Non-invasive Complementary Therapies in Managing Musculoskeletal Pains and in Preventing Surgery.

BACKGROUND: Musculoskeletal disorders are disabling diseases which affect work performance, thereby affecting the quality of life of individuals. Pharmacological and surgical management are the most recommended treatments. However, non-invasive physical therapies are said to be effective, for which the evidence is limited. AIM/PURPOSE: To study the effect of non-invasive physical interventions in preventing surgery among patients recommended for surgery for musculoskeletal complaints, who attended sports and fitness medicine centres in India. SETTINGS: SPARRC (Sports Performance Assessment Research Rehabilitation Counselling) Institute) is a physical therapy centre with 13 branches spread all over India. This Institute practices a combination of manual therapies to treat musculoskeletal complaints. RESEARCH DESIGN: Descriptive cohort study involving the review of case records of the patients enrolled from June 2013 to July 2017, followed by the telephone survey of the patients who have completed treatment. INTERVENTION: Combination of physical therapies such as myofascial trigger release with icing, infra-red therapy, pulsed electromagnetic field therapy, stretch release, aqua therapy, taping, and acupuncture were employed to reduce the pain and regain functionalities. MAIN OUTCOME MEASURES: Self-reported pains were measured using visual analogue scale at different levels of therapy-preand post-therapy and post-rehabilitation. RESULTS: In total, 909 patients were studied, of whom 152 (17%) patients completed the treatment protocol. Majority of patients presented with knee and low-back pain. The reduction in pain due to the treatment protocol in terms of mean VAS score from baseline to post-therapy and baseline to post-rehabilitation was statistically significant (p value = .00). Among those contacted post-rehabilitation, 82 patients remained without surgery, and the median surgery-free time was around two years. CONCLUSION: Thus the study concluded that non-invasive physical therapies may prevent or postpone surgeries for musculoskeletal complaints.

Pre-surgery Stress Monitoring Using Heart Rate Variability Measures.

Pre-surgery stress is common in patients hospitalized for undergoing surgeries. High levels of stress could prolong post-operative recovery time, increasing the duration of hospitalization. Abnormally high stress levels could sometimes have irreversible impacts, leading to post-operative physiological and psychological disorders. Continuous monitoring of patients during the pre-operative period could help in taking necessary measures to control the stress levels. Electrocardiogram (ECG) is one of the signals which is usually monitored continuously for patients in clinical settings. The usability of ECG for Heart Rate Variability (HRV) based stress detection has been explored in this study. HRV features derived from ECG data acquired from 51 patients admitted in the surgical ward during their pre-operative phase were studied. The trend of the features showed similarity in pre-surgery stress experienced by the patients. Using chest leads connected by wires to a wrist wearable for collecting ECG was obtrusive to patients and resulted in loss of more than 50% of the data. Unobtrusive data collection using chest patches can make HRV based stress detection feasible for clinical use. However, an additional monitoring system would require additional responsibility on the part of the healthcare staff involved in patient care. Integrating the HRV based stress detection into the patient monitors already being used in these clinical settings could therefore make the monitoring of stress feasible.

Objective quantification of corneal haziness using anterior segment optical coherence tomography.

PURPOSE: To quantify normal corneal transparency by anterior segment optical coherence tomography (AS-OCT) by measuring the average pixel intensity. To analyze the variation in the average pixel intensity in mild and severe grades of corneal opacities. METHODS: This is an observational, cross-sectional study of 38 eyes from 19 patients with mild or severe grades of corneal opacities greater than 3 mm and a normal contralateral cornea. AS-OCT was performed centered on the opacity with a 3 mm cruciate protocol. A similar image is taken of the contralateral clear cornea in the same quadrant. The average pixel intensity was calculated in a standardized manner using MATLAB software. RESULT: The average pixel intensity of the normal cornea was 99.6 ± 10.9 [standard deviation (SD)]. The average pixel intensity of the mild and severe corneal opacities was 115.5 ± 9.1 and 141.1 ± 10.3, respectively. The differences were statistically significant. CONCLUSIONS: AS-OCT images can be used to quantify corneal transparency. Average pixel intensity is a measure that varies significantly with varying corneal opacification.

Extended localization and adaptive dose calculation using HU corrected cone beam CT: Phantom study.

BACKGROUND AND AIM: The practicability of computing dose calculation on cone beam CT (CBCT) has been widely investigated. In most clinical scenarios, the craniocaudal scanning length of CBCT is found to be inadequate for localization. This study aims to explore extended tomographic localization and adaptive dose calculation strategies using Hounsfield unit (HU) corrected CBCT image sets. MATERIALS AND METHODS: Planning CT (pCT) images of the Rando phantom (T12-to-midthigh) were acquired with pelvic-protocol using Biograph CT-scanner. Similarly, half-fan CBCT were acquired with fixed parameters using Clinac2100C/D linear accelerator integrated with an on-board imager with 2-longitudinal positions of the table. For extended localization and dose calculation, two stitching strategies viz., one with "penumbral-overlap" (S1) and the other with "no-overlap" (S2) and a local HU-correction technique were performed using custom-developed MATLAB scripts. Fluence modulated treatment plans computed on pCT were mapped with stitched CBCT and the dosimetric analyses such as dose-profile comparison, 3D-gamma (γ) evaluation and dose-volume histogram (DVH) comparison were performed. RESULTS: Localizing scanning length of CBCT was extended by up to 15 cm and 16 cm in S1 and S2 strategies, respectively. Treatment plan mapping resulted in minor variations in the volumes of delineated structures and the beam centre co-ordinates. While the former showed maximum variations of -1.4% and -1.6%, the latter showed maximum of 1.4 mm and 2.7 mm differences in anteroposterior direction in S1 and S2 protocols, respectively. Dosimetric evaluations viz., dose profile and DVH comparisons were found to be in agreement with one another. In addition, γ-evaluation results showed superior pass-rates (≥98.5%) for both 3%/3 mm dose-difference (DD) and distance-to-agreement (DTA) and 2%/2 mm DD/DTA criteria with desirable dosimetric accuracy. CONCLUSION: Cone beam tomographic stitching and local HU-correction strategies developed to facilitate extended localization and dose calculation enables routine adaptive re-planning while circumventing the need for repeated pCT.