Investigating behavior, attitudes, knowledge, awareness and barriers to the implementation of evidence-based practice by physiotherapists in Egypt: A cross sectional study.

Few studies exist regarding the attitudes and behaviours of Egyptian physiotherapists in relation to the use of evidence in practice (EBP). The purpose of this study was to describe the beliefs, attitudes, knowledge, and behaviours of Egyptian physical therapists as they relate to evidence-based practice. It also explores their perception of possible barriers to implement EBP. Four hundred and seventy Egyptian therapists responded to our questionnaire with results revealing participants' awareness towards EBP was quite diverse. Only terms of systematic review and randomized controlled trial were well understood while remaining terms showed various level of comprehension which were rather low. Results also revealed significant correlations between attitudes towards EBP and overall awareness as well as attitudes and knowledge (r = 0.270 and 0.107) respectively. In addition, a significant relationship was also found between EBP awareness and knowledge with (r = 0.219). With regards to the barriers, insufficient teaching in previous education was identified as the primary barrier (34.4 %), followed by lack of funding and resources (31.1 %), while lack of time (10.2 %) was reported as the least. These barriers highlight the need to enhance implementation of EBP within Egyptian Physiotherapists. Findings of this study can be used as a foundation for the implementation of EBP in various clinical settings by understanding the limitations and barriers reported. Our study concluded that despite Egyptian physiotherapists declare their awareness of EBP, nevertheless, knowledge is restricted to a small number of terms. More focus is required to enhance the knowledge and practice of EBP. Focusing on adjustable factors, including increasing the awareness of value of research would help reduce time and resource demands for physiotherapists when implementing EBP.

The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis.

Introduction: Orthopedic ankle injuries are considered among the most common musculoskeletal injuries. A wide variety of modalities and techniques have been used for the management of these injuries, and virtual reality (VR) is one modality that has been examined in ankle injuries rehabilitation. Purpose: This study aims to systemically review previous studies evaluating the effect of virtual reality in rehabilitating orthopedic ankle injuries. Methods: We searched six online databases: PubMed, Web of Science (WOS), Scopus, the Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL), and Cochrane Central Register of Controlled Trials (CENTRAL). Results: Ten randomized clinical trials met the inclusion criteria. Our results showed that VR had a significant effect on overall balance compared to conventional physiotherapy (SMD = 0.359, 0.009-0.710 P = 0.04), [I 2= 17%, P = 0.30]. Compared with conventional physiotherapy, VR programs significantly improved gait parameters such as speed and cadence, muscle power, and perceived ankle instability; however, no significant difference was detected in the foot and ankle ability measure (FAAM). Additionally, significant improvements in static balance and perceived ankle instability were reported after the use of VR balance and strengthening programs. Finally, only two articles were deemed to have good quality, and the other studies' quality ranged from poor to fair. Conclusion: VR rehabilitation programs can be used to rehabilitate ankle injuries, as they are regarded as safe interventions and have promising effects. However, there is a need for studies with high quality since most included studies' quality varied from poor to fair.

Dietary Thymoquinone Alone or Combined with Swimming Exercise Protect against Microcystin-LR-Induced Oxidative Injury in Mice.

Microcystin-leucine-arginine (MCLR) is the most abundant cyanotoxin produced by cyanobacteria. It induces potent cytotoxicity through oxidative stress and DNA damage. Thymoquinone (TQ) is a natural nutraceutical antioxidant derived from black cumin (Nigella sativa). Physical exercise (EX) improves whole-body metabolic homeostasis. Therefore, this study examined the protective role of swimming exercise and TQ against MC-induced toxicity in mice. Fifty-six healthy adult male albino mice (25-30 g) were randomized into seven groups; group (I) was the negative control and received oral physiological saline for 21 days; group (II) received water EX for 30 min daily; group (III) was intraperitoneally injected with TQ (5 mg/kg daily, for 21 days); group (IV) was intraperitoneally administered MC (10 µg/kg daily, for 14 days) and acted as the positive toxic control; group (V) was treated with MC and water EX; group (VI) was injected with MC and TQ; finally, group (VII) was treated with MC with TQ and water EX. In comparison with the control group, the results showed hepatic, renal, and cardiac toxicity in the MCLR-treated group, indicated by a significant increase (p < 0.05) in serum levels of alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine transferase (ALT), cholesterol, lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase-myocardial band (CK-MB), urea, creatinine, interleukin-6, interleukin -1ß, and tumor necrosis factor-α levels. In addition, there were significant elevations (p < 0.05) in malondialdehyde (MDA) and nitric oxide (NO) levels and a significant decrease in reduced glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD) in hepatic, cardiac, and renal tissues. Treatment with either TQ or water EX significantly improved (p < 0.05) the MC-induced toxicity with superiority of the TQ group in the restoration of normal ranges; however, cotreatment with both TQ and swimming EX showed the most improvement and restoration to normal ranges as a result of increasing EX clinical efficacy by TQ.

The COVID-19 pandemic impacts all domains of quality of life in Egyptians with spinal cord injury: a retrospective longitudinal study.

BACKGROUND AND OBJECTIVE: During the COVID-19 pandemic, several aspects of life have been affected. These aspects have been impacted especially in persons with spinal cord injury (SCI). The current study explored the overall effect of the COVID-19 pandemic on quality of life (QOL) domains in persons with SCI as well as evaluated their adherence to WHO-COVID 19-preventive measures. DESIGN: A retrospective longitudinal study was conducted after asking participants to complete an online validated Arabic version of the WHOQOL-BREF questionnaires including their demographics. The WHOQOL-BREF questionnaires were completed targeting two separate occasions to represent their scores prior to and during the pandemic. Participants were asked to rate their adherence to WHO-COVID-19 preventive measures on a 10-point scale. SETTING AND PARTICIPANTS: 115 participants with complete/ incomplete SCI were recruited via social media and contacted by phone to complete the questionnaires. RESULTS: Persons with SCI had lower QOL scores during the COVID-19 period compared to their QOL during the pre-COVID-19 period; all QOL domains (Physical Health, Psychological, Social Relationships, and Environment) showed a significant decrease (P < 0.001). Regarding COVID-19 preventative measures, participants were most likely to endorse self-isolation as well as staying home measures and least likely to adhere to hand washing and social distancing measures. CONCLUSION: The robustly reduced QOL reported by individuals with SCI during the COVID-19 pandemic highlights the need for rehabilitation and mental health services, particularly administered via telehealth, to buffer the effects of the pandemic. Additionally, psychoeducation and support regarding COVID-19 preventative behaviors in this region would be critical.

Effects of Electrical Stimulation Training on Body Composition Parameters After Spinal Cord Injury: A Systematic Review.

OBJECTIVE: To determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. DATA SOURCES: Three independent reviewers searched PubMed, Web of Science, Scopus, Cochrane Central, and Virtual Health Library until March 2020. STUDY SELECTION: Studies were included if they applied NMES/FES on the lower limb muscles after spinal cord injury, reported stimulation parameters (frequency, pulse duration, and amplitude of current), and body composition parameters, which included muscle cross-sectional area (CSA), fat-free mass, lean mass (LM), fat mass, visceral adipose tissue, and intramuscular fat. DATA SYNTHESIS: A total of 46 studies were included in the final analysis with a total sample size of 414 subjects. NMES loading exercise and FES cycling exercise were commonly used for training. Increases in muscle CSA ranged from 5.7-75%, with an average of 26% (n=33). Fifteen studies reported changes (both increase and decrease) in LM or fat-free mas ranged from -4% to 35%, with an average of less than 5%. Changes in fat mass (n=10) were modest. The effect on ectopic adipose tissue is inconclusive, with 2 studies showing an average reduction in intramuscular fat by 9.9%. Stimulation parameters ranged from 200-1000 µs for pulse duration, 2-60 Hz for the frequency, and 10-200 mA in amplitude. Finally, increase in weekly training volumes after NMES loading exercise resulted in a remarkable increase in percentage changes in LM or muscle CSA. CONCLUSIONS: NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing LM. Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. Furthermore, positive muscle adaptations occur despite the applied stimulation parameters. Finally, the included studies reported wide range of stimulation parameters without reporting rationale for such selection.

Benefits of Aerobic Exercise for Breast Cancer Survivors: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Physical exercise may be beneficial to breast cancer (BC) survivors. Here, we systematically summarized the effects of aerobic exercise in BC survivors. We conducted a systematic review of randomized controlled trials (RCTs). METHODS: We searched PubMed, Web of knowledge, Scopus, Cochrane Central, Virtual Health Library and PEDRO databases for relevant RCTs, comparing aerobic exercise with usual care among BC survivors. Data were extracted and evidence was synthesized narratively. RESULTS: Twelve studies were included in this systematic review. Studies reported that aerobic exercise can significantly improve the quality of life in BC survivors. Moreover, aerobic exercise alleviated the symptoms of depression and anxiety. However, current evidence from the included studies showed that there was no significant benefit for aerobic exercise in terms of weight loss. CONCLUSION: Our study suggests that aerobic exercise is beneficial to BC survivors. CLINICAL RELEVANCE: Aerobic exercise should be recommended in the therapeutic and rehabilitative regimens of BC survivors.
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Prevalence, Profile, and Response to Work-Related Musculoskeletal Disorders among Egyptian Physiotherapists.

BACKGROUND: Despite that physiotherapists (PTs) are supposed to have adequate knowledge of musculoskeletal disorders and the different prevention strategies, they are at high risk of developing work-related musculoskeletal disorders (WRMDs). AIM: This study aimed to investigate the prevalence, profile, predictors, and response to WRMDs among Egyptian PTs. METHODS: A self-administrated questionnaire was distributed either manually or via e-mail to 564 PTs with at least two years of working experience. Questions elicited information about the personal and occupational history of the respondents in addition to the experience of WRMDs in the past two years. RESULTS: Four hundred and fourteen respondents (82.6%) reported WRMDs within the last two years, with the lower back as the most common area affected (68.8%). More than half the PTs (54.8%) who sustained a WRMD reported that their injury took place in a private setting. Significant predictors for WRMDs were age (AOR = 0.78; 95% CI = 0.66, 0.91) and number of years of experience in physiotherapy practice (AOR = 1.26; 95% CI = 1.07, 1.49). In response to the injury, about 73.9% of the respondents stated that they did not officially report their injury and 55.8% of them reported losing a half day or more from their work. CONCLUSION: The prevalence of WRMDs among Egyptian physiotherapists is high. Despite socioeconomic and cultural differences between Egypt and other countries, our study findings were consistent with the published reports. Further studies are needed to explore the cultural and psychosocial risk factors of WRMDs.

Barriers and Motivators of Physical Activity Participation in Middle-aged and Older-adults - A Systematic Review.

Identifying the difference in barriers and motivators between middle-age and older adults could contribute toward the development of age-specific health promotion interventions. The aim of this review was to synthesize the literature on barriers and motivators for physical activity in middle-aged (50-64 years) and older adults (65-70 years). The review examined qualitative and quantitative studies using the theoretical domain framework as the guiding theory. The search generated 9400 results from seven databases. A total of fifty-five articles meeting the inclusion criteria. Results indicate that barriers are comparable across the two age groups with environmental factors and resources being the most commonly identified barriers. In older adults, social influences, reinforcement and assistance in managing change were the most identified motivators. Middle-aged identified goals settings, believe that activity will be beneficial and social influences were most important. Findings can be used by professionals to encourage engagement with and adherence to physical activity.

The Effects of Electrical Stimulation Parameters in Managing Spasticity After Spinal Cord Injury: A Systematic Review.

Controversial findings about the effects of neuromuscular electrical stimulation and functional electrical stimulation in managing spasticity have been raised after spinal cord injury. A systematic review was conducted to identify the range of the stimulation parameters that may alleviate spasticity. Three independent reviewers searched Medline (PubMed), web of knowledge, Scopus, Cochrane Central, Virtual Health Library, and Physiotherapy Evidence Database until January 2018. Inclusion criteria were applications of neuromuscular electrical stimulation/functional electrical stimulation on the lower limb muscles, stimulation parameters (frequency, pulse duration, and amplitude of current), and measures of spasticity after spinal cord injury. The primary outcome was spasticity as measured by the Modified Ashworth Scale and the secondary outcome was spasticity assessed by other indirect measures. Twenty-three clinical and nonclinical trials were included with 389 subjects. Neuromuscular electrical stimulation/functional electrical stimulation provided reductions in spasticity by 45%-60% with decrease in electromyography activity and increase in range of motion after spinal cord injury. The identified stimulation parameters were frequency of 20-30 Hz, pulse duration of 300-350 µs, and amplitude of the current greater than 100 mA. Neuromuscular electrical stimulation/functional electrical stimulation provides an effective rehabilitation strategy in managing spasticity. However, a recommendation of the stimulation parameters cannot be accurately assumed because of high variability in the methodology, design, and heterogeneity of the included studies.

Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis.

We performed this meta-analysis to investigate the efficacy of low-level laser therapy (LLLT), a physiotherapy modality with anti-inflammatory and analgesic effects, in the management of mild-to-moderate carpal tunnel syndrome (CTS). We searched PubMed, Web of Knowledge, Scopus, Cochrane Central, and Virtual Health Library for randomized controlled trials (RCTs) that compared the effects of LLLT with or without splinting versus placebo on functional and electromyographic outcomes in CTS. All outcomes were pooled as mean differences (MD) under the inverse variance or random effects model, using the statistical add-in (MetaXL, version 5.0). Eight RCTs (473 patients/631 wrists) were eligible for the final analysis. The overall effect estimates did not favor LLLT therapy group over placebo in all primary outcomes: visual analogue scale (MD -1.11, 95% CI [-2.58, 0.35]), symptom severity scale score (MD -1.41, 95% CI [-5.12, 2.29]), and functional status scale score (MD -1.33, 95% CI [-3.27, 0.61]). However, LLLT was superior to placebo in terms of grip strength (MD 2.19, 95% CI [1.63, 2.76]) and inferior to placebo in terms of sensory nerve action potential (MD -2.74, 95% CI [-3.66, -1.82]). Laser therapy is superior to placebo in terms of improving the grip strength; however, no significant difference was found between both groups in terms of functional status improvement, pain reduction, or motor electrodiagnostic evaluations. Further high-quality trials with longer follow-up periods are required to establish the efficacy of LLLT for CTS treatment.

Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis.

There is a consensus in the literature that regional anesthesia (RA) improves local hemodynamic parameters in comparison to local anesthesia (LA) during arteriovenous fistula (AVF) surgical construction. However, the effects of both techniques on fistula patency and failure rates are still controversial. The aim of this meta-analysis is to synthesize evidence from published randomized trials and observational studies regarding the safety and efficacy of RA versus LA in AVF surgical construction. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central retrieved six randomized trials (462 patients) and one retrospective study (408 patients). Pooling data using RevMan software (version 5.3) showed that RA was superior to LA in terms of primary fistula patency rate (RR = 1.22, 95% CI [1.08, 1.37], p = 0.0010); however, both types were comparable in terms of primary fistula failure rate (RR = 0.81, 95% CI [0.47, 1.40], p = 0.46). In comparison to LA, RA was associated with improved hemodynamic parameters including fistula blood flow (MD = 25.08, 95% CI [19.40, 30.76], p<0.00001), brachial artery diameter (SMD = 2.63, 95% CI [2.17, 3.08], p<0.00001), and outflow venous diameter (SMD = 0.93, 95% CI [0.30, 1.75], p = 0.004). Postoperative complications were comparable between both groups (OR = 0.23, 95% CI [0.05, 0.97], p = 0.05). In conclusion, RA was associated with higher primary patency rates of AVF and improved local blood flow in comparison to LA; however, both procedures were comparable in terms of primary failure rates and postoperative complications. Larger well-designed trials with longer follow-up periods should compare both techniques in terms of long-term patency rates and safety outcomes.