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Pérez-Porta I, Flórez-García MT, García-Pérez F, Fernández-Matías R, Pérez-Manzanero MÁ, Araujo-Narváez AM, Urraca-Gesto MA, Fernández-Lagarejos C, Plaza-Manzano G, Pérez-Fernández E, Velasco-Arribas M. Effects of a web application based on multimedia animations to support therapeutic exercise for rotator cuff-related shoulder pain: protocol for an open-label randomised controlled trial. BMJ Open 2024; 14:e085381. [PMID: 39038866 DOI: 10.1136/bmjopen-2024-085381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain. Currently, exercise is proposed as the first-line treatment for patients suffering from RCRSP. However, adherence to therapeutic exercise programmes can be poor in the long term in a home setting. The aim of this study is to evaluate the effects of adding video animations to a traditional paper-based exercise programme. METHODS AND ANALYSIS A single-centre, randomised, open-labelled clinical trial will be conducted in a hospital in Spain. Adults aged between 18 and 80 years diagnosed with RCRSP who meet the eligibility criteria will be included. Patients (n=132) will be randomised into two groups, with both receiving paper-based exercises, and the experimental group will also be provided with video animations. The participants will receive seven face-to-face physical therapy sessions and will be asked to perform the exercises at home for 6 months. The primary outcome measure will be the Shoulder Pain and Disability Index, measured at baseline, 3 weeks, 3 months (primary analysis) and 6 months. Secondary outcomes will be the patient's pain intensity during the last week (rest, during movement and at night); expectations of improvement; satisfaction with treatment; impression of improvement; perceived usability, usefulness and satisfaction of multimedia animations; and adherence to exercises. Generalised least squares regression models with an autoregressive-moving average lag one correlation structure will be implemented, with an intention-to-treat analysis. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of Hospital Universitario Fundación Alcorcón (Madrid, Spain), reference number CI18/16. All participants will sign an informed consent. The results will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION ClinicalTrials.gov, NCT05770908.
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Affiliation(s)
- Irene Pérez-Porta
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
- International Doctoral School, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain
| | - Mariano Tomás Flórez-García
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
| | - Fernando García-Pérez
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain
- Doctoral School, Department of Physical Therapy, Universitat de Valencia, Valencia, Comunitat Valenciana, Spain
| | - M Ángeles Pérez-Manzanero
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
| | - Aurora María Araujo-Narváez
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
| | - M Alicia Urraca-Gesto
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, and Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain
| | - César Fernández-Lagarejos
- Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation, and Physical Therapy, Universidad Complutense de Madrid, Madrid, Spain
- Fisioterapia Contemporánea (InPhysio) Research Group, Health Research Institute, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain
| | - Elia Pérez-Fernández
- Research Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain
| | - María Velasco-Arribas
- Research Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain
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Digital Rehabilitation Programs Improve Therapeutic Exercise Adherence for Patients With Musculoskeletal Conditions: A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther 2022; 52:726-739. [PMID: 35960507 DOI: 10.2519/jospt.2022.11384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate the effects of digital rehabilitation for improving adherence to therapeutic exercise in people with musculoskeletal conditions. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from their inception to March 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials evaluating digital rehabilitation programs to improve adherence to therapeutic exercise for people with musculoskeletal conditions. DATA SYNTHESIS: We calculated standardized mean differences (SMDs) or mean differences (MDs) and 95% confidence intervals (CIs). Certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Bias was assessed using the Cochrane risk of bias tool. RESULTS: Eleven trials were included in the meta-analysis (n = 1144 participants). At short-term follow-up, digital rehabilitation was no better than nondigital rehabilitation (3 trials, adherence rate of prescribed exercise test SMD 0.50, 95% CI: -0.13, 1.13; 2 trials, self-reported exercise adherence test MD 1.07, 95% CI: 0.58, 1.56; 2 trials, assessor-reported exercise adherence test SMD -0.10, 95% CI: -0.56, 0.36). At intermediate-term follow-up, digital rehabilitation improved exercise adherence compared with nondigital rehabilitation (6 trials, adherence rate of prescribed exercise test SMD 0.53, 95% CI: 0.35, 0.70; 2 trials, self-reported exercise adherence test MD 1.50, 95% CI: 0.76, 2.25; 2 trials, Exercise Adherence Rating Scale test MD 5.86, 95% CI: 0.08, 11.65). At long-term follow-up, there was no clinically important difference between digital and nondigital rehabilitation (2 trials, adherence rate of prescribed exercise test SMD 0.28, 95% CI: -0.14, 0.70; 1 trial, self-reported exercise adherence test MD 0.20, 95% CI: -0.91, 1.31). CONCLUSION: Digital rehabilitation was effective at improving therapeutic exercise adherence in musculoskeletal conditions at mid-term follow-up, but not at short- and long-term follow-up. J Orthop Sports Phys Ther 2022;52(11):726-739. Epub: 12 August 2022. doi:10.2519/jospt.2022.11384.
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Jirasakulsuk N, Saengpromma P, Khruakhorn S. Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis. JMIR Rehabil Assist Technol 2022; 9:e36028. [PMID: 36048520 PMCID: PMC9478822 DOI: 10.2196/36028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers. Objective We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness. Methods A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane’s risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR’s effectiveness based on different treatments, controls, and outcome measures. Results The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI –0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment. Conclusions We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. Trial Registration PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289
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Affiliation(s)
- Nathaphon Jirasakulsuk
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Pattaridaporn Saengpromma
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
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Edgar MC, Lambert C, Abbas A, Young JJ, McIsaac W, Monteiro R, Girdhari R, Schofield L, Miller L, Kopansky-Giles D. Development of a low resource exercise rehabilitation application for musculoskeletal disorders to help underserved patients in a primary care setting. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:130-145. [PMID: 36275080 PMCID: PMC9512304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We set out to create a Family Medicine EHR (electronic health record) embedded exercise application. This was done to evaluate the utility of the exercise app for providers and to understand the usefulness of the exercise app from the perspective of patients. METHODS This exercise application was developed through an iterative process with repeated pre-testing and feedback from an interprofessional team and embedded into the EHR at an academic family medicine clinic. Anecdotal feedback from patients was used to inform pre-testing adaptations. RESULTS The application required six iterations prior to clinical utility. It had several features that clinicians and patients felt were beneficial. These features involved a customizable exercise directory with pre-made templated plans which could be further modified. To overcome accessibility barriers, the application was developed to include digital and printable copies with an integrated direct email option for ease of remote sharing with patients. CONCLUSION A customizable, open-source exercise application was developed to facilitate provider exercise prescription and support patient self-management. This project may be useful for other providers interested in developing similar programs to address musculoskeletal conditions in their patients. Next steps are to undertake pilot testing of the app with broader provider and patient feedback.
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Affiliation(s)
- Michael C Edgar
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto
- Canadian Memorial Chiropractic College
| | | | - Anser Abbas
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto
- Canadian Memorial Chiropractic College
| | - James J Young
- Canadian Memorial Chiropractic College
- Centre for Muscle and Joint Health, University of Southern Denmark
| | - Willem McIsaac
- Department of Family and Community Medicine, University of Toronto
| | - Rhea Monteiro
- Department of Family and Community Medicine, University of Toronto
| | - Rajesh Girdhari
- Unity Health-St. Michael's Hospital Academic Family Health Team
- University of Toronto Department of Family & Community Medicine
| | - Lee Schofield
- Unity Health-St. Michael's Hospital Academic Family Health Team
- University of Toronto Department of Family & Community Medicine
| | - Lisa Miller
- Unity Health-St. Michael's Hospital Academic Family Health Team
| | - Deborah Kopansky-Giles
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto
- Canadian Memorial Chiropractic College
- Department of Family and Community Medicine, University of Toronto
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Feasibility of a Self-Managed, Video-Guided Exercise Program for Community-Dwelling People with Stroke. Stroke Res Treat 2021; 2021:5598100. [PMID: 34035890 PMCID: PMC8116139 DOI: 10.1155/2021/5598100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Ongoing rehabilitation after stroke is limited. Using video-guided exercises, which are implemented with a self-management approach, may be a way to facilitate ongoing exercise in the home environment. Objectives To investigate the feasibility of a video-guided exercise program, implemented with a self-management approach for people with stroke. Methods A phase I, single-group, clinical trial. The study comprised two phases: in phase one, four weeks of the program was supported by weekly supervised sessions and in phase two, four weeks of the program was completed without direct supervision. Demographic information was recorded at baseline. Adherence and adverse events were self-reported via a logbook. Acceptability was measured through a purpose-built scale. Physical performance, physical activity, and exercise self-efficacy were measured at baseline and 4 and 8 weeks. Results Sixteen people with stroke were recruited; however, 14 commenced and completed the study. Adherence during the supervised phase was 3.3 hours per week and 2.3 hours per week during the self-directed phase. There were no adverse events. Most participants indicated that the program was easy to use (92%) and would recommend the program to others (86%). Walking speed improved over the duration of the program (mean difference -0.12 m/s, 95% CI -0.22 to -0.02, p = 0.02). Self-efficacy and physical activity did not change over the duration of the program. Conclusion The findings support the feasibility of a video-guided exercise program for people with stroke. Further research to confirm the effectiveness of this intervention to improve physical function is warranted.
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Abstract
Advancements in medical science and technology, along with global increases in life expectancy, are changing the way health care services are delivered to the aging society. Telerehabilitation refers to rehabilitation services involving evaluation and treatment. It is an attractive option for older adults who may have multiple comorbidities. Limited access to in-person services and the concern about potential exposure to severe acute respiratory syndrome coronavirus-2 during this pandemic accelerated the implementation of telerehabilitation. This article review the scope, need, and implementation of telehealth and telerehabilitation in the aging population from the perspective of clinicians, patients, and caregivers.
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Affiliation(s)
- Mooyeon Oh-Park
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10605, USA.
| | - Henry L Lew
- Department of Communication Sciences and Disorders, University of Hawai'i at Mānoa, John A. Burns School of Medicine, 677 Ala Moana Boulevard, Suite 625, Honolulu, HI 96813, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Collado-Mateo D, Lavín-Pérez AM, Peñacoba C, Del Coso J, Leyton-Román M, Luque-Casado A, Gasque P, Fernández-del-Olmo MÁ, Amado-Alonso D. Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2023. [PMID: 33669679 PMCID: PMC7922504 DOI: 10.3390/ijerph18042023] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022]
Abstract
Physical inactivity is a major concern and poor adherence to exercise programs is often reported. The aim of this paper was to systematically review published reviews on the study of adherence to physical exercise in chronic patients and older adults and to identify those adherence-related key factors more frequently suggested by reviews for that population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results were classified considering the target population and participants' characteristics to identify the most repeated factors obtained for each condition. Fifty-five articles were finally included. Fourteen key factors were identified as relevant to increase adherence to physical exercise by at least ten reviews: (a) characteristics of the exercise program, (b) involvement of professionals from different disciplines, (c) supervision, (d) technology, (e) initial exploration of participant's characteristics, barriers, and facilitators, (f) participants education, adequate expectations and knowledge about risks and benefits, (g) enjoyment and absence of unpleasant experiences, (h) integration in daily living, (i) social support and relatedness, (j) communication and feedback, (k) available progress information and monitoring, (l) self-efficacy and competence, (m) participant's active role and (n) goal setting. Therefore, adherence to physical exercise is affected by several variables that can be controlled and modified by researchers and professionals.
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Affiliation(s)
- Daniel Collado-Mateo
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Ana Myriam Lavín-Pérez
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
- GO fitLAB, Ingesport, 28003 Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain;
| | - Juan Del Coso
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Marta Leyton-Román
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Antonio Luque-Casado
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Pablo Gasque
- Department of Physical Education, Sport and Human Motricity, Autónoma Univesity, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain;
| | - Miguel Ángel Fernández-del-Olmo
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Diana Amado-Alonso
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
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Evaluation of a Cervical Stabilization Exercise Program for Pain, Disability, and Physical Impairments in University Violinists with Nonspecific Neck Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155430. [PMID: 32731521 PMCID: PMC7432242 DOI: 10.3390/ijerph17155430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Cervical stabilization exercises are frequently used to reduce pain, maximize function, and improve physical impairments for people with nonspecific neck pain. We conducted a single arm study to evaluate the effects of a home-based cervical stabilization exercise program for university violin players with nonspecific neck pain who frequently assume an asymmetrical neck posture and activate their superficial cervical flexors to stabilize the violin. Twenty violin players with nonspecific neck pain from university symphony orchestras participated in this study. All participants received assessments twice before the intervention and once immediately after a 6-week cervical stabilization exercise program. No significant differences were found between the two pretests before the intervention. After the intervention, the Numeric Rating Scale, the Neck Disability Index, the craniocervical flexion test, muscle endurance tests, cervical range of motion (all directions except flexion) tests, and cervicocephalic relocation tests (flexion and left rotation) showed improvements. The forward head posture indicated by the craniovertebral angle also slightly improved. The results of this single arm study suggest that cervical stabilization exercise is feasible and has the potential to improve physical health for collegiate violin players with nonspecific neck pain.
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Kim HS, Strickland KJ, Pinto D, Arroyo C, Courtney DM, McCarthy DM, Lambert BL. Evaluating the Feasibility of an Emergency Department Physical Therapy Intervention for Acute Low Back Pain. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Dennett R, Madsen LT, Connolly L, Hosking J, Dalgas U, Freeman J. Adherence and drop-out in randomized controlled trials of exercise interventions in people with multiple sclerosis: A systematic review and meta-analyses. Mult Scler Relat Disord 2020; 43:102169. [PMID: 32470858 DOI: 10.1016/j.msard.2020.102169] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The short-term benefits of exercise in people with multiple sclerosis (MS) are well established. To sustain benefits exercise needs to continue long-term. Despite important clinical implications, no systematic reviews have synthesized evidence on adherence and drop-out in MS exercise interventions. OBJECTIVES 1) To summarize reported adherence and drop-out data from randomized controlled trials (RCTs) of exercise interventions, and 2) identify moderators related to adherence and drop-out. METHODS Nine databases were electronically searched in October 2018. Included studies were RCTs of exercise interventions in adults with MS published from January 1993 to October 2018. Abstracts and full texts were independently screened and selected for inclusion by two reviewers. Methodological quality was assessed using the TESTEX rating scale. RESULTS Ninety three articles reporting 81 studies were included. Forty one studies (51%) reported both adherence and drop-out data during the intervention period with three (4%) also reporting follow-up data. Of the 41 studies, < 25% pre-defined adherence or described how adherence was measured. Meta-analyses of 59 interventions (41 studies) showed a pooled adherence estimate of 0.87 (95% CI 0.83 to 0.90) and 0.73 (CI 0.68-0.78) when including drop-outs. Mean age, proportion of females and intervention duration were inversely associated with adherence. CONCLUSION Little consensus existed on definition of adherence or determination of drop-out in MS exercise studies, with reporting generally of poor quality, if done at all. Hence it is largely unknown what can moderate adherence and whether exercise continued following an exercise intervention. Researchers should ensure clear transparent measurement and reporting of adherence and drop-out data in future trials.
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Affiliation(s)
- Rachel Dennett
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.
| | - Laurits T Madsen
- Exercise Biology, Dep. Public Health, Aarhus University, Denmark
| | - Luke Connolly
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Joanne Hosking
- Medical Statistics, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth
| | - Ulrik Dalgas
- Exercise Biology, Dep. Public Health, Aarhus University, Denmark
| | - Jennifer Freeman
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
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Emmerson KB, Harding KE, Fong C, Taylor NF. A resource analysis of the use of the video function of electronic devices for home exercise instruction in rehabilitation. Disabil Rehabil 2019; 43:1391-1395. [PMID: 31526061 DOI: 10.1080/09638288.2019.1663281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare resources required to provide paper-based versus videoed instructions for home exercises in rehabilitation. MATERIALS AND METHODS An observational cohort study included twenty-two allied health professionals (physiotherapists [n = 13], occupational therapists [n = 6] and speech pathologists [n = 3]), providing exercise instructions for n = 110 patients within a community rehabilitation program of a large metropolitan health service. Home exercise instructions were provided to patients with various health conditions. Patients chose between receiving paper-based home exercise instructions, or using their own smart technology to video their home exercises. The primary outcome measure was cost from a health service perspective, based on health professional time, paper used, and printing. RESULTS A total of 128 initial home exercise instructions were provided to 110 patients, with 36 patients reviewed at least once. Each initial exercise instruction provided using electronic devices saved 5.5 min (95% CI 0.5 to 10.5) with a cost saving of Australian dollar $4.70 (95% CI -8.89 to -0.52) compared with paper-based instructions. There were no significant cost differences (MD $1.16 95% CI -3.87 to 6.18) between modes for exercise review. CONCLUSIONS Home exercise instructions provided on electronic devices cost less than paper-based instructions when patients are using their own smart devices.Implications for rehabilitationCosts are minimised when home exercise instructions are provided using the video function of the patient's own electronic devices compared with paper-based instructions.Since patient outcomes appear to be similar with instructions provided in electronic or paper-based mode, exercise instructions in community rehabilitation should be provided using the video function of electronic devices where these are available.
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Affiliation(s)
- Kellie B Emmerson
- College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Katherine E Harding
- College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Cynthia Fong
- Rehabilitation & Ambulatory Specialist Clinics, Eastern Health, Wantirna, Australia
| | - Nicholas F Taylor
- College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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