Salem F. Alatawi

Background: In Saudi Arabia, stroke incidence is 29.8 cases per 100,000 inhabitants annually, and Hemiplegic shoulder pain (HSP) is a prevalent issue after stroke, affecting approximately 47% of patients with stroke. This study aimed to assess physiotherapists’ knowledge, attitudes, and practices toward Hemiplegic Shoulder Pain (HSP) management in Saudi Arabia.Methods: This cross-sectional study included 523 physiotherapists who treated patients with stroke between August and November 2023 in Saudi Arabia. An online survey was administered to the physiotherapists. The questionnaire comprised four main parts, covering sociodemographic characteristics, participants’ knowledge, attitudes, and current practices regarding HSP, HSP assessment, and HSP management.Results: A total of 300 (57.63%) participants responded. The results showed that 48% of the participants treated 1–5 patients with stroke in their daily practice. In addition, 46.3% of the participants reported that up to 75% of the patients with stroke they treated experienced HSP. Furthermore, the most commonly used interventions to manage HSP were repetitive task-specific practice, functional strengthening exercises, and range of motion exercises. A notable correlation was observed between the participants’ educational level and experience and their responses regarding their knowledge and attitudes toward HSP.Conclusion: Physiotherapists in Saudi Arabia demonstrated positive attitudes, knowledge, and practices toward HSP rehabilitation. The complex challenges related to HSP rehabilitation highlight the importance of sharing knowledge and information, teamwork, and up-to-date exercise practices for the effectiveness of HSP rehabilitation.

Background/objective: Tailoring involves adapting research findings and evidence to suit specific contexts and audiences. This study examines how international stroke guidelines can be tailored to address gait issues after a stroke. Methods: A three-phase consensus method approach was used. A 10-member health experts panel extracted recommendations from three national clinical guidelines in the first phase. In the second phase, 362 physiotherapists completed an online questionnaire to assess the feasibility of adopting the extracted recommendations. In the third phase, a 15-physical therapist consensus workshop was convened to clarify factors that might affect the tailoring process of the extracted recommendations of gait disorder rehabilitation. Results: In phase one, 21 recommendations reached consensus. In the second phase, 362 stroke physiotherapists rated the applicability of these recommendations: 14 rated high, 7 rated low, and none were rejected. The third phase, a nominal group meeting (NGM), explored four themes related to tailoring. The first theme, “organizational factors”, includes elements such as clinical setting, culture, and regulations. The second theme, “individual clinician factors”, assesses aspects like clinical experience, expertise, abilities, knowledge, and attitudes toward tailoring. The third theme, “patient factors”, addresses issues related to multimorbidity, comorbidities, patient engagement, and shared decision-making. The final theme, “other factors”, examines the impact of research design on tailoring. Conclusions: Tailoring international clinical guidelines involves multiple factors. This situation brings home the importance of a systematic strategy for tailoring that incorporates various assessment criteria to enhance the use of clinical evidence. Future research should investigate additional implementation theories to enhance the translation of evidence into practice.

Non-pathological neck pain (NPNP) is neck pain without a known cause. It might weaken the hand grip strength (HGS) by affecting the neck, shoulder, and upper extremity muscles. Head-neck positions (HNPs) can have a significant impact on neck pain. However, no previous study investigated the effect of NPNP and different HNPs on the HGS among healthcare professionals (HCPs). To determine how HNPs influence the HGS of medical personnel with NPNP. A cross-sectional study recruited 46 healthcare professionals: 21 (45.7%) with and 25 (54.3%) without NPNP. A dynamometer, cervical range of motion, and visual analogue scale measured HGS, HNPs, and NPNPs, respectively. Participants were instructed to squeeze the handgrip dynamometer handle in 90-degree elbow flexion as much as possible from a seated position to measure HGS from the neutral head position (NHP), 40° head neck flexion (HFP40°), and 30° head neck extension (HEP30°). Data differences were analysed using ANOVA. The significance level was set at p < 0.05. The mean HGS for the dominant hand in NHP, HFP40°, and HEP30° was 29.27 (±9.03), 27.24 (±9.08), and 26.37 (±9.32), respectively, while for the non-dominant hand it was 27.45 (±9.62), 25.23 (±9.36), and 24.61 (±10.17). There was no significant correlation between HNPs and HGS. However, the only significant difference was between dominant HGS in the NHP and non-dominant HGS in the HEP30° (P = 0.018). Furthermore, NPNP had no significant effect on the HGS (P = 0.325). NPNP had no significant influence on HGS in any of the three HNPs for either hand. Future studies should include other HNPs and other potential variables such as age, gender, weight, and pain intensity.

Introduction: Dual tasking (DT) requires individuals to carry out two actions simultaneously, comparable to how the brain can perform a cognitive function while the body is in motion, which eventually enhances human balance. This paper aims to examine and compare the impact of DT on the risk of falling (ROF) among Saudi female students. Methods: A cross-sectional design was used. 120 female students were recruited and divided into two groups: literary group (LG) (n = 34) and scientific group (SG) (n = 86). Participants, aged 18– 25, had a normal body mass index (BMI) and cognitive and balancing skills. ROF was measured using the Biodex balancing device for balance alone (no DT) and with DT (motor and two cognitive tasks). After three trials, the mean and average were calculated. The ICC calculation showed a reliable result of < 0.8. BMI was represented as the mean (M) and standard deviation (SD) for both groups. ROF was compared within and between groups using paired and unpaired T-tests. Mann–Whitney compared the two groups throughout DT. The level of significance was P = 0.05. Results: There was no significant difference in ROF in SG (P = 0.06) between the performance with and without a DT; on the contrary, LG demonstrated a significant difference (P = 0.001) for the same tests. In addition, the only time there was a significant difference between the two groups was when they performed DT (P = 0.006). Conclusion: Female students who used critical and analytical thinking and motor performance in their study and daily routine were more balanced and resistant to falling than their peers who did not. This study may improve efficient treatments for fall prevention and balance. Future research could investigate the complex nature of additional DT that may be complicated by gender and BMI outside of the normal range.

Objectives: The professional literature guides manual handling in numerous health care settings. The effects of these guidelines on stroke rehabilitation and the clinical communication of health care professionals are unknown. This paper aims to investigate the perspectives of nurses and physiotherapists on handling guidelines in their professions to identify conflicts in opinions to provide optimum care to people with stroke. Design: A qualitative focus group study. Methods: Three focus groups were conducted. The participants were physiotherapists or nurses with 1 year of stroke care experience. The data were thematically analysed. Results: Nineteen participants (12 physiotherapists and 7 nurses) were interviewed. The data analysis revealed 3 themes. First, “The application of handling in stroke rehabilitation” includes clinical reasoning and real-world handling practices. The second theme, “Physical Effects on Therapists,” examines the long-term effects of manual handling on therapists, including work-related musculoskeletal disorders. The final theme, “Conflicts among health care professionals,” investigates stroke rehabilitation equipment conflicts between nurses and physiotherapists. Conclusion: The study concludes that stroke transfer guidelines in the specialised literature may impact health care professionals’ perspectives. Conflicts among health care professionals can impair teamwork. Thus, health care professionals should work together as stroke rehabilitation teams to develop unified transfer guidelines that aid rehabilitation and avoid work-related musculoskeletal disorders.

[Purpose] To determine how different head-neck positions (HNPs) influence the hand grip strength (HGS) of medical personnel with non-pathological neck pain (NPNP). [Participants and Methods] A cross-sectional study recruited 46 healthcare professionals: 21 (45.7%) with NPNP and 25 (54.3%) without. A dynamometer, cervical range of motion, and visual analogue scale measured HGS, HNPs, and NPNPs. Participants were instructed to squeeze the handgrip dynamometer handle in 90-degree elbow flexion as much as possible from a seated position to measure HGS from the neutral head position (NHP), 40° head neck flexion (HFP40°), and 30° head neck extension (HEP30°). [Results] The mean HGS for the dominant hand in NHP, HFP40°, and HEP30° was 29.27 kg (± 9.03), 27.24 kg (± 9.08), and 26.37 kg (± 9.32), while for the non-dominant hand it was 27.45 kg (± 9.62), 25.23 kg (± 9.36), and 24.61 kg (± 10.17). There was no significant correlation between HNPs and HGS. However, the only significant difference was between dominant HGS in the NHP and non-dominant HGS in the HEP30°. [Conclusion] NPNP had no significant influence on HGS in any of the three HNPs for either hand. Future studies should include other HNPs and other potential variables such as age, gender, weight, and pain intensity.

The recent emergence of research on cerebral palsy (CP) in developing countries aims to improve knowledge on affected children and the utilization of the available services. This study seeks to describe children with CP in Saudi Arabia and service utilization as per Gross Motor Function Classification System (GMFCS) levels and geographic regions. A cross-sectional survey of 227 children with CP (Mean age 6.3, SD 3.9 years) was conducted. Parents reported on children’s demographics, impairments, and service utilization. Half of the children (n = 113, 49.8%) had ≥3 impairments with speech, visual and learning impairments being the most frequent. The total number of impairments differed significantly by GMFCS, F (4, 218) = 8.87, p < 0.001. Most of the children (n = 86, 83.4%) used 2–5 services. Moreover, 139 (62.3%) did not attend school, 147 (65.9%) did not receive occupational therapy, and only 32 (14.3%) received speech therapy. More children in GMFCS level I did not receive neurologist services. Profiles of children and services were described by GMFCS and by regions. This was the first study to describe children with CP and service utilization in Saudi Arabia. Although many impairments affected the children, there was low utilization of related services. Data on service utilization and on unmet needs support a comprehensive approach to rehabilitation and the proper service allocation.

Background: Dual tasking (DT) requires individuals to carry out two actions simultaneously, comparable to how the brain can perform a cognitive function while the body is in motion, which eventually enhances human balance. Objective: To examine and compare the impact of DT on the risk of falling (ROF) among Saudi female students enrolled in the literary and scientific faculties. Method: A cross-sectional design was used. 120 female students consented to this study after 150 were invited. Specialization led to the formation of the scientific (SG, 86) and literary (LG, 34) groups. All participants, aged 18 to 25, had a normal BMI and normal cognitive and balance skills. Using the Biodex balancing system, ROF during balance alone (no DT) and with DT (motor and two types of cognitive tasks) were assessed. ROF was compared within and between groups using paired and unpaired T-tests, respectively. Mann-Whitney compared the two groups throughout the DT. The level of significant was considered at P=0.05. Results: There was no significant difference in ROF in SG (P 0.05) between the performance with and without dual tasking, contrary, LG demonstrated a significant difference (P=0.05) for the same tests. In addition, the only time there was a significant difference between the two groups was when they performed DT. Conclusion: SG students are better capable than LG students in maintaining balance and resisting the ROF during DT. This study's findings may pave the way for improved interventions to reduce fall risk and improve balance during neurorehabilitation.

Background. One of the most frequent consequences of stroke is a reduction in heart function. After a stroke, one of the main aims of physiotherapy practice is to improve cardiovascular fitness (CVF). This paper is aimed at identifying the best effective intervention of improving the cardiovascular fitness (CVF) after stroke while focusing on body weight‐supported treadmill training (BWSTT), over gait training (OGT), and therapeutic exercise. Methods. Different electronic databases were searched until July 2022. Controlled randomized trials examining the effects of BWSTT, OGT, and therapeutic exercise to improve CVF on an ambulatory person with stroke, written in English and reporting cardiovascular fitness or at least one of its indicators, such as peak oxygen consumption (VO₂), gait speed, gait energy expenditure, and functional independence measure for locomotion (FIM‐L), were included. The quality of the methodology was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results. The research yielded 3854 relevant studies, of which 22 met the eligibility criteria. The primary indicators of the CVF, VO₂ and energy expenditure, were used to examine the CVF in only three studies, while the rest used other indicators of the CVF. There was a lack of sufficient evidence to establish the superiority of one intervention over another. However, it appears that utilizing BWSTT to improve the CVF after stroke is effective. Conclusion. Physiotherapy has the potential to enhance the CVF of stroke patients. However, effective interventions and long‐term effects remain debatable.

Background: Knee osteoarthritis (OA) is the most common kind of arthritis that occurs due to degeneration of the joint articular cartilage, producing pain, stiffness, and impaired movement. The objective of the study was to evaluate the short-term effectiveness of Kinesio taping (KT) plus conventional physical therapy (CPT) and CPT alone in subjects with knee OA. Materials and methods: Forty male subjects were divided into two groups at random using a parallel assignment, double-blinded study design, viz., KT with CPT (transcutaneous electrical nerve stimulation and exercise therapy), and CPT alone for the period of 6 weeks of treatment. At baseline, third, and sixth weeks, the following outcome measures were taken, such as pain intensity (NPRS), knee range of motion (goniometry), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Time Up and Go (TUG) test. Statistical analysis: To reveal the patient’s demographic profile concerning the outcome parameters, a descriptive statistic was applied. Furthermore, two-way mixed ANOVA and Tukey HSD post hoc tests were used to analyze within and between-group comparisons in SPSS 20.0. Results: In both groups, pain and knee flexion were significantly improved during the 6-week period of interventions (p < 0.05). WOMAC and TUG test scores improved only in the KT plus CPT group. Conclusion: KT combined with CPT was found to be more effective than CPT alone in the third and sixth weeks of the treatment. In knee OA, this combination of treatments was found to reduce pain, enhance range of motion, and improve physical functioning.