Journal of Physiotherapy & Physical Rehabilitation

Introduction: COPD (chronic obstructive pulmonary disease) presents a low degree of systemic inflammation responsible for the disease’s extra pulmonary consequences. Its inflammatory profile can be altered by acute exercise. However, acute effects of a sub maximum test, capable of reproducing activities of daily living (ADL) in sedentary COPD individuals, are not well-known

Objective: To evaluate if the six-minute walk test (6MWT) is capable of altering interleukin-6 (IL-6) blood levels, tumoral necrosis factor alfa (TNF-α) and hypersensitive C reactive protein (hs-CRP) in relation to the basal level of COPD individuals.

Methods: 21 individuals with moderate and severe COPD and 8 healthy individuals, with no history of smoking, sedentary, matched by age were assessed regarding plasma levels of IL-6, TNF-α and hs-CRP before and right after a 6MWT. They also did spirometry and body composition analysis.

Results: 6MWT did not provoke significant alteration in IL-6 levels in COPD individuals (pre=4.53 ± 9.0 pg/ml vs. post=7.14 ± 11.31 pg/ml, p=0.11), whereas in healthy individuals this increase was significant (pre=1.56 ± 6.45 pg/ml vs. post=4.37 ± 8.0 pg/ml, p<0.01). COPD individuals present higher hs-CRP blood levels when compared to healthy subjects both in rest (8.15 ± 9.68 pg/ml vs. 2.60 ± 1.88 pg/ml, p=0.02), and after exercise (8.18 ± 9.08 pg/ml vs. 2.62 ± 1.85 pg/ml, p=0.02. TNF-α did not present difference between groups during rest (COPD=2.13 ± 1.03 pg/ml vs. healthy=2.00 ± 0.59 pg/ml, p>0.05) as well as after 6MWT (COPD=2.48 ± 1.92 pg/ml vs. healthy=1.89 ± 0.69 pg/ml, p>0.05), and their intragroup focus was not affected by the effort (p>0.05).

Conclusions: In COPD patients, 6MWT does not induce acute inflammatory response of IL-6 at the same proportion of that of healthy subjects. Hs-CRP’s and TNFα’s response to 6MWT was similar between groups. COPD patients presented higher concentrations of hs-CRP than healthy individuals.

Background: Sports related injuries such as lower limb tendinopathies can result in long-standing impairment of athletic performance. In recent years, treatment interventions like eccentric exercises, Platelet Rich Plasma (PRP) injections and Extracorporeal Shockwave Therapy (ESWT) have gained popularity among Physiotherapists and sports clinicians, but the evidence of their effectiveness is very limited. Purpose: To investigate the effectiveness of ESWT on Achilles and Patellar tendinopathy. Methods: A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, AMED, CINAHL, PEDro and Cochrane databases and bibliographic searches from inception until April 2013 to identify randomized control trials comparing ESWT with other treatment methods. Results: Of 306 titles screened, 9 papers, including 487 patients were included in this review. Meta-analysis showed no significant differences between the intervention and control group on the pooled VISA-A scores (p=0.59, 95% CI-15.02, 26.51) or load-induced pain (p=0.51, 95% CI-3.15, 1.56) for Achilles tendinopathy and no significant differences between the pooled VISA-P scores for patellar tendinopathy (p=0.27, CI-7.86, 27.87). Conclusions: The meta-analysis did not demonstrate a statistically significant improvement in symptoms or load induced pain for ESWT compared to other treatments or control. Adequately powered, high quality studies with longer follow-ups are required.

Background: The hamstring muscles are regularly injured during high risk sports involving sprinting and kicking activities. Currently there is inconclusive evidence regarding hamstring muscle length measurements as a predictor for hamstring injury using the active knee extension test. A more functional hamstring flexibility test may be a better measure of hamstring muscle length compared to the active knee extension test as it more closely represents the position of the hamstrings during high risk activities. Purpose: The aim of this study was to compare hamstring muscle length measurements determined using the traditional the active knee extension test and newly proposed functional hamstring flexibility test. Study Design: Comparative single group cohort study. Methods: Thirty seven healthy males aged 18-40 years currently involved in rugby union, Australian football, soccer or sprinting were included in the study. Hamstring muscle length was measured using the active knee extension test and the functional hamstring flexibility test on both right and left legs. Results: The functional hamstring flexibility test measured a significantly smaller knee extension angle (p<0.001) compared to the active knee extension test. Conclusion: A functional position such as that in the functional hamstring flexibility test results in a significantly smaller measure of knee extension than a non-functional assessment position, such as the active knee extension test.

Introduction: The Urinary Incontinence (UI) is a kind of lower urinary tract disfunction that may happen when there are alterations in the physiologic urination process. The use of therapeutic exercises has shown itself very efficient in the treatment of UI, with the objective of improving the efficiency of the urethral sphincter during the intraabdominal pressure raise periods. Objective: Evaluate the efficiency of the perineal exercises and vaginal electrostimulation on the quality of life of women bearers of urinary incontinence. Method: About 10 patients with urinary incontinence (UI) were submitted to a series of perineal exercises and electrostimulation. A UI specific questionnaire “Incontinence Quality of Life Instrument” (I-QOL) was used for the evaluation of the patients. Results: There was an improvement in the general score of the I-QOL whereas without significant improvement values. Conclusion: Therapeutic Exercises associated to electrostimulation may bring improvements to the urinary incontinence patients’ quality of life.

Question: Can Temporal-Mandibular Joint (TMJ) dislocation will be reduced with external support (taping technique)?

Participant: A healthy adult with grade 1 TMJ anterior dislocation left side.

Intervention: Treatment which Taping to the TMJ and followed with jaw strengthening exercises.

Outcome: The primary outcome is reduction in pain and secondary is to increase the mobility.

Conclusion: The people with TMJ dislocation with various reasons will be benefitted with this approach in which we can aim to treat the cause at local level, anxiety and distress at the psychological level.

Recent psychophysiological data supports the concept that hypnotic interventions for pain management are beneficial. The aim of this study was to evaluate pain relief induced through hypnosis in two chronic pain conditions: fibromyalgia (FM) and chronic migraine (CM). Participants were treated during 5 weekly hypnosis sessions, each lasting 60 minutes. A battery of self-reported questionnaires assessing quality of life, pain intensity, and depression levels were administered at the beginning and at the end of treatment. We observed important group differences in outcomes, in particular for CM patients.

Objective: Knee complaints are the most common disorders seen in daily physiotherapy routine, apart from lower back pain. A number of studies have documented a strong correlation between knee, hip and foot biomechanics. Spiraldynamik® is a holistic therapeutic and movement concept. It combines integral natural principles, such as the helix, with archaic evolutionary movement patterns. According to the Spiraldynamik® concept, the functionality of the knee joint is strongly dependent on the functionality of the hip and foot joints. Treatment of the knee joint therefore includes the hip and foot joints as the entire leg is seen as a kinematic chain governed by structural principles. The aim of this study was to document the outcome of the specific Spiraldynamik® therapy in patients with knee disorders. Methods: This quality assurance study was performed during standardized Spiraldynamik® treatment in patients with knee disorders in three Spiraldynamik® centers. The patient-reported outcome measure Activity Index was used. The study included 48 patients (mean age: 52.7 year, min: 19 year, max: 89 year) with different knee disorders. Mean treatment duration was six sessions (of 50 minutes each). Results: A significant reduction was measured for maximum pain (p=0.00), average pain (p=0.00), limitations to activity during household work (p=0.01) and limitations to activity during leisure activity (p=0.00). No significant effect was documented for limitations to activity during work activities (p=0.07), quality of sleep (p=0.12) and general health (p=0.68). A high satisfaction score was documented (97.2%). Conclusion: The Spiraldynamik® concept can be useful in the therapeutic treatment of patients with knee pain and knee disorders. It seems to be effective in reducing disability in daily activities. In addition, a high treatment satisfaction score was documented. Future quality assurance studies should include randomized observational settings and comparisons with standard care.

Background: Back pain in an occupational group stands for one of the most ordinary and most costly workrelated health problems in both developed and developing countries. Its reasons have been described as multifactorial and prevalence rate changes between body sites and location of study. Objective: The objective of study to find out the frequency of low back pain and its associated factors in boy’s college teachers working at twin cities (Rawalpindi and Islamabad) of Pakistan. Methodology: A cross sectional survey based on self-administered pre tested questionnaire among 450 college teachers. Non probability purposive sampling was used to recruit teachers from their institutions in which they work. Duration of study was 6 months (July to December 2015) and data was analyzed using SPSS 20. Results: Frequency of back pain was 44% as there were total 200 teachers who experienced it out of 450 teachers in selected colleges. There were 180 (90%) teachers who reported that they spend 3 hours on class preparation and self-study and the daily work burden was 4-12 hours. Conclusion: This study showed high prevalence of low back pain among male teachers associated with increased standing time and higher workload which have negative impact on their performance and daily activities.

Introduction: Berg Balance Scale is a commonly used outcome measure in patients with stroke. But certain items in the scale when performed on affected or unaffected side may score differently. Procedure: It was an observational study on 50 patients with stroke. Berg Balance scale was administered on these patients. 6 items in the scale were performed first with affected side BBS-A and then with unaffected side BBS-NA. Rest was performed with routine procedure. Results: Item wise and cumulative means were calculated and ICC was computed for each. Cumulative score was statistically significantly different between BBS A and BBS NA (ICC=0.23). Item wise also there were significant differences between the scores. Conclusion: Results of the study indicates that there is a difference in the scores obtained when some items are performed with affected or non-affected extremity.

The need for effective population mental health promotion approaches is urgent as mental health concerns are escalating globally and current allopathic treatment regimens are insufficient to bring people towards the state of mental well-being (citation). Successfully alleviating stress has the potential to promote wellbeing and prevent illness. Worldwide, yoga is gaining popularity as an accessible, acceptable and cost-effective practice for mind and body. People are turning to yoga for mental health improvement because of preferences for: self-treatment as opposed to clinical intervention; perceived greater efficacy than medication; fewer side effects; lack of response to medication. Yoga has minimal side effects and is cost-effective in comparison with pharmacological treatments and psychotherapy. Yoga’s added benefit is that it improves physical fitness and encourages self-reliance. In this brief article we discuss the evidence for yoga as a form of mental health promotion, illness prevention and treatment for depression.

We describe a 34-year-old female diagnosed with Bethlem Myopathy Muscular Dystrophy (BMMD). The initial examination revealed decreased muscle strength and range of motion, and impaired gait. The patient was unable to work and lived with her mother who assisted with all activities of daily living. The patient received aquatic and landbased physical therapy interventions 2 times a week for 12 weeks. After 24 sessions, the patient was able to return to work, walk around the park, go shopping and to the movies, participate in the community pool program, and use a fitness center to maintain strength and endurance. Physical therapy was effective in improving safety and independence for functional transfers, mobility, and community participation, which improved patient-reported quality of life. Further research is needed to assess effectiveness of physical therapy interventions on functional mobility, community participation, and quality of life for patients with Bethlem Myopathy Muscular Dystrophy.

Introduction: Back pain is a common occurrence in persons with a lower extremity amputation, and can cause a chronic disability. Early physical therapy interventions of gait training with prosthesis could prevent amputees from becoming disabled by chronic back pain. Free swing gait training is sometimes utilized in physical therapy with transfemoral amputees learning to use prosthesis. However, there is a lack of evidence for the benefits of free swing gait training on decreasing back pain. The purpose of this study is to describe the effect of free swing gait training on low back pain in an amputee. Case Description: The patient was a 57 year old Caucasian male with a history of a left transtibial amputation and a recent right transfemoral amputation. He was referred to physical therapy to learn how to utilize his new transfemoral prosthetic and find functional independence as a bilateral amputee. One of his chief complaints was debilitating low back pain that had increased since his latest amputation. Intervention: Physical therapy intervention included free swing gait training intended to normalize the patient’s gait pattern while ambulating with a left transfemoral and a right transtibial prostheses. It was hypothesized that the normalization of the patient’s gait pattern would decrease his complaint of back pain. Results: After 8 weeks of physical therapy, including 3 weeks of free swing gait training, the patient demonstrated decreased low back pain, increased strength, and improved gait quality and distance. Discussion: The results of this case report demonstrate that the use of free swing gait training can be beneficial to decrease back pain in a bilateral amputee.

Introduction: Chronic pain is an important and costly health problem worldwide. Unfortunately, most traditional medical treatments for chronic pain focus exclusively on reducing or managing pain sensations. If left untreated, pain can lead to serious emotional and physical complaints such as depression, sleeping disorders, immune suppression, eating disorders, cognitive impairments and other long-term deleterious effects. The aim of this study is to describe outcomes observed in a patients suffering from chronic pain, treated at the FLENI interdisciplinary outpatient pain rehabilitation program (IOPRP) during an eight-year period, while working under international standards. Methods: We report results of an interdisciplinary, 16-session chronic pain treatment program, in 1176 patients followed as outpatients at our clinic, between January 2006 and December 2014. A battery of self-reported questionnaires was completed at the beginning and end of the program; follow up visits were scheduled three months and one year after discharge. Treatment included pain medication, physical and occupational therapy, as well as cognitive and behavioral techniques for pain and stress management. Results: Patient demographics were as follows: mean age was 55.76 ± 0.44 years (range 18-98 years); 68.9% were females (n=810); 302 patients had chronic cervical pain (25.7%) and 874 chronic lumbar pain (74.3%). IOPRP at baseline showed substantial pain problems (VAS 5.66 ± 0.07), poor quality of life (SF36, 41.9 ± 0.54), subclinical insomnia (ISI 11.31 ± 0.26), mild mood disturbance (BECK 13.87 ± 0.24) and excess weight (BMI 27.52 ± 0.20). At the end of the program, statistically significant improvement (p<0.05) was observed on SF-36 (8 domains), EVA, RMT, ODI, BECK, HAQ and ISI. Discussion: Results indicated not only that application of an IOPRP is feasible in Argentina, but also that results were uniform and sustained throughout the study period. Based on our experience, we encourage other centers to treat chronic pain in an interdisciplinary fashion, following international quality standards.