Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial.

BACKGROUND: The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. OBJECTIVE: To compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in patients with stroke. METHODS: A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30-45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography. RESULTS: Except for FVC (%pred) (F=4.432, p=0.018, np2=0.174), FEV1(%pred) (F=3.725, p=0.032, np2=0.151), and MEP (F=3.861, p=0.029, np2=0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p>0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred), FEV1(%pred) and MEP (p>0.025). CONCLUSIONS: The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.

Effects of robot-assisted arm training on respiratory muscle strength, activities of daily living, and quality of life in patients with stroke: a single-blinded randomized controlled trial.

BACKGROUND: Post-stroke clinical changes not only affect extremities and trunk muscles but also the respiratory muscles. PURPOSE: To determine the effect of robot-assisted arm training with conventional rehabilitation (CombT) on respiratory muscle strength, activities of daily living (ADL), and quality of life in patients with stroke and to compare the results with conventional rehabilitation (CR). METHODS: It was a two-arm, single-blinded, randomized controlled trial in which 66 patients were randomly allocated to either CombT or CR to receive 30 sessions (5/week) over 6 weeks. The respiratory muscle strength (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), activities of daily life (ABILHAND questionnaire), and quality of life (Stroke Impact Scale (SIS)) were measured before and 6 weeks after training. RESULTS: The CombT group showed significantly better MIP, MEP, and performance in ADLs after 6 weeks of training compared to the CR group (p < .01). The effect size was large for MIP (d = 0.9) and MEP (d = 0.9), whereas medium for performance in ADLs (d = 0.62). Also, the SIS-arm strength (p < .01), hand function (p = .04), ADLs (p = .02), and recovery (p = .04) were significantly better in CombT group with a medium (d = 0.6, d = 0.5, d = 0.5, and d = 0.5, respectively) effect size compared with CR group. CONCLUSIONS: Both CombT and CR groups improved respiratory muscle strength, performance in ADLs, and quality of life in patients with stroke. However, CombT appears to offer more comprehensive benefits, highlighting its valuable role in respiratory and functional recovery after stroke.

The effects of low-intensity resistance training with blood flow restriction versus traditional resistance exercise on lower extremity muscle strength and motor functionin ischemic stroke survivors: a randomized controlled trial.

BACKGROUND: Blood flow restriction (BFR) training can temporarily reduce cortical GABA concentrations and increase the size of motor volleys to deafferented muscles, which can promote motor recovery in stroke survivors. OBJECTIVE: To determine the effect of low-intensity resistance training with BFR (LIRT-BFR) on lower extremity muscle strength, balance, functional mobility, walking capacity, gait speed, anxiety, and depression in stroke survivors and to compare the results with high-intensity resistance training (HIRT). METHOD: It was a two-arm, single-blinded, randomized controlled trial in which 32 ischemic stroke participants were randomly allocated to LIRT-BFR or HIRT group. The LIRT-BFR group received low load resistance training (40% of 1-Repetition Maximum (1-RM)) with BFR, whereas HIRT group received high load resistance training (80% of 1-RM). The 6-Minute Walk Test (6-MWT), five-time sit-to-stand test (5TSTST), Timed Up and Go (TUG) test, and Barthel index were the primary outcome measures. The secondary outcome measures included gait speed (m/s), stride length (cm), cadence (steps/min), and Hospital Anxiety and Depression. RESULTS: All the primary and secondary outcome measures were significantly improved in both groups (p < 0.05). The LIRT-BFR group showed a slightly greater, but non-significant, improvement as compared to the HIRT group in terms of mean change observed in 6-MWT (81 m vs 62 m), 5TSTST (-5.27 vs -4.81), gait speed (0.19 vs 0.12), stride length (18 vs 13), and cadence (8 vs 6). No adverse event was reported. CONCLUSION: LIRT-BFR produced a significant improvement in muscle strength, balance, walking capacity, and anxiety and depression in ischemic stroke patients, and the improvement are comparable to HIRT. CLINICAL TRIAL REGISTRATION: NCT05281679.

A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study.

BACKGROUND: Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments. OBJECTIVE: This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents. METHODS: Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength. RESULTS: There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25-75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively). CONCLUSION: Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD.

Non-invasive Brain Stimulation Techniques for the Improvement of Upper Limb Motor Function and Performance in Activities of Daily Living After Stroke: A Systematic Review and Network Meta-analysis.

OBJECTIVE: To compare the efficacy of non-invasive brain stimulation (NiBS) such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), theta-burst stimulation (TBS), and transcutaneous vagus nerve stimulation (taVNS) in upper limb stroke rehabilitation. DATA SOURCES: PubMed, Web of Science, and Cochrane databases were searched from January 2010 to June 2022. DATA SELECTION: Randomized controlled trials (RCTs) assessing the effects of "tDCS", "rTMS", "TBS", or "taVNS" on upper limb motor function and performance in activities of daily livings (ADLs) after stroke. DATA EXTRACTION: Data were extracted by 2 independent reviewers. Risk of bias was evaluated with the Cochrane Risk of Bias tool. DATA SYNTHESIS: 87 RCTs with 3750 participants were included. Pairwise meta-analysis showed that all NiBS except continuous TBS (cTBS) and cathodal tDCS were significantly more efficacious than sham stimulation for motor function (standardized mean difference [SMD] range 0.42-1.20), whereas taVNS, anodal tDCS, and both low and high frequency rTMS were significantly more efficacious than sham stimulation for ADLs (SMD range 0.54-0.99). NMA showed that taVNS was more effective than cTBS (SMD:1.00; 95% CI (0.02-2.02)), cathodal tDCS (SMD:1.07; 95% CI (0.21-1.92)), and Physical rehabilitation alone (SMD:1.46; 95% CI (0.59-2.33)) for improving motor function. P-score found that taVNS is best ranked treatment in improving motor function (SMD: 1.20; 95% CI (0.46-1.95)) and ADLs (SMD:1.20; 95% CI (0.45-1.94)) after stroke. After taVNS, excitatory stimulation protocols (intermittent TBS, anodal tDCS, and HF-rTMS) are most effective in improving motor function and ADLs after acute/sub-acute (SMD range 0.53-1.63) and chronic stroke (SMD range 0.39-1.16). CONCLUSIONS: Evidence suggests that excitatory stimulation protocols are the most promising intervention in improving upper limb motor function and performance in ADLs. taVNS appeared to be a promising intervention for stroke patients, but further large RCTs are required to confirm its relative superiority.

Does noninvasive brain stimulation combined with other therapies improve upper extremity motor impairment, functional performance, and participation in activities of daily living after stroke? A systematic review and meta-analysis of randomized controlled trial.

BACKGROUND: Several studies have investigated the effect of noninvasive brain stimulation (NIBS) on upper limb motor function in stroke, but the evidence so far is conflicting. OBJECTIVE: We aimed to determine the effect of NIBS on upper limb motor impairment, functional performance, and participation in activities of daily living after stroke. METHOD: Literature search was conducted for randomized controlled trials (RCTs) assessing the effect of "tDCS" or "rTMS" combined with other therapies on upper extremity motor recovery after stroke. The outcome measures were Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI). The mean difference (MD) and 95%CI were estimated for motor outcomes. Cochrane risk of bias tool was used to assess the quality of evidence. RESULT: Twenty-five RCTs involving 1102 participants were included in the review. Compared to sham stimulation, NIBS combined with other therapies has effectively improved FMA-UE (MD0.97 [95%CI, 0.09 to 1.86; p = .03]) and BI score (MD9.11 [95%CI, 2.27 to 15.95; p = .009]) in acute/sub-acute stroke (MD1.73 [95%CI, 0.61 to 2.85; p = .003]) but unable to modify FMA-UE score in chronic stroke (MD-0.31 [95%CI, -1.77 to 1.15; p = .68]). Only inhibitory (MD3.04 [95%CI, 1.76 to 4.31; I2 = 82%, p < .001] protocol is associated with improved FMA-UE score. Twenty minutes of stimulation/session for ≥20 sessions was found to be effective in improving FMA-UE score (Stimulation time: ES0.45; p ≤ .001; Sessions: ES0.33; p ≤ .001). The NIBS did not produce any significant improvement in WMFT as compared to sham NIBS (MD0.91 [95% CI, -0.89 to 2.70; p = .32]). CONCLUSION: Moderate to high-quality evidence suggested that NIBS combined with other therapies is effective in improving upper extremity motor impairment and participation in activities of daily living after acute/sub-acute stroke.

Reliability and Validity of the Turkish Version of the Modified Dynamic Gait Index in the Elderly.

The modified Dynamic Gait Index (mDGI) is one of the valid instruments used in the evaluation of gait disorders. This study aimed to translate the mDGI into Turkish and evaluate the evidence for its reliability and validity for use in an elderly population. For test-retest reliability, the mDGI was administered twice, and for inter-rater reliability, the mDGI was administered alone on the same day by two raters. Concurrent validity of the mDGI was assessed using Pearson's correlation analysis between the Turkish version of the mDGI score and the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-m Walk Test (10-MWT), respectively. The internal consistency of the mDGI was found to be excellent (Cronbach's alpha = 0.97) and test-retest (ICC = 0.95; 95% Cl (0.84-0.95)) and inter-rater reliability (ICC = 0.95; 95% Cl (0.85-0.95)) were excellent. A negative, moderate correlation was found between mDGI and TUG (r = -0.73, p < .0001), and a positive, moderate correlation with BBS (r = 0.71, p < .0001) and 10-MWT (r = 0.72, p < .0001). The Turkish version of the mDGI was found to be a valid and reliable assessment instrument for gait and balance in the elderly.

Which type of mind-body exercise is most effective in improving functional performance and quality of life in patients with Parkinson's disease? A systematic review with network meta-analysis.

BACKGROUND: Several studies have investigated the effect of mind-body exercise (MBE) on functional performance and health-related quality of life (HRQoL) in Parkinson's disease (PD), but it is still very difficult for clinicians to make informed decision on the best mind-body exercise for PD. PURPOSE: We analyzed the relative efficacy of MBE (yoga, Tai-Chi, Pilates, Qigong, and dance) in improving functional performance and HRQoL in patients with PD. METHODS: A systematic review of randomized controlled trials (RCTs) was performed using network meta-analysis (NMA), searching the following databases: Cochrane, Web of Science, and PubMed using specific keywords until December 28, 2021, assessing the effects of MBE on functional performance and HRQoL in patients with PD. RESULTS: This review included 60 RCTs with 2037 participants. A ranking of MBE for modifying various aspects of functional performance and HRQoL was achieved. Pairwise NMA showed Pilates to be the most effective in improving functional mobility (MD: - 3.81; 95% CI (- 1.55, - 6.07) and balance performance (SMD: 2.83; 95% CI (1.87, 3.78). Yoga (MD: - 5.95; 95% CI (- 8.73, - 3.16) and dance (MD: - 5.87; 95% CI (- 8.73, - 3.01) to be the most effective in improving motor function, whereas Qigong (MD: 0.32; 95% CI (0.00, 0.64) was most effective in improving gait speed. Considering HRQoL, dance was found to be the most effective (SMD: - 0.36; 95% CI (- 0.70, -0.01). CONCLUSION: MBE should be considered an effective strategy for improving functional performance and HRQoL in patients with PD. The most effective MBE intervention varied with the functional performance domain. Dance was an effective exercise for improving HRQoL among people with PD. PROSPERO REGISTRATION ID: CRD42022301030.

Effect of Pulmonary Rehabilitation Approaches on Dyspnea, Exercise Capacity, Fatigue, Lung Functions, and Quality of Life in Patients With COVID-19: A Systematic Review and Meta-analysis.

OBJECTIVE: To qualitatively synthesize and quantitatively evaluate the effect of pulmonary rehabilitation (PR) on dyspnea, lung functions, fatigue, exercise capacity, and quality of life (QoL) in patients with COVID-19. DATA SOURCES: PubMed, Web of Science, and Cochrane databases were searched from January 2020 to April 2022. DATA SELECTION: Randomized controlled trials (RCTs) assessing the effect of PR on dyspnea, lung functions, fatigue, exercise capacity, and QoL in patients with COVID-19. DATA EXTRACTION: The mean difference (MD) and a 95% CI were estimated for all the outcome measures using random effect models. The following data were extracted by 2 independent reviewers: (1) first author; (2) publication year; (3) nationality; (4) number of patients included (5) comorbidities; (6) ventilatory support; (7) length of inpatient stay; (8) type of PR; (9) outcome measures; and (10) main findings. The risk of bias was evaluated using the cochrane risk of bias tool. DATA SYNTHESIS: A total of 8 RCTs involving 449 participants were included in the review. PR was found to be significantly effective in improving dyspnea (5 studies, SMD -2.11 [95% CI, -2.96 to -1.27; P<.001]) and exercise capacity (MD 65.85 m [95% CI, 42.86 to 88.83; P<.001]) in patients with both acute and chronic COVID-19 with mild to severe symptoms, whereas fatigue (MD -2.42 [95% CI, -2.72 to -2.11, P<.05]) and lung functions (MD 0.26 L [95% CI, 0.04 to 0.48, P<.05]) were significantly improved in acute COVID-19 patients with mild symptoms. The effect of PR on QoL was inconsistent across studies. PR was found to be safe and feasible for patients with COVID-19. CONCLUSION: Evidence from studies indicates that PR program is superior to no intervention in improving dyspnea, exercise capacity, lung functions, and fatigue in patients with COVID-19. PR appears to be safe and beneficial for both acute and chronic COVID-19 patients.

The Adjunct of Electric Neurostimulation to Rehabilitation Approaches in Upper Limb Stroke Rehabilitation: A Systematic Review With Network Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: This review analyzed the current evidence and the potential for the application of electric neurostimulation such as transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS) in upper limb stroke rehabilitation. MATERIALS AND METHODS: We performed a systematic review of randomized controlled trials (RCTs) using network meta-analysis (NMA), searching the following data bases: PubMed, Web of Science, Cochrane, and Google Scholar, using specific keywords, from January 2010 to April 2021, and assessing the effects of "tDCS" or "VNS" combined with other therapies on upper limb motor function and activities of daily living (ADL) after stroke. RESULTS: We included 38 RCTs with 1261 participants. Pairwise NMA showed transcutaneous VNS (tVNS) and anodal tDCS were effective in improving upper limb motor function (tVNS: mean difference [MD]: 5.50; 95% CI [0.67-11.67]; p < 0.05; anodal tDCS: MD: 5.23; 95% CI [2.45-8.01]; p < 0.05). tVNS and tDCS (anodal and cathodal) were also effective in improving ADL performance after stroke (tVNS: standard MD [SMD]: 0.96; 95% CI [0.15-2.06]; p < 0.05; anodal tDCS: SMD: 3.78; 95% CI [0.0-7.56]; p < 0.05; cathodal tDCS: SMD: 5.38; 95% CI [0.22-10.54]; p < 0.05). Surface under the cumulative ranking curve analysis revealed that tVNS is the best ranked treatment in improving upper limb motor function and performance in ADL after stroke. There was no difference in safety between VNS and its control interventions, measured by reported adverse events (VNS: risk ratio = 1.02 [95% CI = 0.48-2.17; I2 = 0; p = 0.96]). CONCLUSION: Moderate- to high-quality evidence suggests that tVNS and anodal tDCS were effective in improving upper limb motor function in both acute/subacute and chronic stroke. In addition to tVNS and anodal tDCS, cathodal tDCS is also effective in improving ADL performance after stroke.

Prevalence of musculoskeletal pain and its impact on quality of life and functional exercise capacity in patients with pulmonary arterial hypertension.

BACKGROUND: In pulmonary arterial hypertension (PAH), pathophysiological consequences of the disease and the drugs used to treat PAH may adversely affect musculoskeletal system. Aim of the study was to evaluate musculoskeletal pain prevalence and its impact on quality of life (QoL) and exercise capacity in PAH patients. METHODS: 61 PAH patients were evaluated with Nordic Musculoskeletal Questionnaire (NMQ) for musculoskeletal pain presence, EmPHasis-10 and Minnesota Living with Heart Failure Questionnaire (MLHFQ) for QoL, 6-min walk test (6MWT) for functional exercise capacity and International Physical Activity Questionnaire- Short Form (IPAQ-SF) for physical activity participation. RESULTS: 77% of PAH patients reported musculoskeletal pain. Pain prevalence was highest at low back (38%), followed by knees (36%), shoulders (36%) and neck (33%). Hemodynamic indicators of PAH severity were associated with pain presence in various parts of the body. Patients receiving any PAH-specific drug were more likely to experience pain compared to the patients whose drug therapy has not yet been initiated (RR = 1.6-2.0). Pain presence in neck, shoulder, low back and knees significantly correlated to worse QoL scores in both EmPHasis-10 and MLHFQ (p < 0.05). Pain presence in knees had the strongest influence on QoL, and it was the only significant correlate of 6MWT (r = -0.424) and IPAQ-SF (r = -0.264) (p < 0.05). CONCLUSIONS: Musculoskeletal pain is a common complaint in PAH patients, which significantly impairs QoL and physical functioning. Treatment strategies should include a more comprehensive assessment for musculoskeletal pain complaints of these patients and address pain presence accordingly, which may help providing a better management for PAH.

Does Duke Activity Status Index help predicting functional exercise capacity and long-term prognosis in patients with pulmonary hypertension?

BACKGROUND: To investigate the association of Duke Activity Status Index (DASI) with 6-minute walk test (6MWT) and WHO-Functional Class (WHO-FC) in patients with pulmonary hypertension (PH), as well as exploring whether DASI can discriminate between the patients with better and worse long-term prognosis according to 400 m cut-off score in 6MWT. METHODS: Eighty-five medically stable PH patients who met eligibility criteria were included. All patients were evaluated using 6MWT and DASI. The prognostic utility of the DASI was assessed using univariate linear regression and receiver operating characteristic (ROC) curve analysis. RESULTS: The DASI was an independent predictor for both 6MWT and WHO-FC, explaining 50% of variance in 6MWT and 30% of variance in WHO-FC class (p < 0.001). In addition, DASI significantly correlated to 6MWT (r = 0.702) and WHO-FC class (r = 0.547). The ROC curve analysis revealed that the DASI had a discriminative value for identifying the patients with better long-term prognosis (p < 0.001), with an area under ROC curve of 0.867 [95% CI = 0.782-0.952]. The DASI ≥26 was the optimal cut-off value for better long-term prognosis, having sensitivity of 0.74 and a specificity of 0.88. CONCLUSIONS: The DASI is a valid tool reflecting functional exercise capacity in patients with PH. Considering its ability to discriminate between the patients with better or worse long-term prognosis, it may help identifying the patients at higher risk.

The relationship between smartphone addiction and musculoskeletal pain prevalence among young population: a cross-sectional study.

BACKGROUND: In the literature, there have been debates as to whether smartphone use has negative effects on physical and mental health. The present study investigated the extent to which smartphone addiction impacts on musculoskeletal pain prevalence among university students. METHODS: The questionnaire consisted of three sections: demographic information, the Smartphone Addiction Scale (SAS), and the modified Nordic Musculoskeletal Questionnaire. RESULTS: A total of 249 participants were included in this cross-sectional study. The body parts that were reported with highest prevalence of musculoskeletal pain were the upper back (70.3%), neck (65.9%), and wrists/hands (68.7%). The SAS scores were correlated with duration of smartphone use on a typical day (P = 0.001), duration of owning a smartphone (P = 0.027), and musculoskeletal pain prevalence in the neck (P = 0.001), wrists/hands (P = 0.001), shoulders (P = 0.025), and upper back (P = 0.023). The SAS score was significantly associated with prevalence of musculoskeletal pain in the neck (odd ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.10; P = 0.002), wrists/hands (OR, 1.07; 95% CI, 0.97-1.09; P = 0.001), and upper back (OR, 1.10; 95% CI, 0.98-1.11; P = 0.033). CONCLUSIONS: The findings indicated that the upper back, neck, and wrists/hands have a higher prevalence of musculoskeletal pain among smartphone users, particularly those with a smartphone addiction. Smartphone addiction scores were correlated with duration of smartphone use on a typical day, duration of owning smartphone, and musculoskeletal pain prevalence in the neck, wrists/hands, shoulders, and upper back.

Chest Wall Mobility: Identification of Underlying Predictors.

OBJECTIVE: The purpose of this study was to identify factors contributing to normal mobility or hypermobility of the chest wall. METHODS: Seventy-eight young adults were divided into 2 groups: patients with normal mobility (group 1, n = 40) and hypermobility of the chest wall (group 2, n = 38). The mean mobility of the chest wall in groups 1 and 2 was 9.9 and 6.1 cm, respectively. The mean age of groups 1 and 2 was 22.2 and 21.5 years, respectively. The Brief Symptom Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory, and the Perceived Stress Scale were used to evaluate the psychometric properties. Quality of life was assessed using 12-Item Short Form Health Survey. Smoking status was determined via self-report of current smoking status. Chest wall mobility was measured using thoracic and axillary cirtometry. Pulmonary functions were evaluated using a Spirobank II device. Subsequently, forced vital capacity (FVC), forced expiratory volume in 1 second, peak expiratory flow, and forced expiratory flow 25% to 75% were verified. Carefusion Micro RPM and the 6-minute walk test were used to evaluate maximal respiratory pressures and functional capacity, respectively. RESULTS: With backward linear regression models, FVC and obsessive-compulsive traits were significant predictors of chest wall mobility (R²â€¯= 0.27; P < .001 and P = .01, respectively). In logistic regression models, FVC, maximum inspiratory pressure, and obsessive-compulsive traits were significant predictors of normal mobility/hypermobility of the chest wall (R²â€¯= 0.42; P < .001, P = .01, and P = .03, respectively). CONCLUSION: Forced vital capacity, maximum inspiratory pressure, and obsessive-compulsive traits are significant predictors of chest wall mobility and normal mobility or hypermobility of the chest wall.

A systematic review of musculoskeletal complaints, symptoms, and pathologies related to mobile phone usage.

BACKGROUND: In the past decade, mobile phone usage rates have increased and there have been concerns that overuse of mobile phones may contribute to various musculoskeletal (MSK) problems. OBJECTIVES: The aim of the present study was to systematically review available literature on the prevalence of MSK complaints, symptoms, and pathologies associated with mobile phone use. STUDY DESIGN: Systematic review. METHOD: In this systematic review, Medline (Pubmed), Wiley, WOS, and EMBASE electronic databases were searched for studies published in English between January 1, 2000 and March 25, 2019 using the following. KEY TERMS: 'mobile phone', 'smartphone', 'musculoskeletal pain', 'pain', 'musculoskeletal symptoms', and 'musculoskeletal pathology'. RESULTS: The search strategy identified 196 papers, of which 18 met the inclusion criteria. Among the studies included in the systematic review, five were high quality, twelve were of acceptable quality, and one was of low quality. The review demonstrated that the prevalence of MSK complaints among mobile phone users ranged 8.2%-89.9%, and that neck and upper back complaints had the highest prevalence rates ranging from 55.8% to 89.9%. The most common MSK symptom associated with mobile phone use was pain. Myofascial pain syndrome, fibromyalgia, thoracic outlet syndrome, tendonitis, and De Quervain's syndrome were the most commonly associated MSK pathologies. CONCLUSION: The evidence concerning MSK complaints among mobile phone is somewhat limited because the data were obtained from cross-sectional and case-control study results. Consequently, there is need for higher quality and prospective studies to better understand the relationship between mobile phone use and MSK symptoms and pathologies.

Stretching exercises combined with ischemic compression in pectoralis minor muscle with latent trigger points: A single-blind, randomized, controlled pilot trial.

BACKGROUND AND PURPOSE: Latent trigger points (LTrPs) in the pectoralis minor (PM) muscle lead to muscle tightness. This study aimed to investigate which type of stretching exercise used after ischemic compression (IC) was more effective on LTrPs in the PM muscle. MATERIALS AND METHODS: Forty participants with PM muscle tightness and an LTrP in the PM muscle were divided among groups 1 (IC with modified contract-relax proprioceptive neuromuscular facilitation (PNF) stretching), 2 (IC with static stretching), 3 (IC with myofascial release) and 4 (no intervention). The PM muscle index (PMI), PM length (PML), rounded shoulder posture, pressure pain threshold, pulmonary function, and maximal respiratory pressure were evaluated. RESULTS: Improvement in the PMI and PML was found immediately after the intervention in groups 1 and 3 compared with baseline (p = 0.01). The overall group-by-time interaction in the repeated measures analysis of variance was significant for the PMI in favor of Group 1 (F1, 36 = 3.53, p = 0.02). CONCLUSION: IC may be followed by contract-relax PNF stretching to increase the length of PM muscle with LTrPs.

Does robot-assisted gait training improve mobility, activities of daily living and quality of life in stroke? A single-blinded, randomized controlled trial.

The purpose of this study was to investigate the effects of robot-assisted gait training (RAGT) on mobility, activities of daily living (ADLs), and quality of life (QoL) in stroke rehabilitation. Fifty-one stroke patients randomly assigned to Group 1, Group 2, and Group 3 received conventional training (CT) plus RAGT, CT, and RAGT, respectively. The training duration was for 6 weeks. The primary outcome measures were the Barthel Index (BI), Stroke Specific Quality of Life Scale (SS-QOL), 6-Minute Walk Test (6-MWT), and Stair Climbing Test (SCT). The secondary outcomes were Fugl Meyer Assessment-Lower Extremity (FMA-LE), Comfortable 10-m Walk Test (CWT), Fast 10-m Walk Test (FWT), and Rate of Perceived Exertion (RPE). The mean change in all the primary [BI (p = 0.001), 6-MWT (p = 0.001), SS-QOL (p < 0.0001), and SCT (p = 0.004)] and except the FWT (p = 0.354) all the other secondary outcomes [FMA-LE (p = 0.049), CWT (p = 0.025) and RPE (p = 0.023)] improved significantly between the three groups. In the subgroup analysis, BI, 6-MWT, SS-QOL, and SCT improved significantly in Group 1 compared to Group 2 and Group 3 (p < 0.016). However, FMA-LE, CWT, and the RPE significantly improved in Group 1 compared to Group 2 and, also, only CWT improved significantly in Group 1 compared to Group 3 (p = 0.011). In a subgroup analysis of the primary and secondary outcome measures, there were no significant differences in Group 2 compared to Group 3 (p > 0.05). While combined training leads to more improvement in mobility, ADLs, and QoL, CT showed a similar improvement compared to the RAGT in stroke patients.

Effects of core stabilization exercises on pulmonary function, respiratory muscle strength, and functional capacity in adolescents with substance use disorder: Randomized controlled trial.

BACKGROUND: Adolescent substance abuse is a serious and growing problem worldwide. The aim of this study was to investigate the effects of core stabilization exercises on pulmonary function, respiratory muscle strength, and functional capacity in adolescents with substance use disorder (SUD). METHODS: This was a prospective randomized controlled trial. A total of 49 adolescent male patients with SUD were randomly assigned to either the exercise group (n = 25; mean age 16.6 years) or the control group (n = 24; mean age 16.7 years), for 6 weeks. All participants underwent a medical and behavioral therapy program 5 days a week for 6 weeks. The exercise group received five core stabilization exercises combined with deep breathing as a group training for 45 to 60 minutes, twice a week for 6 weeks, and the control group received recreational activities in addition to the usual care for 45 to 60 minutes, twice a week for 6 weeks. Spirometry, maximal inspiratory and expiratory pressures, and the 6-minute walk test were performed and measured at baseline and after training. RESULTS: There were significant improvements in maximal inspiratory pressure (24.16 cm H2 O; P < 0.0001), maximal expiratory pressure (30.28 cm H2 O; P < 0.0001), forced vital capacity (5.80% predicted, P < 0.0001), forced expiratory volume in 1 second (7.34% predicted; P = 0.002), peak expiratory flow (13.32% predicted; P = 0.0003), forced expiratory flow 25%-75% (11.84% predicted; P = 0.027), and the 6-minute walking distance (65.84 m; P < 0.0001) in the exercise group compared with the control group. CONCLUSIONS: Core stabilization exercise can improve pulmonary function, respiratory muscle strength, and functional capacity in adolescents with SUD.

The effects of body weight-supported treadmill training on static and dynamic balance in stroke patients: A pilot, single-blind, randomized trial.

OBJECTIVES: This study aims to compare effectiveness of isolated body weight-supported treadmill training (BWSTT) with conventional and combined training on balance, mobility, and fear of falling in stroke patients. PATIENTS AND METHODS: Between November 2014 and November 2015, a total of 45 post-stroke patients (32 males, 13 females; mean age 53.1±13.2 years; range, 19 to 73 years) were randomly assigned to combined training group (CombTG), conventional training group (CTG), and BWSTT group (BWSTTG). The CombTG received 45 min conventional therapy for five days a week along with 45 min of BWSTT twice a week. The CTG received only conventional therapy for five days a week. The BWSTTG received only BWSTT twice a week. Training duration was six weeks for all groups. Primary outcome measures were the Berg Balance Scale (BBS), affected and non-affected side Single Leg Stance Test (e-SLST/n-SLST), and Timed Up and Go Test (TUG) results. Secondary outcomes were the Falls Efficacy Scale-International (FES-I), Rivermead Mobility Index (RMI), Comfortable 10-m Walk Test (CWT), and Stair Climbing Test (SCT) results. RESULTS: The mean change of outcome measures demonstrated that the improvements between groups were significantly different among the three groups, except for the CWT (p=0.135). In subgroup analysis, except for the RMI and CWT, all primary and secondary outcome measures improved significantly in favor of the CombTG, compared to the CTG and BWSTTG (p<0.016). However, no statistically significant difference was found in the mean change of the CTG and BWSTTG (p>0.05). CONCLUSION: This study demonstrates that combined training has considerable effects on balance, mobility, and fear of falling parameters, while lower frequency of isolated BWSTT is as much effective as higher frequency of conventional training in ambulatory post-stroke patients.