Musculoskeletal Rehabilitation

Background: In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented by entire populations, including 'stay-at-home' orders in many countries. The long-term health and economic consequences of the COVID-19 pandemic are not yet known.

Background: Postflight reconditioning of astronauts is understudied.  Despite a rigorous, daily inflight exercise countermeasures programme during six months in microgravity (µG) on-board the International Space Station (ISS), physiological impairments occur and postflight reconditioning is still required on return to Earth. Such postflight programmes are implemented by space agency reconditioning specialists.
Case Description and Assessments:  A 38 year old male European Space Agency (ESA) crewmember’s pre- and postflight (at six and 21 days after landing) physical performance from a six-month mission to ISS are described. Assessments: muscle strength (squat and bench press 1 Repetition Maximum) and power (vertical jump), core muscle endurance and hip flexibility (Sit and Reach, Thomas Test). 
Interventions: In-flight, the astronaut undertook a rigorous daily (2-hour) exercise programme. The 21 day postflight reconditioning exercise concept focused on motor control and functional training, and was delivered in close co-ordination by the ESA physiotherapist and exercise specialist to provide the crewmember with comprehensive reconditioning support.
Outcomes: Despite an intensive inflight exercise programme in this highly motivated crewmember, postflight performance showed impairments at R+6 for most parameters, all of which recovered by R+21 except muscular power (jump tests).
Conclusions: Regardless of intense inflight exercise countermeasures and excellent compliance to postflight reconditioning, postflight performance showed impairments at R+6 for most parameters. Complex powerful performance tasks took longer to return to preflight values. Research is needed to develop optimal inflight and postflight exercise programmes to overcome the negative effects of microgravity and return the astronaut to preflight status as rapidly as possible.

Objective: Hippotherapy or Equine Assisted Therapy (EAT) is an alternative therapeutic treatment
which is based on the special benefits of horse riding. The purpose of the herein review is to
investigate the efficacy of this method for the treatment of several dysfunctions affecting the
musculoskeletal system.
Materials and Methods: International literature was thoroughly studied, with special focus on
indications and therapeutic effectiveness of this method in injuries and diseases of musculoskeletal
interest.
Results: EAT seems to contribute positively to spasticity reduction, following spinal cord injuries
(SCIs) and affects the overall patients’ quality life. It also acts positively on the prevention of falls inthe elderly. Less evidence exists on the usefulness of this method in scoliotic curvature reduction
in children with cerebral palsy (CP) and in treatment of Low back Pain (LBP).
Conclusion: Hippotherapy improves muscle strength, balance and coordination of movement and
it also contributes to relaxation and control of posture. Thus, it seems that as a supplementary
method, accompanying other individualized therapeutic approaches, it can address a number of
problems of the musculoskeletal system. More and well-designed studies are needed to draw firm
conclusions about the benefits and the indications of the method.

Abstract
Background: Patient satisfaction is an important indicator in assessing quality of health care. Physiotherapy services is a core
service required to promote quality coverage of healthcare universally.
Objective: This study aimed to evaluate patient satisfaction with physiotherapy services in a tertiary facility.
Materials and Method: A descriptive survey of 141 patients aged between 18 and 64years who received at least 3 sessions of
physiotherapy from June 2018 to December 2019. Data was collected using the Patient satisfaction questionnaire III (PSQ-III).
Results: The respondents were 56% males with 44% females. Respondents in the age range of 36-45years and employed in
the formal public sector were 47.5%. Respondents who had post-secondary education were 77.4%. Satisfaction with physical
therapy services was graded good (29.1%), very good (64.5%) and excellent (1.4%). Communication (95.7%), technical quality
(92.9%) and interpersonal aspects (90.1%) rated highest in satisfaction, time aspect had the highest grade of fairly satisfied
patients. Poor satisfaction responses were recorded against convenience, time spent and cost as most patients paid out of
pocket. Factors such as employment of physiotherapists, access to physiotherapy care and increase in number of visits
covered under various prepayment schemes would enhance quality of care delivered in the state.
Conclusion: Patient satisfaction is an important factor in improving the healthcare of patients. Patients were reasonably
satisfied with the services received. Factors identified to impact negatively, can be managed to improve the patient
experience.
Keywords: Physiotherapy, Patient satisfaction, Healthcare.

Objective: Bell's palsy is one of the most frequent forms of facial palsy affecting 75% of the cases. Different physiotherapy techniques are utilized for treating Bell's palsy which aims to rebuild normal facial expressions and restore normal strength and function of facial muscles alongside decreasing all associated symptoms. This research was conducted to evaluate the effectiveness of facial neuro-muscular retraining with and without mirror visual feedback in patients with Bell's palsy. Methods: A randomized controlled trial was conducted. 64 subjects were recruited in the sample. Patients were randomly divided into two groups with 32 patients in each group. Both groups received Neuromuscular Retraining exercises (NMR). Group 1 received Mirror Visual Feedback (MVF) additionally. Facial symmetry and motor function of facial muscles was assessed by using Facial Disability Index (FDI) and House Brackmann Scale (HBS). Readings were taken at baseline and then at 3 rd and 7 th week follow ups. Research took 9 months duration to complete and data analysis was done using SPSS 22. Results: Results of the research demonstrated no significant difference of FDI-P, FDI-S and HBS score at baseline between both groups with p value being 0.893, 0.321 and 0.317 respectively. Significant difference was observed in FDI-P, FDI-S and HBS scores at 3 rd week and 7 th week follow up between 2 groups with p value being 0.00 for all outcome measures. Conclusion: Mirror Visual Feedback used in combination with NMR was found more effective in improving the facial symmetry and movement and in decreasing the functional disability than NMR used alone in Bell's palsy patients.

In the field of Oral and Maxillofacial Surgery, dental extractions play a major role at a dental undergraduate level. This study embarks to investigate the level of dental undergraduates psychological status, hand skills as a dental clinician in performing chairside dental extractions. Three projects will be undertaken pertaining to the flow of assessment to exclude any individual bias of the participants. Project One will investigate the psychological level of the undergraduates through anxiety tests, confidence level and self-efficacy tests. Project 2 will involve a calibration amongst occupational therapists prior to implementation of hand skills tests to the participants. Musculoskeletal problems will be identified and results will be tabulated in Project 3. Analysis of all test results will be done and any correlations will be assessed to find any associations in performing dental extractions. Based on the result of this study, we aim to recommend an intervention programme to improve dental clinicians quality of life, through improving their psychological level, dexterity and self-efficacy levels in our next study

Background: Many countries have started adopting musculoskeletal imaging as part of
physiotherapy practice and their educational programmes are expected to bridge the gaps in
training.
Objectives: To develop an instrument that can be used to explore the level and nature
of training, attitude, competence and utilisation of musculoskeletal imaging among
physiotherapists.
Method: An exploratory sequential mixed methods design was used. An in-depth international
literature search was conducted, followed by a focus group discussion (FGD). The FGD
informants were recruited through maximum variation sampling. The results of the FGD and
the information from relevant literature were used to draft the physiotherapist’s musculoskeletal
imaging profile questionnaire (PMIPQ). The PMIPQ was then subjected to face, content and
criterion validity and pilot testing. The final version of the PMIPQ consists of six domains: (A)
demographic details, (B) nature of training in musculoskeletal imaging, (C) level of training,
(D) attitude towards musculoskeletal imaging, (E) utilisation and (F) competence. Data were
analysed using means, standard deviation, Spearman’s correlation ( ρ) and Cronbach’s alpha
(α); SPSS 20 software (p ≤ 0.05).
Results: The results showed that the PMIPQ has good psychometric properties: validity
and internal consistency. The test–retest reliability (p-value) across the domains was: C (0.973),
D (0.979), E (0.842) and F (0.716).
Conclusion: Physiotherapist’s musculoskeletal imaging profile questionnaire is a relevant
instrument for assessing the musculoskeletal imaging profile of physiotherapists in Nigeria
and in other countries with a similar scope of training and practice.
Clinical implications: Musculoskeletal system imaging is a potentially useful adjunct to
physiotherapists in clinical practice.
Keywords: Imaging; Musculoskeletal; Physiotherapy; Profile; Questionnaire.

Athletes attach vital values to full recovery after injury based on the needs for optimal performance. However, limited quantitative studies emphasising playing position, age and circumstance, and therapeutic patterns used for the treatment of injured First Capital Plus Premier League soccer players have been conducted. This study hence describes (a) injury types based on playing position, age and circumstance, and (b) therapeutic patterns used for the treatment of injured First Capital Plus Premier League soccer players. Athletes' case files containing medical teams' injury reports for 2012/2013 and 2013/2014 Ghana Football Association league seasons and a total of 209 injury cases of football players with age range of 19-30 years and mean age of 23.67±0.90 years were described. Ages 25-27(78, 37.32%) sustained more injuries while fracture lasted for 90 days. Eighty-eight (42.1%) athletes had contusion which lasted for between 3-28 days, Strain (37, 17.1%) and Sprain (23, 11.0%) were most prevalent. Midfielders sustained higher injury (83, 39.72%) of foul contact (186, 89.0%) circumstance. Frontal head (63, 30.2%) and Knee (43, 20.5%) were anatomical structures mostly hampered by injury. Significant differences exist in injury based on playing positions, causes and players' age (p<0.05). Therapeutic patterns of RICE (123, 58.85%, p<0.05), psychotherapy (122, 58.37%, p>0.05), analgesia (114, 54.55%, p<0.05) and tapping and wrapping (110, 52.65%, p<0.05) administered to injury sustained were significant. Given that RICE is the mostly used therapeutic pattern based on injury type, we recommend that all Ghana club owners should abundantly make portable cold application materials and methods available to medical teams for use during games. This could reduce the risk of acute injury and lessen early career termination of premier league soccer players.

Spaceflight and exposure to microgravity have wide-ranging effects on many systems of the human body. At the European Space Agency (ESA), a physiotherapist plays a key role in the multidisciplinary ESA team responsible for astronaut health, with a focus on the neuro-musculoskeletal system.  In conjunction with a sports scientist, the physiotherapist prepares the astronaut for spaceflight, monitors their exercise performance whilst on the International Space Station (ISS), and reconditions the astronaut when they return to Earth. This clinical commentary outlines the physiotherapy programme, which was developed over nine long-duration missions. Principles of physiotherapy assessment, clinical reasoning, treatment programme design (tailored to the individual) and progression of the programme are outlined. Implications for rehabilitation of terrestrial populations are discussed. Evaluation of the reconditioning programme has begun and challenges anticipated after longer missions, e.g. to Mars, are considered.

Abstract.

Introduction: The Proprioceptive Neuromuscular Facilitation concept (PNF-concept) is a widely used rehabilitation concept, and is in many countries part of the undergraduate curriculum of physiotherapy education. It is also offered in postgraduate training worldwide. The modern physiotherapist is confronted with the application of evidence-based practice; therefore the aim of this review is to summarize the available evidence for this rehabilitation concept.
Method: A search was completed using Pubmed, ScienceDirect, PEDro, Cochrane library and the International PNF Association (IPNFA) website. An evidence-based practice approach has been promoted in the field of physiotherapy since the early 1990’s, hence we limited the search from 1990 until 2014.
Major findings: Seventy-four sources that were found were categorized in: A) PNF philosophy, B) PNF basic principles and procedures, C) PNF techniques in rehabilitation.  In the reviewed publications, a variety of indications and subject populations were identified including: neurological, musculoskeletal, pulmonary, geriatric, and mixed disorders. The publications varied in type and quality, ranging from case studies, clinical trials, randomized controlled trials (RCTs), and reviews. This variety of publications, treatment indications and outcome measures in the publications warranted a narrative review
Discussion and conclusion: The scope and diversity of articles in the review make it difficult to study the PNF-concept in a methodical way, since different components of a comprehensive rehabilitation approach may act as confounders when measuring the effects of one specific part of the approach. There is a substantial body of research which supports the use of PNF as a comprehensive rehabilitation concept. The literature also describes that the PNF-concept is applied in clinical practice in a variety of populations and indications, however efficacy for specific indications and populations requires further investigation.

Study Design: Randomized clinical trial. Background: Mechanical neck pain has a lifetime prevalence of nearly 50%, estimates suggest that 70% of the population will experience neck pain during their life. Several studies implicate cervical and thoracic spine in causing neck pain. Recent evidence suggests that symptoms of mechanical neck pain can be effectively reduced by using high velocity low amplitude thrust manipulation directed to cervical and thoracic spine. This study was aimed to find the efficacy of two treatment techniques in reducing symptoms of patients with mechanical neck pain. Objective: To investigate the long-term effects of cervical spine thrust manipulation (cervical group) versus thoracic spine thrust manipulation (thoracic group) in individuals with mechanical neck pain. Methods: Ninety patients with persistent chronic mechanical neck pain participated in this study. Patients were evaluated using the Neck Disability Index and a numeric pain rating scale for pain. Patients with CMNP were randomly allocated to multi-level cervical manipulation (MCM) or multi-level thoracic manipulation (MTM). both groups also received global postural re-education (GPR). Outcome measures Numeric pain rating scale (NPRS) and Neck Disability Index (NDI) scores were measured at baseline, 1 month, 3 month and at 6-month follow-up. Results: Numeric pain rating scale (NPRS), and Neck Disability Index (NDI) were (P<0.05) improved in the both MCM and MTM groups. But significant improvement seen in cervical manipulation group. Participants in the cervical manipulation group demonstrated significantly greater improvements (P<.001) on both the numeric pain rating scale and Neck Disability Index in all follow-up period compared to those in the comparison of thoracic group. Conclusion: These results suggest that both multi-level cervical and thoracic spine high velocity low amplitude thrust manipulation plus global posture re-education demonstrated better overall long -term outcomes on the numeric pain rating scale, and Neck Disability Index at baseline,1 month,3 month and at 6-month follow-up in Patients with chronic mechanical neck pain.  Authorship Credit. “Equal Contribution” (EC). Citation. Mehul Padasala, Sharmila B, Rosario D’Onofrio, Claudio Civitillo, Jaymin Bhatt : Long term effects of cervical thrust versus thoracic thrust Manipulation in patients with chronic mechanical neck pain: Double blinded randomized clinical trial.  Ita. J. Sports Reh. Po. 2022; 9 (19); 1;2; 1964 – 1988-; ISSN 2385-1988 [online];
IBSN 007-111-19-55; CGI J OAJI 0,101)]. Published online.                                                              Corresponding Author email: padasalamehulkumar@gmail.com,

This paper describes the development of the Workplace Ergonomic Risk Assessment (WERA) for investigating the physical risk factor associated with work-related musculoskeletal disorders (WMSDs). The initial development of WERA tool involved the following procedures: (1) first stage, development of WERA prototype from literature review, (2) second stage, evaluation of the psychometric properties including (a) validity trials and (b) reliability and usability trials. In the validity trials, the relationship of the individual WERA body part scores to the development of pain or discomfort is statistically significant for the wrist, shoulder and back regions. It shows that the WERA assessment provided a good indication of work-related musculoskeletal disorders which might be reported as pain, ache or discomfort in the relevant body regions. In the reliability trials, the results of inter-observer reliability shows that moderate agreement among the observers while from the feedback questionnaire survey about the usability of WERA tool, all participants including expert and management teams agreed that the prototype of WERA tool was easy and quick to use, applicable to workplace assessment for the wide range of job/task and valuable at work. It was confirmed that there was no need of training required to do WERA assessment. Therefore, the WERA assessment has been designed for easy and quick use, and for those who are trained to use it do not need previous skills in observation techniques although this would be an advantage. As WERA is a pen and paper technique that can be used without any special equipment, WERA assessment can be done in any space of workplaces without disruption to the task that have been observed.