The role of tuning fork in the evaluation of musculoskeletal disorders and pallesthesia: A scoping review.

BACKGROUND: Musculoskeletal and neurological conditions disorders are important conditions that need to be assessed in clinical practice. The tuning fork (TF) has been proposed as a practical tool to investigate suspected fractures and for the evaluation of pallesthesia in subjects with peripheral neuropathy. OBJECTIVE: the aim of this study is to define whether the tuning fork can be useful in the clinical evaluation of patients with musculoskeletal disorders and deep somatosensory dysfunctions. METHODS: This scoping review was performed in accordance with Joanna Briggs Institute. MEDLINE, Cochrane Library, PEDro, CINAHL, Web of Science, UpToDate, Scopus Database were consulted. RESULTS: 14 studies were included in the final analysis. Nine studies regard the use of tuning fork to detect fractures. If the tuning fork was used with a stethoscope, the test reached a high sensitivity ranging between 83% and 94%. Five studies investigated the tool to evaluate pallesthesia dysfunctions among which possible differences between biceps femoris strain and simple clinical rules for detecting peripheral neuropathy. CONCLUSION: The 128 Hz tuning fork could be potentially useful to detect some type of traumatic fractures. The Rydel-Seiffer tuning fork appears to be a useful tool for assessing potential nerve conduction deficits in the evaluation of pallesthesia.

Abductor muscle strengthening in THA patients operated with minimally-invasive anterolateral approach for developmental hip dysplasia.

OBJECTIVE: In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients. METHODS: A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally-invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken. RESULTS: Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group. CONCLUSION: In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.

Bio-Electro-Magnetic-Energy-Regulation (BEMER) for the treatment of type I complex regional pain syndrome: A pilot study.

Objective: The study aimed to evaluate the efficacy of Bio-Electro-Magnetic-Energy-Regulation (BEMER) magneto-therapy on pain and functional outcome in complex regional pain syndrome type I (CRPS-I). We hypothesized that BEMER therapy, based on its declared effects on microcirculation, could be beneficial in the treatment of this condition. Methods: This was a randomized controlled double-blind pilot study that included 30 patients with CRPS-I. Patients were divided into two groups: a study group, in which the rehabilitation program was combined with BEMER therapy for 10 consecutive days, and a control group, in which the rehabilitation program was combined with a sham BEMER treatment. Outcome measures (Visual Analogic Scale pain; Hand Grip Strength; Disabilities of the Arm, Shoulder, and Hand ; Maryland Foot Score) were taken at the beginning and end of treatment, and at 1 month follow-up. Results: The study demonstrated that the group treated with BEMER combined with rehabilitation yielded better results in the short term, in terms of pain reduction and functional improvement both at the upper and lower limbs. Conclusions: Data from the present pilot study suggest that BEMER therapy can be indicated, in combination with traditional rehabilitation programs, for the treatment of CRPS-I.

Deep heating therapy via MF radiowaves versus superficial heating therapy in the treatment of nonspecific chronic low back pain: A double blind randomized trial.

BACKGROUND: Nonspecific Chronic Low Back Pain (CLBP) is a condition difficult to treat due to multiple etiopathogenesis and there is wide consensus on the multidisciplinary approach. In physiotherapy, the Medium Frequencies (MF) diathermy has recently been introduced but without enough evidence of effectiveness. OBJECTIVE: To explore the effects of a deep heating therapy (DHT) produced by a MF diathermy for the treatment of CLBP compared with a superficial heating therapy (SHT). The study was a double blind randomized trial. METHODS: Forty-nine patients affected by CLBP were randomly subdivided in 2 groups and treated with either DHT (450 KHz) or SHT via electric resistance applying the same instrument on the lumbar spine. NRS (Numerical Rating Scale) for pain and ODI (Oswestry Disability Index) for disability were used as outcome measures. The follow up was: T1, 15 days (end of the therapy); T2, 30 days; T3, 45 days after T0. RESULTS: Both therapies were effective in reducing pain throughout the follow up with greater improvement in DHT group at T1. DHT resulted to have a higher efficacy with respect to SHT in reducing disability (ODI) throughout all follow ups. CONCLUSION: This study provides evidence of the positive effects of MF radio waves diathermy in the treatment of CLBP.

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference.

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field.

Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study.

Quadriceps weakness has been associated with knee osteoarthritis (OA). High-frequency localized muscle vibration (LMV) has been proposed recently for quadriceps strengthening in patients with knee OA. The purpose of this study was (a) to investigate the clinical effectiveness of high-frequency LMV on quadriceps muscle in patients with knee OA and (b) to disentangle, by means of surface electromyography (sEMG), the underlying mechanism. Thirty patients, aged between 40 and 65 years, and clinically diagnosed with knee OA were included in this randomized, controlled, single-blinded pilot study. Participants were randomly assigned to two groups: a study group treated with LMV, specifically set for muscle strengthening (150 Hz), by means of a commercial device VIBRA, and a control group treated with neuromuscular electrical stimulation. Clinical outcome was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, knee range of motion, Timed Up and Go test, and Stair climbing test. To assess changes in muscle activation and fatigue a subgroup of 20 patients was studied with the use of sEMG during a sustained isometric contraction. The LMV group showed a significant change in Western Ontario and McMaster Universities Osteoarthritis Index score, Visual Analogue Scale score, Timed Up and Go test, Stair Climbing Test, and knee flexion. These improvements were not significant in patients treated with neuromuscular electrical stimulation. sEMG analysis suggested an increased involvement of type II muscle fibers in the group treated with LMV. In conclusion, the present study supports the effectiveness of local vibration in muscle function and clinical improvement of patients with knee OA.

Cross-Cultural and Construct Validity of the Animated Activity Questionnaire.

OBJECTIVE: The Animated Activity Questionnaire (AAQ) assesses activity limitations in patients with hip/knee osteoarthritis and consists of video animations; the patients choose the animation that best matches their own performance. The AAQ has shown good validity and reliability. This study aims to evaluate cross-cultural and construct validity of the AAQ. METHODS: Cross-cultural validity was assessed using ordinal logistic regression analysis to evaluate differential item functioning (DIF) across 7 languages. Construct validity was assessed by testing correlations between the AAQ and a patient-reported outcome measure (PROM) and performance-based tests. RESULTS: Data from 1,239 patients were available. Compared to the Dutch language (n = 279), none of the 17 items showed DIF in English (n = 202) or French (n = 193), 1 item showed uniform DIF in Spanish (n = 99) and Norwegian (n = 62), and 2 items showed uniform DIF in Danish (n = 201). In all these languages, the occurrence of DIF did not influence the total score, which remained comparable with the original Dutch version. For Italian (n = 203) versus Dutch, however, 6 items showed uniform DIF, and 1 item showed nonuniform DIF, indicating some problems with the cross-cultural validity between these countries. With regard to construct validity, the correlations with PROM (0.74) and performance-based tests (0.36-0.68) were partly as expected (>0.60). CONCLUSION: The AAQ, an innovative tool to measure activity limitations that can be placed on the continuum between PROMs and performance-based tests, showed a good overall cross-cultural validity, and seems to have great potential for international use in research and daily clinical practice in many European countries.