Mansour Abdullah Alshehri

The effectiveness of manual therapy in treating cervicogenic dizziness: a systematic review

[Purpose] This review provides an evaluation of the evidence for the effectiveness of using manual therapy to treat cervicogenic dizziness. [Subjects and Methods] The literature was systematically searched on the May 2, 2016 using the following online databases: Medline, EMBASE, CINAHL and PEDro. This review included randomised controlled trials and compared the efficacy of manual therapy for the treatment of cervicogenic dizziness, compared to other types of intervention. This study measured changes based on dizziness intensity and frequency. [Results] The primary search found 30 articles, but only four articles met the inclusion criteria. Assessment of methodological quality was performed by two researchers using the PEDro scale. The level of evidence was determined using a recognised grading scale. Three out of the four articles were deemed to have high methodological quality, while the fourth was rated as moderate quality. The attributed level of evidence was moderate (level 2). [Conclusion] Manual therapy is potentially effective for managing cervicogenic dizziness. However, due to the heterogeneity of the results and techniques and the low number of studies, further research is recommended to provide conclusive evidence.

The effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness: A systematic review

Background: Dizziness is a non-specific term used by patients to describe several symptoms ranging from true vertigo, light headedness, disorientation or sense of imbalance. Vestibular rehabilitation (VR) is a specific form of exercise-based therapy programme aimed at alleviating the primary and secondary problems of a vestibular pathology. The aim of this study was to investigate the effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness. Methods: The following five databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, PubMed, the Physiotherapy Evidence Database (PEDro) and Scopus (Elsevier). Two investigators independently reviewed all articles and a systematic review of literature was performed using the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles were included if they met the following inclusion criteria: (1) randomised controlled trial, (2) people with chronic dizziness, (3) adults aged 18 or over, (4) exercise-based VR, (5) VR exercises compared with sham or usual care, non-treatment or placebo and (6) only studies published full text in English. Results: The initial search identified 304 articles, four of which met the criteria for analysis. All studies involved some form of vestibular rehabilitation, including vestibular compensation, vestibular adaptation and substitution exercises. These exercises were compared with usual medical care (three studies) or placebo eye exercise (one study). The Vertigo Symptom Scale was the most commonly used outcome measure to assess subjective perception of symptoms of dizziness (three studies). According to the PEDro scale, three studies were considered to be of high quality, and one was rated as fair. Conclusions: This review suggests that exercise-based vestibular rehabilitation shows benefits for adult patients with chronic dizziness with regard to improvement in the vertigo symptom scale, fall risk, balance and emotional status.

Efficacy of high intensity laser therapy in the treatment of male with osteopenia or osteoporosis: a randomized placebo-controlled trial

[Purpose] To investigate the effect of high intensity laser therapy, alone or combined with exercise on pain, health related quality of life and fall risk in male with osteopenia or osteoporosis. [Subjects and Methods] 100 male patients with osteopenia or osteoporosis participated in the study. They had T-scores ≤−1.5. Patients were randomly assigned into four groups and treated with laser plus exercise, placebo laser plus exercise, laser alone and placebo laser in groups I, II, III, and IV respectively. Laser was applied to the lower back and hip regions. Exercises included aerobic exercises, weight-bearing, flexibility, and strengthening and balance exercises. Treatment were performed 3 times/week for 12 weeks. The measured outcomes were pain, health related quality of life and fall risk. [Results] All measured outcomes were significantly decreased post-treatment in all treatment groups. Laser plus exercises showed a higher significant effect than exercises with a least significant effect in the laser group in reduction of pain and quality of life. [Conclusion] High intensity laser is an effective modality for male patients with osteopenia or osteoporosis. Laser combined with exercise is more effective than exercises or laser alone in decreasing pain, fall risk an increasing quality of life after 12 weeks of treatment.

The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review

[Purpose] The aim of this study is to investigate the effectiveness of physical therapy interventions in the treatment of sacroiliac joint dysfunction (SIJD). [Subjects and Methods] MEDLINE, PUBMED, CINAHL, AMED, PEDro, and CIRRIE databases were searched and only relevant data from studies that matched the inclusion criteria were included. CASP tools for critical appraisal were used to assess the quality of studies included. [Results] Nine articles met the inclusion criteria, of which, three examined the effect of exercise on SIJD, three used kinesio tape and four studies examined the effect of manipulation. Various outcomes were used including the visual analogue pain scale (VAS), Oswestry disability questionnaire (ODQ), numerical pain rating scale (NPRS) and pelvic position measurement (PALM, pelvimeter and photogrammetry). The quality of included studies ranged from low to average as the CASP tools revealed several limitations that affect the validity of the studies. The results showed that physiotherapy interventions are effective in reducing pain and disability associated with SIJD, with manipulation being the most effective approach and most commonly used within physical therapy clinics. [Conclusion] Manipulation, exercise and kinesio tape are effective in the treatment of pain, disability and pelvic asymmetry in SIJD.

Long-Term Effect of Pulsed Nd:YAG Laser in the Treatment of Children with Juvenile Rheumatoid Arthritis: A Randomized Controlled Trial

OBJECTIVE The aim of this study was to evaluate the long-term impact of a pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser [high-intensity laser therapy (HILT)] in the treatment of juvenile rheumatoid arthritis (JRA). MATERIALS AND METHODS A sample of 30 children participated in this study (15 in the laser group and 15 in the placebo group), with a mean age of 10.53 ± 1.25 years. Children who were randomly assigned to the laser group received HILT thrice per week for 4 weeks, plus the exercise program. HILT scanned each knee with 600 J in two phases and 15 J to 10 points for a total of 750 J for each knee. The placebo laser group received placebo HILT plus the same exercise program. The outcomes measured in this study were the pain level by the visual analog scale (VAS) and gait parameters by the GAITRite® system. Statistical analysis was performed by ANOVA with repeated measures to compare the differences between the baseline, post-treatment, and 12-week follow-up measurements for both groups. The level of significance was set at p < 0.05. RESULTS The VAS results significantly decreased post-treatment in the laser group relative to the placebo group and were still improved at the 12-week follow-up. Gait parameters significantly increased in the laser group after 4 weeks of treatment and after 12 weeks compared to the placebo group. CONCLUSIONS HILT, when combined with an exercise program, appears to be more effective in children with JRA than a placebo laser procedure with exercises.

Factors affecting the extent of utilization of physiotherapy services by physicians in Saudi Arabia

[Purpose] To investigate physicians’ attitudes, opinions and experiences towards physiotherapy services as well as to identify the potential factors that may affect the extent of utilization of physiotherapy services (based on physicians’ beliefs) in Saudi Arabia (SA). [Subjects and Methods] A cross-sectional study was conducted. [Results] A total of 108 respondents met the inclusion criteria. The respondents’ attitude towards physiotherapy was slightly low (53.5%), while their opinions and experiences of physiotherapy indicated some important issues. For example, 50% of them believed that physiotherapists did not create a good awareness about physiotherapy services and 55.5% admitted that they did not have enough information about physiotherapy services. The most potential factor reported by physicians that may affect the extent of utilization of physiotherapy services was the lack of physiotherapist’s skills and knowledge to assess and treat patients (55.3%), followed by the limited knowledge of physicians regarding the types of physiotherapy services (44.5%) and the lack of cooperation between physicians and physiotherapists (40.7%). [Conclusion] There were some factors that limited the extent of utilization of physiotherapy services in SA. Physiotherapy academics and clinicians should attempt to change physicians’ negative attitudes, promoting awareness to provide them with a better understanding of physiotherapy services.

The awareness of healthcare staff towards post-stroke cognitive impairment: a cross sectional study.

[Purpose] This study aimed to determine the awareness amongst healthcare staff of post-stroke cognitive impairment in a university teaching hospital and supporting stroke rehabilitation unit. [Subjects and Methods] A cross sectional study was employed to collect data from 20 healthcare staff about post-stroke cognitive impairment. This study was conducted in Ireland at two sites, the Acute Stroke unit in Cork University Hospital, and the Stroke Rehabilitation unit and Assessment and Treatment Centre in St. Finbarr’s Hospital. [Results] Approximately 75% of participants felt that they had knowledge about post-stroke cognitive deficits, with around 50% of them having patients with persistent cognitive decline between 40% and 60%. Most participants (70%) agreed that cognitive function should be routinely assessed and the majority (85%) discussed the potential impact of post-stroke cognitive deficits with patients and their families. However, some participants need to be aware of post-stroke cognitive deterioration. [Conclusion] Although there was evidence of good practice, a small number of healthcare staff felt that they did not have sufficient knowledge about post-stroke cognitive deficits. Thus, further professional education should be provided to improve the knowledge of healthcare staff about potential cognitive impairments after stroke.

Effect of pulsed high intensity laser therapy on delayed caesarean section healing in diabetic women

[Purpose] The objective of this study was to determine the effect of pulsed high intensity laser therapy on delayed caesarean section healing in diabetic women. [Subjects and Methods] This study was conducted on forty diabetic women with delayed caesarean wound healing, ranging in age from 28 to 38 years. They were randomly assigned into two groups; the group I (n=20) received pulsed high intensity laser therapy for 6-weeks, 3 times per week plus standard medical treatment for treatment of diabetes and caesarean wound patients, the group II (n=20) received sham laser treatment for 6 weeks, 3 times per week plus standard medical treatment for treatment of diabetes and caesarean wound patients. The wound size and appearance in all participants were measured by the tracing method and pressure sore status tool before and after the 6-week treatment. [Results] Pulsed high intensity laser therapy produced a significant difference in wound size and appearance in comparison to the sham laser treatment in diabetic women with delayed caesarean wound healing. [Conclusion] Pulsed high intensity laser therapy is effective in the treatment of delayed caesarean section healing in diabetic women.

Efficacy of high intensity laser therapy in the management of foot ulcers: a systematic review

[Purpose] The aim of this systematic review was to assess the efficacy of high intensity laser therapy (HILT) on wound surface area in patients with foot ulcers. [Methods] Four databases including PubMed, MEDLINE, the Cochrane library, and the Physiotherapy Evidence Database (PEDro) were searched up to the end of April 2018 to identify relevant studies. Studies were included if they met the following criteria: randomised controlled trial (RCT), assessed the efficacy of HILT in patients with foot ulcers, evaluated wound surface area, and written in English language with available full text. The PEDro scale was used to evaluate the quality of studies. [Results] A total of three RCTs met the inclusion criteria, with two studies of the efficacy of HILT in adult patients with diabetic foot ulcers and one in spina bifida children with neuropathic foot ulcers. According to the PEDro scale assessment, all three studies were rated as a fair quality. All studies found that HILT provided significantly better outcomes compared to sham laser or standard medical therapy. [Conclusion] This systematic review suggests that HILT is an effective modality for wound healing in patients with foot ulcers, but further large-scale studies are required to confirm its efficacy.

The feasibility of using exergames as a rehabilitation tool: the attitudes, awareness, opinions and experiences of physiotherapists, and older people towards exergames

[Purpose] The aim of this study was to investigate the feasibility of using exergames as a rehabilitation tool by determining the attitudes, awareness, opinions and experiences of physiotherapists, and older people towards exergames. [Subjects and Methods] A cross-sectional study was conducted and two short self-developed questionnaires (for physiotherapists and older people) were distributed in three hospitals in Cork (Ireland) to assess the attitudes towards and familiarity with exergames among physiotherapists and older people. The data were analysed using Microsoft Excel version 2013. [Results] The results show that a lot of older people have seen exergames devices but have not attempted to play them. This may indicate a lack of interest in or information about these devices and how to use them. With regard to the second group, physiotherapists underestimate older people’s knowledge about exergames. [Conclusion] Older people were not very familiar with exergames but they were willing to try them. In addition, despite physiotherapists being familiar with exergames, they see them as an additional tool that will not replace or change any traditional exercise methods.