The Efficiency of Rehabilitation Therapy in Patients Diagnosed with Neurogenic Bladder: A Systematic Review.

Considerable research efforts have been directed towards investigating neurogenic bladder dysfunction over the preceding decade. This condition stands as the most prevalent and incapacitating pelvic floor disorder amidst patients afflicted with specific upper motor neuron syndromes, including multiple sclerosis, stroke, and spinal cord injury. The current study aims to bring up-to-date findings on rehabilitation methods for treating neurogenic bladder. The Web of Science database (MEDLINE, PsychINFO, EMBASE, CENTRAL, ISRCTN, and ICTRP) was screened for randomized controlled studies and clinical studies using combinations of keywords including "neurogenic bladder", "stroke", "multiple sclerosis", and "spinal cord injury". The PEDro scale was used to assess the quality of the articles included in this study. After a thorough examination, eleven articles met the criteria for inclusion in our research. The outcome measures showed a variety of forms of electrostimulation that can be combined with or without PFMT. These interventions significantly enhance health-related quality of life, as evidenced by various assessment methods. The physical approach constitutes an effective therapeutic method that can reduce the severity of urinary incontinence.

Efficacy of electrophysical agents in fibromyalgia: A systematic review and network meta-analysis.

OBJECTIVE: To examine the effectiveness of electrophysical agents in fibromyalgia. DATA SOURCES: CINAHL, Cochrane Library, Embase, Medline, PEDro, and Web of Science were searched from their inceptions to March 27, 2023. METHODS: This study was registered in PROSPERO (CRD42022354326). Methodological quality of included trials was assessed using PEDro scale, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. The primary outcomes were pain, functional status, and mood. RESULTS: Fifty-four studies involving 3045 patients with fibromyalgia were eligible for qualitative synthesis and 47 (pain), 31 (functional status), and 26 (mood) for network meta-analysis. The network consistency model revealed that, when compared with true control, transcutaneous electrical nerve stimulation and microcurrent improved pain symptoms (P = 0.006 and P = 0.037, respectively); repetitive transcranial magnetic stimulation improved patient functional status (P = 0.018); and microcurrent (P = 0.001), repetitive transcranial magnetic stimulation (P = 0.022), and no treatment (P = 0.038) significantly improved mood after intervention. Surface under the cumulative ranking indicated that microcurrent was most likely to be the best for managing pain and mood (surface under the cumulative ranking: 70% and 100%, respectively); low-level laser therapy for pain and mood (80% and 70%, respectively); and repetitive transcranial magnetic stimulation for improving functional status and mood (80% and 70%, respectively). CONCLUSION: This review found low to moderate quality evidence that microcurrent, laser therapy, and repetitive transcranial magnetic stimulation are the most effective electrophysical agents for improving at least one outcome in fibromyalgia.

Photobiomodulation promotes neural regeneration when compared to simvastatin treatment in a sciatic nerve crush model.

To determine whether the effects of photobiomodulation (PBM) were associated with the use of Simvastatin in the functional recovery from sciatic nerve in mice submitted to crush injury. Fifty Swiss mice (approximately 3 months old; average weight 40 g) were randomly divided into six groups: naive, sham, control, PBM (660 nm, 10 J/cm2; 30 mW; 0.6 J per day for 28 days; 0.06 cm2; 16.8 J total and 20 s), Simvastatin (20 mg/kg), and PBM/Simv (association of the two protocols). The sciatic functional index (SFI), thermal heat hyperalgesia, mechanical hyperalgesia, and thermographic evaluation were used as analyses. The evaluations were performed preoperatively and 7, 14, 21, and 28 days after the initial injury analyzed by two-way analysis of variance (ANOVA) for mixed models followed by the Bonferroni post-test. All groups except sham and naive presented an SFI compatible with severe peripheral nerve injury on the 7th day of evaluation. The PBM group presented better results in the SFI analysis (p < 0.001) on the 21st postoperative day compared to the control group. This benefit was maintained when compared to the Simvastatin (p < 0.001) and PBM/Simv groups (p < 0.01). The results of the thermal and mechanical hyperalgesia and thermography analyses were not significant (p > 0.05). The obtained results showed that PBM alone was more effective compared to Simvastatin alone or PBM combined with Simvastatin for sciatic nerve injury in mice.

Thermophysiological responses to capacitive resistive monopolar radiofrequency electromagnetic radiation in patients with osteoarthritis of the knee joint: A randomised controlled experimental study.

This study investigated the effect of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) on the superficial and deep physiological responses of patients with osteoarthritis (OA) of the knee(s). Forty-five patients diagnosed with OA in their knee(s) were enrolled into a three-group randomised controlled study, from the waiting list of a local hospital. They received localized treatment with either CRMRF, CRMRF placebo or a control (no treatment) to the knee for 15 minutes. Pre, post, and 20 min follow-up measurements of skin temperature (SKT) and skin blood flow (SBF) were obtained from the knee using the FlexComp Infiniti (SA7550) physiological measurement system. Pre and post-treatment deep blood flow were recorded using Doppler ultrasound. Core temperature, blood pressure (BP) and pulse rate (PR) were concurrently monitored. Group data were compared using the ANOVA model. Statistical significance was set at p ≤ 0.05, 0.8 power, and 95% CI. Significant increases and sustenance of SKT and SBF, and significant increases in volume and intensity of deep blood flow were demonstrated with CRMRF over the placebo and control interventions in all comparisons (p< .001). No meaningful changes in blood flow velocity, core temperature, BP, or PR were noted for any condition. The findings were markedly more pronounced than those previously reported in asymptomatic adults. However, the patients had received a higher average dose of CRMRF (mean (SD): 46.87 (4.08) W) compared to the asymptomatic sample (mean (SD): 42.37 (4.64) W); therefore, further research is needed to better understand the differences in physiological responses between patients and asymptomatic people.

Changes in availability and usage of electrophysical agents by physical therapists: a 5†year longitudinal follow-up study.

[Purpose] There have been concerns that the availability and usage of electrophysical agents have decreased, based on data from cross-sectional surveys. The aim of this study was to conduct the first five-year follow-up longitudinal survey to determine the changes in the availability and usage of electrophysical agents in Nagano Prefecture, Japan. [Participants and Methods] This longitudinal observational study employed the same postal questionnaire survey of practicing clinicians in 2014 and 2019. A total of 22 modalities had been selected for inclusion in the questionnaire based on what is used in clinical facilities and hospitals. [Results] The response rate was 71% and 63% for 2014 and 2019, respectively. The modalities that were high in availability and usage for both 2014 and 2019 were hot packs, ultrasound, cryotherapy and low frequency. While most modalities demonstrated a decreased trend in usage, electrical stimulation devices increased from 2014 to 2019. The results also demonstrated that usage was affected by gender (males greater than females), years of experience (older greater than younger), qualifications (diplomas greater than degrees), and confidence (confident greater than non-confident). [Conclusion] Our results may assist educators with designing educational curricula that is consistent with the needs of clinicians.

Monopolar dielectric diathermy by emission of radiofrequency in Patellofemoral pain. A single-blind-randomized clinical trial.

Despite the high incidence of patellofemoral pain syndrome (PFPS), few studies show the effects of radiofrequency on pain and functionality in these patients. For this reason, the aim of this study was to determine the efficacy of monopolar dielectric diathermy by emission of radiofrequency (MDR) in dynamic applications aimed at treating pain and improving function in patients with PFPS. For this purpose, a single-blind randomized clinical trial was conducted. Eighty-four participants with PFPS were evenly divided into an experimental group (EG) and a control group (CG). All subjects receive 10 min of daily home exercises along 3 weeks, and in addition, the subjects of the EG received 10 sessions based on the dynamic application of MDR. Variables measured included Visual Analogue Scale (VAS), DN4 questionnaire, Lower Extremity Functionality Scale (LEFS), Kujala scale, Range of Movement (ROM) in knee flexion and extension and drug intake. The EG showed a statistically significant reduction in pain (VAS = 4.8 [5.5-4.1] [p < .001]; DN4 = 3.8 [4.4-3.2] [p < .001]), and an increase in functionality (LEFS = 16 [19-13] [p < .001]; Kujala = 19 [23-14] [p < .001]) and in ROM (flexion 18º [21º-16º] [p < .001]). No statistically significant changes in drug intake were found. Based on this data, the dynamic application of MDR seems effective in reducing pain and increasing functionality and flexion in patients with PFPS. Diathermy by emission of radiofrequency could be recommended as complement or main therapy in the treatment of PFPS.

Acute effects of capacitive and resistive electric transfer (CRet) on the Achilles tendon.

This study aimed to investigate the acute effects of capacitive and resistive electric transfer (CRet) on Achilles tendon elongation during muscle contraction, as well as the circulation in the peritendinous region. Sixteen healthy men participated in this study. All 16 participants underwent 2 interventions: (1) CRet trial and (2) CRet without power (sham trial). Tendon elongation was measured four times. Using near-infrared spectroscopy, the blood circulation (volume of total-hemoglobin (Hb), oxygenated hemoglobin (oxy-Hb), and deoxygenated hemoglobin (deoxy-Hb)) was measured for 5 min before the intervention and for 30 min after the intervention. The differences between the measurements obtained before and after intervention were compared between the two interventions. The changes in tendon elongation and deoxy-Hb were not significantly different between the interventions. Total- and oxy-Hb were significantly increased in the CRet trial compared with the sham trial. In addition, the increases in total-Hb and oxy-Hb lasted for 30 min after the CRet intervention (CRet vs. sham: oxy-Hb: F = 8.063, p = 0.001, total-Hb: F = 4.564, p = 0.011). In conclusion, CRet significantly improved blood circulation in the peritendinous region.

Skin thermophysiological effects of 448 kHz capacitive resistive monopolar radiofrequency in healthy adults: A randomised crossover study and comparison with pulsed shortwave therapy.

Radiofrequency-based electrophysical agents (EPA) have been used in therapy practice over several decades (e.g., shortwave therapies). Currently, there is insufficient evidence supporting such devices operating below shortwave frequencies. This laboratory-based study investigated the skin physiological effects of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) and compared them to pulsed shortwave therapy (PSWT). In a randomised crossover study, seventeen healthy volunteers received four treatment conditions - High, Low and Placebo dose conditions receiving 15-min CRMRF treatment and a Control condition receiving no intervention. Fifteen participants also received high dose PSWT for comparison. Treatment was applied to the right lower medial thigh. Pre, post and 20-min follow-up measurements of skin temperature (SKT), skin blood flow (SBF) and nerve conduction velocity (NCV) were obtained using Biopac MP150 system. Group data were compared using the ANOVA model. Statistical significance was set at p ≤ 0.05 (0.8P, 95%CI). Significant increase and sustenance of SKT with both high and low dose CRMRF was demonstrated over the other groups (p < 0.001). PSWT increased SKT significantly (p < 0.001) but failed to sustain it over the follow-up. However, among the five conditions, only high dose CRMRF significantly increased and sustained SBF (p < 0.001). Overall, the CRMRF physiological responses were significantly more pronounced than that of PSWT. No significant changes in NCV were noted for any condition. Physiological changes associated with CRMRF were more pronounced when compared to PSWT, placebo or control. Any potential stronger therapeutic benefits of CRMRF need to be confirmed by comparative clinical studies.

Thermal build-up, decay and retention responses to local therapeutic application of 448 kHz capacitive resistive monopolar radiofrequency: A prospective randomised crossover study in healthy adults.

PURPOSE: Radiofrequency-based electrophysical agents are widely used in therapy-related clinical practice for their thermal effects, mainly relieving pain and inflammation and improving tissue extensibility. The most commonly used and researched are shortwave therapies that operate at 27.12 MHz. Although relatively new, electrophysical agents employing much lower frequencies have also emerged. Capacitive resistive monopolar radiofrequency employing 448 kHz is one such therapy. This laboratory-based study was aimed to investigate the skin thermal responses to 448 kHz radiofrequency-based therapy in healthy adults. METHODS: In a two-group randomised crossover study, 15 volunteers attended two modes (capacitive and resistive) of 448 kHz radiofrequency-based therapy (using 'Indiba Activ 902') administered locally to the lower thigh region. Starting at minimum, the intensity was increased incrementally until thermal discomfort was felt. Participants reported three time points: thermal onset, definite thermal sensation, and onset of thermal discomfort. Local skin temperature was measured before, immediately post-treatment and up to 45 min post-treatment. RESULTS: Both capacitive and resistive modes of therapy significantly increased the skin temperature and sustained it over the 45-min follow-up. There was statistically significant difference between the thermal response patterns produced by the two modes. Peak post-treatment temperatures attained were not significantly different between the two; however, the retention rate at follow-up was significantly higher for the resistive mode. CONCLUSIONS: This study confirms that radiofrequency-based therapy at 448 kHz can significantly increase and sustain skin temperature. The study also provides useful baseline data for further research in the low frequency ranges of radiofrequency-based therapy that remain largely unexplored.

Physiotherapy Efficiency in Post-stroke Upper Extremity Spasticity: TENS vs. Ultrasound vs. Paraffin.

BACKGROUND/AIM: Post-stroke spasticity is a significant debilitating condition with negative consequences on individual functional independence and quality of life. This study aimed to identify the differences between transcutaneous electrical stimulation (TENS), ultrasound therapy and paraffin procedures on post-stroke upper extremity spasticity and dexterity. PATIENTS AND METHODS: Twenty-six patients were enrolled in the study, divided into three therapy groups: TENS (n=9), paraffin (n=10) and ultrasound therapy (n=7). For 10 days, the patients received specific group therapy and conventional physical therapy exercises for upper extremities. Modified Ashworth Scale, Functional Independence Measure, Functional Coefficient, Stroke Specific Quality of Life Scale, Activities of Daily Living score and ABILHAND questionnaire were used to assess the participants before and after therapy. RESULTS: The results of the group comparisons by analysis of variance showed no significant difference between outcomes by the applied treatments. In contrast, one-way analysis of variance suggested significant improvements in patients in all three groups after therapy. Step-wise regression results on functional independence measure and quality-of-life scales suggested that functional range of motion values for elbow and wrist influence individual independence and quality of life. CONCLUSION: TENS, ultrasound, and paraffin therapy bring equal benefits in the management of post-stroke spasticity.