Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow limitation. Patient participation in Pulmonary Rehabilitation (PR) programs has a beneficial effect on disease management, improving patients’ functional capacity and quality of life. As an alternative to traditional programs or as a complementary activity, the inclusion of virtual reality (VR) games is proposed. The aim of this research study was to investigate the effectiveness of incorporating VR in the pulmonary rehabilitation program of patients with COPD. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, and Pedro from January 2014 to March 2022. The search involved screening for studies examining the effectiveness of enhancing PR with VR. The PEDro (Physiotherapy Evidence Database) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. Six studies were included in this systematic review. The PEDro scale showed five studies of good methodological quality and one of fair quality. The variables examined were aerobic capacity for exercise, lung function, and anxiety and depression, with significant improvement regarding 6MWT and FEV1 (p < 0.05). There was variability noted in the VR applications and the proposed rehabilitation that the experimental groups followed. The application of VR is recommended for COPD patients, in combination with conventional PR. VR was found to be effective in increasing therapeutic effect and should be considered as a mean of increasing accessibility to PR. Therefore, further research, as well as additional RCTs regarding the effectiveness of VR in patients with COPD, seems necessary.

Background and objectives: Mechanical ventilation is often used in intensive care units to assist patients’ breathing. This often leads to respiratory muscle weakness and diaphragmatic dysfunction, causing weaning difficulties. Inspiratory muscle training (IMT) has been found to be beneficial in increasing inspiratory muscle strength and facilitating weaning. Over the years, different protocols and devices have been used. Materials and Methods: The aim of this systematic review and meta-analysis was to investigate the effectiveness of low-medium (LM-IMT) and high-intensity (H-IMT) threshold inspiratory muscle training in critically ill patients. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, Scopus, and Science Direct. The search involved screening for studies examining the effectiveness of two different intensities of threshold IMT in critically ill patients published the last 10 years. The Physiotherapy Evidence Database (PEDro) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. Results: Fourteen studies were included in the systematic review, with five of them having high methodological quality. Conclusions: When examining LM-IMT and H-IMT though, neither was able to reach statistically significant improvement in their maximal inspiratory pressure (MIP), while LM-IMT reached it in terms of weaning duration. Additionally, no statistical difference was noticed in the duration of mechanical ventilation. The application of IMT is recommended to ICU patients in order to prevent diaphragmatic dysfunction and facilitate weaning from mechanical ventilation. Therefore, further research as well as additional RCTs regarding different protocols are needed to enhance its effectiveness.

Background: Virtual Reality (VR) is a new technology used more and more in clinical trial. Aim: The aim of this study is to investigate the effects of immersive VR as a rehabilitation approach of cognitive functions. Method and Material: A systematic literature review was conducted in the electronic databases of PubMed, Cochrane, OTseeker and PsycINFO for articles published until August 2021. The main search terms were "immersive virtual reality," and "cognitive rehabilitation". The research was strictly limited in immersive technologies and adult patients suffering from neurological disorder or a traumatic injury or elderly with cognitive decline, and no reviews are included. Totally, 16 citations reviewed. Results: All intervention studies reported improvements either in cognitive functions or in stress management and relaxation. In particular, most of the studies demonstrated improvement in attention (N=6) but also in executive functions (N=3), in memory (N=5) and in navigation skills (N=1). Regarding safety and feasibility, most of the participants in the studies completed successfully the tasks and did not report stimulation sickness. Conclusions: The available limited data indicate that immersive VR environments can a) be feasible and safe and b) have a positive impact in cognitive functions in the dynamic process of rehabilitation. Further research is warranted in large-scale longitudinal clinical trials in various patients’ groups in order to compare the effects of immersive and non-immersive VR interventions. Future studies should further investigate the long-term impact on cognitive functions in interventions using immersive VR.

Physiotherapy is an essential component of respiratory management and mobilisation/rehabilitation for patients in the Intensive Care Unit (ICU). However, the current practices across Europe related to organisational models, referral pathways, or clinical techniques are not well-defined. To examine physiotherapy provision and practice of respiratory management and mobilisation/rehabilitation for mechanically ventilated patients in European ICUs. An online survey was developed, piloted and distributed in 11 languages via national coordinators, professional societies, and social media. The ICU physiotherapy leads, or in their absence, medical/nursing leaders from each ICU (one reply per ICU), completed the survey, which included information regarding ICU structure, physiotherapy provision, and current practice. Data were analysed descriptively. In total, 845 responses from 33 countries were included, with the largest representation from Spain (12%), the United Kingdom (11%), and France (11%). Most respondents were physiotherapists (88%) working in university hospitals (69%) and caring primarily for adult ICU patients (87%). Less than half (41%) of physiotherapists were dedicated to ICU, but 91% of them had received some ICU-specific training. Physiotherapy is initiated upon a referral in 52% of ICUs. It usually includes routine respiratory assessment (80%) and both respiratory management and mobilisation/rehabilitation for mechanically ventilated patients (85%). The most common techniques included endotracheal suctioning (55%) and manually assisted cough (51%), with less frequent use of mechanical insufflation-exsufflation (20%) and saline instillation (18%). Mobilisation/rehabilitation was widely practised, with 76% of respondents reporting patients sitting at the edge of the bed, 69% standing, and 71% walking during their ICU stay. Physiotherapy is a well-integrated part in European ICUs with physiotherapists providing both respiratory management and mobilisation/rehabilitation techniques, although heterogeneity persists in organisation, referral pathways and the use of specific techniques. These results inform the development of future training and workforce planning, ultimately improving interprofessional ICU care across Europe, particularly in underrepresented areas.

Objectives: New smartphone-based methods for measuring cervical spine range of motion (CS-ROM) and posture are emerging. The purpose of this study was to assess the reliability and validity of three such methods in patients with non-specific chronic neck pain (NSCNP). Methods: The within-day test–retest reliability of CS-ROM and forward head posture (craniovertebral angle-CVA) was examined in 45 patients with NSCNP. CS-ROM was simultaneously measured with an accelerometer sensor (KFORCE Sens^®) and a mobile phone device (iHandy and Compass apps), testing the accuracy of each and the parallel-forms reliability between the two methods. For construct validity, correlations of CS-ROM with demographics, lifestyle, and other cervical and thoracic spine biomechanically based measures were examined in 90 patients with NSCNP. Male–female differences were also explored. Results: Both methods were reliable, with measurements concurring between the two devices in all six movement directions (intraclass correlation coefficient/ICC = 0.90–0.99, standard error of the measurement/SEM = 0.54–3.09°). Male–female differences were only noted for two CS-ROM measures and CVA. Significant associations were documented: (a) between the six CS-ROM measures (R = 0.22–0.54, p < 0.05), (b) participants’ age with five out of six CS-ROM measures (R = 0.23–0.40, p < 0.05) and CVA (R = 0.21, p < 0.05), (c) CVA with two out of six CS-ROM measures (extension R = 0.29, p = 0.005 and left-side flexion R = 0.21, p < 0.05), body mass (R = −0.39, p < 0.001), body mass index (R = −0.52, p < 0.001), and chest wall expansion (R = 0.24–0.29, p < 0.05). Significantly lower forward head posture was noted in subjects with a high level of physical activity relative to those with a low level of physical activity. Conclusions: The reliability of both CS-ROM methods was excellent. Reductions in CS-ROM and increases in CVA were age-dependent in NSCNP. The significant relationship identified between CVA and CWE possibly signifies interconnections between NSCNP and the biomechanical aspect of dysfunctional breathing.

Background/Objectives: The Nijmegen Questionnaire (NQ) has been a prevalent screening tool for dysfunctional breathing for the past 40 years. Until recently, the validity of the NQ has been established for the general population with hyperventilation syndrome (HVS) and for individuals with asthma, but not for people with COPD. The aim of the study was to examine the validity and reliability of the NQ in individuals with COPD. Methods: Construct, convergent, divergent and discriminant validity as well as internal consistency reliability were examined in a sample of 84 people with stable COPD. Results: A three-factor solution with 16 items and 74.70% of explained variability was extracted through principal component analysis. High internal consistency (Cronbach alpha = 0.94) of the 16 NQ items was found. Significant differences were found between COPD individuals with and without DB (p < 0.001) and among people of all COPD levels of severity (p < 0.001). The value “>23” was found to detect the presence of DB, with 95.92% sensitivity and 94.29% specificity. Significant correlations were found between the total NQ score with BODE index (r = 0.81), Borg dyspnea scale (r = 0.47) and CAT (r = 0.49). The prevalence of DB for the specific sample was found to be 58.3%. Conclusions: The present study provided the first validity and reliability evidence for the NQ for people with stable COPD.