Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study

Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4=male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ±4.3; since onset of stroke: 30.8 ±10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and one month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (

Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial

Objective: To evaluate the effectiveness of exercise, ergonomic modification, and a combination of training exercise and ergonomic modification on the scores of pain in office workers with neck, shoulders, and lower back pain. Methods: Participants (N = 142) in this randomized controlled trial were office workers aged 20–50 years old with neck, shoulders, and lower back pain. They were randomly assigned to either the ergonomic modification group, the exercise group, the combined exercise and ergonomic modification group, or the control group (no-treatment). The exercise training group performed a series of stretching exercises, while the ergonomic group received some modification in the working place. Outcome measures were assessed by the Cornell Musculoskeletal Disorders Questionnaire at baseline, after 2, 4, and 6 months of intervention. Results: There was significant differences in pain scores for neck (MD −10.55; 95%CI −14.36 to −6.74), right shoulder (MD −12.17; 95%CI −16.87 to −7.47), left shoulder (MD −11.1; 95%CI −15.1 to −7.09) and lower back (MD −7.8; 95%CI −11.08 to −4.53) between the exercise and control groups. Also, significant differences were seen in pain scores for neck (MD −9.99; 95%CI −13.63 to −6.36), right shoulder (MD −11.12; 95%CI −15.59 to −6.65), left shoulder (MD −10.67; 95%CI −14.49 to −6.85) and lower back (MD −6.87; 95%CI −10 to −3.74) between the combined exercise and ergonomic modification and control groups. The significant improvement from month 4 to 6, was only seen in exercise group (p < 0.05). Conclusion: To have a long term effective on MSDs, physical therapists and occupational therapists should use stretching exercises in their treatment programs rather than solely rely on ergonomic modification

Borg CR-10 scale as a new approach to monitoring office exercise training

Background: There are many potential training exercises for office workers in an attempt to prevent musculoskeletal disorders. However, to date a suitable tool to monitor the perceived exertion of those exercises does not exist. Objective: The primary objective of this study was to examine the validity and reliability of the Borg CR-10 scale to monitor the perceived exertion of office exercise training. Methods: The study involved 105 staff members employed in a government office with an age range from 25 to 50 years. The Borg CR-10 scale was self-administered two times, with an interval of two weeks in order to evaluate the accuracy of the original findings with a retest. Face validity and content validity were also examined. Results: Reliability was found to be high for the Borg CR-10 scale (0.898). Additionally a high correlation between the Borg CR-10 scale and Visual Analog Scale (VAS) was identified (rs = 0.754, P < 0.01). Conclusions: This study found the Borg CR-10 scale to be a reliable and valid tool for monitoring the perceived exertion of office exercise training and may potentially be useful for occupational therapists to measure physical activity intensity levels

Developing an intervention to promote physical activity engagement for people with multiple sclerosis living in rural settings

Background: Increasing physical activity participation and reducing sedentary behaviour is important for the health and quality of life of people with multiple sclerosis (pwMS). It is important not only to reduce the impact of the primary impairments caused by MS but also to prevent the secondary comorbidities associated with sedentary behaviour. The challenge lies in engaging, and more importantly maintaining this engagement, of pwMS in regular physical activity. This is especially problematic for those people living in rural areas. Reasons for this may be the lack of exercise facilities and health professionals (such as physiotherapy services). Behaviour Change Interventions (BCI) and Telerehabilitation may be solutions to increase physical activity engagement long term for pwMS. Two previously described and investigated interventions aimed at improving long term engagement in physical activity for pwMS are Web-Based Physiotherapy (WBP) and Blue Prescription (BP). Combined, these two interventions may offer telerehabilitation-based BCI that may be of benefit to pwMS living rurally. Aims: This thesis aimed to understand and evaluate a combination of Web-Based Physiotherapy (WBP) and Blue Prescription (BP) to enhance long-term engagement in the physical activity of pwMS living rurally. Design: As this combined intervention can be considered a complex intervention, the United Kingdom’s Medical Research Council investigative approach to complex interventions was adopted. In this respect, a narrative literature review was undertaken to understand theoretical concepts and knowledge underpinning the topic. Then a systematic review was conducted to investigate whether the BCIs were effective in improving physical activity participation in pwMS. Described BCIs were mapped to the WBP and BP interventions as the next step to develop a better understanding of each intervention “BCI ingredients”. A proof of concept study (n=4 pwMS living rurally) using a mixing method design followed to investigate the acceptability of the combined intervention, and to trial research procedures and outcome measures. The proof of concept study related in changes being made to the delivery of the combined intervention and research design. The final study of this thesis was a feasibility study with a mixed method, RCT design (n=10 pwMS living rurally) conducted to re-evaluate the acceptability of modified intervention and research design and investigate the feasibility and potential benefits of the combined intervention. Intervention: WBP is a telerehabilitation intervention that uses website-based exercise video clips and written instructions to encourage pwMS to exercise. BP is an intervention in which the physiotherapist works alongside the person, supporting them to choose a physical activity they would like to do and when and how often they wish to do this activity. The underlying philosophy being that if the person has ownership and choice over what they do, they are more likely to maintain their participation long term. In combining the two interventions, it was anticipated that the WBP would introduce people to appropriate exercise and enhance their confidence to exercise. Having achieved this, then BP would be introduced to provide people with choice and ownership of what they would like to do (they could chose to continue with the WBP exercise or chose something else more to their liking). The combined intervention has 24 weeks in duration, comprising 12 weeks of WBP followed by 12 weeks of BP. In WBP a physiotherapist visited a participant and prescribed relevant exercises based on an in-home evaluation session. During the BP phase, the same physiotherapist interacted three times with the participant. At the first interaction, using motivational interviewing technique the physiotherapist collaboratively supported the participant’s choice of physical activity. The following interactions were aimed at barrier identification and problem-solving sessions. In between these three interactions the physiotherapist supported the participant as required via teleconference tools, email, text messages, or telephone. Data Analysis: the qualitative data were analysed with use of the Inductive Thematic Analysis. The ANOVA was used to analysis the quantitative data. Results: The systematic review showed that the BCIs might increase the physical activity level of pwMS however, the generalisation of these results were challenged by the heterogeneity of the studies. The mapping activity demonstrated that seven different BCI groups (based on the Michie taxonomy) could be found in the WBP intervention and six in the BP intervention. The proof of concept study illustrated that the combination of the interventions was acceptable to pwMS living rurally although the telerehabilitation component offered technological challenges to some participants. Some amendments were required to improve the flow between the two interventions. The feasibility study showed that the modified combined intervention was acceptable but feasibility could be improved with more training of the physiotherapists in the BP intervention training. A key finding was the importance of the human-human relationship to both participants and physiotherapists and that this cannot or should not be replaced by technology alone. Technology acts as an appropriate communication tool. However, the participants’ motivation to join and continue their interventions belonged to the physiotherapist and not the computers. No significant quantitative results were shown in the outcome measures analysis. The recruitment strategies used in the feasibility study were not optimal, resulting in a very slow and sporadic recruitment, and a less than desired sample size. Conclusion: Overall, it seems that the combination of the two interventions, WBP and BP is acceptable and potentially feasible. However, physiotherapists delivering this intervention require more training, especially in BP. More investigation is warranted to gain a better understanding of the relationships between motivation, technology and education. Future research is now required to evaluate whether the combined intervention does indeed increase physical activity engagement long term for pwMS living rurally

Study about the effects of rehabilitation on quality of life in multiple sclerosis patients

Abstract Background and aimMultiple sclerosis is a progressive demyelization disease which can progress to physical disability in many patients. People with multiple sclerosis face many problems and complications which require appropriate education and interventions. Multidisciplinary neurorehabilitation is an effective treatment for quality of life improvement in MS patents. The purpose of this study is to examine the effect of Hayate noo center rehabilitation protocol on quality of life of MS patents. Materials and methodsIn this  clinical trial  130 MS patients (65 patients as treatment group and 65 as control group) were studied. Participants  were randomly selected  from  patients attending Iran MS society in Tehran. The  two groups were  matched in terms of sex, age, education, type of MS , marital status , time of onset of MS, and disability status. A questionnaire was used for data collection . The  questionnaire consisted of three parts .Part one is demographics information and the 2end part consisted of Persian  version of MSQOL-54 questionnaire . This questionnaire has been translated and validated in previous studies , with an 0.96  coefficient (alpha cronbach) reliability . The 3rd part included Persian version of PDDS questionnaire .This test is  designed  to measure the  disability status and has  a correlation coefficient of  0.80( spearman correlation)  with EDSS(expanded disability status scale).Patients in treatment group  participated in the multidisciplinary rehabilitation protocol. This protocol was designed in  Hayate noo  center. Each patient in treatment group attended in at least 8 sessions of Hayate noo  multidisciplinary neurorehabilitation protocol for 3 months.  All participants were assessed in terms of their disability status prior to the study.  Participants in both groups completed MSQOL-54 before and after the study .  The data were analyzed using SPSS software, version 16. Student t-test was used to compare means and Pearson correlation coefficient was used for measuring the correlations. Findings Changes in Quality of life scores in treatment group were statistically significant (

The Relationship between Disability and Quality of Life in Multiple Sclerosis Patients

Background: Disability is the most important determinants of disease course, treatment and rehabilitation outcomes and consequently the quality of life in patients with multiple sclerosis. The aim of the present study was to determine the relationship of disability and quality of life in multiple sclerosis patients. Methods: This cross-sectional study was performed on 325 patients referred to the physiotherapy unit of the Multiple Sclerosis Society of Iran (Tehran). Data collection tools were MSQOL-54 questionnaire for evaluating quality of life and Expanded Disability Status Scale (EDSS) for assessing the degree of disability. Data analysis was performed through SPSS16 and using t-test, chi-square test and linear regression. Results: Mean age of patients was 39.1± 10.4 years. Among 14 domains of quality of life, the highest score was related to pain (67.8 ± 25.7) and the least was related to role limitations due to physical problems (31 ± 17.1). Linear regression model showed significant negative effect of disability on both physical and mental health domains of quality of life (P <0.001). Conclusion: The present study showed the association between disability and factors such as age of disease onset and gender and quality of life in multiple sclerosis patients. Therefore supportive care to reduce disability and maintain patients’ functions at the highest possible level, particularly in women and patients with later age of disease onset, in order to improve the quality of life is recommended. Keywords: Disability, Quality of life, Multiple sclerosis, MSQOL-5

Biomechanical differences at the hemiparetic knee in people with stroke : A systematic review and meta-analysis protocol

Understanding the effect of stroke on knee biomechanics in gait is important for clinicians and practitioners who work with people with stroke. Biomechanical differences have been established between the hemiparetic knee, and the unaffected knee and healthy controls during gait. These data have not yet been systematically summarised and analysed. This protocol describes the background and methods for a systematic review and meta-analysis of three-dimensional biomechanics of the hemiparetic knee whilst walking overground, based on data collected using optical motion capture systems

Digital Technologies for Women’s Pelvic Floor Muscle Training to Manage Urinary Incontinence Across Their Life Course: Scoping Review

Background: Women with urinary incontinence (UI) may consider using digital technologies (DTs) to guide pelvic floor muscle training (PFMT) to help manage their symptoms. DTs that deliver PFMT programs are readily available, yet uncertainty exists regarding whether they are scientifically valid, appropriate, and culturally relevant and meet the needs of women at specific life stages. Objective: This scoping review aims to provide a narrative synthesis of DTs used for PFMT to manage UI in women across their life course. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework. A systematic search of 7 electronic databases was conducted, and primary quantitative and qualitative research and gray literature publications were considered. Studies were eligible if they focused on women with or without UI who had engaged with DTs for PFMT, reported on outcomes related to the use of PFMT DTs for managing UI, or explored users’ experiences of DTs for PFMT. The identified studies were screened for eligibility. Data on the evidence base for and features of PFMT DTs using the Consensus on Exercise Reporting Template for PFMT, PFMT DT outcomes (eg, UI symptoms, quality of life, adherence, and satisfaction), life stage and culture, and the experiences of women and health care providers (facilitators and barriers) were extracted and synthesized by ≥2 independent reviewers. Results: In total, 89 papers were included (n=45, 51% primary and n=44, 49% supplementary) involving studies from 14 countries. A total of 28 types of DTs were used in 41 primary studies, including mobile apps with or without a portable vaginal biofeedback or accelerometer-based device, a smartphone messaging system, internet-based programs, and videoconferencing. Approximately half (22/41, 54%) of the studies provided evidence for or testing of the DTs, and a similar proportion of PFMT programs were drawn from or adapted from a known evidence base. Although PFMT parameters and program compliance varied, most studies that reported on UI symptoms showed improved outcomes, and women were generally satisfied with this treatment approach. With respect to life stage, pregnancy and the postpartum period were the most common focus, with more evidence needed for women of various age ranges (eg, adolescent and older women), including their cultural context, which is a factor that is rarely considered. Women’s perceptions and experiences are often considered in the development of DTs, with qualitative data highlighting factors that are usually both facilitators and barriers. Conclusions: DTs are a growing mechanism for delivering PFMT, as evidenced by the recent increase in publications. This review highlighted the heterogeneity in types of DTs, PFMT protocols, the lack of cultural adaptations of most of the DTs reviewed, and a paucity in the consideration of the changing needs of women across their life course

The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis

Objective: A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions. Data resources: MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015. Trial selection: Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity. Data extraction: Data extraction was conducted by two independent reviewers and the Cochrane Collaboration’s recommended method was used to assess the risk of bias of each included study. Results: A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I2 = 68%) (eight to 12 weeks’ duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue. Conclusion: Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis