Role
of Physiotherapy in Functional Recovery
Faisal Mousa Alotaibi1*, Mohamed
Al Marshod2, Osamah Keridis3
1 Physiotherapist, PSMMC, Riyadh
osama-kridis@hotmail.com
2 Physiotherapist, PSMMC, Riyadh
3 Physiotherapy Technician, PSMMC, Riyadh
Abstract : In the treatment of a
broad range of health issues, including musculoskeletal injuries, neurological
disorders, cardiac illnesses, and post-surgical rehabilitation, physiotherapy
is an essential component in the process of facilitating functional recovery.
The fundamental objective of physiotherapy is to restore optimum mobility,
improve physical function, and increase the overall quality of life of those
who have been impacted by an accident, disease, or handicap. Pain reduction,
muscle strengthening, joint mobility, balance, and coordination are all areas
that may be improved with the use of physiotherapy. This is accomplished
through the use of evidence-based therapies such as therapeutic exercises, manual
therapy, electrotherapy, gait training, and patient education. In addition to
this, it places an emphasis on early mobilization, the avoidance of secondary
problems, and the development of independence in activities of daily life. In
the treatment of neurological and chronic disorders, physiotherapy helps to
promote neuroplasticity, functional adaptability, and long-term self-management
and management. In addition, physiotherapy takes a comprehensive and
patient-centered approach to treatment, including not only the physical but
also the psychological and social elements of medical healing. A
physiotherapist's job description include not just rehabilitation but also
health promotion, injury prevention, and community-based care in addition to
rehabilitation functions. When taken as a whole, physiotherapy is an important
component of multidisciplinary healthcare, making a substantial contribution to
the functional recovery and long-term rehabilitation results.
Keywords: Physiotherapy; Functional
Recovery; Rehabilitation; Therapeutic Exercise; Quality of Life.
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INTRODUCTION
Physical
therapy, an ever-evolving and evidence-based healthcare specialty, is concerned
with the prevention, diagnosis, and treatment of impairments in motor skills,
balance, and general mobility at all stages of life. Its foundation is in the
scientific study of human motion and functional performance; in order to
diagnose and treat physical dysfunction, it draws on fundamental fields
including pathology, kinesiology, neurology, anatomy, and physiology. In
addition to alleviating current limitations, physiotherapy treatments aim to
forestall future problems and foster overall physical health. Physiotherapy has
transformed from an auxiliary or supporting function in modern healthcare systems
into an essential and pivotal part of functional recovery and rehabilitation,
acknowledged for the substantial impact it has on patient-centered treatment.
[1]
Physiotherapists
are versatile and may be found providing therapy in many different areas, such
as hospitals, rehabilitation centers, community health programs, workplaces,
sports arenas, and even patients' homes. Injuries both recent and long-term,
complications after surgery, problems with the nervous system or the heart and
lungs, deterioration with age, and abnormalities in birth defects or
developmental delays are among the many types of functional impairments that
these professionals treat. Physiotherapists maximize functional results by
thorough evaluation and personalized treatment planning. They use therapeutic
exercises, manual therapy, physical modalities, movement re-education, and
assistive methods. Enhancing rehabilitation, increasing quality of life, and
minimizing the risk of long-term impairment and reliance are all goals of physical
therapy, which places an emphasis on mobility efficiency, independence in ADLs,
and active patient engagement. [2]
Functional Recovery's Significance and Range
Restoring
one's independence in carrying out routine duties, interacting socially, and
participating in meaningful work and leisure activities is the goal of
functional rehabilitation, which is an all-encompassing and ever-improving
process. Rehabilitation is to restore maximum physical function, independence,
and meaningful engagement in daily life, rather than just reducing pain or
clinical symptoms. Functional recovery acknowledges that health is
multi-faceted and encompasses not only bodily capacities but also mental
health, emotional strength, and social integration.
In
line with this idea is the International Classification of Functioning, Disability,
and Health (ICF) developed by the World Health Organization. The ICF takes into
account impairments in body structure and function as well as limitations in
activity and restrictions in participation when assessing a person's overall
health. [3] According to this model, the goal of functional recovery is to
reduce impairment and increase potential functionality by taking into account
both intrinsic and extrinsic variables. By methodically addressing mobility
impairments, strength deficiencies, balance disorders, coordination issues, and
endurance limits that impede everyday functioning, physiotherapy provides a
crucial and strategic role in aiding functional rehabilitation.
Safe
and progressive reintegration into daily life or activities close to it may be
achieved via physiotherapy's evidence-based rehabilitation methods. To provide
meaningful and lasting rehabilitation, individualized treatment programs are
devised taking into account functional evaluation, patient objectives, and
contextual considerations. Physiotherapy greatly aids in the improvement of
independence, social involvement, and quality of life by increasing physical
performance, improving confidence, and promoting active participation. [4]
The Role of Physiotherapy in Musculoskeletal Recovery
All
age groups are affected by musculoskeletal problems, which may lead to
discomfort, limited mobility, and impaired function. These illnesses include
fractures, osteoarthritis, rheumatoid arthritis, ligament and tendon injuries,
damage from sports, and conditions that occur after surgery. Reduced joint
range of motion, weak muscles, decreased coordination, and trouble with
everyday tasks are common symptoms of these disorders, which may have a detrimental
impact on an individual's independence and quality of life. When it comes to
managing musculoskeletal problems, physiotherapy is crucial and supported by
research. Its main goals include pain relief, mobility restoration, strength
and endurance increase, and the correction of abnormal movement patterns. [5]
To
help with healing and getting back to normal functioning, physiotherapists use
a broad variety of techniques. Therapeutic exercises are designed to help
patients become more mobile, build strength in weak areas, increase stamina,
and get their range of motion back to normal. Pain relief, better joint
mechanics, and increased tissue extensibility are all goals of manual therapy,
which includes manipulation, mobilization, and soft tissue methods. Moreover,
physical modalities including ultrasound, electrical stimulation, heat/cold
treatment, and laser therapy are often used to help with tissue repair,
inflammation reduction, and pain alleviation at various points in the recovery
process.
In
order to avoid compensatory tactics that might result in more injuries or
long-term health problems, physiotherapy can detect and treat biomechanical
imbalances, postural deviations, and movement dysfunctions. [6] Safely
returning to work, sports, and other everyday activities is possible with the
help of functional training and task-specific exercises. Because it shortens
recovery time, decreases reliance, speeds healing, and lowers the risk of
stiffness and muscular atrophy, early and well directed physiotherapy
intervention is very important. Physiotherapy is crucial in avoiding long-term
impairment and recurrence of musculoskeletal issues, in addition to
facilitating efficient recovery.
The function of physical therapy in neurological
recovery
Functional
deficits impacting mobility, posture, balance, coordination, and general
autonomy are common outcomes of neurological disorders including stroke,
traumatic brain injury, multiple sclerosis, cerebral palsy, Parkinson's
disease, spinal cord injury, and Parkinson’s disease. Weak muscles, spasticity,
poor sensation, reduced motor control, trouble walking, and trouble with ADLs
are all possible outcomes of these disorders. By methodically and
goal-orientedly treating these complicated deficits and encouraging the
restoration of functional mobility, physiotherapy is an essential component of
neurological rehabilitation. [7]
Physiotherapy
for neurological disorders mainly aims to enhance gait patterns, balance,
coordination, postural stability, and motor control. Improving movement
efficiency and functional independence is a common goal of many evidence-based
therapies, including task-oriented training, neurodevelopmental approaches,
functional gait training, balance re-education, and proprioceptive
neuromuscular facilitation. Neuroplasticity refers to the brain's capacity to
rearrange and create new connections between neurons in response to experience
and training; these therapies aim to promote this process. Motor learning and
functional restructuring of the nervous system may be facilitated by
physiotherapy through repeated practice of functional activities in meaningful
circumstances. [8]
Physical
therapy not only aids in functional rehabilitation, but it also serves an
important preventative role by reducing the likelihood of subsequent problems
that are often seen in neurological illnesses. Respiratory physiotherapy
promotes efficient breathing and lessens the likelihood of pulmonary problems;
regular mobility, stretching, and positioning exercises aid in the prevention
of joint contractures, muscle shortening, pressure ulcers, and postural
deformities. People with neurological conditions can greatly benefit from
physiotherapy because it is an individualized, long-term intervention that
helps them adapt functionally, boosts their confidence, and encourages them to
be active in their social, occupational, and community lives.
Physiotherapy's Function in Cardiopulmonary
Recuperation
An
individual's functional capacity, exercise tolerance, and overall endurance can
be significantly affected by cardiopulmonary conditions such as asthma, COPD,
ILD, heart failure, post-cardiac surgery, and post-COVID-19 implications.
Breathlessness, exhaustion, impaired aerobic capacity, and impaired ability to
carry out ADLs are common signs of these disorders, which may lead to physical
deconditioning and a worse quality of life. When it comes to managing and
helping people recover from cardiopulmonary illnesses, physiotherapy is crucial
because it addresses both the limits of the respiratory system and the
circulatory system. [9]
Respiratory
exercises, airway clearing methods, chest physiotherapy, cardiovascular
conditioning, and progressive exercise training are all part of cardiopulmonary
rehabilitation's physiotherapy approach. Diaphragmatic breathing, pursed-lip
breathing, and thoracic expansion exercises are some of the breathing methods
that might help you breathe more efficiently and with less effort. Improved
lung function and oxygenation may be achieved with chest physiotherapy by
moving and eliminating respiratory secretions. Individualized aerobic and
endurance training regimens improve patients' cardiovascular fitness, muscular
efficiency, and exercise tolerance, letting them go about their everyday lives
with less exhaustion and shortness of breath.
Patients
may progressively rebuild physical endurance, self-confidence, and functional
independence in a safe and supervised setting via structured cardiac and
pulmonary rehabilitation programs directed by physiotherapists. Patients in
these programs learn how to save energy, how to pace themselves, and how to
make positive changes to their lifestyle, such as giving up smoking and
increasing their physical activity levels. Reducing healthcare expenditures,
improving long-term survival rates, and speeding up functional recovery are all
possible outcomes of therapies guided by physiotherapy. Physiotherapy
dramatically improves functional capacity, quality of life, and long-term
cardiopulmonary health by promoting regular physical exercise and good
lifestyle behaviors. [10]
Early Physiotherapy Intervention's Significance
In
order to achieve the best possible functional recovery after an accident,
surgery, or sickness, it is essential to begin physical therapy as soon as
possible. Muscle atrophy, stiff joints, decreased flexibility, impaired neuromuscular
coordination, impaired cardiovascular endurance, and other secondary problems
are common outcomes of poor or postponed rehabilitation. [11] Mental health
problems including worry, despair, and decreased motivation may worsen from
being immobile for an extended period of time, making rehabilitation much more
difficult. Thus, to avoid functional deterioration and encourage active
recovery, it is crucial to begin physiotherapy at the earliest suitable stage.
Prompt
mobilization, preservation of joint mobility, and preservation of muscular
strength and endurance are the tenets of early physiotherapy intervention.
Reducing the risk of muscular atrophy, blood vessel problems, and stiffness is
the goal of gentle therapeutic exercises, positioning techniques, and aided
movements. When it comes to respiratory treatment, ambulation, safe bed
mobility, and transfers, physiotherapists are invaluable in acute care settings
like ICUs and post-operative wards. When it comes to boosting oxygenation and
reducing pulmonary problems, techniques including breathing exercises, airway
clearing, and posture control are crucial. [12]
Early
rehabilitation has many advantages, according to strong clinical data. These include
better functional results, a quicker return to independence, and a shorter
hospital stay. By decreasing complications, readmissions, and total healing
time, early physiotherapy also helps to minimize healthcare expenses. A
critical factor in achieving functional recovery and long-term functional
independence is the timely implementation of physiotherapy interventions, which
comprehensively treat physical limitations. [13]
A customized and patient-focused approach to
rehabilitation
Since
functional recovery is more of a journey than a destination, one of the
cornerstones of physiotherapy is tailoring treatment to each patient's unique
needs. Considerations such as age, illness kind and severity, comorbidities,
level of physical fitness, dietary habits, psychological variables, and
individual objectives greatly impact each person's recovery potential and
rehabilitation requirements. [14] By taking these distinctions into account,
physiotherapists may create treatments that are practical, applicable, and in
line with the patient's goals for functional improvement.
Physiotherapists
start patients out on the road to recovery by doing a thorough examination of
their range of motion, strength, flexibility of joints, balance, stamina, pain
tolerance, and functional capacities. This evaluation is the foundation for creating
unique treatment programs to overcome functional restrictions and impairments.
Rehabilitation is kept goal-oriented and successful by regularly modifying
interventions based on the patient's progress. By customizing the technique,
functional deficiencies may be more precisely targeted, leading to better
recovery results. [15]
In
patient-centered physiotherapy, the patient plays an integral role in their own
treatment. Patients are motivated to actively participate in their own healing
by working together to establish goals, learning about their illness, and
creating techniques for self-management. Patients are given the tools they need
to continue making progress even after they leave the clinic, including
education on ergonomics, home exercise routines, and lifestyle adjustment. In
addition to increasing the efficacy of therapy, this interactive and
individualized method boosts patients' confidence, motivation, and compliance.
Significance, durability, and sustainability of functional recovery are guaranteed
via physiotherapy's attention to each patient's specific physical,
psychological, and functional requirements. [16]
Physiotherapy for the Functional Recovery of the
Elderly
There
is a consistent association between aging and a progressive reduction in
physical function, muscular strength, flexibility, balance, and mobility. These
factors, when taken together, increase the risk of falls, accidents, and
functional reliance in older persons. Physiological changes that are associated
with aging, when coupled with the presence of chronic illnesses, often result
in decreased levels of activity, dread of movement, and a loss of independence
in tasks that are performed on a daily basis. A significant contribution that
physiotherapy makes to the aged population is the promotion of functional
recovery, the prevention of disability, and the support of healthy and active
aging within this demographic. [17]
The
primary goals of physiotherapy therapies for older persons are to preserve and
enhance the patient's strength, balance, coordination, endurance, and
functional mobility. Exercises that focus on balance and proprioception may
considerably minimize the chance of falling, while structured strength training
programs can assist prevent the loss of muscle mass that is inevitable with
advancing age. Training in gait and functional task practice, such as exercises
that include sitting to standing and negotiating stairs, improve mobility and
confidence in the ability to carry out tasks that are performed on a daily basis.
The therapies in question are intended to be risk-free, progressive, and
tailored to the specific physical capabilities and health conditions of the
person.
In
addition, physiotherapy is an excellent treatment for age-related illnesses
such as osteoporosis, osteoarthritis, chronic back pain, and post-fracture
rehabilitation, especially in cases when the patient has suffered a fracture to
the hip or vertebral bone. Through the treatment of pain, the restoration of
mobility, and the correction of posture, physiotherapy assists older adults in
regaining their functional independence and preventing these issues from
occurring further. Physiotherapy dramatically enhances quality of life, social
engagement, and general well-being in older persons. It does this by increasing
physical capability, promoting confidence in mobility, and encouraging active
participation. This enables older adults to keep their autonomy and dignity in
later life. [18]
Preventive and Promotive Role of Physiotherapy
In
addition to its function in rehabilitation, physiotherapy also plays a vital
role in the prevention and promotion of a healthy lifestyle. Its primary
objective is to avoid accidents, the recurrence of diseases, and the loss in
functional capacity via the provision of education, ergonomic guidance, and
exercise prescription. Physiotherapy practice includes a number of essential
components, including ergonomics in the workplace, programs to avoid sports
injuries, and initiatives to modify lifestyles. Physiotherapy helps lessen the
burden of non-communicable illnesses and disability by encouraging exercise and
good movement patterns. This is accomplished via the promotion of physical
activity. This proactive strategy helps to contribute to functional well-being
over the long run and lowers the need for medical treatments. [19]
Multidisciplinary Approach in Functional Recovery
Recovery
from functional impairment often calls for a coordinated and interdisciplinary
strategy that includes the participation of medical professionals, nurses,
occupational therapists, psychologists, and social workers. Movement-based
therapies that are complementary to medical and surgical treatments are
provided by physiotherapy, which is an essential part of this team.
Comprehensive and holistic treatment may be ensured via effective communication
and coordination among individuals working in the healthcare industry.
Physiotherapists are also essential in the process of discharge planning and reintegrating
patients into the community. The total efficiency of rehabilitation programs is
improved by physiotherapy, which also helps to maintain sustained functional
recovery. This is accomplished via the cooperation of professionals from many
fields. [20]
From
the perspective of functional recovery, physiotherapy performs a role that is
both broad and important across a wide range of health problems and demographic
groups. The treatment of physical impairments, the enhancement of functional
capacities, and the promotion of independence are all ways in which physiotherapy
contributes to a material improvement in quality of life. Taking a
patient-centered, evidence-based, and comprehensive approach to treatment
provides both short-term healing and long-term well-being for the individual.
Physiotherapy is becoming an increasingly important component of modern
healthcare practice as it continues to play an increasingly important part in
functional recovery. This is due to the fact that healthcare systems are increasingly
placing an emphasis on rehabilitation and quality of life. [21]
OBJECTIVES
- To investigate how
physiotherapy therapies might help people with physical limitations become
more independent, mobile, and functioning.
- To investigate the efficacy of
physiotherapy in facilitating functional recovery in patients suffering
from musculoskeletal, neurological, cardiac, and geriatric diseases.
MATERIAL AND METHODS
Databases and search strategy
During the month of March 2021, we conducted research
using the following databases: Web of Science, PubMed, Scopus, and the BRAIN
resource search engine that is maintained by Universidad Rey Juan Carlos
(Manchester). For the purpose of this study, the following keywords were
utilized: "physical therapy," "physiotherapy,"
"rehabilitation," "functional movement disorders,"
"functional motor symptoms," and "psychogenic motor
symptoms," all of which were mixed using the Boolean operator AND (Table
1). We looked at procedures that were published in journals and manually examined
the references that were referenced in the papers that we acquired from our
literature search in order to find studies that were relevant to our
investigation. [22]
Eligibility criteria
We established the following inclusion criteria:
- Study
type: randomized, controlled studies that have been
published since 2013 and have been reported in either English or Spanish
- Participants: people
who have been diagnosed with FMD were included in the research.
- Type
of intervention: investigations of the effects of specialized
physical therapy treatments, either on their own or in conjunction with
other therapies in a multidisciplinary approach, as well as comparisons
between the effects of a specialized physical therapy intervention and
those of normal physical therapy
- Outcome
measures: Evaluations of changes in motor symptoms,
activity (gait, mobility, and balance), perceived health status, quality
of life, or cognitive or emotional state are included in this research. [23]
Data was collected on the sample that was included in
each research, the inclusion and exclusion criteria were applied, outcome
measures were obtained, treatments were outlined, and data was collected on the
result of the intervention. In order to assess whether or not the papers that
were collected satisfied the inclusion criteria, one of the writers of this
research went through the titles and abstracts of the publications. It was
determined that the complete texts of publications that could have satisfied
all of the inclusion criteria were scrutinized in further depth. The author,
together with another researcher, was responsible for making the ultimate final
selection of papers. [24]
Evaluation of methodological
quality and risk of bias
For the purpose of evaluating the methodological
quality and objectiveness of the studies that were included, the Oxford Quality
Scoring System was used. Scores below three indicate a lack of methodological
quality, scores between three and four suggest a moderate level of
methodological quality, and a score of five indicates a high level of
methodological quality.
[25]
We used the Cochrane risk of bias tool to evaluate the
potential for bias in each trial. This tool evaluates a number of factors,
including random sequence generation, allocation concealment, blinding of
participants and personnel, blinding of outcome assessment, incomplete outcome
data, selective outcome reporting, and other potential sources of bias. A
rating of low, high, or uncertain may be assigned to each domain based on the
potential for bias. Within the framework of the PRISMA statement, the literature
evaluation was carried out in accordance with its recommendations. The primary
author conducted an analysis of the methodological quality as well as the
potential for bias.
Study selection
The total number of articles that were retrieved was
360; only 186 original articles were retained for the purpose of evaluation
after duplicate articles were removed. With the purpose of determining whether
or not the publications in question were relevant to our evaluation and
satisfied the inclusion criteria, we examined the abstracts of possibly
eligible papers. At long last, we decided to include four research, which
reported data from a total of 188 people. The procedure for selecting the
studies to be conducted is outlined in the flow chart shown in Figure 1. [26]
Study characteristics and
synthesis of results
As a component of the therapeutic intervention,
physical therapy was used in each of the four investigations. A specialized
education-based physical therapy program, movement retraining (to restore
normal function by shifting attentional focus), and a self-management plan
utilizing a workbook were all used in two separate investigations. [27] According to the findings of
one research, integrating physical therapy with cognitive-behavioral treatment
should include the use of distraction tactics, motor strategies to minimize
tremor, and walking at a low to moderate intensity. Within the context of a
multidisciplinary cognitive-behavioral framework, the remaining research
established a program of tailored physical exercise. [28] The three primary components
of the intervention were the explanation of symptoms, the positive
reinforcement of normal function, and the avoidance of the positive
reinforcement of dysfunction.
Individuals in the control groups were typically
provided with normal medical treatment or routine physical therapy. In one of
the trials, the control group did not get any kind of physical therapy. In the
other research, the control group got the same treatment as the intervention
group, but the treatment began four weeks later. [29]
Figure 1
Flow chart illustrating the study selection process.
Two of the studies used outpatient interventions,
whereas the other two studies utilized inpatient programs. [30] Outpatient interventions were
employed in two of the investigations.
RESULTS
The length of each session varied from forty-five to
ninety minutes every day; however, this information was not included in the
research conducted by Jordbru et al. There was a significant amount of
variation in the duration of the intervention. In one study, the participants
were subjected to intensive treatment for a period of five consecutive days. In
another study, the intervention lasted for three weeks. In yet another study,
the intervention was designed to last for twelve weeks, with two sessions per
week. However, in the study conducted by Teodoro et al., the duration of the
intervention was not specified. [31]
Every single study included a follow-up period for the
participants following the intervention, and the duration of the follow-up
period varied from four weeks to one year. In two of the studies, participants
were only required to attend a single follow-up consultation. However, in the
other two studies, they were evaluated at two distinct time points: the first
time was at one-third of a month after the intervention, and the second time
was at six to twelve months after the intervention.
Physical therapy, as shown by the findings of this
research, is effective in improving motor symptoms, activity levels, quality of
life, and the perception of one's overall health state.
Motor symptoms and activity
The outcome measures that were used to evaluate motor
function differed from study to study. Surface electroencephalography was used
by Teodoro and colleagues in order to investigate motor performance, response
time, and beta-frequency cortical oscillations while performing reaction time
tasks with both predictive and nonpredictive signals. They discovered that
individuals with FMD did not see an improvement in their response times when
the cue was predictive of the movement that was about to occur. [32] During the motor preparation
process, these patients exhibited persistent beta synchronization and a lack of
lateralized beta desynchronization. This may be explained by the defective
explicit movement control that was found in these patients as a consequence of
excessive self-directed attention. In light of the fact that event-related beta
desynchronization shows movement preplanning and preparation, this alludes to
poor motor performance for the individual.
[33]
The Berg Balance Scale, the Timed 10-Meter Walk Test,
the Functional Mobility Scale, the Disabilities of the Arm, Shoulder, and Hand
questionnaire, and the Brief Illness Perception Questionnaire all showed signs
of improvement after the intervention, according to Nielsen et al. 72% of
patients in the intervention group reported an improvement in their perception
of motor symptoms, while only 18% of patients in the control group reported
such an improvement. Using the Functional Mobility Scale and the Functional
Independence Measure, Jordbru et al. observed substantial improvements in gait
and functional independence. These gains were assessed. During the follow-up
period of one month and one year, these improvements remained unchanged.
Quality of life and perceived
health status
Upon completion of the physical therapy program,
Teodoro and colleagues found that the participants' scores on the physical
function domain of the Short Form-36 Health Survey (SF-36) were significantly
improved. The same thing happened with Nielsen et al., who found that there
were substantial gains in three different areas of the SF-36: social function,
physical role, and physical function.
[34]
After receiving therapy, Jordbru et al. found that the
patient saw substantial improvements in both the physical and mental categories
of the SF-12. Nevertheless, throughout the subsequent conversation, these
enhancements continued to be significant since they were not limited to the
physical world.
According to the findings of the research conducted by
Dallocchio and colleagues, the controls showed significant improvements in the
severity and functional impact subscales of the Psychogenic Movement Disorders
Rating Scale after therapy.
[35]
Cognitive and emotional status
There were a number of research that looked at anxiety
and depression. The Hospital Anxiety and Depression Scale was used by Nielsen
et al., who discovered that there were no significant differences between the
groups included. Secondary outcome measures were used in the research conducted
by Dallocchio and colleagues. These measures included the scores on the Beck
Anxiety Inventory and the Hamilton Depression Rating Scale.
This table provides a summary of the features of the
study.
Assessment of methodological
quality
The Oxford Quality Scoring System found that three of
the studies offered a methodological quality that ranged from moderate to high,
while the other one presented a methodological quality that was low. Because of
the nature of the intervention, the participants in any research were not blind
to the therapy, and either the raters or the participants themselves were not
blind in certain instances.
[36]
Assessment of risk of bias
In two of the investigations, the randomization method
was a source of uncertainty about the potential for bias, whereas the risk of
bias was minimal in the other two trials. There was a minimal risk of bias in
all of the investigations since there were variations from the treatments that
were planned. A minimal risk of bias was exhibited by each of the studies since
there was a lack of outcome data. A substantial risk of bias was found in the
measurement of the outcome in two of the investigations, whereas the risk of
bias was found to be minimal in the other two studies. Every single one of the
four trials had a minimal risk of bias as a result of selective outcome
reporting. With regard to the overall risk of bias, none of the studies were
evident (Figs. 2 and 3).
[37]
In recent years, there has been an increasing interest
in patients with FMD from both a clinical and scientific perspective. This can
be seen in the vast number of publications that have been published on the
subject over the course of the last decade. FMD may be recognized using the
diagnostic criteria that are now in use; however, diagnosis is not predicated
on the exclusion of other conditions. The pathophysiological and neurological
reasons of the condition are still largely unknown, and there is a lot that is
still unknown. [38]
Neuroimaging has been an essential component in
determining and redefining our knowledge of frontotemporal dementia (FMD). As a
result of these research, anatomical and functional abnormalities in the
central nervous system have been revealed. These abnormalities include enhanced
regulation by the limbic system as well as hypoactivation of cortical and
subcortical motor pathways. A defective control of motor action and
inappropriate emotional processing are hypothesized to be present in these
individuals, according to neurobiological hypotheses.
It is generally agreed upon that specialized
multidisciplinary units should be responsible for providing therapy for
patients suffering from FMD. Retraining your activity level is the primary
focus of treatment, and physiotherapists play an important part in this
process. In accordance with the paradigm of the International Classification of
Functioning, Disability, and Health (ICF), patients are diagnosed on the basis
of the existence of certain deficiencies. However, in order to assess activity
limitation and participation restriction, special methods are required to be
used. [39]
An examination of the most current scientific
information about physical therapy for FMD is presented in this review. It is
necessary for treatment to include many disciplines, with the goals of
educating patients about their condition, achieving motor retraining, and
providing tools for self-care. The improvement of motor symptoms and activity
via specialized physical therapy programs leads to an improvement in both the
individual's perception of their health condition and their quality of life.
There was not a single study that did not analyze
specialized physical therapy therapies that was included in our evaluation. [40] A single individual was the
only one to mix cognitive-behavioral therapy with physical treatment.
Education, movement retraining, and a self-management plan are the three
pillars that form the foundation of physical therapy practices, as was
described before. It is necessary for patients to get education in order for
them to comprehend their diagnosis and symptoms and make an active contribution
to their therapy. The goal of movement retraining is to demonstrate to patients
that normal mobility may be achieved within the framework of their regular
routines at home. Minimizing self-directed attention via distractions such as
music, variations in rhythm, and tapping is essential to the process of
retraining. This diminishes cognitive control of movement, which ultimately
results in movement being more automatic. In order to retrain movement, motions
are first disassembled into fundamental motor components that are asymptomatic.
These components are then reorganized in order to restore a normal movement
pattern. Neurorehabilitation makes use of the main principles of movement
retraining in this process. These principles include the repetition of
task-oriented exercises, the progressive increase in the complexity of the
task, and feedback strategies such as mirror training, films, electromyography,
and so on. One last thing that is absolutely necessary is a self-management
strategy, which is often based on the use of a workbook. Strategies that are
intended at normalising movement are included in the contents of the workbook.
Additionally, a list of circumstances that precipitated and perpetuated the
movement, indicators of improvement, and future objectives are given. [41]
Table 1:
Summary of results
|
Study |
Patients |
Intervention |
Outcome
Measures |
Results |
||||
|
Dallocchio
et al. [44] |
IG: n =
11 CG: n = 10 Age: 34.7 years (SD: 10.1) Sex: 2 M / 9 W Symptom duration:
17.1 months (SD: 12.9) |
IG:
CBT, 90 min (1 session/week) CG: CBT + APA (distraction techniques, motor
strategies to reduce tremor and gait impairment), 2 × 60 min sessions/week
CG: standard care |
Primary:
PDRS at T0 and T1 Secondary: HADS BAI PHQ-15 |
The
total PDRS score showed a significant improvement in the primary outcome,
whereas the 2 PDRS subscales and HADS, BAI, and PHQ-15 scores presented
secondary outcomes. Improvements were observed between baseline (T0) and
post-intervention scores (T1) in primary and secondary outcomes in both IG (p
< 0.05) and CG (p < 0.05). No changes were observed in the CG (p >
0.05). No differences were observed between the two IGs (p > 0.05). |
||||
|
Teodoro
et al. [45] |
IG: n =
11 Age: 33.7 years (SD: 7.9) Sex: 4 M / 6 W Symptom duration: 20.7 months
(SD: 10.5) CG: n = 8 Age: 32.9 years (SD: 9.8) Sex: 2 M / 6 W Symptom
duration: 9.8 months (SD: 7.6) |
IG: EEG
analysis of motor performance and beta-frequency cortical oscillations during
reaction-time tasks |
SF-36 |
Reaction
times were similar between patients receiving predictive and non-predictive
cues, both at baseline (p > 0.05) and after intervention (p > 0.05).
However, in the IG, predictive cues showed a trend toward a contralateral
hemisphere (mean = −0.086 μV, CI 95%: −0.33 to 0.19; p =
0.166). |
||||
|
Teodoro
et al. [46] |
Age:
42.7 (SD: 12.1) Sex: 4 M / 7 W Diagnosis of FMD; main symptoms were weakness
(n = 11) and tremor (n = 8) |
11
patients received specialised physical therapy (education, movement
retraining, and self-management plans) and 12 patients received standard
physical therapy CG: no intervention Treatment: not described Follow-up:
after a mean of 4.7 weeks |
EEG,
reaction time, and beta power |
After
treatment, the IG showed higher scores on the physical function domain of the
SF-36 (mean [SD] of 30 [21.6] at onset vs 40 [30] at follow-up; p = 0.029). |
||||
|
Nielsen
et al. [47] |
IG: n =
13 Age: 41.2 (SD: 14.4) Sex: 4 M / 9 W Healthy individuals: IG: n = 29 CG: n
= 28 Age: 44 years (SD: 13.1) Sex: 8 M / 22 W Symptom duration: 5.9 years
(SD: 8.3) |
IG: 8
sessions (45–90 min) of specialised physical therapy (education, movement
retraining, and self-management plan) for 5 consecutive days. Explanation of
diagnosis before intervention CG: standard physical therapy (1–17 sessions)
Treatment: 5 consecutive days Follow-up: at 4 weeks and at 6 months |
SF-36
QALY HADS EQ-5D-5L WSAS |
At 6
months, the IG showed higher scores in 3 domains of the SF-36: physical
function (p = 0.01), physical role (p = 0.037), and social function (p =
0.007). There was also a significant improvement between the BDS (p = 0.01),
FMS (p = 0.03), PHQ-15 (p = 0.015), and WSAS. No significant differences were
observed in the remaining scales. Motor symptoms improved in 72% of
individuals in the IG, vs 18% in the CG. Symptoms worsened at 6 months in 32%
of individuals in the CG, vs 3% in the IG. At QALY, the IG achieved a 0.08
QALY gain. Cost-effectiveness analysis indicated the intervention was
cost-effective. |
||||
Figure 2:
Traffic light plot for risk of bias.
Figure 3:
Bar plot for risk of bias.
DISCUSSION
The trials that were included in our evaluation used
programs that were very diverse, both in terms of the number of sessions that
were conducted and the length of time that each session lasted, as well as the
overall intervention. During the course of two of the trials, interventions
were carried out on an outpatient basis, whereas the other two investigations
used inpatient programs. In a general sense, inpatient treatment programs are
more intense than outpatient programs. In contrast, the majority of the
therapies consisted of inpatient programs in other studies that were not
included in our evaluation. These studies covered both prospective and
retrospective research. On the other hand, there have been published studies of
outpatient therapies that involve large samples and indicate positive effects.
Some of these studies use a mixed design, in which patients first finish an
inpatient rehabilitation program and then go on to a supervised, home-based
self-management plan.
For the selection of participants, the majority of
studies selected people based on pre-established inclusion criteria that were
comparable to those suggested by Gupta and Lang.
Long follow-up periods were included in each and every
study, and patients were observed throughout the course of both the medium and
long term. Considering the chronic nature of the condition and the need to
determine if the advantages of the intervention are long-lasting, this appears
to be a sensible conclusion to reach.
[42]
Changes were evaluated using a variety of outcome
measures, which varied according to the factors that were examined. These
included motor symptoms, activity and quality of life, perceived health status,
cognitive and emotional state, and perceived health status. There was a
significant increase in scale scores across all of the trials that included the
physical therapy intervention. Some researchers have concentrated their efforts
on the creation of evaluation instruments that are tailored particularly for
functional movement disorders (FMD). These tools include the Psychogenic
Movement Disorders Rating Scale and the Simplified Functional Movement
Disorders Rating Scale, which was developed more recently. These scales have
been evaluated by a number of writers, who have then provided suggestions for
the outcome measures that are the most suitable. Despite the fact that the process
of standardizing specialized physical treatment for individuals with FMD is now
under progress, the techniques that have been offered by various authors
continue to exhibit inconsistencies. Considering the vast population that was
included in the research as well as the fact that it covered both inpatient and
outpatient therapies, the multicenter study that was conducted by Nielsen and
colleagues may provide some insight into some of these concerns. [43]
Recent years have seen the implementation of telerehabilitation
programs in clinical settings. These programs include those developed by
Gelauff et al., in which patients were provided with access to a website that
offered non-guided education and self-help in addition to the standard care
that they received, and those developed by Demartini et al., who combined
in-person sessions with telemedicine sessions. It has not yet been decided if
telerehabilitation on its own is adequate or whether it should be used within
the framework of a multidisciplinary treatment program that takes place in
person. There is no question that the introduction of new technology has made
it possible for patients and therapists to communicate more effectively, hence
enhancing patients' access to pertinent information on their health.
This systematic review has a number of shortcomings
that need to be addressed. First of all, it only contains a small number of
research, which led to a restricted number of patients being included in the
sample. [48] Second,
the intervention was different in each of the studies we looked at. In
addition, the number of sessions and the length of time spent in each session
differed from study to study, which prevented us from making an objective
comparison of the outcomes. Due to the fact that we only considered research
that were published in either English or Spanish, it is possible that we
overlooked studies that were published in other languages. [49]
Physical
therapy is an essential component in the treatment of patients who have Functional
Movement Disorders (FMD). It makes a substantial contribution to the
alleviation of motor symptoms, the enhancement of daily activity performance,
the enhancement of perceived health, and the enhancement of overall quality of
life. Patients often have improved motor control and a better degree of
independence when it comes to conducting activities of daily living when they
participate in focused therapies such as task-specific exercises, gait
training, balance and coordination exercises, and functional mobility practice.
Additionally, physiotherapy has the potential to have a beneficial effect on
psychological well-being by lowering stress levels associated with disability
and fostering a sense of self-efficacy, both of which contribute to the
enhancement of functional recovery. Despite the fact that these advantages have
been identified, the present research suggests that there is still a
substantial need for further studies that are of a high quality and are well
structured in order to completely examine the efficacy of physical therapy in a
variety of clinical settings and patient types. To be more specific, the
objective of research should be to find the best intensity, frequency, and
length of treatments, as well as to develop tailored treatment techniques that
cater to the specific requirements of each particular patient. Furthermore, it
is vital to construct outcome measures that are both reliable and sensitive in
order to properly evaluate gains in motor function, activity engagement, and
quality of life. This will enable clinicians to make choices based on evidence
and successfully customize rehabilitation techniques. Providing greater
clinical advice, optimizing therapy results, and improving the overall care of
patients with FMD are all possible objectives that might be achieved by future
research that address these gaps.
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