Investigating the effects of core stability training on balance and gait in people with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Balance disorders are a common concern in people with multiple sclerosis (PwMS). Core stability exercises are recommended as one of the treatment principles of rehabilitation in patients with balance disorders. This systematic review and meta-analysis investigate the effects of core stabilization exercises (CSE) on balance in PwMS. METHODS: Online databases were searched from 1980 to December 15, 2022, including PubMed/Medline, Scopus, Web of Science, CINAHL, PEDro, Embase, and ProQuest to identify randomized controlled trials (RCTs) investigating the effects of CSE on balance in PwMS. The methodological qualities of the included studies were assessed using the modified Cochrane risk bias tool for randomized trials. Random-effect meta-analyzes were performed on the Berg balance test and Biodex balance system outcomes. RESULTS: Seven RCTs were included in this study. A total of 379 patients (EDSS<6) were enrolled in the included studies. All researchers had applied CSE within six to ten weeks with the frequency of two to three sessions/week. According to qualitative results, core stability exercise significantly changes the most balanced outcomes. The meta-analyses illustrated that allocated participants to experimental groups had statistically significantly higher Berg balance test scores (standardized mean difference: 1.1; 95 % CI: [0.1, 2.1]) and insignificant lower Biodex score (standardized mean difference: -0.59; 95 % CI: [-1.09, -0.09]) compared to the control groups. CONCLUSION: Six to ten weeks of CSEs is an effective therapeutic strategy for balance improvement in PwMS that can help improve balance, especially in patients with moderate disability levels (EDSS3.5-6). Further randomized clinical trials are needed to compare the efficacy of CSEs and routine balance training in PwMS.

Effects of dry needling on spasticity, cortical excitability, and range of motion in a patient with multiple sclerosis: a case report.

BACKGROUND: Dry needling is an intervention used by physiotherapists to manage muscle spasticity. We report the effects of three sessions of dry needling on ankle plantar flexor muscle spasticity and cortical excitability in a patient with multiple sclerosis. CASE PRESENTATION: The patient was a 40-year-old Iranian woman with an 11-year history of multiple sclerosis. The study outcomes were measured by the modified modified Ashworth scale, transcranial magnetic stimulation parameters, and active and passive ankle range of motion. They were assessed before (T0), after three sessions of dry needling (T1), and at 2-week follow-up (T2). Our result showed: the modified modified Ashworth scale was improved at T2 from, 2 to 1. The resting motor threshold decreased from 63 to 61 and 57 at T1 and T2, respectively. The single test motor evokes potential increased from 76.2 to 78.3. The short intracortical inhibition increased from 23.6 to 35.4 at T2. The intracortical facilitation increased from 52 to 76 at T2. The ankle active and passive dorsiflexion ROM increased ~ 10° and ~ 6° at T2, respectively. CONCLUSION: This case study presented a patient with multiple sclerosis who underwent dry needling of ankle plantar flexors with severe spasticity, and highlighted the successful use of dry needling in the management of spasticity, ankle dorsiflexion, and cortical excitability. Further rigorous investigations are warranted, employing randomized controlled trials with a sufficient sample of patients with multiple sclerosis. Trial registration IRCT20230206057343N1, registered 9 February 2023, https://en.irct.ir/trial/68454.

Comparison Between the Effects of Transfer Energy Capacitive and Resistive Therapy and Therapeutic Ultrasound on Hamstring Muscle Shortness in Male Athletes: A Single-Blind Randomized Controlled Trial.

BACKGROUND: Transfer energy capacitive and resistive (TECAR) therapy (TT) is a newly developed deep heating therapy that can generate heat within tissues through high-frequency wave stimulation. Compared to conventional physiotherapy methods, the application of TT especially in sports rehabilitation is becoming more popular. This study aimed to investigate the comparative effect of TT and therapeutic ultrasound (US) on hamstring muscle shortness. Additionally, the effects of TT with static stretching (SS) were compared with US combined with SS. MATERIALS AND METHODS: Totally, 39 male athletes with hamstring shortness were randomly assigned into three groups: A, B, and C. Group A received 15 minutes of TT plus SS, while Group B received 15 minutes of US with SS, and Group C only performed SS. Hamstring flexibility was measured by active knee extension (AKE), passive knee extension (PKE), and the sit and Reach (SR) tests before the intervention, and following the first, and third treatment sessions. RESULTS: The range of motion of the AKE and PKE, and displacement range in the SR test improved significantly after the first and third sessions in all three groups (P0.0001). The improvement of the three flexibility indices in the TT group was greater than in the other two groups. CONCLUSION: The present study showed that TT could increase the flexibility of hamstring muscles more than US therapy. However, TT in combination with SS had a similar effect to SS alone.

Computerized Simulation Education on Physiotherapy Students' Skills and Knowledge: A Systematic Review.

Introduction: Applying computerized simulation education tool for learning in medical domains is widely used in many countries. This review is aimed at systematically investigating the computerized simulation tools developed to educate physiotherapy students and determine the effectiveness of these interventions. Methods: A comprehensive search was conducted in Medline (through PubMed) and Scopus databases from inception to Sept. 10, 2022. The studies that examined the effectiveness of computerized simulation-based interventions were included. Results: Sixteen studies were included in this systematic review. All included examinations were ranked "good" or "low risk of bias" based on the criteria utilized in the Joanna Briggs Institute (JBI) scale and the Effective Public Health Practice Project (EPHPP) tool. Most of the articles (43%) were conducted in the USA and 25% in Australia. In 43% of the total studies, the study population was only physiotherapy students, and in 12.5% of them, the scope of education was related to practical skills training. Three of the 16 reviewed articles presented positive qualitative results; thirteen quantitative investigations also declared statistically positive effects. Positive effects have been seen in areas such as improving professional and behavioral abilities, improving knowledge and self-confidence, and reducing stress. The sample size of the studies ranged from eight to 162 participants. The limited sample sizes in groups, lack of interaction, and short follow-up duration were the most consistent limitations evident within the included studies. Conclusion: Computerized simulation education approaches can help to improve physiotherapy students' skills and knowledge. They also have great potential to reduce learning costs and increase the quality of education.

Discriminative ability of fall efficacy scale international in Iranian people with multiple sclerosis.

BACKGROUND: The discriminative validity of fall efficacy scale international (FES-I) in differentiating between fallers and non-fallers, levels of functional mobility, dynamic balance and disability has not been assessed in Persian speaking people with multiple sclerosis (MS). OBJECTIVE: To assess reliability, factor structure, construct and known group validity, sensitivity and specificity of FES-I for differentiating individuals with and without a history of fall and determining a cutoff point of the Persian version of the FES-I in people with MS. METHOD: One hundred thirty people with all subtypes of MS were included. The ability of FES-I in differentiating fall history was assessed using receiver operating characteristic (ROC). Also the FES-I score of groups based on expanded disability status scale (EDSS) 1-3.5 low and 4-6 moderate, time up and go (TUG) ≥14 sec and functional reach test (FRT) ≥25 cm were compared. The correlation between FES-I with EDSS, TUG, FRT and short form health survey (SF-36) was assessed. RESULTS: The ROC curve analysis revealed that the FES-I could differentiate people with MS based on fall history at a cutoff score of 35.5. The area under the curve (AUC) was 0.86 (sensitivity 76%; specificity 95%). Significant difference was observed between the FES-I score of groups with moderate and low EDSS scores (d = 2.98), higher than 14 sec TUG (d = 2.18) and lower than 25 cm FRT(d = 2.53). Significant high correlation was observed between FES-I with TUG (r = 0.88), EDSS (r = 0.91), FRT (r = -0.83), SF-36 physical (r =  -0.87) and mental (r =  -0.70) subscales. CONCLUSIONS: The Persian versions of the FES-I could differentiate people with MS with fall history, higher disability, lower functional mobility and balance deficiency.