The impact of COVID-19 on neck pain intensity and onset: A systematic review.

BACKGROUND: The COVID-19 pandemic has had significant impacts on most aspects of life, including physical and psychological wellbeing. Neck pain is a very common musculoskeletal complaint worldwide, and one that has been impacted by COVID-19. Such impacts have been studied by a few researchers, but not without inconstancies. Moreover, understanding those impacts in relation to rehabilitation is not fully comprehended. OBJECTIVE: The aim of this study was to systematically examine the impacts of COVID-19 on neck pain intensity and onset pre and post the pandemic. METHODS: This study was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A systematic literature search was conducted on PubMed-MEDLINE, EMBASE, and Cochrane Library. Keywords used were "COVID-19" and "Neck Pain". Risk of bias was assessed using the Joanna Briggs Institute Checklist for prevalence studies. RESULTS: A total of five studies were included with an overall sample size of 2618 participants. Three studies were at moderate risk and two were at high risk of bias. Results from three studies reported an increase in neck pain intensity and onset, while the other two did not report an increase. CONCLUSION: The impact of COVID-19 on neck pain is unclear. The inconsistency in results sheds the light on the importance of having future research (including longitudinal studies) to help guide us towards understanding the real impacts of COVID-19 on neck pain.

Knowledge and Awareness of Dental Practitioners About the Utilization of Endocrown in Post-endodontic Management.

BACKGROUND: The objective of this study was to evaluate the knowledge, and awareness of dentists in Ha'il, Kingdom of Saudi Arabia, regarding the use of endocrown as post-endodontic restorations, utilizing an online questionnaire. METHODS: A cross-sectional study was carried out among dental practitioners working in Ha'il, Kingdom of Saudi Arabia. Dentists who practice in the Ha'il were included in the current study. The survey study involved a sample size of 245 participants. The researchers employed the snowball sampling technique in this investigation. The validated, closed-ended questionnaires were disseminated to the entire sample of selected dental practitioners using electronic mail. The initial section of the survey encompassed inquiries pertaining to the demographic characteristics of the participants, encompassing variables such as gender, years of professional experience, and workplace. The subsequent section of the survey focused on assessing the participants' knowledge and opinions regarding the endocrown technique. The Chi-square test was employed to assess the associations between categorical variables. RESULTS: The most of participants 228 (93.1%) had knowledge about endocrown and 94 (38.4%) of them received information from their educational institutions. Among the responses of the participants, 232 (94.7%) expressed their preference for utilizing endocrown restorations specifically for molar teeth. Moreover, 183 (74.7%) of respondents indicated that the endocrown is preferred when there is a restricted amount of inter-arch space available. A majority of respondents 152 (62.0%) indicated that the ferrule does not exert any influence on the endocrown. A majority of participants 135 (55.1%) expressed a preference for utilizing lithium disilicate ceramic in the fabrication of endocrown. The most of participants 209 (85.3%) opted to use resin cement for the purpose of cementation. The characteristics of gender, experience, and working place were found to have a significant relationship with the knowledge of the participants about endocrown (p <0.05). CONCLUSIONS: The study participants need to enhance their knowledge and awareness pertaining to the utilization of endocrowns as a post-endodontic treatment.

A novel approach to improve hamstring flexibility: A single-blinded randomised clinical trial.

BACKGROUND: The hamstrings play a major role in body posture. Shortening or tightness of the hamstrings affects postural alignment and results in possible musculoskeletal pain. OBJECTIVES: The aim of this study was to develop a novel approach to improve hamstring flexibility in young adults. METHOD: A single-blinded randomised clinical trial included 60 participants aged 18-24 with shortened hamstrings recruited from the Hashemite University, Zarqa, Jordan. The range of motion of knee extension was measured with the hip at 90° flexion using a simple goniometer to detect the level of hamstring flexibility. Participants received either a passive hamstring stretch (PS), followed by two sets of 10 tibial nerve neurodynamic technique (ND), or PS followed by three sets of 10 repetitions of active knee extension-quadriceps activation (QA), or PS only. RESULTS: There was a significant improvement of hamstring flexibility in the QA group compared to the PS group (13.4 ± 12.1° vs. 6.2 ± 6.4°, p = 0.05). There was a significant improvement in hamstring flexibility post-intervention compared to pre-intervention in the PS group by 6.2 ± 6.4 (30.5 ± 10.8° vs. 36.6 ± 9.5°, p = 0.001), ND group by 9.3 ± 6.2 (26.7 ± 10.9° vs. 36.0 ± 9.5°, p = 0.001) and QA group by 13.4 ± 12.1 (20.3 ± 9.0° vs. 33.4 ± 8.9°, p = 0.001). CONCLUSION: Quadriceps muscle activation following passive stretching of the hamstrings appears to be superior to the PS and ND techniques in improving hamstring muscle flexibility. CLINICAL IMPLICATIONS: Quadriceps activation following passive hamstring stretching can be used in physiotherapy settings to improve hamstring muscle flexibility.

Physical therapy practice in intensive care units in Jordanian hospitals: A national survey.

OBJECTIVE: A national survey was conducted to determine the current status of physical therapy practice in the intensive care units (ICUs) of Jordanian hospitals. METHODS: An online survey was sent via email to physical therapists working at Jordanian hospitals. Questions of the survey addressed the physical therapy demographics, staffing, education, training, and barriers of practice. The responses were compared among four different hospital sectors in the country. RESULTS: The response rate was 31% (50/161). Thirty-six percent of participants had more than 10 years of experience in physical therapy, and 26% had less than 1 year of experience in the intensive care practice. Staffing of physical therapists working in ICUs relative to the total ICU beds was the highest in public hospitals compared with other hospital sectors. Among all participants, only 4% had received specialized postgraduate ICU training. The barriers to ICU physical therapy practice in Jordan included insufficient staffing, inadequate training, and lack of understanding of physical therapy role for ICU patients. CONCLUSION: The study showed the main barriers to ICU physical therapy practice in Jordan. There is a need for well-structured strategies to overcome these barriers to help improve the delivery of physical therapy services in Jordan.

Knowledge and attitude towards total knee arthroplasty among the public in Saudi Arabia: a nationwide population-based study.

PURPOSE: Studies on total knee arthroplasty (TKA) in Saudi Arabia are scarce, and none have reported the knowledge and attitude of the procedure in Saudi Arabia. Our study aims to measure the knowledge and attitude of TKA among the adult Saudi population. METHODS: To encompass a representative sample of this cross-sectional survey, all 13 administrative areas were used as ready-made geographical clusters. For each cluster, stratified random sampling was performed to maximize participation in the study. In each area, random samples of mobile phone numbers were selected with a probability proportional to the administrative area population size. Sample size calculation was based on the assumption that 50% of the participants would have some level of knowledge, with a 2% margin of error and 95% confidence level. To reach our intended sample size of 1540, we contacted 1722 participants with a response rate of 89.4%. RESULTS: The expected percentage of public knowledge was 50%; however, the actual percentage revealed by this study was much lower (29.7%). A stepwise multiple logistic regression was used to assess the factors that positively affected the knowledge score regarding TKA. Age [P = 0.016 with OR of 0.47], higher income [P = 0.001 with OR of 0.52] and participants with a positive history of TKA or that have known someone who underwent the surgery [P < 0.001 with OR of 0.15] had a positive impact on the total knowledge score. CONCLUSIONS: There are still misconceptions among the public in Saudi Arabia concerning TKA, its indications and results. We recommend that doctors use the results of our survey to assess their conversations with their patients, and to determine whether the results of the procedure are adequately clarified.

Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial.

BACKGROUND: It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE: The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS: Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS: Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION: The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial.

Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

Tactile intervention as a novel technique in improving body stability in healthy elderly and elderly with diabetes.

BACKGROUND: Body sway increases in the elderly because of normal aging and high incidence of disease such as diabetes. Prevalence of sway is greater in the elderly with diabetes because of damage to the central and peripheral nervous systems. Increase in body sway is associated with an elevated risk of falling. Falling is one of the major causes of morbidity and mortality in the elderly. The purpose of this study was to develop a new technique to improve body stability and decrease body sway in the elderly people with or without diabetes. SUBJECTS AND METHODS: Twenty-two subjects--12 elderly (mean age, 75.5±7.3 years) and 10 age-matched elderly with diabetes (mean age, 72.5±5.3 years)--were recruited for this study. Subjects received tactile feedback as a tingling sensation resulting from electrical stimulation triggered by body sway. RESULTS: The results showed a significant reduction in body sway in the elderly while standing on foam with eyes open (1.0±0.31 vs. 1.9±0.8; P=0.006) and eyes closed (1.8±0.7 vs. 3.3±1.5; P=0.001). In the group with diabetes, there was a significant reduction in body sway while standing on foam with eyes closed (1.4±0.5 vs. 2.3±0.8; P=0.045) but not with eyes open. CONCLUSIONS: In this small study, this technique offers a new tool for training people with diabetes and elderly people to improve body stability and balance.

The effect of acute administration of vitamin D on micro vascular endothelial function in Caucasians and South Asian Indians.

BACKGROUND: Vitamin D is a modulator of the immune system. There is some limited evidence that it also increases local blood flow in response to stress. MATERIAL AND METHODS: In the present study, we examined 20 age matched subjects; 10 whom were from India and 10 Caucasians from the United States. Subjects were administered 4000 IU of Vitamin D3 for 3 weeks at breakfast. The function of the endothelial cells was evaluated in 2 ways; first, the response to 4 minutes of vascular occlusion was measured with a laser Doppler flow meter and second, the blood flow response to local heat at 42°C for 6 minutes. RESULTS: The results of the experiments showed that, as reported previously, the endothelial function in people from India was less than their Caucasian counterparts. The blood flow response to heat was reduced after 3 weeks administration of vitamin D in both groups and the response to vascular occlusion in the Caucasian group. But there was only a 20% reduction in the blood flow response to heat in the Caucasian group and a 50% reduction in the group from India. CONCLUSIONS: Thus acute doses of vitamin D may increase vascular tone and reduce blood flow to tissue during stressors. Dosages administered for a longer duration may have beneficial effects on endothelial function but this was not examined here.

What is more damaging to vascular endothelial function: Diabetes, age, high BMI, or all of the above?

BACKGROUND: It is well established that there is a reduction in the skin blood flow (SBF) in response to heat with age and diabetes. While it is known that high BMI creates a stress on the cardiovascular system and increases the risk of all cause of morbidity and mortality, little is known of the effect of high BMI on SBF response to heat. Since diabetes is associated with age and a higher BMI, the interrelationship between age, BMI and SBF needs to be investigated to better understand the contribution diabetes alone has to endothelial impairment. MATERIAL AND METHODS: This study examined the SBF to heat in young and old people with low and high BMI and people with diabetes with high BMI to determine the contribution these variables have on SBF. Subjects were ten young and older people with BMI <20 and ten young and older people with BMI >20 and ten subjects with diabetes with BMI >20. The SBF response, above the quadriceps, was determined during a 6 minutes exposure to heat at 44°C. RESULTS: Even in young people, SBF after the stress of heat exposure was reduced in subjects with a high BMI. The effect of BMI was greatest in young people and lowest in older people and people with diabetes; in people with diabetes, BMI was a more significant variable than diabetes in causing impairment of blood flow to heat. BMI, for example, was responsible for 49% of the reduction in blood flow after stress heat exposure (R=-0.7) while ageing only accounted for 16% of the blood flow reduction (R=-0.397). CONCLUSIONS: These results would suggest the importance of keeping BMI low not only in people with diabetes to minimize further circulatory vascular damage, but also in young people to diminish long term circulatory vascular compromise.

Electroencephalography to assess motor control during balance tasks in people with diabetes.

BACKGROUND: Balance is sensed through peripheral and central receptors and mediated by central control through the brain and spinal cord. Although some evidence exists as to the areas of the brain involved and how processing of data occurs in young individuals, nothing has been published on people with diabetes. The purpose of this study was to examine the electroencephalogram (EEG) during common sensorimotor and balance training tasks and to relate these to task difficulty. SUBJECTS AND METHODS: Postural sway and EEG change of alpha, beta, and sigma wave bands were measured in 17 young subjects, 10 older subjects, and 10 subjects with diabetes during eight progressively more difficult balance tasks with eyes open and closed, feet in tandem or apart, and on foam or a firm surface. RESULTS: EEG power of beta and sigma wave bands showed significant increases on the cortical and parietal areas of the brain relative to the control tasks when eyes were open (P<0.05). The cortical involvement decreased as the task became more difficult with vision and somatosensory information reduced, whereas that of the parietal area increased with task difficulty. The greatest increase was in subjects with diabetes, and the least was in younger people. Individuals with diabetes had increased sigma and beta EEG power in all regions of the brain examined with increased complexity of the balance task. CONCLUSIONS: This study demonstrated cortical and parietal involvement in static balance tasks commonly used in sensorimotor training. The results support the proposal that there was increased subcortical control with increase in task difficulty in the young subjects, but in subjects with diabetes, there was a major increase in activity across the brain.

The interrelationship between air temperature and humidity as applied locally to the skin: the resultant response on skin temperature and blood flow with age differences.

BACKGROUND: Most studies of the skin and how it responds to local heat have been conducted with either water, thermodes, or dry heat packs. Very little has been accomplished to look at the interaction between air humidity and temperature on skin temperature and blood flow. With variable air temperatures and humidity's around the world, this, in many ways, is a more realistic assessment of environmental impact than previous water bath studies. MATERIAL/METHODS: Eight young and 8 older subjects were examined in an extensive series of experiments where on different days, air temperature was 38, 40, or 42°C. and at each temperature, humidity was either 0%, 25%, 50%, 75%, or 100% humidity. Over a 20 minute period of exposure, the response of the skin in terms of its temperature and blood flow was assessed. RESULTS: For both younger and older subjects, for air temperatures of 38 and 40°C., the humidity of the air had no effect on the blood flow response of the skin, while skin temperature at the highest humidity was elevated slightly. However, for air temperatures of 42°C., at 100% humidity, there was a significant elevation in skin blood flow and skin temperature above the other four air humidity's (p<0.05). In older subjects, the blood flow response was less and the skin temperature was much higher than younger individuals for air at 42°C. and 100% humidity (p<0.05). CONCLUSIONS: Thus, in older subjects, warm humid air caused a greater rise in skin temperature with less protective effect of blood flow to protect the skin from overheating than is found in younger subjects.

The effect of moist air on skin blood flow and temperature in subjects with and without diabetes.

BACKGROUND: Endothelial function is known to be impaired in response to heat in people with diabetes, but little has been done to see how air humidity alters the skin blood flow response to heat. METHODS: Seventeen male and female subjects were divided in two groups, one with type 2 diabetes and the other the control subjects without diabetes, age-matched to the diabetes group. All subjects participated in a series of experiments to determine the effect of the warming of the skin by air on skin temperature and skin blood flow. On different days, skin temperature was warmed with air that was 38°C, 40°C, or 42°C for 20 min. Also, on different days, at each temperature, the air humidity was adjusted to 0%, 25%, 50%, 75%, or 100% humidity. Skin blood flow and temperature were measured throughout the exposure period. This allowed the interactions between air humidity and temperature to be assessed. RESULTS: For the control subjects, the moisture in the air had no different effect on skin blood flow at air temperatures of 38°C and 40°C (analysis of variance, P>0.05), although skin blood flow progressively increased at each air temperature that was applied. But for the warmest air temperature, 42°C, although the four lower humidities had the same effect on skin blood flow, air at 100% humidity caused the largest increase in skin blood flow. In contrast, in the subjects with diabetes, blood flow was always significantly less at any air temperature applied to the skin than was observed in the control subjects (P<0.05), and skin blood flow was significantly higher for the two higher humidities for the two higher air temperatures. Skin temperature paralleled these findings. CONCLUSION: These data show that individuals with diabetes do not tolerate moist, warm air above 50% humidity as well as controls without diabetes.

The ability of different areas of the skin to absorb heat from a locally applied heat source: the impact of diabetes.

BACKGROUND: When heat is applied to the skin, heat is conducted away because of the latent heat transfer properties of the skin and an increase in skin circulation, but little attention has been paid to the heat transfer properties of skin in different areas of the body and in people with diabetes. research design: Thirty subjects in the age range of 20-75 years had a thermode (44°C) applied to the skin of their arm, leg, foot, and back for 6 min to assess the heat transfer characteristics of skin in these four areas of the body. Skin blood flow and skin temperature were monitored over the 6-min period. RESULTS: For the younger subjects, blood flow was not statistically different in response to heat in three areas of the body, starting at less than 200 flux measured by a laser Doppler imager and ending at approximately 1,200 flux after heat exposure. The foot had higher resting blood flow and higher blood flow in response to heat. Temperature and the rate of rise of temperature were also not different in any of the areas. The heat added to raise temperature, however, varied by body region. The arm required the least, whereas the leg and foot required the most. For the older group and subjects with diabetes, the heat required for any region of the body was much less to achieve the same increase in skin temperature, and blood flows were also much less; the subjects with diabetes showed the least blood flow and required the fewest calories to heat the skin. Whereas the foot required the greatest number of calories to heat the tissue in younger and older subjects, in subjects with diabetes, the foot took proportionally fewer calories. CONCLUSION: Thus, specific areas of the body are damaged more by diabetes than other areas.

The ability of the skin to absorb heat; the effect of repeated exposure and age.

BACKGROUND: When heat is applied to the skin, it is dissipated due to conductive heat flow in the tissue and the blood. While heat flow has been studied after applying a single heat exposure, the physiology of repeated exposures to local heat has not been well investigated. MATERIAL/METHODS: Twenty male and female subjects in the age range of 20-65 years old participated in a series of experiments during which a thermode was placed on their leg above the quadriceps muscle for 20 minutes, and on 3 sequential days, to see the effect of repeated local heat on skin blood flow, skin temperature, and on caloric transfer from a thermode used to raise skin temperature. RESULTS: The results of the experiment showed that, for young subjects, to raise skin temperature to 40 degrees C required more than double the calories required in older subjects. Further, in the younger subjects, the blood flow response in the first 20 minutes of heat exposure was over 30% higher than that seen in the older subjects. However, on the 2nd and 3rd day, the blood flow response of the younger subjects, was not significantly different between day 2 and 3, but was significantly less than day 1. There was no statistical difference in the blood flow response between day 1, 2 and 3 in the older subjects. In the younger subjects, in the 2 and 3rd day, the number of calories needed to warm the skin was also significantly less than that seen in the first day. CONCLUSIONS: In younger subjects but not older subjects, there appears to be some degree of acclimatization with an enhanced blood flow response in the first day that was protective to the skin which was not seen in repeated heat exposure.

The contribution of skin blood flow in warming the skin after the application of local heat; the duality of the Pennes heat equation.

As predicted by the Pennes equation, skin blood flow is a major contributor to the removal of heat from an external heat source. This protects the skin from erythema and burns. But, for a person in a thermally neutral room, the skin is normally much cooler than arterial blood. Therefore, if skin blood flow (BF) increases, it should initially warm the skin paradoxically. To examine this phenomenon, 10 young male and female subjects participated in a series of experiments to examine the contribution of skin blood flow in the initial warming the skin after the application of local heat. Heat flow was measured by the use of a thermode above the brachioradialis muscle. The thermode was warmed by constant temperature water at 44°C entering the thermode at a water flow rate of 100 cm(3)/min. Skin temperature was measured by a thermistor and blood flow in the underlying skin was measured by a laser Doppler imager in single point mode. The results of the experiments showed that, when skin temperature is cool (31-32°C), the number of calories being transferred to the skin from the thermode cannot account for the rise in skin temperature alone. A significant portion of the rise in skin temperature is due to the warm arterialized blood traversing the skin from the core areas of the body. However, as skin temperature approaches central core temperature, it becomes less of a heat source and more of a heat sync such that when skin temperature is at or above core temperature, the blood flow to the skin, as predicted by Pennes, becomes a heat sync pulling heat from the thermode.

The influence of aging and diabetes on heat transfer characteristics of the skin to a rapidly applied heat source.

BACKGROUND: Numerous studies have examined the blood flow of the skin at rest and in response to sustained heat and shown that, in older people and people with diabetes, the skin blood flow response to heat is diminished compared to younger people. It is not sustained heat, however, that usually causes burns; it is a more rapid application of heat. SUBJECTS AND METHODS: Ten younger subjects, 10 older subjects, and 10 subjects with diabetes were examined before and after applying a water-filled thermode to the skin above the quadriceps muscle to observe the changes in skin temperature and skin blood flow and the ability of the skin to absorb heat after a 2-min heat exposure with water at 44°C. RESULTS: Skin temperature rose from 31.2°C at rest to 38.3°C after 2 min of heat application in all subjects (P > 0.05 between groups). The calories required in the younger group of subjects was 2.26 times the calories required in the older group of subjects for the same change in skin temperature and 13.8 times the calories needed to increase skin temperature in the subjects with diabetes. Furthermore, the blood flow at rest was lower in people with diabetes than older subjects and both groups less than that seen in younger subjects. The blood flow response to heat was slower in the subjects with diabetes compared to the older subjects and much slower than that seen in the younger subjects. CONCLUSIONS: Reduced skin blood flow of older and subjects with diabetes, decreased thickness of the dermal layer, and increased subcutaneous fat, as well as damage to transient receptor potential vanilloid 1 receptors, may account for some of the differences between the groups.