Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain

Midterm results of chronic anterior instability of the sternoclavicular joint managed using a standardized treatment algorithm

AIMS

There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery.

METHODS

Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.

RESULTS

A total of 47 patients (50 SCJs, three bilateral) responded for 75% return rate. Of these, 31 SCJs were treated with physiotherapy and 19 with surgery. Overall, 96% (48/50) achieved a stable SCJ, with 60% (30/50) achieving unrestricted function. In terms of outcomes, 82% (41/50) recorded good-to-excellent OSIS scores (84% (26/31) physiotherapy, 79% (15/19) surgery), and 76% (38/50) reported low pain VAS scores at final follow-up. Complications of the total surgical cohort included a 19% (5/27) revision rate, 11% (3/27) frozen shoulder, and 4% (1/27) scar sensitivity.

CONCLUSION

This is the largest midterm series reporting chronic anterior SCJ instability outcomes when managed according to a standardized treatment algorithm that emphasizes the importance of appropriate patient selection for either physiotherapy or surgery, based on a history of trauma. All but two patients achieved a stable SCJ, with stability maintained at a median of 70 months (11 to 116) for the physiotherapy group and 87 months (6 to 144) for the surgery group.Cite this article: Bone Jt Open 2022;3(10):815-825.

Ultrasound-guided dry needling versus traditional dry needling for patients with knee osteoarthritis: A double-blind randomized controlled trial

Objective

To compare the effect of ultrasound (US)-guided dry needling (DN) with traditional DN in the treatment of pain and dysfunction for patients with knee osteoarthritis (KOA).

Design

A double-blind, randomized controlled trial.

Methods

Patients (25 male and 65 female), age 50–80 years diagnosed with KOA were recruited and randomly assigned to one of three groups in a 1:1:1 ratio for intervention: real US-guided DN with exercise therapy (G1), placebo US-guided DN with exercise therapy (G2), and exercise therapy solely (G3). G1 and G2 were blinded to the application of real or placebo US guidance by turning the monitor of US imaging out-of-view from participants’ vantage points. The effectiveness of blinding was evaluated by asking the participants whether they had received real-US guided DN. The responses were assessed by Chi-square test. Visual Analogue Scale (VAS), Knee injury, and Osteoarthritis Outcome Score (KOOS) subscales (KOOS-pain, KOOS-symptoms, KOOS-quality-of-life (QoL)) were collected at baseline, 4 weeks, and 8 weeks by a blinded assessor. Data were analyzed by mixed model analysis of variance (ANOVA) with Bonferroni correction.

Results

Eighty-four participants (61.26±5.57 years) completed the study. G1 achieved significant improvement in VAS at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = -15.61, 95% CI [-25.49, -5.51], p = 0.001; G1 vs. G3: MD = -19.90, 95% CI [-29.71, -10.08], p< 0.001). G1 achieved significant improvement in KOOS-pain at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = 9.76, 95% CI [2.38, 17.14], p = 0.006; G1 vs. G3: MD = 9.48, 95% CI [2.31, 16.66], p = 0.010). KOOS-symptoms and KOOS-QoL were not statistically significant between groups. G2 had no significant difference of the perceptions as G1 with p = 0.128. G2 were successfully blinded to placebo US-guided DN.

Conclusion

US-guided DN with exercise therapy may be more effective than traditional DN with exercise therapy or exercise therapy alone in reduce pain of KOA.

Comparison of the effects of ultrasound- guided needle puncture, radial shock wave therapy, and combined treatments on calcific tendinitis of the shoulder: A single-blind randomized controlled trial

BACKGROUND

Calcific tendinitis of the shoulder is a common disorder resulting in restricted motion and pain.

OBJECTIVE

This study compared the effects of ultrasound-guided fine-needle puncture (USNP), radial shock wave therapy (RSWT), and the combination of both treatments (COMB) on calcific tendinitis of the shoulder.

METHODS

We enrolled 62 patients who had unilateral shoulder pain for more than 3 months. The patients were randomly divided into three groups: USNP, RSWT, and COMB. All USNP needle punctures were guided with ultrasound (US), and RSWT was delivered at 2 Hz (2000 shock waves; 0.26 mJ/mm2) once a week for 3 weeks. The COMB group received three weekly rounds of RSWT after a single US-guided needle puncture. The primary outcome was the pain visual analog scale (VAS), and secondary outcomes were the Constant scores, 36-Item Short-Form Health Survey, and range of motion.

RESULTS

A within-group comparison at 3 months revealed significant improvements in the pain VAS (p< 0.05, during activity) and Constant (p< 0.05) scores, but between-group comparisons revealed no statistically significant differences in the pain VAS (p> 0.05) or Constant (p= 0.089) scores. Only improvement differences in role-emotional (SF-36; p= 0.01) and active external rotation (p= 0.035) were determined over time, which favored the USNP and COMB groups.

CONCLUSIONS

Although no significant differences were observed among the groups in the treatment of calcific tendinitis of the shoulder, more satisfactory outcomes were noted in the USNP and COMB groups than in the RSWT group. Larger samples, longer follow-up times, and other treatment protocols are suggested for future studies.

Impact of different types of anaesthesia for cesarean delivery on subacute low back pain intensity and disability: A retrospective cohort

Background. Low back pain (LBP) is common after cesarean delivery. So, this study was conducted to assess and compare the intensity of subacute LBP and disability among women who underwent cesarean delivery with different anaesthetic types. Methodology. This retrospective cohort study was conducted to 38 women “26 of them underwent cesarean delivery, assessed after 6 to 12 weeks from delivery, they were classified into: [epidural anaesthetic group (Group A) n = 6, spinal anaesthetic group (Group B) n = 13, general anaesthetic group (Group C) n = 7], they were either primiparous or multiparous who did not receive anaesthesia for at least one year prior to the last delivery, the other 12 women were the control group (Group D) who didn’t experience pregnancy or anaesthesia”. Results. The mean values of visual analogue scale (VAS) in Group A, Group B, Group C, and Group D were 5.00 ± 1.67, 4.62 ± 1.12, 5.14 ± 1.21, and 2.17 ± 0.71, respectively. The ANOVA test revealed a significant difference in VAS (P = 0.0001; P < 0.05) among the four groups. while the post-hoc test revealed non-significant differences (P = 1.000; P > 0.05) between the three anaesthetic groups. Also, the mean values of Oswestry Disability Index (ODI) in the same four groups were 26.00 ± 16.68, 27.00 ± 11.72, 30.00 ± 6.87, and 25.00 ± 9.33, respectively. The ANOVA test revealed non-significant difference in ODI (P = 0.838; P < 0.05) among the four groups. Conclusion. Epidural, spinal and general anaesthesia for cesarean delivery are associated with increased intensity of subacute LBP, but without significant differences between these anaesthetic types. However, they do not increase the disability.

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial

Background

Fibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM.

Objective

To evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM.

Methods

This two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann−Whitney were used to compare variables between groups.

Results

After intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention.

Conclusion

An anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy.

Clinical Trial Registration

[https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].

Patient's satisfaction in physiotherapy outpatient departments of Amhara regional comprehensive specialized hospitals, Ethiopia

Background

Satisfaction is basically the state of being gratified and act of fulfilling one's need or desires. Nowadays, evidence-based practice concept is prevailing and there has been a growing interest in the measurement of patient satisfaction in healthcare research. Patient satisfaction surveys provide several benefits for healthcare professionals. Assessing patient’s satisfaction with physiotherapy service could generate knowledge that can utilized for improving or maintaining quality service. Although a wide coverage and high emphasis givens to patient satisfaction studies in developed counties, there are few research’s done in Africa. This study aimed to assess satisfaction in physiotherapy service and identify predictors that affect satisfaction among patient treated in physiotherapy outpatient department.

Objectives

To assess satisfaction in physiotherapy service and identify associated factors among patients in physiotherapy outpatient department in Amhara regional state comprehensive specialized hospitals.

Method

Institution based cross-sectional study was conducted among physiotherapy outpatients from April to June 2021, at three selected Comprehensive specialized hospitals. Data were collected by interviewing participants using semi-structured questionnaire. Patient satisfaction was determined by using Medrisk tool. Data were analyzed by using descriptive statistics and bivariate and multivariable logistic regression method were used to identify predictor factors.

Result

A total of 409 participants with a response rate of 95% were included in this study. The overall satisfaction among physiotherapy outpatient attendee was 50.1% with 95% CI (46.2–55.7). Pain level (AOR = 5.59 95%CI (2.58–12.1), longitudinal continuity of care (AOR = 3.02 95%CI (1.46–6.62) and self-rated health improvement (AOR = 3.76, 95% CI (1.78–7.94) were significantly associated factors.

Conclusion

The overall satisfaction in this study were found to be low in Amhara regional state comprehensive specialized hospitals. pain level, self-rated health improvement and longitudinal continuity of care were significantly associated factors.

Gluteus Medius Repair using a Gluteus Maximus Flap Augmented with Synthetic Polyethylene Mesh: Surgical Technique and Case Series

Introduction

Gluteus medius tendon tears may not be feasible for direct repair when significant retraction or fatty degeneration is present. Several augmentation techniques have been reported for challenging cases. We describe a novel technique using a transfer of the anterior portion of the gluteus maximus combined with synthetic mesh to reinforce the direct suture of the gluteus medius. The goal of this study was to assess the functional and pain outcomes in three patients treated with this reconstruction technique.

Case presentation

A retrospective study was performed including 3 patients with complete and retracted ruptures of the abductor mechanism. When conservative management failed, surgical treatment was attempted. After a minimum follow-up of 12 months (mean follow-up of 18 months), all of the patients showed clinical improvement.The mean Harris Hip Score improved from 31.8 to 75.6, with an average postoperative abduction strength of 3 in the Medical Research Council muscle strength grading system, and no residual limp was noticed. The mean Visual Analogue Scale pain score decreased from 8.3 preoperatively to 1.6 postoperatively. No complications were reported.

Conclusion

In conclusion, this technique demonstrates efficacy in terms of improving clinical symptoms and functional status and is a reproducible way to augment irreparable gluteus medius tears.

Influence of adding strain-counterstrain to standard therapy on axioscapular muscles amplitude and fatigue in mechanical neck pain: a single-blind, randomized trial

BACKGROUND

Strain-counterstrain technique (SCS) or positional release therapy is strongly recommended for patients with mechanical neck pain (MNP) because this method has excellent benefits, but the clinical significance of this method is unclear.

AIM

The aim of this study was to investigate the influence of adding the SCS technique to standard therapy on pain, pressure pain threshold, disability according to Neck Disability Index (NDI), and electrophysiological characteristics (amplitude and fatigue) of the upper part of trapezius in the axioscapular muscles of patients with mechanical neck pain.

DESIGN

Single-blind, randomized clinical trial.

SETTING

Outpatient clinic.

POPULATION

Sixty patients (19-38 years old) with mechanical neck pain participated in this study and were recruited from the outpatient clinic at the faculty of physical therapy after a referral from an orthopedist.

METHODS

Patients were randomly assigned by opaque sealed envelope to two treatment groups: group A received SCS, standard therapy in form of active range of motion, stretching exercises, and postural correction exercises (PCES), whereas group B, received standard therapy only; therapeutic sessions were performed three times/week for 4 weeks. The visual analogue scale, pressure pain threshold, NDI, upper trapezius median frequency, and root mean square were used to evaluate the patients' pretreatment and post-treatment status.

RESULTS

Multiple pairwise comparisons within each group revealed statistically significant differences in all outcome variables with favor to the SCS group.

CONCLUSIONS

The Strain-counterstrain technique combined with traditional standard therapy is an effective method more than traditional standard therapy alone for the management of patients with MNP.

CLINICAL REHABILITATION IMPACT

The present study has implications, especially for clinical decision-making about therapy of choice in MNP to reduce pain, improve function as measured through SCS technique and its impact on normal lifestyle, and to highlight the need for active intervention.

The comparison of the effectiveness of Kinesio Taping and dry needling in the treatment of lateral epicondylitis: a clinical and ultrasonographic study

BACKGROUND

The aim of this study was to investigate the short- and long-term effects of Kinesio Taping (KT) and dry needling (DN) applications on pain, functionality, and muscle strength in patients with lateral epicondylitis by use of questionnaires and ultrasonography.

METHODS

Seventy-eight patients were randomized into 3 groups. Each group followed a program that consisted of 9 treatment sessions in total, with 3 sessions per week for 3 weeks. Group 1 received KT and performed exercise, group 2 received DN and performed exercise, and group 3 performed exercise alone. Pain, functional status, grip strength, and the thickness and echogenicity of the common extensor tendon were evaluated before treatment, after treatment (at the end of the third week), and after 6 months.

RESULTS

In intragroup evaluations, KT and DN were found to be effective in the short and long term in terms of pain, functional status, muscle strength, and tendon thickness (P < .01). In intergroup evaluations, improvement in the KT and DN groups was superior to that in the control group for all parameters (P < .05). On comparison of the KT and DN groups, improvements in the clinical parameters and tendon thickness, heterogeneity, and elastography were significantly better in the DN group in the short and long term (P < .05).

CONCLUSIONS

The ultrasonographic outcomes in our study objectively demonstrated that although DN in general is superior in the treatment of lateral epicondylitis, KT treatment is also effective.

Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis

CONTEXT

To determine optimal treatment strategies for shoulder impingement syndrome (SIS).

OBJECTIVE

To compare subacromial nonsteroidal anti-inflammatory injections (SNIs) and subacromial corticosteroid injections (SCIs) on pain relief and functional improvement in individuals with SIS. Second, to perform a cost analysis of the 2 injections.

DATA SOURCES

MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials using several keywords.

STUDY SELECTION

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized, and 10 studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 scale and the Cochrane Collaboration tool.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Baseline and follow-up scores of the visual analog, Constant-Murley, and University of California Los Angeles shoulder scales were extracted to calculate effect sizes (ESs), represented as Cohen d. Metaregression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines.

RESULTS

A total of 7 high and 3 good quality studies were included, with a mean score of 21.1. Only 1 study had a high risk of bias. The meta-analyses produced pooled ESs of 0.05 (P = 0.83), 0.12 (P = 0.71), and 0.07 (P = 0.79) for each scale, respectively, with CIs crossing 0. Procedural costs were equal between groups, whereas ketorolac was the least costly medication ($0.47). There was no significant difference in side effects between the 2 injections.

CONCLUSION

SNIs are as effective as SCIs for short-term pain relief and improving function in patients with subacromial impingement syndrome. In addition, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with SIS.

Prevalence of pain in adult patients with moderate to severe haemophilia: a systematic review

OBJECTIVES

Patients with haemophilia (PwH) often suffer from joint pain due to repetitive haemarthroses and resulting arthropathy. Literature focuses so far on pain causes, diagnosis or treatment. A summary of prevalence rates, providing facts on the absolute occurrence of pain, is not sufficiently described so far. This review aimed to explore and systematically review different pain conditions, focussing on prevalence rates of pain in adult PwH.

METHODS

A review of English articles using PubMed and Web of Science was conducted in February 2020. The search strategy included patients with haemophilia A or B suffering from pain. The articles were selected based on defined PICOS-selection criteria.

RESULTS

Out of 606 identified articles, 13 studies matched the given eligibility criteria and indicated pain prevalence rates. The weighted mean (WM) for the prevalence rate (varying timeframes) for chronic pain was 40% whereas for point prevalence the rate was WM=75%. Regarding pain intensity, findings of the EQ-5D-3L revealed moderate pain to be more present (61.0%) compared to extreme (11.6%). The main problem was the inconsistency of the definition of both acute and chronic pain as well as for prevalence types.

CONCLUSIONS

Pain is a major problem in patients with haemophilia. Pain therapy should be carried out taking into account the difference between bleeding-related or arthropathy-related causes of pain. In addition, the intensity and duration of pain should be recorded consistently to better monitor therapy and allow comparison with existing data.

Effectiveness of Ultrasonography Visual Biofeedback of the Diaphragm in Conjunction with Inspiratory Muscle Training on Muscle Thickness, Respiratory Pressures, Pain, Disability, Quality of Life and Pulmonary Function in Athletes with Non-Specific Low Back Pain: A Randomized Clinical Trial

Diaphragmatic weakness and thickness reduction have been detected in athletes with lumbopelvic pain (LPP). Strength training of inspiratory muscles may be necessary for athletes with LPP. Inspiratory muscle training (IMT) and visual biofeedback by rehabilitative ultrasound imaging (RUSI) have been proposed as possible interventions. Here, we determine the effectiveness of visual biofeedback by RUSI with a proposed novel thoracic orthotic device to facilitate diaphragmatic contraction in conjunction with high-intensity IMT in athletes with non-specific LPP. A single-blinded, parallel-group, randomized clinical trial was performed (NCT04097873). Of 86 participants assessed for eligibility, 64 athletes with non-specific LPP (39 males and 25 females; mean age, 33.15 ± 7.79 years) were recruited, randomized, analyzed and received diaphragm visual biofeedback by RUSI in conjunction with high-intensity IMT (RUSI+IMT; n = 32) or isolated high-intensity IMT (IMT; n = 32) interventions for 8 weeks. Diaphragmatic thickness during normal breathing, maximum respiratory pressures, pain intensity, pressure pain threshold on lumbar musculature, disability by the Roland−Morris questionnaire, quality of life by the SF-12 questionnaire and spirometry respiratory parameters were assessed at baseline and after the 8-week intervention. There were significant differences (p = 0.015), within a medium effect size (Cohen’s d = 0.62) for the forced expiratory volume in 1-s (FEV1), which was increased in the RUSI+IMT intervention group relative to the IMT alone group. Adverse effects were not observed. The rest of the outcomes did not show significant differences (p > 0.05). Diaphragm visual biofeedback by RUSI with the proposed novel thoracic orthotic device in conjunction with high-intensity IMT improved lung function by increasing FEV1 in athletes with non-specific LPP.

The Efficacy of Vitamin D Supplementation in the Treatment of Fibromyalgia Syndrome and Chronic Musculoskeletal Pain

Fibromyalgia syndrome (FMS) and chronic widespread musculoskeletal pain (CMP) are diffuse suffering syndromes that interfere with normal activities. Controversy exists over the role of vitamin D in the treatment of these diseases. We carried out a systematic literature review of randomized controlled trials (RCT) to establish whether vitamin D (25OHD) deficiency is more prevalent in CMP patients and to assess the effects of vitamin D supplementation in pain management in these individuals. We searched PubMed, Physiotherapy Evidence Database (PEDro), and the Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs published in English from 1 January 1990 to 10 July 2022. A total of 434 studies were accessed, of which 14 satisfied the eligibility criteria. In our review three studies, of which two had the best-quality evidence, a correlation between diffuse muscle pain and 25OHD deficiency was confirmed. Six studies, of which four had the best-quality evidence, demonstrated that appropriate supplementation may have beneficial effects in patients with established blood 25OHD deficiency. Eight studies, of which six had the best-quality evidence, demonstrated that 25OHD supplementation results in pain reduction. Our results suggest a possible role of vitamin D supplementation in alleviating the pain associated with FMS and CMP, especially in vitamin D-deficient individuals.

Sling suspension therapy is an effective treatment method of juvenile spinal osteochondrosis in adolescent girls

BACKGROUND

Juvenile spinal osteochondrosis (JSO) affects vertebral endplates and may cause intervertebral discs alterations. The condition is typically related to pain, and weakness and shortening of trunk muscles. Sling suspension therapy (SST) has been shown to reduce lumbar pain effectively. It is, however, unclear whether SST is superior to other treatment methods in reducing pain, correcting posture, and activating trunk stabilizers in JSO.

OBJECTIVE

In this study, we intended to compare the effectiveness of two different exercise modalities; Sling Suspension Therapy and Gym Ball Exercise in the treatment of JSO in adolescent girls.

METHODS

A randomised controlled single centre clinical trial was carried out in an inpatient rehabilitation unit at a sanatorium. Forty adolescent girls (age 16.3 ± 0.47 yrs.), who were diagnosed with JSO (according to ICD-10 Version: 2016 - M 42.0) were randomly assigned into two groups: Group 1 - Sling suspension therapy (SST), Group 2 - Gym ball exercises (GBE). Both groups received interventions for 3 weeks, 15 sessions, and 30 minutes a day for 5 consecutive days a week. Back pain, endurance of trunk muscles and standing posture were evaluated pre- and post-interventions.

RESULTS

Both groups demonstrated significant improvement in all measured outcomes. SST was more effective in reducing pain (p< 0.05), increasing the endurance of trunk muscles (p< 0.05) and improving the standing posture (p< 0.05) compared to GBE (p< 0.05).

CONCLUSIONS

Sling suspension therapy is more effective compared with Gym ball exercises in the treatment of juvenile spinal osteochondrosis in adolescent girls in terms of back pain, posture and endurance of trunk muscles.

Comparative Efficacy of Nonoperative Treatments for Greater Trochanteric Pain Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

An evolved understanding of the pathophysiology of greater trochanteric pain syndrome has led to a number of proposed nonoperative management strategies. The objective of this review was to compare the efficacy of the various nonoperative treatments for greater trochanteric pain syndrome (GTPS).

DESIGN

Systematic review and network meta-analysis.

SETTING

PubMed, Embase, CENTRAL, SCOPUS, and Web of Science were searched to January 2020.

PATIENTS

Patients undergoing nonoperative treatment for GTPS.

INTERVENTIONS

Nonoperative treatment strategies for GTPS including injections of corticosteroids, platelet-rich plasma, hyaluronic acid, dry needling, and structured exercise programs and extracorporeal shockwave therapy.

MAIN OUTCOME MEASURES

Pain and functional outcomes. Bayesian random-effects model was performed to assess the direct and indirect comparison of all treatment options.

RESULTS

Thirteen randomized controlled trials and 1034 patients were included. For pain scores at 1 to 3 months follow-up, both platelet-rich plasma (PRP) and shockwave therapy demonstrated significantly better pain scores compared with the no treatment control group with PRP having the highest probability of being the best treatment at both 1 to 3 months and 6 to 12 months. No proposed therapies significantly outperformed the no treatment control group for pain scores at 6 to 12 months. Structured exercise had the highest probability of being the best treatment for improvements in functional outcomes and was the only treatment that significantly improved functional outcome scores compared with the no treatment arm at 1 to 3 months.

CONCLUSION

Current evidence suggests that PRP and shockwave therapy may provide short-term (1-3 months) pain relief, and structured exercise leads to short-term (1-3 months) improvements in functional outcomes.

A randomized comparative study between high-intensity laser vs low-intensity pulsed ultrasound both combined with exercises for the treatment of knee osteoarthritis

OBJECTIVE

To compare the effects of high-intensity laser therapy (HILT) plus exercise therapy (ET) vs low-intensity pulsed ultrasound (LIPUS) plus ET in knee osteoarthritis (KOA).

METHODS

A single blinded randomized controlled trial in an outpatient setting. There were 60 participants with grades II and III KOA based on the radiological findings in Kellgren and Lawrence grading scale. Participants were allocated randomly into three groups, study group I (HILT+ET), study group II (LIPUS+ET), and control (ET) group. Participants in the three groups received active range of motion (ROM) exercises, muscle strengthening, and flexibility exercises. Treatment was administered 5 times/wk for two successive weeks. Primary outcomes involved visual analog scale (VAS), secondary outcomes involved knee ROM, proprioceptive accuracy and Western Ontario and McMaster Universities Arthritis Index scale. All outcomes were measured pre- and post-treatment.

RESULTS

The mean age of participants was 55.4 ± 6.34, 55.2 ± 4.77 and 57 ± 6.39 years in HILT+ET, LIPUS+ET and control group respectively. There were statistically significant time-by-group effects (mixed-design multivariate analysis of variance) on all measured outcomes for all groups (P < .0001). However, HILT+ET yielded better improvement than the other groups (P < .0001). Between-group comparison revealed a significant difference in all measured outcomes between study group 1 vs study group 2, and between each study group vs the control group (P = .0001).

CONCLUSION

The effect of HILT combined with exercises achieved better results in pain, knee ROM, proprioceptive accuracy and functional disability than LIPUS combined with exercises and both are better than exercises only.

Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee

Background

Treatment of multisurface articular cartilage lesions of the knee is a challenging problem.

Hypothesis

Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function.

Study Design

Cohort study; Level of evidence, 3.

Methods

Patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. The study included patients who received OCA transplantation for multisurface unipolar defects in 1 knee and had minimum 2-year follow-up data, including patient-reported outcome measures, failures, reoperations, and complications. The OCA transplants had been stored using 2 methods: standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS). Preoperative data were compared with outcomes at 1 year and final follow-up, and risk factors for revision surgery or failure (total knee arthroplasty) were analyzed.

Results

The sample included 25 patients with a mean age of 37.2 years (range, 13-51 years), body mass index of 27.7 (range, 18-38), and follow-up of 45.1 months (median, 49 months; range, 24-68 months). OCAs stored using SP were transplanted into 6 patients, and those stored using MOPS were transplanted into 19 patients. The initial success rate was significantly higher for MOPS OCAs (94.7%) than SP OCAs (33.3%). There were statistically significant improvements in all patient-reported outcomes at 1 year and final follow-up in the MOPS cohort (P < .0001 for all). Revision surgery/failure was significantly associated with patients who were nonadherent to the prescribed postoperative restrictions and rehabilitation protocols (P = .038; odds ratio = 13.5) and with OCAs that had a viable chondrocyte density <70% of the established reference range mean at transplantation (P = .0037; odds ratio = 76).

Conclusion

OCA transplantation for treatment of large multisurface cartilage defects in the knee resulted in a 94.7% initial success rate when grafts with high viable chondrocyte density (≥70%) were used and when patients strictly adhered to prescribed postoperative rehabilitation protocols. Successful outcomes were associated with statistically significant improvements in patient-reported outcome measures of pain and function.

Comparing dextrose prolotherapy with other substances in knee osteoarthritis pain relief: A systematic review

The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field.

The Effects of Meditation with Stabilization Exercise in Marine Region on Pain, Tactile Sense, Muscle Characteristics and Strength, Balance, Quality of Life, and Depression in Female Family Caregivers of People with Severe Physical Disabilities: A Randomized Single-Blinded Controlled Pilot Study

Female caregivers of people with disabilities are burdened physically and mentally. To improve these symptoms, an intervention that is easy to apply and has fewer side effects, such as natural healing, has been proposed, but the effect of healing using marine resources is unclear until now. The purpose of this study is to investigate the effect of meditation accompanied with stabilization exercise in the marine region on the improvement of pain, tactile sense, muscle characteristics, muscle strength, balance, quality of life, and depression in female caregivers of people with severe physical disabilities. Twenty-four female family caregivers were recruited and were randomly assigned to the marine therapy group (MTG, n = 12) and the control group (CG, n = 12). Both groups performed the same meditation (35 min) and stabilization exercise (25 min) twice a day for 3 nights and 4 days per session (total 8 sessions). The MTG performed these in the marine region, whereas the CG performed the interventions in the urban region. Pain (pain intensity and pain pressure threshold), tactile sense (tactile spatial acuity), muscle characteristics (stiffness, elasticity), muscle strength (hand and pinch grip strength), balance, quality of life, and depression were measured before and after the intervention and 4 weeks after the intervention. Both groups showed significant improvements in pain intensity (resting pain: f(2) = 72.719, p < 0.001; movement pain: f(2) = 24.952, p < 0.001), muscle strength (right pinch grip: f(2) = 15.265, p < 0.001), and depression (f(2) = 13.312, p < 0.001), while tactile spatial acuity (TSA) (upper part: f(2) = 14.460, p < 0.001; lower part: f(2) = 7.672, p = 0.002), dynamic balance (f(2) = 4.196, p = 0.024), and quality of life (overall quality of life & general health: f(2) = 5.443, p = 0.009; physical health: f(2) = 13.991, p < 0.001; psychological: f(2) = 9.946, p < 0.001; environmental: f(2) = 20.004, p < 0.001; total: f(2) = 11.958, p < 0.001) were significantly improved only in MTG. There was no significant change in pain pressure threshold (upper trapezius (UT): f(2) = 0.765, p = 0.473; levator scapula (LS): f(2) = 0.213, p = 0.809; splenius capitis (SC): f(2) = 0.186, p = 0.831) and muscle characteristics (UT stiffness: f(2) = 1.486, p = 0.241; UT elasticity: f(2) = 0.358, p = 0.702; LS stiffness: f(2) = 2.440, p = 0.102; LS elasticity: f(2) = 0.544, p = 0.585) in both groups. In comparison between groups, the MTG showed a significant difference in sensory function compared to the CG (resting pain: f(2) = 10.487, p = 0.005; lower part: f(2) = 5.341, p = 0.034 in TSA). Our findings suggest that meditation combined with stabilization exercise improved pain, muscle strength, and depression of female caregivers. In particular, greater benefits on tactile sense, balance, and quality of life were found in performing these in the marine region compared to the urban region.

LongHest project: A prospective, observational study of extended half-life treatment in the musculoskeletal health of patients with severe haemophilia A

Background

Prophylactic treatment is the gold standard in the treatment of patients with haemophilia. Prophylaxis with extended half‐life (EHL) treatment has shown long‐term safety and efficacy in patients with haemophilia.

Aim

To evaluate the efficacy of prophylaxis with EHL treatment in the frequency of haemarthrosis and musculoskeletal health in adult patients with severe haemophilia A.

Methods

Prospective cohort study. Forty‐six patients with severe haemophilia A were recruited. The frequency of haemarthrosis (self‐reports), joint condition (Haemophilia Joint Health Score), pain intensity (visual analogue scale), range of motion (goniometry), and strength (dynamometry) and muscle activation (surface electromyography) were evaluated. Three assessments were carried out: at baseline (T0), at 6 months (T1) and at 12 months following treatment (T2).

Results

There were significant changes in the within‐subject effect in the frequency of haemarthrosis in elbow (F(1.05;96.20) = 3.95; P < .001) and knee (F(1.73;157.99) = 9.96; P < .001). Significant within‐subject effect in elbow pain intensity (F(2;182) = 63.51; P < .001) was found. The mean values of the frequency haemarthrosis in elbow (from .66±1.01 to .04±.20) and knees (from .55±.68 to .33±.53) decrease after the period study. The intensity of elbow pain and (from 3.08±1.69 to 2.67±1.73), decrease after the 12‐month follow‐up period.

Conclusions

Prophylaxis with extended half‐life treatment reduces the frequency of haemarthrosis in elbow and knee in adult patients with haemophilia. EHL treatment reduces the intensity of elbow pain in patients with haemophilic arthropathy.

Simulated Forest Immersion Therapy: Methods Development

Shinrin-yoku, forest bathing, may provide relief from chronic and breakthrough pain in patients with axial spondyloarthritis and improve immune function through increasing NK cell numbers and activity and their downstream effectors, perforin and granulysin, after chemo- or radiation therapy in breast and prostate cancer patients. The aim of this paper is to describe the study protocol for a simulated forest immersion therapy using virtual reality and atomized phytoncides, volatile organic compounds found in forested areas designed to effect positive change for these two patient populations. The setting, including the room set up and samples with inclusion/exclusion specific to this type of intervention, is outlined. Measures and calibration procedures pertinent to determining the feasibility of simulated forest immersion therapy are presented and include: ambient and surface room temperatures and relative humidity in real time, ambient ultrafine particulate matter, ambient droplet measurement that coincides with volatile organic compounds, specific phytoncides, and virtual reality and atomization of phytoncide set up. Particular lessons learned while training and setting up the equipment are presented. Simulated forest immersion therapy is possible with attention to detail during this early phase when development of methods, equipment testing, and feasibility in deploying the intervention become operational. The expected outcome of the development of the methods for this study is the creation of a standardized approach to simulating forest therapy in a controlled laboratory space.

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses

The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in individuals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability.

Mechanical traction from different knee joint angles in patients with knee osteoarthritis: A randomized controlled trial

OBJECTIVE

To compare the effect of mechanical traction from different knee angles on pain, physical function, and range of motion in patients with knee osteoarthritis.

DESIGN

A single-blinded, randomized controlled trial.

SETTING

Outpatient public and governmental Hospital clinics.

PARTICIPANTS

One hundred and twenty patients with knee osteoarthritis were randomly assigned into 4 equal groups with 30 patients in each group.

INTERVENTIONS

Group (A) received conventional physiotherapy(CPT) treatment; group (B) received CPT with knee traction from full extension, group (C) received CPT with knee traction from 90° flexion, while group (D) received CPT with knee traction from 20° flexion. Interventions were applied 3 sessions a week for 4 weeks.

OUTCOME MEASUREMENTS

Visual analog scale (VAS), knee passive range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured at baseline, immediately after 4 weeks of intervention, and after 4 weeks of no intervention as a follow-up.

RESULTS

After eight weeks, the mean (SD) for VAS scores were 30.97 ± 8.68, 24.0 ± 8.8, 15.43 ± 6.31, and 16.17 ± 6.11 mm; for total WOMAC scores were 26.77 ± 9.19, 20.3 ± 8.52, 13.27 ± 6.25, and 13.43 ± 7.14 for groups A, B, C and D, respectively. The three traction groups showed statistically significant changes in pain scores, physical function, and total WOMAC, but not for knee passive range of motion, in favor of traction groups C and D than the conventional group (P < 0.05).

CONCLUSIONS

Traction from 90°and 20° of knee flexion was found superior to full extension knee in improving pain and physical function, but not for knee passive range of motion, in patients with knee osteoarthritis.

Effectiveness of graded motor imagery in subjects with frozen shoulder: a pilot randomized controlled trial

Background

Subjects with frozen shoulder (FS) might not be comfortable with vigorous physical therapy. Clinical trials assessing the effect of graded motor imagery (GMI) in FS are lacking. The aim of this study was to determine the effect of GMI as an adjunct to conventional physiotherapy in individuals with painful FS.

Methods

Twenty subjects aged 40–65 years having stage I and II of FS were randomly divided into two study groups. The conventional physiotherapy group (n = 10) received electrotherapy and exercises while the GMI group (n = 10) received GMI along with the conventional physiotherapy thrice a week for 3 weeks. Pre- (Session 1) and post- (Session 9) intervention analysis for flexion, abduction, and external rotation range of motion (ROM) using a universal goniometer, fear of movement using the fear avoidance belief questionnaire (FABQ), pain with the visual analogue scale, and functional disability using the shoulder pain and disability index (SPADI) was done by a blinded assessor.

Results

Statistically significant difference was seen within both the groups for all the outcomes. In terms of increasing abduction ROM as well as reducing fear of movement, pain, and functional disability, the GMI group was significantly better than control group. However, both groups were equally effective for improving flexion and external rotation ROM.

Conclusions

Addition of GMI to the conventional physiotherapy proved to be superior to conventional physiotherapy alone in terms of reducing pain, kinesiophobia, and improving shoulder function for stage I and II of FS.

Acute lateral ankle sprain alters muscle and tendon properties: Case series

BACKGROUND

Acute lateral ankle sprain (LAS) is the most prevalent acute sports trauma. Ankle muscle atrophy and tendon volume decrease have not been analyzed concomitantly with functional impairment and pain following LAS. The objective of the present study was to investigate muscle cross-section area (CSA), tendon CSA and volume, ankle function, and pain in individuals who suffered an acute LAS.

METHODS

A series of cases, cross-sectional study with 20 participants who suffered moderate (grade II) and severe (grade III) acute LAS was undertaken. CSA for muscles (Tibialis Posterior, Fibularis, and Soleus) and tendons (Tibialis Anterior, Tibialis posterior, Fibularis, and Achilles), and volume were measured by magnetic resonance imaging (MRI) less than 48 h (baseline) and 6-weeks after the acute LAS. Ankle function (Cumberland Ankle Instability Tool [CAIT] and Foot and Ankle Outcome Score [FAOS]), ankle mechanical instability (Anterior Drawer Test [ADT]), and pain were also assessed.

RESULTS

All tendons and muscles showed a significant reduction in CSA and volume between baseline and 6-weeks (P < .001). A significant decrease in ankle function was observed 6 weeks after the LAS, along with a reduction in pain and mechanical instability (P = .001). Regarding sprain magnitude, the only difference observed was greater atrophy in muscle CSA in participants with grade III ankle sprain.

CONCLUSION

Patients with acute LAS showed atrophy of ankle muscles and decreased tendon volume and CSA, followed by function impairments at 6-week follow-up.

LEVEL OF EVIDENCE

IV, Case series study.

Virtual Reality Assisted Non-Pharmacological Treatments in Chronic Pain Management: A Systematic Review and Quantitative Meta-Analysis

Virtual reality (VR) is a developing technology that has recently attracted the attention of healthcare practitioners. Recently, VR systems have been used to treat pain symptoms. The present study aims to evaluate the VR effectiveness on chronic pain management. A systematic literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were used to discover the potentially eligible studies. The primary focus of the present investigation was to evaluate the possible effect of VR-assisted treatments on chronic pain, especially in the commonly occurring low back and neck pain. Nine studies reporting randomized controlled trials were included in the present study. VR-mediated interventions demonstrated significant improvement for pain symptoms in patients experiencing chronic pain. In addition, VR-mediated therapy decreased pain intensity and disability in the case of chronic neck pain compared to control conditions. However, the VR interventions showed a statistically non-significant improvement in chronic low back pain when experimental groups were compared with controls. VR therapy positive effect on chronic pain did not differ from the one reported for other types of interventions for pain management, as physical exercise and laser therapy. Taken together, these findings showed that currently available lines of evidence on the effect of VR-mediated therapy in chronic pain management, despite pointing towards possible therapeutical benefits of the VR-based intervention, are overall inconclusive and that more research on VR-assisted therapy for chronic pain is needed.

Validation of Visual Analogue Scales of job demand and job control at the workplace: a cross-sectional study

OBJECTIVES

Work-related stress is a major concern. One of the best performing models is the Job Content Questionnaire (JCQ) of Karasek, assessing job demand and job control using 18 items. However, the JCQ is long and complex. Visual Analogue Scales (VASs) are easy to use and quick to implement. VASs have been validated to assess pain and occupational stress; however, VASs demand and control have not been evaluated. Therefore, we aimed to validate the use of VAS demand and control compared with the 18 items of the JCQ.

DESIGN

We implemented a cross-sectional observational study, by administering a self-reported questionnaire to the users of Wittyfit software, with a second test (retest) proposed 1 week later. In addition to JCQ, VAS demand and control, we measured sociodemographic outcomes, as well as characteristics of work, sleep, well-being, stress, depression and anxiety.

PARTICIPANTS

190 volunteers French workers using WittyFit software participated in the study, and 129 completed the test-retest.

RESULTS

VAS demand and VAS control correlated with the two Karasek domains from the JCQ, respectively, at 0.59 and 0.57 (p<0.001). Test-retest reliability highlighted concordance coefficients higher than 0.70. Sensitivity was higher than 70% for each VAS. External validity was acceptable. For both demand and control, VAS cut-offs were 75/100. Compared with other workers, senior executives and individuals with master's degrees had higher levels of job control but did not differ in job demand using the VAS and JCQ.

CONCLUSIONS

VAS demand and VAS control are valid, quick, easy to use, and reliable tools for the assessment of job demand and job control. They can be used in daily clinical practice for primary prevention and diagnosis. However, when results are over 75 mm on VAS, we promote the use of JCQ to be more discriminant and specific to initiate action plans to help workers.

TRIAL REGISTRATION NUMBER

NCT02596737.

Minimally invasive hallux valgus correction: Is it better than open surgery?

BACKGROUND

The aim was to compare the minimally invasive (MIS) chevron osteotomy to the well-established open chevron osteotomy for the correction of hallux valgus deformity.

METHODS

Two retrospective cohorts of patients treated with MIS or open chevron osteotomy for hallux valgus correction, matched for age and gender with a minimum follow up of six months were reviewed. Functional outcomes were evaluated using pre and post-operative Manchester Oxford Foot and Ankle Questionnaire (MOXFQ), Visual Analog Score (VAS) for pain and the Unified Elective Orthopaedic Score (UnEOS). Two independent, blinded examiners evaluated the radiographic correction of hallux valgus (HV) and intermetatarsal (IM) angle.

RESULTS

A Total of 54 cases (27 per study group) with a mean follow-up of 25.9 months were included in the study. Pre-operatively, VAS (p = 0.76) and MOXFQ (p = 0.46) scores and HV angle (p = 0.1) were comparable in both groups. However, IM angle was significantly larger in the MIS group (p = 0.005). Post-operatively there was significant improvement in VAS and MOXFQ scores as well as significant correction of the HV and IM angles (p < 0.0001) for both groups. Comparing the two procedures, there was no significant difference between groups for VAS (p = 0.34), MOXFQ scores (p = 0.56) and HV angles (p = 0.069) but the MIS technique was significantly better in improving the IM angle (p = 0.016). The post-operative UnEOS score and the Satisfaction UnEOS domain reached excellent levels for the entire cohort with no statistical difference between the two groups (p = 0.2 and 0.28 respectively).

CONCLUSION

Results show MIS chevron osteotomy provides better radiographic correction of the IM angle but functional outcomes for all parameters were comparable to the open technique. It can therefore be considered at least equivalent to standard open surgery when compared using validated Patient Reported Outcome Measures (PROMs).

Assessment of sick building syndrome using visual analog scales

BACKGROUND

Despite there is no recommendations for assessing symptoms of sick building syndrome, the use of visual analog scales (VAS) seems attractive and appropriate. We aimed to demonstrate the benefits of using VAS for evaluating subjective symptoms of sick building syndrome.

METHOD

We compared an exposed group to a control group with a one-year follow-up. To assess chronology of symptoms, employees were asked to complete four VAS at different times: after vacations (time 1), beginning of the week-beginning of the day (time 2), beginning of the week-end of the day (time 3), and end of the week-end of the day (time 4). Measurements were repeated before and after ventilation work for the exposed group and at the same time in the control group without intervention. Confounding factors were assessed.

RESULTS

We included 36 employees (21 in the exposed group and 15 in the control group). Both groups were comparable. Prior to ventilation work, the exposed group had more subjective symptoms than the control group with a chronology of symptoms. After ventilation work, symptoms did not differ between groups, and most symptoms decreased within the exposed group.

PRACTICAL IMPLICATION

The use of VAS provided reliable data for assessing sick building syndrome and showed a dose-response relationship between occupational exposure and symptoms.

Dry needling in active or latent trigger point in patients with neck pain: a randomized clinical trial

The purpose was to determine the efficacy of deep dry needling (DDN) applied on an active myofascial trigger point (MTrP) versus a latent-MTrP versus a non-MTrP location, on pain reduction and cervical disability, in patients with chronic neck pain. A randomized, double-blind clinical trial design was used. A sample of 65 patients was divided into non-MTrP-DDN, active-MTrP-DDN and latent-MTrP-DDN groups. The visual analog scale (VAS), reproduction of the patient's pain, number of local twitch responses, pressure pain threshold (PPT) and Neck Disability Index (NDI) were assessed before, during and after the intervention and up to 1 month post-intervention. The active-MTrP-DDN-group reduced pain intensity more than non-MTrP-DDN-group after a week and a month (P < 0.01), as well as showing the greatest improvement in tibialis muscle PPT. The treatment of both Active and Latent MTrPs was associated with the reproduction of the patient's pain. The application of DDN on an active-MTrP in the upper trapezius muscle shows greater improvements in pain intensity after 1 week and 1 month post-intervention, compared to DDN applied in latent-MTrPs or outside of MTrPs in patients with neck pain.

Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study

To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45–70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2- and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6.64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).

Population-based normative data for the Scoliosis Research Society 22r, EQ-5D, and VAS questionnaires among individuals aged 20 to 69 years

Aims

To provide normative data that can assess spinal-related disability and the prevalence of back or leg pain among adults with no spinal conditions in the UK using validated questionnaires.

Methods

A total of 1,000 participants with equal sex distribution were included and categorized in five age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years. Individuals with spinal pathologies were excluded. Participants completed the Scoliosis Research Society-22 (SRS-22r), visual analogue scale (VAS) for back/leg pain, and the EuroQol five-dimension index (EQ-5D/VAS) questionnaires, and disclosed their age, sex, and occupation. They were also categorized in five professional groups: doctors, nurses, allied health professionals, office workers, and manual workers.

Results

The mean age of all participants was 43.8 years (20 to 69). There was no difference in the SRS-22r, EQ-5D, or VAS scores among male and female participants (p > 0.05). There was incremental decrease in SRS-22r total scores as the age increased. The mean EQ-5D index score (0.84) ranged little across the age groups (0.72 to 0.91) but reduced gradually with increasing age. There was difference between the SRS-22r total score (4.51), the individual domain scores, and the EQ-5D score (index: 0.94 and VAS: 89) for the doctors’ group compared to all other occupational categories (p < 0.001). Doctors had a younger mean age of participants, which may explain their improved spinal health. There was no difference in the total or sub-domain SRS-22r and EQ-5D scores between the other four occupational groups.

Conclusion

This study provides the first normative data for the SRS-22r, EQ-5D, and VAS for back/leg pain questionnaires among adults in the UK. We recorded an excellent correlation between the three assessment tools with individuals who reported less back and leg pain having better quality of life and greater function. The participants’ age, rather than their sex or profession, appears to be the major determinant for spinal health and quality of life.

Cite this article: Bone Jt Open 2022;3(2):130–134.

Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?

This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159-0.909) and 2-year (p = 0.029, 0.057-0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: -0.28-0.499) and 2 years (p = 0.401, -0.226-0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.

The effect of therapeutic exercise and vegan diet on pain and quality of life in young female patients with chronic non-specific neck pain

Background and purpose

In recent years, dietary practices have begun to be used in painful conditions. This study aimed to investigate the effect of a vegan diet and therapeutic exercise in patients with chronic non-specific neck pain.

Materials and methods

A total of 45 young female patients with chronic non-specific neck pain, aged 18–25 years, participated in the study. Body mass index and body fat percentage were measured with bioelectrical impedance analysis. Pain severity was assessed using the Visual Analogue Scale, quality of life with the short form-36 scale, kinesiophobia with the Tampa scale of kinesiophobia and neck disability with the Neck Disability Index.

Results

The pain severity reduced in the diet group and exercise group after treatment (p = 0.001). After treatment, Neck Disability Index score decreased in the diet group and exercise group (p = 0.001). Tampa scale of kinesiophobia score decreased in the diet group and exercise group (p = 0.001). The eight domains of the short form-36 scale score increased in the diet group and exercise group (p < 0.05). No difference was found in the body mass index and fat percentage in all groups before and after treatment (p˃ 0.05).

Conclusion

A vegan diet and therapeutic exercise are beneficial to patients with chronic non-specific neck pain in terms of pain severity and quality of life.

Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review

PURPOSE

This systematic review aims to summarise the outcomes of gastrocnemius release in the management of Achilles Tendinopathy.

METHODS

A systematic review was performed according to PRISMA guidelines. A computer-based search was performed in PubMed, Embase, Cinahl, Scopus and ISI Web of Science. Two independent reviewers performed both title/abstract and full-text screening according to a-priori selection criteria. English-language original research studies reporting outcomes for gastrocnemius recession in patients with Achilles tendinopathy were included. Study quality and risk of bias were assessed using the MINORS criteria.

RESULTS

Of the 229 articles identified following database searching, nine studies describing 145 cases of gastrocnemius recession were included in the review. Clinically important differences were reported across a range of validated patient reported outcome scores including VISA-A, FFI, FAAM and VAS pain score. Outcomes appear to be superior in patients with noninsertional Achilles tendinopathy, however further research is required to confirm this. Studies also reported an increase in ankle dorsiflexion range of motion and a good rate of return to sport/work. The overall complication rate was 10/123 (8.1%), with sural nerve injury being the most common complication, occurring in 5/123 (4.1%) of cases.

CONCLUSION

The results of this review suggest gastrocnemius release to be an effective treatment option in the management of patients with Achilles tendinopathy, who have gastrocnemius contracture and have previously failed to respond adequately to non-operative treatment.

LEVEL OF EVIDENCE

Level IV.

Comparing Functional Motor Control Exercises With Therapeutic Exercise in Wrestlers With Iliotibial Band Syndrome

Context: Iliotibial band syndrome (ITBS) is a common overuse injury in runners with parallels to our findings of overuse in Greco Roman wrestlers. Despite research indicating coordination and movement-based factors about the hip, no studies were found using functional motor control (FMC) in runners or wrestlers with ITBS. Thus, we compared FMC exercises and therapeutic exercises (TEs) on pain, function, muscle strength, and range of motion (ROM) in national-level Greco Roman wrestlers with ITBS. Design: Controlled laboratory study. Methods: Sixty national-level Greco Roman wrestlers diagnosed with ITBS were randomly assigned to 8 weeks of FMC exercises, TE, and a control group (20 individuals for each group). Pain (visual analog scale), function (triple hop test for distance, single-leg vertical jump test, and agility T test), muscle strength (handheld dynamometer), and ROM (goniometer) were measured at baseline and 8 weeks after intervention as posttest. Results: Although both interventions significantly reduced pain (P < .001, η2 = .87), improved function (triple hop test P = .004, η2 = .94; single-leg vertical jump P = .002, η2 = .93; and T test P < .001, η2 = .93) and strength (hip abduction (P < .001, η2 = .52), hip external rotation (P = .02, η2 = .95), knee flexion (P ≤ .001, η2 = .94), and knee extension (P < .001, η2 = .91) compared with the control group, FMC showed more significant improvements in comparison with TE. Significant differences (P = .001) were observed between FMC and TE compared with the control group in ROM outcome. However, TE was more effective than FMC in improving ROM hip abduction (P < .001, η2 = .93), hip adduction (P = .000, η2 = .92), hip internal rotation (P < .001, η2 = .92), and hip external rotation (P < .001, η2 = .93). Conclusion: FMC exercises were superior to TE in terms of pain, function, and muscle strength, whereas TE was more effective for improving ROM. FMC exercise is suggested as an effective intervention for improvement of the outcomes related to ITBS in national-level Greco Roman wrestlers.

The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.

Characteristics and Risk Factors of Persistent Neuropathic Pain in Recovered COVID-19 Patients

Objectives

To assess risk factors for persistent neuropathic pain in subjects recovered from COVID-19 and to study the serum level of neurofilament light chain (NFL) in those patients.

Design

Case-control study

Setting

Persistent post COVID-19 pain

Subjects

45 patients with post COVID-19 pain and another 45 age and sex-matched healthcare workers who recovered from COVID-19 without pain.

Methods

The included participants were subjected to medical history taking, screening for depressive disorders, comprehensive neurological examination, and pain evaluation using the Douleur Neuropathique en 4 questions (DN4). All patients who had a score at least 4/10 on DN4 were included. The serum NFL level was measured for both groups at the time of patients’ enrollment.

Results

The frequency of depression, moderate and severe COVID-19 cases, disease duration and serum ferritin were significantly higher in the cases with post COVID-19 pain than controls. Binary logistic regression revealed that depression, azithromycin use, moderate and severe COVID-19 increased the odds of post COVID-19 pain by 4.462, 5.444, 4.901, & 6.276 times, respectively. Cases with post COVID-19 pain had significantly higher NFL (11.34 ± 9.7, 95%CI: 8.42 – 14.25) than control group (7.64 ± 5.40, 95%CI: 6.02–9.27), (P-value= 0.029). Patients with allodynia had significantly higher NFL (14.96 ± 12.41, 95%CI: 8.58—21.35) compared to those without (9.14 ± 6.99, 95%CI: 6.43—11.85) (P-value= 0.05).

Discussion

Depression, azithromycin, moderate and severe COVID-19 are independent predictors of persistent post COVID-19 pain. Serum NFL may serve as a potential biomarker for persistent neuropathic pain after COVID-19.

Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes

Periacetabular osteotomy (PAO) is a surgery for persons with symptomatic acetabular dysplasia (AD) that increases acetabular coverage of the femoral head for reducing hip pain and improving function. Patient-reported outcomes (PROs) are significantly improved following PAO, yet little is known regarding mobility-related outcomes. This narrative review provides a synthesis of evidence regarding PROs and mobility-related outcomes in persons with AD following PAO. We further identified important future research directions, chiefly the need for measurement of real-world outcomes. We searched PubMed using comprehensive predefined search terms. We included studies that (i) enrolled persons with AD undergoing PAO, (ii) included PROs and/or mobility-related outcomes and (iii) were written in English. We synthesized and summarized study characteristics and findings. Twenty-three studies were included in this review. Commonly evaluated PROs included pain (n = 14), hip function (n = 19) and quality of life (n = 9). Mobility-related outcomes included self-reported physical activity (PA; n = 11), walking speed and cadence (n = 4), device-measured PA (n = 2), and sit-to-stand, four-square-step and timed stair ascent tests (n = 1). Persons with AD had significant improvements in PROs following PAO, yet mobility-related outcomes (e.g. walking speed and device-measured PA levels) did not change over 1 year following PAO. Few studies have evaluated mobility-related outcomes following PAO, and these studies were of a low methodological quality. Future research might include experience sampling data collection approaches and body-worn devices as free-living, technology-driven methodologies to evaluate mobility and other outcomes in persons with AD undergoing PAO.

Postoperative Prescription of Low-dose Narcotics Yields Equivalent Pain Outcomes Compared to High-dose Narcotics in Opioid-naïve Patients Undergoing Spine Surgery

STUDY DESIGN

Retrospective cohort study at a single institution. Patients undergoing specific, elective spinal procedures between 2012 and 2018.

OBJECTIVE

The aim of thi stsudy was to investigate the relationship between opioid prescriptions during the immediate, post-discharge period, and patient-reported pain outcomes.

SUMMARY OF BACKGROUND DATA

Medically prescribed opiates contribute to the opioid crisis, manifesting in significant mortality and economic burden. Although opioids are a mainstay of pain amelioration following spinal surgery, prescription practices are heterogeneous.

METHODS

Inclusion criteria included: patients who underwent one of 10 spinal procedures (Table 1); patients with preoperative, postoperative day (POD 1, and POD 30 pain scores reported on the visual analog scale (VAS); patients discharged without a complicated perioperative course. Opioids were converted to morphine milligram equivalents per day (MME/day) using a standard reference table. χ2, Kruskal-Wallis, and logistic regression were utilized to investigate associations between clinical variables and postoperative pain scores. Univariate and multivariable linear regression models with Stepwise selection (cut off: P = 0.05) were employed as appropriate on POD 30 VAS pain scores.

RESULTS

Smoking status and postoperative LOS were associated with opioid prescription doses. Patients prescribed opioids <40 MME/day, equivalent to five tablets of 5 mg oxycodone/day, showed no significant difference in POD 30 VAS score (β coefficient: 0.095, P  = 0.752) when compared to patients who received the highest-dose opioids (>80 MME/day-equivalent to 10 tablets of 5 mg oxycodone/day). Adjusted multivariable logistic regression analysis revealed that postoperative opioid dosage/prescription was not a significant predictor of patients reporting at least 50% pain improvement, suggesting that 40 MME/day is sufficient to maintain patient satisfaction.

CONCLUSION

Patients receiving the lowest dosage of opioid prescriptions with sufficient nonopiate analgesics did not report worse pain relief at POD 30 compared to those receiving higher opioid prescriptions. In light of the opioid epidemic, this study supports initial dosing recommendations by the American Society for Addiction Medicine.Level of Evidence: 3.

The Effect of Dry Needling on Pain, Range of Motion of Ankle Joint, and Ultrasonographic Changes of Plantar Fascia in Patients With Plantar Fasciitis

CONTEXT

Plantar fasciitis (PF) is a common and devastating disease. Despite different treatments, there is no clear evidence for the effect of these treatments on PF. One of the therapy methods used in physiotherapy is dry needling (DN). So the purpose of this study is to investigate the effect of DN on the pain and range of motion of the ankle joint and plantar fascia thickness in subjects with PF who are suffering from the trigger points of the gastrocnemius and soleus muscles.

METHODS

In this study, 20 volunteer females with PF were randomly assigned into DN treatment and control groups. Measurements were range of motion in dorsiflexion and plantar flexion, plantar fascia thickness, and visual analog scale measured before, immediately, and 1 month after the end of the intervention in both groups.

RESULTS

There were significant differences in the plantar fascia thickness and visual analog scale between the 2 groups. Plantar fascia thickness (P = .016) and visual analog scale (P = .03) significantly decreased in the treatment group. However, there was no significant difference in plantar flexion (P = .582) and dorsiflexion range of motion (P = .173) between groups.

CONCLUSION

The result of this study showed that DN can reduce pain and plantar fascia thickness in women with PF who are suffering from trigger points of the gastrocnemius and soleus muscles.

LEVEL OF EVIDENCE

Level 1, randomized controlled trial.