ABSTRACT
INTRODUCTION: Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day-to-day activities and their quality of life. OBJECTIVE: To determine whether the order of application and the dose of modified constraint-induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance. DESIGN: Single-blinded randomized controlled trial. PARTICIPANTS: Twenty-one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain. INTERVENTIONS: The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint-induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint-induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks. OUTCOME MEASURES: The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral-Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10. RESULTS: The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint-induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint-induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint-induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09). CONCLUSIONS: Modified constraint-induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance. GOV IDENTIFIER: NCT03465046.
Subject(s)
Cerebral Palsy , Hemiplegia , Child , Humans , Child, Preschool , Quality of Life , Treatment Outcome , Physical Therapy Modalities , Movement , Upper ExtremityABSTRACT
OBJECTIVE: The aim of this meta-analysis was to evaluate the evidence of the effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy. METHODS: A bibliographic search was conducted in four databases. Studies were grouped according to the intervention program(muscle training versus control and individual home-based versus physiotherapist-guided muscle training). RESULTS: Eight studies were selected for meta-analysis after satisfying the selection criteria. The data show that pelvic floor muscle training improves continence rate in the short (RR=2.16; p<0.001), medium (RR=1.45; p=0.001) and long term (RR=1.23; p=0.019) after surgery. The number of randomized controlled trials and the heterogeneity in the study population and type of pelvic floor muscle training were the main limitations. CONCLUSION: Programs including at least three sets of 10 repetitions of muscle training daily appear to improve continence rate after radical prostatectomy. Our meta-analysis shows that muscle training programs for urinary incontinence provide similar results to those of physiotherapist-guided programs, therefore being more cost-effective.
