Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials.

The aim of this study is to compare the efficacy of different exercise interventions for adult flexible flatfoot. Nine databases (PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PRDro, Google Scholar, China National Knowledge Infrastructure(CNKI) and Wanfang data) were systematically searched from their inception until February 2024. The search resulted in 2112 records, with 11 studies included. All networks revealed low heterogeneity and non-significant inconsistency (I2 ≤ 25.0%). Three network plots were formed for navicular drop. Firstly, compared with the control group, strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE (MD: 3.32, 95% CI: 1.78, 4.89), PNF (MD: 1.81, 95%CI: -0.05, 3.70), SFE (MD: 1.23, 95%CI: 1.02, 1.44) all showed better effects. And strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE exercise is considered to be the most effective intervention, with SUCRA of 0.97. Secondly, compared with the control group, hip-focused neuromuscular exercise (MD: 6.22, 95% CI: -1.69, 14.12), SFE with EMG biofeedback (MD: -0.81, 95%CI: -1.59, 3.21) all showed better effects. And hip-focused neuromuscular exercise is considered to be the most effective intervention, with SUCRA of 0.92. Thirdly, the internal foot muscle training combined with gluteus muscle strengthening is significantly better than the other two groups, with SUCRA of 0.99. For the foot posture index, comprehensive reinforcement (MD: 1.95, 95% CI - 0.19, 4.03) showed better effects compared with the control group. In the probability ranking table, comprehensive reinforcement is significantly better than the other two groups, with SUCRA of 0.98. For the foot function index, orthoses wear + stretching + eccentric progressive resistive exercise of tibialis posterior is significantly better than the other two groups, with SUCRA of 0.92. In conclusion, various exercise therapies improve the arch shape and function of patients with flexible flatfoot, particularly hip muscle and lower limb overall muscle training.

Recovery of physical function, muscle mass, and quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation.

This study aimed to investigate the recovery of physical function, muscle mass, and quality of life (QOL) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients 1 year after the procedure. A total of 71 patients who underwent allo-HSCT at our institution between February 2010 and June 2020, for whom a physical therapy assessment could be performed before allo-HSCT, at discharge, and 1 year after the procedure, were included. Exercise therapy during hospitalization was provided individually by a physical therapist, and exercise was self-administered after discharge. One year after allo-HSCT, handgrip strength and results of the 6-minute walk test recovered to pre-HSCT levels. However, muscle mass 1 year after allo-HSCT did not reach the pre-HSCT level. All subscales of QOL, 1 year after allo-HSCT, recovered to pre-HSCT levels, but only two of the eight subscales recovered to the national standard of 50. Multivariate analysis revealed factors associated with the recovery of physical function, muscle mass, and QOL, hemoglobin levels and albumin levels, especially among men. In contrast, factors that negatively affected recovery were age, acute graft-versus-host disease, and pre-HSCT intensity conditioning. The results suggest a potential recovery in handgrip strength, endurance, and QOL 1 year after allo-HSCT.

Autonomic Dysregulation in Pulmonary Hypertension: Role of Physical Exercise.

Pulmonary hypertension (PH) is a rare and severe condition characterized by increased pressure in the pulmonary circulation, often resulting in right ventricular failure and death. The autonomic nervous system (ANS) plays a crucial role in the cardiovascular and pulmonary controls. Dysfunction of ANS has been implicated in the pathogenesis of cardiopulmonary diseases. Conversely, dysfunctions in ANS can arise from these diseases, impacting cardiac and pulmonary autonomic functions and contributing to disease progression. The complex interaction between ANS dysfunction and PH plays a crucial role in the disease progression, making it essential to explore interventions that modulate ANS, such as physical exercise, to improve the treatment and prognosis of patients with PH. This review addresses autonomic dysfunctions found in PH and their implications for the cardiopulmonary system. Furthermore, we discuss how physical exercise, a significant modulator of ANS, may contribute to the prognosis of PH. Drawing from evidence of aerobic and resistance exercise training in patients and experimental models of PH, potential cardiovascular benefits of exercise are presented. Finally, we highlight emerging therapeutic targets and perspectives to better cope with the complex condition. A comprehensive understanding of the interaction between ANS and PH, coupled with targeted physical exercise interventions, may pave the way for innovative therapeutic strategies and significantly improve the treatment and prognosis of vulnerable patients.

Expanding horizons in pulmonary hypertension management: A systematic review and meta-analysis of non-pharmacological interventions.

BACKGROUND: Pulmonary hypertension (PH) is a progressive and life-threatening disorder characterized by elevated pulmonary arterial pressure, leading to right heart failure and reduced exercise capacity. Traditional pharmacological and surgical treatments offer limited efficacy and significant side effects, necessitating the exploration of alternative therapeutic options. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of non-pharmacological interventions, including exercise, dietary modifications, and psychosocial therapies, in the management of pulmonary hypertension. METHODS: Comprehensive searches were conducted in PubMed, Cochrane Library, and Scopus up to 2024, identifying randomized controlled trials and observational studies examining non-pharmacological interventions for PH. Primary outcomes assessed included pulmonary arterial pressure, right heart function, exercise capacity, and quality of life, with secondary analysis on safety and adverse effects. Data synthesis was performed using random-effects meta-analysis. RESULTS: The review included 30 studies, totaling 2000 participants with various forms of PH. Meta-analysis demonstrated significant improvements in exercise capacity as measured by the 6 min walk distance (mean increase of 45 meters, 95 % CI: 30-60, p<0.001), enhanced quality of life scores, and reduction in pulmonary arterial pressure (mean reduction of 5 mmHg, 95 % CI: 3-7, p<0.01). Non-pharmacological therapies also showed a favorable safety profile, with minor adverse effects reported. CONCLUSION: Non-pharmacological interventions provide a viable and effective complement to traditional treatments for pulmonary hypertension, significantly improving functional capacity and hemodynamic parameters without severe adverse effects. These findings support the integration of tailored non-pharmacological strategies into the therapeutic regimen for PH patients, emphasizing the need for broader implementation and further research to optimize intervention protocols.

Physiotherapeutic Interventions for Patients With Rare Genetic Muscle-Wasting Disorders: A Systematic Review and Meta-Analysis.

Patients with rare genetic muscle-wasting disorders (MWDs) often experience significant motor function impairments, making effective management strategies crucial for improving their quality of life. This systematic review and meta-analysis aimed to evaluate the impact of physiotherapeutic interventions on motor outcomes in this patient population.  A comprehensive literature search was conducted to identify randomized controlled trials (RCTs) and cohort-based studies that assessed physiotherapeutic interventions in patients with rare genetic MWDs. The primary outcome measure was the 6-minute walk test (6MWT). A random effects model was employed to calculate the mean difference (MD) and 95% confidence interval (CI).  Nine studies were selected for inclusion, and most demonstrated observable improvement in different facets of individuals with MWDs using physiotherapy. The meta-analysis of RCTs showed that physiotherapy statistically improved 6MWT performance (MD: -35.25 meters; 95% CI: -54.14 to -16.37) with low heterogeneity (Tau² = 0.00; Chi² = 0.48, df = 2, P = 0.79; I² = 0%). Similarly, the cohort-based studies demonstrated an overall MD (MD: -10.00; 95% CI: -11.07 to -8.93), with low heterogeneity (Tau² = 0.00; Chi² = 0.01, df = 1, P = 0.94; I² = 0%). Both analyses indicated significant improvements in 6MWT performance (RCTs: Z = 3.66, P = 0.0003; cohort-based: Z = 18.26, P < 0.00001). Physiotherapeutic interventions significantly enhanced motor function in patients with rare genetic MWDs, as evidenced by improved 6MWT performance. Exercise and intensive physiotherapy programs were particularly effective, although the benefits varied depending on the specific intervention and patient population. These findings support incorporating tailored physiotherapeutic strategies in MWD management to improve motor outcomes and overall quality of life.

Effects of exercise in adults with cancer pain: a systematic review and Network meta-analysis.

CONTEXT: Pain is one of the most common symptoms of cancer patients, affecting the patient's physical, psychological, behavioral, social relations and other aspects. Previous studies have demonstrated that exercise is effective for cancer pain, and the optimal exercise is still unknown. OBJECTIVES: This study aimed to compare the effects of different exercise interventions on cancer pain in adults. METHODS: Randomized control trials identified from medical literature databases that reported effects of exercise in adults with cancer pain were included in this study. Literature screening and data extraction were conducted independently by two researchers. Cochrane Bias Assessment 2.0 was used to assess the quality of the literature, and Stata 15.0 software was used for Network meta-analysis. RESULTS: Forty-one studies were included, involving 3537 patients with cancer pain. The types of exercise involved included aerobic exercise, medium intensity continuous training, high-intensity interval training, resistance exercise, mind-body exercise and comprehensive exercise program (CEP). The results suggested that CEP was more effective than the usual care in relieving pain intensity in cancer patients [SMD=-1.96,95%CI (-3.47, -0.44)] (SUCRA=97.9%). Mind-body exercise outperformed usual care in reducing pain interference in cancer patients [SMD = -0.65, 95% CI (-1.21, -0.09)] (SUCRA=83.8%). CONCLUSION: Current evidence shows that CEP is the best way to relieve the pain intensity of cancer patients, and mind-body exercise is the best way to reduce pain interference of cancer patients. Due to the limited number and quality of the included studies, the above conclusions need to be further verified by more high-quality studies.

Perceived social support impacts on exercise adherence in patients with chronic low back pain.

BACKGROUND: Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP). OBJECTIVE: This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise). METHODS: This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis. RESULTS: A positive relationship was found between participants' perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (ß 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (ß 243.96, 95% CI: -258.08 to 746.01). CONCLUSION: Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People's self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.

Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation: a Delphi study.

OBJECTIVE: To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise hip bone mineral density (BMD) loss following traumatic lower limb amputation. METHODS: In three Delphi rounds, statements were presented to a panel of 13 experts from six countries. Experts were identified through publications or clinical expertise. Round 1 involved participants rating their agreement with 22 exercise prescription statements regarding BMD loss post amputation using a 5-point Likert scale. Agreement was deemed as 3-4 on the scale (agree/strongly agree). Statements of <50% agreement were excluded. Round 2 repeated remaining statements alongside round 1 feedback. Round 3 allowed reflection on round 2 responses considering group findings and the chance to change or maintain the resp onse. Round 3 statements reaching ≥70% agreement were defined as consensus. RESULTS: All 13 experts completed rounds 1, 2 and 3 (100% completion). Round 1 excluded 12 statements and added 1 statement (11 statements for rounds 2-3). Round 3 reached consensus on nine statements to guide future exercise interventions. Experts agreed that exercise interventions should be performed at least 2 days per week for a minimum of 6 months, including at least three different resistance exercises at an intensity of 8-12 repetitions. Interventions should include weight-bearing and multiplanar exercises, involve high-impact activities and be supervised initially. CONCLUSION: This expert Delphi process achieved consensus on nine items related to exercise prescription to minimise hip BMD loss following traumatic lower limb amputation. These recommendations should be tested in future interventional trials.

Therapeutic Importance of Exercise in Neuroplasticity in Adults with Neurological Pathology: Systematic Review.

Neuroplasticity is an essential mechanism by which the nervous system shapes and adapts according to functional requirements. Evidence suggests that physical exercise induces a cascade of cellular processes that favours brain plasticity. The Brain Derived Neurotrophic Factor (BDNF) is a neurotrophin closely linked to neuroplasticity that can be increased due to exercise. To verify the effects of therapeutic exercise on neuroplasticity and/or peripheral BDNF levels in neurological conditions in adults, such as stroke, Parkinson's and Alzheimer's diseases and mild cognitive impairment and address its clinical relevance in the treatment of neurological dysfunctions. A systematic review was carried using PUBMED, Web of Science and Scopus databases. Inclusion criteria were: randomized controlled trials or pilot studies; humans with age > 18 yrs with neurological condition; English language; score ≥ 6 in PEDro Scale (moderate to high quality). Reviews, meta-analyses and other articles that did not meet the criteria were excluded. The PRISMA methodology was applied for studies' selection. A total of 9 studies were selected for a systematic and comprehensive analysis. According to these studies, moderate to high intensity aerobic exercise (AE), increases the level of peripheral BDNF and positively influences functional gains in neurological conditions. Larger outcomes are observed in protocols with minimum session duration of 30 minutes, frequency of 3 times/week and intervention duration of 4 weeks. Current evidence shows that moderate to high intensity AE induces neuroplasticity in neurological patients, thus being a fundamental therapeutic strategy to include in interventions aiming to repair/delay neurological dysfunctions.

The implementation of exercise therapy within hospital-based mental healthcare: Delphi study.

BACKGROUND: The physical health comorbidities and premature mortality experienced by people with mental illness has led to an increase in exercise services embedded as part of standard care in hospital-based mental health services. Despite the increase in access to exercise services for people experiencing mental illness, there is currently a lack of guidelines on the assessment and triage of patients into exercise therapy. AIMS: To develop guidelines for the pre-exercise screening and health assessment of patients engaged with exercise services in hospital-based mental healthcare and to establish an exercise therapy triage framework for use in hospital-based mental healthcare. METHOD: A Delphi technique consisting of two online surveys and two rounds of focus group discussions was used to gain consensus from a multidisciplinary panel of experts. RESULTS: Consensus was reached on aspects of pre-exercise health screening, health domain assessment, assessment tools representing high-value clinical assessment, and the creation and proposed utilisation of an exercise therapy triage framework within exercise therapy. CONCLUSIONS: This study is the first of its kind to provide guidance on the implementation of exercise therapy within Australian hospital-based mental healthcare. The results provide recommendations for appropriate health assessment and screening of patients in exercise therapy, and provide guidance on the implementation and triage of patients into exercise therapy via a stepped framework to determine (a) the timeliness of exercise therapy required and (b) the level of support required in the delivery of their exercise therapy.

Tailored Physical Activity Interventions for Long COVID: Current Approaches and Benefits-A Narrative Review.

This narrative review explores the essential role of physical activity in managing long COVID, which is characterized by persistent symptoms such as fatigue, breathlessness, and cognitive impairments following SARS-CoV-2 infection. In this context, "physical activity" includes various exercises, such as aerobic and resistance training, as well as flexibility and balance exercises, thereby encompassing the subset known as "exercise". The methodology involved a comprehensive literature search across PubMed, EBSCO (EDS), and Google Scholar, selecting peer-reviewed articles from December 2019 to June 2024 focusing on long COVID physical activity interventions. The review highlights that tailored exercise programs, adjusted to individual health status and abilities, significantly alleviate symptoms and enhance psychological well-being. Key findings emphasize the importance of personalized exercise prescriptions due to the variability in patient responses and the need for a multidisciplinary approach in developing and monitoring interventions. Despite promising outcomes, the review identifies research gaps, including the need for long-term studies, randomized controlled trials, and deeper mechanistic insights. It suggests that standardized reporting, templates like the Consensus on Exercise Reporting Template (CERT), and integrating digital health tools are essential for optimizing interventions. Overall, the review advocates including personalized physical activity or exercise programs in standard care for long COVID to improve patient outcomes and quality of life.

Factors influencing functional recovery after limb-salvage surgery for lower extremity musculoskeletal tumours: a qualitative study combining patients' and healthcare professionals' perspectives.

PURPOSE: Survival rates of lower extremity musculoskeletal tumours (LEMTs) have been increasing. However, patients continue to experience functional limitations after LEMT followed by limb-salvage surgery (LSS). This study aimed to identify factors influencing functional recovery after LSS for LEMT. METHODS: A qualitative study was conducted using semi-structured interviews with a purposive sample of adult patients who underwent LSS for LEMT (n=7) and healthcare professionals (HCPs) with expertise in orthopaedic oncology (n=7). Recruitment continued until data saturation. A combination of deductive and inductive qualitative content analysis was performed to analyse the transcribed data, producing subthemes under the main International Classification of Functioning, disability and health (ICF)-model domains. RESULTS: Four themes were described: (1) bodily functions and structures, (2) activities and participation, (3) environmental factors, and (4) expectations. Physical aspects such as larger resection size and complications negatively affected recovery. The importance of communication strategies of tertiary HCPs and the unfamiliarity of the primary physical therapists with the disease, its surgical treatment, and related consequences were emphasised by both the interviewed patients and HCPs. CONCLUSIONS: Functional recovery after LSS for LEMT is a multifactorial process. To improve patient care, improving (intercollegiate) communication strategies on treatment details and expectations about functional outcomes is warranted.Implications for rehabilitationHealthcare professionals should be aware some patients experience limited functional recovery after limb-salvage surgery (LSS) for lower extremity musculoskeletal tumours.Healthcare professionals should use multiple communication strategies to bridge the gap between the information provided and what the patient recalls.Knowledge exchange and communication between primary and tertiary care should be more extensive.Multidisciplinary consultations and/or case managers are needed to address all aspects of the individual's functional recovery after LSS.

Effects of hypopressive exercise associated with aerobic and muscle strength training on the treatment of fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecologic cancer: A randomized clinical trial protocol.

Introduction: Therapeutic exercise has an important role in the population living with cancer as it improves function and quality of life and reduces the symptoms of cancer treatment. There is little clinical evidence on the effects of hypopressive exercise in women with gynecological cancer. Objective: Evaluate the effects of 4 weeks of hypopressive exercise associated with muscle strength training and aerobic exercises on fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecological cancer compared to a group that will perform conventional training. Methods: This randomized, single-blinded clinical trial study is set in the Clinical Research Laboratory, Department of Kinesiotherapy, at a Chilean University. Patients will be randomly assigned to an experimental group of hypopressive exercises associated with muscle strength training and aerobic exercises or a control group of muscle strength training and aerobic exercises. Twelve tele-rehabilitation sessions will be performed. Women over 18 years of age with gynecologic cancer who have been prescribed radiotherapy or chemotherapy will participate. Fatigue, quality of life, urinary incontinence symptoms, and sexual function will be assessed before and after the intervention. Expected results: The results of this clinical trial have important implications for specific treatment for the cancer population and generate new techniques in the practice of oncology-specialized kinesiologists. Hypopressive exercise is expected to reduce incontinence symptoms due to neuromuscular activation of the pelvic floor muscles. However, more studies are needed to confirm the beneficial effects of hypopressive exercises in face-to-face or remote rehabilitation.

Introducción: El ejercicio terapéutico juega un rol importante en la población con cáncer, ya que mejora la función, la calidad de vida y reduce los síntomas del tratamiento contra el cáncer. Hay poca evidencia clínica sobre los efectos del ejercicio hipopresivo en mujeres con cáncer ginecológico. Objetivo: Evaluar los efectos de cuatro semanas de ejercicio hipopresivo asociado con entrenamiento de fuerza muscular y ejercicios aeróbicos sobre la fatiga, los síntomas de incontinencia urinaria, la función sexual y la calidad de vida en mujeres tratadas por cáncer ginecológico, en comparación con un grupo que realizará entrenamiento convencional. Métodos: El escenario para este estudio de ensayo clínico aleatorizado y simple ciego es el Laboratorio de Investigación Clínica, Departamento de Kinesiología, en una Universidad Chilena. Las pacientes serán asignadas aleatoriamente a un grupo experimental de ejercicios hipopresivos asociados con entrenamiento de fuerza muscular y ejercicios aeróbicos, o a un grupo de control de entrenamiento de fuerza muscular y ejercicios aeróbicos. Se realizarán doce sesiones de telerehabilitación. Participarán mujeres mayores de 18 años con cáncer ginecológico a quienes se les haya indicado radioterapia o quimioterapia. Se evaluarán la fatiga, la calidad de vida, los síntomas de incontinencia urinaria y la función sexual antes y después de la intervención. Resultados: esperados Los resultados de este ensayo clínico tienen importantes implicaciones en términos del tratamiento específico para la población con cáncer y generan nuevas técnicas en la práctica de kinesiólogos especializados en oncología. Se espera que el ejercicio hipopresivo reduzca los síntomas de incontinencia debido a la activación neuromuscular de los músculos del suelo pélvico. Sin embargo, se necesitan más estudios para confirmar los efectos beneficiosos de los ejercicios hipopresivos, ya sea en rehabilitación presencial o a distancia.

Corrigendum: Exercise for reducing chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials.

[This corrects the article DOI: 10.3389/fneur.2023.1252259.].

A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study.

BACKGROUND: Restoring hand and finger function after a traumatic hand injury necessitates a regimen of consistent and conscientious exercise. However, motivation frequently wanes due to unchallenging repetitive tasks or discomfort, causing exercises to be performed carelessly or avoided completely. Introducing gamification to these repetitive tasks can make them more appealing to patients, ultimately increasing their motivation to exercise consistently. OBJECTIVE: This study aims to iteratively develop a serious virtual reality game for hand and finger rehabilitation within an appealing and engaging digital environment, encouraging patient motivation for at least 2 weeks of continuous therapy. METHODS: The development process comprised 3 distinct stages, each of which was subject to evaluation. Initially, a prototype was created to encompass the game's core functionalities, which was assessed by 18 healthy participants and 7 patients with impaired hand function. Subsequently, version 1 of the game was developed and evaluated with 20 patients who were divided into an investigation group and a control group. On the basis of these findings, version 2 was developed and evaluated with 20 patients who were divided into an investigation group and a control group. Motivation was assessed using the Intrinsic Motivation Inventory (IMI), while the application's quality was rated using the Mobile Application Rating Scale and the System Usability Scale. User feedback was gathered using semistructured interviews. RESULTS: The prototype evaluation confirmed the acceptance and feasibility of the game design. Version 1 significantly increased motivation in 2 IMI subscales, effort (P<.001) and usefulness (P=.02). In version 2, a significant increase in daily performed exercises was achieved (P=.008) compared to version 1, with significantly higher motivation in the IMI subscale effort (P=.02). High Mobile Application Rating Scale scores were obtained for both versions 1 and 2, with version 2 scoring 86.9 on the System Usability Scale, indicating excellent acceptability. User feedback provided by the semistructured interviews was instrumental in the iterative development regarding improvements and the expansion of the playable content. CONCLUSIONS: This study presented a virtual reality serious game designed for hand and finger rehabilitation. The game was well received and provided an environment that effectively motivated the users. The iterative development process incorporated user feedback, confirming the game's ease of use and feasibility even for patients with severely limited hand function.

Efficacy of High-Intensity and Low-Level Laser Therapy Combined With Exercise Therapy on Pain and Function in Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.

Introduction: High-intensity laser therapy (HILT) and low-level laser therapy (LLLT) combined with exercise therapy (ET) have emerged as effective treatment options for musculoskeletal pain. However, there have remained uncertainties regarding the magnitude of their effects in reducing pain and improving function in patients with knee osteoarthritis. Hence, we performed a systematic review and network meta-analysis of available evidence in the literature to answer this query. Methods: A literature search was carried out in Embase, PubMed, and Scopus databases without any language restrictions from 1 January 1990 to 31 December 2023. We examined randomized controlled trial (RCT) studies that investigated the efficiency of HILT or LLLT plus knee osteoarthritis ET in pain and functional improvement of the knee. We performed a network meta-analysis and provided the standardized mean difference (SMD) with a 95% confidence interval (CI) by pooling the continuous data on the visual analogue scale (VAS) pain score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score using a random-effects model. Results: In total, 11 eligible RCTs were included. Our analysis revealed significant improvements in the VAS pain and WOMAC function scores on weeks 4 and 8 after interventions in groups treated with LLLT+ET and HILT+ET compared with placebo+ET. Moreover, HILT+ET showed a greater reduction in the VAS pain score (SMD=-1.41; 95% CI: -2.05 to -0.76) and improvement in the WOMAC function score (SMD=-2.20; 95% CI: -3.21 to -1.19) than LLLT+ET in week 8. Conclusion: Based on our findings, both HILT+ET and LLLT+ET treatments effectively reduced pain and improved function, but HILT+ET showed a more significant improvement in both outcomes compared to LLLT+ET.

Immediate effects of upper limb exercises with and without deep breathing on lung function after cardiac surgery - a randomized crossover trial.

BACKGROUND: Open heart surgery, involving median sternotomy, may cause diminished chest wall motion and restrictive pulmonary function in the early postoperative period. Thoracic and upper extremity range of motion (ROM) exercises are often recommended after surgery but have not been evaluated regarding effect on lung volumes and oxygenation. The objective of this study was to evaluate the immediate effect of upper limb elevations, with or without simultaneous deep breathing, on lung function after cardiac surgery. METHODS: In a randomized 2 × 2 crossover trial, 22 adult patients (> 18 years old) were assessed during one of the first days after surgery in the spring of 2022 at Örebro University Hospital, Sweden. Exercises involving five bilateral upper limb elevations, performed either with simultaneous deep breathing (ROM-DB) or without (ROM), while sitting in an upright position at the edge of the bed, were evaluated. Peripheral oxygen saturation (Rad-5v; Masimo, Irvine, USA) was the primary outcome. Tidal volume and respiratory rate were recorded continuously during the exercises (Spiropalm; Cosmed, Rome, Italy). Heart rate, pain, exertion and dyspnoea were evaluated before and after the exercises. RESULTS: Both ROM-DB and ROM momentarily increased peripheral oxygen saturation (+ 1% ± 1, p = 0.004 and + 1% ± 1, p < 0.001, respectively), with no significant differences between these exercises (p = 0.525). ROM-DB significantly increased the VT compared with ROM (798 ± 316 vs. 602 mL ± 176, p = 0.004). However, ROM-DB induced more pronounced pain (p = 0.012), exertion (p = 0.035) and dyspnoea (p = 0.013) than ROM. CONCLUSIONS: Upper limb elevations improved oxygenation momentarily, both performed with and without simultaneous deep breathing, with no significant differences between these exercises. The additive deep breathing improved tidal volume compared with upper limb elevations alone, but induced more pain, exertion and dyspnoea during the performance of exercise. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05278819).

Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Available evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD. METHODS: We conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2-3 times per week for 8-12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values. RESULTS: Of 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67). CONCLUSIONS: PR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016.

Isolated bladder training or in combination with other therapies to improve overactive bladder symptoms: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Bladder training (BT), the maintenance of a scheduled voiding regime at gradually adjusted intervals, is a common treatment for overactive bladder (OAB). OBJECTIVES: To assess the effects of isolated BT and/or in combination with other therapies on OAB symptoms. METHODS: A systematic review of eight databases was conducted. After screening titles and abstracts, full texts were retrieved. Cochrane RoB 2 and the GRADE approach were used. RESULTS: Fourteen RCTs were included: they studied isolated BT (n = 11), BT plus drug treatment (DT; n = 5), BT plus intravaginal electrical stimulation (IVES; n = 2), BT plus biofeedback and IVES (n = 1), BT plus pelvic floor muscle training and behavioral therapy (n = 2), BT plus percutaneous tibial nerve stimulation, and BT plus transcutaneous tibial nerve stimulation (n = 1). In a meta-analysis of short-term follow-up data, BT plus IVES resulted in greater improvement in nocturia (mean difference [MD]: 0.89, 95% CI: 0.5, 1.20), urinary incontinence (UI; MD: 1.93, 95% CI: 1.32, 2.55), and quality of life (QoL; MD: 4.87, 95% CI: 2.24, 7.50) than isolated BT, while DT and BT improved UI (MD: 0.58, 95% CI: 0.23, 0.92) more than isolated BT. CONCLUSION: In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL. The limited number of RCTs and heterogeneity among them provide a low level of evidence, making the effect of BT on OAB inconclusive, which suggests that new RCTs should be performed.