Background and PurposeMulligan's mobilization with movement was shown to be effective when implemented in multimodal therapy for knee osteoarthritis. However, no study has evaluated the Mulligan's technique in isolation and compared the relative effectiveness with sham‐controlled interventions. Hence, the present study examined the immediate effects of Mulligan's techniques with sham mobilization on the numerical pain rating scale (NPRS) and timed up and go (TUG) test in individuals with knee osteoarthritis.MethodsThirty participants (mean age: 55.3 ± 8.3 years) with symptoms at the knee and radiographic diagnosis of knee osteoarthritis were randomized into sham (n = 15) and intervention (n = 15) groups. The intervention (I) group received Mulligan's mobilization glides that resulted in relative pain relief for three sets of 10 repetitions. For the sham (S) group, the therapist's hand was placed over the joint surfaces mimicking the pain‐relieving glides, without providing the gliding force. The outcome measures NPRS and TUG were recorded by a blinded assessor pre‐ and post‐intervention.ResultsStatistically significant differences were identified between the groups in post‐intervention median (interquartile range) NPRS (I group: 4.00 [2.00–5.00]; S group: 6.00 [4.00–7.00]) and TUG scores (I group: 10.9 [9.43–10.45]; S group: 13.18 [10.38–16.00]) with the intervention group demonstrating better outcomes (p < .05). Within‐group, the post‐intervention scores of NPRS and TUG were significantly lower (p < .05) compared to the pre‐intervention scores in the intervention group. In the sham group, a statistically significant pre–post change was noticed only in the NPRS scores but not in the TUG scores.ConclusionMulligan's techniques were effective in improving pain and functional mobility in individuals with knee osteoarthritis. The underlying mechanisms for observed effects must be examined further, as participants reported pain relief following sham mobilization.

Background and Purpose: Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA. Methods: An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale. Results and Discussion: The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment. Conclusion: The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.

Objective: The objective of the review is to determine whether conditioned pain modulation (CPM) is impaired in adults with chronic low back pain (CLBP) when compared with pain-free individuals. Methods: A a systematic search of the literature was undertaken using the databases: MEDLINE, Scopus, CINAHL and Web of Science. The citations of included studies were reviewed for additional studies. Observational, cross-sectional, case-control studies published in English between January 1990 and August 2019 were considered. Studies that investigated the efficiency of standardized CPM regimens among defined cases of CLBP and in comparison, with pain-free controls were included. After initial title and abstract screening, 2 authors reviewed the full texts of the eligible articles independently. Risk of bias was carried out using assessment of 4 categories: blinding of the outcome assessors, representativeness of cases to the specified population, comparability of cases and controls, and control of confounding variables. Results: In total, 643 records were identified, of which 7 studies were included. Overall, the results of the studies reported mixed conclusions on the efficiency of CPM in CLBP. Three studies identified significant differences for CPM between CLBP and pain-free controls and the other 4 studies reported no significant differences. The common methodological limitations were unclear reporting about blinding of the outcome assessors and inadequate control of confounding factors. Conclusions: High-quality research is strongly recommended to determine the function of endogenous pain modulatory mechanisms in CLBP.

Background and Objective: Exercise intervention can be personalized and delivered digitally to achieve better outcomes in people with diabetes. The study aim was to analyse the effect of supervised exercise prescription delivered as part of Fitterfly diabetes digital therapeutics program in people with diabetes (PWD) after completion of the program. Method: De-identified data of 150 participants (mean age 45.29 ± 10.53 years, 39.3% females) who completed the 90-day program was analyzed. Structured virtual physiotherapy consultations and personalized exercise prescriptions were provided by physiotherapists along with expert-led care by a multidisciplinary team. Participants received access to Fitterfly mobile application for digital logging of meals and physical activity, regular follow-ups from physiotherapists to ensure adherence to the personalized prescription and for reviewing the goals to be achieved during the course of the program. Wilcoxon test was used for the statistical analysis with p < 0.05 considered statistically significant. Results: After completion of the program, significant median improvement in 6-minute walk test and total fitness score by 5.35% (p < 0.001) and 46.86% (p < 0.001) respectively was observed. Participants were categorized based on their activity levels at the beginning of the program, 26% (39/150) of participants were in the sedentary category, 55% (82/150) were in the aerobic category and 19% (29/150) were in the strength training category. After completion of the program, all the participants were following strength training as part of their exercise regimen. Median exercise duration per week in these participants improved by 180 (135,270) min, 70 (0,141.25) min and 60 (0, 142.50) min respectively. Post-program, median HbA1c reduction by -0.8 (-2.00, -0.38) % was observed, with 87.33% (131/150) of the participants showing significant HbA1c reduction. Median weight reduction was found to be -2.5 (-1.00, -4.50) kg and median waist circumference reduction was -4.00 (-7.00, -0.08) cm. Among users who started with HbA1c above recommended level (>7%), 48.39% (45/93) reduced their HbA1c in the recommended range after completion of the program. Conclusion: The study demonstrated improvement in cardiorespiratory and physical fitness, exercise duration and incorporation of strength training in the exercise regimen of the participants. Significant improvement in glycemic control and a significant reduction in body weight and waist circumference was also observed. Virtual supervised exercise guidance as a part of Fitterfly diabetes digital therapeutics program can help in improving safety and adherence to physical activity among people with T2DM for effective diabetes management.

Osteoporosis is defined as a condition characterised by low bone mass, leasing to a decline in the bone's microarchitecture and an increased risk of falls. This condition affects predominantly Caucasians, women and older people. As the life expectancy in-3. International Osteoporosis Foundation (IOF) website.