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1.
J Altern Complement Med ; 26(1): 44-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31580695

RESUMO

Background: Chronic neck pain (NP) attributed to myofascial pain syndrome is one of the particularly common skeletal muscle disorder associated with the hyperirritable zone in the taut band of muscle. Trigger points (TPs) are the physical interpretation of the myofascial pain syndrome. In the United States, 30%-85% of pain patients have been affected by myofascial TPs. Objectives: To reveal preliminary evidence on the clinical efficacy of ischemic compression therapy, dry cupping, and their combination on improving the TPs' pressure pain threshold (PPT), neck range of motion (NROM), and neck disability index (NDI) in patients with TPs and nonspecific NP. Besides, assess the feasibility of conducting a randomized clinical trial (RCT). Design: A randomized pilot study was conducted on 24 patients with TPs and nonspecific NP. Patients were randomly assigned to three groups: the cupping group, the ischemic compression group, and the combination therapy group. PPT, NROM, and NDI were assessed before and after 4 weeks of treatment. Results: The results showed a statistically significant improvement in NDI, PPT, and NROM compared with values before the treatment (p < 0.05) in all groups. Although no significant difference was detected between ischemic compression (IC) and dry cupping, the combination approach showed significantly higher and faster improvement (p < 0.05). Conclusions: It is feasible to conduct a main RCT. Both IC and dry cupping may hold promise in treating TPs; a combination of the two therapies may provide superior improving rate.


Assuntos
Manipulações Musculoesqueléticas , Dor Musculoesquelética , Modalidades de Fisioterapia , Pontos-Gatilho/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/reabilitação , Dor Musculoesquelética/terapia , Projetos Piloto
2.
Br J Sports Med ; 54(2): 79-86, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30826805

RESUMO

OBJECTIVES: To identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs). DESIGN: Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations. ELIGIBILITY CRITERIA: Included MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment. DATA SOURCES: Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. RESULTS: 6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work. CONCLUSION: These 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.


Assuntos
Dor Musculoesquelética/terapia , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Humanos , Qualidade da Assistência à Saúde
3.
Chiropr Man Therap ; 27: 59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827767

RESUMO

Background: In children, spinal pain is transitory for most, but up to 20% experience recurrent and bothersome complaints. It is generally acknowledged that interventions may be more effective for subgroups of those affected with low back pain. In this secondary analysis of data from a randomized clinical trial, we tested whether five indicators of a potential increased need for treatment might act as effect modifiers for manipulative therapy in the treatment of spinal pain in children. We hypothesized that the most severely affected children would benefit more from manipulative therapy. Method: This study was a secondary analysis of data from a randomised controlled trial comparing advice, exercises and soft tissue treatment with and without the addition of manipulative therapy in 238 Danish school children aged 9-15 years complaining of spinal pain. A text message system (SMS) and clinical examinations were used for data collection (February 2012 to April 2014).Five pre-specified potential effect modifiers were explored: Number of weeks with spinal pain 6 months prior to inclusion, number of weeks with co-occurring musculoskeletal pain 6 months prior to inclusion, expectations of the clinical course, pain intensity, and quality of life.Outcomes were number of recurrences of spinal pain, number of weeks with pain, length of episodes, global perceived effect, and change in pain intensity. To explore potential effect modification, various types of regression models were used depending on the type of outcome, including interaction tests. Results: We found that children with long duration of spinal pain or co-occurring musculoskeletal pain prior to inclusion as well as low quality of life at baseline tended to benefit from manipulative therapy over non-manipulative therapy, whereas the opposite was seen for children reporting high intensity of pain. However, most results were statistically insignificant. Conclusions: This secondary analysis indicates that children more effected by certain baseline characteristics, but not pain intensity, have a greater chance to benefit from treatment that include manipulative therapy. However, these analyses were both secondary and underpowered, and therefore merely exploratory. The results underline the need for a careful choice of inclusion criteria in future investigations of manipulative therapy in children. Trial registration: NCT01504698; results.


Assuntos
Dor nas Costas/terapia , Manipulação da Coluna , Dor Musculoesquelética/terapia , Adolescente , Criança , Terapia por Exercício , Feminino , Humanos , Masculino , Qualidade de Vida , Retorno ao Trabalho
4.
Undersea Hyperb Med ; 46(5): 647-654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683363

RESUMO

Introduction: The effects of hyperbaric oxygen (HBO2) therapy on sprains, ligament injuries, and muscle strains have been reported in several animal studies. In a dog model of compartment syndrome and in a rat contused skeletal muscle injury model, the significant effects of HBO2 therapy on the reduction of edema and muscle necrosis have been reported. In basic research HBO2 therapy stimulated fibroblast activity to improve the healing process. Because of this it expected that HBO2 therapy might improve focal edema and pain in the acute phase and accelerate the healing of injured tissues in athletes with a medial collateral ligament (MCL) injury of the knee. This study aimed to examine the short-term effects of HBO2 application subjectively, and the long-term effects of HBO2 therapy in Japanese professional or semi-professional rugby players with grade 2 MCL injury of the knee. Methods: Thirty-two professional or semi-professional rugby players with grade 2 MCL injury of the knee were investigated. First, in the HBO2 group (n=16), HBO2 therapy was performed during the acute phase. Visual analog scales (VASs) immediately before and after HBO2 therapy on the same day were compared. Next, we retrospectively evaluated the time to return to play in the HBO2 (n=16) and non-HBO2 (n=16) groups. Results: VAS scores for pain while walking immediately before and after HBO2 therapy on the same day were 37.4 ± 20.1 (mean ± standard deviation) and 32.4 ± 21.8, respectively (p⟨0.001). The VAS scores for pain while jogging were 50.7 ± 25.6 and 43.9 ± 25.0, respectively (p⟨0.001). The time to return to play was 31.4 ± 12.2 days in the HBO2 group and 42.1 ± 15.8 days in the non-HBO2 group, indicating a significant difference between the groups (p⟨0.05). Conclusion: HBO2 therapy may reduce pain and accelerate the return to play in athletes with grade 2 MCL injury of the knee in this non-randomized study.


Assuntos
Futebol Americano/lesões , Oxigenação Hiperbárica , Ligamento Colateral Médio do Joelho/lesões , Dor Musculoesquelética/terapia , Volta ao Esporte , Cicatrização/fisiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Humanos , Japão , Corrida Moderada , Instabilidade Articular/classificação , Masculino , Dor Musculoesquelética/reabilitação , Medição da Dor/métodos , Caminhada , Adulto Jovem
5.
Medicine (Baltimore) ; 98(45): e17926, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702675

RESUMO

BACKGROUND: This systematic review protocol aims to provide the methods used to evaluate the effectiveness of acupotomy therapy for treating soft tissue disorder comparing to local steroid injection. METHODS: Fifteen databases will be searched from inception to Dec 2019. We will include randomized controlled trials (RCTs) assessing acupotomy for soft tissue disorder. All RCTs on acupotomy or related interventions will be included. Study inclusion, data extraction and quality assessment will be performed independently by two reviewers. Assessment of risk of bias and data synthesis will be performed using RevMan 5.3 software. Cochrane criteria for risk-of-bias will be used to assess the methodological quality of the trials. RESULTS: This study will provide a high-quality synthesis of pain visual analog scale and functional disability or the quality of life, the success treatment rate, the recurrent rate, and the complications rate to assess the effectiveness and safety of acupotomy for soft tissue disorder patients compare to local steroid injection. CONCLUSION: This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with soft tissue disorder. PROSPERO REGISTRATION NUMBER: CRD42018109080.


Assuntos
Terapia por Acupuntura , Dor Musculoesquelética/terapia , Lesões dos Tecidos Moles/terapia , Humanos , Injeções , Esteroides/administração & dosagem , Revisão Sistemática como Assunto
6.
Unfallchirurg ; 122(11): 834-839, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31690985

RESUMO

A small proportion of patients with exertional leg pain (ELP) have deep posterior chronic exertional compartment syndrome (dp-CECS). These individuals report pain, tightness and cramps deep in the calf muscles that are elicited by exercise, but may also be present during rest to a lesser extent. Physical examination often reveals painful palpation of the flexor muscles in the area immediately dorsomedial to the tibial bone. Diagnosis is confirmed by intracompartmental pressure testing. Various entities may mimic or coincide with dp-CECS, including medial tibial stress syndrome (MTSS) and popliteal artery entrapment syndrome (PAES). Fasciotomy of multiple flexor muscles is the only treatment that achieves a beneficial outcome. The aim of this overview is to discuss the diagnosis and management of dp-CECS.


Assuntos
Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Músculo Esquelético/cirurgia , Dor Musculoesquelética/etiologia , Doença Crônica , Síndromes Compartimentais/etiologia , Exercício , Fasciotomia , Humanos , Perna (Membro) , Dor Musculoesquelética/terapia
7.
Pain Res Manag ; 2019: 4867904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565109

RESUMO

Local bone denervation by magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool for alleviation of pain in patients with painful bone metastasis (BM). Considering the underlying mechanism of pain alleviation, MRgFUS might be effective for various bone and joint diseases associated with local tenderness. This study was conducted to clarify the therapeutic effect of focused ultrasound in patients with various painful bone and joint diseases that are associated with local tenderness. Ten patients with BM, 11 patients with lumbar facet joint osteoarthritis (L-OA), and 19 patients with knee osteoarthritis (K-OA) were included. MRgFUS treatment was applied to the bone surface with real-time temperature monitoring at the target sites. Pain intensity was assessed using a 100 mm numerical rating scale (NRS) at various time points. Pressure pain threshold (PPT) was evaluated on the sonication area and control sites. Compared to baseline, the pain NRS scores significantly decreased in all groups 1 month after treatment, and PPT at the treated sites significantly increased in all groups 3 months after treatment. The percentage of patients who showed a ≥ 50% decrease in pain NRS scores at 1 month after treatment was 80% in BM, 64% in L-OA, and 78% in K-OA groups. PPTs were significantly higher after treatment at all evaluation time points. This study indicated that MRgFUS is effective in reducing pressure pain at the site of most severe tenderness in patients with painful bone and joint diseases. Treatment response was comparable between patients with BM, L-OA, and K-OA.


Assuntos
Dor do Câncer/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/terapia , Osteoartrite da Coluna Vertebral/terapia , Idoso , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite da Coluna Vertebral/complicações
8.
Unfallchirurg ; 122(11): 840-847, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31628498

RESUMO

Exercise-induced leg pain (ELP) and tightness may be caused by a chronic exertional compartment syndrome (CECS). Although CECS can develop in any muscle compartment, most individuals suffer from an anterior tibial muscle CECS (ant-CECS). Typically, a patient with ant-CECS experiences discomfort toward the end of sports activity or in the hours thereafter. Physical examination may reveal tenderness upon palpation of the anterior tibial muscle belly. The gold standard diagnostic tool is a dynamic intracompartmental pressure (ICP) measurement demonstrating elevated muscle tissue pressures. Duplex analysis and imaging may be indicated for exclusion of concomitant entities such as entrapment of the popliteal artery or nerves. Conservative treatments including modification of the patient's running technique can be successful. A fasciotomy must be considered in recalcitrant cases. Residual or recurrent disease may necessitate partial removal of the fascia. The aim of this overview is to discuss the management of CECS in the anterolateral portion of the leg.


Assuntos
Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Dor Musculoesquelética/etiologia , Doença Crônica , Síndromes Compartimentais/etiologia , Fasciotomia , Humanos , Perna (Membro) , Músculo Esquelético/cirurgia , Dor Musculoesquelética/terapia
9.
Medicina (Kaunas) ; 55(8)2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31409027

RESUMO

Background: Deep friction massage (DFM) is a widely used technique by physical therapists worldwide for chronic pain management. According to Dr. James Cyriax, compliance with the proposed guidelines is vital to obtain the desired therapeutic results. Objectives: This study explored the beliefs and attitudes of Cypriot physical therapists to DFM and their compliance with the suggested guidelines to identify any empirical-based application patterns and compare them to the suggestions of Cyriax. In addition, the prevalence of DFM use in clinical practice in Cyprus was investigated. Methods: Questionnaires, consisting of 18 multiple choice questions and a table of six sub-questions, were distributed to 90 local physical therapists. Results: A total of 70% of respondents declared that they perform DFM in their daily practice. The respondents answered 11 out of the 19 technical questions in compliance with the guidelines. Conclusion: The study revealed the DFM application pattern of Cypriot physical therapists. The compliance percentage of this pattern to Cyriax guidelines was 58% in general and 62.5% for patients with chronic conditions.


Assuntos
Dor Crônica/terapia , Fricção , Conhecimentos, Atitudes e Prática em Saúde , Massagem , Dor Musculoesquelética/terapia , Fisioterapeutas , Chipre , Humanos , Inquéritos e Questionários
10.
BMC Musculoskelet Disord ; 20(1): 375, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421668

RESUMO

BACKGROUND: Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting symptoms. In order to identify predictors for treatment success and pain in lateral epicondylitis, we used data from a randomized controlled trial. This trial investigated the efficacy of physiotherapy alone or combined with corticosteroid injection for acute lateral epicondylitis in general practice. METHODS: The outcomes treatment success and pain score on VAS were assessed at 6, 12, 26 and 52 weeks. We ran a univariate binary logistic regression with generalized estimating equations (GEE) and subsequently an adjusted multilevel logistic regression to analyze the association between potential prognostic indicators and the outcome success/ no success. To assess the changes in pain score we used a two-level multilevel linear regression (MLR) followed by an adjusted MLR model with random effects. RESULTS: The most consistent predictor for reduced treatment success at all time points was a high Pain Free Function Index score signifying more pain on everyday activities. Being on paid sick-leave and having a recurring complaint increased short term treatment success but gave decreased long-term treatment success. The patients reporting symptoms after engaging in probable overuse in an unusual activity, tended towards increased treatment success at all time-points, but significant only at 12 weeks. The most consistent predictor of increased pain at all time points was a higher overall complaints score at baseline. CONCLUSIONS: Our results suggest that in treating acute lateral epicondylitis, a consideration of baseline pain, a registration of the patient's overall complaint on a VAS scale and an assessment of the patient's perceived performance in everyday activities with the Pain Free Function Index can be useful in identifying patients that will have a more protracted and serious condition. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00826462 . Date of registration January 22, 2009. The Trial was prospectively registrated.


Assuntos
Glucocorticoides/administração & dosagem , Dor Musculoesquelética/diagnóstico , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Adulto , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Medição da Dor , Modalidades de Fisioterapia , Prognóstico , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento , Triancinolona/administração & dosagem
11.
BMC Musculoskelet Disord ; 20(1): 378, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421688

RESUMO

BACKGROUND: Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain. METHODS: A systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). RESULTS: A total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, - 0.86 to - 0.26) and foot orthoses (SMD -0.91; 95% CI, - 1.69 to - 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, - 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, - 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, - 1.31 to - 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings. CONCLUSIONS: Based on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is not more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence. REGISTRATION: PROSPERO registration number CRD42016053216 .


Assuntos
Fasciíte Plantar/terapia , Glucocorticoides/administração & dosagem , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Transfusão de Sangue Autóloga , Fasciíte Plantar/complicações , Fasciíte Plantar/fisiopatologia , Órtoses do Pé , Calcanhar/fisiopatologia , Humanos , Injeções Intralesionais , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Placebos/administração & dosagem , Plasma Rico em Plaquetas , Recuperação de Função Fisiológica , Resultado do Tratamento
12.
BMC Musculoskelet Disord ; 20(1): 351, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366332

RESUMO

BACKGROUND: In the treatment of Lateral Epicondylitis (LE) no single intervention concerning injection therapies has been proven to be the most effective with regard to pain reduction. In this trial 3 injection therapies (perforation with application of autologous blood, perforation with application of dextrose and perforation only) will be compared in a standardized and ultrasound guided way. The objective is to assess the effectiveness of these 3 injection therapies on pain, quality of life and functional recovery. By conducting this study, we hope to make a statement on the effectiveness of injection therapy in the treatment of LE. Hereby, unnecessary treatments can be avoided, a more universal method of treatment can be established and the quality of the treatment can be improved. METHODS/DESIGN: A multicenter, randomized controlled trial with a superiority design and 12 months follow-up will be conducted in four Dutch hospitals. One hundred sixty five patients will be recruited in the age of 18 to 65 years, with chronic symptomatic lateral epicondylitis lasting longer than 6 weeks, which have concordant pain during physical examination. Patients will be randomized by block randomization to one of the three treatment arms. The treatment will be blinded for patients and outcome assessors. The following three injection therapies are compared: perforation with application of autologous blood, perforation with application of dextrose and perforation only. Injections will be performed ultrasound guided in a standardized and automated way. The primary endpoint is: pain (change in 'Visual Analogue Scale'). Secondary endpoints are quality of life and functional recovery. These measurements are collected at baseline, 8 weeks, 5 months and 1 year after treatment. DISCUSSION: When completed, this trial will provide evidence on the effectiveness of injection therapy in the treatment of lateral epicondylitis on pain, quality of life and functional recovery. In current literature proper comparison of the effectiveness of injectables for LE is questionable, due to the lack of standardization of the treatment. This study will overcome bias due to manually performed injection therapy. TRIAL REGISTRATION: This study is registered in the Trial Register ( www.trialregister.nl ) of the Dutch Cochrane centre. Trial ID; NTR4569. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4569.


Assuntos
Transfusão de Sangue Autóloga/métodos , Glucose/administração & dosagem , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Adolescente , Adulto , Idoso , Estudos de Equivalência como Asunto , Feminino , Humanos , Injeções/instrumentação , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Cotovelo de Tenista/complicações , Cotovelo de Tenista/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto Jovem
13.
Mayo Clin Proc ; 94(8): 1475-1487, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31279543

RESUMO

OBJECTIVE: To synthesize the evidence regarding the effect of spinal stimulation (SS) vs medical therapy (MT) and the effect of newer SS technologies vs conventional SS on pain reduction in patients with intractable spine or limb pain. METHODS: A comprehensive literature search was conducted by a reference librarian. The literature search encompassed January 1, 1995 - December 31, 2017. Reviewers worked independently to select and appraise trials. Random-effect meta-analysis and frequentist indirect comparison methods were used to compare the three interventions. Results were expressed as odds ratio (OR) or weighted mean difference (WMD) with 95% CIs. RESULTS: We identified 12 trials enrolling 980 patients. Compared with MT, SS significantly increased the odds of reducing pain by 50% or more in three trials (OR, 13.01; 95% CI, 4.96-34.17) and significantly reduced pain as measured by visual analogue scale scores in three trials (WMD, 1.43 scale points; 95% CI, 0.16-2.71). Using the common comparator of MT, newer stimulation technology (eg, high-frequency 10 kilohertz spinal stimulation, Burst, dorsal root ganglion) was associated with increased odds of pain relief compared with conventional SS (OR, 2.07; 95% CI, 1.35-3.19). CONCLUSIONS: In patients with intractable spine/limb pain, SS was associated with better pain reduction than MT. New stimulation technology was likely associated with better pain reduction than conventional stimulation.


Assuntos
Dor nas Costas/terapia , Tratamento Conservador/métodos , Terapia por Estimulação Elétrica/métodos , Dor Musculoesquelética/terapia , Medição da Dor , Dor Intratável/terapia , Dor nas Costas/diagnóstico , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Dor Musculoesquelética/diagnóstico , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Phys Ther ; 99(10): 1304-1325, 2019 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-31343702

RESUMO

BACKGROUND: Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation. PURPOSE: The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation. DATA SOURCES: Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done. STUDY SELECTION: Two reviewers screened studies for eligibility first by title and abstract and then full text. DATA EXTRACTION: Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain. DATA SYNTHESIS: Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n = 116; standardized mean difference = -0.21; 95% confidence interval = -0.58 to 0.15). LIMITATIONS: Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included. CONCLUSION: The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Dor Musculoesquelética/terapia , Ortopedia , Reabilitação , Realidade Virtual , Humanos
15.
Chiropr Man Therap ; 27: 45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31338157

RESUMO

Background: Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review aimed to synthesize published literature exploring the nature, models, and outcomes of chiropractic services provided to active duty military globally. Method: We employed scoping review methodology. Systematic searches of relevant databases, including military collections and hand searches were conducted from inception to October 22, 2018. We included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. Paired reviewers independently reviewed all citations and articles using a two-phase screening process. Data from relevant articles were extracted into evidence tables and sorted by study type. Results were descriptively analyzed. Results: We screened 497 articles and 20 met inclusion criteria. Chiropractic services were commonly provided on-base only in the US. Services were accessed by physician referral and commonly after initiation or non-response to other care. Use of scope of practice was determined by the system/facility, varying from intervention specific to comprehensive services. Back pain with and without radiculopathy accounted for most complaints. Treatment outcomes were reported primarily by case reports. However, two recent randomized trials reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain. Specific reaction time measures in special operation forces military did not improve after chiropractic care compared to wait-list control. Conclusions: Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military. Yet despite reported benefits in Australia, Canada, and the US, there is a need for further qualitative, descriptive, and clinical trial data worldwide to inform the role of chiropractic services in active duty military.


Assuntos
Manipulação Quiroprática , Militares/estatística & dados numéricos , Dor Musculoesquelética/terapia , Quiroprática , Humanos
16.
Bull Cancer ; 106(12): 1073-1079, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31358289

RESUMO

BACKGROUND: Complementary and Alternative Medicines (CAM) are increasingly used in the therapeutic arsenal, particularly for pain management. Foot reflexology (FR) is still poorly evaluated, specifically in the pediatric population. The aim of this study was to evaluate the effectiveness of FR sessions in children experiencing chronic or persistent pain. METHODS: We conducted a prospective study in two pediatric centers from January 2011 to January 2014. Sessions of FR were offered to children regardless of their age, experiencing persistent pain (>72h) or chronic pain (>3 months). A form was completed by the patient before and after each FR sessions. The effectiveness of the session was evaluated using a Visual Analogue Scale (VAS) for both pain and anxiety. RESULTS: One hundred and twenty-two patients suffering from persistent pain were included. We observed a significant decrease of mean VAS pain scores after each session (respectively P<0.001, P<0.001 and P=0.015) and of mean VAS anxiety scores (P<0.001) for all sessions). Seventy patients suffering from chronic pain were included. Decrease in VAS pain scores was statistically significant after each reflexology session for children suffering from headache and musculoskeletal pain (P<0.001). Anxiety was significantly lower after each session (P<0.001). CONCLUSION: In 192 pediatric patients, FR significantly reduce pain and anxiety in children suffering from persistent or chronic pain. This CAM could have a place in pain management in children but needs to be evaluated in larger cohorts.


Assuntos
Dor Crônica/terapia , , Manipulações Musculoesqueléticas/métodos , Adolescente , Ansiedade/terapia , Criança , Pré-Escolar , Dor Crônica/psicologia , Estudos de Viabilidade , Feminino , Cefaleia/psicologia , Cefaleia/terapia , Humanos , Lactente , Masculino , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/terapia , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
17.
BMC Musculoskelet Disord ; 20(1): 337, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31325954

RESUMO

BACKGROUND: The objectives of this study were to estimate the population prevalence and distribution of plantar heel pain in mid-to-older age groups, examine associations with selected health status and lifestyle factors, and report the frequency of healthcare use. METHODS: Adults aged ≥50 years registered with four general practices were mailed a health survey (n = 5109 responders). Plantar heel pain in the last month was defined by self-reported shading on a foot manikin, and was defined as disabling if at least one of the function items of the Manchester Foot Pain and Disability Index were also reported. Population prevalence estimates and associations between plantar heel pain and demographic characteristics, health status measures and lifestyle factors were estimated using multiple imputation and weighted logistic regression. Healthcare professional consultation was summarised as the 12-month period prevalence of foot pain-related consultation. RESULTS: The population prevalence of plantar heel pain was 9.6% (95% CI: 8.8, 10.5) and 7.9% (7.1, 8.7) for disabling plantar heel pain. Occurrence was slightly higher in females, comparable across age-groups, and significantly higher in those with intermediate/routine and manual occupations. Plantar heel pain was associated with physical and mental impairment, more anxiety and depression, being overweight, a low previous use of high-heeled footwear, and lower levels of physical activity and participation. The 12-month period prevalence of foot pain-related consultation with a general practitioner, physiotherapist or podiatrist/chiropodist was 43.0, 15.1 and 32.8%, respectively. CONCLUSIONS: Plantar heel pain is a common, disabling symptom among adults aged 50 years and over. Observed patterns of association indicate that in addition to focused foot-specific management, primary care interventions should also target more general physical and psychological factors that could potentially act as barriers to treatment adherence and recovery.


Assuntos
Calcanhar , Dor Musculoesquelética/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Feminino , Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/terapia , Cooperação do Paciente/psicologia , Prevalência , Estudos Prospectivos , Fatores Socioeconômicos , Reino Unido/epidemiologia
18.
J Foot Ankle Res ; 12: 36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312257

RESUMO

Background: Multimorbidity is prevalent and adversely affects health outcomes. Foot pain is common and one of the primary reasons for utilisation of podiatry services. At present, little is known about the impact of multimorbidity on foot health and related outcomes following podiatric intervention. The aims of this study were to evaluate whether there is a difference in foot health outcomes following exposure to podiatric foot care for people with and without multimorbidity; and ii) to evaluate whether the presence or absence of multimorbidity affects patients' perceptions of change in foot pain. Methods: The PROMFoot study is a prospective cohort study of adults with a new episode of foot pain attending the podiatry service within the NHS Greater Glasgow and Clyde health board. Baseline medical comorbidity status (no condition, single condition, multiple conditions), longitudinal data on foot health measured using the Foot Health Status Questionnaire (FHSQ), and patient rating of change scores for foot pain were obtained from the PROMFoot study at baseline, and 3 and 6 months after podiatric intervention. Foot health scores (pain, function, footwear and general foot health) and perceptions of change for foot pain were compared between comorbidity groups. Results: A total of 115 participants (59% female) with a mean age of 55 years were included. Multimorbidity was common, affecting 61 participants (53%); while 28 (24.3%) and 26 (22.6%) reported single or no medical comorbidities respectively. Significantly worse foot health scores for all FHSQ domains were observed for the multimorbidity group at baseline, 3 and 6 months. Change scores for foot pain were similar between groups and demonstrate modest improvements, however multimorbidity group membership was strongly associated with a perceptions of change in foot pain. Multimorbidity was independently associated with poorer foot function outcomes at 3 months, and poorer foot pain and foot function outcomes at 6 months. Conclusions: Multimorbidity was associated with poor foot health outcomes and lower rates of self-perceived improvement in foot pain over 6 months following podiatric intervention in a sample of patients attending podiatric biomechanics clinics for a new episode of foot pain.


Assuntos
Doenças do Pé/epidemiologia , Doenças do Pé/terapia , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/terapia , Podiatria/estatística & dados numéricos , Adulto , Feminino , Pé/patologia , Doenças do Pé/patologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Dor Musculoesquelética/patologia , Estudos Prospectivos
19.
Arch Orthop Trauma Surg ; 139(10): 1399-1405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203381

RESUMO

INTRODUCTION: The use of evaporative coolants in the management of acute musculoskeletal injury has received increasing attention recently. However, its efficacy compared with conventional cryotherapy in treating injured human subjects remains unclear. The purpose of this study is to compare the efficacy of evaporative coolants with that of ice packs in preoperative management of edema and pain in patients with an ankle fracture. MATERIAL AND METHODS: Sixty-three patients in need of surgical treatment for ankle fracture were randomly assigned to either an evaporative coolant group or an ice pack group. Both treatments were applied for 5 days after injury and outcomes were measured daily. The primary outcome was a reduction in edema as measured by the figure-of-eight-20 method and the secondary outcome was measured by visual analog scale (VAS) for pain. RESULTS: Two-way analysis of variance with repeated measures showed no significant group effect and no significant group-by-time interaction in terms of reduction of edema and VAS score for pain between two groups. No adverse effects were reported in either group. CONCLUSION: Evaporative coolants exhibited comparable efficacy to ice packs in preoperative cryotherapy of ankle fractures without adverse effects. While evaporative coolants are more expensive than ice packs, they can present a viable option for cryotherapy. LEVEL OF EVIDENCE: Level I, prospective randomized study.


Assuntos
Fraturas do Tornozelo/terapia , Crioterapia/métodos , Edema/terapia , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Cuidados Pré-Operatórios/métodos , Adolescente , Adulto , Idoso , Análise de Variância , Fraturas do Tornozelo/complicações , Bandagens , Feminino , Humanos , Gelo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
20.
J Rehabil Med ; 51(8): 587-597, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31198975

RESUMO

OBJECTIVE: Patient enablement reflects patient's understanding of and coping with illness. The aim of this study was to investigate the content validity, construct validity, internal consistency and self-rated change (SRC) of the Patient Enablement Instrument (PEI) in patients with whiplash-associated disorders, cervical radiculopathy and mixed chronic pain treated in different settings. DESIGN: Psychometric analyses. PARTICIPANTS: Patients with disabling non-malignant chronic musculoskeletal pain. METHODS: Participants answered questionnaires on disability (Neck Disability Index (NDI) or Functional Rating Index (FRI)), anxiety/depression (Hospital Anxiety and Depression Scale; HADS) and general health (EuroQol; EQ-5D). Content validity, construct validity (confirmatory factor analysis), internal consistency and cut-off for SRC were investigated for the PEI after treatment. The SRC value was the receiver operating characteristic (ROC) curve optimal cut-off point. RESULTS: After treatment all items were completed by 516 patients (mean standard deviation (SD) age 45.1 years (SD 10.1), women 75% (n = 385)). The 1-factor PEI model had approximate fit to the data. The internal consistency Cronbach's alpha was between 0.878 and 0.929 for the 3 groups. Correlations between the PEI and the NDI/FRI, HADS and EQ-5D were fair to good. The SRCROC for whiplash-associated disorders, cervical radiculopathy and mixed chronic pain groups was 5, 6 and 4 points in the PEI, respectively. CONCLUSION: The PEI showed fair content validity, construct validity and internal consistency. However, the scale needs further development to improve measurement of change.


Assuntos
Dor Musculoesquelética/terapia , Psicometria/métodos , Dor Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
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