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OBJECTIVE: The purpose of this systematic review with meta-analysis was to investigate the effect of early physical therapy (PT) for the management of acute low back pain (LBP) on patient-reported outcomes of pain and disability, compared to delayed PT or non-PT care. LITERATURE SURVEY: Randomized controlled trials in three electronic databases (MEDLINE, CINAHL, Embase) were searched from inception to June 12, 2020, and updated on September 23, 2021. METHODOLOGY: Eligible participants were individuals with acute low back pain. The intervention was early PT compared to delayed PT or non-PT care. Primary outcomes included the patient-reported outcomes of pain and disability. The following information was extracted from included articles: demographic data, sample size, selection criteria, PT interventions, and pain and disability outcomes. Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Random effects models were used for the meta-analysis. SYNTHESIS: Seven of 391 articles met the eligibility criteria and were included in the meta-analysis. Random effects meta-analysis comparing early PT to non-PT care for acute LBP indicated a significant reduction in pain (standard mean difference [SMD] = 0.43, 95% confidence interval [CI]: -0.69 to -0.17) and disability (SMD = 0.36, 95% CI: -0.57 to -0.16) in the short term. Early PT compared to delayed PT did not result in improvement in short-term pain (SMD = -0.24, 95% CI: -0.52 to 0.04) or disability (SMD = 0.28, 95% CI: -0.56 to 0.01), or long-term pain (SMD = 0.21, 95% CI: -0.15 to 0.57) or disability (SMD = 0.14, 95% CI: -0.15 to 0.42). CONCLUSIONS: This systematic review and meta-analysis suggest early PT versus non-PT care is associated with statistically significant reductions in short-term pain and disability (up to 6 weeks) with small effect sizes. The results indicate a nonsignificant trend favoring a small benefit of early PT over delayed PT for outcomes at short-term follow-up but no effect at long-term follow-up (6 months or greater).
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Dor Aguda , Dor Crônica , Dor Lombar , Humanos , Dor Lombar/terapia , Dor Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Modalidades de Fisioterapia , Medidas de Resultados Relatados pelo PacienteRESUMO
INTRODUCTION: We examined the prognostic value of electrodiagnostic (EDX) studies for ulnar neuropathy at the elbow (UNE). METHODS: In this retrospective study, EDX results were compared with subjective recovery (resolution of symptoms) and surgery in patients diagnosed with UNE. RESULTS: Of the 193 patients, 59 with "definite" UNE were included in the analysis. The combination of conduction block across the elbow to the first dorsal interosseous (FDI) and normal distal compound muscle action potential (CMAP) amplitude from the abductor digiti minimi (ADM) was strongly associated with recovery: 86% of these subjects achieved full subjective recovery compared to only 7% without conduction block and with an abnormal CMAP. There were no EDX predictors of surgery. CONCLUSION: EDX results contain useful prognostic information in UNE.
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Cotovelo/fisiopatologia , Eletrodiagnóstico/métodos , Neuropatias Ulnares/diagnóstico , Neuropatias Ulnares/fisiopatologia , Adolescente , Adulto , Idoso , Cotovelo/inervação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Prognóstico , Estudos Retrospectivos , Nervo Ulnar/fisiopatologia , Adulto JovemRESUMO
The clinical use of lumbar epidural steroid injections has increased dramatically. Although there are certainly beneficial effects to using epidural steroid injections in a treatment regimen for lumbar radicular pain, there is a lack of well designed, placebo-controlled studies to define conclusively specific indications and techniques for different spinal diagnoses. This article reviews the pathophysiology of lumbar radiculopathy and the use of epidural steroid injections as one treatment option, as well as describes their risks and benefits. Based on current literature, we offer an evidence-based perspective regarding rational use of lumbar epidural steroid injections for certain indications and treatment goals.