Featured Articles #002: Hyperkyphosis, Stroke, Lateral Epicondylitis and UI

Previously featured articles: August 21, 2021 – September 22, 2021.

Decreasing thoracic hyperkyphosis – Which treatments are most effective? A systematic literature review and meta-analysis

Abstract

Background

A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications.
Objective: To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis.

Methods

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE.

Results

Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD -2.8; 95%CI -4.3 to −1.3) and older populations (SMD -0.3; 95%CI -0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD -1.0, 95%CI -1.3 to −0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis.

Conclusion

Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.

Task Oriented Training Activities Post Stroke Will Produce Measurable Alterations in Brain Plasticity Concurrent with Skill Improvement

Abstract

Background

Task-oriented training with upper extremity (UE) skilled movements has been established as a method to regain function post stroke. Although improved UE function has been shown after this type of therapy, there is minimal evidence that brain plasticity is associated with this training. The accelerated skill acquisition program (ASAP) is an example of an approach for promoting UE function using targeting movements.

Objective

To investigate the effects of a single 2-hour session of ASAP in individuals with stroke on measures of brain plasticity as represented by corticospinal excitability (CE) and determine associations with reach-to-grasp (RTG) performance.

Methods

Eighteen post-acute stroke patients were randomized to two groups. Experimental group (n = 9) underwent ASAP for 2 hours, while the control group (n = 9) received dose equivalent usual and customary care. Both groups were evaluated for CE and RTG performance prior to the session and then four times after training: immediately, 1 day, 6 days, and 12 days.

Results

Significant alterations in CE were found in the peak-to-peak of Motor Evoked Potential amplitude of elbow and wrist extensor muscles in the lesioned hemisphere. The experimental group also demonstrated improved execution (shortened total movement time, TMT), feed-forward mechanism (deceleration time, DT) and planning (lengthened relative time to maximum hand aperture, RTApmax) compared to the control group.

Conclusion

Alterations in brain plasticity occur concurrently with improvements in RTG performance in post-acute stroke patients with mild impairment after a single 2-hour session of task-oriented training and persist for at least 12 days.

Physiotherapy treatment of lateral epicondylitis: A systematic review

Abstract

Background

Lateral epicondylitis is a tendinopathy with a prevalence of between 1–3% of the population aged 35–54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost).

Objective

The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques.

Methods

A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy.

Results

Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration.

Conclusion

Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.

Exercise Interventions to Improve Pelvic Floor Muscle Functioning in Older Women With Urinary Incontinence: A Systematic Review

Abstract

Background

An estimated 200 million people worldwide live with urinary incontinence, and women are more affected than men. The World Health Organization and the International Continence Society recommend pelvic floor muscle training to treat urinary incontinence in women.

Objective

The purpose of this systematic review was to examine pelvic floor muscle function and understand its impact on urinary incontinence in women older than 50 years.

Methods

Medline, PsycINFO, Webscience, CINAHL, and Scopus were searched for articles from 1988 to May 2019. Included studies had a comparison or control group, exercise intervention aimed to train the pelvic floor musculature, women 50 years and older, and had been published in peer-reviewed journals.

Results

Eight studies were included in this review. Exercise interventions included home-based as well as supervised pelvic floor muscle-strengthening, and indirect pelvic floor muscle-strengthening exercises via co-contraction of surrounding muscles. All interventions were able to improve pelvic floor muscle strength as well as urinary incontinence symptoms, with bigger improvements found in supervised interventions.

Conclusion

This review has shown that exercise interventions targeting the pelvic floor muscles may be effective in improving pelvic floor muscle strength, urinary incontinence symptoms, and even quality of life measures. Exercise interventions that were supervised or included some type of biofeedback device showed greater and faster improvements than interventions without additional assistance.