Neurodynamic exercises provide no additional benefit to extension-oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial.

BACKGROUND: Chronic low back-related leg pain may involve mixed pain mechanisms. A strategy to address both neuropathic and nociceptive pain symptoms would be combining treatments. OBJECTIVE: To assess the effects of adding neurodynamic exercises to extension-oriented exercises in patients with chronic low back-related leg pain and a directional preference. DESIGN: Two arm, single blind, randomized clinical trial. METHOD: Eligible participants were aged between 18 and 65 years, had low back pain radiating below gluteus for at least 3 months, pain intensity greater than 3 points in the numerical pain rating scale, positive SLR test and a directional preference for lumbar extension movements. Thirty-one participants were randomly allocated into one of two groups: extension-oriented exercises (EE) or extension exercises plus neurodynamic exercises (EEN). Primary outcomes were leg pain intensity and function at 3 weeks. Secondary outcomes were low back pain intensity, disability, global perceived effect and quality of life at 3 weeks and at 1 month. RESULTS: Retention rate was 100% (n = 14) in EE and 94% (n = 16) in EEN for primary outcome analysis. There was no between-group difference for the primary outcomes and for low back pain intensity, GPE and quality of life at 3 weeks. For some outcomes, EE was superior to EEN. CONCLUSIONS: We found no benefits in adding neurodynamic exercises to extension-oriented exercises for patients with nerve-related leg pain and a directional preference. As this study has a small and very specific sample, results may be interpreted with caution.

Enhancement of the functionality of women with knee osteoarthritis by a gel formulation with Caryocar coriaceum Wittm ("Pequi") nanoencapsulated pulp fixed oil.

Osteoarthritis (OA) is a degenerative joint disease that occurs when there is a change in the mechanical and biological properties of the articular cartilage and the subchondral bone; The condition is more prevalent in women than in men. Pequi oil (PO), which is extracted from the fruits of the pequi tree (Caryocar coriaceum Wittm), is widely used in traditional medicine in the Brazilian northeast for the management of inflammation and joint pain. The aim of this study was to develop a pharmaceutical formulation containing Carbopol® hydrogel nanoencapsulated with pequi pulp fixed oil (PeONC) and evaluate its therapeutic effect on functionality and pain in women with knee osteoarthritis. The study was divided into two stages: Stage 1 - preparation and physico-chemical characterization of the pharmaceutical formulation containing PeONC, cell viability assays and skin irritability testing. Step 2 - A double-blind randomized clinical trial evaluating knee symptoms, quality of life, pressure pain, function, muscle strength and range of motion. The nanoformulation was in a gel form, with a particle size of 209.5 ± 1.06 nm, a pH of 6.23 ± 0.45, a zeta potential of - 23.1 ± 0.4 mV, a polydispersity index of 0.137 ± 0.52, and containing nanocapsules with a spherical shape a polymeric wall and an oily nucleus. The gel showed no cytotoxicity and was not irritating to human skin. The treatment with PeONC increased the strength of the knee flexor and extensor muscles and the total motion range of the knee. In addition, the treatment reduced knee instability, pain, swelling, and locking; There was also an improvement in some items of the SF-36 quality of life questionnaire such as in respect of functional capacity and social aspects. In conclusion, PeONC was found to be a stable, safe formulation with no toxicity in respect of topical use in humans. Additionally, the treatment produced an increase in muscle strength and functionality that was associated with reduced knee symptoms and improved quality of life. Our findings showed that in a group of women treated with PeONC mitigated the symptoms of knee osteoarthritis.

Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial.

OBJECTIVE: To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. DESIGN: A prospective, randomized controlled trial. SETTING: A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. INTERVENTION: The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. MAIN MEASURES: The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. RESULTS: Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked (p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed (p = 0.363), lactate levels (p = 0.302), knee extensor strength (p = 0.117), handgrip strength (p = 0.882), global muscle strength (p = 0.104), electromyographic activity (p = 0.179) and Functional Independence Measure (p = 0.059). CONCLUSIONS: Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.

Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis.

BACKGROUND: Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. METHODS: Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. RESULTS: Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. CONCLUSIONS: There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO REGISTRATION NUMBER: CRD42020148650.

Do patients with low back pain and central sensitization have differences in physical fitness?

INTRODUCTION: Low back pain is one of the main musculoskeletal complaints, and may be associated with central sensitization (CS). The physical capacity of patients with low back pain and CS is not very clear. METHODS: A cross-sectional study, with 92 patients divided into two groups according to their risk of CS. The patient's physical capacity ability was assessed using 6-min walking test (6MWT); timed up and go test (TUG); sit-to-stand test (STS); and trunk flexor, extensor and side-bridge endurance tests. In addition, participants completed questionnaires regarding disability, kinesiophobia, catastrophization and quality of life. RESULTS: The group with a higher risk of CS had worst performance in the 6MWT (U = 1248; p < 0.001), STS (t(83) = 3.63; p < 0.001) and TUG (t(83) = -4.46; p < 0.001). Similarly, endurance in the right (U = 1453,5; p = 0,002) and left (U = 1467; p = 0,003) side-bridge tests, and the trunk extensor test (U = 1546; p = 0,003) was worse. Disability (U = 1272; p < 0.001), physical capacity kinesiophobia (t(83) = -2.21; p = 0.03) work kinesiophobia (U = 1452; p < 0.001), and pain catastrophization (t(77.57) = -5.03; p < 0.001), were also higher in the group with a higher risk of CS. Quality of life indicators were worse in the higher risk group for all domains of the EQ-5D-3L: Mobility (X2(1) = 12.92; p < 0.001), self-care (X2(1) = 16,3; p = 0,012), usual activities (X2(2) = 14.14; p = 0.001), pain (X2(2) = 27.79; p < 0.001), anxiety and depression (X2(2) = 15.05; p = 0.001). CONCLUSION: Patients with low back pain and higher risks of CS appear to show lower performance in physical capacity tests, higher rates of disability, kinesiophobia, pain catastrophization, and lower quality of life compared to those with lower risks of CS.

The Influence of Clinical, Functional, and Psychosocial Factors on Walking Time in Individuals With Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to investigate whether clinical, functional, and psychosocial factors are associated with walking time in patients with chronic low back pain. METHODS: This study included patients aged ≥18 years with low back pain for at least 3 months who visited our outpatient clinic between October 2017 and February 2018. We used the following scales/questionnaires: International Physical Activity Questionnaire for self-reported walking time, Numerical Pain Rating Scale for pain intensity, self-report assessing symptom duration, Roland Morris Disability Questionnaire for disability, Patient-Specific Functional Scale for function, Pain Catastrophizing Scale for pain catastrophizing, and screening questions to assess depression and anxiety. Odds ratios (ORs) with their respective 95% CIs were obtained using logistic regression analysis. RESULTS: Neither clinical nor functional factors were associated with the total walking time. Among psychosocial factors, only anxiety showed a negative association with the total walking time (OR 0.23, 95% CI 0.06-0.82)-an association that persisted even after adjusting for confounders (OR 0.15, 95% CI 0.03-0.77). CONCLUSION: Anxiety was shown to be associated with the total walking time in patients with CLBP. No clinical or functional factors seem to be associated with walking in this study sample.

Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial

Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery

Ambulation capacity and functional outcome in patients undergoing neuromuscular electrical stimulation after cardiac valve surgery: A randomised clinical trial.

BACKGROUND: Early mobilization and physical exercise are considered fundamental components in cardiovascular surgery rehabilitation; however, occasionally they are inadequate for inhibiting functional decline. Neuromuscular electrical stimulation (NMES) is a promising tool in cardiovascular rehabilitation; however, to date, no randomized clinical trial has measured the effects of NMES on functional capacity and quality of life in patients who undergo routine cardiac surgery with a short intensive care unit (ICU) stay. Therefore, we aimed to investigate the effects of NMES on walking ability, muscle strength, functional independence, and quality of life in cardiac valve surgery patients in the immediate postoperative period. METHODS: A randomized, parallel, controlled, 2-arm clinical trial with assessor blinding was conducted. Fifty-nine adult patients in the preoperative period after cardiac valve reconstruction and/or replacement were randomly assigned to a control or intervention group. The intervention group underwent NMES in the quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10 sessions. The primary outcome was ambulation ability, assessed through the Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO). Secondary outcomes were muscular strength (assessed through the Medical Research Council scale), functional independence measure (assessed through the Functional Independence Measurement Questionnaire), and quality of life (assessed through the Nottingham Health Profile) at baseline (preoperative) and at postoperative days 3 and 5. RESULTS: The baseline characteristics were similar in both groups, except for body mass index. There was no statistically significant difference, with a small effect size, between both groups regarding the distance walked (95% CI, -64.87 to 65.97) and walking speed (95% CI, -0.55 to 0.57). There was a statistically significant difference in upper-limb muscle strength loss and decline in mobility at postoperative day 3, which had a tendency to recover to initial values at 5PO, in both groups. No significant between-group difference was noted for muscle strength, functional independence, and quality of life. CONCLUSIONS: The use of NMES had no effect on walking ability, strength, quality of life, or functional outcome in the postoperative period for patients that underwent regular valve replacement.