Comparison of Neuromuscular Joint Facilitation and Quadriceps Strengthening Exercise in Knee Osteoarthritis: a Randomized Controlled Trial.

Objectives: To compare the effect of neuromuscular joint facilitation (NJF) and quadriceps strengthening exercises on pain, physical function, static posture, and balance control in subjects with knee osteoarthritis. Design: Randomized controlled trial. Setting: Department of Physiotherapy, Manipal Hospitals, Bangalore. Participants: Subjects diagnosed with knee osteoarthritis according to the American College of Sports Medicine criteria. The mean age of subjects in the control group was 63.12 ± 8.08 years; in the experimental group was 61.77 ± 8.46 years. Interventions: The intervention group received NJF treatment twice a week for six weeks, and the control group received quadriceps strengthening exercises. Standard knee exercises were given as a home program to both groups. Outcome Measures: Numeric Pain Rating Scale (NPRS), 30-second chair stand (30s-CST), and single leg stance (SLS) were used to assess physical function, static posture, and balance control, respectively, at the end of the sixth week. Results: Sixty subjects were randomly allocated to intervention and control groups. The experimental and control group showed a mean difference of 3.89 and 4.17 in NPRS, 4.19 and 4.17 in 30s-CST, 6.81 and 5.71 in SLS at the end of six weeks. This change was significant within both groups (p value .000) and not significant between groups (NPRS p value .303; 30s-CST p value .09; SLS p value .525) at the end of six weeks. Conclusions: NJF and quadriceps strengthening exercises effectively reduced pain and improved physical function, static posture, and balance control in subjects with knee osteoarthritis. Both groups had the same effect on all clinical variables at six weeks of follow-up. Hence, further studies with long term follow-up are warranted.

Effect of breathing re-training on end-tidal carbon-di-oxide in patients with asthma: a systematic review and meta-analysis.

OBJECTIVE: The review aims to determine the effect of breathing re-training on End-tidal carbon-di-oxide (ETCO2) in patients with asthma. DATA SOURCES: A systematic search of articles was performed in PubMed, Cochrane, PEDro, Scopus, and Ovid databases from their inception till May 2022. STUDY SELECTIONS: Studies were included if the patients were clinically diagnosed with mild-moderate asthma. Randomized controlled trials that monitored ETCO2 as a primary or secondary outcome were included. Studies were examined for potential risk of bias using the Revised Cochrane risk of bias tool by two independent reviewers. RESULTS: Eight articles were included. The trials used various techniques like Buteyko, Papworth, Biofeedback, and holistic approach. Quantitative analysis was conducted to examine the effects on ETCO2 at various time points. A significant large effect was seen on ETCO2 following breathing re-training post-treatment, 3 and 6 months post-intervention. CONCLUSION: There is moderate evidence for a significant effect of breathing re-training on ETCO2 in the short and long term in patients with asthma. However, high-quality randomized controlled trials using standardized measurement of ETCO2 are required to evaluate the effects of different breathing re-training techniques.

The effectiveness of mindfulness-based stress reduction intervention on physical function in individuals with chronic low back pain: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Mindfulness-based stress reduction (MBSR) is often used as a complementary treatment for chronic low back pain (CLBP), but its effects on the physical function component of the outcome are not addressed. This systematic review aims to examine the effectiveness of MBSR on outcomes of physical functions in CLBP individuals. METHODS: Databases searched included PubMed/MEDLINE, PEDro, The Cochrane Database of Systematic Reviews, Web of Science, Scopus, CINAHL, Embase, and other sources (Google Scholar, ProQuest, Research Gate) from inception to January 2022. Randomized controlled trials (RCTs) comparing MBSR with additional interventions that evaluated physical function among CLBP individuals were included. Two independent reviewers performed data extraction. The risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS: Six RCTs involving CLBP individuals were eligible for review. The between-group differences in RMDQ for the MBSR therapies against comparator therapies were significant at eight weeks follow-up (3 RCTs; MD, -1.28 [CI, -2.04 to -0.53]) and six months follow-up (2 RCTs; MD, -0.16 [CI, -1.01 to 0.69]). CONCLUSION: MBSR therapy improves physical function at 8 weeks and 6 months follow-up in CLBP individuals. Further high-quality RCTs are warranted for the long-term effect of MBSR therapy on physical function outcomes.

Comparison of Glutues Maximus Activation to Flexion Bias Exercises Along with MET Technique in Subjects with Anterior Rotated Sacroiliac Joint Dysfunction-a Randomised Controlled Trial.

BACKGROUND: Sacroiliac joint dysfunction (SIJD) is the primary source of low-back pain. Main muscles forming the force closure of sacroiliac joint are the biceps femoris and gluteus maximus which increase the stability through massive attachments via sacrotuberous ligament. However, there is a dearth of literature of the importance of activation of gluteus maximus in SIJD. PURPOSE: To study the effect of gluteus maximus activation on Oswestry Disability Index (ODI), visual analog scale (VAS), and pelvic tilt angle in subjects with anterior rotated sacrolilac joint dysfunction. SETTINGS: The study was conducted in outpatient Physiotherapy Department, Manipal Hospital, Bangalore, India. PARTICIPANTS: Anterior rotated SIJD subjects were recruited in the study. They were divided into two groups (experimental and control groups) by block randomisation. RESEARCH DESIGN: This is a randomised control trial. CONTROLLED TREATMENT: Treatment order was determined by block randomisation. The subjects of both experimental and control group received Muscle Energy Technique (MET) technique on 1st session to correct the anterior rotated SIJD. The experimental group received gluteus maximus activation protocol, whereas the control group received flexion bias exercises. The groups received the treatment of 20 mins per session. There were two supervised sessions per week for four weeks. MAIN OUTCOME MEASURES: The primary outcome measure in the study is Oswestry Disability Index (ODI). The secondary outcome measures included visual analog scale (VAS) and Palpation Meter (PALM). RESULTS: 48 subjects (26 females, 22 males) were randomised into experimental and control groups having anterior rotation SIJD, and average age in groups was 38.83 ± 11.4 years and 34.96 ± 9.5 years, respectively. The within-group analysis showed significant improvements in only ODI outcome of both the groups (p = .001). The between-group analysis in both groups did not show any statistical significant difference in ODI, VAS, or PALM. CONCLUSION: The flexion bias exercise and the gluteus maximus activation exercises used in this study were equally effective in improving physical function and reduction in pain, and maintaining the normal pelvic angle in subjects with anterior rotated SIJD.

Comparison of the effects of Buteyko and pranayama breathing techniques on quality of life in patients with asthma - a randomized controlled trial.

OBJECTIVE: To compare two breathing exercises (Buteyko and pranayama) with a control group in patients with asthma. DESIGN: Randomized controlled trial. SUBJECTS: One hundred and twenty subjects were randomized to three groups through block randomization. Subjects with an Asthma Quality of Life Questionnaire score <5.5 participated in the study. SETTING: Outpatient pulmonary medicine department. INTERVENTIONS: Subjects in the Buteyko and pranayama groups were trained for 3-5 days and instructed to practise the exercises for 15 minutes twice daily, and for three months duration. The control group underwent routine pharmacological management during the study period. OUTCOME MEASURES: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire and pulmonary function test. RESULTS: The baseline characteristics were similar in all three groups. Post intervention, the Buteyko group showed better trends of improvement (mean (95% confidence interval), P-value) in total Asthma Quality of Life Questionnaire score than the pranayama (0.47 (-0.008-0.95), P = 0.056) and control groups (0.97 (0.48-1.46), P = 0.0001). In comparison between the pranayama and control groups, pranayama showed significant improvement (0.50 (0.01-0.98), P = 0.042) in total Asthma Quality of Life Questionnaire score. CONCLUSION: The Buteyko group showed better trends of improvement in quality of life and asthma control than the group performing the pranayama breathing exercise.

Effect of diaphragmatic breathing exercise on quality of life in subjects with asthma: A systematic review.

The aim of this systematic review was to determine if diaphragmatic breathing exercise improves quality of life (QoL) in asthma. Electronic databases were searched for randomized controlled trials (RCTs). Data were extracted and risk of bias was assessed by two independent reviewers. Three RCTs were eligible for inclusion (254 subjects). Two studies compared diaphragmatic breathing exercise to asthma education, and one compared with asthma medication. Meta-analysis was not possible due to clinical heterogeneity of the studies. All three studies had a low risk of bias. All studies reported short-term effects, and long-term effects of breathing exercise on asthma quality life. There is a moderate evidence of improvement in QoL following diaphragmatic breathing both in short-term and long-term basis.

Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey.

CONTEXT: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. AIMS: The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT). SETTINGS AND DESIGN: Cross-sectional survey of 363 nurses in a multispecialty hospital. MATERIALS AND METHODS: The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate 'correct', 'incorrect', or 'unsure.' The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items). STATISTICAL ANALYSIS USED: Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson's co-efficient using SPSS version 16.0 for Windows. RESULTS: The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05). CONCLUSIONS: Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.

A review on assessment and treatment of the trunk in stroke: A need or luxury.

Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke. The primary contribution of the trunk muscles is to allow the body to remain upright, adjust weight shifts, and control movements against constant pull of gravity and is considered central key point of the body. Proximal stability of the trunk is a pre-requisite for distal limb mobility, balance, gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross-sectional study. Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors, extensors and rotator muscles in both acute and chronic hemiplegic patients. This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke. Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk, and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients. However, trunk exercises given early after stroke could produce enhanced balance performance post- stroke. This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.

Attitudes and Beliefs About Chronic Pain Among Nurses-Biomedical or Behavioral? A Cross-sectional Survey.

CONTEXT: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in chronic pain. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and attitudes and beliefs related to chronic pain. AIMS: The objective of this paper was to assess the chronic pain-related attitudes and beliefs among nursing professionals in order to evaluate the biomedical and behavioral dimensions of their perceptions on pain. SETTINGS AND DESIGN: Cross-sectional survey of 363 nurses in a multispecialty hospital. MATERIALS AND METHODS: The study utilized a self-report questionnaire - pain attitudes and beliefs scale (PABS) - which had 31 items (statements about pain) for each of which the person had to indicate the level at which he or she agreed or disagreed with each statement. Factor 1 score indicated a biomedical dimension while factor 2 score indicated a behavioral dimension to pain. STATISTICAL ANALYSIS USED: Comparisons across individual and professional variables for both dimensions were done using one-way ANOVA and correlations were done using the Karl-Pearson co-efficient using SPSS version 11.5 for Windows. RESULTS: The overall factor 1 score was 52.95 ± 10.23 and factor 2 score was 20.93 ± 4.72 (P = 0.00). The female nurses had a higher behavioral dimension score (21.1 ± 4.81) than their male counterparts (19.55 ± 3.67) which was significant at P < 0.05 level. CONCLUSIONS: Nurses had a greater orientation toward the biomedical dimension of chronic pain than the behavioral dimension. This difference was more pronounced in female nurses and those nurses who reported very "good" general health had higher behavioral dimension scores than those who had good general health. The study findings have important curricular implications for nurses and practical implications in palliative care.