Search Results (141)

Background/Objectives: Non-specific low back pain (LBP), a highly prevalent musculoskeletal condition, may be associated with overuse of radiological imaging, despite clinical guidelines restricting its use to cases with suspected serious pathology. This study investigated demographic, clinical, and physiotherapy-related factors influencing radiological imaging use in patients with non-specific LBP. Methods: A retrospective cross-sectional study included 179 non-specific LBP patients from an outpatient physiotherapy clinic in Saudi Arabia. Patient data were anonymized and retrieved from electronic health records, including demographic, clinical, physiotherapy and imaging information. Independent variables included patient demographics, non-specific LBP characteristics, physiotherapy engagement, and pain-related outcomes. Descriptive, inferential, and multiple linear regression analyses were conducted to identify predictors of radiological imaging. Results: Among the total study sample (n = 179), 159 (88.8%) patients underwent radiological imaging, primarily X-ray (32.4%) and Magnetic Resonance Imaging (8.4%); 48.0% received multiple imaging modalities. Significant predictors of imaging use included gender (p < 0.001), higher body mass index (BMI) (p = 0.012), greater physiotherapist experience (p = 0.019), and presence of comorbidities (p = 0.023). Non-specific LBP medication use was negatively associated with imaging (p = 0.032). Physiotherapy engagement and pain-related outcomes showed no significant impact on imaging use. Conclusions: Gender, BMI, physiotherapist experience, and comorbidities could influence radiological imaging use in non-specific LBP patients. These findings highlight potential biases in imaging referral patterns and reinforce the need for adherence to evidence-based guidelines to prevent unnecessary imaging, reduce healthcare costs, and enhance patient care. Full article

This study aims to investigate whether a combined action observation–motor imagery practice may enhance the effects of conventional physical rehabilitation in a stroke survivor population. A total of 8 (7 male, 1 female) post-stroke patients with upper limb hemiparesis were enrolled into a single-blinded, randomised, study. Five times per week for three weeks, four patients experienced 60’ conventional physical therapy, while the other 4 experienced 30’ conventional physical therapy and 30’ action observation–motor imagery practice. The Fugl-Meyer Assessment-Upper Extremity and the Wolf Motor Function Test scores from the baseline and post-physiotherapy were used to evaluate upper extremity motor function. Patients who received the AO + MI alongside conventional physical rehabilitation benefitted more than those who received only conventional physical rehabilitation. However, the sample size was very small (only eight participants), which reduces both the statistical power and the ability to generalise the results. Moreover, there was no follow-up; therefore, it is unclear whether the observed improvements lasted over time. Finally, some potentially confounding factors, such as stroke type or lesion site, were not statistically controlled. Notwithstanding these limitations, our findings may serve as a basis for future large-scale, well-controlled studies on AO + MI in stroke rehabilitation. Full article

Optimal recovery supports health and enhances performance in soccer players, yet the empirical evidence on various recovery strategies in soccer is complex to interpret. This review aimed to summarize the literature on post-exercise recovery modalities in male and female soccer players of all ages and competition levels. Following PRISMA guidelines, PubMed, SPORTDiscuss, and Web of Science were systematically searched until 17 October 2023. Randomized controlled trials or within-subjects crossover design studies that examined the effects of post-exercise recovery interventions on physical, psychological, or performance outcomes in soccer players were included. A single reviewer extracted data and assessed study quality using the Physiotherapy Evidence Database (PEDro) scale. Overall, 41 studies were included in the final review. The recovery strategies represented in these studies were organized into the following categories: active recovery, blood flow restriction, cold water immersion, contrast water therapy, compression garments, active cool-down, cryotherapy, cold garments, sleep and daytime nap, pneumatic cooling, foam rolling, mindfulness interventions, nutritional intervention, and static stretching. The findings demonstrated that cold-water immersion consistently improved jump performance and perceptions of fatigue, soreness, and overall well-being. Other recovery strategies, such as active recovery, compression therapy, sleep interventions, and nutrition supplementation, also positively impacted recovery, albeit with varying levels of effectiveness and evidence. However, the studies exhibited heterogeneity in methods, outcome measures, and recovery intervention protocols, posing challenges for generalizability. This review summarizes recovery strategies for soccer players, emphasizing the need for practitioners, coaches, and athletes to individualize interventions based on athletes’ needs, preferences, and competition level. Full article

Background: Physical activity, metacognitive awareness, and empathy are interconnected factors that play a significant role in the overall well-being of university students. Together, these elements contribute to the development of more self-aware, emotionally intelligent, and academically engaged students. The aim of this study is to explore the relationship between physical activity, empathy, and metacognition among physiotherapy students, as well as determining whether differences exist between undergraduate and graduate students. Methods: A cross-sectional study evaluated 468 physiotherapy students using the International Physical Activity Questionnaire—short version, the Metacognitive Awareness Inventory, and a shortened version of the Empathy Quotient supplemented with demographic questions. The respondents were students of undergraduate and graduate studies of physiotherapy, were male and female, and were between the ages of 18 and 25 years. Results: Higher levels of vigorous-intensity physical activity, walking, and total physical activity are significantly associated with increases in Declarative Knowledge (p = 0.000; p = 0.001; p = 0.000), Empathy Quotient (p = 0.029; p = 0.000; p = 0.006), and Cognitive Empathy (p = 0.002; p = 0.000; p = 0.001). Undergraduate students demonstrated higher levels of Declarative Knowledge (p = 0.000), whereas graduate students scored higher in Procedural Knowledge (p = 0.020), Planning (p = 0.000), Information Management Strategies (p = 0.000), and Evaluation (p = 0.005). Undergraduate students demonstrated higher overall empathy, cognitive empathy, and social skills (p = 0.000). Conclusions: This is the first study to examine this issue in the context of physiotherapy students. Our findings highlight the importance of creating integrated programs that promote physical activity, metacognitive awareness, and empathy concurrently among physiotherapy students. Enhancing metacognitive skills through targeted educational strategies helps students strengthen their critical thinking and self-regulation, enhance academic outcomes, and better prepare students for their professional role. Full article

Background: The COVID-19 pandemic has significantly disrupted healthcare delivery globally, particularly affecting physiotherapy practices that rely on close patient interactions. Objectives: This study investigates the knowledge and readiness of Libyan physiotherapists to adopt telerehabilitation during the pandemic. Methodology: A cross-sectional questionnaire-based study was conducted on a total of 109 physiotherapists who were recruited through convenience sampling from public and private hospitals, with a demographic distribution of 54 males and 55 females, aged 25 to 55 years. Results: Approximately 64% of physiotherapists reported being impacted by COVID-19. Among the participants, 67.9% indicated they had limited knowledge of telerehabilitation, whereas only 32.1% were familiar with the concept. Of those who were knowledgeable, only 57.1% had actually practiced telerehabilitation, and just 35% successfully integrated it into their patient management strategies. Key barriers to implementation included poor internet connectivity (71.6%) and high technology costs (38.5%). Conclusions: Our study highlights the importance of telerehabilitation for the future of physical therapy, particularly for patients with chronic conditions. Proper staff training, robust IT infrastructure, and patient education are all essential for enhancing the quality of service physiotherapists deliver in today’s evolving healthcare landscape. Full article

Background: Chronic low back pain markedly impairs quality of life and imposes a significant economic burden on public health. The complex pathophysiology of chronic low back pain arises from the complex anatomical configuration of the lumbar region, which includes a diverse array of structures. Consequently, etiologies may involve intervertebral disc degeneration, facet joint osteoarthritis, spinal stenosis, spondylosis, and spondylolisthesis. Therapeutic interventions for chronic low back pain are equally varied, ranging from pharmacological treatments to physiotherapy, kinetotherapy, balneotherapy, and image-guided local injectable procedures such as prolotherapy. Prolotherapy is a regenerative injection technique designed to stimulate the body’s healing processes by applying a regenerative treatment (typically dextrose), which aims to modulate neurogenic inflammation and diminish nociceptive signaling. Methods: A systematic review of the literature was performed in alignment with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Studies published within the last ten years evaluating the effects of prolotherapy on pain reduction in individuals with chronic low back pain were included, following a search across six databases. Results: The review revealed several studies evaluating the influence of prolotherapy on pain in chronic low back pain patients. Findings were heterogeneous, with some studies indicating significant pain reduction and others showing minimal or no improvement. Conclusions: The current evidence regarding the efficacy of prolotherapy for pain relief in chronic low back pain remains inconclusive, highlighting the necessity for further in-depth research. Continued and updated investigations into prolotherapy’s role are imperative for enhancing the quality of life of affected patients. Full article

Background: Knee osteoarthritis (KOA) is a degenerative joint disorder marked by cartilage degradation, synovial inflammation, and altered synovial fluid (SF) rheology, resulting in pain and impaired joint function. Intra-articular hyaluronic acid (IA-HA) injections aim to restore SF viscoelasticity and improve lubrication; however, their efficacy may be potentiated when combined with physiotherapy (PT). This monocentric observational study evaluated whether the addition of a multimodal PT program to IA-HA therapy enhances SF rheologic properties compared to IA-HA alone. Methods: A total of 52 patients (aged 47–61) with radiographically confirmed moderate KOA (Kellgren–Lawrence grade 2) were enrolled. Patients were assigned to a pilot group (PG; n = 37) receiving IA-HA (Kombihylan^®, 3 MDa) combined with a multimodal PT protocol, or a control group (CG; n = 15) receiving IA-HA alone. The PT program included ten sessions of transcutaneous electrical nerve stimulation, low-level laser therapy, therapeutic ultrasound, progressive exercise, and cryotherapy. SF samples were collected immediately after the first injection and again at six weeks, then analyzed rheologically using the Kinexus Pro+ rheometer. Viscosity parameters were assessed via steady and oscillatory shear tests. Results: At baseline, both groups demonstrated comparable SF viscosity profiles. After six weeks, the PG exhibited significantly higher shear viscosity values across all measured percentiles and reduced variability in rheological parameters, suggesting a more stable intra-articular milieu. Rheometric analysis indicated enhanced SF viscoelasticity, potentially mediated by reduced inflammation and stimulation of endogenous HA synthesis. In contrast, the CG showed inconsistent viscosity changes, reflecting variable responses to IA-HA monotherapy. Conclusions: Combining IA-HA with multimodal PT significantly improves SF rheological properties in moderate KOA patients compared to IA-HA alone. These findings support the role of mechanical stimulation in enhancing joint lubrication and homeostasis, offering a more consistent and effective approach to viscosupplementation. Full article

Background: Physical exercise can improve certain musculoskeletal conditions, but adherence remains low due to intimidating environments, limited government support, and financial constraints faced by many individuals. Home-based exercise is a potential strategy to treat that population. Objective: Discuss the main home-based resistance exercise protocols that have been studied and implemented for six highly prevalent musculoskeletal disorders. Methods: A narrative literature review was conducted, using the PubMed database to search for six highly prevalent musculoskeletal conditions: shoulder impingement syndrome (SIS), nonspecific low back pain (NSLBP), greater trochanteric pain syndrome (GTPS), knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and Achilles tendinopathy (AT). The strategy included the listed pathologies and the keywords “physical exercise” or “physiotherapy”. Clinical trials, reviews, and retrospective studies from the last 30 years published in English, Portuguese, or Spanish were included. Only studies with sufficient details on the training protocols used and outcome measures were included in the analysis. Results: In SIS, exercise protocols have been more effective in the long term than in the short term. In PFPS and GTPS, strengthening the quadriceps and hip muscles helps reduce pain and improve function. For NSLBP, exercises like Pilates and core training demonstrate pain relief. In knee osteoarthritis, physical exercise improves pain, function, and quality of life both immediately and over time. Eccentric training promotes type I collagen formation in the tendons of patients with Achilles tendinopathy. Conclusions: Home-based resistance exercises studied and implemented in this review offer several general health benefits, including pain reduction, improved functionality, increased muscle strength, and enhanced motor control. Full article

This study aimed to develop a website providing physiotherapy, exercise, and disease knowledge information as a digital tool for use with children with chronic suppurative lung diseases (CSLDs). Data were analyzed using a mixed qualitative and quantitative approach. Initially, a comprehensive list of the website’s content and functions was developed through a Focus Group study with healthcare professionals (HCPs) and parents. Afterward, two rounds of an online Delphi survey were conducted with a group of expert HCPs (pediatricians and physiotherapists) who were recruited based on their expertise in the field of pediatric physiotherapy. The Focus Groups established 10 main themes. Two rounds of Delphi questionnaires established the important items of a website, based on expert consensus from HCPs. A Delphi survey containing 36 outcomes was completed by participants from Greece. The findings support the integration of multidisciplinary and user-centered approaches in the design of a pediatric website. This website is expected to enhance disease self-management, improve treatment adherence, and support families in daily care. Full article

University Social Responsibility (USR) integrates academic goals with ethics, civic engagement, and sustainability. This study assessed community service attitudes among 529 higher health sciences students using the Portuguese Community Service Attitudes Scale. Although 52.9% reported prior volunteer experience, 75.2% had not participated in community service during university. An association was found between academic programme and prior involvement, particularly among Dental Medicine and Physiotherapy students. While no sex differences were observed, programme-specific trends suggest that practical training fosters stronger civic responsibility. Integrating structured, discipline-specific community service into curricula may enhance civic identity and better align education with sustainable development goals. Full article

Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores the integration of external vagus nerve stimulation (eVNS) into a multimodal physical therapy approach targeting both mechanical and neurophysiological contributors to CGH. Case Description: A 63-year-old female presented with chronic CGH characterized by right-sided suboccipital and supraorbital pain, impaired sleep, and postural dysfunction. Examination revealed a right rotational atlas positional fault, restricted left atlantoaxial (AA) mobility, suboccipital hypertonicity, and reduced deep neck flexor endurance. Initial treatment emphasized manual therapy to restore AA mobility and atlas symmetry, combined with postural correction and neuromuscular training. Intervention: After initial symptom improvement plateaued, eVNS targeting the auricular branch of the vagus nerve was introduced to modulate autonomic tone. The patient used a handheld eVNS device nightly over three weeks. Outcomes: Substantial improvements were observed in the Neck Disability Index (↓77%), Headache Disability Inventory (↓72%), and pain scores (↓100%). Cervical mobility, atlas symmetry, and deep neck flexor endurance improved markedly. The patient reported reduced anxiety, improved sleep, and sustained headache relief at one-month follow-up. Conclusions: This case highlights the potential synergistic benefits of integrating eVNS within a physiotherapy-led CGH management plan. Further research is warranted to explore its role in targeting autonomic imbalance and enhancing conservative treatment outcomes. Full article

Background: Virtual reality (VR), often used with motion sensors, provides interactive tools for physiotherapy aimed at enhancing motor functions. This systematic review examined the effects of VR-based interventions, alone or combined with conventional physiotherapy (PT), on balance and gait in individuals with Parkinson’s disease (PD). Methods: Following PRISMA guidelines, eight randomized controlled trials (RCTs) published between January 2019 and April 2025 were included. Interventions lasted between 5 and 12 weeks and were grouped as VR alone or VR combined with PT. Methodological quality was assessed using the PEDro Scale. Results: Of the 31 comparisons for balance and gait, 30 were favored by the experimental group, with 12 reaching statistical significance. Secondary outcomes (function, cognition, and quality of life) showed mixed results, with 6 comparisons favoring the experimental group (3 statistically significant) and 4 favoring the control group (1 statistically significant). Overall, the studies showed fair to good quality and a moderate risk of bias. Conclusions: VR-based interventions, particularly when combined with PT, show promise for improving balance and gait in PD. However, the evidence is limited by the small number of studies, heterogeneity of protocols, and methodological constraints. More rigorous, long-term trials are needed to clarify their therapeutic potential. Full article

Background/Objectives: Sudden cardiac arrest (SCA) is a major global health concern with high mortality despite advances in resuscitation techniques. Achieving return of spontaneous circulation (ROSC) represents merely the initial step in the extensive rehabilitation journey. This review highlights the critical role of structured, multidisciplinary rehabilitation following ROSC, emphasizing the necessity of integrated physiotherapy, neurocognitive therapy, and psychosocial support to enhance quality of life and societal reintegration in survivors. Methods: This narrative review analyzed peer-reviewed literature from 2020–2025, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar. Emphasis was on clinical trials, expert guidelines (e.g., European Resuscitation Council 2021, American Heart Association 2020), and high-impact journals, with systematic thematic analysis across rehabilitation phases. Results: The review confirms rehabilitation as essential in addressing Intensive Care Unit–acquired weakness, cognitive impairment, and post-intensive care syndrome. Early rehabilitation (0–7 days post-ROSC), focusing on parameter-guided mobilization and cognitive stimulation, significantly improves functional outcomes. Structured interdisciplinary interventions encompassing cardiopulmonary, neuromuscular, and cognitive domains effectively mitigate long-term disability, facilitating return to daily activities and employment. However, access disparities and insufficient randomized controlled trials limit evidence-based standardization. Discussion: Optimal recovery after SCA necessitates early and continuous interdisciplinary engagement, tailored to individual physiological and cognitive profiles. Persistent cognitive fatigue, executive dysfunction, and emotional instability remain significant barriers, underscoring the need for holistic and sustained rehabilitative approaches. Conclusions: Comprehensive, individualized rehabilitation following cardiac arrest is not supplementary but fundamental to meaningful recovery. Emphasizing early mobilization, neurocognitive therapy, family involvement, and structured social reintegration pathways is crucial. Addressing healthcare disparities and investing in rigorous randomized trials are imperative to achieving standardized, equitable, and outcome-oriented rehabilitation services globally. Full article

Background: Arthrofibrosis, mixed contracture, and patellofemoral impingement are frequent complications following total knee arthroplasty (TKA), potentially leading to chronic pain and poor recovery of range of motion (ROM). The comprehensive management of these complications remains challenging and controversial. Methods: This study analyzed the outcomes of arthroscopic arthrolysis performed in 27 patients diagnosed with arthrofibrosis, mixed contracture, and patellofemoral impingement post-TKA to evaluate the efficacy of this technique in improving knee function, enhancing ROM, and reducing pain, as assessed by the Knee Society Score (KSS). A total of 27 patients underwent arthroscopic arthrolysis following unsuccessful conservative rehabilitation. The arthroscopic procedure included removal of fibrous adhesions within the suprapatellar pouch, restoration of medial and lateral gutters, and lateral retinacular release of the patella. Intensive physiotherapy and continuous passive motion commenced immediately postoperatively. The mean follow-up period ranged from 24 to 60 months. Pain and functional outcomes were evaluated using KSSs. Results: Clinical improvements were evident in 26 cases, with the Knee Society Score rising from a preoperative average of 48 to 86, and pain scores improving from 30 to 41. Only one patient did not experience positive outcomes following the procedure. Arthroscopic arthrolysis appears beneficial for patients suffering from arthrofibrosis, patellofemoral impingement, and mixed contracture post-TKA, significantly improving clinical pain scores and KSS outcomes. Conclusions: Further research is recommended to refine specialized surgical instruments and enhance arthroscopic arthrolysis techniques. Full article

Background: Chronic musculoskeletal disorders (CMDs) represent a leading cause of global disability and diminished quality of life, and they are often resistant to conventional physiotherapy. Emerging technologies such as virtual reality (VR), augmented reality (AR), and exergaming are increasingly used to enhance rehabilitation outcomes, yet their comparative effectiveness remains unclear. Objective: To systematically evaluate the effectiveness of VR, AR, and exergaming interventions in improving pain, function, balance, and psychological outcomes among adults with CMDs. Methods: This systematic review and exploratory meta-analysis followed PRISMA 2020 guidelines and was prospectively registered (PROSPERO: CRD42024589007). A structured search was conducted in PubMed, Cochrane CENTRAL, Scopus, and PEDro (up to 1 May 2025). Eligible studies were randomized controlled trials (RCTs) involving adults (≥18 years) with CMDs receiving VR, AR, or exergaming-based rehabilitation. Risk of bias was assessed using the PEDro scale and the Downs and Black checklist. Where feasible, standardized mean differences (SMDs) for pain outcomes were pooled using a random-effects model. Results: Thirteen RCTs (n = 881 participants) met the inclusion criteria. Interventions spanned immersive VR, AR overlays, exergaming platforms (e.g., Kinect, Wii), and motion-tracking systems. Pain, function, and quality of life improved in most studies. An exploratory meta-analysis of eight RCTs (n = 610) yielded a significant pooled effect favoring VR/AR interventions for pain reduction (SMD = −1.14; 95% CI: −1.63 to −0.75; I² = 0%). Exergaming showed consistent improvements in physical performance, while immersive VR was more effective for kinesiophobia and psychological outcomes. AR was underrepresented, with only one study. Risk of bias was generally low; however, publication bias could not be excluded due to limited funnel plot power (n < 10). Conclusions: VR, AR, and exergaming are effective adjuncts to conventional rehabilitation for CMDs, improving pain and function with high patient adherence. Nevertheless, gaps in long-term data, economic evaluation, and modality comparison persist. Future RCTs should address these limitations through standardized, inclusive, and longitudinal design. Full article