The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study.

To evaluate clinical and ultrasonographic efficacy of high-intensity laser therapy (HILT) in patients with hemiplegic shoulder pain (HSP) accompanied by partial thickness rotator cuff tear (PTRCT). The study was designed as a prospective, randomized, controlled trial. Patients with HSP accompanied by PTRCT (n = 44) were randomly assigned to HILT and control groups. Both groups were treated with a multidisciplinary stroke rehabilitation and a therapeutic exercise program to the affected shoulder supervised by physiotherapists. In addition, HILT group received 3 sessions of the intervention per week for 3 weeks. Primary outcome measure was visual analogue scale (VAS) for pain. Secondary outcome measures were range of motion (ROM) of the shoulder joint, Shoulder Pain and Disability Index (SPADI), Brunnstrom Recovery Stage (BRS), Modified Ashworth Scale (MAS), Nottingham Health Profile (NHP), Functional Independence Measure (FIM), and ultrasonographic PTRCT size. Participants were assessed at pre- and post-treatment. A total of 41 patients completed the study. A statistically significant improvement was observed in VAS, ROM, FIM, SPADI, NHP, and PTRCT parameters in HILT group at post-treatment compared to pre-treatment (all P < 0.05). However, control group indicated significant improvement only in VAS, ROM, and SPADI parameters (all P < 0.05). When differences in clinical parameters at pre- and post-treatment assessment were compared between two groups, change in VAS, FIM, BRS, SPADI, NHP, and PTRCT in HILT group was significantly better than control group (all P < 0.05). HILT combined with therapeutic exercise seems to be clinically and ultrasonographically more effective in the treatment of patients with HSP accompanied by PTRCT than therapeutic exercise alone in the short term. Further studies are needed with long-term follow-up. CinicalTrials.gov Identifier: NCT04669405.

Insulin resistance and related factors in patients with moderate and severe traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) is associated with atherosclerosis and cardiovascular mortality. However, the causal relationship between TBI and atherosclerosis is unclear. AIMS: This study aimed to evaluate insulin resistance in patients with TBI and its relationship with clinical and demographic characteristics of the patients. METHODS: The case-controlled study included 60 patients with moderate and severe TBI in the chronic phase and 60 healthy controls matched for sex, age, and body mass index (BMI). Demographic characteristics, serum insulin, and fasting blood glucose levels of both groups were assessed. Insulin resistance was determined by the Homeostasis Model Assessment insulin resistance. The clinical features of the TBI group were also recorded. RESULTS: Insulin resistance was observed to be higher in the TBI group than in the control group (46.7% vs. 18.33%, P = 0.002). However, no significant difference was determined between TBI patients with and without insulin resistance in terms of all demographic and clinical parameters examined (all P > 0.05). Age, sex, BMI, and trauma severity were not significant predictors of insulin resistance in TBI patients. CONCLUSION: Moderate-to-severe TBI patients have more prevalent insulin resistance than healthy controls. Evaluation of insulin resistance in these patients, who currently have limited participation in life activities and healthy lifestyles, may be useful to prevent cardiovascular diseases caused by insulin resistance.

Comparison of ultrasound-guided subacromial corticosteroid and ozone (O2-O3) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial.

Background: : The authors aimed to compare the effects of a one-time ultrasound (US)-guided subacromial corticosteroid injection and three-time ozone (O2-O3) injection in patients with chronic supraspinatus tendinopathy. Methods: : Participants were randomly assigned to the corticosteroid group (n = 22) or ozone group (n = 22). Injections in both groups were administered into subacromial bursa with an US-guided in-plane posterolateral approach. Primary outcome measure was the change in the Western Ontario Rotator Cuff Index (WORC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale and Shoulder Pain and Disability Index scores. Assessments were recorded at baseline, and 4-weeks and 12-weeks post-injection. Results: : Forty participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both the groups showed clinically significant improvements in shoulder pain, quality of life, and function. Baseline, 4-week post-injection, and 12-week post-injection WORC scores (mean ± standard deviation) were 57.91 ± 18.97, 39.10 ± 20.50 and 37.22 ± 27.31 in the corticosteroid group, respectively and 69.03 ± 15.89, 39.11 ± 24.36, and 32.26 ± 24.58 in the ozone group, respectively. However, no significant group × time interaction was identified regarding all outcome measures. Conclusions: : Three-time ozone injection was not superior to a one-time corticosteroid injection in patients with chronic supraspinatus tendinopathy. It might be as effective as corticosteroid injection at 4-weeks and 12-weeks post-injection in terms of relieving pain and improving quality of life and function.

A comparison of two different prosthetic feet on functional capacity, pain severity, satisfaction level and quality of life in high activity patients with unilateral traumatic transtibial amputation.

AIM: Prescribing optimal prosthetic feet to ensure successful rehabilitation is difficult since there are no generally established clinical guidelines based on objective data. The aim of the study was to compare functional capacity, pain intensity, satisfaction level and quality of life (QoL) of high activity patients with unilateral transtibial amputation using non-articulated carbon foot (non-articulating ankle, NAA) with those of using carbon foot with hydraulic ankle (articulating hydraulic ankle, AHA). METHODS: Forty-two patients (21 with NAA and 21 with AHA) with unilateral transtibial traumatic amputation from tertiary rehabilitation center were participated in this cross-sectional study. Outcome measures were six-minute walking test (6MWT), Visual Analogue Scale (VAS) and the Short Form-36 (SF-36). The level of difficulty experienced during ambulating on different terrains was recorded on a 5-point Likert scale. RESULTS: There were no significant statistical differences in 6MWT, pain intensity, prosthetic foot satisfaction level and QoL between the two groups. The level of difficulty experienced during descending ramps was higher in the NAA group than in the AHA group (p = 0.016). The most common reason for dissatisfaction were inflexibility for the NAA group (14.3%), frequent dysfunction for the AHA group (28.6%). CONCLUSION: Our results showed that the level of difficulty experienced during descending ramps was higher in the NAA group than in the AHA group. Further studies with larger sample sizes are needed comparing microprocessor AHAs with NAA and AHA.

Serum endothelin-1 levels, radiographic and ultrasonographic evaluations, and clinical parameters in patients with knee and/or hand osteoarthritis.

BACKGROUND: Endothelin-1 (ET-1) is one of the probable inflammatory factors stimulating cartilage degradation in osteoarthritis (OA) pathogenesis. OBJECTIVE: To assess ET-1 level in OA and its correlation with radiographic findings, cartilage morphology and clinical parameters. METHODS: One hundred and thirty-nine subjects (89 OA, 50 controls) were included in this cross-sectional study. Both knee and hand joints of the participants were examined using plain radiography and ultrasound imaging by which distal femoral cartilage thickness/grading and second metacarpophalangeal cartilage thickness were assessed. Subjects were evaluated for pain and functional status using visual analogue scale, Western Ontario and McMaster Universities Arthritis Index and Duruöz Hand Index. RESULTS: Serum ET-1 levels were higher in the OA group than the control group. Serum ET-1 levels were not correlated with cartilage thickness in patients with OA. Serum ET-1 levels were not correlated with either pain or other clinical parameters in the knee OA group and in the hand OA group. CONCLUSION: This is the first study evaluating the relationship between serum ET-1 levels and cartilage morphology and clinical parameters, which did not show any conclusive result. Future studies, overcoming the limitations of this study, might provide a better understanding of the role of ET-1 in the pathogenesis of OA.