Lendraitienė, Eglė

Background and Objectives: Frail patients after open-heart surgery often experience worse treatment outcomes in improving physical performance and muscle strength. As the functional recovery of frail patients after open-heart surgery is slower, conventional rehabilitation is frequently insufficient to achieve treatment goals. Therefore, the inclusion of additional exercise interventions in cardiac rehabilitation is becoming more relevant. The aim of this study was to assess and compare the effectiveness of additional exercise interventions—multicomponent and computer-based programs—applied along with conventional cardiac rehabilitation in improving the functional capacity and strength of frail patients after open-heart surgery. Materials and Methods: The population of this single-center, three-arm, parallel-group, randomized controlled trial comprised 153 frail patients aged more than 65 years who underwent open-heart surgery. All patients were randomized into three groups: control (CG, n = 51), intervention 1 (IG-1, n = 51), and intervention 2 (IG-2, n = 51). All groups received conventional rehabilitation program six times/week, while the IG-1 additionally received the multicomponent dynamic training program 3 times/week, and the IG-2, the combined computer-based program 3 times/week. The primary outcome measure was change in the Short Physical Performance Battery (SPPB) score. Secondary outcome measures included the 6 min walk distance (6MWD), peak workload, grip strength, and leg press. Primary and secondary outcome measures were assessed before and after cardiac rehabilitation. Results: A total of 138 patients completed rehabilitation (46 in each group), and their data were included in the main analysis that followed a per-protocol approach. Although significant differences in the primary outcome—the SPPB score—were found in each group while performing within-group comparisons (p < 0.001), no significant pre-to-post rehabilitation differences were observed compared to all three groups (p = 0.939), and the effect sizes were small. Regarding secondary outcome measures, within-group comparison revealed significant differences in all parameters of all groups (p < 0.05), except for the grip strength of both hands in the IG-1. Between-group comparisons showed that the pre-to-post 6MWD difference between the CG and the IG-1 was significant (p = 0.014), but the effect size was small (ES = 0.240). Moreover, significant pre-and-post leg press 1RM differences (p < 0.001) were found between the CG and the IG-1 as well as between the CG and the IG-2 with the effect sizes being moderate (ES = 0.480) and large (ES = 0.613), respectively. Conclusions: Within-group comparison showed that all three rehabilitation programs are effective in improving almost all parameters of physical performance and muscle strength in frail patients after open-heart surgery. However, between-group comparisons indicated that computer-based interventions were more effective in improving leg press 1RM with a large effect size, while multicomponent training resulted in more effective gains in the 6MWD, although with a small effect size. These findings suggest that in clinical practice, computer-based exercise programs may be more suitable for patients with muscle weakness, while multicomponent exercise programs may be for those with reduced endurance.

Magistro baigiamasis darbas – reikšmingas žingsnis profesinio bei akademinio augimo kelyje. Tai galimybė gilintis į dominančias temas, formuoti kritinį požiūrį į šiuolaikinius iššūkius reabilitacijos srityje, pritaikyti sukauptas žinias, parodyti kūrybiškumą, kritinį mąstymą ir gebėjimą savarankiškai spręsti aktualias reabilitacijos srities problemas. Šios metodinės rekomendacijos skirtos Lietuvos sveikatos mokslų universiteto Medicinos akademijos Slaugos fakulteto reabilitacijos krypties antrosios pakopos studijų programos magistrantams, siekiantiems tikslingai, kryptingai ir kokybiškai parengti savo magistro baigiamąjį darbą. Rekomendacijose nuosekliai apžvelgiami svarbiausi magistro baigiamojo darbo rengimo aspektai – nuo bendrųjų nuostatų ir pagrindinių sąvokų iki struktūrinių, metodologinių bei techninių reikalavimų. Pirmojoje šių metodinių rekomendacijų dalyje išdėstytos bendrosios nuostatos, antrojoje – pagrindinės sąvokos, magistranto ir darbo vadovo funkcijos, pareigos ir atsakomybė, trečiojoje – baigiamojo darbo rengimo ir gynimo tvarka, ketvirtojoje – baigiamojo darbo reikalavimai, o penktojoje dalyje pateikiami priedai, kuriuose yra dokumentai, reikalingi rengiant magistro baigiamąjį darbą. Tikimės, kad šios metodinės rekomendacijos atsakys į klausimus, iškylančius rengiant magistro baigiamąjį darbą ir padės rasti tinkamus sprendimus bei taps praktiniu įrankiu, padėsiančiu sėkmingai įveikti kiekvieną baigiamojo darbo rengimo etapą. Linkime kūrybiškumo, atkaklumo ir akademinio įkvėpimo siekiant paversti Jūsų idėjas prasmingu ir vertingu moksliniu darbu.

Background and Aims Exercise-based cardiac rehabilitation (CR) is the most commonly used after open-heart surgeries (OHS)(1), these patients are more likely to have frailty syndrome(2) and have walking difficulties(3). There are no universally accepted standards for CR patients. Aim was to evaluate and compare the effects of additional exercises in CR on gait parameters in frail patients after OHS. Methods All 105 patients ≥65 years, after OHS and with frailty were invited to the study. Patients were randomly assigned to 3 different groups: control group (CG), intervention group 1 (IG-1), and intervention group 2 (IG-2). All groups received 20-day conventional CR program that included aerobic, stretching, breathing exercises 6 times/week; IG-1 additionally received multicomponent dynamic aerobic, balance and strength training (with unstable balance platforms, resistance bands and weights) 3 times/week; the IG-2, a combined computer-based program (with computer devices for gait, balance, strength training) 3 times/week. Groups were assessed 2 times: on admission and after CR. Frailty level was measured using Edmonton Frail Scale (≥4 score). Gait parameters were measured using Zebris program with force plate. Foot rotation, step and stride length, step width, double stance, step and stride time, cadence and gait speed were recorded. Results Within-group comparisons showed that significant differences were observed in all 3 groups in step, stride length, double stance phase and gait speed. Step, Stride time and cadence significantly improved results in CG and IG-2 groups, however, foot rotation significantly changed only in IG-2 group. Results showed that significant change in measuring step and stride time was found between CG and IG-1 as well as between the CG and the IG-2. Double stance significant change was observed only between the IG-1 and IG-2 groups. Conclusion All programs improved almost all gait parameters, however, combined computer-based program showed a greater effect on the results of gait parameters compared with other programs.

Anterior cruciate ligament (ACL) injuries are increasingly prevalent among adolescents, posing significant functional and psychological challenges. The optimal autograft choice for ACL reconstruction (ACLR) in this age group remains controversial. This dissertation compares clinical outcomes, knee stability, isokinetic muscle strength, and psychological readiness in 54 patients aged 12–17 years undergoing ACLR with quadriceps tendon (QT) or hamstring tendon (HT) autografts. Patients were assessed using the Genourob arthrometer (3, 6, 12 months post-surgery), Biodex isokinetic testing (6, 12 months post-surgery), and patient-reported outcomes: IKDC and Lysholm scores (preoperative and 12 months) and ACL-RSI scale (12 months). Both graft types demonstrated comparable functional recovery and return-to-sport rates. However, QT autografts showed more consistent anterior tibial translation and strength balance, while female patients exhibited more favorable outcomes with HT autografts. These results highlight that both grafts are effective for adolescent ACLR, with selection influenced by patient sex and strength profiles. The study emphasizes individualized rehabilitation based on objective knee stability, muscle strength and psychological readiness to optimize safe return-to-sport.

Lėtinis nespecifinis apatinės nugaros dalies skausmas – tai sudėtinga biopsichosocialinė problema, dažna tarp jauno amžiaus sėdimą darbą dirbančių asmenų. Tyrimo tikslas – įvertinti objektyvių ir subjektyvių judėjimo sistemos rodiklių bei lėtinio nespecifinio apatinės nugaros dalies skausmo sąsajas. Remiantis Tarptautinės funkcionavimo, negalumo ir sveikatos klasifikacijos modeliu, analizuota tyrimo dalyvių kūno laikysena, raumenų jėga ir aktyvumas, kūno pajautimas, fizinis aktyvumas, skausmo intensyvumas ir funkcinė būklė. Nustatyta, kad blogesnė subjektyviai vertinama funkcinė būklė siejosi su padidėjusia stuburo slankstelių rotacija, didesniu skausmo intensyvumu ir ilgesne skausmo trukme, padidėjusiu nugaros tiesiamųjų raumenų aktyvumu bei šlaunies tiesiamųjų raumenų jėgos disbalansu. Amžius, kūno laikysena, fizinis aktyvumas bei sėdimo darbo trukmė neturėjo tiesioginių sąsajų su funkciniais apribojimais. Tyrimo rezultatai parodė, kad integruotas vertinimo požiūris padeda geriau suprasti skausmo, funkcinės būklės ir judėjimo sistemos tarpusavio ryšius bei prisideda prie tikslesnio kineziterapinės diagnozės nustatymo ir funkcinės būklės įvertinimo.

Introduction. Facial muscle pain significantly affects daily functioning and quality of life, often linked to temporomandibular joint (TMJ) dysfunction and myofascial pain syndrome (3). These conditions are common in adults, with 5-12% of the population experiencing TMJ disorders or orofacial pain in their lifetime (1). This pain can limit jaw movement, cause emotional distress, and impair quality of life (2). This study evaluates the effectiveness of combining myofunctional therapy, transcutaneous electrical nerve stimulation (TENS), and myofascial release in treating facial muscle pain, focusing on pain reduction and functional improvement. Research methods and organization. The study was conducted at the Balčiūnų Clinic in Marijampolė, involving 30 patients aged 25–60 years, all with chronic facial muscle pain. Participants were randomly divided into two equal groups of 15. Group 1 received myofunctional therapy combined with myofascial release, and Group 2 received Transcutaneous Electrical Nerve Stimulation (TENS) combined with myofascial release. Inclusion criteria: Jaw or head pain, persistent or recurrent pain in the masticatory muscle area lasting at least three months, pain intensity ≥ 2 on the Visual Analog Scale, and age between 18–65 years. Exclusion criteria: Systemic inflammatory diseases, severe dentoalveolar anomalies, facial-jaw trauma, generalized pain syndromes, pregnancy, or pacemakers. Study group: The age of participants was 40.83 years, with 10 men and 20 women. The interventions lasted for 3 months, with sessions held three times a week, each lasting 30–40 minutes. Measured variables: Pain intensity was assessed using the VAS (0–10), range of motion was measured in centimeters, stress levels were assessed using the Perceived Stress Scale (PSS, 0–40), and the severity of Temporomandibular Dysfunction (TMD) was assessed using the Fonseca Questionnaire (0–100). The analysis of the results was performed using the IBM SSPS Statistics program. Nonparametric criteria were chosen for data analysis because the sample is small and the normality criterion is not met. The Wilcoxon Signed-Rank test was used to compare two dependent samples. The Mann– Whitney U test was used to compare two independent samples, to compare the effects of different interventions. Statistical significance was set at p < 0.05. Paired data (pre- and post-intervention): The Wilcoxon Signed-Rank test this test was appropriate for analyzing changes in variables before and after the interventions. Independent group comparisons: The Mann–Whitney U test was applied to compare two independent groups when the data distribution was non-normal Statistical significance was set at p < 0.05. Results. The study demonstrated significant improvements in facial muscle pain intensity and range of motion following the interventions. Pain intensity was assessed using the Visual Analog Scale (VAS), which ranges from 0 (no pain) to 10 (unimaginable pain). Before the interventions, the median pain score was 5.50 (min = 2; max = 10), which significantly decreased to 2.00 (min = 0; max = 7) after the interventions. This reduction was statistically significant (Z = -4.867, p < 0.001), confirming the efficacy of the interventions in reducing pain. Moreover, there was no statistically significant difference in post-intervention pain between patients who received different interventions (U = 105.5, p = 0.790), indicating that both approaches were equally effective. The second research objective aimed to assess and compare the changes in facial muscle movement amplitude between the two groups before and after therapy. In Group 1, which received myofunctional therapy combined with myofascial release, the median amplitude before intervention was 4.30 cm (min = 3.20; max = 5.40), and after the intervention increased to 5.10 cm (min = 4.40; max = 6.00). This improvement was statistically significant (Z = -3.524, p < 0.001). Improvement was also observed in Group 2, which received TENS combined with myofascial release. The median amplitude before the intervention was 3.70 cm (min = 2.70; max = 5.10), and after the intervention it increased to 4.85 cm (min = 3.30; max = 5.50). This difference was statistically significant (Z = -2.966, p = 0.003). Although Group 1 showed better outcomes, the difference between the two groups was not statistically significant (U = 78.50, p = 0.161). Stress levels, measured using the Perceived Stress Scale (PSS), significantly decreased in both groups after the interventions. In Group 1, the median stress level before the intervention was 20.00 (min = 16.00; max = 25.00), which significantly decreased to 16.00 (min = 13.00; max = 23.00) after the intervention (Z = -3.425, p < 0.001). Similar results were observed in Group 2, where the median stress level before the intervention was 18.00 (min = 11.00; max = 23.00) and decreased to 15.50 (min = 6.00; max = 19.00) post-intervention. This change was statistically significant (Z = -3.15, p = 0.002). Combined analysis of both groups also showed a significant overall decrease (Z = -4.634, p < 0.001). Importantly, no significant differences were found between the two groups after the intervention (U = 105.5, p = 0.790), suggesting that both interventions had a comparable effect in reducing perceived stress. However, it should be noted that based on the PSS score interpretation, both before and after the interventions, the participants' stress levels remained within the moderate range (14–26). This suggests that factors other than TMD may have contributed to the participants' perceived stress. Finally, Temporomandibular Dysfunction (TMD) severity, assessed using the Fonseca Index (FI), showed significant improvement in both groups. The FI ranges from 0 to 100, with the following classifications: 0–15: minimal TMD symptoms, 20–40: mild TMD symptoms, 45–65: moderate TMD symptoms, 70+: severe TMD symptoms. The median Fonseca Index score before the interventions was 40 (mild TMD symptoms), and post-intervention it was 20 (minimal TMD symptoms). In Group 1, the median FI score before the intervention was 70 (min = 55; max = 80), which significantly decreased to 32.50 (min = 15; max = 50) post-intervention (Z = -3.537, p < 0.001). Group 2 also demonstrated significant improvement, with the median score before the intervention being 70 (min = 35; max = 80), and decreasing to 32.50 (min = 15; max = 45) after the intervention (Z = -3.31, p = 0.001). The overall analysis (Z = -4.803, p < 0.001) confirmed that both interventions significantly reduced facial pain severity and were equally effective in improving patients quality of life. Conclusions. Both myofunctional therapy and electrostimulation, combined with myofascial release, significantly reduced facial muscle pain, improved muscle function, and decreased the severity of temporomandibular joint disorders. The interventions showed comparable efficacy in improving pain intensity, range of motion, and stress levels, suggesting their potential as effective treatments for patients with chronic facial muscle pain and temporomandibular joint dysfunction.

Indtroduction: Neck pain is the 4th most common cause of pain-related disability and ranges from 30% to 50% in the general population (1). Conservative methods are still the most important in pain relief. Research is being conducted to find the best way, combining several therapies (2). Studies have shown that active therapy is more effective than passive therapy. During the sling exercise program, the deep muscles surrounding the spine are activated, which maintain balance and posture (3). It restores normal movement patterns and increases the amplitude of movements by unloading the forces of gravity (4). The aim of this study was to compare the effects of a sling system and elastic resistance bands exercises on neck function and pain intensity. Research methods and organization: This study was approved by the Bioethics Center of the Lithuanian University of Health Sciences. (Approval No. 2024-BEC2-987). All participants provided written informed consent. The study was conducted from November to February (2024-2025). 22 patients (6 men and 16 women), aged 25-62 with non-specific neck pain, were enrolled. There were 2 study groups. The average age of the group 1 was 41,55 (26-61) years, and the group 2 was 44,45 (25- 62) years. Inclusion criteria were: negative neurological tests (Spurling, distraction, arm nerves stretching tests); pain intensity is assessed by no more than 5 points on the VAS scale; working-age individuals (18-64); pain lasts longer than 3 months. Exclusion criteria: patients with fractures, infectious or oncological diseases; spinal surgery performed in the last 12 months; taking pain medication. They were randomly assigned into two groups: group 1 (n=11, 4 men 7 women): neck stretching and strengthening exercises + elastic resistance band; group 2 (n=11, 2 men 9 women): neck stretching and strengthening exercises + sling system. The exercises were performed for a total of 7 days, 4 of which were elastic resistance bands or sling system exercises. The training session lasted 30 minutes. Both groups performed exercises to stretch and strengthen the neck and shoulder girdle. Pain intensity was assessed using Visual Analogue Scale, functional condition was evaluated with Neck Disability Index which is designed to assess self-rated physical disability caused by neck pain. Deep neck flexors endurance was evaluated by The Deep Muscle Endurance Test. The analysis of the results was performed using the IBM SPSS Statistics program. Arithmetic mean (m), median (xme), minimum (xmin), maximum (xmax) of the data were calculated. The Mann-Whitney U test was used for independent samples and Wilcoxon for depended samples with a non-normal distribution. Significance level p<0.05. Results: Pain: Before physiotherapy, the pain assessment of the group 1 and the group 2 were 4 (2-5; 4,09) scores. There were no statistically significant differences between groups before physiotherapy (p=1,000; U=60,500). After physiotherapy, the pain assessment of group 1 was 4 (2-5; 3,64) scores, and group 2 was 2 (1-5; 2,45) scores. A statistically significant change was found in group 1 (p=0,025; Z=-2,236) and group 2 (p=0,004; Z=-2,842). After the intervention, there was a statistically more significant change in group 2 (p=0,036; U=30) compared to group 1. Deep neck flexors endurance (in seconds): Before physiotherapy, the endurance of the group 1 was 22 (11-35; 21,73) seconds, and the group 2 was 28 (13-42; 28,27) seconds. There were no statistically significant differences between groups before physiotherapy (p=0.094; U=86). After physiotherapy the deep neck flexors endurance of the group 1 was 26 (16-44; 26,45) seconds, and the group 2 was 31 (17-45; 32,45) seconds. A statistically significant change was found in group 1 (p=0,003; Z=2,952) and group 2 (p=0,003; Z=2,992). Neck Disability Index: Before physiotherapy, the disability score of the group 1 was 9 (4- 21; 11,27) scores, and the group 2 was 7 (2-18; 7,64) scores. There were no statistically significant differences between groups before physiotherapy (p=0.081; U=34). After physiotherapy the neck disability index of group 1 was 8 (4-17; 9,27) scores, and the group 2 was 3 (1-14; 4,45) scores. A statistically significant change was found in group 1 (p=0,005; Z=-2,825) and group 2 (p=0,003; Z=- 2,947). After the intervention, there was a statistically more significant change in group 2 (p=0,010; U=21,500) compared to group 1. Conclusions: After physiotherapy in both study groups pain intensity decreased, and neck functional status improved statistically significantly in patients with non-specific neck pain. Comparing the results of physiotherapy using elastic resistance bands and a sling system, the physiotherapy with sling system was more effective on decreasing neck pain intensity and functional disability in patients with non-specific neck pain.

Introduction. Lower back pain (LBP) is a leading cause of disability worldwide, affecting quality of life, mobility, and work ability (1). In 2020, it was estimated that over 600 million people were affected globally, with a projected increase to 843 million cases by 2050 (2). Although physiotherapy is widely applied to manage LBP, there is no consensus on the most effective rehabilitation strategies (3). Recent attention has focused on integrating balance exercises, but their added value remains unclear. The aim of this study was to evaluate the impact of physiotherapy programs with and without balance exercises on pain, functional disability, balance ability, and trunk muscle endurance in individuals with lower back pain. Research methods and organization. This study included 30 participants aged 20–50 years with lower back pain. The study was conducted from October to December 2022 at the Lithuanian University of Health Sciences (LSMU) Kaunas Hospital, Children's Diseases Clinic, Rehabilitation Department "Žibutė," with approval from the LSMU Bioethics Center (Approval No. BEC-SR(M)- 08). Participants were randomly divided into two groups: the experimental group (n = 15; mean age 32.3 ± 12.2 years) and the control group (n = 15; mean age 30.8 ± 10.8 years). Inclusion criteria: age 20–50 years, presence of lower back pain, voluntary consent. Exclusion criteria: chronic comorbidities, diagnosed spinal pathologies (e.g., scoliosis, herniation), history of trauma in the last 12 months. The experimental group performed physiotherapy with core strengthening, stretching, stabilization, and balance exercises. The control group received conventional physiotherapy without balance exercises. Sessions were conducted three times per week for four weeks, each lasting 30 minutes. Pain was measured using the Self-Assessment Scale (SAS). Functional disability was assessed with the Oswestry Disability Index (ODI). Balance was evaluated using the Fullerton Balance Test. Static endurance of abdominal, back, and lateral trunk muscles was measured using standardized endurance tests: timed static holding until fatigue. Statistical analysis was performed using IBM SPSS Statistics 23.0. Normality was tested with the Kolmogorov-Smirnov test. For comparisons, the Mann-Whitney U test (independent samples) and the Wilcoxon Signed-Rank test (paired samples) were used. Statistical significance was set at p < 0.05. Results. Both groups showed significant reductions in back pain. In the experimental group, pain decreased from 3.73 ± 1.79 to 2.45 ± 1.51 (p < 0.05), and in the control group from 3.36 ± 1.50 to 2.72 ± 1.62 (p < 0.05). No significant difference in pain reduction between groups was observed (p > 0.05). The experimental group demonstrated a significant decrease in functional disability (ODI: 10.63 ± 3.91 to 9.82 ± 3.31; p < 0.05), whereas no significant change was observed in the control group (9.91 ± 3.75 to 9.27 ± 3.23; p > 0.05). Disability scores were lower in the control group both before and after therapy (p < 0.05). Balance scores assessed by the Fullerton Test did not show significant changes within or between groups (p > 0.05). Static endurance of the back muscles significantly improved in both groups (p < 0.05), with significant differences observed between groups both at baseline and post-intervention (p < 0.05). Abdominal and lateral trunk muscle endurance also improved significantly within each group (p < 0.05), but no significant difference between groups was found after the intervention (p > 0.05). Conclusions. Both physiotherapy programs effectively reduced back pain and improved trunk muscle endurance. However, the addition of balance exercises did not provide superior effects on balance ability or functional disability compared to conventional physiotherapy alone. Physiotherapy remains a reliable method to enhance physical condition and reduce pain in individuals with lower back pain.

Introduction. Multiple sclerosis is a chronic neurological disorder affecting over 2.8 million people worldwide, often leading to fatigue, disability, and poor quality of life [1]. Fatigue, one of the most disabling symptoms, affects over 80% of patients and is frequently resistant to medication [2]. While exercise is recognized as an effective non-drug approach to fatigue, most programs focus only on mobility, neglecting respiratory muscle weakness, which also limits function in MS [3,4]. Combining mobility and breathing exercises in rehabilitation may improve outcomes, yet this remains underexplored [5,9]. This study evaluates the effects of such a combined program on fatigue, endurance, and quality of life using validated multidimensional tools. Research methods and organization. The study was conducted at the Multiple Sclerosis Association “Feniksai” with ethical approval from the Lithuanian University of Health Sciences Biomedical Research Ethics Committee (Approval No. 2024-BEC2-016). Participants were individuals diagnosed with multiple sclerosis (MS) for over 2 years, experiencing fatigue, of low-to-moderate physical activity, and physically capable of participating in an exercise program. Exclusion criteria included severe spasticity, inability to walk, chronic respiratory or joint diseases, or injuries that could limit participation. A total of 27 participants (mean age 41.85 ± 13.2 years) were assigned to two groups: the intervention group (n = 12; 6 males, 6 females) and the control group (n = 15; 9 males, 6 females). The intervention group engaged in a structured group-based exercise program (stretching, strengthening, and respiratory exercises) three times per week for three weeks (30 minutes per session), alongside to routine educational and recreational activities. The control group participated only in the latter. Primary outcomes were assessed pre- and post-intervention using standardized tools: fatigue (Modified Fatigue Impact Scale, MFIS [6]; Visual Analog Scale, VAS [8]), quality of life (Multiple Sclerosis Quality of Life-54, MSQOL-54) [7], and physical endurance (6-Minute Walking Test, 6MWT [9]). Additional data included age, sex, MS type, disease duration, and physical activity levels. No statistically significant baseline differences were observed between groups (p > 0.05). The data was analyzed using SPSS 29. Normality was assessed using the Shapiro–Wilk test. Depending on data distribution, within-group comparisons were conducted using either paired t-tests or Wilcoxon signedrank tests, while between-group comparisons used independent t-tests or Mann–Whitney U tests. Spearman’s correlation was used to explore associations among fatigue, quality of life, and endurance. Significance was set at p < 0.05. Results. Prior to the intervention, no significant differences were observed between the intervention and control groups across all key measures. Total fatigue scores (MFIS) were 38.53 ± 17.18 vs. 37.33 ± 21.36 (p = 0.750), cognitive and psychosocial fatigue components also did not differ (p = 0.599; p = 0.656). Mental quality of life Mental Health Composite was 58.42 ± 24.56 vs. 53.98 ± 21.50 (p = 0.621), and physical quality of life Physical Health Composite 59.69 ± 23.65 vs. 53.27 ± 21.80 (p = 0.471). Fatigue intensity (VAS) was 5.00 ± 1.20 vs. 5.50 ± 1.17 (p = 0.300), and 6- minute walk test results were 488.93 ± 85.04 m vs. 518.42 ± 80.92 m (p = 0.367). These findings confirm that the groups were comparable at baseline. Following the intervention, mental quality of life (MSQOL-54 Mental Health Composite) improved significantly in the intervention group (t(11) = – 2.52, p = 0.024), while physical fatigue decreased (mean change = –2.56), though not significantly (Z = 38.5, p = 0.375). Cognitive fatigue also showed a non-significant decrease (mean = –2.75 ± 10.5, p = 0.492). Between-group comparisons of change revealed statistically significant improvement in physical fatigue (U = 137.5, p = 0.021) and physical performance as measured by the 6-minute walking test (U = 8.5, p < 0.001), both favoring the intervention group. Other domains such as pain, emotion, and cognition showed non-significant improvement trends. Spearman’s correlation analysis showed strong and significant negative relationships between total fatigue and physical quality of life (ρ = – 0.78, p < 0.001), mental quality of life (ρ = –0.73, p < 0.001), and physical performance (6MWT: ρ = –0.82, p < 0.001). These results indicate that lower fatigue levels were associated with higher quality of life and better physical capacity. Furthermore, a strong positive correlation was found between physical and mental quality of life domains (ρ = 0.87, p < 0.001), suggesting interdependence between these two constructs Conclusions. The structured mobility and respiratory function improvement program led to significant positive changes in individuals with multiple sclerosis. Mental quality of life and physical endurance improved significantly after the intervention. A statistically significant reduction in physical fatigue was also observed compared to the control group, indicating the program’s effectiveness in improving core health indicators.

Background and Objectives: Research on the effectiveness of different exercise programs on reducing fall risk and improving gait parameters among frail patients after open heart surgery is scarce. Therefore, the aim of this study was to evaluate and compare the effects of different exercise interventions on fall risk and gait parameters in frail patients after open heart surgery during inpatient rehabilitation. Materials and Methods: A prospective randomized study was conducted at Kulautuva Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, from July 2021 to November 2023. A total of 105 pre-frail and frail patients were randomized into three groups: control (CG, n = 35), intervention 1 (IG-1, n = 35), and intervention 2 (IG-2, n = 35). All three groups completed a conventional rehabilitation program that included aerobic training tailored based on each person’s health status six times/week. The IG-1 additionally received multicomponent dynamic aerobic balance and strength training three times/week, and the IG-2 received a combined computer-based interactive program three times/week. The overall stability index, as an outcome of fall risk, Short Physical Performance Battery (SPPB) score, and gait parameters (geometry, stance, and timing) were assessed before and after rehabilitation. Results: Of the 105 patients, 87 completed the study. The median age of the patients was 71 years (range: 65–88); 64.76% were male. After rehabilitation, within-group comparisons showed a significant improvement in the overall stability index, SPPB, and all phase gait parameters in all groups. Of all geometry gait parameters, none of the groups showed a significant improvement in step width, and foot rotation was significantly reduced only in the IG-2. All timing gait parameters improved in the CG and IG-2 after rehabilitation, while in the IG-1, only gait speed was significantly improved. Between-group comparisons after rehabilitation revealed significant differences in the overall stability index among the groups and in all phase gait parameters except for stance phase between the IG-1 and the IG-2. The greatest significant difference was documented for the double stance phase between the IG-1 and the IG-2, and the smallest was recorded for the single limb support phase. Significantly greater differences in step time and stride time were found in the IG-1 and the IG-2 than in the CG. Conclusions: All applied interventions were effective in reducing fall risk based on the overall stability index. However, interactive exercise interventions decreased fall risk based on the overall stability index by one-fifth as compared to the conventional rehabilitation program. The incorporation of interactive exercise interventions in rehabilitation resulted in improved double stance phase, stride time, and step time parameters, but did not have any effect on gait speed as compared to other exercise interventions.