Interactions Between Biologic Therapies and Other Treatment Modalities.

Biologic therapies are becoming increasingly utilized by veterinarians. The literature regarding the interaction of biologic therapies with other therapeutics is still in its infancy. Initial studies have examined the effects of exercise, stress, various pharmaceutical interventions, extracorporeal shockwave, therapeutic laser, and hyperbaric oxygen on biologic therapies. Continued research is imperative as owners and veterinarians increasingly choose a multimodal approach to injury and illness. Further, understanding the effects of concurrently administered treatments and pharmaceuticals as well as the health status of the horse is imperative to providing the optimal therapeutic outcome.

Effectiveness of Dry Cupping as a Treatment for Plantar Fasciitis: A Critically Appraised Topic.

CLINICAL SCENARIO: Plantar fasciitis is a very common pathology experienced by a wide array of individuals in the United States. Patients most commonly experience tightness and pain along the plantar aspect of their foot and on the medial side of the heel. A variety of treatment methods have been used to improve the pain levels and function of patients with plantar fasciitis. An emerging treatment method for plantar fasciitis is dry cupping, where negative pressure is created to increase blood flow to the injured area and facilitate the healing process. CLINICAL QUESTION: Is there evidence to suggest dry cupping is effective at improving pain and function for patients experiencing plantar fasciitis when compared with therapeutic exercise or electrical stimulation? SUMMARY OF KEY FINDINGS: Three studies examining the effectiveness of dry cupping for the treatment of plantar fasciitis were included in this review. Two studies compared dry cupping to therapeutic exercises and stretching, and 1 study used electrical stimulation. CLINICAL BOTTOM LINE: There is moderate evidence to support the use of dry cupping to improve pain and function in patients with plantar fasciitis. STRENGTH OF RECOMMENDATION: There is level B evidence to support dry cupping as an effective treatment method for improving pain and function in patients with plantar fasciitis as compared with therapeutic exercise and electrical stimulation.

Instrument-Assisted Soft Tissue Mobilization Increased Hamstring Mobility.

CONTEXT: Limited research reveals that the use of different soft tissue mobilization techniques increases tissue mobility in different regions of the body. OBJECTIVE: The purpose of this study was to determine whether there is a difference between administering instrument-assisted soft tissue mobilization (IASTM) and therapeutic cupping (TC) on hamstring tightness. DESIGN: Subjects attended one session wherein treatment and leg order were randomized before attending the session. A statistical analysis was completed using a 2 (intervention) × 2 (time) repeated-measures analysis of variance at α level ≤ .05. PARTICIPANTS: Thirty-three subjects between the age of 18-35 years old with bilateral hamstring tightness participated in this study. INTERVENTIONS: The IASTM and TC were administered on different legs for 5 minutes and over the entire area of the hamstring muscles. One TC was moved over the entire treatment area in a similar fashion as the IASTM. MAIN OUTCOME MEASURES: The intervention measurements included soreness numeric rating scale, Sit-n-Reach (single leg for side being tested), goniometric measurement for straight-leg hip-flexion motion, and superficial skin temperature. The timeline for data collection included: (1) intervention measurements for the first randomized leg, (2) 5-minute treatment with the first intervention treatment, (3) intervention measurements repeated for postintervention outcomes, and (4) repeat the same steps for 1 to 3 with the contralateral leg and the other intervention. RESULTS: There was a main effect over time for Sit-n-Reach, measurement (pre-IASTM-29.50 [8.54], post-IASTM-32.11 [8.31] and pre-TC-29.67 [8.21], post-TC-32.05 [8.25]) and goniometric measurement (pre-IASTM-83.45 [13.86], post-IASTM-92.73 [13.20] and pre-TC-83.76 [11.97], post-TC-93.67 [12.15]; P < .05). CONCLUSION: Both IASTM and TC impacted hamstring mobility during a single treatment using only an instrument-assisted soft tissue mobilization technique without any additional therapeutic intervention.

Vitiligo and the Role of Newer Therapeutic Modalities.

Our understanding of the etiology of vitiligo, which is now categorically recognized as an autoimmune illness characterized by the occurrence of chalky-white patches over the skin as a consequence of focal melanocyte loss, has made significant strides in recent years. The notion that vitiligo results from a mix of etiologic factors that affect melanocyte functionality rather than solely due to underlying mutations, melanocytes reacting to chemical or radiation exposure, or hyperreactive T cells, has undoubtedly remained consistent. Since then, new research has contributed to our understanding of gradual depigmentation. The next stage of vitiligo research-the expansion of efficient therapeutic modalities-will be propelled by knowledge of the relative significance of such etiologic aspects and a thorough evaluation of the most targetable pathways. Although vitiligo is frequently written off as a cosmetic issue, it can have terrible psychological implications and significantly interfere with daily activities. A patient's interpersonal and social conduct may be impacted by their perception of stigmatization, which ultimately raises their chance of developing depression. This review is a summary of various theories of the pathogenesis of vitiligo as well as an overview of the therapeutic modalities that are currently available for the same.

Antithrombotic and antiplatelet effects of plant-derived compounds: a great utility potential for primary, secondary, and tertiary care in the framework of 3P medicine.

Thromboembolism is the third leading vascular disease, with a high annual incidence of 1 to 2 cases per 1000 individuals within the general population. The broader term venous thromboembolism generally refers to deep vein thrombosis, pulmonary embolism, and/or a combination of both. Therefore, thromboembolism can affect both - the central and peripheral veins. Arterial thromboembolism causes systemic ischemia by disturbing blood flow and oxygen supply to organs, tissues, and cells causing, therefore, apoptosis and/or necrosis in the affected tissues. Currently applied antithrombotic drugs used, e.g. to protect affected individuals against ischemic stroke, demonstrate significant limitations. For example, platelet inhibitors possess only moderate efficacy. On the other hand, thrombolytics and anticoagulants significantly increase hemorrhage. Contextually, new approaches are extensively under consideration to develop next-generation antithrombotics with improved efficacy and more personalized and targeted application. To this end, phytochemicals show potent antithrombotic efficacy demonstrated in numerous in vitro, ex vivo, and in vivo models as well as in clinical evaluations conducted on healthy individuals and persons at high risk of thrombotic events, such as pregnant women (primary care), cancer, and COVID-19-affected patients (secondary and tertiary care). Here, we hypothesized that specific antithrombotic and antiplatelet effects of plant-derived compounds might be of great clinical utility in primary, secondary, and tertiary care. To increase the efficacy, precise patient stratification based on predictive diagnostics is essential for targeted protection and treatments tailored to the person in the framework of 3P medicine. Contextually, this paper aims at critical review toward the involvement of specific classes of phytochemicals in antiplatelet and anticoagulation adapted to clinical needs. The paper exemplifies selected plant-derived drugs, plant extracts, and whole plant foods/herbs demonstrating their specific antithrombotic, antiplatelet, and fibrinolytic activities relevant for primary, secondary, and tertiary care. One of the examples considered is antithrombotic and antiplatelet protection specifically relevant for COVID-19-affected patient groups.

Instrument-Assisted Soft Tissue Mobilization Forces Applied by Trained Clinicians During a Simulated Treatment.

CONTEXT: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. OBJECTIVE: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. DESIGN: Experimental. SETTING: University research laboratory. PARTICIPANTS: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). INTERVENTION: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. MAIN OUTCOME MEASURES: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. RESULTS: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. CONCLUSIONS: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.

Equine Rehabilitation: A Scoping Review of the Literature.

Injuries to the locomotor system are a common problem in athletic horses. Veterinarians address these injuries using appropriate medical, surgical, and pharmacological treatments. During or after recovery from the initial injury, horses may be treated for functional locomotor deficits using specific rehabilitation techniques aimed at restoring full athletic performance. This study reviews the literature to identify which rehabilitative techniques have been used most frequently in horses over the past 20 years, the protocols that were used, and the outcomes of the treatments in naturally occurring injuries and diseases. Publications were identified using keyword selection (Equine Athlete OR Equine OR Horse) AND (Rehabilitation OR Physiotherapy OR Physical Therapy). After removing duplicates and screening papers for suitability, 49 manuscripts were included in the study. The majority of publications that met the inclusion criteria were narrative reviews (49%) in which the authors cited the relatively small number of published evidence-based studies supplemented by personal experience. Observational/descriptive studies were also popular (35%). Randomized control trials accounted for only 10%. The most frequently reported rehabilitation techniques were exercise, electrotherapy, and hydrotherapy. The findings highlight the need for further information regarding type of intervention, parameterization, and outcomes of equine rehabilitation in clinical practice.

Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

CONTEXT: The effects of an exercise program (EP) for the treatment of patellofemoral pain syndrome (PFPS) are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. OBJECTIVE: To evaluate the effects of OMT versus EP on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with PFPS. DESIGN: This is a randomized controlled trial. SETTING: Human performance laboratory. PARTICIPANTS: A total of 82 runners with PFPS participated in this study. INTERVENTIONS: The participants were randomized into 3 groups: OMT, EP, and control group. The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. The EP group performed specific exercises for lower limbs. The control group received no intervention. MAIN OUTCOME MEASURES: The main evaluations were pain through the visual analog scale, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. RESULTS: There was a significant pain decrease in the OMT and EP groups when compared with the control group. OMT group showed increased functionality, decreased PPMF, and increased PTF. The range of motion for hip extension increased only in the EP group. CONCLUSION: Both OMT and EP are effective in treating runners with PFPS.

Training Room Procedures and Use of Therapeutic Modalities in Athletes.

Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.

Physical Rehabilitation for the Management of Canine Hip Dysplasia.

Hip dysplasia is among the most common orthopedic conditions affecting dogs. Joint laxity is responsible for abnormal development of the femoral head and acetabulum, leading to excessive wear of the articular cartilage. Wear leads to secondary osteoarthritis. Rehabilitation is either conservative or after surgical management. Conservative rehabilitation therapies are directed at decreasing pain, improving hip range of motion (ROM), and building or maintaining muscle mass. Postoperatively, rehabilitation focuses on decreasing postoperative pain and inflammation, improving comfort and limb use, and protecting the surgical site. Once the patient has healed, rehabilitation is directed at improving ROM and promoting muscle mass.

Mental Health Disorder Therapeutic Modalities Modified for the GMS.

BACKGROUND: Mental health disorders can affect physical and psychological behaviors. The people of the Greater Mekong Subregion (GMS) have a high risk of mental health disorders, such as depression, stress, and substance abuse be-cause the people in this region are trafficked for forced sex work and various forms of forced labor. In these situations, vic-tims often endure violence and abuse from trafficking recruiters, employers, and other individuals. The purposes of this study were to identify the elements characterizing mental health disorders, especially in terms of depression, stress, and sub-stance abuse, and to identify the treatment modalities for mental health disorders in the GMS. METHODS: The researcher undertook a comparative analysis of the literature, reviews of epidemiological studies and mental disorder therapies, and overviews of previous research studies, were used to generate a synthesis of the existing knowledge of the mental disorder therapeutic modalities. Regarding the search methods, the data from the electronic databases PubMed, PsycINFO, Dynamed and ScienceDirect were supplemented with a manual reference search covering relevant studies from 2005 to 2016. RESULTS: Thirty-one papers were included in the review of elements characterizing mental health disorders, especially in terms of depression, stress, and substance abuse, and to identify the treatment modalities for mental health disorders in the GMS. Nine papers defined characterizing mental health disorders, in terms of depression, stress, and substance abuse. Twenty-two papers showed the treatment modalities for mental health disorders that the treatment was effective, these in-cluded pharmacological treatments and psychological treatments, such as mindfulness-based cognitive therapy, biofeedback, and music therapy. Useful guidance can be provided for the prevention and treatment of mental health disorders, and for the care of people in the Greater Mekong Subregion. CONCLUSION: The finding of this review confirms the therapeutic modalities can provide useful guidance for the prevention and treatment of mental health disorders and the care of the people in the Greater Mekong Sub-region. In addition, the effective interventions should be tested regarding their suitability for the socio-cultural context in the Greater Mekong Subregion.

[Faecal incontinence - serious medical and social issue]. / Fekální inkontinence - závazný medicínský a spolecenský problém.

Faecal incontinence presents gastrointestinal disorder with high prevalence (more than 2% of population) and serious impact on the quality of life. General practitioners, gastroenterologists and colorectal surgeons play the principal role in screening, diagnostics and providing health care to patients who suffer from faecal incontinence. Insufficient knowledge about faecal incontinence and minimal training aimed at its diagnostics and therapy lead to the low quality of provided health care.Authors offer comprehensive up-to-date review focused on faecal incontinence - its definition, prevalence, seriousness, consequences, pathophysiology, diagnostics and management. Detailed anatomical and physiological assessment of each patient is fundamental in determining correct cause of faecal incontinence and consequent selection of the most appropriate therapeutic modality.Broad spectrum of available therapeutic options comprises conservative management (lifestyle modification, diet, medications, and absorbent tools), biofeedback and surgical interventions (sphincter augmentation, sphincter reconstruction, sacral nerve stimulation, sphincter substitution and stools diversion). Application of the most appropriate treatment can lead in majority of patients to significant improvement in faecal incontinence and quality of life. Early diagnosis prevents possible complications, which would possibly deteriorate patients quality of life.

Immediate Effect of Patterned Electrical Neuromuscular Stimulation on Pain and Muscle Activation in Individuals With Patellofemoral Pain.

CONTEXT: For individuals with patellofemoral pain (PFP), altered muscle activity and pain are common during functional tasks. Clinicians often seek interventions to improve muscle activity and reduce impairments. One intervention that has not been examined in great detail is electrical stimulation. OBJECTIVE: To determine whether a single patterned electrical neuromuscular stimulation (PENS) treatment would alter muscle activity and pain in individuals with PFP during 2 functional tasks, a single-legged squat and a lateral step down. DESIGN: Cohort study. SETTING: Sports medicine research laboratory. PATIENTS OF OTHER PARTICIPANTS: A total of 22 individuals with PFP (15 women, 7 men; age = 26.0 ± 7.9 years, height = 173.8 ± 8.1 cm, mass = 75.1 ± 17.9 kg). INTERVENTION(S): Participants were randomized into 2 intervention groups: a 15-minute PENS treatment that produced a strong motor response or a 15-minute 1-mA subsensory (sham) treatment. MAIN OUTCOME MEASURE(S): Before and immediately after the intervention, we assessed normalized electromyography amplitude, percentage of activation time across functional tasks, and onset of activation for the vastus medialis oblique, vastus lateralis, gluteus medius, adductor longus, biceps femoris, and medial gastrocnemius muscles during a single-legged squat and a lateral step down. Scores on the visual analog scale for pain were recorded before and after the intervention. RESULTS: After a single treatment of PENS, the percentage of gluteus medius activation increased (0.024) during the lateral step down. Visual analog scores decreased during both the single-legged squat (PENS: preintervention = 2.7 ± 1.9, postintervention = 0.9 ± 0.7; sham: preintervention = 3.2 ± 1.6, postintervention = 2.8 ± 1.9; group × time interaction: P = .041) and lateral step down (PENS: preintervention = 3.4 ± 2.4, postintervention = 1.1 ± 0.8; sham: preintervention = 3.9 ± 1.7, postintervention = 3.3 ± 2.0; group × time interaction: P = .023). No changes in electromyography or pain measures were noted in the sham group. CONCLUSIONS: The PFP participants who received PENS had immediate improvement in gluteus medius activation and a reduction in pain during functional tasks.

Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review.

The purpose of this systematic review was to assess whether electrical stimulation (ES), when used in conjunction with a standard treatment, can reduce levels of functional impairment, edema, and pain compared to a standard treatment alone, in patients following a lateral ankle sprain. We searched PubMed, CINAHL, SportDiscus, and Medline (OVID) databases through June 2014 using the terms "ankle sprain or ankle sprains or ligament injury or ligamentous injury," and "electric stimulation or electric stimulation or electrotherapy." Our search identified four randomized control trials, of which, neuromuscular ES and high-voltage pulsed stimulation were the only two ES modalities utilized. Effect sizes and 95% confidence intervals (CI) were estimated using Cohen's d for comparison between treatment groups. Three of four effect sizes for function had 95% CI that crossed zero. Twenty-four of the thirty-two effect sizes for edema had 95% CI that crossed zero. All effect sizes for pain had 95% CI that crossed zero. Therefore, the use of ES is not recommended as a means to improve function, reduce edema, or decrease pain in the treatment of acute lateral ankle sprains.

Scleroderma and evidence based non-pharmaceutical treatment modalities for digital ulcers: a systematic review.

OBJECTIVE: Digital ulcers are difficult to heal, increasing the chance of infection, gangrene, amputation and limited functional use of hands. They are a complication in scleroderma or systematic sclerosis (SSc) and occur in approximately 50% of patients. This is a systematic review of the evidence supporting the use of non-pharmaceutical therapeutic modalities and their effectiveness to facilitate the healing of chronic digital ulcers in patients with scleroderma. METHOD: A comprehensive review of computerised databases from 2000-2013: PubMed/MEDLINE, CINAHL, Pedro, OT Seeker, OT Search, OVID, and Proquest as well as manual review of other resources was completed using the following search terms scleroderma or systemic sclerosis and/or digital ulcers, specific modalities (low level laser therapy, electrical stimulation, intermittent compression, ultrasound, vitamin E, myofascial release, wound dressings, iontophoresis, negative pressure therapy, and exercise), chronic wounds, and wound care. English language studies, from 2000 to January 2013, which used therapeutic modalities to facilitate healing of digital ulcers and use healing of the digital ulcer as an outcome measure were reviewed. RESULTS: Of the 403 identified articles, only 11 studies addressed non-pharmaceutical treatment modalities to facilitate healing for digital ulcers. Exercise had no direct effect on healing ulcers. The following studies were positive but have limitations in design and sample size:: hyperbaric oxygen therapy (n=2), negative pressure therapy (n=1), intermittent compression (n=27) and acoustic pressure wound healing (n=1). Vitamin E gel showed a significant difference compared to a control group (n=27). Iontophoresis studies have shown that the modality increases blood flow but the results in five different studies are mixed and the application and intensity were inconsistent. CONCLUSION: No one modality was proven to be the most effective. Larger efficacy studies on treating digital ulcers are needed in order to develop appropriate care guidelines to improve outcomes, promote function and lower health-care costs.

Are room temperature and thermal neutral synonymous terms? An investigation of common therapeutic modality control variables.

CONTEXT: Therapeutic modality control variables are thought to be thermal neutral, a term sometimes used interchangeably with room temperature. We question this common assumption. OBJECTIVE: To determine thermal neutrality of common therapeutic modality control variables. DESIGN: We performed 5 laboratory experiments, including (1) water temperature over 3 weeks in 3 different containers (glass, plastic, and polystyrene); (2) water temperature and volume of 4 beakers (2 insulated, 2 uninsulated) over 4 weeks, with 1 beaker of each type covered by polyethylene; and skin interface temperature of (3) a dry, nonheated hydrocollator pack held against the chest, (4) kitty litter applied to the knee, and (5) room-temperature ultrasound gel to the forearm. SETTING: Therapeutic modalities laboratory. PATIENTS OR OTHER PARTICIPANTS: College student volunteers were subjects in experiments 3, 4, and 5. MAIN OUTCOME MEASURE(S): We measured temperature and volume change. Data were evaluated using descriptive and interferential statistics. RESULTS: Water temperature plateaued significantly below room temperature. Temperatures significantly increased in all but the open, insulated container. Open containers plateaued at approximately 2 degrees C below room temperature and lost significant amounts of water; closed containers plateaued at room temperature with negligible water loss. In experiments 3 through 5, skin temperatures rose significantly during hydrocollator pack, kitty litter, and ultrasound gel application. CONCLUSIONS: Room-temperature water baths, dry hydrocollator packs, kitty litter, and ultrasound gel were not thermally neutral. Room temperature should not be used synonymously with thermal neutral. Care must be taken to ensure that control variables truly are controlled.