Search Results (147)

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/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Background: The rehabilitative treatment of muscle injuries is mostly conservative, but it does not always follow precise protocols. Appropriate physiotherapy, exercises, and training are essential components of the rehabilitation and reconditioning of injured muscles. The purpose of this review is to assess the good rehabilitative practices in the treatment of patients affected by muscle injuries. Methods: We performed research on Medline and Cochrane Database. Guidelines focusing on the rehabilitative treatment of muscle injuries were evaluated for inclusion. Statements about non-rehabilitative treatments were also reported only for the guidelines that mainly focused on rehabilitative treatments. Results: Eight guidelines meeting the inclusion criteria were included in the review. Results were framed into a narrative overview. Two of them mainly focused on hamstring rehabilitation, the others focused on several muscular districts. Conclusions: Conservative treatment of muscle injuries is currently the gold standard, with good results in terms of both rehabilitation times and post-injury sports performance. However, there is not a complete agreement on the type of exercises and the timing of rehabilitation when these should be performed. More research is needed to draw conclusions about the use of physical therapy instruments and other rehabilitation approaches and techniques. Full article

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three intervention groups of equal size, receiving either cervical spine (according to the Mulligan Concept) and diaphragm manual therapy plus breathing reeducation exercises (experimental group—EG1), cervical spine manual therapy plus sham diaphragmatic manual techniques (EG2), or conventional physiotherapy (control group—CG). The treatment period lasted one month (10 sessions) for all groups. The effect on the cervical spine range of motion (CS-ROM) and on the craniovertebral angle (CVA) was examined. Outcomes were collected before treatment (0/12), after treatment (1/12), and three months after the end of treatment (4/12). The main analysis comprised a two-way mixed ANOVA with a repeated measures factor (time) and a between-groups factor (group). Post hoc tests assessed the source of significant interactions detected. The significance level was set at p = 0.05. Results: No significant between-group baseline differences were identified. Increases in CS-ROM and in CVA were registered mainly post-treatment, with improvements maintained at follow-up for CS-ROM. EG1 significantly improved over CG in all movement directions except for flexion and over EG2 for extension only, at 1/12 and 4/12. All groups improved by the same amount for CVA. Conclusions: EG1, which included diaphragm manual therapy and breathing re-education exercises, registered the largest overall improvement over CG (except for flexion and CVA), and for extension over EG2. The interaction between respiratory mechanics and neck mobility may provide new therapeutic and assessment insights of patients with NSCNP. 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

The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques and electrophysical modalities in the conservative treatment of cubital tunnel syndrome (CuTS). A total of 128 upper limbs affected by CuTS were initially enrolled in this study, with 82 completing the full treatment protocol. The participants were divided into the following two intervention arms: the first arm (MT) (42 arms) received therapy based on sliding and tensioning neurodynamic techniques, while the second arm (EM) (40 arms) underwent physiotherapy based on electrophysical modalities, specifically low-level laser therapy (LLLT) and ultrasound therapy (US). Chi² and Student’s t-test were used to compare the intervention arms, and no statistically significant differences were found. The evaluated outcomes included nerve conduction testing, ultrasound assessments (measuring cross-sectional area and shear modulus), pain levels, two-point discrimination, thresholds for cutaneous sensory perception, symptom severity, functional ability in specific tasks, and overall post-treatment improvement. Baseline comparisons indicated no statistically significant differences in any measured variables between the intervention groups (p > 0.05). Following treatment, each group exhibited significant improvements in their respective parameters (p < 0.01). Comparisons between groups post-intervention revealed statistically significant differences in nerve conduction results, ultrasound measurements (cross-sectional area and shear modulus), two-point discrimination, and sensory perception thresholds. These parameters improved more in the MT intervention arm. The use of neurodynamic techniques, ultrasound, and low-level laser therapy in the conservative treatment of mild to moderate forms of CuTS has a beneficial therapeutic effect. Full article

Background/Objectives: Population aging and the rise in chronic diseases challenge healthcare systems to adopt person-centered approaches, especially in palliative care (PC), where symptom management remains limited. Physiotherapy plays a key role in alleviating discomfort but faces inconsistent integration in Portugal due to lack of recognition. Variations in intervention methods hinder uniform care delivery, limiting timely patient access to comfort-focused treatments and knowledge. This study aims to deepen the understanding of physiotherapy’s role in Portuguese PC to improve its integration into teams and enhance patient access to comfort care. Methods: This study used a descriptive qualitative approach with online focus groups (FG), guided by Krueger and Casey’s methodology and adhering to the COREQ checklist. A non-probabilistic convenience sample of physiotherapists working in palliative care across mainland Portugal and the islands was selected based on inclusion criteria. Three FGs were planned with up to ten participants each. However, due to availability and attendance issues, only 15 physiotherapists participated: 5 in FG1 (in-hospital PC units), 6 in FG2 (inpatient units), and 4 in FG3, the minimum appropriate number from community-based units. Results: Physiotherapy plays a crucial yet underrecognized role in PC, emphasizing the need for its full integration into care teams rather than reliance on late, on-call referrals. Techniques such as positioning, mobilization, pain and dyspnea relief, adapted exercises, massage, music therapy, and emotional support are employed. Conventional physiotherapy tools are used and personalized according to the patient’s context, duration, setting, dosage, and individual needs. Conclusions: Physiotherapy should be recognized as a fundamental part of PC, contributing not only to the prolongation of life but also to ensuring comfort and dignity for patients and their families. To achieve this, its role within multidisciplinary teams must be strengthened and supported by regulations that guarantee access and the formal integration of physiotherapists. However, a significant gap remains in patients’ regular access to comfort-focused interventions at the appropriate time, perhaps due to the considerable variation in physiotherapy practices depending on the patient and care setting, which presents a challenge for knowledge development both in Portugal and globally. Full article

Diabetic retinopathy (DR) is a leading cause of vision loss in patients with diabetes. While medical treatments like retinal laser photocoagulation, anti-VEGF therapy, and vitrectomy are primary, complementary therapies are gaining increasing attention. Based on the existing literature, a healthy lifestyle, including a balanced diet, stress management techniques, and regular physical activity targeting DR, can help regulate blood sugar levels and improve overall physical and mental health to reduce complications. This article explores physical activities and visual training methods related to DR, emphasizing complementary therapies, even though some of these practices are currently not fully integrated into evidence-based ophthalmology. Low vision exercises and aids help patients make the most of their remaining vision, improving their ability to perform everyday tasks, reducing the impact of vision loss, and promoting independence. There is some evidence that eye-related physiotherapy can improve the quality of life for patients with DR, although selection bias cannot be excluded in the presented studies. Consistent physical activity promotes holistic health, and therapies should be regularly monitored by ophthalmologists. This review further helps integrative healthcare professionals in offering appropriate therapies for rehabilitation purposes in the treatment of ophthalmic diseases, particularly DR. Full article

Acupuncture has been widely incorporated into rehabilitation protocols for dogs and cats because of its potential analgesic efficacy. The aim of this study was to evaluate the potential positive effect of integrating acupuncture and electroacupuncture techniques on the recovery of ambulation capacity in non-ambulating paraparetic patients undergoing physiotherapy in the postoperative period following mini-/hemilaminectomy for thoracolumbar spinal cord decompression due to acute disc extrusion. Forty-one patients were included and underwent descriptive and analytical statistical analysis, divided into two groups: dogs that received a physiotherapy protocol with acupuncture and dogs that received physiotherapy only. The results showed that the dogs in the acupuncture group had a higher likelihood of regaining ambulation. Full article

Background: Burn injuries constitute a significant global health challenge, especially in pediatric populations, where they are a leading cause of morbidity and mortality. Pediatric burns require particular attention due to their unique pathophysiology, long-term consequences on growth and development, and psychological impacts. Methods: We propose a comprehensive review of recent advancements in understanding the key aspects of hormonal and metabolic changes in burned children, aiming to guide therapeutic interventions, improve outcomes, and reduce the global burden of these injuries. Results: Effective management of the physiological stress response in pediatric burn patients necessitates a multidisciplinary approach integrating medical, nutritional, and rehabilitative strategies. Timely nutritional support and individualized plans preserve muscle mass, promote wound healing, and reduce complications and organ dysfunction risk. Advances in pharmacological interventions, such as beta-blockers, anabolic agents, and hormonal treatment, offer promising pathways to improve recovery and mitigate long-term complications. Early mobilization and physiotherapy are essential for preventing complications of prolonged immobility, including muscle wasting, joint contractures, and functional decline; their effectiveness is closely tied to advancements in minimally invasive procedures, regenerative medicine, and reconstructive techniques, particularly for pediatric patients. Conclusions: While current strategies have significantly improved survival and outcomes for pediatric burn patients, ongoing research is critical to refine these new care strategies. Full article

Primary cervical dystonia (PCD), or spasmodic torticollis, is a focal dystonia characterized by involuntary and often painful muscle contractions, leading to abnormal cervical movements and postures. While botulinum toxin injections are the first-line treatment, additional therapies, such as segmental muscle vibration (SMV), remain underexplored. SMV, a non-invasive neuromodulation technique, may enhance motor cortex excitability and promote neuroplasticity, offering potential benefits in PCD management. This single-center triple-blinded randomized controlled trial evaluates SMV’s efficacy in reducing dystonic pain and improving quality of life in PCD patients undergoing standardized rehabilitation after botulinum toxin treatment. Participants with a pain level of ≥3 on the Numerical Rating Scale will be randomized into two groups. The experimental group will receive 80 Hz SMV during a 10-session rehabilitation program, while the control group will undergo sham SMV. Both groups will follow identical physiotherapy and occupational therapy protocols. The primary outcomes include changes in pain intensity and function, assessed at baseline, mid-treatment, and post-treatment using validated scales. The secondary outcomes will evaluate quality of life and patient satisfaction. This study hypothesizes that SMV will significantly reduce dystonic pain and enhance quality of life, supporting its integration into multidisciplinary rehabilitation for dystonic disorders. Trial registration number: NCT06748846. Full article

Background/Objectives: Chronic ruptures of the quadriceps and Achilles tendons present significant reconstructive challenges due to factors such as tendon retraction, scar tissue formation, and compromised tissue quality. Traditional repair methods, including V–Y tendinoplasty, autografts, and synthetic scaffolds, often prove inadequate for large or neglected defects. Achilles tendon bone–tendon allografts have emerged as a promising alternative, offering strong fixation, biological incorporation, and sufficient length for bridging extensive gaps. This study aims to document the clinical, radiographic, and MRI outcomes of two challenging cases treated with Achilles tendon bone–tendon allografts and to synthesize these findings within the context of the existing literature to evaluate the broader viability of this reconstructive approach. Methods: An observational analysis was conducted at the Orthopedic and Traumatology Clinic of “Victor Popescu” Military Emergency Hospital in Timișoara, encompassing two patients with chronic, iterative tendon ruptures—one quadriceps tendon rupture and one Achilles tendon rupture. Both patients had previously failed primary repairs, resulting in significant tendon retraction and tissue deficits. Reconstruction was performed using Achilles tendon bone–tendon allografts, involving specific osteotomy techniques for patellar and calcaneal fixation. Postoperative protocols included immobilization followed by structured physiotherapy. Clinical assessments and MRI evaluations were conducted at 8, 12, and 24 weeks postoperatively. Additionally, a comprehensive literature review was performed to compare our findings with existing studies on Achilles bone–tendon allograft utilization in chronic tendon reconstructions. Results: Both patients exhibited substantial improvements in their range of motion and reported low pain levels at the 8- and 12-week follow-ups. MRI assessments indicated well-aligned graft fibers, early bone block integration, and the absence of complications such as re-rupture or infection in the long term. Functional recovery was achieved with complete bone block union and return to normal activities by 24 weeks. The literature review corroborated these outcomes, demonstrating that Achilles tendon bone–tendon allografts provide robust fixation and facilitate biological integration, particularly in cases with large defects and poor tissue quality. Comparative studies highlighted similar functional improvements and graft stability, reinforcing the efficacy of bone–tendon allograft constructs over traditional repair methods in chronic tendon ruptures. Conclusions: Achilles tendon bone–tendon allografts are effective in reconstructing chronic quadriceps and Achilles tendon ruptures, offering robust fixation and facilitating biological integration. These findings, supported by the existing literature, suggest that Achilles bone–tendon allografts are a viable alternative to traditional repair strategies, especially in patients with extensive tendon defects and compromised tissue quality. Further comparative studies are warranted to establish the superiority of bone–tendon allograft constructs over conventional methods. Full article

Background and Objectives: Optimizing functional recovery alongside wound healing remains a challenge in acute wound management. Negative Pressure Wound Therapy (NPWT) is widely used to promote tissue regeneration and reduce edema, yet its impact on functional outcomes and quality of life is less explored. This study evaluates the effects of NPWT alone versus NPWT combined with physiotherapy, focusing on functional recovery and patient-reported outcomes. Materials and Methods: This prospective study included patients with acute wounds at the Timisoara County Emergency Clinical Hospital, treated between 2020 and 2024. Participants were divided into two groups: Group 1, receiving NPWT exclusively, and Group 2, undergoing NPWT combined with physiotherapy (Proprioceptive Neuro-muscular Facilitation, Kabat diagonals, manual lymphatic drainage, and proprioceptive exercises). Assessments included joint mobility (goniometry), edema (circumferential measurements), muscle strength (Manual Muscle Testing), and patient-reported outcomes using WHOQOL-BREF, SF-36, and HADS questionnaires. Results: Results demonstrated that, at 10 days, patients in the specialized physiotherapy group had significantly greater ankle dorsiflexion (18.10 ± 1.63°) compared to the classical group (10.05 ± 1.76°; p < 0.001). Knee flexion in the specialized group was 134.58 ± 5.15° versus 115.57 ± 5.32° in the classical group (p < 0.001). Edema circumference and depth were reduced in both groups, with minor but notable improvements in the specialized group at later follow-ups (p < 0.05). Self-reported quality of life (SF-36, WHOQOL-BREF) and mental health (HADS) scores were slightly better at 10 days in the specialized group, although differences diminished by 6 months. Conclusions: Combining NPWT with specialized physiotherapy techniques enhances functional recovery and quality of life in acute wound patients. These findings support the integration of multi-disciplinary rehabilitation to optimize patient outcomes. Full article

Background/Objective: To assess the effectiveness of therapy based on sliding and tensioning neurodynamic techniques in the conservative treatment of mild and moderate forms of cubital tunnel syndrome (CuTS) compared to sham therapy. Methods: A single-blinded, randomized placebo-controlled trial. The study was conducted at several medical clinics. Individuals diagnosed with CuTS (initially 136 subjects, of whom 91 completed the full protocol) participated in the experiment. In the experimental group (MT), sliding and tensioning neurodynamic techniques were applied, whereas in the control group (ST), a sham therapy was used, involving the performance of neurodynamic techniques in an intermediate position without following the specific neurodynamic sequence for the ulnar nerve. The therapy was administered five times per week over the course of 10 sessions. All participants underwent assessments, including nerve conduction studies, ultrasound imaging (cross-sectional area and shear modulus), pain levels, two-point discrimination sensation, cutaneous sensory perception threshold, symptoms, ability to perform certain activities, and changes in improvement following treatment. Results: A baseline assessment revealed no significant inter-group differences in all examined parameters (p > 0.05). After therapy, there was a statistically significant intra-group improvement in all parameters tested (p < 0.01). In the MT group, the intra-group differences were significant across all parameters tested (p < 0.01). However, in the ST group (sham therapy), only the shear modulus showed statistically significant changes, while the other tested parameters remained unchanged. Conclusions: Neurodynamic techniques demonstrate superior therapeutic effects compared to sham therapy in the treatment of mild to moderate forms of CuTS. Full article

Background and Objectives: There is evidence of decreasing knee pain in patients with knee osteoarthritis when knee mechanical traction is performed surgically. Our aim was to measure the effects of standard physiotherapy with the addition of knee mechanical traction on pain, physical activity and quality of life in patients with knee osteoarthritis. Materials and Methods: A clinical observational study with intervention and without a control group was conducted at three outpatient health clinics on a primary level of the health care system. Twenty-three patients with knee osteoarthritis voluntarily participated in the study. Standard physiotherapy included education, therapeutic and aerobic exercise, conventional TENS, low-intensity laser and manual soft tissue techniques. Mechanical traction of 150 N continuous force for 15 min with the knee joint at 25° flexion was added to standard physiotherapy. The following outcome measures were used: VAS, Knee Injury and Osteoarthritis Outcome Score and a 30 s sit-to-stand test. Results: The pain measured for the VAS at rest (p < 0.001) and during movement (p < 0.001) as well as for the Knee Injury and Osteoarthritis Outcome Score pain part decreased (p < 0.05). The quality of life did not improve (p > 0.05), but the physical activity of the patients did (p < 0.05). A decrease in pain correlated with body mass (p < 0.05). Conclusions: Standard physiotherapy with the addition of mechanical traction had an effect on reducing pain and improving physical activity. Full article