Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson’s Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention ProgramRead the full article
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Role of Cervical Spinal Magnetic Stimulation in Improving Posture and Functional Ambulation of Patients with Relapsing Remitting Multiple Sclerosis
Balance impairment is one of the hallmarks of early MS. Proprioceptive deficit was found to be one of the main causes of this imbalance. The cervical enlargement has a strong proprioceptive system, with its projections to the reticular formation and the central pattern generators, helping in rhythmic pattern generation and alternate leg movements. Repetitive trans-spinal magnetic stimulation (rTSMS) is a noninvasive technique, which can trigger massive proprioceptive afferents. Therefore, it has the potential of improving proprioceptive deficits and motor control. Objective. To determine the effectiveness of repetitive cervical magnetic stimulation in improving functional ambulation of patients with relapsing remitting multiple sclerosis (RRMS). Design. Prospective sequential clinical trial. Setting. University and academic hospital. Participants. A total of 32 participants () with RRMS. Interventions. Outpatient rehabilitation. The 32 patients received 10 sessions over two weeks of 20 Hz cervical spinal magnetic stimulation (SMS). Both groups were assessed at baseline, after 2 weeks, then one month later. Patients were enrolled as a control group at first and received Sham SMS, and then a wash out period of one month was done for all the patients, followed by a baseline assessment. Second, the same 32 patients rejoined as the active group, which received real magnetic stimulation. Both groups performed an intensive physical therapy program with the spinal magnetic stimulation. Main Outcome Measures. Extended Disability status score (EDSS), Timed up and Go test (TUG), Mini-Best test, dynamic posturography sensory organization composite score, and motor composite score. Results. Thirty-two RRMS patients with EDSS range from 1.5 to 6. They showed statistically significant difference between active and control groups in Mini-Best test score. We divided our patients according to EDSS into 3 subgroups: (a) mild: ≤2.5, (b) moderate: 3-5.5, and (c) severe: ≥6. Mild cases showed significant differences in EDSS score, TUG test, Mini-Best test, and dynamic posturography sensory composite scale. The effect size between the different patient subgroups was also measured and showed highly significant improvements in all measured parameters among our mild patients, indicating that this subgroup could be the best responders to cervical repetitive high-frequency magnetic stimulation. Moderate cases showed highly significant improvement in TUG score and Mini-Best test and significant change in EDSS score and the dynamic posturography sensory composite score. Severe cases showed only significant improvements in TUG, Mini-Best test, and sensory composite score. Conclusion. Cervical repetitive magnetic stimulation can help improve balance and functional ambulation and decreases the risk of falls in RRMS patients, especially in the mild, low disability cases.
Facilitators and Barriers That Transfemoral Amputees Experience in Their Everyday Life: A Norwegian Qualitative Study
Background. Living with a lower limb amputation influences multiple facets of life due to altered function. Individuals achieve a varied level of function post amputation, depending on several variables like age, level of function prior to amputation, and available personal and environmental resources. Releasing the potential to live life to the fullest despite a disability is important to the individual. Objectives. The primary objective of this study is to identify barriers and facilitators for function which lower limb amputees experience in their lives several years after amputation, from the amputee’s perspective. This knowledge can contribute to further development of the clinical pathway for lower limb amputees in a Norwegian rehabilitation hospital. Methods. The study has a descriptive and exploratory qualitative design with a phenomenological hermeneutical approach. Semistructured, individual interviews were conducted for data collection. Thematic analysis inspired by Braun and Clarke was used for data analysis. The sample consisted of eight transfemoral amputees ( (58-77 years)) living in the southern part of Norway. Average time since amputation was 11 years. Results. The results have been categorised into two main themes with subthemes: (1) facilitators: personal resources, a well-fitted prosthesis, rehabilitation, social network, balance in activity/rest, and accessibility and (2) barriers: walking distance, poorly fitted prosthesis, pain, comorbidities, climate/terrain/falling, reduced local competence on amputation, and pandemic. Conclusion. Lower limb amputees experience barriers in their everyday life, but they also develop strategies to cope with their disability. Clinical implications can include increased nutritional guidance, structural psychological mapping and follow-up, structured follow-ups over a significant period of time, and extended use of digital consultation.
Healthcare Professionals’ Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study
Background and Aim. Cognitive impairment is a common consequence following stroke. Previous research shows differences in rehabilitation services supporting physical, cognitive, and psychosocial needs. The aim of the current study was to explore health professionals’ experiences with service provision for patients with mild and moderate cognitive impairment after stroke in a North Norwegian context. Methods. A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors’ rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach. Results. We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run. Conclusion. The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors’ and carers’ long-term needs.
Isometric Quadriceps Exercises for Patients with Knee Osteoarthritis: A Randomized Controlled Trial Comparing Knee Joint Position Flexion versus Extension
Objective. To compare the effect of quadriceps isometric exercises performed in two different positions in addition to the combined physical therapy program on pain, stiffness, and physical function in patients with knee osteoarthritis (OA). Methods. A total of 30 patients with OA (age range 45 to 70 years) who were admitted to Istanbul Private Ekotom Medical Center, Department of Physical Medicine and Rehabilitation Outpatient Clinic, were included. The patients were randomly divided into two groups according to the type of performing the quadriceps isometric exercises as group 1 (performing in knee extension, ) and group 2 (performing in knee flexion, ). All patients also received a combined physical therapy program. Exercise protocols were applied six days a week for four weeks. The pain was evaluated using a 10 cm visual analog scale for pain (VAS) in rest and activity; pain, joint stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. A significant difference was found in the VAS and WOMAC scores of both groups in group comparisons (). When the groups were compared in terms of change values, a significant difference was found in the WOMAC stiffness score in favor of group I (). Discussion. It is possible to obtain positive results with quadriceps isometric exercises to reduce pain and joint stiffness and increase physical function in patients with knee OA. However, exercises performed in knee extension were found to be more effective in reducing joint stiffness.
Cross-Cultural Adaptation and Clinimetric Testing of Functional Rating Index (FRI) Outcome Measure into the Arabic Language
Background. The Functional Rating Index (FRI) is a self-report scale widely used to determine the level of disability in low back pain (LBP) populations. Objectives. This study was aimed at conducting the cross-cultural adaptation of the FRI-Arabic version (FRI-Ar) and testing the clinometric properties of FRI-Ar. Methods. The cross-cultural adaptation process was used to develop the FRI-Ar. This study included acute and subacute LBP patients. Each patient was asked to complete the questionnaires at three time points: baseline, 24-hour follow-up, and two-week follow-up. The questionnaires used were FRI-Ar, Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Numerical Pain Rating Scale (NPRS), Global Perceived Effect Scale (GPE), and Patient-Specific Functional Scale (PSFS). Statistical analysis was carried out to measure the instrument’s reliability, validity, and responsiveness. Results. The FRI was cross-culturally adapted to the Arabic language, and the adapted version was validated. Two hundred patients completed the questionnaires at the baseline; however, 120 patients completed the questionnaires at 24-hour and two-week follow-up. Cronbach’s alpha, interclass correlation coefficient (ICC2,1), standard error of measurement (SEM), and minimal detectable change (MDC95%) for the FRI-Ar were observed as 0.85, 0.85, 1.17 (2.9%), and 3.24, respectively. The FRI-Ar showed a moderate positive correlation only with the RMDQ, ODI, and NPRS (). Also, it showed the responsiveness with a small effect size () and standardized response mean (). Conclusion. The FRI-Ar was developed, and it showed good reliability and validity. However, it revealed the responsiveness with the small change. It can evaluate both pain and functional limitations in acute and subacute LBP patients. Before using it in the Arabic population with acute and subacute LBP, it is recommended to conduct further research to test internal and external responsiveness using an external criterion with a more extended follow-up period and suitable interventions.
Exploring Saudi Physical Therapists’ Perceptions and Opinions on Their Profession: A Mixed-Method Study
Background and Purpose. The social standing of any occupation is often referred to as occupational prestige. Occupational prestige is often evaluated as how a particular occupation is regarded relative to other occupations by different groups in the society. Occupational prestige is a useful indicator of a profession’s marketability and desirability. As physical therapists (PTs) are essential members of the healthcare team, the aim of this study is to determine Saudi PT’s (students and graduates) perception of their occupational prestige and satisfaction with their career choice. Methods. A cross-sectional, mixed-method study was employed. Practicing PTs and PT students were recruited to fill out a self-administered questionnaire to rank nine different professions (including PT) across different dimensions. Further, participants reported on their job satisfaction and participated in a semistructured interview regarding their responses. Results. A total of 175 individuals participated in this study. The physical therapy profession was rated 6th on level of education, last (9th) on level of income and level of social standing, 5th on level of responsibility, and 3rd on level of usefulness. In the overall occupational prestige, the physical therapy profession was ranked the lowest compared to the other professions. Lastly, the data from the semistructured interviews corroborated the findings identified from the quantitative aspect of our study. Discussion. The overall results of the study indicate that the current perceived level of occupational prestige among Saudi PTs and PT students is somewhat disappointing. Participants generally viewed their profession in a low occupational prestige status, which is in contrast to previous studies conducted in other countries. While some of these results can be explained by the nature and history of the profession in Saudi Arabia, Academic institutions and policy makers should make an effort to promote the occupational prestige of the physical therapy profession.