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1.
Int J Dent Hyg ; 18(1): 27-43, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31054209

RESUMO

OBJECTIVES: To investigate whether chlorhexidine mouthwash (CHX-MW), with an anti-discoloration system(ADS), is effective in preventing extrinsic tooth surface discoloration. Additionally, this paper seeks to evaluate whether CHX combined with an ADS maintains its efficacy with respect to reducing plaque and gingivitis scores. MATERIAL AND METHODS: MEDLINE-PubMed and Cochrane-Central were searched up to October 2018 to identify eligible studies. Papers evaluating the effect of CHX-MW+ADS compared to CHX without an ADS were included. A descriptive analysis and when feasible a meta-analysis was performed. RESULTS: Screening resulted in 13 eligible publications, presenting 16 comparisons. Six of these evaluated the MW in a non-brushing model and ten as an adjunct to toothbrushing. A descriptive analysis demonstrated that the majority showed no differences in bleeding, gingivitis and plaque scores. This was confirmed by the meta-analysis. In non-brushing experiments, the difference-of-means (DiffM) for plaque scores was 0.10 (P = 0.45, 95%CI: [-0.15; 0.34]) and for the gingival index 0.04 (P = 0.15,95%CI: [-0.02; 0.11]). The DiffM in brushing studies for plaque scores was 0.01 (P = 0.29, 95%CI: [-0.01; 0.02]) and for the gingival index 0.00 (P = 0.87,95%CI: [-0.05; 0.06]). With respect to staining scores, the meta-analysis revealed that in non-brushing studies, the standardized mean difference was 3.19 (P = 0.0005,95%CI: [-3.98; -1.41]) while in brushing studies, the DiffM was 0.12 (P = 0.95,95%CI: [-3.32; 3.55]). CONCLUSION: There is moderate quality evidence from non-brushing studies that the addition of an ADS to CHX-MW reduces tooth surface discoloration and does not appear to affect its properties with respect to gingival inflammation and plaque scores. In brushing studies, there is also moderate quality evidence that ADS does not affect the anti-plaque and anti-gingivitis efficacy of CHX. The majority of comparisons and the meta-analysis including these indicate no significant effect of ADS on tooth staining in situations where the mouthwash is used in addition to toothbrushing.


Assuntos
Anti-Infecciosos Locais , Placa Dentária , Gengivite , Descoloração de Dente , Clorexidina , Humanos , Antissépticos Bucais
2.
J Knee Surg ; 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31634936

RESUMO

Multiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

3.
BMJ Open Sport Exerc Med ; 5(1): e000532, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31191976

RESUMO

Objectives: To assess the outcome of conservative treatment for chronic exertional compartment syndrome (CECS) as it relates to the reduction in surgical fasciotomy and return to active duty in a military population. Methods: Historic cohort. From 2015 to 2018, 75 surgically eligible patients with pressure-positive anterior CECS (Group 1), or with positive pressures and associated medial tibial stress syndrome (Group 2), underwent a conservative treatment programme emphasising gait retraining of running and marching. Treatment success was defined as return to duty, without surgery. Fifty patients from 2015 to 2017 were surveyed to assess mid-term outcomes. Results: The average duration of conservative treatment was 144.9 (±59.6) days. Initially, 65% (49/75) were able to return to duty; 28% (21/75) were referred for surgery and 7% (5/75) left the armed forces. There was no difference in outcomes between Group 1 and Group 2. Survey response rate, on average after 742 days (SD 267, range 381-1256), was 84% (42/50); 57% (24/42) had continued duty, without surgery; of them, 43% were at the same military specialty, 57% in a physically less demanding job. Conclusion: A conservative treatment programme for anterior CECS was able to return 65 % of patients to active duty, without surgery. At 2 years, the success rate decreased slightly, but remained positive at 57%. In this high-risk group, initiating a conservative treatment protocol with an emphasis on gait retraining can significantly reduce the need for surgical fasciotomy. For those that fail conservative treatment, surgical release may still be indicated.

5.
J Occup Rehabil ; 29(3): 585-594, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30539374

RESUMO

Purpose Three out of ten patients do not return to work after total knee arthroplasty (TKA). Patient expectations are suggested to play a key role. What are patients' expectations regarding the ability to perform work-related knee-demanding activities 6 months after TKA compared to their preoperative status? Methods A multi-center cross-sectional study was performed among 292 working patients listed for TKA. The Work Osteoarthritis or joint-Replacement Questionnaire (WORQ, range 0-100, minimal important difference 13) was used to assess the preoperatively experienced and expected ability to perform work-related knee-demanding activities 6 months postoperatively. Differences between the preoperative and expected WORQ scores were tested and the most difficult knee-demanding work-related activities were described. Results Two hundred thirty-six working patients (81%) completed the questionnaire. Patients' expected WORQ score (Median = 75, IQR 60-86) was significantly (p < 0.01) higher than their preoperative WORQ score (Median = 44, IQR 35-56). A clinical improvement in ability to perform work-related knee-demanding activities was expected by 72% of the patients, while 28% of the patients expected no clinical improvement or even worse ability to perform work-related knee-demanding activities 6 months after TKA. Of the patients, 34% expected severe difficulty in kneeling, 30% in crouching and 17% in clambering 6 months after TKA. Conclusions Most patients have high expectations, especially regarding activities involving deep knee flexion. Remarkably, three out of ten patients expect no clinical improvement or even a worse ability to perform work-related knee-demanding activities 6 months postoperatively compared to their preoperative status. Therefore, addressing patients expectations seems useful in order to assure realistic expectations regarding work activities.

6.
Front Psychol ; 9: 287, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29623052

RESUMO

Background: The frequent and intensive training and performance of pre-professional ballet dancers and sportspersons is offered at a time when young ballet dancers and young athletes may be vulnerable to injury due to the progress through adolescence and growth spurts. Hypothesis: There are changes in range of motion during the progress through adolescence and growth periods in dancers and sportspersons. These changes in ROM can be linked to the increase of injury. Objectives: The primary aim of this systematic review is to determine whether there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. The secondary aim is to determine whether these changes can predict the risk of injuries for adolescent dancers and sportspersons. Search strategy: Pubmed, Cochrane Register of Controlled Trails (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), EBSCO Host databases: CINAHL Plus, MEDLINE, SPORTDiscus, Embase were searched using MeSH terms. Manual search in the Journal of Dance Medicine and Science and screening of the reference lists of identified studies and reviews was conducted. Selection criteria: Studies included adolescent dancers and sportspersons, aged 8-18, both sexes, growth spurt related to changes in ROM and injury incidence. Data collection and analysis: Search strategy was performed in the flow diagram of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently appraised each included study using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for methodological quality of the included studies. For data extraction, the following information was systematically extracted: first author and year of publication, study design, participants (sample size of mean age), age, maturation (if assessed), intervention, outcome(s), and some notes of each study. For evaluation of the risk of bias and precision the Research Triangle Institute Item Bank (RTI-IB) is included. Main results: Seven observational studies met the inclusion criteria of this current review. The results of this review suggest that there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes may lead to an increase in injury incidence. Conclusion: There is evidence linking to changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes in ROM may be related to injury incidence.

7.
Eur J Orthod ; 39(5): 509-518, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28379334

RESUMO

Background: Dentofacial deformities frequently require orthodontic treatment. Understanding of preventable risk factors is essential for reducing treatment need. Upper airway obstruction (for example due to hypertrophic adenoids and/or tonsils) has been hypothesized to be a risk factor. Objectives: This systematic review aimed to reflect the contemporary evidence on the risk of obstruction by hypertrophic adenoids and/or tonsils, by assessing the dentofacial changes after adeno- and/or tonsillectomy. Search methods: A systematic search of electronic databases and manual searches of grey literature and reference lists of relevant studies was performed. Selection criteria: No restrictions were placed on publication language. Experimental, cohort, and case-control studies were eligible for inclusion. Studies reporting associations between treatment of adenoid and/or tonsil hypertrophy and dentofacial deformities in children were included. Adenoidectomy and/or tonsillectomy were performed in all patients; outcomes were assessed before and after surgery. Data collection and analysis: Data were extracted by two independent reviewers in duplicate. The Cochrane Risk of Bias tool was used to assess the methodological quality of the included papers. Results: The initial search yielded 1196 papers, of which 16 articles could be included. All papers described controlled prospective cohort studies, reporting on a total of 461 patients and controls (mean age, 4.1-13.9 years). A descriptive and quantitative synthesis of dentofacial change postoperatively is presented. Consistent findings across studies were the normalisation towards labial inclination of the upper and lower incisors and towards a more horizontal mandibular growth pattern. No change in vertical or sagittal maxillary growth was reported after surgical treatment. Post-surgical increase in maxillary archwidth and decrease in lateral crossbite-frequency were consistently reported. Findings on overjet, overbite and angle from S to N to B (SNB-angle), mandibular arch width, and gonial angle were inconsistent. Conclusion: The available literature suggests that treatment of hypertrophic adenoids and/or tonsils affects dentofacial deformity. This could indicate a relationship between nasopharyngeal obstruction (i.e. upper airway obstruction) and the dentofacial growth pattern. However, the high risk of bias and considerable diversity between studies impedes a clear conclusion regarding this effect. Registration: None.


Assuntos
Adenoidectomia , Desenvolvimento Maxilofacial , Tonsilectomia , Tonsila Faríngea/patologia , Estudos de Casos e Controles , Humanos , Hipertrofia/cirurgia , Incisivo/crescimento & desenvolvimento , Incisivo/patologia , Má Oclusão/terapia , Mandíbula/crescimento & desenvolvimento , Mandíbula/patologia , Maxila/crescimento & desenvolvimento , Maxila/patologia , Tonsila Palatina/patologia , Estudos Prospectivos
8.
Neuromodulation ; 20(1): 71-80, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27778413

RESUMO

OBJECTIVES: To examine whether converting from conventional Spinal Cord Stimulation (SCS) to High Density (HD) SCS reduces neuropathic pain over a period of 12 months in patients with failed SCS therapy. METHODS: Retrospective, open label, single center, consecutive case series of 30 neuropathic pain patients (Failed Back Surgery Syndrome [FBSS], Complex Regional Pain Syndrome [CRPS], and polyneuropathy [NP]). Patients with an initial adequate response to conventional SCS, but in whom pain increased over time, were included (Numeric Rating Scales [NRS] >6). These patients were stimulated with HD-SCS parameters and followed-up for 12 months. We report pain intensity, measured with NRS, before SCS implantation, 1 and 3 months after starting SCS with conventional stimulation, and after 1, 6, and 12 months of HD SCS. RESULTS: Pain reduction with conventional stimulation was initially adequate (NRS mean 8.6 to 5.3 at three months postimplant) but increased over time to a mean NRS of 7.7 at the time of reprogramming. NRS scores decreased significantly to 4.3 (p = 0.015) after reprogramming from conventional SCS (30 Hz, 300 µsec, 3.0 V) to HD SCS (409 Hz, range 130-1000 Hz, 409 µsec, 2.4V) in the patients still using HD-SCS at 12 months. In the nonresponders (patients who stopped HD-SCS for any reason), 76% had a diagnosis of FBSS. Almost half of the patients aborting HD-SCS preferred to feel paresthesias despite better pain relief. There was a significant difference between nonresponders and responders regarding the amount of electrical energy delivered to the spinal cord. CONCLUSION: Neuropathic pain suppression is significantly enhanced after converting from failed conventional SCS to HD SCS in patients with FBSS, CRPS, and NP over a measured period of 12 months. There appears to be a dose-related response between the amount of energy delivered to the spinal cord and clinical effect.


Assuntos
Fenômenos Biofísicos/fisiologia , Síndrome Pós-Laminectomia/terapia , Neuralgia/terapia , Estimulação da Medula Espinal/métodos , Estudos de Coortes , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
9.
J Sci Med Sport ; 20(2): 128-133, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27476374

RESUMO

OBJECTIVES: Medial tibial stress syndrome (MTSS) is one of the most common sporting injuries. As of yet, the development of effective therapeutic interventions to treat MTSS is hindered by the fact that its pathology is unknown. Our aim was to explore the pathology of MTSS, by assessing whether the presence of MTSS is related to periosteal, bony or tendinous abnormalities in the lower leg. DESIGN: Case-control study. METHODS: Participants with MTSS and athletic control participants were recruited from the same (high-risk) base population. Musculoskeletal ultrasonography was performed on the posteromedial tibial border and deep plantar flexor muscles by an experienced radiological specialist who was blinded to group membership. Associations between MTSS and tissue abnormalities were expressed in odds ratios (OR). RESULTS: A total of 42 participants, 15 MTSS cases and 27 control athletes completed the study. Overall, periosteal and tendinous abnormalities were common in cases with and without MTSS. Periosteal edema was present in 8 (53.3%) MTSS cases and in 10 (37.0%) control athletes, in specific painful spots in the distal 2/3 of the posteromedial tibial border OR=1.9 (95% CI 0.54-6.99, p=0.35). Also, tendinous abnormalities in the tibialis posterior muscle were frequently seen in MTSS cases (N=7, 46.7%) and in control athletes (N=13, 48.1%) (OR=0.97, 95% CI 0.27-3.51, p=0.96). No bone abnormalities were observed in either group. CONCLUSIONS: Periosteal and tendinous findings seem to be common in both athletes with and without MTSS, and consequently are not associated with MTSS.


Assuntos
Síndrome da Tensão Tibial Medial/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Periósteo/diagnóstico por imagem , Tendões/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Traumatismos em Atletas , Estudos de Casos e Controles , Edema , Feminino , Humanos , Masculino , Síndrome da Tensão Tibial Medial/patologia , Músculo Esquelético/patologia , Razão de Chances , Medição da Dor/métodos , Periósteo/patologia , Análise de Regressão , Tendões/patologia , Adulto Jovem
10.
J Clin Periodontol ; 43(12): 1050-1058, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27513809

RESUMO

AIMS: The aim of this systematic review was to establish the efficacy of brushing with and without a dentifrice for dental plaque removal. MATERIALS AND METHODS: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched. The inclusion criteria were randomized controlled trials and controlled clinical trials and subjects ≥18 years of age with good general health. Studies that evaluated the effect of toothbrushing with a dentifrice compared to brushing without a dentifrice were included. Data were extracted from the eligible studies, and a meta-analysis was performed where feasible. RESULT: The search was conducted until June 2016 and retrieved 10 eligible publications that included 20 comparisons. On average, 49.2% of plaque was removed when brushing was performed with a dentifrice, and 50.3% of plaque was removed when toothbrushing was performed without a dentifrice. The descriptive analysis indicated that the majority of the comparisons did not show an additional effect of dentifrice use. Regarding the meta-analysis of post-brushing scores, no significant difference was observed between toothbrushing with and without a dentifrice (DiffM 0.00, 95%CI [-0.05: 0.05], p = 0.91). The meta-analysis of incremental data (as means or percentages) supported and strengthened these findings. CONCLUSION: The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque.


Assuntos
Placa Dentária , Índice de Placa Dentária , Dentifrícios , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Escovação Dentária , Cremes Dentais
11.
Arthrosc Tech ; 4(6): e863-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27284525

RESUMO

Anterolateral rotatory instability (ALRI) occurs after injury to the anterior cruciate ligament (ACL) and the anterolateral structures of the knee. We present a technique for anterolateral extra-articular soft-tissue (ALES) reconstruction of the knee that can be used in revision ACL reconstruction cases, cases of persistent ALRI after adequate ACL reconstruction, and cases with severe ALRI after primary ACL rupture. The surgeon performs ALES reconstruction with a strip of iliotibial tract autograft while respecting the anatomic origin and insertion of the anterolateral ligament. The purpose of this reconstruction is to restore the normal anterolateral rotatory stability of the knee in ALES-deficient patients.

12.
Br J Sports Med ; 49(10): 657-72, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25416198

RESUMO

BACKGROUND: The effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. We investigated the effect of PRP injections in patients with knee OA based on decreasing pain, improving function, global assessment and changes regarding joint imaging. METHODS: We performed a comprehensive, systematic literature search in computerised databases (MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science and PEDro) until June 2014 for randomised or non-randomised controlled trials. These were graded for risk of bias and a level of evidence was provided. If possible, meta-analysis was performed. RESULTS: Ten trials were included. In these, intra-articular PRP injections were more effective for pain reduction (mean difference (MD) -2.45; 95% CI -2.92 to -1.98; p value <0.00001 and MD -2.07; 95% CI -2.59 to -1.55; p value <0.00001, single and double PRP injections, respectively) compared with placebo at 6 months postinjection. Intra-articular PRP injections were compared with hyaluronic acid and showed a statistically significant difference in favour of PRP on pain reduction based on the visual analogue scale and numeric rating scale (standardised mean difference -0.92; 95% CI -1.20 to -0.63; p value <0.00001) at 6 months postinjection. Almost all trials revealed a high risk of bias. CONCLUSIONS: On the basis of the current evidence, PRP injections reduced pain more effectively than did placebo injections in OA of the knee (level of evidence: limited due to a high risk of bias). This significant effect on pain was also seen when PRP injections were compared with hyaluronic acid injections (level of evidence: moderate due to a generally high risk of bias). Additionally, function improved significantly more when PRP injections were compared with controls (limited to moderate evidence). More large randomised studies of good quality and low risk of bias are needed to test whether PRP injections should be a routine part of management of patients with OA of the knee.


Assuntos
Osteoartrite do Joelho/terapia , Plasma Rico em Plaquetas , Ensaios Clínicos como Assunto , Humanos , Injeções Intra-Articulares , Pessoa de Meia-Idade , Dor/etiologia , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Resultado do Tratamento
13.
Arthroscopy ; 29(11): 1879-95, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24209682

RESUMO

PURPOSE: The aim of this systematic review was to determine which patient determinants and injury factors, before anterior cruciate ligament reconstruction by arthroscopic single-bundle techniques, affect postoperative rehabilitation. METHODS: A search of PubMed, Embase, and the Cochrane Database of Clinical Trials was performed up to February 2013. After application of our inclusion criteria, a final selection was made based on studies' methodologic score assessed with the Newcastle-Ottawa Scale. Meta-analysis was planned for each prognostic factor when data were considered clinically and statistically homogeneous. RESULTS: Meta-analysis showed that male patients have better functional outcomes. Qualitative synthesis from 18 high-quality studies showed that patients operated on before 30 years of age reach higher activity levels. Patients with high baseline body mass index have lower activity levels after surgery. Smoking results in more symptoms and lower activity levels and subjective scores. Reconstruction before 3 months results in higher activity levels. Preoperatively, a less than 20% quadriceps strength difference, 50° of tibial external rotation or less, absence of flexion deficits, low knee influence on the patient's activity level, and less anterior knee pain result in higher functional scores. Preoperative anterior laxity difference does not predict functional scores. The prognostic value of preoperative activity and competition level for postoperative functional outcome is controversial. Patients with concomitant meniscal injuries have worse functional outcomes. The prognostic value of concomitant chondral pathology for postoperative functional outcome is controversial. Collateral ligament injury could predict functional scores or activity level. CONCLUSIONS: Male gender, patient age younger than 30 years, reconstruction before 3 months, and high baseline activity level contribute to better functional outcomes. Smoking, high body mass index, quadriceps strength, and range-of-motion deficits affect rehabilitation negatively. Preoperative anterior laxity does not influence rehabilitation. The role of preoperative prognostic injury factors remains unclear because of limited evidence. LEVEL OF EVIDENCE: Level III, systematic review of Level II and III studies.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/reabilitação , Traumatismos do Joelho/cirurgia , Adulto , Fatores Etários , Medicina Baseada em Evidências , Feminino , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Prognóstico , Amplitude de Movimento Articular , Fatores Sexuais
14.
Sports Med ; 43(12): 1315-33, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23979968

RESUMO

BACKGROUND: Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. OBJECTIVE: The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS. STUDY SELECTION: Published or non-published studies, reporting randomized or non-randomized controlled trials of any treatment in subjects with MTSS were eligible for inclusion. Treatments were assessed for effects on pain, time to recovery or global perceived effect. DATA SOURCES: Computerized bibliographic databases (MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus) and trial registries were searched for relevant reports, from their inception to 1 June 2012. Grey literature was searched for additional relevant reports. STUDY APPRAISAL: The Cochrane Risk of Bias Tool was used to appraise study quality of randomized clinical trials (RCTs) whereas the Newcastle Ottawa Scale was used to appraise non-randomized trials. The 'levels of evidence', according to the Oxford Centre for Evidence-Based Medicine, addressed the impact of the assessed trials. Two reviewers independently performed the search for articles, study selection, data extraction and appraised methodological quality. RESULTS: Eleven trials were included in this systematic review. All RCTs revealed a high risk of bias (Level 3 of evidence). Both non-randomized clinical trials were found to be of poor quality (Level 4 of evidence). RCTs, studying the effect of a lower leg brace versus no lower leg brace, and iontophoresis versus phonophoresis, were pooled using a fixed-effects model. No significant differences were found for lower leg braces (standardized mean difference [SMD] -0.06; 95 % CI -0.44 to 0.32, p = 0.76), or iontophoresis (SMD 0.09; 95 % CI -0.50 to 0.68, p = 0.76). Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking and extracorporeal shockwave therapy (ESWT) could be effective in treating MTSS when compared with control (Level 3 to 4 of evidence). Low-energy laser treatment, stretching and strengthening exercises, sports compression stockings, lower leg braces and pulsed electromagnetic fields have not been proven to be effective in treating MTSS (level 3 of evidence). CONCLUSION: None of the studies are sufficiently free from methodological bias to recommend any of the treatments investigated. Of those examined, ESWT appears to have the most promise.


Assuntos
Medicina Baseada em Evidências/métodos , Síndrome da Tensão Tibial Medial/terapia , Manejo da Dor/métodos , Humanos , Resultado do Tratamento
15.
J Orthop Sports Phys Ther ; 43(6): 352-67, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23628788

RESUMO

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVES: To review and critically appraise the literature for factors that increase the risk for meniscal tears. BACKGROUND: Meniscal tears are an important cause of disability and time lost from work, and are associated with a 4-fold increase in the long-term risk of knee osteoarthritis. Knowledge of the risk factors that lead to meniscal tears can help to correctly diagnose knee injuries and is important to the development of prevention strategies for knee osteoarthritis. METHODS: A search of the Cochrane Database of Systematic Reviews, MEDLINE, and Embase, from 1950 to January 2012, and a hand search of reference lists of all initially selected studies, without restriction on language or date of publication, were conducted. Prospective, retrospective, and case-control studies that included individuals over 16 years of age, who had no previous meniscal injuries or surgeries, were selected. A meta-analysis for 17 risk factors was performed. Where considerable heterogeneity among studies was present or the data did not provide sufficient information to perform a meta-analysis, a qualitative synthesis was conducted. RESULTS: Eleven studies, with a total of 7358 participants, were selected for systematic review. Data were available for meta-analysis for 10 of the 11 studies. Qualitative analysis was conducted using data from 3 of the 11 studies. Results showed strong evidence that age (older than 60 years), gender (male), work-related kneeling and squatting, and climbing stairs (greater than 30 flights) were risk factors for degenerative meniscal tears. We also found strong evidence that playing soccer and playing rugby were strong risk factors for acute meniscal tears. Waiting longer than 12 months between the anterior cruciate ligament injury and reconstructive surgery was a strong risk factor for a medial meniscal tear but not for a lateral meniscal tear. CONCLUSION: The literature indicates a number of risk factors leading to either degenerative or acute meniscal tears, with some of these factors being potentially modifiable. LEVEL OF EVIDENCE: Prognosis, level 2a.


Assuntos
Traumatismos do Joelho/epidemiologia , Lesões do Menisco Tibial , Humanos , Instabilidade Articular/complicações , Traumatismos do Joelho/etiologia , Fatores de Risco
16.
Spine (Phila Pa 1976) ; 34(8): E281-93, 2009 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-19365237

RESUMO

STUDY DESIGN: Systematic review. OBJECTIVE: To review and critically evaluate the past literature for spinal mechanical load as risk factor for low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP is a costly health problem worldwide, and treatments are often unsuccessful. Therefore, prevention might be more beneficial in the management of LBP. With respect to prevention, the knowledge of risk factors is essential. From the literature, exposures involving spinal mechanical load is frequently discussed as a potential risk factor for LBP. For a better understanding of this risk factor, we performed a systematic review of the literature. Additionally, we evaluated exposures of spinal mechanical load for possible dose-response relations with LBP. METHODS: We systematically searched Medline, Embase, PsycINFO, and CINAHL databases (without language restriction) for full-report publications of prospective cohort studies, evaluating spinal mechanical load during work and/or leisure time activities as risk factors for nonspecific LBP in patients (>18 years of age) free of LBP at baseline. We assessed the methodology of each article and extracted information on population, response rates, characteristics of LBP, exposures, and estimated association(s), using standardized forms. We performed a best evidence synthesis of the obtained information. RESULTS: In total, 18 studies were eligible (all rated as high methodologic quality) reporting on 24,315 subjects. CONCLUSION: We found strong evidence that leisure time sport or exercises, sitting, and prolonged standing/walking are not associated with LBP. Evidence for associations in leisure time activities (e.g., do-it-yourself home repair, gardening), whole-body vibration, nursing tasks, heavy physical work, and working with ones trunk in a bent and/or twisted position and LBP was conflicting. We found no studies, thus no evidence, for an association between sleeping or sporting on a professional level and LBP.


Assuntos
Dor Lombar/fisiopatologia , Doenças Profissionais/fisiopatologia , Coluna Vertebral/fisiopatologia , Estudos de Coortes , Exercício Físico/fisiologia , Humanos , Dor Lombar/etiologia , Doenças Profissionais/complicações , Postura/fisiologia , Estudos Prospectivos , Medição de Risco , Fatores de Risco
17.
Man Ther ; 14(1): 68-74, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18165146

RESUMO

The medical costs associated with low back pain (LBP) potentially pose an enormous economic burden to society. Prevention (secondary) might be beneficial when there is no definitive conclusion on the most appropriate intervention. For this purpose, individual advice focusing on modification of spinal mechanical load obtained with the 24 Hour Schedule-24HS-(an instrument for quantifying spinal mechanical load) in addition to standard care of guideline-recommendations might be effective. Naturally, this should be examined in controlled studies. Considering the costs involved carrying out a controlled study, the feasibility of 24HS-advice should be assessed first. We performed two surveys in primary care setting in 97 patients with acute (<6 weeks) non-specific LBP (who received a 24HS assessment and 24HS-advice at baseline), and 18 physiotherapists (all involved in 24HS baseline assessments). Patients and physiotherapists were first contacted by telephone after 6 months by a research assistant and requested to complete a questionnaire developed to assess feasibility. During this interview patients again completed a follow-up 24HS assessment. Eighty-eight patients and 17 physiotherapists participated in the follow-up. The median score of patients' questionnaire was 7 (interquartile range 5.9-8.3) and of physiotherapists' questionnaire 8 (interquartile range 7-8.5). Both questionnaires exceeded the criteria for feasibility, which we had previously set at seven or higher (out of 10). Subsequently, 24HS-advice was considered feasible for use in primary care healthcare providers and patients with LBP. In patients, the absence of LBP during the follow-up period and in physiotherapists 'lack of time' were identified as factors that could potentially threaten the feasibility in 24HS-advice.


Assuntos
Dor Lombar/diagnóstico , Dor Lombar/terapia , Manipulação da Coluna/métodos , Adulto , Estudos de Coortes , Estudos de Viabilidade , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Exame Físico/métodos , Modalidades de Fisioterapia , Atenção Primária à Saúde/métodos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
18.
Eur Spine J ; 16(7): 933-41, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17429701

RESUMO

Prospective inception cohort. To assess the prognostic value of spinal mechanical load, assessed with the 24-hour schedule (24HS), in subjects with acute non-specific low back pain (ALBP) and to examine the influence of spinal mechanical load on the course of ALBP. In view of the characteristics of the natural course of ALBP, this should be viewed as a persistent condition in many patients rather that a benign self-limiting disease. Therefore, secondary prevention could be beneficial. Spinal mechanical load is a risk factor for ALBP and possibly a (modifiable) prognostic factor for persistent (i.e. recurrent and/or chronic) LBP. One hundred patients from primary care with ALBP were eligible for inclusion. At 6 months, 88 subjects completed the follow-up. For the follow-up assessment a research assistant, unaware of our interest in the prognostic factors, contacted the subjects by telephone. Questionnaires were completed focusing on changes in demographic data and on the course and current status of ALBP. Persistent LBP occurred in 60% subjects. After multivariate regression analysis smoking (harmful) and advanced age (protective) were associated with persistent LBP. Differences in 24HS scores at baseline and follow-up were univariate-related to persistent LBP. Spinal mechanical load, quantified with the 24HS, is not a prognostic factor for persistent LBP. Modification of spinal mechanical load in terms of 24HS scores could be beneficial for secondary prevention in patients with acute LBP.


Assuntos
Dor Lombar/prevenção & controle , Dor Lombar/fisiopatologia , Coluna Vertebral/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Coortes , Feminino , Humanos , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Postura , Prognóstico , Recidiva , Fumar , Inquéritos e Questionários
19.
Eur Spine J ; 16(1): 107-13, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16649030

RESUMO

A case-control study was conducted to assess the daily loading of the spine as a risk factor for acute non-specific low back pain (acute LBP). Acute LBP is a benign, self-limiting disease, with a recovery rate of 80-90% within 6 weeks irrespective of the treatment type. Unfortunately, recurrence rates are high. Therefore, prevention of acute LBP could be beneficial. The 24-Hour Schedule (24HS) is a questionnaire developed to quantify physical spinal loading, which is regarded as a potential and modifiable risk factor for acute and recurrent low back pain. A total of 100 cases with acute LBP and 100 controls from a primary care setting were included. Cases and controls completed questionnaires regarding acute LBP status and potential risk factors. Trained examiners blinded to subjects' disease status (acute LBP or not) assessed spinal loading using the 24HS. The mean difference of 24HS sum-scores between groups was statistically significant (P < 0.0001). After multivariate regression analysis, previous episode(s), the 24HS and the Nottingham Health Profile were associated with the presence of acute LBP. High 24HS scores, indicating longer and more intensive spinal loading in flexed position, are strongly associated with acute LBP.


Assuntos
Remoção/efeitos adversos , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Coluna Vertebral/fisiopatologia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Postura/fisiologia , Fatores de Risco , Suporte de Carga/fisiologia
20.
Phys Ther ; 83(7): 608-16, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12837122

RESUMO

BACKGROUND AND PURPOSE: Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. SUBJECTS AND METHODS: Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. RESULTS: Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. DISCUSSION AND CONCLUSION: Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.


Assuntos
Manipulação Quiroprática/métodos , Cotovelo de Tenista/terapia , Adulto , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento , Terapia por Ultrassom , Punho
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