Objective To determine whether a fully immersive virtual reality (VR) intervention combined with conventional rehabilitation (CR) can improve upper limb function more than CR alone in patients with spinal cord injury (SCI), we conducted a prospective, randomized, controlled clinical trial.Methods Participants were randomly assigned to either the control group (CG; n=10) or experimental group (EG; n=10). The participants in the CG received 60 minutes of conventional therapy per day, 4 days per week for 4 weeks, whereas those in the EG received 30 minutes of VR training and 30 minutes of conventional therapy per day, 4 days per week for 4 weeks. The clinical outcome measures included Medical Research Council grade, the American Spinal Injury Association upper extremity motor score (ASIA-UEMS), and scores in the Hand Strength Test, Box and Block Test, Nine-Hole Peg Test, Action Research Arm Test, and Korean version of the Spinal Cord Independence Measure (K-SCIM). The assessments were performed at the beginning (T0) and end of the intervention (T1).Results Grip power and K-SCIM score significantly improved in the EG after the intervention. When comparing differences between the groups, elbow extensor, wrist extensor, ASIA-UEMS, grip power, lateral pinch power, and palmar pinch power were all significantly improved.Conclusion VR training of upper limb function after SCI can provide an acceptable adjunctive rehabilitation method without significant adverse effects.

Background: Osteosarcopenia is a syndrome characterized by the co-existence of osteoporosis and sarcopenia. This study aimed to examine the relationship between various types of physical activity and osteosarcopenia in community-dwelling Korean adults aged 65 years or older. Methods: This cross-sectional study used raw data from the fourth and fifth editions of the Korean National Health and Nutritional Survey Examination, conducted from 2008 to 2011. The researchers exclusively recruited participants aged 65 years or older for the study. These participants were categorized into four distinct groups based on their clinical factors, namely individuals without osteoporosis or sarcopenia, those with osteoporosis alone, those with sarcopenia alone, and individuals with osteosarcopenia. The International Physical Activity Short-Form was used to calculate the weekly time spent walking, moderate-intensity aerobic physical activity, and vigorous aerobic physical activity. Number of days in performing strengthening or stretching exercises were also surveyed. We used logistic regression analyses to examine the association between various physical activities and occurrence of osteosarcopenia. Results: A total of 1,342 participants (639 men and 703 women) were included in the analysis. No significant difference was observed in the amount and level of aerobic physical activity between the groups. The odds ratios below were based on participants without osteoporosis or sarcopenia as the reference category. The un-adjusted odds ratio of participants who performed stretching (male, 0.179, 95% CI 0.078–0.412; female 0.430, 95% CI 0.217–0.853) and strengthening exercises (male, 0.143, 95% CI 0.051–0.402; female, 0.044, 95% CI 0.006–0.342) at least twice per week was significantly lower in participants with osteosarcopenia compared to those without. In the adjusted analysis (adjusted by age, body mass index, house income, educational level, smoking habits, drinking status, and protein intake), only female patients in the osteosarcopenia group had a significantly lower adjusted odds ratio for performing strengthening exercise compared to female participants without osteoporosis or sarcopenia (0.062, 95% CI 0.007–0.538). Conclusions: After adjusting for confounding factors and protein intake, women aged 65 years and older who suffered osteosarcopenia had considerably lower odds ratio of performing strengthening exercises.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder.Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework.Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial.Conclusion: These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Kim JL, et al. Ann Rehabil Med. 2016 Aug;40(4):583-591. https://doi.org/10.5535/arm.2016.40.4.583

We evaluated the efficacy of a 6-month progressive resistance exercise in postmenopausal women with osteosarcopenia. Thirty-four community-dwelling postmenopausal women with osteosarcopenia were randomly assigned to either a resistance exercise group (RE; n = 17) or a home exercise group (HE; n = 17). Both groups received home exercise brochures and nutritional supplementation. The RE group additionally participated in supervised resistance training sessions twice weekly. The primary outcome was the change in the skeletal muscle index (SMI) and bone mineral density (BMD). The secondary outcomes included changes in handgrip strength (HGS) and physical performance. Seventeen and sixteen participants in the RE and HE groups, respectively, completed the intervention. The RE group showed significantly greater SMI improvement at the 12-week follow-up (0.310 ± 0.343 kg/m² vs. 0.011 ± 0.423 kg/m² in HE). However, there was no significant difference between groups at the 24-week follow-up. The other primary outcome, BMD, did not show any statistically significant differences either within or between groups. While both groups showed significant improvement in HGS and physical performance over time, the RE group had significantly higher HGS at the 6-week and 18-week follow-ups. A 6-month program of progressive resistance exercise combined with nutritional support improved muscle mass and strength in postmenopausal women with osteosarcopenia. Although the HE group showed less improvement at earlier time points, their muscle strength and physical performance were comparable to those of the RE group by the end of the intervention.

Objective: To investigate the feasibility and effects of a mobile app-based home cycling exercise program compared to home cycling exercise without additional monitoring system. Compared with fitness facilities or outdoor exercise, home-based exercise programs effectively improve physical performance in an indwelling community. However, a flexible, informal environment may decrease motivation and impair adherence to physical exercise. Mobile devices for aerobic exercise and mobile applications provide real-time monitoring, immediate feedback, and encouragement to increase motivation and promote physical performance. We investigated the feasibility and effects of a mobile app-based home exercise program on body composition, muscular strength, and cardiopulmonary function.Methods: Between February and May 2023, 20 participants were randomly allocated to the intervention (mobile application with a tablet) and control groups, and they performed aerobic exercise using a stationary bicycle for ≥150 minutes per week for 6 weeks (≤30-minute exercise session, with 3-minute warm-up and 3-minute cool-down). Karvonen formula-based heartrate defined the weekly increase in exercise intensity. Outcome measures included body-composition parameters, isokinetic knee flexor and extensor strength tests, cardiopulmonary exercise test results, and rate of target heart rate (HR) achievement. Participants were assessed at baseline and after the intervention.Results: Unrelated personal events led two participants to drop out. The intervention and control groups had similar baseline characteristics. Compared with the control group, in the post-intervention isokinetic strength test, bilateral knee flexor and extensor power, and time to target HR achievement significantly increased each week in the intervention group.Conclusion: Home-based exercise to achieve long-term cardiovascular fitness with portable electronic/mobile devices facilitates individualized exercise using real-time feedback to improve motivation and adherence.