To examine the acute effect of a self-regulated dual-task during resistance exercise on muscular endurance, pain intensity and pressure pain threshold (PPT) in patients undergoing carpal tunnel release (CTR). Participants were randomly assigned to resistance exercise combined with a self-regulated cognitive task (dual-task) or resistance exercise alone (single-task). Exercise was prescribed using elastic resistance until task failure with a prespecified intensity of 3 on the Borg CR10 scale. The primary outcome measure was muscular endurance (maximum number of repetitions to failure) for wrist flexors and extensors. Secondary outcomes included pain intensity (visual analogue scale) and pressure sensitivity (PPT). Covariates included: catastrophizing, kinesiophobia, self-efficacy and perceived difficulty. Twenty-two participants (63.6% female) with a mean age of 47.8±10.3years. Participants performed a greater number of repetitions to failure under the dual-task condition compared with the single-task condition, with increases of 9.7 [95% CI: 5.7-13.8] repetitions for wrist flexion and 12.0 [95% CI: 7.7-16.2] repetitions for wrist extension. Pain intensity decreased in both conditions, with no significant condition or time×condition effects. PPTs increased following exercise at the unaffected hand and at the lateral epicondyle, whereas only a trend was observed at the affected hand. No significant time×condition interactions were identified for pain intensity or PPT. Catastrophizing and kinesiophobia were negatively associated with changes in PPT, whereas self-efficacy showed a positive association. In patients recovering from CTR surgery, dual-tasking as a cognitive distraction strategy acutely improved exercise capacity by increasing the number of repetitions to failure. Protocol Registration Number: ClinicalTrials.gov (NCT05592184).

Musculoskeletal complications are common yet under-recognized consequences of stroke, contributing to functional limitation and reduced quality of life. Limited evidence exists from Bangladesh regarding post-stroke musculoskeletal sequelae and associated risk factors. A hospital-based cross-sectional study was conducted among 105 adult stroke survivors (falling short of the calculated target of 143) receiving care in a tertiary hospital in Dhaka, Bangladesh. Data were collected using a semi-structured questionnaire and clinical assessment checklist, including the Numerical Pain Rating Scale and Oxford muscle strength grading. Associations between musculoskeletal complications and demographic and clinical factors were analysed using descriptive statistics and chi-square tests. Most of the respondents were elderly, with 64.8% aged 72-90years; the majority were male (78.1%), and 94.3% reported at least one musculoskeletal complication. Muscle wasting (73.3%) and musculoskeletal pain (63.8%) were most prevalent. Joint stiffness, shoulder subluxation, foot drop, and spasticity were also observed. Musculoskeletal complications were significantly associated with age, marital status, and onset timing (all p<0.001). Most participants relied on wheelchairs (68.6%), and 80% participated in some form of rehabilitation programme. Musculoskeletal complications are highly prevalent among stroke survivors in Dhaka and significantly contribute to post-stroke disability. Early identification, timely physiotherapy, and structured caregiver education are essential to mitigate these complications. Strengthening rehabilitation services within routine stroke care can improve functional outcomes and quality of life.

NHS Lanarkshire (NHSL) Physiotherapy Musculoskeletal (MSK) service receives approximately 30,000 referrals annually, facing long waiting times and workforce pressures. To address these challenges, NHSL piloted Community Appointment Days (CADs)-a patient-centred model offering same-day assessment, advice, and community support in non-medical settings. A mixed-methods service evaluation was conducted using retrospective analysis of data from ten CADs delivered across three leisure centres in 2024-2025. Quantitative data from the Patient Management System included attendance, outcomes, and re-access rates. Qualitative data were collected via patient passports, surveys, and interviews. Objectives were to assess impact on waiting times, patient experience, cost avoidance, and sustainability. Of 2,287 patients booked, 1,866 attended. Outcomes included discharge (10%), patient-initiated review (PIR) (53%), and return appointment (37%). Average time per CAD was 69 minutes. PIR return rate was 8%, with 0% ED attendances for the same condition. CADs enabled a 3.7-fold increase in new patient capacity on the day, reducing waiting times in targeted waiting lists by 5 weeks in 2024 and 9 weeks in 2025. Initial setup costs were £16,388; subsequent CADs projected cost avoidance of £4,132 each. Patient feedback was highly positive, with strong Care CollaboRATE scores, though some reported environmental challenges. Staff reported CADs as less stressful or similar to routine work. CADs are a scalable, patient-centred model that improves access, reduces waiting times, and supports self-management while maintaining safety. Future work should refine triage, enhance booking systems, and evaluate long-term outcomes to ensure sustainability.

Chronic low back pain is a highly prevalent and disabling condition that impairs physical function and has a broad social impact. This study aimed to assess the effects of manipulative techniques on static, quasi-static, and dynamic balance in individuals with chronic low back pain, and to compare these outcomes between an experimental group and a placebo group. The study is justified by the high prevalence of low back pain, the economic burden associated with treatment and work absence, and the need to clarify the effectiveness of therapeutic approaches. A randomized, controlled, longitudinal, pre/post-intervention clinical trial was conducted with 30 participants (18-59years), of both sexes, all experiencing chronic low back pain. Individuals with other musculoskeletal, neurological, cognitive, cardiorespiratory, or balance-affecting conditions were excluded. Participants were randomly allocated to an experimental group, which received global spinal manipulation in the thoracolumbar and lumbopelvic regions, or a placebo group. Assessments included the modified Sensory Organization Test (SOT), the Star Excursion Balance Test (SEBT), and pain pressure threshold algometry, applied before and after the intervention. Results indicated that a single session of spinal manipulation did not produce significant changes in static, quasi-static, or dynamic balance variables. Additionally, comparisons between pre- and post-intervention (immediate, 24h, and 1week follow-up) revealed no statistically significant differences were found. These findings suggest that a single session of spinal manipulation may not be sufficient to induce measurable changes in balance parameters in this population.

The present study aimed to investigate the associations between ultrasonographic measurements of the geniohyoid muscle and clinical screening indicators of sarcopenia, dysphagia, and physical performance in older adults. This study provides the first known sono-elastographic evaluation of the geniohyoid muscle in relation to sarcopenia and swallowing dysfunction in older adults. Thirty independently living individuals aged ≥65years were included. Sarcopenia and dysphagia risk were assessed using the SARC-F and EAT-10 questionnaires, respectively. Physical performance was evaluated with the five times sit-to-stand test (5-STS). Ultrasonographic assessments of the geniohyoid muscle were performed using a high frequency linear transducer. Cross sectional area (CSA), perimeter and elasticity of the geniohyoid muscle were measured on B-mode images. CSA and perimeter were negatively correlated with SARC-F and EAT-10 scores (p<0.05). In addition, 5-STS showed a significant negative correlation with CSA (p<0.05). Female participants had significantly lower CSA and perimeter and higher sarcopenia and dysphagia risk scores (p<0.05). No statistically significant associations were found between geniohyoid muscle elasticity and the clinical parameters (p>0.05). Intraobserver reliability for elasticity was assessed in a subsample (n=15), yielding an ICC of 0.82. CSA and the perimeter of the geniohyoid muscle were significantly associated with sarcopenia risk, dysphagia risk, and physical performance scores. Although not statistically associated with clinical screening indicators, geniohyoid muscle elasticity was successfully measured using strain elastography, demonstrating good intraobserver reliability. Ultrasonography appears to be a practical and reproducible tool for evaluating geniohyoid muscle structure in older adults, although further validation is needed.

Healthcare systems significantly contribute to carbon emissions, prompting a shift towards sustainable practices. Physiotherapy interventions, particularly those minimising travel, hospitalisation, and pharmaceuticals, offer promising low carbon strategies for musculoskeletal care (MSK). To synthesise evidence from systematic reviews and meta-analyses on 5 physiotherapy intervention domains-telerehabilitation, prehabilitation, self-management strategies, comparisons with NSAIDs and group exercises in adults aged≥18years with non-traumatic musculoskeletal disorders. An umbrella review was conducted following PRISMA guidelines. A search across five physiotherapy intervention domains, four electronic databases from date of inception till may 2025: Pubmed, Cochrane, PEDro and Epistemonikos. Acute to chronic MSK conditions were included. Intervention duration varied across studies ranging from short term (2-6weeks) to long term upto 12months. AMSTAR 2, ROBIS and GRADE were used to assess study quality, bias and certainty of evidence. Primary outcomes were pain intensity and physical function. Secondary outcomes included functional capacity, adherence, healthcare utilisation/cost, quality of life, and adverse events. Telerehabilitation and prehabilitation improved pain, function and hospital stay. Exercise-based physiotherapy showed benefits comparable to NSAIDs with fewer side effects, while self-management and group exercise demonstrated scalable but low certainty. Although sustainability was not a primary selection, all included interventions aligned with low carbon healthcare principles, underscoring their potential for integration into future climate conscious care models. Building on findings, future research should integrate sustainability metrics to support the routine adoption of low carbon physiotherapy in MSK care.

Lumbopelvic Flexion-Rotation Movement Impairment Syndrome is a common pattern observed in individuals with mechanical low back pain (MLBP) characterised by altered postural control and neuromuscular dysfunction. Isolated balance training may offer focused benefits in such cases. To compare the effectiveness of an isolated balance exercise regimen with conventional physiotherapy in managing Lumbopelvic flexion-rotation movement impairment syndrome in male patients with MLBP. A single-centre experimental study was conducted on 30 male patients (aged 18-26years) diagnosed with Lumbopelvic flexion-rotation movement impairment syndrome. Participants were randomly assigned to Group A (Isolated Balance Exercise) or Group B (Conventional Physiotherapy). Outcomes were assessed pre- and post-intervention using standardised pain and disability scales. Both groups showed statistically significant improvements. Group A showed reductions in pain (Mean=1.86, SD=±0.639) and disability (Mean=1.60, SD=±0.736). Group B also improved in pain (Mean=1.66, SD=±0.899) and disability (Mean=1.60, SD=±0.7368). The isolated balance regimen was comparably effective with conventional therapy. Isolated balance training is an effective and viable standalone intervention for managing MLBP due to Lumbopelvic flexion-rotation movement impairment syndrome.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder causing joint damage, pain, and functional limitations. While pharmacotherapy remains central to management, physiotherapeutic interventions are increasingly recognised for their supportive role in symptom alleviation and quality of life enhancement. This systematic review and meta-analysis aimed to evaluate the effectiveness of various physiotherapeutic interventions in reducing pain and improving function and quality of life in patients with RA. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science (2010-2025) identified randomized controlled trials (RCTs) assessing physiotherapy modalities in RA. Methodological quality was appraised using the Cochrane RoB 2.0 tool. Pain outcomes were synthesised via meta-analysis using a random-effects model. Seventeen RCTs involving 1362 participants were included. Interventions encompassed aerobic/resistance exercise, hydrotherapy, manual therapy, electrotherapy, and multimodal approaches. Meta-analysis of five trials (n=307) revealed a statistically significant reduction in pain favouring physiotherapy (SMD=-0.347; 95% CI: -0.571 to -0.124; p=0.002; I*=0%). No significant publication bias was detected. Narrative synthesis indicated potential benefits in functional and cardiorespiratory outcomes, especially with combined exercise and lifestyle interventions. Physiotherapeutic interventions, particularly structured exercise programs, demonstrate moderate evidence for pain reduction in RA. Integrating multimodal physiotherapy with diet and adjunct therapies may enhance patient outcomes. Further high-quality, standardized RCTs are warranted to optimise intervention protocols and assess long-term benefits.