Featured Articles #001: Rotator Cuff, Stroke, PFP and Heart Transplant

Previously featured articles: August 14, 2021 – August 21, 2021.

Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis

Abstract

Background

The purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up.

Methods

According to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured.

Results

The search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P < 0.05) at 3-month follow-up; in terms of forward elevation, external rotation, abduction (P < 0.05), but not in terms of Constant-Murley score at 6-month follow-up; in terms of forward elevation (P < 0.05) at 12-month follow-up. No significant differences between the two group were highlighted at 24-month follow-up.

Conclusion

No statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.

Force-Control vs. Strength Training: The Effect on Gait Variability in Stroke Survivors

Abstract

Purpose

Increased gait variability in stroke survivors indicates poor dynamic balance and poses a heightened risk of falling. Two primary motor impairments linked with impaired gait are declines in movement precision and strength. The purpose of the study is to determine whether force-control training or strength training is more effective in reducing gait variability in chronic stroke survivors.

Methods

Twenty-two chronic stroke survivors were randomized to force-control training or strength training. Participants completed four training sessions over 2 weeks with increasing intensity. The force-control group practiced increasing and decreasing ankle forces while tracking a sinusoid. The strength group practiced fast ankle motor contractions at a percentage of their maximal force. Both forms of training involved unilateral, isometric contraction of the paretic, and non-paretic ankles in plantarflexion and dorsiflexion. Before and after the training, we assessed gait variability as stride length and stride time variability, and gait speed. To determine the task-specific effects of training, we measured strength, accuracy, and steadiness of ankle movements.

Results

Stride length variability and stride time variability reduced significantly after force-control training, but not after strength training. Both groups showed modest improvements in gait speed. We found task-specific effects with strength training improving plantarflexion and dorsiflexion strength and force control training improving motor accuracy and steadiness.

Conclusion

Force-control training is superior to strength training in reducing gait variability in chronic stroke survivors. Improving ankle force control may be a promising approach to rehabilitate gait variability and improve safe mobility post-stroke.

Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis

Abstract

Objective

Previous research suggests that muscle strength exercise is the most effective rehabilitation methods in patients with patellofemoral pain (PFP). This systematic review with meta-analysis compared the effects of Hip&Knee, Hip-only and Knee-only exercise programs on pain relief, muscle strength, and functional performance in patients with PFP.

Methods

Literature searches of PubMed, PEDro and CINAHL databases revealed twenty-one studies included in the final descriptive review, thirteen of which were included in the meta-analysis. Data extraction included baseline and post-intervention means and standard deviations of all eligible outcome measures both for the intervention and control groups, participants baseline demographics and intervention characteristics.

Results

The results showed that Hip&Knee and Hip-only exercise programs were comparatively effective, while the Knee-only exercise programs proved to be inferior to the above-mentioned approaches. The Hip&Knee exercise programs showed the greatest pain relief (mean difference = −1.71 (−3.11, −0.30); p = 0.02; I2 = 96%) and functional improvement (standardized mean difference = 1.28 (0.45, 2.12); p = 0.003; I2 = 84%), although the subgroup analysis did not show any significant difference compared to Hip-only exercise programs (p > 0.05).

Conclusion

Overall, Hip&Knee exercise programs appear to reduce pain and improve function more than other exercise programs and could be used as a primary rehabilitation approach in patients with PFP. However, the difference between the subgroups in most outcome measures suggests that Hip&Knee exercise programs are no more effective than Hip-only exercise programs.

How Effective Is Aerobic Exercise Training in Improving Aerobic Capacity After Heart Transplant? A Systematic Review and Meta-analysis

Abstract

Purpose

Studies suggest that additional exercise (Ex) training beyond “usual care” increases peak VO2 in people post-heart transplant (HTx); however, no recent studies have quantified improvements or compared moderate-intensity aerobic Ex (MOD) to high-intensity interval training (HIIT). The purpose of this study was to quantify improvements in VO2 for patients post-HTx undergoing additional Ex training and compare effectiveness of MOD to HIIT.

Methods

Inclusion criteria were: randomized clinical trials, systematic reviews, or meta-analyses published between 2008 to 2018, subjects post-HTx, participated in an aerobic Ex program beyond usual care, and reported peak VO2.

Results

A total of 242 records were obtained and 7 randomized clinical trials were reviewed. The average PEDro score was 4.86 (range 2–7). The within-group weighted mean difference (WMD) in peak VO2 comparing baseline to post-training for the Ex group = 3.3 (0.5) ml/kg/min and for the control group = −0.2 (0.2) ml/kg/min. The between-group WMD in peak VO2 = 3.5 (7.9) ml/kg/min, Hedge’s g = 0.606 (95% confidence intervals = 0.337–0.874), P < .001, favoring Ex. Comparison between Ex protocols indicated that there was no difference between HIIT and MOD (Q = 1.83, P = .176).

Conclusion

Physical therapists should challenge patients post-HTx with aerobic Ex that goes beyond usual post-HTx care and should consider incorporating HIIT into the treatment plan or home program to maximize the benefits of rehabilitation when possible.