Non-invasive Complementary Therapies in Managing Musculoskeletal Pains and in Preventing Surgery.

BACKGROUND: Musculoskeletal disorders are disabling diseases which affect work performance, thereby affecting the quality of life of individuals. Pharmacological and surgical management are the most recommended treatments. However, non-invasive physical therapies are said to be effective, for which the evidence is limited. AIM/PURPOSE: To study the effect of non-invasive physical interventions in preventing surgery among patients recommended for surgery for musculoskeletal complaints, who attended sports and fitness medicine centres in India. SETTINGS: SPARRC (Sports Performance Assessment Research Rehabilitation Counselling) Institute) is a physical therapy centre with 13 branches spread all over India. This Institute practices a combination of manual therapies to treat musculoskeletal complaints. RESEARCH DESIGN: Descriptive cohort study involving the review of case records of the patients enrolled from June 2013 to July 2017, followed by the telephone survey of the patients who have completed treatment. INTERVENTION: Combination of physical therapies such as myofascial trigger release with icing, infra-red therapy, pulsed electromagnetic field therapy, stretch release, aqua therapy, taping, and acupuncture were employed to reduce the pain and regain functionalities. MAIN OUTCOME MEASURES: Self-reported pains were measured using visual analogue scale at different levels of therapy-preand post-therapy and post-rehabilitation. RESULTS: In total, 909 patients were studied, of whom 152 (17%) patients completed the treatment protocol. Majority of patients presented with knee and low-back pain. The reduction in pain due to the treatment protocol in terms of mean VAS score from baseline to post-therapy and baseline to post-rehabilitation was statistically significant (p value = .00). Among those contacted post-rehabilitation, 82 patients remained without surgery, and the median surgery-free time was around two years. CONCLUSION: Thus the study concluded that non-invasive physical therapies may prevent or postpone surgeries for musculoskeletal complaints.

Completion Rates and Clinical Changes of Patients Seeking Non-Invasive Treatment for Low Back Pain in 13 Centres of a Sports Medicine Institute in India.

BACKGROUND/AIM: Low back pain (LBP) is the major cause of disability worldwide. The existing treatments are expensive and associated with complications. The present study aimed to determine the proportion of patients completing therapy and rehabilitation phases and describe the changes in self-reported symptoms and functional disability among LBP patients enrolled in a private sports medicine institute. METHODS: This is a cohort study involving review of case records. We studied 2 phases out of 3 of non-invasive treatment of LBP: therapy of around 10 days (myofascial trigger point release therapy, cryotherapy, aqua therapy and acupuncture) and rehabilitation of around 3 weeks (muscle strengthening exercises). RESULTS: A total of 443 patients were enrolled; their mean (SD) age was 46 (15) years, 46% were male, and 193 (44%) presented with chronic (>6 months) pain. The numbers of patients who completed the therapy and rehabilitation phases were 327 (74%) and 115 (26%), respectively. The median (IQR) visual analogue scale pain scores were 7 (6-9) at entry, 2 (1-3) at completion of therapy and 1 (0-2) at completion of rehabilitation (p < 0.001). The median (IQR) functional disability scores were 32 (22-53) at entry, 15 (6-26) at completion of therapy and 4 (0-14) at completion of rehabilitation (p < 0.001). CONCLUSION: Low completion rates were observed. Patients who completed therapy reported reduction in pain and improved functionalities.

Halving Time of BCR-ABL1 in Chronic Myeloid Leukemia: Is It Better Than Day-90 Value-A Multicenter Study From South India.

BACKGROUND: The 90-day BCR-ABL1 (breakpoint cluster region-Abelson 1) level has been one of the accepted milestones for predicting the molecular response in patients with chronic myeloid leukemia (CML). The rate of decline in BCR-ABL1 has been considered a better predictor of the response but has not been uniformly accepted. A paucity of evidence is available to predict the accuracy of the rate of decline in the Indian context. Therefore, we tested the accuracy of the rate of decline of BCR-ABL1 in predicting the molecular response compared with the single 90-day values in a retrospective cohort study of selected cancer centers in south India. METHODS AND MATERIALS: Patients with chronic-phase CML diagnosed from January 2013 to December 2018, the serial BCR-ABL1 levels were estimated at 0, 45, and 90 days, 6 months, and 1 year. Data on patient demographics, risk stratification assessed using the Sokal and EUTOS (European Treatment and Outcome Study) scores were extracted using a mobile-based data capture tool from the medical records of the enrolled patients. The halving time, determined by log reduction, was compared with the 90-day BCR-ABL1 values using the receiver operating characteristic curve for the major and complete molecular response at 6 months and 1 year as standards. Accuracy was determined from the area under the curve. The cutoff for the halving time was chosen to balance the sensitivity and specificity. RESULTS: The rate of decline had more predictive accuracy compared with the 90-day BCR-ABL1 values (area under the curve for rate of decline, 0.83; 90-day, 0.80). A halving time of < 20 days identified 95% of the patients who had achieved major molecular response at 12 months compared with 80% using the single 90-day BCR-ABL1 response. CONCLUSIONS: The halving time of BCR-ABL1 appears promising as a predictor of the outcomes for patients with CML.