Impact of electrodiagnostic (EMG/NCS) tests on clinical decision-making and patient perceived benefit in the outpatient physical therapy practice.

BACKGROUND: Utilizing Electromyography and Nerve Conduction Study (EMG/NCS) tests, when indicated, may have implications for efficient patient management and assist in more efficient referral to appropriate providers or specialists. OBJECTIVE: To investigate the impact of Electromyography and Nerve Conduction Studies (EMG/NCS) on clinical decision-making and patient perspectives within PT practice settings. METHODS: 462 patients, who were candidates for diagnostic testing (EMG/NCS) were included in this outcome study and questionnaire-based survey design. Pre-test diagnosis was compared to post-test diagnosis. Post-test, patients were asked to rate their perceived benefit of the testing. RESULTS: Management was changed in 60.61% of patients post EMG/NCS testing (p < 0.0001). The diagnosis was changed post-EMG/NCS test in 39% of the patients with a change in management, which is greater than expected (p < 0.0004). There was no effect of gender or age (p > 0.05) on change in treatment (tx) or diagnosis (dx). 89.8% of patients agreed, or strongly agreed, that they were better able to understand their condition; 92.4% strongly agreed, or agreed, that they were reassured about their condition; 89.1% strongly agreed, or agreed, that they were better able to manage their condition and 92% reported very high, or high, value perceived from the EMG/NCS test administered. CONCLUSION: This study demonstrates that EMG/NCS testing appears to have a significant impact on clinical decision-making, and higher scores on the patient perceived benefit.

Comparative Study of Pain Relief in Two Non-Pharmacological Treatments in Patients with Partial Rotator Cuff Tears: A Randomized Trial.

BACKGROUND: Pain induction is the primary characteristic of a rotator cuff tear while muscle weakness appears as a secondary feature, leading to further disability. OBJECTIVES: The study aimed to determine the effectiveness of physiotherapeutic interventions through transcutaneous electrical nerve stimulation (TENS) or microcurrent electrical nerve stimulation (MENS) in conjunction with kinesiotherapy in patients with partial thickness rotator cuff tear. METHODS: This was a blinded randomized prospective study. The study recruited 42 outpatients with partial rotator cuff tear under conservative treatment selected from the 401 General Military Hospital of Athens and the University General Hospital 'Attikon' during 2015 - 2017. Patients were assessed for pain and disability using the SPADI (shoulder pain and disability index), a numerical rating scale (NRS) for pain, and the EuroQoL-5 questionnaire for the evaluation of the quality of life. The first group received TENS and kinesiotherapy while the second group received MENS and kinesiotherapy. Three measurements were recorded. The first assessment was performed during the initial patient visit; the second after completion of the physiotherapeutic sessions, and the third one three months after the initial assessment. A follow-up ultrasound scan was performed three months after the completion of the therapeutic sessions to assess the anatomical healing of the rotator cuff tear. RESULTS: Repeated measurements analysis indicated a significant improvement in pain scores, functionality, and patients' quality of life (P value < 0.001). Comparison of the two treatment methods did not reveal any significant differences (P value > 0.05) despite the fact that the MENS was associated with a greater improvement in pain intensity and TENS with a greater improvement in functionality and quality of life. CONCLUSIONS: Using MENS and TENS appears to be equally effective in terms of pain relief, functional improvement, and quality of life enhancement in patients.

Nerve conduction velocities in the lower extremity in patients with Raynaud's phenomenon and clinical applications.

BACKGROUND AND PURPOSE: The purpose of the study is to study the nerve conductivity of the tibial motor, peroneal motor, peroneal sensory, and sural nerves in patients with primary and secondary Raynaud's phenomenon (RP). SUBJECTS: Twenty each: primary RP, secondary RP, and normal controls. METHODS: Electromyography using distal latency (DL) and nerve conduction velocity (NCV) as dependent variables. RESULTS: Peroneal nerve DLs were slower and NCVs were weaker for the secondary RP group compared to the primary RP group and controls. Tibial motor nerve DLs from slowest to fastest were: primary RP, secondary RP, and controls. NCV strength order was: secondary RP weakest, primary RP, and controls. DISCUSSION: Patients with secondary RP generally had the slowest DLs and the weakest NCVs, with differences most pronounced in the motor nerves. With the exception of the tibial motor nerve, patients with primary RP had similar NCVs to the control group. Neural mobilization techniques can be applied to assist with patient symptoms.

Effect of topical aerosol skin refrigerant (spray and stretch technique) on passive and active stretching.

OBJECTIVES: The purpose of this study was to examine the effects of the use of a vapocoolant blend of pentafluoropropane and tetrafluoroethane (Gebauer's Spray and Stretch) on hip flexion stretching. METHODS: Thirty volunteers were randomly assigned to spray and stretch treatment and stretch only control groups. Each group was assessed pre- and posttest on passive and active hip flexion range of motion (ROM). RESULTS: Findings indicated greater posttest hip flexion gains for the spray and stretch group over the stretch only group for both active and passive ROM. Additionally, females achieved greater pre- and posttest differences on active ROM compared to males. CONCLUSIONS: Study findings suggest that spray and stretch techniques can be an effective treatment in increasing hip flexion ROM.