Determining the measurement accuracy in assessing the progress of wound healing.

Introduction: Wound management is a challenge in terms of the way, duration and cost of treatment both for the patient and health providers. The healing of skin wounds is a highly multi-step coordinated process. Objective monitoring of treatment at every stage is necessary to assess the applied therapy. Aim: To show the possibility of using the AutoCad software (ACS) as a tool with a slight measurement error for accurate measurement of the venous leg ulcers on the lower limbs. Material and methods: To determine the error of the measurement method Circle Templates For Drafting for four different sizes were used as ulcer models. Seventy-six wounds of various sizes from patients with venous leg ulcers (VLUs) were photographed and outlined with a marker on a transparent foil. The wounds were measured both using ACS and digital planimetry with C-Geo software (CGS). Data were analysed using Wilcoxon test, intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: The mean relative error of the surface wound model area measured by the ACS was 0.30 ±0.31% (range: 0.004-1.25) and a median of 0.18%. Areas and perimeters measured with ACS were higher than areas and perimeters measured with CGS, and the difference was statistically significant. Conclusions: The analysis of the wound images obtained in the ACS showed a very high potential of the software in terms of the accuracy of the analysed areas, which significantly increases the possibility of the analysis and reduces the measurement error in relation to planimetry using a digital digitizer.

Analysis of predicted full recovery time for venous leg ulcers treated with intermittent pneumatic compression.

Introduction: Venous leg ulcers are difficult-to-heal wounds. Reduction of venous hypertension and eradication of oedema is of key importance in the treatment of clinical symptoms of venous hypertension and venous leg ulcers. This can be done by using compression therapy in which external pressure is applied to the skin surface, giving a positive effect on the venous, lymphatic and arterial systems of macro- and microcirculation. Aim: Analysis of full recovery predicted time for venous ulcers. Material and methods: The purpose of our study was to rate the intermittent pneumatic compression (IPC) therapy in venous leg ulcers treatment. In the study group, the IPC therapy (pressure of 60 mm Hg at the ankle) was used - one treatment daily for 4 weeks. The changes of the total area, circumference, maximum length and maximum width of ulcers were measured. Then, based on the collected values, we calculated healing progress (Gilman index), healing rate, predicted healing time and non-linear approximation of the treatment time needed to decrease the ulcer surface area by 50% and then we compared them the treatment times. Results: Analysis of the results shows that a percentage change in the surface area in the treatment group was 52%. There was a statistically significant difference between the ulcer surface area before and after treatment (p < 0.05). There was no statistically significant difference between the healing rate in individual weeks of treatment (p > 0.05). The percentage reduction in circumferences of the lower limb showed a statistically significant advantage in the study group comparison baseline (p < 0.05). Conclusions: Treatment of venous leg ulcers with the IPC therapy is effective.

Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy.

Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy. Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment. Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC). Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05). Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.

Shockwave therapy in selected soft tissue diseases: a literature review.

OBJECTIVE: The aim of our study is to present the current state of knowledge on the use of shockwave therapy (SWT) in the treatment of soft tissue wounds, by reviewing the available literature. METHOD: Medical databases were searched for articles using the keywords: 'shockwave AND wound healing', 'shockwave AND ulcers', 'shockwave AND burns', 'shockwave AND bedsores', 'shockwave AND diabetic foot ulcer', 'ESWT AND wound healing', 'shock wave AND diabetic gangrene'. RESULTS: A total of 14 scientific articles were included in the study which described the methodology of treatments and list the type of generator, physical parameters used during the procedure, number of treatments and the type of treated wounds. From these articles, 191 soft tissue wounds were analysed. CONCLUSION: Evidence from the articles analysed in this study suggests a beneficial effect of SWT to treat diabetic foot ulcers, venous leg ulcers, pressure ulcers and burns. SWT can be used in combination with standard treatment in soft tissue wounds.

Comparison of ultrasound therapy and radial shock wave therapy in the treatment of venous leg ulcers - clinical, pilot study.

INTRODUCTION: Venous insufficiency and venous leg ulcers each year affect more and more people, especially in developed countries. The challenge of our time is to find an effective method of treating venous leg ulcers, which will further shorten treatment time and reduce the cost of treatment. AIM: To compare the effects of treating venous leg ulcers using ultrasound therapy, radial shock wave therapy and standard care. MATERIAL AND METHODS: Group A consisted of 17 patients. Patients were treated with ultrasound therapy US power density 0.5 W/cm2, pulsed wave with a duty cycle of 1/5, and 1 MHz frequency. Group B consisted of 17 patients. Patients were treated with the radial shock wave R-ESWT using surface energy density 0.17 mJ/mm2, 100 impulses/cm2, frequency of 5 Hz and a pressure of 0.2 MPa. Group C (control group) consisted of 17 patients. Patients in this group received standard care: gauze dressing saturated in 0.9% sodium chloride and elastic bandages changed daily for 4 weeks. RESULTS: Ultrasound therapy with 1 MHz and energy power density 0.5 W/cm2 for 4 weeks resulted in an average reduction of 68% of the area of ulceration. We used for venous leg ulcers 4-week treatment with radial shock wave therapy resulting in a 38% mean percentage reduction of the ulceration area. Standard care reduces the area of ulceration by only 16%. CONCLUSIONS: The use of ultrasound therapy for the treatment of venous leg ulcers is more effective than the use of radial shock wave therapy or standard care alone.

Static postural stability in women with stress urinary incontinence: Effects of vision and bladder filling.

AIMS: This case-control study was designed to compare static postural stability between women with stress urinary incontinence and continent women and it was hypothesized that women with incontinence aged around 50 years also have balance disorders. METHODS: Eighteen women with incontinence and twelve women without incontinence aged 50-55 years participated in two 60-s trials of each of four different testing conditions: eyes open/full bladder, eyes open/empty bladder, eyes closed/full bladder, eyes closed/empty bladder. The center of foot pressure (COP): sway range, root mean square, velocity (in the antero-posterior and medio-lateral directions), and COP area were recorded. The stabilograms were decomposed into rambling and trembling components. RESULTS: The groups of women with and without incontinence differed during the full bladder condition in antero-posterior COP sway range, COP area, and rambling trajectory (range in the antero-posterior and medio-lateral directions, root mean square in the antero-posterior and medio-lateral directions and velocity in the antero-posterior direction). CONCLUSION: The women with incontinence had more difficulty controlling their postural balance than continent women while standing with a full bladder. Therefore, developing therapeutic management focused on strengthening the women's core muscles and improving their postural balance seems advisable.

A comparative clinical study on five types of compression therapy in patients with venous leg ulcers.

The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective.

The Efficacy of Extracorporeal Shockwave Therapy Compared with Compression Therapy in Healing Venous Leg Ulcers.

Background: Innovative methods of physical therapy delivered via modern medical devices have significantly extended the possibility of applying conservative treatments in healing venous leg ulcers. The primary objective of this study was to compare the therapeutic efficacy of selected mechanical physical therapies (intermittent pneumatic compression vs. radial extracorporeal shockwave vs. focal extracorporeal shockwave) vs. standard care in the treatment of venous leg ulcers over a 4-week period. Materials: This study included 69 patients, comprising 45 females (65%) and 24 males (35%), with a mean age of 67.1 ± 8.6 years (range: from 52.0 to 80.0 years). Methods: The patients were allocated into four groups: the IPC group was treated with intermittent pneumatic compression therapy, the R-ESWT group was treated with radial extracorporeal shockwave therapy, the F-ESWT group was treated with focal extracorporeal shockwave therapy, and the SC group was treated with standard care. Results: After one month of therapy, the median percentage decrease in wound total surface area after treatment was as follows: in the IPC group, there was a 52.9% decrease (range: 3.3-100%); in the R-ESWT group, there was a 31.6% decrease (range: 2.4-95.8%); in the F-ESWT group, there was an 18.0% decrease (range: 1.9-76.1%); and in the SC group, there was a 16.0% decrease (range: 1.5-45.8%). Conclusions: All the studied therapies caused a statistically significant reduction in the surface area of venous leg ulcers. The best results were observed with the intermittent pneumatic compression, while the radial and focal extracorporeal shockwave therapies appeared less effective. The standard care alone turned out to be the least effective. Our results did not show statistically significant changes in the values of RBC deformability at the investigated shear rates.

Acupuncture and dry needling for physical therapy of scar: a systematic review.

BACKGROUND: There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment. OBJECTIVE: The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture. SEARCH STRATEGY: The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023. INCLUSION CRITERIA: The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included. DATA EXTRACTION AND ANALYSIS: The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results. RESULTS: As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous. CONCLUSIONS: The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation. SYSTEMATIC REVIEW REGISTRATION: INPLASY no. 202310058.

Skeletal muscle mass, muscle strength, and physical performance in children and adolescents with obesity.

Introduction: Sarcopenic obesity (SO) is defined as obesity with low skeletal muscle function and mass. This study aimed to evaluate the presence of sarcopenic obesity according to different diagnostic criteria and assess the elements of sarcopenia in children and adolescents with obesity. Methods: A total of 95 children and adolescents with obesity (diagnosed with the use of International Obesity Task Force (IOTF) criteria) with a mean age of 12.7( ± 3) years participated in the study. Body composition was assessed with the use of bioelectrical impedance-BIA (Tanita BC480MA) and dual-energy X-ray absorptiometry-DXA (Hologic). Fat mass (FM) and appendicular skeletal muscle mass (SMMa) were expressed as kilograms (kg) and percentage (%). Muscle-to-fat ratio (MFR) was defined as SMMa divided by FM. A dynamometer was used in order to measure grip strength. Six-minute walk test (6MWT) and a timed up-and-go test (TUG) were used to assess physical performance. Results: The presence of SO ranged from 6.32% to 97.89%, depending on the criteria used to define sarcopenia. Children with sarcopenia, defined as a co- occurrence of low skeletal muscle mass % (SMM%) measured by DXA (≤9th centile) according to McCarthy et al. and weak handgrip strength (≤10th centile) according to Dodds et al., had significantly lower SMMa measured by both DXA and BIA, lower maximal handgrip strength, and lower physical performance. Maximal handgrip was positively correlated with SMMa (kg) and SMMa% derived from both DXA and BIA and BIA-MFR. Maximal handgrip was negatively correlated with waist-to-height ratio (WHtR). The distance of 6MWT correlated positively with BIA-measured SMMa% and BIA-MFR. 6MWT distance correlated negatively with BIA-FM% and body mass index (BMI) z-score. TUG was positively correlated with BIA-FM%, BMI z-score, WHtR, and IOTF categories and negatively correlated with BIA-SMMa% and BIA-MFR. Discussion: The presence of sarcopenia in our study varied depending on the diagnostic criteria used. This is one of the first studies evaluating muscle mass, muscle strength, and physical performance in children and adolescents with obesity. The study highlighted the need for the implementation of a consensus statement regarding SO diagnostic criteria in children and adolescents.

Physical therapy in the treatment of venous leg ulcers: biophysical mechanisms.

UNLABELLED:  The present study sought to estimate the hemodynamic effects inside wounds after applying infrared thermography. Clinical results were analyzed to evaluate any correspondence with hemodynamic events occurring inside the wounds. METHODS: Group 1 consisted of 20 patients with venous leg ulcers (12 women, 8 men). Patients from group 1 received 1 high-voltage stimulation (HVS) procedure. Group 2 consisted of 23 patients (16 women, 7 men). Patients from group 2 received 1 ultrasound (US) procedure. Group 3 consisted of 21 patients (13 women, 8 men). Patients from group 3 received 1 low-level laser therapy (LLLT) procedure. Group 4 consisted of 23 patients (15 women, 8 men). Patients from group 4 received 1 compression therapy (CT) procedure. Group 5 consisted of 19 patients (11 women, 8 men). Patients from group 5 received 1 quasi-CT procedure. Infrared thermography was used to monitor arterial hemodynamic effects for each ulcer. Infrared thermography, based on analysis of wound surface temperatures, was used to reflect normal or abnormal arterial circulation in capillaries. The average and maximal temperatures before and after each physical procedure were measured 5, 10, 15, and 30 minutes afterward. RESULTS: The application of HVS and LLLT did not change the temperature inside the wounds. A significant temperature increase was noted after application of US and CT. The quasi-CT induced a thermal effect (only for a few minutes), but was not as intense as the effect of the compression stockings. The measurements showed a prolonged and steady thermal effect. CONCLUSION: The hemodynamic effect (improvement of arterial microcirculation inside the venous leg ulcer) is one of the most significant biophysical mechanisms of healing after clinically efficient compression therapy. Hemodynamic reactions are not basic mechanisms of high voltage stimulation and ultrasound therapy during the healing of venous leg ulcers. Computed thermography is a simple and useful tool to measure hemodynamic effects in wound healing. .

Using Physical Modalities in the Treatment of Venous Leg Ulcers: A 14-year Comparative Clinical Study.

UNLABELLED: Venous ulcers are prevalent, challenging wounds; their incidence is rising with the increasing age of the general population. Physical mo- dalities often are used to help heal these chronic wounds. A prospective study was conducted to investigate the application of high-voltage stimu- lation (HVS), ultrasound therapy (US), low-level laser therapy (LLLT, 810 nm, 65 mW, 4 J/cm2), and compression therapy (CT), with and without surgical intervention; along with standard of care comprising drug therapy (micronized flavonoid fraction in two 500-mg tablets once daily) and wet dressings of 0.9% sodium chloride on venous leg ulcer healing. METHODS: The 305-patient study was conducted between 1994 and 2008 among persons with venous ulcers in 3 facilities in Poland. After surgery involving crossectomy, partial [short] stripping of the greater or short saphenous vein, local phlebectomy, and ligation of insufficient perforators, 4 groups of patients were treated with the standard of care drug/dressing therapy and HVS, US, LLLT, or CT, and 1 group received the drug/dressing ther- apy only. Four non-surgical groups received HVS, US, LLLT, or CT and drug/dressing therapy, and 1 group received drug/dressing therapy only. Changes in wound area and volume were compared among all the groups receiving the various treatments using the Gilman index. In all groups therapy lasted 7 weeks. The computed planimetry method for observation of healing process was used. RESULTS: The Gilman index values at 4 weeks were significantly higher in the compression plus surgery compared with other groups (P = 0.01). After therapy for patients from the CT + surgery group, the Gilman index was 1.18 cm (P ≤ 0.001 compared with other groups). The percentage total surface area regression analysis confirmed that compression plus surgery is the most efficient in venous leg ulcer therapy (61.89% reduction after 4 weeks of therapy and 78.19% at the end of study) compared to the other groups (P ≤ 0.001). The HVS and US appeared useful only in conservatively treated patients (P < 0.05). The LLLT did not accelerate reduction of the ulceration surface. CONCLUSION: Venous surgery plus compression therapy is the most effi- cient treatment for venous leg ulcers. Compression therapy should be provided to both surgically and conservatively non-surgically treated pa- tients. High-voltage stimulation and ultrasound therapy are useful meth- ods in conservative treatment of venous leg ulcers. For surgically treated patients, these physical modalities are not effective. Low-level laser ther- apy is not an efficient method for treating venous leg ulcers. .

Comparative Analysis of Human Body Temperatures Measured with Noncontact and Contact Thermometers.

Body temperature measurement is one of the basic methods in clinical diagnosis. The problems of thermometry-interpretation of the accuracy and repeatability of various types of thermometers-are still being discussed, especially during the current pandemic in connection with the SARS-CoV-2 virus responsible for causing the COVID-19 disease. The aim of the study was to compare surface temperatures of the human body measured by various techniques, in particular a noncontact thermometer (infrared) and contact thermometers (mercury, mercury-free, electronic). The study included 102 randomly selected healthy women and men (age 18-79 years). The Bland-Altman method was used to estimate the 95% reproducibility coefficient, i.e., to assess the degree of conformity between different attempts. Temperatures measured with contact thermometers in the armpit are higher than temperatures measured without contact at the frontal area of the head. The methods used to measure with contact thermometers and a noncontact infrared thermometer statistically showed high measurement reliability. In order to correctly interpret the result of measuring human body temperature, it is necessary to indicate the place of measurement and the type of thermometer used.

Analgesic and Functional Efficiency of High-Voltage Electrical Stimulation in Patients with Lateral Epicondylitis-A Report with a 180-Day Follow-Up.

The available publications describing the beneficial effects of electrostimulation does not unequivocally confirm the clinical utility of high-voltage electrical stimulation (HVES) in the treatment of the lateral epicondylitis (LE). The aim of this study was the estimation of the effect of HVES on pain intensity and functional efficiency, both in the short and long term in patients with LE. The trial was registered by the Australian and New Zealand Clinical Trials Registry (ACTRN12621001389897). There were 58 patients allocated into two groups: the HVES group (n = 29, mean age 49.9 ± 11.0 years), treated with HVES (pulse duration: 200µs, frequency: 100 Hz, current amplitude in the range of 18-25 mA, voltage amplitude: 100 V), and the NORM group (n = 29, mean age 48.0 ± 12.6 years), who were healthy and untreated patients. The treatments were performed 5 days a week (from Monday to Friday) for two weeks. Treatment progress was measured by the visual analogue scale (VAS) for rest pain, night pain, and pain during activity; the Laitinen Pain Scale (LPS); and hand grip strength (HGS) before and after the treatment, as well as after 3, 6, 12, and 24 weeks. The reduction of pain (according to the VAS and LPS) and increase in the functional condition (according to the HGS) were observed in all HVES patients in the short- and long-term observation. Therefore, the HVES in treatment of LE was found to be effective and safe.

Reliability of pelvic floor muscle surface electromyography (sEMG) recordings during synchronous whole body vibration.

The primary aim of the study was to assess intraday and interday reliability of surface electromyography (sEMG) reflex activity of the pelvic floor muscles during synchronous whole-body vibration (S-WBV) of two intensities (30Hz/2mm; 40Hz/4mm) using band-stop filter and high-pass filter signal processing. The secondary aim of the study was to assess intraday and interday (test-retest) reliability of sEMG obtained from maximal voluntary contraction (MVC) test. We evaluated the intraday reliability of sEMG recordings obtained during sessions 1 and 2 performed on the same day. The sessions consisting of maximal voluntary pelvic floor muscle contraction and synchronous vibration sets with 1-hour rest in-between sessions 1 and 2 in healthy nulliparous women. The next intraday reliability was evaluated between the results of sessions 3 and 4 performed on the same day but followed at an interval of 4 weeks. to include the entire menstrual cycle. The interday reliability was determined based on the results of sessions 1 and 3 using the intraclass correlation coefficient (ICC 3,3). The intraday ICCs for band-stop filtered mean and median sEMG frequency and mean normalized sEMGRMS amplitude of the 30Hz/2mm (ICC = 0.89-0.99) and 40Hz/4mm vibration (ICC = 0.95-0.99) indicated substantial reproducibility. The intraday reliability of high-pass filter at 100-450Hz for these parameters was also substantial (30Hz/2mm ICC of 0.92 to 0.98; 40Hz/4mm ICC of 0.88 to 0.98). The interday reliability (session 1 vs. session 3) of the mean normalized sEMGRMS amplitude for band-stop filtered means of 40 Hz/4mm and 30Hz/2mm vibration recordings was substantial (ICC = 0.82 and 0.93). However, ICCs of the mean and median frequency were indicative of fair reliability (ICC of 0.43 to 0.59). The interday reliability of mean normalized sEMGRMS amplitude for high-pass filter at 100-450Hz was substantial (30Hz/2mm ICC of 0.90; 40Hz/4mm ICC of 0.73) for the 30Hz/2mm S-WBV and moderate (ICC = 0.73) for the 40/4mm S-WBV. The ICCs for mean and median sEMG frequency ICCs indicated slight to fair reproducibility (ICC of 0.16 to 0.56). The intraday reliability of the strongest MVC contraction and average MVC turned out substantial (ICC = 0.91-0.98). The interday reliability coefficients of the strongest MVC contraction and average MVCs were 0.91 and 0.82, respectively. Concluded, the intraday reliability proved satisfactory for all variables; however, the interday comparison showed sufficient ICC levels only for the mean amplitude. We therefore recommend this parameter should be used when analyzing PFM sEMG recorded during vibration. ICCs of the mean and median frequency for both signal processing methods were indicative of insufficient reliability and did not reach the threshold for usefulness. Our study showed similar reliability of PFM sEMG during S-WBV in case of the two filtering methods used.

A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration.

INTRODUCTION: In physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period. MATERIAL AND METHODS: The patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion. RESULTS: At 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05). CONCLUSIONS: Focused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.

Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises.

The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks' training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire-Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.

Efficiency of Therapeutic Ultrasound for Healing Venous Leg Ulcers in Surgically-treated Patients.

 The aim of this study was to evaluate the efficiency of therapeutic ultrasound (US) for healing of venous leg ulcers in surgically treated patients. Study endpoints were the number of completely healed wounds and the clinical parameters predicting the outcome. Seventy patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups. Group A consisted of 33 patients (21 women, 12 men). They were treated with the US, compression stockings, and drug therapy. Group B (control) consisted of 37 patients (22 women, 15 men). They were treated with the compression stockings and drug therapy only, administered just as in group A. Ten patients in group A and 12 in group B healed completely (P > 0.05). Comparison of Gilman Index and relative change of the total surface area, length, width, and volume did not demonstrate any difference (P > 0.05) between the groups. A more statistically efficient decrease of pus (P = 0.03) and greater promotion of granulation (P = 0.03) were observed in group A compared to group B. However, the noted changes did not have an influence on acceleration of therapy or final stage of the wound healing process because no differences were detected in the epidermization rate of the ulcers in either group. There are no specific indications that US application promotes healing in patients after surgical operation.

[Evaluation of efficiency of the sonotherapy in enhancement of venous leg ulcer healing in patients after surgical and conservative treatment]. / Ocena skutecznosci sonoterapii we wspomaganiu gojenia owrzodzen zylnych goleni u chorych po leczeniu chirurgicznym i zachowawczym.

UNLABELLED: The aim of the study was to evaluate the application of sonotherapy in enhancement venous leg ulcer healing after conservative and surgical therapy. MATERIAL AND METHODS: The 60 patients were included into the study. The 30 patients, who agreed on operation and were accepted by medical team to the surgical treatment, had been included to A and B group. The others, 30 patients were treated conservatively, and had been included to C and D group. The patients in group A and C were additionally treated in use of sonotherapy. The evaluated factors were to estimate the sonotherapy promotes total wound closure and causes any changes of the relative surface, longest and widest dimensions, and volume of tissue defect, pus and granulation degree. RESULTS: After study in all groups, we noticed a therapeutic effect. Treatment was more efficient in patients after surgical operation than in patients after conservative methods. Beneficial effects of sonotherapy in conservative enhancement of ulcer healing were observed. No impact of sonotherapy after surgical procedure was noticed. CONCLUSIONS: The sonotherapy is useful and efficient method only in enhancement of venous leg ulcer healing after conservative treatment. In surgically treated patients is not efficient method, because there is no accelerating impact on wound healing. As well conducted surgical operation more efficiently enhance a healing process than conservative pharmacological procedures.

[The impact of the sonotherapy and compression therapy on enhancement of healing venous leg ulcers after surgical treatment]. / Wplyw sono- i kompresoterapii na wspomaganie gojenia owrzodzen zylnych goleni po leczeniu chirurgicznym.

UNLABELLED: The aim of this paper was to describe the impact of the sonotherapy and compression therapy on enhancement of healing venous leg ulcers after surgical treatment. MATERIAL AND METHODS: Three comparative groups of patients--A, B and C were made at random from patients with venous leg ulcers, which had been earlier operated by modified Babcock' method. The 24 patients were included (in use of software Monte Carlo) to the group A, 25 patients to the group B and 24 patients to the group C (control group). The patients in all comparative groups were treated pharmacologically. Ulcerations at patients in group A were additionally treated in use of ultrasound. And ulcerations at patients in group B were additionally treated in use of compression therapy. The evaluated factors were to estimate the sonotherapy and compression therapy causes any changes of the surface, longest and widest dimensions, and volume of tissue defect. For all comparative groups calculated the Gilman parameter. The weekly speed of changes of surface and volume were estimated too. RESULTS: After therapy there was statistically significant decrease of whole surface and pus-covered and granulation area, longest and widest dimensions, and volume of ulcers in all groups while there was no statistically significant difference--except pus-covered areas--between the groups observed. Comparison in terms of pus-covered area indicated a significant difference between all groups, in favor groups A and B than C. CONCLUSIONS: There are no special reasons for application of ultrasound and compression therapy in enhancement of healing process--however the following results must be verified on bigger population and longer patient observation. The sonotherapy and compression therapy promote only decontamination process compared with control group.