Effect of lower body positive pressure aerobic training on fall risk in patients with diabetic polyneuropathy: randomized controlled trial.

BACKGROUND: Retarded task-oriented gait, balance performance and increased fall risk are among the most debilitating problems in patients with diabetic polyneuropathy (DPN). The lower body positive pressure (LBPP) training was recently introduced in the field of rehabilitation, but evaluating the effects of the LBPP on gait, balance and fall risk in patients with DPN has not been thoroughly investigated. AIM: The aim of this study was to evaluate the effect of LBPP treadmill training program on task-oriented gait, balance performance and fall risk in patients with DPN. DESIGN: Single-blinded, randomized-controlled trial. SETTING: Rehabilitative outpatient unit. POPULATION: Sixty-two patients with DPN were randomly assigned into 5-groups; group-A (100% weight-bearing; N.=12), group-B (75% weight-bearing; N.=13), group-C (50% weight-bearing; N.=13), group-D (25% weight-bearing; N.=12) and group-E (control group; N.=12). METHODS: The intervention groups (A, B, C, D) received moderate intensity aerobic exercise training (AET) program (30-45 minutes, 50-70% heart rate reserve) on the AlterG (AlterG, Inc., Fremont, CA, USA) treadmill for 12-weeks. Task-oriented gait, balance performance and the fall risk were evaluated at baseline (evaluation-1), after 12-weeks (evaluation-2) and 12-weeks poststudy cessation (evaluation-3; follow-up) for all groups using the Tinetti balance assessment tool. RESULTS: At evaluation-2, there were significant "within-groups" increases in the balance, gait and fall risk scores. There were significant "between-groups" differences in the same evaluated variables, with the highest increases were in group-B (P<0.05). At evaluation-3, there was a decline in the mean values of the evaluated variables, but still significant increases in the mean values of balance, gait and fall risk compared to the baseline mean values. There were significant "between-groups" differences in all variables, with the highest increases were in group-B (P<0.05). CONCLUSIONS: Moderate intensity LBPP treadmill training program can effectively improve task-oriented gait, balance performance, and fall risk scores in patients with DPN. The 25% off-loading weight percentage during the LBPP treadmill training program yielded the most favorable short and long-term improvements compared to the other weight off-loading percentages in patients with DPN. CLINICAL REHABILITATION IMPACT: The LBPP aerobic training program is an effective rehabilitation procedure in patients with DPN especially when utilizing the 25% off-loading weight percentage during the LBPP treadmill training program.

Effect of Electromyographic Biofeedback Training on Pain, Quadriceps Muscle Strength, and Functional Ability in Juvenile Rheumatoid Arthritis.

OBJECTIVE: To investigate the effects of electromyographic (EMG) biofeedback training on pain, quadriceps strength, and functional ability in juvenile rheumatoid arthritis (JRA). DESIGN: This is a randomized controlled study; 36 children (11 boys and 25 girls) with polyarticular JRA, with ages ranging from 8 to 13 years, were selected and assigned randomly, using computer-generated random numbers, into 2 groups. The control group (n = 18) received the conventional physical therapy program, whereas the study group (n = 18) received the same program as the control group in addition to EMG biofeedback-guided isometric exercises for 3 days a week for 12 weeks. Pain, peak torque of quadriceps strength, and functional ability were evaluated before, after 6 weeks, and at the end of 12 weeks of the treatment program. RESULTS: By 6 weeks, significant differences were observed in the study group (P < 0.05) in all measured variables except pain levels, whereas nonsignificant differences were observed in all measured variables in the control group. By 12 weeks, each group demonstrated significant improvements in pain, quadriceps strength, and functional ability (P < 0.05), with significantly greater improvements seen in the study group compared to the control group (P < 0.05). Both groups showed significant improvement at 12 weeks compared to that at 6 weeks. CONCLUSIONS: Electromyographic biofeedback may be a useful intervention modality to reduce pain, improve quadriceps strength, and functional performance in JRA.