Alshimaa R. Azab

Objective: To analyse physical fitness trajectories in paediatric burn survivors from discharge to 2 years post-injury, compare them with an age- and gender-matched control group, and identify baseline demographic and clinical determinants. Design: Prospective and longitudinal cohort study. Participants: The study included participants with burn injuries (burn group, n = 45), aged 10–17 years, with burns involving ≥25% of total body surface area, and an age- and gender-matched group of healthy children (control group, n = 45). Main measures: Participants underwent standardised fitness assessments at discharge and 24 months later. Health-related physical fitness was quantitatively assessed using the validated EUROFIT physical fitness test battery. Results: Longitudinal analysis revealed significant improvements in seven of nine fitness domains for participants with burn injuries over two years (pFDR < 0.001). Despite these gains, these participants exhibited persistent fitness deficits compared to healthy controls across all domains at follow-up (all p < 0.001). Among those with burn injuries, greater total body surface area (β = –0.007, p = 0.03) and third-degree burn percentage (β = –0.57, p < 0.001) predicted lower overall fitness, while longer rehabilitation predicted higher fitness (β = 0.50, p < 0.001). No baseline clinical factors significantly predicted the rate of fitness change over time (all interaction p > 0.05). Conclusion: Paediatric burn survivors demonstrated significant improvements in physical fitness over 2 years but failed to close the performance gap with their healthy peers. Injury severity and rehabilitation duration were strong determinants of fitness level, but they did not predict the rate of improvement.

Low back pain (LBP) is a common and severe musculoskeletal ailment that disproportionately affects the elderly. Some of the top causes of disability and impaired functional independence occur worldwide. As populations age and chronic diseases increase, controlling LBP in the elderly is a public health issue. Polypharmacy and age‐related vulnerabilities make widely recommended pharmacologic methods risky for older persons. Physical activity is a favored first‐line remedy due to its safety and multidimensional advantages, especially in the elderly. This review synthesizes the literature on elderly LBP prevention and management through physical exercise. Recent evidence (2020–2024), biological underpinnings of exercise‐related pain regulation, and practical applications of aerobic, resistance, flexibility, and neuromuscular training are highlighted. The biopsychosocial and Kinesio pathophysiological frameworks that inform LBP rehabilitation therapeutic thinking are also reviewed. Fear of pain, social isolation, comorbidities, and environmental limits are examined, along with ways to increase exercise engagement and adherence. This article also assesses literature discrepancies, identifies study gaps, and suggests further research. To help healthcare providers and researchers optimize exercise‐based interventions for the elderly. Physical activity should be a standard therapy method for senior LBP patients, not an optional recommendation.

Objective: This study aimed to assess and compare changes in pain, balance, functional status, and health-related quality of life between adolescents with patellofemoral pain syndrome undergoing 12 weeks of monochromatic infrared energy application as an adjuvant to physical rehabilitation and those receiving physical rehabilitation alone. Design: Randomized controlled trial. Patients: Adolescents aged 15–18. Methods: 46 adolescents were randomly assigned to receive either a standard physical therapy programme or monochromatic infrared energy plus the standard programme. Pain intensity, dynamic postural control, functional status, and health-related quality of life were evaluated pre- and post-intervention. Results: The study group showed a greater reduction in pain intensity (p < 0.001; η2 = 0.36), improvement in dynamic postural control, towards the anterior (p = 0.002; η2 = 0.20), posteromedial (p = 0.009; η2 = 0.14), posterolateral (p = 0.018; η2 = 0.12) directions, and composite postural control (p = 0.001; η2 = 0.24), and enhancement of functional status (p = 0.013; η2 = 0.13) from the pre- to post-treatment occasion than the control group. Moreover, the study group reported better quality of life: physical health (p = 0.035; η2 = 0.10), psychosocial health (p = 0.005; η2 = 0.17), and overall (p = 0.001; η2 = 0.21). Conclusion: Monochromatic infrared energy is likely beneficial in adolescents with patellofemoral pain syndrome.

Objective: To determine the effectiveness of adding inspiratory muscle training (IMT) alongside a pulmonary rehabilitation protocol in terms of inspiratory muscle strength, lung function, and exercise capacity in burned adults.Methods: A randomized, double-blinded, sham-controlled study. Fifty-two adult patients with burn injuries, more than 20 years old and at least 20% total body surface area, were assigned randomly either to the experimental or the conventional group. The participants in the experimental group were given IMT plus a pulmonary rehabilitation program; the conventional group received only a pulmonary rehabilitation program. The interventions were performed for 8 weeks. At the beginning and after 8 weeks of training, the respiratory muscles’ strength, lung function and exercise capacity were all examined.Results: After 2 months of training, the experimental group demonstrated statistically significant improvements than conventional group in maximum inspiratory pressure, maximum expiratory pressure, 6-minute walk test, forced vital capacity, and forced expiratory volume in 1 second (p<0.05).Conclusion: An 8-week IMT program coupled with pulmonary rehabilitation increases respiratory muscle strength, pulmonary functions, and functional capacity in burn patients. IMT is a beneficial and efficient therapy that can be easily implemented for burn patients.

Background and Purpose: To examine the respiratory and functional benefits of manual diaphragmatic release for Cleaning‐Laborers Exposed to Occupational Hazards.Methods: A randomized controlled trial of 36 participants aged 35–45 years was randomly allocated into two groups. The experimental group (n = 18); received manual diaphragm release along with respiratory training exercises, and the control group (n = 18); received respiratory training exercises only. Three times/week for 12 consecutive weeks. The serum immunoglobulin E level, pulmonary functions [forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC, and peak expiratory flow (PEF) rate (PEF)], chest wall mobility, and 6 min walk‐test performance were assessed pre‐ and post‐intervention.Results: There was a greater decline in serum immunoglobulin levels (p = 0.003; Partial η² = 0.23) and enhancement in pulmonary functions [FEV₁ (p = 0.025, Partial η2 = 0.14), FVC (p = 0.017, Partial η² = 0.16), FEV₁/FVC (p = 0.028, Partial η² = 0.13), and PEF (p = 0.012, Partial η2 = 0.17) in the experimental group. Further, there was a greater increase in chest mobility at the xiphoid level (p = 0.002, Partial η² = 0.25) in the experimental group, but this was not the case at the axillary level (p = 0.29, Partial η² = 0.03). Still, the 6 min walk‐test performance improved more significantly in the experimental group (p = 0.002, Partial η² = 0.24).Conclusion: The diaphragmatic release technique may offer a promising approach for mitigating distressing respiratory symptoms, enhancing immune function, and improving 6 min walk‐test performance among cleaning laborers with work‐related respiratory hazards.Trial registration: The study was retrospectively registered at XXX (ID: NCT05802355).

Purpose: The main aim of the trial was to assess the combined impact of graded Thera-Band strengthening exercises and scapular stabilization exercises on shoulder pain, physical function, and quality of life (QoL) in post-mastectomy adhesive capsulitis (AC). Methods: Seventy females with unilateral post-mastectomy AC partook in the trial. Participants were subdivided equally into two groups at random. Both groups obtained the traditional physical therapy program; in addition, the intervention group received graded Thera-Band exercises for shoulder muscles and scapular stabilization exercises 5 days a week for 8 weeks. Range of motion (ROM) and muscle power of shoulder were assessed by digital goniometer and handheld dynamometer, respectively. Disability of the Arm, Shoulder, and Hand questionnaire (DASH) was utilized for assessment of shoulder function and visual analogue scale (VAS) for pain measurement while short-form (SF-36) for QoL assessment. All evaluation data was recorded prior to the trial and at the eighth week of interventions for both groups. Results: All participants achieved improvements in shoulder ROM, muscle power, pain, and all aspects of QoL; however, higher statistical improvements were reported in all measurements with respect to strengthening exercises group (p < 0.001). Conclusion: The addition of graded Thera-Band strengthening exercises and scapular stabilization exercises in post-mastectomy AC rehabilitation program has significant benefits in shoulder function and patients’ QoL. Trial registration: This study is retrospectively registered at ClinicalTrials.gov NCT05311839.

- OBJECTIVE: The long-term consequences of congenital diaphragmatic hernia (CDH), which include altered lung functions and compromised cardiopulmonary capacity, impact functional performance and quality of life. This study investigates the effects of virtual reality-based exercise programs on pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life in children with repaired CDH. PATIENTS AND METHODS: A randomized controlled clinical trial was performed. Fifty-two children with repaired CDH (aged 6-10 years) were enrolled and randomly allocated to virtual reality-based exercises plus traditional physical therapy (VR-EX group, n = 26) or traditional physical therapy alone (control group, n = 26). Interventions were conducted three times a week for 12 weeks. Pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life were assessed before and after the intervention. RESULTS: The VR-EX group demonstrated significantly enhanced post-treatment pulmonary functions and cardiopulmonary capacity compared to the control group after accounting for the pre-treatment values (p < 0.05). In addition, the values in functional performance and quality of life measures showed significantly larger improvements in the VR-EX group (p < 0.05). CONCLUSIONS: Children with repaired CDH may benefit more from VR-based exercises when combined with traditional physical therapy than from traditional physical therapy alone regarding their pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life.

Background. Congenital diaphragmatic hernia (CDH) is a life-threatening condition with long-term complications including respiratory tract infections, respiratory muscle weakness, and abnormal lung functions. This study was designed to ascertain the effects of chest resistance and chest expansion exercises on respiratory muscle strength, lung function, and chest mobility in children with post-operative CDH. Methods. This randomized controlled clinical study was conducted in the outpatient physiotherapy clinic at Prince Sattam bin Abdulaziz University. Thirty-two children with CDH aged 10–14 years between May 2020 and February 2021 were randomly allocated to the study group (n = 16) and the control group (n = 16). The control group underwent a usual chest physiotherapy program; however, the study group underwent a 12-week chest resistance exercise combined with chest expansion exercise in addition to usual chest physiotherapy, with three sessions per week. Respiratory muscle strength, lung function, and thoracic excursion were assessed pre- and post-treatment. Results. Using the 2 × 2 repeated ANOVA, significant time × group interactions were detected in favor of the study group, FVC (F = 4.82, 95% CI = −15.6 to −0.97, p = 0.005, and η² = 0.16), FEV1 (F = 4.54, 95% CI = −11.99 to −2.8, p ˂ 0.001, and η² = 0.14), PImax (F = 5.12, 95% CI = −15.71 to −5.3, p ˂ 0.001, and η² = 0.15), and thoracic excursion (F = 4.41, 95% CI = −2.04 to −0.16, p = 0.036, and η² = 0.17). Conclusions. Concurrent chest resistance and expansion exercises may improve respiratory muscle strength, lung function, and thoracic excursion in children with post-operative CDH. The study findings suggest that concurrent chest and chest expansion exercises be part of an appropriate pulmonary rehabilitation program in children with a history of CDH.