Physiotherapy
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/6
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Item Feasibility, Safety, and Intensity of Frame Running for people with Multiple Sclerosis with Moderate-to-Severe Walking Impairments(Taylor & Francis, 2026) McEwan, Gary; Andreopoulou, Georgia; Koufaki, Pelagia; Bulley, Catherine; Jagadamma, Kavi; Stansfield, Ben; van der Linden, MariettaPurpose: Physical activity is a key symptom management strategy for people with Multiple Sclerosis (pwMS). Yet, pwMS with advanced disability remain less active than the general population, possibly reflecting the dearth of adapted exercise opportunities for this population. This study therefore aimed to evaluate the feasibility of Frame Running, an adapted physical activity, for pwMS with moderate-to-severe walking impairments, its physiological demands, and the feasibility of conducting a definitive trial. Methods: A single-arm, pre-post design was employed, with physical function and self-reported outcomes assessed before and after a 12-week Frame Running programme. Feasibility outcomes included consent and retention rates, adherence, and safety. A one-year follow-up evaluated continued community-based Frame Running participation. Heart rate (HR), steps, cadence, and distance covered during training were recorded. Results: Twenty individuals registered interest, of whom 10 (all with progressive MS; Patient Determined Disease Steps score: 4–6) consented. Consent, retention, and adherence rates were 50.0%, 70.0%, and 86.9%, respectively. Six participants continued attending weekly training sessions one year later. Three participants reported eleven non-serious adverse events. Sessions elicited mean and peak HRs of 64.7±6.7% HRmax and 84.6±9.6% HRmax, respectively. Participants covered 1801±941 m per session, accumulating more steps at cadences ≥100 steps/min on training than non-training days (1756 vs. 767 steps). Conclusion: Frame Running appeared, for those who chose to participate, to present a feasible and safe community-based exercise option for pwMS with substantial mobility impairments, enabling participation in moderate-to-vigorous intensity exercise. Larger controlled trials are warranted to evaluate efficacy and address participation barriers.Item Short-Term Effects of Manual Therapy Combined with Functional Magnetic Stimulation in Individuals with Lumbar Disk Herniation with Radiculopathy: A Randomized Clinical Trial(MDPI AG, 2026-01-24) Lytras, Dimitrios; Iakovidis, Paris; Kasimis, Konstantinos; Georgoulas, Vasileios; Algiounidis, Ioannis; Kamparoudi, Georgia Maria; Tsigaras, Georgios; Tarfali, Georgia; Vergidou, Georgia; Sidiropoulos, Nikolaos; Zerva, Eleftheria; Kallistratos, IliasBackground and Objectives: Lumbar disk herniation with radiculopathy (LDHR) is a prevalent neuromusculoskeletal condition characterized by nociceptive and neuropathic pain components. Manual therapy (MT) is commonly used in its management, whereas Functional Magnetic Stimulation (FMS) represents an emerging modality with limited evidence in radiculopathy. The aim of this study was to examine the short-term effects of combining MT with FMS compared with MT alone on pain intensity, neuropathic pain features, neural mechanosensitivity, and functional disability in individuals with chronic LDHR. Materials and Methods: Forty adults with MRI-confirmed unilateral LDHR were randomly allocated to an MT + FMS group or an MT-only group. Both groups received ten treatment sessions over three weeks. Outcomes included lumbar and leg pain intensity (NPRS), functional disability (RMDQ), neuropathic pain symptoms (S-LANSS), and straight leg raise (SLR) range of motion. Measurements were obtained at baseline and at week 3. Group and time effects were examined using a two-way mixed ANOVA with significance set at p < 0.05. Results: Significant group × time interactions were observed for all outcomes (p < 0.01), indicating greater improvements in the MT + FMS group. Reductions in lumbar and leg pain, disability, and S-LANSS scores exceeded established MCID thresholds, while SLR gains surpassed published MDC values, reflecting both statistical and clinical relevance. Only the MT + FMS group improved below the neuropathic pain diagnostic cutoff (S-LANSS < 12). Conclusions: The findings of this trial suggest that incorporating FMS into a manual therapy program may provide additional short-term clinical benefits for individuals with chronic LDHR. Further research with larger samples, longer follow-up periods, and mechanistic assessments is needed to confirm these preliminary results and to better understand the underlying mechanisms.Item Exploring patients’ experiences of using Transcutaneous Electrical Nerve Stimulation for Claudication(Elsevier BV, 2025-12-13) Seenan, Chris; Hill, Stephanie; Abaraogu, Ukachukwu; McSwiggan, Stephen; Roche, Patricia A; Tan, Chee-Wee; Mercer, Tom; Belch, JillBackground Pain associated with claudication in peripheral arterial disease (PAD) is a key barrier to physical activity, limiting walking ability and impacting quality of life. Transcutaneous Electrical Nerve Stimulation (TENS) may offer non-pharmacological pain relief and has shown potential to improve walking performance. However, little is known about patients’ experiences using TENS in everyday life. Aim To explore the lived experience of using TENS at home among individuals with PAD and claudication. Methods Six participants with PAD and claudication received training in the use of a TENS device for home use during daily walking activities. After four weeks, experiences were explored through a focus group and an individual interview. Data were analysed using thematic analysis. Results Four themes emerged: Pain, Expectations, Usability, and Physical and social functioning. While some participants reported reduced pain and improved walking ability, others expressed disappointment when TENS did not fully meet their expectations. Variability in use and perceived benefit was influenced by prior knowledge, usability challenges, and personal preferences. Conclusions TENS may support self-management of claudication pain and enhance physical activity in some individuals with PAD. However, managing patient expectations and addressing device usability are essential to optimise outcomes. Healthcare practitioners may play a key role in supporting education, tailoring advice, and evaluating the appropriateness of TENS as part of individualised care plans.Item Development of an audio and visual toolkit to support mental health in athletes [Abstract](Hogrefe, 2025-10-24) Kent, Carolyn; McGuigan, MarkAthletes often experience significant emotional challenges including poor performance, negative thoughts, and difficulties with emotional regulation, all of which can impact their mental health and performance. Despite these challenges, only about 22%of elite athletes seek help for mental health concerns, highlighting barriers such as team culture and fears over confidentiality. Building on the ecological systems framework which emphasises mental health literacy and personal development, we developed a brief, accessible audio-visual toolkit targeting common emotional challenges in athletes. The mental health and recovery toolkit consisting of four short podcasts in audio and video format has episodes on ‘Dealing with Emotions’, ‘Dealing with Negative Thoughts’, ‘Dealing with Poor Performance’, and ‘Guided Progressive Muscle Relaxation.’ Each podcast provides specific strategies such as breathing exercises, mindfulness, and progressive muscle relaxation, supported by natural imagery and captions to enhance accessibility. Background videos include greenandblue spaces, designed to promote relaxation and focus. The toolkit is freely available online on all major podcast platforms and YouTube, enabling athletes to access support discreetly in environments like changing rooms or during travel. While podcasts have shown promise in health education and behaviour change, evidence specific to mental health outcomes in athletes is limited; therefore, the toolkit is positioned as an adjunct, not a replacement, for professional care. Further research is required to assess its effectiveness and potential for broader implementation in mental health literacy and athlete support strategies. Published in the poster and short oral presentation abstracts section of this conference report (Protecting Mental Health in Sport and Exercise (PROMISE) conference in Edinburgh (UK), 20–21 September 2025).Item FedFall: Federated Learning Based Framework for Fall Detection(IEEE, 2025-08-27) Pathan, Nazia; Yu, Hongnian; Vassallo, Michael; Koufaki, PelagiaFalls are the world’s second-leading cause of unintentional injury death and disproportionately affect older adults. Wearable sensor methods combined with machine learning (ML) have improved automatic fall detection, but conventional centralised training requires transmitting raw, privacy sensitive signals to the cloud. We propose FedFall, a novel Federated Learning (FL) framework that trains fall detection models collaboratively across distributed, privacy constrained devices(e.g., wearable and ambient sensors). Experiments use the fall specific subset of the UMFall dataset, excluding everyday activities that lie outside this study’s scope. Five architectures are evaluated Deep Neural Network (DNN), Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM), Bidirectional LSTM and a combination of CNN and LSTM. The DNN yielded the best performing results. While centralised baseline training started at just 41% accuracy, FL progressively improved performance, reaching 72% after successive communication rounds. This consistent convergence underscores FedFall’s effectiveness, enhancing detection accuracy while preserving the privacy of distributed sensor data.Item Relationships between lower limb proprioception and motor function, capacity and performance in children with upper motor neuron lesions: An exploratory study(Taylor & Francis, 2025-12-05) Marsico, Petra; Buchmann, Anke; Meier, Lea; Kläy, Andrina; van der Linden, Marietta; Mercer, Tom; van Hedel, Hubertus J.A.Aims: This exploratory study investigated relationships between three proprioceptive modalities - joint movement sense (JMS), joint position sense (JPS), and dynamic position sense (DPS) - assessed with the sensor-based Proprioception Measurement Tool (ProMeTo) and motor outcomes in children with upper motor neuron (UMN) lesions. Methods: In a cross-sectional study, 48 children with UMN lesions (mean age 11.0 ± 3.5; 27 girls) were recruited. Diagnoses included cerebral palsy, acquired brain injury, and other UMN-related conditions. Proprioception at the hip, knee, and ankle was assessed for JMS, JPS, and DPS. Motor outcomes included selective motor control, gait and balance, gross motor function, movement quality, and functional mobility. Statistical analyses comprised Mann-Whitney U, Wilcoxon signed-rank, and Spearman correlations (rho = ρ) tests. Results: Children who correctly identified all JMS directions across joints showed significantly better motor outcomes. Negligible to moderate correlations (ρ = 0.01-0.55) emerged between proprioceptive modalities and motor outcomes, with the strongest relationships found between JPS at the hip (ρ = 0.431-0.46) and ankle (ρ = 0.36-0.55) and outcomes related to motor function, movement quality, and mobility. Conclusions: Proprioceptive function, particularly JPS, shows moderate relationships with motor capacity and movement quality in children with UMN lesions. Further research is needed to confirm these associations and determine their clinical implications.Item Exploring the methodological quality and risk of bias in 200 systematic reviews: A comparative study of ROBIS and AMSTAR-2 tools(Cambridge University Press (CUP), 2025-10-27) Lunny, Carole; Jain, Nityanand; Nazari, Tina; Kosaner-Kließ, Melodi; Santos, Lucas; Goodman, Ian; Osman, Alaa A. M.; Berrone, Stefano; Dadam, Mohammad Najm; Brenna, Connor T. A.; Hussein, Heba; Dahdal, Gioia; Cespedes, Diana A.; Ferri, Nicola; Kanji, Salmaan; Chi, Yuan; Pieper, Dawid; Shea, Beverly; Parker, Amanda; Neupane, Dipika; Khan, Paul A.; Rangira, Daniella; Kolaski, Kat; Ridley, Ben; Berour, Amina; Sun, Kevin; Rad, Radin Hamidi; Ouyang, Zihui; Reid, Emma K.; Pérez-Neri, Iván; Barakat, Sanabel O.; Bargeri, Silvia; Gianola, Silvia; Castellini, Greta; Whitelaw, Sera; Stevens, Adrienne; Kolekar, Shailesh B.; Wong, Kristy; Major, Paityn; Bagheri, Ebrahim; Tricco, Andrea C.AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, version 2) and ROBIS are tools used to assess the methodological quality and the risk of bias in a systematic review (SR). We applied AMSTAR-2 and ROBIS to a sample of 200 published SRs. We investigated the overlap in their methodological constructs, responses by item, and overall, percentage agreement, direction of effect, and timing of assessments. AMSTAR-2 contains 16 items and ROBIS 24 items. Three items in AMSTAR-2 and nine in ROBIS did not overlap in construct. Of the 200 SRs, 73% were low or critically low quality using AMSTAR-2, and 81% had a high risk of bias using ROBIS. The median time to complete AMSTAR-2 and ROBIS was 51 and 64 minutes, respectively. When assessment times were calibrated to the number of items in each tool, each item took an average of 3.2 minutes per item for AMSTAR-2 compared to 2.7 minutes for ROBIS. Nine percent of SRs had opposing ratings (i.e., AMSTAR-2 was high quality while ROBIS was high risk). In both tools, three-quarters of items showed more than 70% agreement between raters after extensive training and piloting. AMSTAR-2 and ROBIS provide complementary rather than interchangeable assessments of systematic reviews. AMSTAR-2 may be preferable when efficiency is prioritized and methodological rigour is the focus, whereas ROBIS offers a deeper examination of potential biases and external validity. Given the widespread reliance on systematic reviews for policy and practice, selecting the appropriate appraisal tool remains crucial. Future research should explore strategies to integrate the strengths of both instruments while minimizing the burden on assessors.Item Integrating Sensors Data and Machine Learning for Enhanced ADL and Fall Detection Systems(IEEE, 2025-09-06) Pathan, Nazia; Yu, Hongnian; Vassallo, Michael; Koufaki, PelagiaDeveloping a fall-proof environment presents various challenges. Statistics show that falls are the leading cause of injury-related death among people aged more than 80. Fall detection and prediction systems can increase stability and safety to reduce the risk. One of the best ways to develop fall detection/ prediction systems (FDPS) is with multi-sensor (accelerometer, gyroscope, magnetometer) data by using machine learning algorithms. However, the challenges for getting this system are a selection of optimal sensors, a fusion of sensors and machine learning (ML) algorithms for the Fall Detection and Prediction System. This study analyses the impact of sensor integration, ML algorithms performance on integrated sensors, and individual data for the FDPS. To achieve the objective of this research, five publicly available multi-sensor datasets are used; a proposed feature selection algorithm is applied for sensor data selection and ML algorithms such as Decision Tree, Naive Bayes, K-Nearest Neighbour, Support Vector Machine, Adaboost, Gradient Boosting, and Random Forest are applied for fall prediction. The ML algorithm’s performance is significantly enhanced by using integrated sensors, achieving an accuracy of 100% on dataset d3. Among the algorithms tested, the Random Forest algorithm emerged as the best-performing model across all five datasets, d1 to d5, with an accuracy of 85%, 98%, 100%, 97%, and 41%, respectively. Additionally, evaluating the performance of individual sensors for predictions, the accelerometer was found to be the most effective sensor.Item Early mobilization in patients on venoarterial extracorporeal membrane oxygenation: A scoping review(Baishideng Publishing Group, 2025-08-26) Kanellou, Vasiliki; Kaliarntas, Konstantinos; Dounavi, Despoina Myrto; Patsaki, Irini; Kalpaxis, Dimitrios; Kourek, Christos; Dimopoulos, StavrosBACKGROUND Extracorporeal membrane oxygenation (ECMO) is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments. Patients that are supported with veno-arterial ECMO (VA-ECMO) are considered very-high risk patients to participate in any type of physical therapy (PT) or mobilization. However, cumulative evidence suggests that early mobilization of critically ill patients is feasible, safe, and efficient under certain circumstances. AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients. METHODS This is a scoping review that used systematic electronic literature searches (from inception until January 2025) on MEDLINE (PubMed), PEDro, DynaMed, CINAHL, Scopus, Science direct and Hellenic Academic Libraries. Snowball searching method was also applied. Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT, published in English and utilized any primary evidence study design. Studies on children, animals and patients placed on any other ECMO, secondary evidence, and ‘grey’ literature were excluded. RESULTS A total of 316 articles were retrieved and 13 were included in the study. Of those, 1 study was a randomized control trial, 4 retrospective studies, 4 retrospective cohort studies, 1 case series and 3 case reports. The sample size of the included studies ranged from 1 to 104 VA-ECMO patients, who were ambulated or received PT interventions, and mobilization frequency ranged from 2 per day to 4 per week. Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position. PT and early mobilization were associated with better weaning from mechanical ventilation, gradual reduction of inotropes and functional capacity improvement after ECMO discharge. CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times. High quality research on early mobilization in VA-ECMO patients is warranted.