Effects of proprioceptive neuromuscular facilitation on shoulder impingement, and perturbation training for balance in the elderly population.

Background. Proprioceptive neuromuscular facilitation, PNF, is a common technique in the field of physical therapy and is often used as a treatment for upper extremity pathologies. In this paper, the effectiveness of PNF as a treatment technique for shoulder impingement is assessed in a systematic review (SR) of all available literature in chapter 2. Based on results taken from the relevant literature, conclusions were drawn as to the effectiveness of PNF on patients suffering from shoulder impingement as well as identifying potential avenues for future research of PNF. A Critically Appraised Topic, CAT, is in chapter 3 and looks at the effects of perturbation training on balance and recovery in the elderly population. Perturbation training is another commonly applied physical therapy technique and is often used for facilitating proprioception and stability. Methods. The SR was conducted by two independent reviewers over 10 databases from June 2020 to January 2021. Articles included in the SR had populations of adults with shoulder impingement; the articles assessed changes in range of motion (ROM) after being treated by PNF or other traditional physical therapy techniques. Articles were excluded from the SR if they were published over 10 years ago, were not in English, or were book chapters or case studies. The CAT was conducted in January 2021 by two independent reviewers, assessing literature from a single database related to perturbation training in healthy, elderly adults. Articles were included if they involved perturbation training as the treatment technique, if they assessed falls and related injuries, and if had populations of otherwise healthy elderly adults. Articles were excluded if they were published before 2015 or were not in English. There were 301 studies screened for the SR, with 291 excluded based on stated criteria. The remaining 10 articles were deemed relevant to the PICO question and included in the SR. Study quality and levels of evidence were assessed using the PEDro and NIH-NHLBI grading tools. For the CAT, 46 articles were screened, with five being relevant to the PICO question and meeting inclusion criteria. Articles for the CAT were appraised using the OCEBM Levels of Evidence, with study quality assessed using PEDro and NIH-NHLBI tools. Results. The 10 articles assessed in the SR concluded that PNF techniques are effective at improving overall ROM, pain-free ROM, and functional reach, as well as decreasing perceived pain and disability. PNF, when combined with traditional treatment, was found to have better outcomes than with traditional treatment alone. From the five articles included in the CAT, perturbation training in healthy, elderly adults was found to reduce both the number of falls and the severity of injury suffered from them. Conclusion. All available evidence appears to conclude that PNF is effective for treating shoulder impingement, especially when combined with traditional therapy techniques. However, there is a lack of consistency within the literature with regard to specific PNF techniques and parameters applied per treatment session. Overall evidence quality for the SR was rated in the fair to good categories from the appraisal tools used. Findings from the CAT indicate that perturbation training is a useful treatment technique for elderly adults, as it effectively decreases the risk of falling and/or suffering severe injuries when a fall does occur. These findings are backed by a strong quality of evidence. Limitations from the SR include inconsistent and non-specific methodologies, both for parameters of PNF treatment given and for what was considered traditional therapy techniques. The CAT was limited by its inherently less rigorous research protocol, although the high quality of studies included helps to offset that limitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved)