Remotely monitored telerehabilitation for cardiac patients: A review of the current situation

Cardiac rehabilitation through center-based programs is an effective multicomponent intervention for the secondary prevention of cardiovascular diseases. Despite the benefits it brings, patients’ participation in rehabilitation programs remains low. In this work, the latest relevant literature regarding remotely monitored cardiac telerehabilitation (TR) was reviewed considering its efficiency and utilization. The main objective was to assess whether TR has the potential to be an appropriate alternative form of rehabilitation. A total of 105 publications on this topic were screened out of 747 full-text articles that were read and evaluated, of which 12 were considered suitable for inclusion in the final review. Feasibility, efficiency, and safety were assessed for each TR intervention. The results of our evaluation indicate that TR seems to be a usable, effective, and safe alternative rehabilitation for patients with heart disease. Most of the currently published articles have studied remotely monitored TR intervention offering a comprehensive approach, which indicates the significant development and steps forward in this field of study. Our research evidence supports the implementation of TR, which could positively influence barriers in participating in cardiac rehabilitation programs.     

Weight stigmatisation in physiotherapy: a systematic review

Background: Physiotherapists play an integral role in the provision of health care to individuals who are overweight or obese. An understanding of weight stigma is therefore important in ensuring best practice. Despite these considerations, no previous systematic reviews have investigated weight stigma in physiotherapy.

Objectives: To determine if (i) physiotherapists demonstrate weight stigma through explicit or implicit means and (ii) how weight stigma is perceived by physiotherapy patients.

Methods: Database searches were conducted to identify quantitative and qualitative studies published between January 1960 and September 2015. Two reviewers independently performed data extraction and assessments of methodological quality. Outcome measures included explicit attitudes, implicit attitudes and beliefs about obesity held by physiotherapists, as well as patient perceptions of obesity management.

Results: Seven high-quality studies were included in the review. Six studies demonstrated the existence of explicit weight stigma, with a majority of physiotherapists describing people with increased weight as ‘noncompliant’ and ‘unmotivated’. One study demonstrated the existence of implicit weight stigma, but this did not appear to influence treatment approaches. Four studies found stigmatising beliefs about weight among physiotherapists, and one study found that physiotherapy patients believed both physical environments and paternalistic communication styles propagated weight stigmatisation.

Conclusions: Explicit weight stigmatisation is common in physiotherapy and is often perceived by patients, who may feel unmotivated or ignored as a result. While implicit stigmatisation also occurs, it is unclear if this influences physiotherapy management. Future research is required to assist in the development of appropriate preventative strategies.     

Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis

Background

Physiotherapy is a routine component of postoperative management following total knee arthroplasty (TKA). As the demand for surgery increases it is vital that postoperative physiotherapy interventions are effective and efficient.

Clinical performance assessment tools in physiotherapy practice education: a systematic review

Background

Clinical performance assessment tools (CPATs) used in physiotherapy practice education need to be psychometrically sound and appropriate for use in all clinical settings in order to provide an accurate reflection of a student’s readiness for clinical practice. Current evidence to support the use of existing assessment tools is inconsistent.

Peri-operative chest physiotherapy for paediatric cardiac patients: a systematic review and meta-analysis

Background

Chest physiotherapy (CPT) is implemented before and after congenital heart disease (CHD) surgery in paediatrics to prevent and treat postoperative pulmonary complications (PPC). Currently, there are no systematic reviews or meta-analyses on the efficacy of CPT in this population.

Effectiveness of physiotherapy for lateral epicondylitis: a systematic review

AIM: To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow. METHOD: Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power. RESULTS: 23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satisfied at least 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound. There is insufficient evidence either to demonstrate benefit or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques for lateral epicondylitis. CONCLUSIONS: Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions for lateral epicondylitis due to contradicting results, insufficient power, and the low number of studies per intervention. Only for ultrasound, weak evidence for efficacy was found. More better designed, conducted and reported RCTs are needed.     

Effectiveness of physiotherapy for lateral epicondylitis: a systematic review

AIM: To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow. METHOD: Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power. RESULTS: 23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satisfied at least 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound. There is insufficient evidence either to demonstrate benefit or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques for lateral epicondylitis. CONCLUSIONS: Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions for lateral epicondylitis due to contradicting results, insufficient power, and the low number of studies per intervention. Only for ultrasound, weak evidence for efficacy was found. More better designed, conducted and reported RCTs are needed.     

Effectiveness of virtual reality in children and young adults with cerebral palsy: a systematic review of randomized controlled trial

BackgroundCerebral palsy (CP) is one of the main causes of disability in childhood. Virtual reality (VR) has been used as a treatment option in this population, however its effectiveness is unclear.ObjectiveTo evaluate the effectiveness of VR in patients with CP.MethodsWe conducted electronic searches in EMBASE, MEDLINE, Cochrane library, PEDro, AMED, PsycoINFO, and LILACS databases and trial site registries such as ClinicalTrials.gov and ICTRP. We included randomized controlled trials that tested the use of VR alone or in combination with other interventions compared to more conventional rehabilitation or usual care in individuals with CP. The primary outcomes were upper and lower limb function, postural control, and balance. The secondary outcomes included global motor function, perception, cognition and spatial functions, motivation, motor learning, and adverse events. Two independent reviewers extracted and assessed included articles for risk of bias using the Cochrane risk of bias tool. We use a meta-analysis with random effect model whenever possible. We analyzed the quality of evidence using theGRADE approach.ResultsWe included 38 trials (pooled n = 1233 participants) in this review. There is very low quality of evidence that VR plus conventional rehabilitation is better than conventional rehabilitation for upper limb function. There is also very low quality evidence that VR alone is no better than conventional rehabilitation for upper and lower limb function. No adverse events were observed among the 10 trials that provided information on this outcome.ConclusionAt present we have very limited to limited confidence in effect estimation for utilization of VR in this population. Future studies may change our confidence in results and effect estimates.Protocol registrationPROSPERO CRD 42018102759.     

Effectiveness of physiotherapy in elderly patients with dementia: a prospective,comparative analysis

Background: The aim of this study was to assess the efficacy of physiotherapy in nursing home patients with comorbid dementia.

Materials and methods: The study group consisted of 88 patients, including 48 people with dementia and 40 people without dementia. Before and after physiotherapy, the Mini Mental State Examination and Barthel Index were used.

Results: Elderly patients without dementia achieved a greater improvement in functional status. The level of cognitive functioning at the time of admission to a nursing home, but not the patient’s functional status, had a significant impact on physiotherapy efficacy.

Conclusion: Understanding the role of dementia in the rehabilitation process is important for care planning. More research is required to ascertain the efficacy of physiotherapy in people with moderate to severe dementia, including the best strategies to improve their functional status.

• Implications for Rehabilitation

• The level of cognitive function is important in the rehabilitation process, and it influences effectiveness of physiotherapy.

• Physiotherapy efficacy in the group of patients with coexisting dementia is lower than that in patients without dementia.

• Regular physiotherapy can also improve functional status in patients with coexisting dementia.

• The results of the study may have utilitarian implications, leading to a change in therapy regimens at physiotherapy centres treating disabled chronically ill people with coexisting dementia.

     

Physiotherapy and walking outcomes in adults with multiple sclerosis: systematic review and meta-analysis

Background: Physiotherapy treatment may result in improved walking performance among persons with multiple sclerosis (MS). The existing literature is unclear as to what type of physiotherapy treatment has a larger effect on walking performance. It is further unclear regarding which domain of walking performance is improved with physiotherapy.

Objective: To systematically review and quantify the effect of physiotherapy on walking performance compared with usual care in MS.

Methods: A literature search of five databases was undertaken to identify randomised controlled trials of physiotherapy treatments that targeted walking outcomes. There were 21 studies that met our inclusion criteria and yielded data for effect size (ES) generation. An overall ES was calculated using a random effects model and expressed as Hedge’s g.

Major findings: Physiotherapy treatments yielded a small, but statistically significant overall improvement in walking outcomes compared with usual care in persons with MS (ES = 0.25; 95% CI = 0.09–0.41; p < .05). Moderator analyses provided no significant evidence that different types of physiotherapy treatment, or different domains of walking performance, yield larger improvements in walking outcomes in persons with MS.

Conclusion: This evidence indicates that overall there is a significant improvement in walking performance following physiotherapy in persons with MS.     

Global physical activity levels among people living with HIV: a systematic review and meta-analysis

Purpose: It is unclear how much physical activity people living with HIV (PLWH) engage in. We conducted a meta-analysis to investigate physical activity levels and its predictors in PLWH.

Methods: PubMed, PsycARTICLES, and CINAHL Plus were searched by two independent reviewers from inception till 1 April 2016 using the keywords: “HIV” OR “AIDS” AND “physical activity” OR “exercise” OR “sports”. A random effects meta-analysis was conducted.

Results: Across 24 studies including 34 physical activity levels there were 3780 (2471♂) PLWH (mean age range: 37–58 years). PLWH spent 98.9 (95%CI?=?64.8–133.1) minutes per day being physically active which is lower than in most other populations with chronic diseases. 50.7% (95%CI?=?39.3–62%) (n?=?2052) of PLWH complied with the physical activity guidelines of 150?min moderate intensity physical activity per week. The number of steps walked per day in 252 PLWH was 5899 (95%CI?=?5678–6418), which is below the 10,000 steps per day recommendation.

Conclusions: Our data demonstrate that a considerable proportion of PLWH are insufficiently physically active. Future lifestyle interventions specifically targeting the prevention of physical inactivity in PLWH are warranted.

• Implications for Rehabilitation

• Many people living with HIV do not comply with general health recommendations.

• Physical activity counseling should be key in the rehabilitation of people living with HIV.

     

Effectiveness of acupuncture for patients with vascular dementia: A systematic review and meta-analysis

ObjectivesThis meta-analysis assessed the treatment effectiveness of acupuncture in patients with vascular dementia.MethodsThe PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure were searched to identify eligible randomized controlled trials (RCTs). The odds ratios (ORs) and weighted mean differences (WMDs) with 95 % confidence intervals (CIs) were used to assess the pooled effect estimates using a random-effects model for categorical and continuous outcomes, respectively.ResultsThirty-four RCTs (2672 patients) were selected for the final meta-analysis. The use of acupuncture showed association with an increased incidence of effective rate (OR: 3.28; 95 % CI: 2.54–4.24; P < 0.001). The pooled WMDs revealed that acupuncture was significantly associated with an improvement in the Hasegawa dementia scale (HDS) (WMD: 4.31; 95 % CI: 3.15–5.47; P < 0.001), and Mini-Mental State Examination scores (MMSE) (WMD: 3.07; 95 % CI: 2.40–3.74; P < 0.001). However, the use of acupuncture showed no association with the level of Activities of daily living (ADL) (WMD: 1.93; 95 % CI: − 2.53 to 6.38; P = 0.397). Finally, acupuncture was associated with lower levels of Scale for the differentiation of syndromes of vascular dementia (SDSVD) (WMD: − 2.15; 95 % CI: − 4.14 to − 0.16; P = 0.034), and National Institutes of Health stroke scale (NIHSS) (WMD: − 3.90; 95 % CI: − 4.87 to − 2.94; P < 0.001).ConclusionsAcupuncture is probably helpful in vascular stroke, but strong supportive data are not yet available. Acupuncture should be used cautiously, owing to the analysis of this study based on low to moderate evidence. Further high-quality, large-scale RCTs should be conducted.     

Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis

The family is the primary caregiver for most patients with schizophrenia, and their roles are essential in patients' illness trajectories and outcomes. Due to this, various family interventions for schizophrenia have been developed and applied to the relatives who take care of their family members with schizophrenia. This study examined the effectiveness of existing family interventions for schizophrenia in achieving their target outcomes at both the family and patient levels by utilizing a systematic review and meta-analysis. Combinations of terms were used to search for relevant studies from the databases. Thirty-seven randomized controlled trials that met the inclusion criteria were included in the analysis. Based on the pooled result of the included studies, the programmes significantly improved the targeted outcomes with large effect size. The programmes' impacts on family-related outcomes were higher than those on patients. Among the targeted outcomes, patients' treatment satisfaction and adherence and family caregivers' mental health were the most remarkable outcomes that had improved from the included programmes. Conversely, outcomes related to family relationships, caregiving experiences, perceived social support of family caregivers, and patients' medication use did not see significant improvements. The programmes delivered to individual family units and only to the family caregivers were more effective than those delivered to groups of caregivers and caregivers and patients together, respectively. Programme-focused interventions were more effective than emotion-focused ones. Based on these findings, an in-home visiting nurse programme or advanced technology is suggested when applying family interventions for schizophrenia in practice.     

A systematic review of clinical outcomes,clinical process,healthcare utilization and costs associated with telerehabilitation

Purpose. To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities.

Method. Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale.

Results. Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, rehabilitation for speech-language impairments, and rehabilitation for varied clienteles. Clinical outcomes were generally improved following a telerehabilitation intervention and were at least similar to or better than an alternative intervention. Clinical process outcomes, such as attendance and compliance, were high with telerehabilitation although few comparisons are made to alternative interventions. Consultation time tended to be longer with telerehabilitation. Satisfaction with telerehabilitation was consistently high, although it was higher for patients than therapists. Few studies examined healthcare utilization measures and those that did reported mixed findings with respect to adverse events, use of emergency rooms and doctor visits. Only five of the studies examined costs. There is some preliminary evidence of potential cost savings for the healthcare facility.

Conclusions. While evidence is mounting concerning the efficacy and effectiveness of telerehabilitation, high-quality evidence regarding impact on resource allocation and costs is still needed to support clinical and policy decision-making.     

Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis

BackgroundDry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis.MethodsDatabases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias.ResultsOut of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies.ConclusionGood quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.     

Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study

IntroductionNeck Pain can be related to the disorders of other adjacent areas such as the Temporomandibular Joint (TMJ). This study aimed to investigate whether there is value in adding TMJ treatments to routine physiotherapy in patients with non-specific chronic neck pain compared with a control group.MethodsA randomized, single-blind, clinical study desined including two groups of patients. Group A (20 people) received routine physiotherapy for neck pain and group B (20 people) received TMJ manual therapy plus exercise therapy in addition to routine physiotherapy for neck pain. The Treatment program included six sessions for two days a week over a period of 21 days. Assessments were performed during the first session, in the last session and one month after treatment as a follow-up. Outcome measures included neck range of motion (ROM), neck disability index (NDI) and visual analogue scale (VAS). Before starting the study, the reliability of methods for measuring neck ROM was evaluated.ResultsParticipants were 21 women and 19 men. Initially, a pilot study was carried out on the 40 volunteers to assess the reliability of the measurement methods, and the results were acceptable. With both the control group and the intervention group, the indexes showed significant improvement (p < 0.001), although the intervention group showed more improvement (p < 0.001).ConclusionThis result means adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up. Moreover, given the clinically important differences, our results for VAS and NDI were acceptable.     

Exercise therapy for low back pain: a small-scale exploratory survey of current physiotherapy practice in the Republic of Ireland acute hospital setting

A small-scale exploratory cross-sectional survey investigated the current use of a range of exercise therapy approaches for low back pain (LBP) by outpatient physiotherapists in the acute hospital setting in the Republic of Ireland, where the majority of publicly funded treatment is delivered. Of the 120 postal questionnaires distributed to 24 physiotherapy departments, 87 were returned (72.5% response rate). The results showed specific spinal stabilization exercises were the most popular exercise therapy for acute (39%; n = 35) and chronic (51%; n = 48) LBP, followed by the McKenzie approach (acute LBP (ALBP) 35.6%; n = 32: chronic LBP (CLBP) 17%; n = 16), and abdominal exercise (ALBP 11.1%; n = 10: CLBP 9.6%; n = 9). The most popular forms of exercise therapy used by outpatient physiotherapists in acute hospital settings in Ireland lack support from evidence-based clinical guidelines, and further large-scale high quality randomized controlled trials of these approaches are warranted. Further research should also establish the use of exercise therapy and attitudes to clinical guidelines of physiotherapists in other countries and healthcare settings.