[Purpose] This study aimed to identify factors that determine the kinematic coupling behavior of calcaneal pronation/supination and shank rotation in a standing position. [Participants and Methods] Study participants included 15 healthy adults (30 legs). Kinematic coupling behavior was quantified as the linear regression coefficient (kinetic chain ratio [KCR]) of the angle of shank rotation against the angle of calcaneal pronation-to-supination measured using a 3-dimensional motion analysis system during pronation and supination of both feet while standing. The relationship between the KCR and the foot bone alignment was also analyzed using 35 parameters that were evaluated based on plain radiography. [Results] Greater the height of the medial longitudinal arch, and greater the backward tilt of the long axis of the talus and the backward tilt of the talar articular surface of the calcaneus, larger the KCR. This alignment differed between the genders. [Conclusion] This study suggested that the KCR increases as the subtalar joint axis approaches the long axis of the shank secondary to the lifting of the medial longitudinal arch of the foot and decreases as the subtalar joint axis approaches the long axis of the foot secondary to the lowering of the medial longitudinal arch of the foot.

[Purpose] Although a correlation has been reported between shoulder strength and maximum swimming power during arm-only swimming, the correlation between shoulder strength and maximum swimming power during front crawl swimming remains unclear. This study aimed to confirm the validity of a clinical assessment method for shoulder strength related to front crawl swimming power. [Participants and Methods] Study participants included 9 healthy male collegiate swimmers. Shoulder strength, including extension and internal rotation torque and swimming power, were measured. [Results] Maximum swimming power was significantly correlated with extension torque in the position of maximum shoulder abduction on the dominant side (r=0.844). No significant correlations were observed between the swimming velocity-to-swimming power ratio and the rate of bilateral differences in extension torque in the position of maximum shoulder abduction. [Conclusion] The extensor strength in the position of maximum shoulder abduction was significantly correlated with the maximum swimming power, suggesting that this assessment method is useful for front crawl swimmers. Notably, measurements on the dominant side may provide useful data that are essential in training to improve front crawl swimming propulsion.

[Purpose] This study was carried out to investigate the effect of orange filtered polarized polychromatic light on post burn pediatric scar. [Participants and Methods] Thirty children with post burn scar in wrist and hands participated in this study. They were between 3 to 7 years old, having hypertrophic burn scar ≥2 months post healing, free from concomitant skin disease and keloids. They were randomly assigned into two groups. The control group (A) (n=15) received Scar Standard Management (SSM) protocol and the study group (B) (n=15) received SSM protocol along with 15 min/area polarized light with medical range filter followed by 15 min/area orange filtered polarized light. All children received the study protocol once a day, 3 times/week for one month. Scar assessment was done before and after the study protocol by using Vancouver Scar Scale (VSS). [Results] All participated children were analyzed. Comparison of post treatment results between groups revealed significant improvement of post burn scar for both groups with significant difference in favor to the study group. [Conclusion] Ultimately it was revealed that Orange filtered polarized light has a special and beneficial effect on decreasing post burn pediatric scar.

[Purpose] The objective of this observational study was to examine the effect of home physiotherapy on pain and disability in participants with knee osteoarthritis. [Participants and Methods] From January 2017 to December 2017, 139 participants who were recipients of HealthCare atHome physiotherapy services across various locations were included in the main analysis. The mean treatment cycle duration was 31.5 days (mean number of sessions delivered, 19.7). Physiotherapy was performed for approximately 45–50 min in the form of electrotherapy, exercise therapy, and manual therapy. Visual analog scale (VAS) scores were documented after each visit, whereas The Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC) as an outcome were recorded weekly. [Results] Statistically significant improvement in the visual analog scale and Western Ontario and Mcmaster Universities Osteoarthritis Index scores were observed, with overall % improvement of 52% and 43%, respectively. [Conclusion] The average scores in pain and disability were reduced after home based physiotherapy.

[Purpose] The present study aimed to investigate the relationship between Frontal Assessment Battery scores and the ability to perform activities of daily living/instrumental activities of daily living based on child development, as well as the ability of Frontal Assessment Battery score to predict functional age. [Participants and Methods] The present cross-sectional study included 85 older adults (mean age: 83.5 years, standard deviation: 7.3; men: 23, women: 62; facility-dwelling: 43, home-based: 42) recruited from nursing homes and day centers in Hiroshima and Hyogo, Japan. All the participants were assessed using the Frontal Assessment Battery and perform activities of daily living/instrumental activities of daily living Cognitive Level Version 2.0 scale (ADL/IADL-COG ver.2.0). Spearman rank correlation coefficients and single regression analyses were performed to determine the relationship between the Frontal Assessment Battery score and functional age. The regression equation was then used to predict functional age based on the Frontal Assessment Battery score. [Results] We observed a strong correlation between the Frontal Assessment Battery score and functional age (rs=0.80). Furthermore, the linear regression equation for functional age exhibited a high predictive accuracy (R²=0.64). Our results thus indicated that Frontal Assessment Battery scores could be used to predict functional age according to the following equation: functional age (years)=0.56 × Frontal Assessment Battery score + 1.19 and Frontal Assessment Battery score=1.15 × functional age (years) + 1.86. [Conclusion] The present results indicate a significant relationship between Frontal Assessment Battery and perform activities of daily living/instrumental activities of daily living ability based on child development. Functional age, as predicted based on the Frontal Assessment Battery score, may aid rehabilitation practitioners in analyzing the relationship between cognitive function and perform activities of daily living/instrumental activities of daily living ability, setting goals regarding perform activities of daily living/instrumental activities of daily living, and selecting intervention targets in older adults.

[Purpose] This study aimed to investigate the effects of mirror neuron system-based self-observation training on lower limb muscle activity and dynamic balance in patients with chronic stroke. [Participants and Methods] Twenty patients with chronic stroke were randomly assigned to a self-observation training group (n=10) or a control group (n=10). Both groups followed a routine 30-minute exercise therapy regimen five days a week for four weeks. The self-observation training group additionally watched video clips of their balance and functional gait training and performed physical training twice over a 10-minute time span. Each self-observation training session was performed for 30 minutes, three times a week for four weeks. Muscle activity was evaluated using surface electromyography; dynamic balance was evaluated using timed up and go and 10-meterwalk tests. [Results] Within-group comparisons showed significant differences in muscular activities of the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius and dynamic balance. Comparing between groups, the muscle activity of the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius and dynamic balance were significantly different between experimental and control groups. [Conclusion] Self-observation training improved lower limb muscle activity and dynamic balance in patients with chronic stroke.

[Purpose] This study aimed to identify the preferential factor of activities of daily living disabilities for selecting between knee-ankle-foot orthosis and ankle-foot orthosis prescription in the early stage after admission. [Participants and Methods] This study included 442 inpatients who had a subacute stroke and received either knee-ankle-foot orthosis or ankle-foot orthosis after admission (mean age, 69 years). The functional independence measure was investigated within 1 week after admission. [Results] Inpatients who had a stroke and received knee-ankle-foot orthosis had significantly lower scores for all individual functional independence measure items than those who received ankle-foot orthosis. Logistic regression analysis revealed that functional independence measure transfer (bed, chair, and wheelchair) was closely associated with the difference in the prescribed lower limb orthosis after multivariate adjustment. [Conclusion] Compared with ankle-foot orthosis, knee-ankle-foot orthosis was prescribed to inpatients with more-severe disabilities, and the difference in the disability related to performing transfer activities was more noticeable than that in disability related to mobility between inpatients for whom knee-ankle-foot orthosis was prescribed and those for whom ankle-foot orthosis was prescribed. To provide effective rehabilitation for people who had a subacute stroke, for whom use of knee-ankle-foot orthosis or ankle-foot orthosis is recommended. The evaluation and intervention focused on standing performance related to performing transfer such as sit-to-stand, standing, moving while standing, and stepping might be a priority in the early stage after admission.

[Purpose] Physical activity influences the prognosis of chronic obstructive pulmonary disease and is influenced by exercise tolerance, and environmental, psychological, and many other factors, but the influence of these factors on physical activity levels in each stage of chronic obstructive pulmonary disease is unknown. This study aimed to clarify this matter. [Participants and Methods] Seventy-one male patients with chronic obstructive pulmonary disease (aged 72.2 ± 4.5 years) participated in this study. We compared physical activity levels (determined as daily steps), presence or absence of daily routine (e.g., housework or hobby), 6-minute walking distance, psychological factors (using the Hospital Anxiety and Depression Scale), and health-related quality of life (Physical and Mental component summary of the 36-item short-form health survey) between patients in different stages of chronic obstructive pulmonary disease. [Results] When examined at each stage of chronic obstructive pulmonary disease, physical activity levels correlated with the presence or absence of daily routine, 6-minute walking distance, and Physical component summary in all stages, but the scores in the anxiety and depression components of the Hospital Anxiety and Depression Scale and Mental component summary correlated only with stage 4. [Conclusion] Physical functioning was related to physical activity levels at any stage of chronic obstructive pulmonary disease, although psychological functioning was related to the progress of disease severity. The approach to promote an active lifestyle must be selected depending on the stage of chronic obstructive pulmonary disease.

[Purpose] To examine the influence of different exercise intensities on cortical activity. [Participants and Methods] Twenty-six healthy adults aged 20–30 years performed exercise at three intensities on a bicycle ergometer as follows: (a) 15-minute exercise at 40% peak oxygen uptake, (b) same as (a) but at 60% peak oxygen uptake, and (c) 15 minutes of rest. The cognitive function of the participants was measured before and after exercise by the Paced Auditory Serial Addition Test (PASAT) under these three conditions. The cerebral blood flow in the left prefrontal and temporal cortices was measured using near-infrared spectroscopy during the PASAT. [Results] The PASAT score was significantly higher after exercise under condition (b) than before exercise (41.4 ± 9.1 vs. 47.7 ± 8.3). The cerebral blood flow in the prefrontal cortex under condition (b) was significantly increased compared to that under condition (c), as determined by the Tukey method (0.019 ± 0.030 vs. −0.008 ± 0.044). Significant differences were not observed in the cerebral blood flow in the temporal cortex under these three conditions. [Conclusion] Cortical activation of the frontal lobe increased after high-intensity aerobic exercise with no change in the cortical activity of the temporal lobe.

[Purpose] The balance exercise assist robot is a training device based on a personal transport assistance robot ridden in the standing position. The personal transport assistance robot uses an inverted pendulum control system and moves in response to movements of the user’s center of gravity. The purpose of this study was to describe the characteristics of postural control during the action of stopping the personal transport assistance robot. [Participants and Methods] Eleven healthy male participants were required to maintain a standing position for 30 s; each task was performed 10 times. The measurement conditions were as follows: (1) on the floor; (2) on the robot, touching the handlebars; and (3) on the robot, not touching the handlebars. [Results] During the robotic tasks, the total locus lengths of the center of gravity and total joint momentums of the hip, knee, and ankle joints were larger, and the amount of displacement of the center of pressure was smaller than that during the floor task. Posture control on the robot was performed actively by mechanical interaction of the ankle, knee, and hip joints within a small base of support. [Conclusion] The balance exercise assist robot can be useful for postural control exercises because maintaining a standing position on the personal transport assistance robot required active postural control.

[Purpose] This study was conducted to investigate pulmonary function before and after the performance of a balloon-blowing exercise in a 90/90 bridge position using a ball among female university students in their twenties. [Participants and Methods] Participants were randomly assigned to the control group, which performed the bridge position using hip and knee flexion on a ball with a diaphragm respiratory exercise, or the experimental group, which performed a 90/90 bridge using a ball with a balloon exercise. The exercise programs were conducted 30 minutes a day, five times a week for four weeks. Pulmonary function was measured with a digital equipment before and after the exercise program period. [Results] The findings suggest that the training group resulted in significant changes in forced vital capacity, vital capacity, peak expiratory flow, and forced expiratory volume at one second. There was no significant increase in maximal voluntary capacity or vital capacity, but the pre- and post-test values improved. To compare the two groups, an independent t-test was conducted to determine vital capacity, and the results showed statistically significant differences between the experimental and control groups. [Conclusion] This study showed that a balloon-blowing exercise in a 90/90 bridge position using a ball can be used to improve pulmonary function.

[Purpose] The aim of this study was to determine whether physiotherapists (PT) scores are consistent over time when using Action Research Arm Test (ARAT) to assess upper limb (UL) function on a videotaped chronic stroke patient. [Participants and Methods] Quantitative correlational study. A convenience-snowball sample of 20 international PT (mean age and experience=32 ± 6.8 and 7.55 ± 7.4 years) used ARAT to score chronic stroke patient’s UL function, observing a video at baseline and again ≈ 2 weeks later. Two sets of non-parametric ordinal data were assessed with Spearman’s (rho) and the alpha (a) value was set at 0.01. Line of equality, Bland-Altman plots and Wilcoxon signed rank test were also considered. [Results] Spearman’s rho was found ≈ 0.78 at a significance level of 0.00. ARAT was scored with a mean difference of 16.6 days and a mean change of 0.6 points was observed. Limits of agreement and coefficient of reproducibility were ± 2.3 and ± 2.6 respectively. The patient’s arm impairment was categorised as moderate and floor or ceiling effects were not detected. [Conclusion] The results suggest that ARAT is consistent, valid and should be used by PT in chronic stroke.

[Purpose] To investigate the association between proprioception and a knee medial to foot position during weight-bearing activities in patients with anterior cruciate ligament reconstruction and anterior cruciate ligament deficiency. [Participants and Methods] Thirty-eight patients with anterior cruciate ligament reconstruction and 13 patients with anterior cruciate ligament deficiency aged 18–40 years were included. Proprioception was assessed by knee kinesthesia measured by the threshold to detection of passive motion. Movement quality was assessed by visual observation of the position of the knee in relation to the foot during the mini squat, the single-leg hop for distance, and the cross-over hop for distance. [Results] In patients with anterior cruciate ligament deficiency, worse kinesthesia was significantly associated with a knee medial to foot position during the single-leg hop for distance. No statistically significant associations were observed between kinesthesia and a knee medial to foot position during the three tasks in patients with anterior cruciate ligament reconstruction. [Conclusion] Poor proprioception may be associated with worse movement quality of the knee in patients with anterior cruciate ligament deficiency, but not in patients with anterior cruciate ligament reconstruction. Differences in sensorimotor function between patients with reconstructed and non-reconstructed anterior cruciate ligament should be considered in training and rehabilitation regimens aiming to enhance performance and prevent further injuries in these patients.

[Purpose] This study investigated the efficacy of our independently developed method for measuring shoulder joint position sense using oral instructions based on body schema (“schema method”) and investigated age-related changes. [Participants and Methods] Forty university students, 19 elderly individuals, and 16 elementary school students were included. Active shoulder abduction was measured in an upright sitting position. Target angles for position sense measurement were 45° of abduction (Target 45) and 90° of abduction (Target 90). The schema method consisted of indicating the target angles through oral instructions alone. The reproduction method and the imitation method were also used to measure angles. Abduction angle, absolute error, and variable error were calculated. [Results] A significant difference in abduction angle at Target 45 was observed between the schema method and the reproduction and imitation methods; no significant differences were observed at Target 90. No significant differences in variable error at Target 90 were observed among the three measurement methods. A significant difference in abduction angle was observed between university students and elderly individuals, and a significant difference in variable error was observed between elementary school students and elderly individuals. [Conclusion] Our body schema-based oral instruction method will be useful for evaluating joint position sense or proprioception.

[Purpose] This study aimed to examine the differences in dynamic postural control during forward step down (FSD) task in patients with patellofemoral pain syndrome (PFPS). [Participants and Methods] Sixty-eight participants (34 males and 34 females) were divided into the following 2 groups: 34 PFPS patients (17 males and 17 females) and 34 healthy controls (17 males and 17 females). Each participant performed FSD task from a height of 20 cm. A force platform was used to extract the center of pressure parameters during FSD task for calculation of time to stabilization (TTS) in the anterior-posterior (A/P) and medial-lateral (M/L) direction. [Results] PFPS group took longer time to stabilize than the healthy control group in A/P and M/L directions. A main effect for direction was found, and this indicated that the A/P TTS of 8.43 ± 0.79s was longer than the M/L TTS of 5.56 ± 1.95s in healthy participants and A/P TTS of 9.09 ± 0.82s was longer than the M/L TTS of 7.15 ± 2.11s in PFPS. [Conclusion] These findings suggest that dynamic postural control can be affected in PFPS patients.

[Purpose] People using technology and handheld devices adopt postures of the upper limb and neck that could result in musculoskeletal pathology. Previous research has explored the postures assumed during isolated use of technology devices, such as a smartphone, however a comparison of posture assumed between multiple devices has not been completed. The purpose of this study was to compare the posture of the upper body and limb between handheld devices and technology. [Participants and Methods] Twenty one healthy college students completed this study. Pictures of participants were taken in a neutral posture and as they performed standard tasks with 3 devices (mobile phone, tablet, laptop). A mobile application calculated sagittal and coronal plane posture variables, which were compared between device conditions with an ANOVA and post-hoc tests. [Results] Head translation and angulation and shoulder angulation varied significantly between conditions in both planes. Shoulder translation varied significantly between conditions in the sagittal plane. Rib translation varied significantly between conditions in the coronal plane. Tablet use produced postures that were statistically different than the other devices. [Conclusion] Use of each device altered posture however, frequent, regular use of a tablet may produce greater deleterious effects than regular use of other handheld devices/technology.

[Purpose] Hip dislocation and subluxation are common in patients with cerebral palsy (CP). Hip abduction orthoses are used to prevent and treat these problems. This study investigated the effects of an underwear-type hip abduction orthosis on sitting balance and sit-to-stand (STS) activity in children with spastic CP. [Participants and Methods] This trial had a cross-over design. Eight children aged 6 to 18 years old with spastic CP and Gross Motor Function Classification level III and IV were randomly allocated to groups with or without use of the underwear-type hip orthosis. The trunk impairment scale (TIS) score was evaluated and the 5-times sit-to-stand test (FTSST) was conducted with and without the underwear. [Results] The dynamic sitting balance scores in the TIS and FTSST showed significant improvement with use of the orthotic underwear. [Conclusion] The dynamic sitting balance scores of the TIS and FTSST were higher, thus indicating better stability, when wearing the orthosis underwear. Thus, it was suggested that underwear-type hip abduction orthoses are effective for promoting sitting balance and STS activities in children with spastic CP.

[Purpose] This study aimed to ascertain whether ankle stretching combined with arm cycling compared with that without arm cycling results in greater improvement in maximum dorsiflexion range of motion (ROM), calf muscle stiffness, and gait velocity in the affected limb of patients with stroke. [Participants and Methods] Random ABAB reversal design was used in this study involving nine patients with stroke. Participants performed 10 min of ankle plantar flexor stretching through weight bearing using the tilt table under the following 2 conditions: with or without arm cycling at 60 revolutions per minute. Pre- and post-stretching maximum ROM and passive plantar flexion torque were measured using a custom-made passive torque indicator. Stiffness was calculated based on passive torque-angle relationships. [Results] Maximum ROM and stiffness significantly improved after stretching in both conditions, whereas no changes in gait velocity were found. The difference in pre- and post-stretching stiffness was significantly greater in the stretching with arm cycling group. Change in maximum ROM showed no difference between both stretching conditions. [Conclusion] This study indicates that ankle plantar flexor stretching combined with arm cycling was more effective than that without cycling in improving calf muscle stiffness in the affected limb of patients with stroke.

[Purpose] The purpose of this study is to examine the effectiveness of a stroke-related scale with regard to outcome, onset, and timing of stroke patients. [Participants and Methods] The participants included 583 out of 996 patients who were admitted to the stroke care unit.The outcomes and 3 stroke scale (National Institutes of Health Stroke Scale: NIHSS, Functional Independence Measure: FIM, modified Rankin Scale: mRS) scores immediately at hospitalization, on day 7 after onset, and on day 30 after onset were investigated. This study was analyzed using a generalization linear model with a binomial distribution. The comparisons between outcomes were made in terms of home discharge versus convalescence, and convalescence versus hospital transfer. [Results] Comparisons of home discharge versus convalescence hospital transfer showed a significant difference in the NIHSS and mRS scores at the time of hospitalization, and a significant difference in the NIHSS scale score on day 7 after onset. In comparisons between convalescence and hospital transfer, significant differences were observed in NIHSS and FIM scores at hospitalization, and the FIM scale score showed significant differences on day 7 and day 30. [Conclusion] The study suggested the efficacy of using multiple scales for prediction of stroke outcome with higher accuracy.

[Purpose] A trial was conducted to examine the effects of promoting daily physical activity, tailored to specific living situations, on physical and mental health indicators in older adults. [Participants and Methods] Participants in the ‘Intervention’ group (N=21) wore accelerometers during the 12-week trial period, and for one week during preliminary and follow-up surveys. Based on their physical activity levels as measured by accelerometers, participants were given instructions to increase their daily physical activity. Participants in the ‘Control’ group (N=18) wore the accelerometer only during the preliminary and follow-up survey. [Results] Number of steps increased significantly in the intervention group and a significant decrease in light physical activity time was observed in the control group. No such decrease was observed in the intervention group. With regard to health-related quality of life, significant interactions were observed between groups based on the 36-Item Short-Form Health Survey Mental Component Summary score, and some sub-items. A combined analysis of both groups found a significant positive correlation between the change in light physical activity time and the Mental Component Summary score. [Conclusion] An increase in daily physical activity was considered to have a sustained bolstering effect on mental health.

[Purpose] To demonstrate immediate alteration in lumbar lordosis and the lumbar angle in each segment after the application of the mechanical pressure technique to the psoas major muscle (PM). [Participants and Methods] In all, 34 participants were assigned to either the PM pressure technique group (n=17) or control group (n=17). Three dimensional (3D) coordinates of the 12th thoracic spinous process and lumbar spinous processes were measured with a 3D digitizer in the prone position with 15° bilateral hip extension to compare the changes in lumbar lordosis and the lumbar extension angle in each segment in both the PM pressure technique group and control group. [Results] Mann-Whitney’s U test revealed no significant differences in lumbar lordosis in either group. However, the lumbar extension angle at L4 decreased significantly after the PM pressure technique compared with that before the pressure technique. Additionally, the lumbar extension angle at L4 also decreased significantly after the PM pressure technique compared with the control group. Conversely, lumbar extension angle at L1 increased significantly after the PM pressure technique compared with that before. There was no significant difference in the lumbar extension angle at L2, L3 and L5 after the PM pressure technique. [Conclusion] This study suggests that the PM pressure technique possibly attenuates PM stiffness while reducing lumbar extension in each segment.

[Purpose] This study investigated the relationship between the amount of scapular anterior tilting and the ratio of internal and external rotation of the shoulder in a supine position. [Participants and Methods] Twenty healthy participants (8 females, 12 males) were enrolled in this study. Internal rotation (IR) and external rotation (ER) of the glenohumeral joint were performed in a supine position, and the IR and ER angles were measured using a universal goniometer. The changing distance of scapular anterior tilting was measured by a three-dimensional motion analysis tracking system while participants performed IR and ER in a supine position. Pearson’s correlation coefficient was used to investigate the relationship between the distance of scapular anterior tilting and the ratio of internal and external rotation angle of the shoulder. [Results] The correlation of the degree of scapular anterior tilting with the IR/ER ratio, particularly the IR angle of the shoulder in a supine position, was good to excellent (r=−0.851). [Conclusion] The findings suggest that asymmetry of the IR and ER angles may cause increased scapular anterior tilting in a supine position.

[Purpose] This study investigated the effect of psoas major pre-activation on the electromyographic (EMG) activity of the abdominal muscles and pelvic rotation during active leg raising (ALR). [Participants and Methods] Twenty healthy participants were enrolled. ALR was performed in a conventional manor or with contralateral psoas major (cPM) pre-activation. The EMG activity of the abdominal muscles, including the rectus abdominalis (RA), external oblique (EO), and internal oblique (IO), was measured, as was pelvic rotation. Paired t-tests were used. [Results] The EMG activity of all studied muscles was significantly increased, and pelvic rotation was significantly decreased, during ALR with psoas major pre-activation compared to the levels under conventional testing. [Conclusion] cPM pre-activation during ALR can increase abdominal muscle activity and minimize pelvic rotation.

[Purpose] This study aims to gather scientific evidence to identify whether clinical trials on Electrostimulation of the Posterior Tibial Nerve (ESPTN) in individuals with overactive bladder present an adequate methodological standard according to the PEDro (Physiotherapy Evidence Database) criteria. [Methods] Integral literature review, including randomized controlled clinical trials found in PEDro. [Results] We found 16 articles, of which only one did not meet the inclusion criteria. This article has shown that ESPTN is a conservative tool of physiotherapy that is less invasive than other therapies, is well tolerated by patients and has been shown to be effective in the treatment of overactive bladder. However, few standardized clinical studies have been conducted, and only 26.6% of the articles included in this review obtained a score of more than five items on the PEDro scale. [Conclusion] This article has shown that ESPTN is a conservative tool of physiotherapy that is less invasive than other therapies, is well tolerated by patients and has been shown to be effective in the treatment of overactive bladder. Thus, there is a need for more clinical articles that follow the quality criteria for randomized clinical trials, allowing more reliable scientific results.

[Purpose] The aim of this systematic review was to assess the efficacy of high intensity laser therapy (HILT) on wound surface area in patients with foot ulcers. [Methods] Four databases including PubMed, MEDLINE, the Cochrane library, and the Physiotherapy Evidence Database (PEDro) were searched up to the end of April 2018 to identify relevant studies. Studies were included if they met the following criteria: randomised controlled trial (RCT), assessed the efficacy of HILT in patients with foot ulcers, evaluated wound surface area, and written in English language with available full text. The PEDro scale was used to evaluate the quality of studies. [Results] A total of three RCTs met the inclusion criteria, with two studies of the efficacy of HILT in adult patients with diabetic foot ulcers and one in spina bifida children with neuropathic foot ulcers. According to the PEDro scale assessment, all three studies were rated as a fair quality. All studies found that HILT provided significantly better outcomes compared to sham laser or standard medical therapy. [Conclusion] This systematic review suggests that HILT is an effective modality for wound healing in patients with foot ulcers, but further large-scale studies are required to confirm its efficacy.