Kiril Panayotov

Health-related quality of life (HRQoL) is a critical outcome measure in oncology research and clinical care. This study aimed to translate, culturally adapt, and psychometrically validate the Bulgarian versions of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy–General (FACT-G), focusing on Internal Consistency (IC), Test–Retest Reliability (TRR), and Construct Validity (CV) in Cancer Survivors (CS) diagnosed with breast, lung, or colorectal cancer. A total of 235 Bulgarian CS (mean age 62.3 ± 11.2 years; 118 males, 117 females) were recruited from five tertiary care hospitals in a cross-sectional study design. The EORTC QLQ-C30 and FACT-G were translated and culturally adapted according to the official EORTC and FACIT guidelines. Psychometric evaluation included data quality (floor and ceiling effects, missing responses), IC, TRR, and CV assessed via convergent and Discriminant Validity (DV). A subsample of 78 study participants (33.2%) completed both questionnaires twice over a 14-day interval for TRR assessment. CV was supported by strong item-scale and cross-instrument correlations (r = 0.62–0.81). IC was excellent across all domains (Cronbach’s α = 0.88–0.95), and TRR demonstrated high stability (ICC = 0.75–0.89). Bland–Altman analysis showed acceptable agreement, with a mean difference of 23.20 (95% CI: 21.87–24.53) and limits of agreement ranging from +3.77 to +42.63. Minimal Floor Effects (FE) were observed, while Ceiling Effects (CE) were noted in specific domains (e.g., Social Functioning (SF) and Global Health (GH) in the EORTC QLQ-C30; Social Well-Being (SWB) and Emotional Well-Being (EWB) in the FACT-G). The findings support that the Bulgarian versions of the EORTC QLQ-C30 and FACT-G are valid, reliable, and culturally appropriate instruments for evaluating HRQoL in Bulgarian CS. Their use is recommended in both clinical practice and research contexts.

Reconstruction of the Anterior Cruciate Ligament (ACL) in Skeletally Immature Patients (SIP) poses challenges due to anatomical and developmental factors. This randomized controlled trial evaluated the Functional Recovery (FR) of pediatric patients undergoing ACL Reconstruction (ACLR), comparing Transphyseal Reconstruction (TPR) and physeal-sparing reconstruction (PSR). Forty-three young athletes (mean age 14.1 ± 2.3 years), including 29 boys and 14 girls, were randomized to TPR (n=23) or PSR (n=20). FR was assessed by using the Pediatric International Knee Documentation Committee (Pedi-IKDC) questionnaire at baseline, 8 months, and 12 months post-surgery. At the 12-month follow-up, the TPR group demonstrated a significantly greater improvement in Pedi-IKDC scores, with a 66.95% increase compared to 56.73% in the PSR group, reflecting notable differences in knee function between the groups at both 8 and 12 months (p < 0.001). Additionally, 80% of participants in the TPR group returned to sports, with 56% resuming limited activities, while the PSR group exhibited a slower recovery trajectory. These preliminary findings indicate that TPR provides superior FR and a faster return to sports compared to PSR, underscoring the importance of tailored rehabilitation protocols and long-term follow-up to optimize outcomes in SIP.

The study aimed to evaluate the effectiveness of radial extracorporeal shock wave therapy (rESWT) and conventional physical therapy (CPT) protocol on the gait pattern in stroke survivors through a new gait analysis technology. Fifteen (n=15) stroke survivors took part in this prospective, observational study and were assessed clinically and through an instrumented treadmill before and after rESWT and CPT. Spasticity grade 95% CI 0.93 (0.79 +/- 1.08), pain intensity 95% CI 1.60 (1.19 +/- 2.01), and clonus score decreased significantly 95% CI 1.13 (0.72 +/- 1.54). The sensorimotor function 95% CI -2.53 (-3.42 +/- 1.65), balance 95% CI -5.67 (-6.64 +/- - 4.69), and gait parameters were enhanced at the end of the program. Step length 95% CI -3.47 (-6.48 +/- 0.46) and step cycle were improved 95% CI -0.09 (-0.17 +/- -0.01), and hip 95% CI -3.90 (-6.92 +/- -0.88), knee 95% CI -2.08 (-3.84 +/- -0.32) and ankle flexion-extension 95% CI -2.08 (-6.64 +/- -4.69) were augmented. Adding the quantitative analysis to the clinical assessment, we gained easy access to track progress and obtained an individualized therapeutic approach for stroke survivors.

A Correction has been published | View Modern rehabilitation is based on the International Classification of Functioning, Disability and Health (ICF). We will discuss this Classification process in frailty. Frailty is defined as a condition of reduced functional reserve, a state of vulnerability that involves poor recovery of homeostasis and increased susceptibility to stressor mechanisms, with consequent difficulty in returning to the previous condition of balance. Rehabilitation of frailty is reported in the ICF, although, its consensus is not sufficiently addressed due to its recent identification and the limited available information regarding how it should be formulated. Thus, the aim of the present article is to present the current evidence-based rehabilitation strategies applied in management of frailty.

Knee osteoarthritis (OA) is the most prevalent joint disease and one of the leading causes of disability, poor physical activity levels (PAL), and quality of life (Qol) of elderly people worldwide. The purpose of this study was to evaluate the superiority of a novel group-based physical therapy (GBPT) intervention compared to a more traditional one-to-one individual physical therapy (IPT) among elderly Bulgarian subjects underwent total knee arthroplasty (TKA). One hundred and thirty elderly TKA recipients of both genders with mean age=72.69±0.44 were randomly assigned to GBPT or to one-to-one IPT. Elderly participants were assessed at baseline and at 3 and 6 months after both rehabilitation interventions, with the use of the following evaluation tools: Physical Activity Scale for the Elderly (PASE), Six-Minute Walk Test (6MWT), and Short Form Health Survey questionnaire (SF-36v2). At 6 months elderly TKA recipients who received GBPT achieved 7.36 points more in the PASE questionnaire when compared with the IPT group. Elderly participants of the GBPT group walked significantly longer distance during the 6MWT than TKA recipients attended IPT, respectively 421.56 m vs. 398.62 m, (p< 0.001). Furthermore, significantly greater improvement in health-related quality of life (HRQoL) was obtained from the elderly participants of the GBPT arm compared with the participants of the IPT arm, respectively 70, 7% vs. 60, 8% at 6 months follow up. We conclude that our results suggest the superiority of the GBPT in terms of PAL (PASE score, 6MWT) and HRQoL among elderly TKA recipients across the first 6 months.

Low back pain (LBP) is a common clinical problem imposing a prominent socio-economic burden. The purpose of this systematic review was to investigate the biopsychosocial effects of the Mulligan Concept (MC) of manual therapy (MT) when applied to patient's with LBP. Three researchers independently evaluated the literature quality, and completed a review on five online databases (Medline, Cochrane Library, Science Direct, ProQuest and Google Scholar) for articles published from January 1st 2010 to November 20th 2021, using a combination of free words, Wildcards and Medical Subject Headings (MESH) terms: " Mulligan mobilization " AND " back pain " OR " SNAGs." In total, 62 studies were selected for full-text reading, from which finally 6 studies were included in the present review. The results revealed that the studies where the MC of MT was applied to treat LBP mainly lacked concern regarding the effect that the intervention has on the cognitive and behavioural parameters. The ones that introduced measure outcomes for at least some parts of the cognitive behavioural components, showed that the MC has a positive effect, even though without a long-term follow-up assessment. This review summarized that the evidence of the MC on cognitive behavioural (CB) aspects of patients with LBP is controversial and scarce.