foot pathologies can impair mobility and negatively impact patients' overall quality of life. Despite their relevance, the specific influence of podiatric manifestations on health-related quality of life in individuals with CD remains insufficiently explored, underscoring a critical gap in current disease management. The aim of this study was to assess the extent to which foot-related health issues affect the quality of life in people living with CD compared with a healthy population. This multicenter observational case-control study was conducted across five provinces in southern Spain-Málaga, Granada, Jaén, Sevilla, and Cádiz-between January 2024 and February 2025. The study included 110 participants, evenly divided between individuals diagnosed with CD (n = 55) and healthy controls (n = 55), matched for age, sex, and body mass index. All participants completed the validated Spanish version of the Foot Health Status Questionnaire (SFHSQ), which assesses four foot-specific domains and four general health domains. Due to the non-normal distribution of the data, non-parametric statistical methods were applied, with the Mann-Whitney U test used to evaluate differences between groups. Participants with CD exhibited significantly lower scores across all domains of the SFHSQ, with the exception of the Footwear domain, which showed no statistically significant difference (p = 0.406). Compared with healthy controls, individuals in the CD group reported greater impairments in foot pain, foot function, general foot health, and in broader health-related domains including general health, physical activity, and social capacity (p < 0.01 for all). CD significantly compromises foot-related QoL. These results highlight the need to include podiatric evaluations as part of comprehensive, multidisciplinary care approaches aimed at enhancing mobility, functional capacity, and general well-being in affected individuals.
The clinical learning environment (CLE) is a crucial component of health professions education, providing the foundation for developing profession-specific clinical skills. This systematic review aimed to identify evaluated assessment tools for the CLE in health professions education and to report their measurement properties. This systematic review was preregistered (IDESR000098), and its protocol was published previously. Eligible studies were peer-reviewed articles in English that developed and validated tools for assessing the CLE among undergraduate health professions students and followed the COSMIN guidelines for systematic reviews of patient-reported outcome measures. Multiple electronic databases, including MEDLINE, the Cochrane Library, ERIC, Education Research Complete, and CINAHL, were searched; studies were independently screened, and data were extracted. Data were synthesized using best-evidence synthesis according to COSMIN guidelines. Of the 6,236 articles included in title and abstract screening, 55 were eligible for full-text screening. A supplementary search identified 13 additional articles, resulting in 40 included articles. Overall, 28 tools were identified, with 4 tools (PET, PET-Midwifery, DECLEI, and MidSTEP) demonstrating sufficient content validity. Only MidSTEP demonstrated sufficient structural validity. Only a minority of the included tools provided sufficient evidence of content and structural validity according to the COSMIN criteria. This finding indicates a systemic need for higher standards in monitoring clinical placements and identifies tools that should be re-evaluated and supported by additional research. Limitations include the exclusion of EMBASE and gray literature and the reliance on studies that predominantly used psychometric-first rather than content-validity-first designs.
The Hand scleroDerma lived Experience (HAnDE) Scale is a patient-reported outcome measure assessing the effect of hand involvement on the life of patients with systemic sclerosis (SSc). The purpose of the study was to translate and cross-culturally adapt HAnDE Scale into the Turkish and investigate its reliability and validity in Turkish-speaking patients with SSc. Individuals diagnosed with SSc, aged between 18 and 65, were included in the study. The HAnDE was culturally adapted across languages following Beaton's guidelines. The internal consistency of the HAnDE-T questionnaire was evaluated using the Cronbach's alpha coefficient. Convergent validity was tested using the Pearson's correlation coefficient. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The construct validity of the HAnDE-T questionnaire was assessed by factor analysis. The construct validity of the HAnDE-T was evaluated by correlating the scores between HAnDE-T and the Health Assessment Questionnaire (HAQ), the 36 Item Short Form Survey (SF-36), and The Mouth Handicap in Systemic Sclerosis Scale (MHISS). Seventy-seven patients with SSc were included in this study. Cronbach's alpha was 0.87, and test-retest reliability assessed using ICC demonstrated moderate reliability (ICC = 0.595). The KMO was 0.829 and the Bartlett Sphericity value was significant. Exploratory factor analysis revealed a four-factor structure explaining 69.5% of the total variance. Correlations of HAnDE-T with HAQ, SF-36, and MHISS scores ranged from low to moderate. The HAnDE-T is a valid and reliable scale for evaluating the comprehensive impact of hand involvement on life experiences of Turkish-speaking patients with SSc. NCT06536595, August 06, 2024, "retrospectively registered".
Forward head posture (FHP) is a common musculoskeletal condition associated with altered craniovertebral angle (CVA), reduced cervical range of motion (CROM), and impaired muscle activation. Conventional treatments mainly target local cervical muscles, often overlooking the role of the interconnected fascial system. Emerging evidence suggests that the posterior chain, particularly the hamstrings, may influence posture; therefore, this study aims to investigate the effect of hamstring stretching on cervical parameters in individuals with FHP. To evaluate the effect of passive hamstring stretching on CVA, CROM, and muscle activation pattern in individuals with FHP. This study will include 70 asymptomatic young adults (18-26 years) with FHP (CVA ≤ 50°) and hamstring tightness (KEA ≥ 20°), randomly assigned to a control group (conventional physiotherapy) or an intervention group (conventional physical therapy plus additional passive hamstring stretching). The intervention will be conducted three times per week for 4 weeks. Outcomes (CVA, CROM, muscle activation pattern, proprioception) will be assessed at pre-intervention, follow-up, and post-intervention stages. The study has been approved by the Institutional Ethical Committee, Jamia Millia Islamia, and registered with the Central Trial Registry of India. Data will be tested for normality using the Shapiro-Wilk test, baseline differences will be analyzed using an independent samples t-test, and intervention effects over time will be evaluated using a mixed-design ANOVA. This study will examine the effect of passive hamstring stretching on CVA, CROM, muscle activation, and cervical proprioception in individuals with FHP, highlighting the biomechanical and fascial links between the lower extremities and cervical spine. The findings may encourage a shift toward holistic interventions that address the entire fascial system, potentially offering more effective and lasting relief for FHP-related issues. This research could also enhance understanding of how different body regions are interconnected in musculoskeletal health. Ethical: 20/11/575/JMI/IEC/2025, CTRI: CTRI/2026/02/102664. © 2026 Wiley Periodicals LLC.
Acute heart failure often leads to impaired physical function, high rehospitalization rates, and poor quality of life. Although exercise-based rehabilitation benefits chronic heart failure patients, its feasibility in acute heart failure is limited. Neuromuscular electrical stimulation offers a potential alternative by safely inducing muscle contractions without causing dyspnea. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42023453116). Following PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library, and Embase was conducted up to October 13, 2025. Randomized controlled trials comparing neuromuscular electrical stimulation to control treatments in patients with acute heart failure were included. Data synthesis was performed using Review Manager 5.4. Seven randomized controlled trials, with methodological quality ranging from fair to excellent (Physiotherapy Evidence Database (PEDro) scores 5-9), were included. Pooled data analysis revealed that neuromuscular electrical stimulation significantly improved 6-min walking distance (mean difference = 69.92 m, 95% confidence interval CI [32.17-1 07.68], p = 0.0003), quality of life (standardized mean difference = 1.53, 95% CI [1.03-2.03], p < 0.00001), and showed preliminary evidence of improvement in leg muscle strength (standardized mean difference = 0.77, 95% CI [0.25-1.29], p = 0.004), whereas no significant difference was observed in left ventricular ejection fraction (mean difference = 1.94%, 95% CI [-3.91 to 7.79], p = 0.52). Neuromuscular electrical stimulation was generally well tolerated, with no serious adverse events directly attributable to the intervention. Neuromuscular electrical stimulation was noted to be effective for improving physical capacity and quality of life in patients with acute heart failure. It offers a promising option for patients unable to engage in conventional rehabilitation. Further large-scale, multicenter Randomized Controlled Trials (RCTs) are needed to confirm these findings.
Cycle ergometer in the postoperative period of open-heart surgery is a safe and economical exercise option. However, its specific effects, whether or not associated with conventional physiotherapy, are not well established in current literature. The objective of this study was to evaluate the effects of cycle ergometer exercise associated or not with conventional physical therapy, compared with only conventional physical therapy, on functional capacity, hospitalization time, peripheral muscle strength, and pulmonary complications of patients after open-heart surgery. MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Embase, Physiotherapy Evidence Database, and Cochrane Library were searched; manual searches were also conducted in the references of the included studies. Randomized controlled trials that analyzed the effects of cycle ergometer exercise associated or not with conventional physical therapy compared with only conventional physical therapy in adult patients after an open-heart surgery were included. Methodological quality was assessed by Cochrane risk-of-bias tool, and the meta-analysis was undertaken using RevMan 5.3. Mean difference in the six-minute walk test (31 meters, 95% confidence interval [CI]: 1.59 to 60.3 meters, P = 0.04) was higher and in intensive care unit stay was lower (-0.5 days, 95% CI: -0.86 to -0.14 days, P = 0.007) in the intervention group. The total hospitalization time (-0.18 days, 95% CI: -0.73 to 0.38 days, P = 0.53) didn't change between groups. Cycle ergometer exercises improved functional capacity but with no clinically relevant effects on hospitalization time after open-heart surgeries.
What is the estimated smallest worthwhile effect of anterior cruciate ligament (ACL) reconstruction followed by rehabilitation for improving knee function and return to sport compared with rehabilitation only? What are the associations between participant characteristics (age, gender, health insurance status, sports participation level, preference for surgery versus non-surgical management, previous ACL rupture) and these smallest worthwhile effect estimates? Benefit-harm trade-off study conducted via an online survey. A total of 92 people engaged in recreational or competitive sport. Participants provided demographic information and answered two benefit-harm trade-off scenarios: a knee function scenario and a return to sport scenario. Participants indicated the minimum additional percentage improvement they would require for ACL reconstruction to be worthwhile compared with the anticipated percentage improvement with rehabilitation only. The expected benefits of rehabilitation only were based on published trial data. Associations between these smallest worthwhile effect estimates and participant characteristics were investigated using univariable regression models. The median smallest worthwhile effect was 12% (IQR 8 to 16) for knee function and 41% (IQR 35 to 47) for return to sport. Smallest worthwhile effects were slightly higher for those participating in competitive sport. Age was associated with smallest worthwhile effect for the knee function scenario (0.3% increase per year older, 95% CI 0.1 to 0.4), although the size of this effect may not be clinically relevant. None of the tested predictors were associated with the smallest worthwhile effect for the return to sport scenario. This study is the first to estimate the smallest worthwhile effect of ACL reconstruction. Participants require an additional 12% improvement in knee function or a 41% increase in the likelihood of returning to sport to justify undergoing ACL reconstruction. Therefore, the effects of surgery reported in many studies fall below what patients consider to be worthwhile. OSF; https://osf.io/2kn97/.
The Exercise-Specific Parkinson's Disease Questionnaire (PDQ-Exercise) is the first patient-reported outcome measure to assess exercise-related challenges in people with Parkinson's disease (pwPD). The aim was to translate and culturally adapt the PDQ-Exercise into Turkish and to evaluate its psychometric properties in pwPD, including structural and construct validity assessed through predefined hypotheses regarding expected relationships with related measures, internal consistency, test-retest reliability, measurement error, and floor/ceiling effects. This cross-cultural adaptation and psychometric validation study involved translating, culturally adapting, and evaluating the psychometric properties of PDQ-Exercise into Turkish. Seventy pwPD were recruited. Structural validity was examined using confirmatory factor analysis (CFA). Construct validity was assessed through correlations with clinical, participation, and quality of life measures. Reliability was assessed through evaluations of internal consistency (Cronbach's alpha and McDonald's omega) and test-retest reliability (ICC) with standard error of measurement (SEM), minimal detectable difference (MDD), and Bland-Altman analysis. The initial CFA model demonstrated poor fit to the data. Following theoretically and statistically justified modifications, including the addition of correlated residuals between selected items, model fit improved substantially. The final model showed good fit indices (CFI = 0.991, TLI = 0.981, SRMR = 0.051), although the RMSEA confidence interval indicated some uncertainty (RMSEA = 0.051, 90% CI: 0.00-0.145). Construct validity was supported by moderate correlations between PDQ-Exercise and Movement Disorder Society Unified Parkinson's Disease Rating Scale (ρ = 0.545), Oxford Participation and Activities Questionnaire (ρ = 0.514), and Parkinson's Disease Questionnaire-8 (ρ = 0.494). PDQ-Exercise demonstrated acceptable internal consistency (Cronbach's alpha = 0.783 and McDonald's omega = 0.788) and excellent test-retest reliability (ICC = 0.985, SEM = 2.6; and MDD = 7.2). The Turkish version of the PDQ-Exercise exhibited a significant floor effect. 28.6% of participants scored the minimum score (0) on the total scale. The Turkish version of the PDQ-Exercise demonstrated acceptable psychometric properties in a sample predominantly consisting of individuals with early-stage PD.
This systematic review and meta-analysis aimed to analyse the effects of resistance-based exercise programs on pain, fatigue, depression, anxiety, sleep quality, quality of life, physical function, and muscle strength in patients with fibromyalgia. Additionally, we investigated whether these effects were influenced by demographic, clinical, or exercise prescription characteristics. A systematic search in seven databases was conducted up to February 2024. Eligible randomized controlled trials examined the effects of resistance-based exercise programs on outcomes of interest in patients with fibromyalgia. Outcomes were analysed using a three-level mixed-effects meta-analysis and meta-regression, with statistical significance set at an α level of 0.05. Twenty-two studies involving 1235 participants were included. Resistance-based exercise showed small but significant improvements in pain (-0.40 SMD, 95%CI: -0.55 to -0.25), fatigue (-0.48 SMD, 95%CI: -0.69 to -0.26), depression (-0.46 SMD, 95%CI: -0.70 to -0.22), and anxiety (-0.31 SMD, 95%CI: -0.43 to -0.19). Small gains were observed also observed in sleep quality and physical function, while lower-limb muscle strength demonstrated a large effect size (1.17 SMD, 95% CI: 0.89 to 1.44). Subgroup analyses indicated benefits irrespective of age, BMI, or duration of illness. Adding aerobic or flexibility exercises did not result in additional effects. Resistance-based exercise programs provide modest but meaningful benefits for managing multiple symptoms of fibromyalgia. A low-dose, moderate-intensity protocol may be sufficient to yield improvements and should be recommended as part of a multidisciplinary treatment approach.
This study aims to compare the effects of moderate- to high-intensity peripheral and inspiratory muscle training, when combined with aerobic training, on muscle strength, respiratory muscle strength, physical performance, functional capacity, sarcopenia, and quality of life in older adults. Thirty-four community-dwelling older adults were randomly assigned to either the peripheral muscle training (PMT) group (n = 17) or the inspiratory muscle training (IMT) group (n = 17). Participants in the PMT group performed resistance training targeting both the upper and lower extremities at 60 to 80% of their one-repetition maximum (1RM). In contrast, the IMT group engaged in IMT at 60 to 80% of their baseline maximum inspiratory pressure (MIP), using a threshold IMT device. Both groups additionally participated in supervised step-aerobic sessions twice weekly for 10 weeks, aiming for 50 to 70% of their individual maximum heart rate. Outcome measures included hand grip strength, MIP, maximum expiratory pressure (MEP), the 6-minute walk test (6-MWT), the Short Physical Performance Battery (SPPB), the SARC-F questionnaire, and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD). All assessments were conducted at baseline and repeated after completion of the 10-week training program in both groups. Between-group comparisons of pre- to post-intervention changes revealed a significant difference in the WHOQOL-OLD death and dying subscale, with greater improvement observed in the IMT group (P = .019, d = 0.185). In the PMT group, significant post-intervention increases were observed in MEP (P = .003, d = 0.876), MEP% (P = .002, d = 0.932), 6-MWT (P = .001, d = 0.974), and the WHOQOL-OLD sensory abilities subscale (P = .035, d = 0.528). In the IMT group, significant improvements were noted in MIP (P = .002, d = 0.788), MIP% (P = .001, d = 1.032), 6-MWT (P = .003, d = 0.889), and the WHOQOL-OLD death and dying subscale (P = .040, d = 0.564). This study demonstrates that moderate- to high-intensity PMT and IMT, when combined with aerobic training, significantly enhances respiratory muscle strength, functional capacity, and quality of life in community-dwelling older adults.