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Schuber AA, Schmidt S, Hombach S, Schaller A. The effects of exercise therapy feedback on subjective treatment outcome and patient satisfaction: study protocol for a mono-centric, randomized, controlled trial in orthopedic rehabilitation (FeedYou). BMC Sports Sci Med Rehabil 2023; 15:17. [PMID: 36755274 PMCID: PMC9905758 DOI: 10.1186/s13102-023-00626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The disease burden of musculoskeletal disorders necessitates multidisciplinary and patient-centered models of care. Exercise therapy represents a first-line treatment strategy and a central component of medical rehabilitation. In order to realize the goals of long-term physical activity and participation as proposed by the ICF, exercise therapy can be supplemented by interventional techniques from the field of psychotherapy. Although psychotherapist feedback has been shown to improve therapeutic outcome and patient satisfaction, feedback use in exercise therapy is mostly limited to motor learning and exercise instruction. The present paper therefore describes the use of multidimensional exercise therapy feedback in medical rehabilitation. The aims of the trial presented in this study protocol are to evaluate the effects of this novel feedback approach on rehabilitation outcomes in comparison to usual care. METHODS The study is designed as a prospective, mono-centric, randomized controlled, superiority trial (RCT) with two parallel groups and three measuring points: T0 = start of three-week inpatient rehabilitation, T1 = end of three-week inpatient rehabilitation, T2 = 12-week follow-up. In total, 132 patients suffering from chronic neck, shoulder and/or lumbar spine disorders will be recruited. The intervention involves multidimensional exercise therapy feedbacks during the initial and final physical therapist examination, as well as short exercise therapy feedbacks during the course units of the mandatory group-based exercise therapy program. Primary outcomes are the subjective treatment outcome, assessed by BPI and indication-specific questionnaires, as well as patient satisfaction, assessed by ZUF-8 and an intervention-specific questionnaire. The final data collection is expected by May 2023. DISCUSSION This study may provide a valuable insight into the effectiveness of multidimensional exercise therapy feedback to improve treatment outcomes and patient satisfaction in medical rehabilitation. This could contribute to rehabilitation quality assurance and the long-term physical activity behavior of rehabilitation patients. Trial registration The trial has been registered with the German Clinical Trial Register (DRKS) under the Registration Number DRKS00027263.
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Affiliation(s)
- André Arik Schuber
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Müngersdorf 6, NawiMedi, Ground Floor, 50933, Cologne, Germany.
| | | | - Sarah Hombach
- Therapy Department, Aggertalklinik, Engelskirchen, Germany
| | - Andrea Schaller
- grid.27593.3a0000 0001 2244 5164Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Müngersdorf 6, NawiMedi, Ground Floor, 50933 Cologne, Germany
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Focus of Attention in Coach Instructions for Technique Training in Sports: A Scrutinized Review of Review Studies. J Funct Morphol Kinesiol 2023; 8:jfmk8010007. [PMID: 36648899 PMCID: PMC9844492 DOI: 10.3390/jfmk8010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Literature reports superior performance when focusing one's attention during a movement on environmental effects of that movement (external focus, EF) compared to focusing on the moving body (internal focus, IF). Nevertheless, IF instructions still play an important role in the daily practice of coaches, trainers, and therapists. The current review compiles evidence for focus-of-attention concepts on movement form corrections and technique training. Reviews on the topic and selected additional papers addressing the effect of attentional focus on movement form or on kinetic, kinematic or muscle activity data were included. Both EF and IF instructions affect movement form. The reviews revealed that IF instructions seem to be better applicable to direct movement form changes than EF instructions. In contrast, EF instructions better facilitate optimization within the whole-body coordination, often resulting in better performance outcomes not directly linked to movement pattern changes. Several studies discuss focus-of-attention effects in the context of the optimal feedback control theory expanding on the constrained action hypothesis. In summary, EF and IF instructions both affect form and performance of movements, however, their relative efficacy is situation dependent. The often-purported superiority of EF over IF instructions cannot be generalized to all application contexts.
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Castillo-Vejar L, Lizama-Fuentes M, Bascour-Sandoval C, Cuyul-Vásquez I. [Attentional focus instructions for therapeutic exercise in people with musculoskeletal disorders. A scoping review]. Rehabilitacion (Madr) 2022; 56:344-352. [PMID: 35469643 DOI: 10.1016/j.rh.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/28/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.
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Affiliation(s)
- L Castillo-Vejar
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - M Lizama-Fuentes
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - C Bascour-Sandoval
- Departamento de Medicina Interna, Universidad de La Frontera, Temuco, Chile; Carrera de Kinesiología, Universidad Autónoma de Chile, Temuco, Chile
| | - I Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile.
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Lee R, James C, Edwards S, Skinner G, Young JL, Snodgrass SJ. Evidence for the Effectiveness of Feedback from Wearable Inertial Sensors during Work-Related Activities: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:6377. [PMID: 34640695 PMCID: PMC8512480 DOI: 10.3390/s21196377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 01/03/2023]
Abstract
Background: Wearable inertial sensor technology (WIST) systems provide feedback, aiming to modify aberrant postures and movements. The literature on the effects of feedback from WIST during work or work-related activities has not been previously summarised. This review examines the effectiveness of feedback on upper body kinematics during work or work-related activities, along with the wearability and a quantification of the kinematics of the related device. Methods: The Cinahl, Cochrane, Embase, Medline, Scopus, Sportdiscus and Google Scholar databases were searched, including reports from January 2005 to July 2021. The included studies were summarised descriptively and the evidence was assessed. Results: Fourteen included studies demonstrated a 'limited' level of evidence supporting posture and/or movement behaviour improvements using WIST feedback, with no improvements in pain. One study assessed wearability and another two investigated comfort. Studies used tri-axial accelerometers or IMU integration (n = 5 studies). Visual and/or vibrotactile feedback was mostly used. Most studies had a risk of bias, lacked detail for methodological reproducibility and displayed inconsistent reporting of sensor technology, with validation provided only in one study. Thus, we have proposed a minimum 'Technology and Design Checklist' for reporting. Conclusions: Our findings suggest that WIST may improve posture, though not pain; however, the quality of the studies limits the strength of this conclusion. Wearability evaluations are needed for the translation of WIST outcomes. Minimum reporting standards for WIST should be followed to ensure methodological reproducibility.
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Affiliation(s)
- Roger Lee
- School of Health Sciences, The University of Newcastle, Newcastle 2308, Australia; (C.J.); (S.J.S.)
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle 2308, Australia
| | - Carole James
- School of Health Sciences, The University of Newcastle, Newcastle 2308, Australia; (C.J.); (S.J.S.)
- Centre for Resources Health and Safety, The University of Newcastle, Newcastle 2308, Australia
| | - Suzi Edwards
- School of Health Sciences, The University of Sydney, Sydney 2006, Australia;
| | - Geoff Skinner
- School of Information and Physical Sciences, The University of Newcastle, Newcastle 2308, Australia;
| | - Jodi L. Young
- Department of Physical Therapy, Bellin College, Green Bay, WI 54311, USA;
| | - Suzanne J. Snodgrass
- School of Health Sciences, The University of Newcastle, Newcastle 2308, Australia; (C.J.); (S.J.S.)
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle 2308, Australia
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Moslehi M, Letafatkar A, Miri H. Feedback improves the scapular-focused treatment effects in patients with shoulder impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2021; 29:2281-2288. [PMID: 32725447 DOI: 10.1007/s00167-020-06178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the effects of scapular-focused treatment with (SFTF) and without (SFT) feedback on pain, function, and scapular kinematics in patients with Shoulder Impingement Syndrome (SIS). METHODS Seventy-five males and females with SIS were randomly assigned into SFTF (n = 25), SFT (n = 25) and control (n = 25) groups. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function and scapular kinematics, assessed by DASH Questionnaire and a 3-D motion capture, respectively. All outcomes were measured at the baseline and after the 8-week interventions. RESULTS A post hoc analysis performed to show significant differences between groups after the 8-week interventions. For pain, there were significant differences between SFTF vs. SFT (ES (95% CI) = - 0.3(- 0.4 to - 0.1); P = 0.04), SFTF vs. control (ES (95% CI) = 1.3(0.7-1.9); P = 0.01). For DASH, also, there were significant differences between SFTF vs. SFT (ES (95% CI) = 1.8(1.1-2.4); P = 0.03), SFTF vs. control (ES (95% CI) = 4.4(3.3-5.4); P = 0.01), and SFT vs. control (ES (95% CI) = 2.6(1.8-3.4); P = 0.01). For scapular internal rotation (the sagittal or scapular planes), scapular upward rotation, and the scapular tilt, however, there were no differences between SFTF vs. SFT. CONCLUSION Based on the study results, a rehabilitation program integrated with verbal feedbacks is effective to relieve pain, and improve function and scapular kinematics in patients with SIS. Adding feedback to an exercise therapy could clinically enhance outcomes in patients with SIS. LEVEL OF EVIDENCE Level II. TRIAL REGISTRATION This study was prospectively registered at UMIN-CTR website, and the unique trail number is UMIN000036399.
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Affiliation(s)
- Mahsa Moslehi
- Department of Physical Education and Sports Sciences, Raja University, Qazvin, Iran
| | - Amir Letafatkar
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran.
| | - Hadi Miri
- Department of Physical Education and Sports Sciences, Amir Kabir University of Technology, Tehran, Iran
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Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial. Hum Mov Sci 2020; 74:102709. [PMID: 33137581 DOI: 10.1016/j.humov.2020.102709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 09/14/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effects of three different foci of attention (internal, external and mixed) on motor learning using craniocervical flexion test in inexperienced participants. METHODS Ninety healthy young adults, with no experience in the task, practiced the craniocervical flexion test under three different focus of attention: a) Mixed Focus (internal plus external), b) Internal Focus, and c) External Focus. We assessed immediate, post-training, and retention (one week after the last training session) aspects of motor learning by quantifying (i) the activity of the superficial cervical flexors muscles, (ii) craniocervical range of motion, and (iii) the performance on the craniocervical flexion test. RESULTS None of the groups showed any significant immediate, post-training, or retention effects on superficial neck flexors activity and craniocervical range of motion progression. At immediate assessment, mixed focus had greater craniocervical flexion performance than external (MD 0.9, 95%CI 0.2 to 1.5), and internal foci (MD 1.4, 95%CI 0.8 to 2.1). At post-training, mixed focus led to better craniocervical performance compared to external (MD 1.6, 95%CI 0.8 to 2.4) and internal foci (MD 2.7, 95%CI 1.9 to 3.5). External focus had better scores on the craniocervical flexion test performance than internal focus (MD 1.1, 95%CI 0.3 to 1.9). Results remained similar at retention, with mixed focus being superior to internal (MD 2.3, 95%CI 1.7 to 3) and external foci (MD 1.5, 95%CI 0.9 to 2.1) on craniocervical flexion test performance. Similarly, the performance on the craniocervical flexion test performance remained similar at retention between external and internal foci (MD 0.9, 95%CI 0.2 to 1.5). CONCLUSION In inexperienced asymptomatic participants, different foci of attention were not able to change cervical muscle activity and craniocervical range of motion during the craniocervical flexion test. Mixed focus was better than external and internal focus on the craniocervical flexion test. These findings were retained after one week.
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Ganesh GS, Kaur P, Meena S. Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review. J Bodyw Mov Ther 2020; 26:374-393. [PMID: 33992272 DOI: 10.1016/j.jbmt.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/11/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Motor control exercise (MCEs), spinal stabilization or core stability exercises were developed with the aim of restoring the coordination, control, and capacity of the trunk muscles and systematic reviews (SR) evaluating their effectiveness has shown conflicting results. This we hypothesized was due to the non-consideration of principles of neuroplasticity. The objective of this review was to review the operating definitions used in these reviews for these exercises and evaluate if these reviews have considered and satisfied the principles of these exercises in persons with NSLBP, both acute and chronic. METHODS The available evidence to address the research question was sought in the reviews published in English between January 2006 and April 2019 using the population, intervention, comparison, and outcome format. Data were extracted against the following factors: satisfy the principles of specific inclusion criteria; interventions; experience-dependent plasticity; and measure any one of the concepts of motor control. The quality of the evidence obtained was graded using the National Institute for Health and Care Excellence protocol and the quality of SRs evaluated using the R-AMSTAR. RESULTS Eleven reviews on core stability/spinal stabilization exercises and four reviews on MCE were considered in this review. The results showed that most of the studies considered by the reviews did not adhere to the principles of these exercises. CONCLUSION There is wide heterogeneity in the understanding, administration, and progression of exercises. The exercises were implemented without considering the potential for neuroplasticity of the nervous system and the principles of motor learning.
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Affiliation(s)
- G Shankar Ganesh
- Composite Regional Centre for Skill Development, Rehabilitation and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India.
| | | | - Sadhana Meena
- Department of Physiotherapy, Sports Injury Centre, Safdarjung Hospital, New Delhi, India.
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Flynn D, Eaton LH, Langford DJ, Ieronimakis N, McQuinn H, Burney RO, Holmes SL, Doorenbos AZ. A SMART design to determine the optimal treatment of chronic pain among military personnel. Contemp Clin Trials 2018; 73:68-74. [PMID: 30145267 PMCID: PMC6234001 DOI: 10.1016/j.cct.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 12/18/2022]
Abstract
Chronic pain is a leading cause of disability among active duty service members in the U.S. armed forces. Standard rehabilitative care and complementary and integrative health therapies are used for chronic pain rehabilitation. However, the optimal sequence and duration of these therapies has yet to be determined. This article describes a sequential multiple assignment randomized trial (SMART) protocol being used to identify the optimal components and sequence of standard rehabilitative care and complementary and integrative health therapies for reducing pain impact and improving other patient outcomes. Active duty service members referred to Madigan Army Medical Center for treatment of chronic pain are being recruited to the Determinants of the Optimal Dose and Sequence of Functional Restoration and Integrative Therapies study. Study participants are randomized to either standard rehabilitative care (physical and occupational therapy and psychoeducation) or complementary and integrative health therapies (chiropractic, acupuncture, yoga and psychoeducation). Those participants who do not respond to the first 3 weeks of treatment are randomized to receive an additional 3 weeks of either (1) the alternative treatment or (2) the first-stage treatment plus the alternative treatment. This study will also determine factors associated with treatment response that can support clinical decision making, such as baseline fitness, pain catastrophizing, kinesiophobia, post-traumatic stress, pain self-efficacy, and biological indicators. The information gained from this research will be applicable to all integrative chronic pain rehabilitation programs throughout the U.S. Department of Defense and the U.S. Department of Veterans Affairs, and the broader rehabilitation community.
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Affiliation(s)
- Diane Flynn
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Linda H Eaton
- School of Nursing & Health Studies, University of Washington Bothell, Box 358531, Bothell, WA 98011, USA.
| | - Dale J Langford
- School of Medicine, University of Washington Seattle, Box 356340, Seattle, WA 98195, USA.
| | - Nicholas Ieronimakis
- Madigan Army Medical Center, Department of Clinical Investigations, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Honor McQuinn
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Richard O Burney
- Madigan Army Medical Center, Department of Clinical Investigations, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Samuel L Holmes
- Madigan Army Medical Center, Department of Pain Management, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Chicago, IL 60612, USA.
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Hotta GH, Queiroz POP, de Lemos TW, Rossi DM, Scatolin RDO, de Oliveira AS. Immediate effect of scapula-focused exercises performed with kinematic biofeedback on scapular kinematics in individuals with subacromial pain syndrome. Clin Biomech (Bristol, Avon) 2018; 58:7-13. [PMID: 30005425 DOI: 10.1016/j.clinbiomech.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/14/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Given the changes in the patterns of muscular activation and scapular movement in individuals with subacromial pain syndrome, the use of neuromuscular training has been considered in rehabilitation protocols. There is currently no evidence of the effects of the use of three-dimensional (3D) kinematic biofeedback on individuals with subacromial pain syndrome. This study aimed to determine the immediate effect of scapular motor control exercises using 3D kinematic biofeedback on the scapular kinematics, inter-segment coordination and pain of individuals with subacromial pain syndrome. METHOD The kinematics of the scapulothoracic joint of 26 subjects with subacromial pain syndrome were assessed in the movement arm elevation and lowering in the sagittal plane before and after performance of three scapula-focused exercises using kinematic biofeedback. The individuals were familiarized with the selected exercises to acquire a greater scapular posterior tilt, while kinematic biofeedback, with visual and auditory stimuli, was used in real time. Scapular kinematics, pain, and subjective perception of exertion were the pre- and post-test measures. FINDINGS In the movement of arm elevation and lowering, no differences were found in scapular tilt and on coordination between the segments pre- and post-test and the effect size was considered small. INTERPRETATION Our results demonstrate that the performance of scapula-focused exercises using kinematic biofeedback does not cause immediate changes in the magnitude of scapular movement. However, inter-segmental coordination showed evidence of changes for scapular tilt in the lowering of the arm and internal rotation in the elevation and the lowering of the arm in individuals with subacromial pain syndrome.
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Affiliation(s)
- Gisele Harumi Hotta
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Paulo Otávio Pimenta Queiroz
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Tenysson Will de Lemos
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Denise Martineli Rossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Ramon de Oliveira Scatolin
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Piccoli A, Rossettini G, Cecchetto S, Viceconti A, Ristori D, Turolla A, Maselli F, Testa M. Effect of Attentional Focus Instructions on Motor Learning and Performance of Patients with Central Nervous System and Musculoskeletal Disorders: a Systematic Review. J Funct Morphol Kinesiol 2018; 3:E40. [PMID: 33466969 PMCID: PMC7739330 DOI: 10.3390/jfmk3030040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
Exercise is one of the main rehabilitative interventions, commonly used to improve performance and motor learning. During the application of attentional focus strategies, External Focus of Attention (EFA) aiming at the movement effect has been reported to have more efficacy than Internal Focus of Attention (IFA) aiming at movement characteristics in healthy subjects. There are not many studies that compare the EFA and IFA instructions in people with Musculoskeletal (MSK) and Central Nervous System disorders (CNS). The purpose of this systematic review is to determine if IFA or EFA, in patients with CNS or MSK, may improve performance and have some effects on motor learning. Databases used for research: PubMed, CINAHL, Cochrane Library, PEDro, PsycINFO, SCOPUS. Inclusion criteria: Randomized Controlled Trial, quasi-Randomized Controlled Trial, enrolled subjects with CNS or with MSK and compared the efficacy of EFA and IFA. The studies suggest that the EFA is better than IFA in affecting the movement execution in patients with MSK, while conflicted findings emerge in presence of CNS disorders. Studies included in the qualitative analysis showed heterogeneous methodological features in study design and conductance, so results must be interpreted with caution.
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Affiliation(s)
- Alessandro Piccoli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | | | - Antonello Viceconti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Andrea Turolla
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
- Fondazione Ospedale San Camillo IRCCS, 30126 Venezia, Italy
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
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Storberget M, Grødahl LHJ, Snodgrass S, van Vliet P, Heneghan N. Verbal augmented feedback in the rehabilitation of lower extremity musculoskeletal dysfunctions: a systematic review. BMJ Open Sport Exerc Med 2017; 3:e000256. [PMID: 29018544 PMCID: PMC5623330 DOI: 10.1136/bmjsem-2017-000256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background Verbal augmented feedback (VAF) is commonly used in physiotherapy rehabilitation of individuals with lower extremity musculoskeletal dysfunction or to induce motor learning for injury prevention. Its effectiveness for acquisition, retention and transfer of learning of new skills in this population is unknown. Objectives First, to investigate the effect of VAF for rehabilitation and prevention of lower extremity musculoskeletal dysfunction. Second, to determine its effect on motor learning and the stages of acquisition, retention and transfer in this population. Design Systematic review designed in accordance with the Centre for Reviews and Dissemination and reported in line with Preferred Reporting Items for Systematic Review and Meta-analysis. Method MEDLINE, Embase, PubMed and five additional databases were searched to identify primary studies with a focus on VAF for prevention and rehabilitation of lower extremity musculoskeletal dysfunction. One reviewer screened the titles and abstracts. Two reviewers retrieved full text articles for final inclusion. The first reviewer extracted data, whereas the second reviewer audited. Two reviewers independently assessed risk of bias and quality of evidence using Cochrane Collaboration’s tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Results Six studies were included, with a total sample of 304 participants. Participants included patients with lateral ankle sprain (n=76), postoperative ACL reconstruction (n=16) and healthy individuals in injury prevention (n=212). All six studies included acquisition, whereas retention was found in five studies. Only one study examined transfer of the achieved motor learning (n=36). VAF was found to be effective for improving lower extremity biomechanics and postural control with moderate evidence from five studies. Conclusion VAF should be considered in the rehabilitation of lower extremity musculoskeletal dysfunctions. However, it cannot be unequivocally confirmed that VAF is effective in this population, owing to study heterogeneity and a lack of high-quality evidence. Nevertheless, positive effects on lower extremity biomechanics and postural control have been identified. This suggests that further research into this topic is warranted where an investigation of long-term effects of interventions is required. All stages (acquisition, retention and transfer) should be evaluated.
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Affiliation(s)
- Marianne Storberget
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Linn Helen J Grødahl
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Suzanne Snodgrass
- School of Health Sciences (Physiotherapy), University of Newcastle, Callaghan, New South Wales, Australia
| | - Paulette van Vliet
- School of Health Sciences (Physiotherapy), University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicola Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Oliveras I, Losilla JM, Vives J. Methodological quality is underrated in systematic reviews and meta-analyses in health psychology. J Clin Epidemiol 2017; 86:59-70. [DOI: 10.1016/j.jclinepi.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/09/2016] [Accepted: 05/02/2017] [Indexed: 01/09/2023]
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Rossettini G, Testa M, Vicentini M, Manganotti P. The Effect of Different Attentional Focus Instructions during Finger Movement Tasks in Healthy Subjects: An Exploratory Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2946465. [PMID: 28286760 PMCID: PMC5329693 DOI: 10.1155/2017/2946465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022]
Abstract
External focus of attention (EFA) and internal focus of attention (IFA) represent commonly used strategies to instruct subjects during exercise. Several studies showed EFA to be more effective than IFA to improve motor performance and learning. To date the role of these strategies on motor performance during finger movement was less studied. The objective of the study was to investigate motor performance, patient's preference induced by IFA and EFA, and the focus during control condition. Ten healthy right-handed participants performed a finger movement task in control, EFA, and IFA conditions (counterbalanced). Errors, patient's preference, and type of attentional focus spontaneously adopted during the control condition were recorded. EFA determined less error (p < 0.01) compared to control and IFA. Participants preferred EFA against IFA and control condition. In the control group 10% of subjects adopted a purely EFA, 70% of subjects adopted a purely IFA, and 20% of subjects adopted a mixture of the two foci. Our results confirm that EFA is more effective than IFA and control in finger movement task. Due its clinical relevance, the interaction between attention and finger movement should be further investigated.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto 2, 17100 Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto 2, 17100 Savona, Italy
| | | | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical Science, Surgery and Health, University of Trieste, Via Farneto 3, 34142 Trieste, Italy
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Antunes A, Carnide F, Matias R. Real-time kinematic biofeedback improves scapulothoracic control and performance during scapular-focused exercises: A single-blind randomized controlled laboratory study. Hum Mov Sci 2016; 48:44-53. [DOI: 10.1016/j.humov.2016.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/04/2016] [Accepted: 04/16/2016] [Indexed: 01/12/2023]
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Haozous EA, Doorenbos AZ, Stoner S. Pain Management Experiences and the Acceptability of Cognitive Behavioral Strategies Among American Indians and Alaska Natives. J Transcult Nurs 2016; 27:233-40. [PMID: 25403169 PMCID: PMC4433858 DOI: 10.1177/1043659614558454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this project was to explore the chronic pain experience and establish cultural appropriateness of cognitive behavioral pain management (CBPM) techniques in American Indians and Alaska Natives (AI/ANs). DESIGN A semistructured interview guide was used with three focus groups of AI/AN patients in the U.S. Southwest and Pacific Northwest regions to explore pain and CBPM in AI/ANs. FINDINGS The participants provided rich qualitative data regarding chronic pain and willingness to use CBPM. Themes included empty promises and health care insufficiencies, individuality, pain management strategies, and suggestions for health care providers. CONCLUSION Results suggest that there is room for improvement in chronic pain care among AI/ANs and that CBPM would likely be a viable and culturally appropriate approach for chronic pain management. IMPLICATIONS This research provides evidence that CBPM is culturally acceptable and in alignment with existing traditional AI/AN strategies for coping and healing.
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Kleynen M, Braun SM, Rasquin SMC, Bleijlevens MHC, Lexis MAS, Halfens J, Wilson MR, Masters RSW, Beurskens AJ. Multidisciplinary Views on Applying Explicit and Implicit Motor Learning in Practice: An International Survey. PLoS One 2015; 10:e0135522. [PMID: 26296203 PMCID: PMC4546413 DOI: 10.1371/journal.pone.0135522] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/22/2015] [Indexed: 12/27/2022] Open
Abstract
Background A variety of options and techniques for causing implicit and explicit motor learning have been described in the literature. The aim of the current paper was to provide clearer guidance for practitioners on how to apply motor learning in practice by exploring experts’ opinions and experiences, using the distinction between implicit and explicit motor learning as a conceptual departure point. Methods A survey was designed to collect and aggregate informed opinions and experiences from 40 international respondents who had demonstrable expertise related to motor learning in practice and/or research. The survey was administered through an online survey tool and addressed potential options and learning strategies for applying implicit and explicit motor learning. Responses were analysed in terms of consensus (≥ 70%) and trends (≥ 50%). A summary figure was developed to illustrate a taxonomy of the different learning strategies and options indicated by the experts in the survey. Results Answers of experts were widely distributed. No consensus was found regarding the application of implicit and explicit motor learning. Some trends were identified: Explicit motor learning can be promoted by using instructions and various types of feedback, but when promoting implicit motor learning, instructions and feedback should be restricted. Further, for implicit motor learning, an external focus of attention should be considered, as well as practicing the entire skill. Experts agreed on three factors that influence motor learning choices: the learner’s abilities, the type of task, and the stage of motor learning (94.5%; n = 34/36). Most experts agreed with the summary figure (64.7%; n = 22/34). Conclusion The results provide an overview of possible ways to cause implicit or explicit motor learning, signposting examples from practice and factors that influence day-to-day motor learning decisions.
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Affiliation(s)
- Melanie Kleynen
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Adelante Rehabilitation Centre, Department of Brain Injury, Hoensbroek, The Netherlands
- Department of Family Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Rehabilitation Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Susy M. Braun
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sascha M. C. Rasquin
- Department of Rehabilitation Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Michel H. C. Bleijlevens
- Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Innovation Platform Sevagram, Sevagram Zorgcentra, Heerlen, the Netherlands
| | - Monique A. S. Lexis
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jos Halfens
- Adelante Rehabilitation Centre, Department of Brain Injury, Hoensbroek, The Netherlands
| | - Mark R. Wilson
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Rich S. W. Masters
- Institute of Human Performance, University of Hong Kong, Hong Kong, China
- Te Oranga School of Human Development and Movement Studies, University of Waikato, Hamilton, New Zealand
| | - Anna J. Beurskens
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Snodgrass SJ, Heneghan NR, Tsao H, Stanwell PT, Rivett DA, Van Vliet PM. Recognising neuroplasticity in musculoskeletal rehabilitation: a basis for greater collaboration between musculoskeletal and neurological physiotherapists. ACTA ACUST UNITED AC 2014; 19:614-7. [PMID: 24530068 DOI: 10.1016/j.math.2014.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 11/17/2022]
Abstract
Evidence is emerging for central nervous system (CNS) changes in the presence of musculoskeletal dysfunction and pain. Motor control exercises, and potentially manual therapy, can induce changes in the CNS, yet the focus in musculoskeletal physiotherapy practice is conventionally on movement impairments with less consideration of intervention-induced neuroplastic changes. Studies in healthy individuals and those with neurological dysfunction provide examples of strategies that may also be used to enhance neuroplasticity during the rehabilitation of individuals with musculoskeletal dysfunction, improving the effectiveness of interventions. In this paper, the evidence for neuroplastic changes in patients with musculoskeletal conditions is discussed. The authors compare and contrast neurological and musculoskeletal physiotherapy clinical paradigms in the context of the motor learning principles of experience-dependent plasticity: part and whole practice, repetition, task-specificity and feedback that induces an external focus of attention in the learner. It is proposed that increased collaboration between neurological and musculoskeletal physiotherapists and researchers will facilitate new discoveries on the neurophysiological mechanisms underpinning sensorimotor changes in patients with musculoskeletal dysfunction. This may lead to greater integration of strategies to enhance neuroplasticity in patients treated in musculoskeletal physiotherapy practice.
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Affiliation(s)
- Suzanne J Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Henry Tsao
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter T Stanwell
- Discipline of Medical Radiation Science, School of Health Sciences, Faculty of Health and Medicine and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
| | - Darren A Rivett
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
| | - Paulette M Van Vliet
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
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