Effectiveness of high-intensity laser application combined with splinting and therapeutic exercise in subacute de Quervain's tenosynovitis: A pilot study.

The purpose of this study is to determine the additional effect of high-intensity laser therapy (HILT) when combined with therapeutic exercise and splinting in the treatment of patients diagnosed with de Quervain's tenosynovitis. Nineteen patients diagnosed with de Quervain's tenosynovitis were randomly divided into two groups: the HILT group and the sham HILT group. A total of 9 HILT or sham HILT sessions were administered, with 3 sessions per week for 3 consecutive weeks. Both groups received the thumb spica splint and therapeutic exercise. A comparison was conducted between the two groups, as well as pre- and post-treatment, focusing on the following outcomes: Visual Analog Scale (VAS) for pain, hand grip strength, and Thai version of Patient-Rated Wrist and Hand Evaluation (PRWHE-Thai) as a disability score. No significant differences were found between the HILT group and the sham group across all evaluated outcomes. However, when examining changes within each group over time, both the HILT and sham groups showed significant reductions in pain and improvements in disability score at the follow-up assessments compared to baseline. On the other hand, no statistically significant differences were observed in grip strength outcomes at any of the measured time points. The combination of HILT with a splint and exercise demonstrates effectiveness as a method for pain management and functional improvement in patients with subacute de Quervain's tenosynovitis. It is important to note that HILT does not offer any additional advantages when compared to the combined use of a splint and exercise.

The prevalence of diabetic peripheral neuropathy in youth with diabetes mellitus.

PURPOSE: Diabetic neuropathy (DN) is a serious complication in diabetes mellitus. We aimed to determine the prevalence of DN in pediatric-onset diabetes in a tertiary care center and to assess the sensitivity and specificity of monofilament testing and noninvasive screening to diagnose DN compared with the gold standard nerve conduction study (NCS). METHODS: Sixty-five Thai children and adolescents (39 females) diagnosed with diabetes before 15 years of age were included. All subjects were screened for DN by foot and neurological examinations, light touch sensation by 10 g Semmes-Weinstein monofilaments, and the Michigan Neuropathy Screening Instrument (MNSI). NCSs were used as the gold standard for diagnosis of DN. RESULTS: Fifty-eight patients had type 1 diabetes ( T1D), 5 patients had type 2 diabetes, and 2 patients had other types of diabetes. The mean age was 17.7±4.6 years (8-33 years). The prevalence of DN in this cohort was 12.3% by NCS. All subjects were asymptomatic. Mean diabetes duration did not differ between the groups (with DN 8.0±3.0 years vs. no DN 8.2±5.0 years). Notably, one patient with T1D developed DN within 3 years after diagnosis. Poor glycemic control was a significant risk factor for DN. Glycosylated hemoglobin was higher in the DN group (10.6%±2.3% vs. 8.5%±1.6%, P=0.008). The occurrence of diabetic nephropathy was associated with DN (prevalence rate ratio, 4.97; 95% confidence interval, 1.5-16.46). Foot and neurological examinations, monofilaments, and the MNSI failed to detect DN in all subjects with abnormal NCS. CONCLUSION: The prevalence of DN in pediatric-onset diabetes is not uncommon but mainly is subclinical. Poor glycemic control is the main risk factor. Noninvasive screening tests for DN exhibited poor diagnostic sensitivity in the pediatric population.

The validity and reliability of the PHQ-9 in screening for post-stroke depression.

BACKGROUND: Depression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. METHODS: The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks-2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. RESULTS: In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach's alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78-0.96). CONCLUSIONS: The Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.

Effectiveness of Phonophoresis Treatment in Carpal Tunnel Syndrome: A Randomized Double-blind, Controlled Trial.

OBJECTIVE: To determine the effects of phonophoresis of piroxicam (PH-P) and phonophoresis of dexamethasone sodium phosphate (PH-Dex) on mild to moderate carpal tunnel syndrome (CTS), and to compare each of them with the control group of nondrug ultrasound (US) therapy. DESIGN: A randomized, double-blind controlled trial. SETTING: Department of rehabilitation medicine, university hospital. PARTICIPANTS: Patients with clinical signs and symptoms of CTS underwent an electrophysiological study to confirm the diagnosis of CTS and severity grading. Thirty-three patients, 50 hands (52% of the patients had bilateral CTS, n = 17) with mild to moderate CTS were randomly allocated into three study groups: PH-P, PH-Dex, or US. INTERVENTION: All three groups received 10 sessions of 1-MHz frequency, 1.0 w/cm2 intensity ultrasound wave with stroking technique, continuous mode, at the palm side of the hand over the carpal tunnel area-10 minutes per session, two to three times per week for 4 weeks, for a total of 10 sessions. During each session, the patients received 15 cm3 of study gel according to the study groups. The PH-P group received 0.5% piroxicam gel mixture (equivalence of 20 mg of piroxicam). The PH-Dex group received 0.4% dexamethasone sodium phosphate gel mixture (equivalence 60 mg of dexamethasone). The US group received nondrug gel. MAIN OUTCOME MEASUREMENTS: Boston Carpal Tunnel Questionnaire for symptom severity (BCTQ SYMPT), Boston Carpal Tunnel Questionnaire for functional status (BCTQ FUNCT) and electrophysiological parameters of the median nerve including distal sensory latency (DSL) and distal motor latency (DML) were evaluated before the first treatment and after the last treatment. RESULTS: After treatment, all treatment groups (PH-P, PH-Dex, and US) showed significant improvements of the BCTQ SYMPT (P < .001, -0.74 ± 0.73 [-1.12, -0.37], -0.91 ± 0.96 [-1.41, -0.42], and - 0.68 ± 0.71 [-1.05, -0.30], respectively) and the BCTQ FUNCT (P < .001, -0.68 ± 0.89 [-1.14, -0.22], -0.74 ± 0.84 [-1.17, -0.30], and - 0.80 ± 0.80 [-1.22, -0.37], respectively). For the BCTQ SYMPT, only the PH-Dex showed an improvement score above MCID at 0.8 level [-0.91 ± 0.96]. The improvement of BCTQ FUNCT score of all groups was above Minimal Clincally Important Difference (MCID) at 0.5 level (-0.68 ± 0.89, -0.74 ± 0.84 and - 0.80 ± 0.80, respectively).The DSL was decreased in all groups but the changes were not statistically significant (P = .70, -0.11 ± 0.34 [-0.28, 0.06], -0.09 ± 0.32 [-0.26, 0.07], and - 0.14 ± 0.29 [-0.29, 0.02], respectively). The DML showed decrease only in PH-DEX and the US group but it was not statistically significant (P = .68, 0.05 ± 0.44 [-0.17, 0.27], -0.09 ± 0.51[-0.34, 0.17], and - 0.27 ± 0.49 [-0.53, 0.01], respectively). All measured outcomes were not statistically different in between-group-comparison of BCTQ SYMPT, BCTQ FUNCT, DSL, and DML (P = .58, P = .79, P = .20 and P = .39, respectively). However, there was a clinically significant difference of the improvement of BCTQ SYMPT in between-group comparison; only the PH-DEX was above the MCID level, while the PH-P and US were not. CONCLUSIONS: Neither nondrug US nor phonophoresis treatments (PH-P and PH-Dex) were effective to improve the DSL and DML in mild to moderate CTS. All three groups showed significant improvements in clinical symptoms (BCTQ SYMPT) and functional status (BCTQ FUNCT). At 1 MHz frequency and 1.0 w/cm2 intensity of ultrasound wave, there is no statistically significant difference between phonophoresis and the nondrug US. LEVEL OF EVIDENCE: I.

Ultrasound combined transcutaneous electrical nerve stimulation (UltraTENS) versus phonophoresis of piroxicam (PhP) in symptomatic knee osteoarthritis: A randomized double-blind, controlled trial.

BACKGROUND: Ultrasound combined with transcutaneous electrical nerve stimulation (UltraTENS) and phonophoresis of piroxicam (PhP) are combined modality therapy that frequently used in musculoskeletal pain including knee osteoarthritis (OA). But it is lack of a good clinical trial to prove and compare their effects. OBJECTIVE: To compare the effects of UltraTENS with PhP on mild to moderate degree of symptomatic knee OA. METHODS: Sixty-one patients (55 women), mean age of 63.4 ± 8.1 y, 50-90 mm VAS of knee pain and Kellgren-Lawrence score of grade I-III were randomly allocated into UltraTENS and PhP (N = 31 and 30, respectively). The UltraTENS group received a combined ultrasound with TENS program and a non-drug gel, whereas the PhP group got an ultrasound program with piroxicam gel and sham TENS. All patients were treated for a total of 10 sessions, consisting of five times per week and 10 min per session. Before and after treatment, patients were evaluated knee pain by using the 100-mm VAS and functional performance by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. RESULTS: The UltraTENS and PhP groups experienced considerable improvement in both VAS and total WOMAC scores post-treatment (P< 0.001). The PhP had better VAS of pain and WOMAC scores but no statistical significance. CONCLUSIONS: Results show that UltraTENS and PhP were effective for relieving pain and improve functionality knee OA without significant differences between their effects.

Effects of phonophoresis of piroxicam and ultrasound on symptomatic knee osteoarthritis.

OBJECTIVE: To compare the effects of phonophoresis of piroxicam (PhP) and ultrasound therapy (UT) in patients with mild to moderate, symptomatic knee osteoarthritis (OA). DESIGN: A randomized, double-blind, controlled trial. SETTING: Department of rehabilitation medicine, university hospital. PARTICIPANTS: Patients with knee OA (N=46; mean age ± SD, 58.91±10.50y) who had visual analog scale (VAS) scores of 50 to 92mm (mean, 71.5mm) for knee pain intensity and Kellgren-Lawrence grades of I to III were randomly allocated into 2 groups: PhP and UT (23 in each group). INTERVENTIONS: Both the PhP and UT groups were treated with an ultrasound program using the stroking technique, continuous mode, 1.0W/cm(2), 10 minutes per session, and 5 times per week for 2 weeks. Four grams of 0.5% piroxicam gel (20mg of piroxicam drug) was used in the PhP group, while the nondrug coupling gel was used in the UT group. MAIN OUTCOME MEASURES: A 100-mm VAS for usual pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated before and after treatment in both groups using a double-blinded procedure. RESULTS: The VAS and total WOMAC scores were significantly improved after treatment in both groups (P<.001). The PhP group showed more significant effects than the UT group, both in reducing the VAS pain score (P=.009) and in improving the WOMAC score, although it did not reach the level of significance (P=.143). CONCLUSIONS: Our results indicated that PhP was significantly more effective than UT in reducing pain and tended to improve knee functioning in Kellgren-Lawrence grades I to III knee OA. PhP is suggested as a new, effective method for treatment of symptomatic knee OA.

Effects of the treadmill walking exercise on the biochemical bone markers.

OBJECTIVE: To study the effects of moderate-intensity treadmill walking exercise on the biochemical bone markers in the menstruating and menopausal women. STUDY DESIGN: Experimental study. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Twenty-two healthy volunteer women at the age of 30-70 were recruited: 11 menstruating women and 11 menopausal women. The exercise consisted of the treadmill walking exercise, intensity of 50% of heart rate reserve, for the duration of 30 minutes, at the frequency of 3 times a week, over a 3-month period. Serum beta CTx, PINP and NMID osteocalcin were measured at the baseline and in the 1st, 2nd, and 3rd months. RESULTS: Twenty women: 11 menstruating women and 9 menopauses completed the exercise protocol. The baseline characteristics including age, body mass index, serum beta CTx, PINP and NMID were statistically different. The serum beta CTx and NMID levels were decreased from the baseline from Month 1 to 3 in both menstruating and menopausal groups. Serum PINP was not significantly changed in the 1st and 2nd months except the significant decreasing in the 3rd month in the menstruating women. There were no significant differences of bone marker changes between the menstruating women and the menopauses. The biochemical bone markers' levels (beta CTx, PINP and NMID) had the strong correlations analyzed by Pearson's correlation coefficients (> 0.8 with p-value < 0.001). CONCLUSION: The present study clearly demonstrates that the moderate intensity treadmill walking exercise for 30 minutes, 3 times a week reduces bone resorption and bone turnover markers in both the menstruating women and the menopauses after the first month until the third month of the experiment. Although the bone formation markers had a tendency of decreasing after exercising, the significant changes showed only in the 3rd month in the menstruating group. All of the bone markers including beta CTx, NMID osteocalcin and PINP were highly correlated.

Comparison of amplitude and area decrement in repetitive nerve stimulation.

OBJECTIVE: To access the percentage of the patients whose repetitive nerve stimulation (RNS) studies were negative for 10% amplitude decrement but positive for 10% area decrement and to compare these disagreed results with specialist physician's diagnosis. STUDY DESIGN: Retrospective descriptive study. SETTING: Electrodiagnosis laboratory, Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: All of the electromyography (EMG) reports of RNS studies were reviewed Both 10% amplitude and area decrement were used as criteria for diagnosis in each patient. The disagreed results would be compared to final diagnosis of the specialist physicians that were recorded in out-patient medical records. RESULTS: Eighty-three reports were included in the present study. Nineteen records (22.9%) were negative for 10% amplitude decrement but positive for 10% area decrement. Three records (3.6%) were positive for 10% amplitude decrement but negative for 10% area decrement. Twenty-two patients had disagreed results. Sixteen disagreed out-patient medical records (72.7%) were available for review the final specialist doctors' diagnosis. About 69% of patients, whose test was negative for 10% amplitude decrement but positive for 10% area decrement, were diagnosed as myasthenia gravis (MG) or suspected MG. All of the patients, whose test was negative for 10% area decrement but positive for 10% amplitude decrement, were diagnosed as MG. The use of both 10% amplitude and area decrement instead of 10% amplitude decrement alone will provide additional diagnostic yields in about 13% of the cases. CONCLUSION: Twenty-three percent of patients had disagreed RNS results that were negative for 10% amplitude decrement but positive for 10% area decrement. When these disagreed results were compared to the final diagnosis of specialist doctors, 69% of these patients were diagnosed or suspected and treated as MG. Using both 10% amplitude and area decrement may improve sensitivity of MG diagnosis in about 13% of the cases.

Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain.

OBJECTIVE: To study the effectiveness of suprascapular nerve block in hemiplegic shoulder pain for reducing pain and increasing range of motion, and compare them to treatments with therapeutic ultrasound. STUDY DESIGN: Randomized controlled trial study. SETTING: Thai Red Cross Rehabilitation Center. MATERIAL AND METHOD: Stroke patients with hemiplegic shoulder pain who met the inclusion criteria were included into the present study and allocated to the suprascapular nerve block (SSNB) and ultrasound groups by block of four-randomization technique. Patients of the SSNB group were done the nerve block twice, after pre-assessment on the first day and the next week of follow-up. For the ultrasound group, patients were treated 5 days a week. During four weeks of study, all of the patients were given the same standard program of range of motion exercise and were evaluated the VAS score of pain and range of motion every week until four weeks. RESULTS: Ten stroke patients were equally allocated to SSNB and US groups. There were significant improvements of VAS score at the 2nd and 4th week in the SSNB group with mean decreasing VAS scores of 40.6 +/- 25.4 and 51.0 +/- 20.7 respectively. For ROM outcome of the SSNB group, the increase offlexion at the 2nd and 4th week was 17.0 +/- 6.3 and 25.4 +/- 10.4 and abduction was 13.2 +/- 11.3 and 20.6 +/- 12.5, respectively. Statistically significant increase was detected at the 4th week inflexion motion (p = 0.026). SSNB produced a faster relief of pain than the ultrasound but there was no significant difference for restoration of ROM There was no complication observed during the present study. CONCLUSION: The present study suggests that suprascapular nerve block is a safe and effective treatment for hemiplegic shoulder pain. It was more rapid and effective than therapeutic ultrasound in reducing pain score but there is a similar result for improvement of ROM.

Comparison of removable rigid dressing and elastic bandage in reducing the residual limb volume of below knee amputees.

OBJECTIVE: Compare the reducing volumes of the residual limbs between the removable rigid dressing method and the elastic bandaging technique. STUDY DESIGN: Randomized controlled trial. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Twenty-six below-the-knee amputees (11 men (42.3%) and 15 women (57.69%)) who were informed and gave written consents were included in this study. The mean age was 68.19 +/- 10.83 years. The patients who met the eligible criteria were randomized into two groups. Fourteen subjects (53.8%) were in the EB group and 12 (46.2%) in the RRD group. The first group was taught to use a removable rigid dressing (RRD) while the second group was taught to use an elastic bandage (EB) for stump shaping and volume reduction. Both groups were trained with the same pre-prosthetic program. The circumference of the stump was measured and calculated for volume at the beginning, 2 weeks, and 4 weeks. The volume reduction was compared between the two groups. RESULTS: Twenty subjects were amputated on the right side (76.92%). The majority underlying was diabetes mellitus (80.77%). Fifteen cases of amputation were peripheral vascular disease (57.69%). The stump volume reduction of the RRD group at 2 and 4 weeks were 42.73 +/- 62.70 and 79.9 +/- 103.33 cm3, respectively. The stump volume reduction of the EB group were 21.89 +/- 118.49 and 83.03 +/- 113.05 cm3, respectively. There were no statistically significant differences of volume reduction between the two groups at 4 weeks. CONCLUSION: Removable rigid dressing had a tendency to reduce residual limb volume of below knee amputees faster than elastic bandage at 2 weeks but the decreasing volumes were not different at 4 weeks.

Incidence of vertebral fractures in Thai women and men: a prospective population-based study.

BACKGROUND: Vertebral fracture is the most common but the least well-investigated osteoporotic fracture. A population-based prospective study was conducted to determine incidence of vertebral fracture in Thai older adults. METHODS: Lateral thoracic and lumbar spine radiographs obtained in 1997 and 2002 of 322 participants were evaluated morphometrically. Incidence of fracture was considered if the vertebra was determined as normal at baseline and any of the anterior, central, posterior vertebral heights on the follow-up film showed a decrease of at least 20% or 4 mm compared with baseline height. RESULTS: Incidences of vertebral fracture in women and men were 32.1/1000 and 54.5/1000 person-year, respectively. Incident rates in men were higher than those in women in all age groups. Incidence increased with age, ranging from 27.4/1000 person-year at ages 50-59 years to 46.1/1000 person-year at ages of 70 years or more for women, and 42.3/1000 person-year at ages 50-59 years to 66.7/1000 person-year at ages of 70 years or more in men. The incidence was markedly high compared with other studies conducted in white older adults. Thai older adults with incidental vertebral fractures had a much higher proportion of having multiple-level fractures compared with white older adults. CONCLUSIONS: This study showed a remarkably high incidence of vertebral fractures in a Thai population, particularly in men. The main contributing factor for incidental vertebral fracture was likely to be trauma or micro-trauma associated with strenuous physical activity or work rather than osteoporosis, particularly among the younger age group and men.

Correlation between volumes and circumferences of residual limb in below knee amputees.

OBJECTIVE: To determine the correlation between the stump circumference at different levels (at tibial tubercle, 4-cm, 8-cm and the distal end) with the stump volumes in below knee amputees. DESIGN: Cross sectional descriptive design. SETTING: King Chulalongkorn Memorial Hospital and Sirindhorn National Medical Rehabilitation Center PARTICIPANTS: Fifty five unilateral below knee amputees were recruited from the outpatient rehabilitation department. MEASUREMENT: Residual limb volumes of each subject were measured by water displacement method with volumeter and measured different circumferences level with a tape twice for each method. RESULTS: The Pearson correlation coefficients of residual limb volume and circumference at tibial tubercle level, 4- and 8- cm from the tubercle, and distal end level were 0.814, 0.892, 0.878, and 0. 715, respectively. CONCLUSION: The results revealed significant correlation in all levels studied. Maximum correlation coefficient was observed at 4 centimeters below tibial tubercle.

Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome.

OBJECTIVE: To investigate the efficacy of low intensity ultrasound thermotherapy, a conservative option of treatment of mild to moderate carpal tunnel syndrome (CTS). DESIGN: Prospective experimental, placebo- controlled, before-after treatment trial. SETTING: King Chulalongkorn Memorial Hospital, Outpatient Clinic and Electrodiagnostic Laboratory, Department of Rehabilitation Medicine. PATIENTS: Eighteen women, 30 hands who had clinical and electrophysiologic evidence of mild to moderate CTS. INTERVENTIONS: Patients of CTS were divided into two groups; A and B of 15 hands by random sampling. Group A was given placebo and continuous ultrasound therapy with the intensity of 0.5 W/cm2 applied to the palmar carpal tunnel for 10 minutes. Group B was given Diclofenac 75 mg/day in divided doses and sham ultrasound. The ultrasound was applied 5 days a week for 4 weeks. OUTCOME MEASURES: Each patient was clinically and electrophysiologically evaluated before and after treatment. RESULTS: There were statistically significant improvements (p < 0.05), in the clinical parameters of both groups after treatment. In the electrophysiologic study, the median SNAP amplitude was increased significantly after the treatment in ultrasound group (group A). When both groups were compared, group A had significant difference in increasing of median SNAP amplitude after treatment. CONCLUSION: The therapeutic efficacy of low intensity ultrasound thermotherapy was satisfied for mild to moderate CTS. However, the electrophysiological changes after ultrasound treatment need further investigation.