Karagiannis, Christos

Purpose: Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. Methods: Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. Results: Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. Conclusions: In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.

We evaluated the effects of Cognitive Behavioural Therapy (CBT) alone or with additional interventions on pain, disability, kinesiophobia, anxiety, stress, depression, quality of life, and catastrophizing of patients with chronic neck pain (CNP). Nineteen studies met the inclusion criteria, and fourteen studies were quantitatively analysed. Risk of bias was assessed using the PEDro scale and the certainty of evidence using the GRADE approach. Studies were pooled (where applicable) and subgroup analyses were performed for CNP, or whiplash associated disorders. Studies compared—directly or indirectly—CBT interventions to no treatment, conservative interventions such as exercise and/or physiotherapy, or multimodal interventions. We present effect estimates at 8-week, 12-week, 6-month, and 1-year follow-up. Low certainty evidence suggests a clinically significant pain reduction (short-term) favouring CBT with or without additional intervention compared to no intervention SMD = −0.73; 95%CI: −1.23 to −0.23). Very low and low certainty evidence suggest clinically significant improvements in kinesiophobia (very short-term SMD = −0.83; 95%CI: −1.28 to −0.39 and short-term SMD = −1.30, 95%CI: −1.60 to −0.99), depression SMD = −0.74, 95%CI: −1.35 to −0.14) and anxiety SMD = −0.76, 95%CI: −1.34 to −0.18) favouring a multimodal intervention with CBT (short-term) compared to other conservative interventions. Combining different types of CBT interventions resulted in potentially heterogeneous comparisons.

The objective of this study was to investigate the test-retest reliability of measurement of grip strength in full elbow extension. The grip strengths of 19 healthy participants were measured using the Jamar dynamometer by the same rater on two occasions with an interval of 7 days between measures. Test-retest reliability of grip strength measurement was excellent in full elbow extension and associated with low values of standard error of measurement and small variations in the differences between the two measurements in both testing sessions.

Background/purpose: Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT. Case description: A 44 years old male ex-football player presented with a 20-year history of persistent Achilles tendon pain (ATP) consistent with AT diagnosis. The patient attended 12 treatment sessions receiving a high-velocity, low amplitude lumbar spine manipulation. Outcome measures were collected at baseline, 2 weeks, 4 weeks, 3 months and 6 months and included pain in visual analogue scale, the American Orthopedic Foot and Ankle Score, the 36-Item Short Form Health Survey and the Victorian Institute of Sport Assessment-Achilles questionnaire. Pressure pain threshold was also assessed using an electronic pressure algometer. Outcomes: Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation. Conclusion: These findings have demonstrated the positive effects of lumbar spine manipulation on ATP and disability. Further studies, specifically clinical trials investigating the effect of lumbar spine manipulation or combining this technique with exercises and functional activities are suggested.

BackgroundThe effectiveness of both neural mobilization and intermittent cervical traction (ICT) has been previously explored in some studies of generally low methodological quality. However, the effect of simultaneous application of these techniques in people with cervical radiculopathy (CR) has not been previously investigated. AimTo investigate the effect of neural mobilization with simultaneously applied ICT on pain, disability, function, grip strength and cervical range of motion in patients with CR. DesignRandomized, controlled, assessor-blinded, clinical trial. MethodsParticipants (n = 42) diagnosed with unilateral CR were randomly allocated to intervention (neural mobilization combined with ICT, n = 21) or control (n = 21) groups. Participants in the intervention group were asked to attend for 12 treatment sessions to receive 6 sets of 60s grade II–IV ICT with simultaneously applied ‘slider’ neural mobilizations with median nerve bias. Participants randomized to the control group did not receive any type of treatment and were asked to avoid prescription or over-the-counter analgesia or anti-inflammatory medication. The Neck Disability Index (NDI), the Patient-Specific Functional Scale (PSFS), the Numeric Pain Rating Scale (NPRS), and measures of grip strength (GS) and cervical spine active range of motion (CSAROM) were administered at baseline and at 4-weeks. ResultsThe intervention group demonstrated significant improvements in NDI scores (mean difference = −16.95; 95% CI = −22.47 to −11.43, ES = 0.42), PSFS scores (mean difference = 2.88; 95% CI = 2.33 to 3.43, ES = 0.66), NPRS scores (mean difference = −3.74; 95% CI = −4.92 to −2.96, ES = 0.37), GS (mean difference = 1.87 kg; 95% CI = 0.51 to 3.23; ES = 0.07), and CSAROM (except for lateral flexion), compared to the control group where significant changes were not detected. ConclusionNeural mobilization with simultaneous ICT can improve, pain, function, disability, grip strength and cervical range of motion in people with CR. Further clinical trials comparing neural mobilization with cervical traction to other standard interventions are justified.

BackgroundEccentric (ECC) exercise is an “economical” type of exercise with low energy requirements and does not cause early fatigue. Therefore, it is used for cardiac patients, who have low physical activity and exercise intolerance, as an easier kind of training. ObjectiveThis systematic review aimed to investigate the efficacy of ECC exercise for functional capacity (FC) in patients with ischemic heart disease. DesignSystematic review. MethodsMEDLINE via PubMed and EBSCO databases were searched for articles of randomized controlled trials of adults with ischemic heart disease who underwent ECC training as compared with other forms of exercise (concentric exercise) or no exercise and assessed FC. The methodologic quality of studies was assessed by the PEDro scale. A meta-analysis was performed with sufficient homogeneity between at least 2 studies in the pre-defined comparisons. ResultsFour studies, investigating a total of 99 subjects, met the inclusion criteria. The results of the studies did not clearly indicate whether ECC exercise could improve FC better than traditional forms of exercise. However, the small number of studies and their methodologic weaknesses do not allow for drawing firm conclusions. ConclusionsWe found contradictory results about the effectiveness of ECC as compared with concentric exercise in terms of FC in ischemic cardiac patients. Further investigation with well-designed randomized trials is needed to determine the effectiveness of this kind of exercise for FC in such patients.

ObjectiveThe purpose of this study was to evaluate the test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy (CR). MethodsA convenience sample of 19 participants (14 men and 5 women; mean ± SD age, 50.5 ± 12 years) with CR was measured using a Jamar hydraulic hand dynamometer by the same rater on 2 different testing sessions with an interval of 7 days between sessions. Data collection procedures followed standardized grip strength testing guidelines established by the American Society of Hand Therapists. During the repeated measures, patients were advised to rest their upper limb in the standardized arm position and encouraged to exert 3 maximum gripping efforts. The mean value of the 3 efforts (measured in kilogram force [Kgf]) was used for data analysis. The intraclass correlation coefficient, SEM, and the Bland-Altman plot were used to estimate test-retest reliability and measurement precision. ResultsGrip strength measurement in CR demonstrated an intraclass correlation coefficient of 0.976, suggesting excellent test-retest reliability. The small SEM in both testing sessions (SEM1, 2.41 Kgf; SEM2, 2.51 Kgf) as well as the narrow width of the 95% limits of agreements (95% limits of agreement, −4.9 to 4.4 Kgf) in the Bland-Altman plot reflected precise measurements of grip strength in both occasions. ConclusionsExcellent test-retest reliability for grip strength measurement was measured in patients with CR, demonstrating that a hydraulic hand dynamometer could be used as an outcome measure for these patients.

Background: Although both neural mobilization (NM) and cervical traction (CT) are widely used interventions in cervical radiculopathy (CR), there is limited clinical data to support their use. Objective: To evaluate the effects of CT, with or without the addition of NM, on pain, function, and disability in patients with CR. Design: A randomized, double-blinded, placebo-controlled clinical trial. Methods: 66 patients with CR were randomly allocated to: a group (n = 22) received CT combined with NM (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), grip strength and cervical spine mobility were used as outcome measures. A two-way analysis of variance was used to evaluate differences between the three groups at baseline and at 4-week follow-up. Results: Statistically and clinically significant between-group differences at 4-week follow-up were found between CT + NM and WLC groups in favor of CT + NM group in NDI scores (d = 1.30), NRPS (d = 1.94), and active cervical rotation towards the opposite arm (d = 1.18) and between CT + NM and CT + shamNM groups in favor of CT + NM group in NRPS (d = 1.21). No significant differences were observed between CT + shamNM and WLC groups in all outcome measures. Clinically significant within-group improvements were found only for the CT + NM group. Conclusion: At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.