Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty

Manual lymphatic drainage before and after total knee arthroplasty, a randomized controlled trial

Purpose

Manual lymphatic drainage (MLD) is a routine therapeutic technique used to decrease peripheral oedema by activating lymphatic drainage. Evidence for its efficacy remains sparse. Therefore, the purpose of this study was to evaluate the effect of MLD before and after total knee arthroplasty (TKA).

Methods

This was a single-centre randomized, controlled and observer-blinded trial. 112 patients were randomly assigned to one of three groups: group 1 underwent MLD for 30 min daily on five consecutive days both before and after TKA; group 2 underwent MLD for 30 min daily on five consecutive days only after TKA; and the control group did not undergo MLD. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, range of knee motion, swelling and pain were assessed before TKA, after two days, five days and six weeks.

Results

The overall age of the patients was 69.4 years (SD = 9.8, range = 41-87). The groups were well matched in terms of sex, age, height, weight, and body mass index. There was no statistically significant difference with regard to any of the outcome measures between the groups.

Conclusions

The present results indicate that MLD had no significant benefits when applied either before or early after TKA. Therefore, we do not recommend the routinely use of MLD in the early period before or after TKA. Further studies should evaluate the effect of MLD after arthroscopic surgery.

Level of evidence

Therapeutic Level II, Lower quality RCT with follow up <80.

Transitional Pain Service: Optimizing Complex Surgical Patients

PURPOSE OF REVIEW

The care of patients with complex postsurgical pain can be challenging and burdensome for the healthcare system. Transitional pain service (TPS) is a relatively new concept and has not been widely adopted in the USA. This article explores the benefits and barriers of transitional pain services and describes the development of a TPS at our institution.

RECENT FINDINGS

Evidence from a few institutions that have adopted TPS has shown decreased postsurgical opioid consumption for patients on chronic opioids and decreased incidence of chronic postsurgical opioid use for opioid-naïve patients. The development of a transitional pain service may improve outcomes for these complex patients by providing longitudinal and multidisciplinary perioperative pain care. In this article, we describe the implementation of a TPS at a tertiary medical center. Our TPS model involves a multidisciplinary team of anesthesiologists, pain psychologists, surgeons, and advanced practice providers. We provide longitudinal care, including preoperative education and optimization; perioperative multimodal analgesic care; and longitudinal follow-up for 90 days post-procedure. With our TPS service, we aim to reduce long-term opioid use and improve functional outcomes for our patients.

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR.

METHODS

A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence.

RESULTS

In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083).

CONCLUSIONS

Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.

[Rehabilitative technologies in patients after total endoprosthesis of lower limbs' major joints: scientometric analysis]

Dynamically developing sphere of physical and rehabilitative medicine raises an important issue on implementation of technologies with proven effectiveness to recover neuromuscular, skeletal and movement-related functions, activity and partipation of traumatological patients into rehabilitation practice. The aim of this review is the consistent information analysis and synthesis of evidence-based researches of current effective methods in the context of medical rehabilitation after endoprosthesis of lower limbs' major joints, as well as the provision of structured information that helps to influence on decision-making for doctors of physical and rehabilitative medicine and other professionals who take part in multidisciplinary interaction.

Level I of evidence does not support manual lymphatic drainage for total knee arthroplasty: a meta-analysis

It is unclear whether manual lymphatic drainage (MLD) following primary total knee arthroplasty (TKA) is effective in reducing pain and swelling and improving knee function. The present study investigated the efficacy of MLD after TKA. The outcomes of interest are the range of motion (ROM), pain (visual analogue scale, VAS), and circumference of the lower leg. This meta-analysis was conducted according to the 2020 PRISMA statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase, with no time constraint. Only level I evidence studies, according to the Oxford Centre of Evidence-Based Medicine, were considered. All the randomised controlled trials (RCTs) comparing patients who have received MLD versus a group of patients who did not undergo MLD following primary TKA were accessed. Data from four RCTs (197 TKAs) were retrieved. 67% (132 of 197 patients) were women. The mean length of follow-up was 7.0 ± 5.8 weeks. The mean age of the patients was 69.6 ± 2.7 years, and the mean BMI was 28.7 ± 0.9 kg/m2. At baseline, between-group comparability was evidenced in the male:female ratio, mean age, mean BMI, knee flexion, and VAS. No difference was found in flexion (P = 0.7) and VAS (P = 0.3). No difference was found in the circumference of the thigh (P = 0.8), knee (P = 0.4), calf (P = 0.4), and ankle (P = 0.3). The current level I of evidence does not support the use of MLD in primary TKA.

Postoperative swelling after elbow surgery: influence of a negative pressure application in comparison to manual lymphatic drainage-a randomized controlled trial

PURPOSE

Postoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery?

METHODS

A total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care.

RESULTS AND CONCLUSION

NP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p <  0.05).

CONCLUSION

Our findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.

The effect of massage therapy on pain after surgery: A comprehensive meta-analysis

BACKGROUND

Findings on the usefulness of massage therapy (MT) in postoperative pain management are often inconsistent among studies.

OBJECTIVES

This study's aim is to conduct a meta-analysis of randomized controlled trials (RCT) to clarify the effects of massage therapy in the treatment of postoperative pain.

METHODS

Three databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95 % confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I². Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry.

RESULTS

The analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, -1.32; 95 % CI, -2.01 to -0.63; p = 0.0002; I² = 98.67 %). A similar significant effect was found for both short (immediate assessment) and long terms (assessment performed 4-6 weeks after the MT). Remarkably, we found neither the duration per session nor the dose had an impact on the effect of MT and there seemed to be no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery.

LIMITATIONS

Publication bias is possible due to the inclusion of studies in English only. Additionally, the included studies were extremely heterogeneous. Double-blind research on MT is difficult to implement, and none of the included studies is double-blind. There was some heterogeneity and publication bias in the included studies. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias.

CONCLUSIONS

MT is effective in reducing postoperative pain in both short and long terms.

Role of synovial lymphatic function in osteoarthritis

BACKGROUND

Osteoarthritis (OA) affects the entire joint, initially with a low degree of inflammation. Synovitis is correlated with the severity of OA clinical symptoms and cartilage degradation. The synovial lymphatic system (SLS) plays a prominent role in clearing macromolecules within the joint, including the pro-inflammatory cytokines in arthritic status. Scattered evidence shows that impaired SLS drainage function leads to the accumulation of inflammatory factors in the joint and aggravates the progression of OA, and the role of SLS function in OA is less studied.

DESIGN

This review summarizes the current understanding of synovial lymphatic function in OA progression and potential regulatory pathways and aims to provide a framework of knowledge for the development of OA treatments targeting lymphatic structure and functions.

RESULTS

SLS locates in the subintima layer of the synovium and consists of lymphatic capillaries and lymphatic collecting vessels. Vascular endothelial growth factor C (VEGF-C) is the most critical regulating factor of lymphatic endothelial cells (LECs) and SLS. Nitric oxide production-induced impairment of lymphatic muscle cells (LMCs) and contractile function may attribute to drainage dysfunction. Preclinical evidence suggests that promoting lymphatic drainage may help restore intra-articular homeostasis to attenuate the progression of OA.

CONCLUSION

SLS is actively involved in the homeostatic maintenance of the joint. Understanding the drainage function of the SLS at different stages of OA development is essential for further design of therapies targeting the function of these vessels.

Manual lymphatic drainage and Kinesio taping applications reduce early-stage lower extremity edema and pain following total knee arthroplasty

BACKGROUND

Controlling early symptoms following total knee arthroplasty (TKA) is critical for long-term outcomes.

OBJECTIVE

The purpose of this study was to compare the efficacy of manual lymphatic drainage (MLD) and Kinesio Taping®(KT) applications in terms of reducing lower extremity edema, pain, and improving function in the early postoperative period of TKA.

METHODS

Forty-five female patients with unilateral TKA were allocated to an additional postoperative MLD treatment (n = 15) with exercises, additional Kinesio Taping® (n = 15) with exercises, or exercise-only (n = 15). Lower limb circumference, range of motion (ROM), pain level, and knee osteoarthritis outcome score (KOOS) were compared.

RESULTS

Both MLD (p < .001; effect size range = 0.65-0.87) and the KT group (p = .001; effect size range = 0.74-0.78) had lower edema and pain levels (MLD group: p < .001; effect size = 0.84; KT group: p < .001; effect size = 0.78) compared to the control group on postoperative day 4. These beneficial effects continued only two weeks postoperatively, and no group differences were found by six weeks.

CONCLUSION

Additional MLD or KT applications to standard exercises were both effective on early-stage lower extremity edema and pain levels. Clinicians might implement one of these applications to the standard rehabilitation programs to control pain and edema following TKA.

Feasibility and initial efficacy of a multimodal swelling intervention after total knee arthroplasty: A prospective pilot study with historical controls

BACKGROUND

Swelling after total knee arthroplasty (TKA) is often profound and persistent, increasing risks of DVT, infection, and wound dehiscence, and impairing rehabilitation. We investigated the feasibility and initial efficacy of a multimodal swelling control intervention (MSI), comprised of an inelastic adjustable compression garment (CG), manual lymph drainage (MLD) massage, and home exercise program (HEP) after total knee arthroplasty (TKA) compared to a control group.

METHODS

Sixteen individuals (mean age 64.7 ± 7.1y) performed MSI for three weeks after TKA, through day 21 (D21). Outcome measures included patient satisfaction, safety, patient adherence, and swelling measured by Single Frequency Bioimpedance Assessment (SF-BIA). All outcomes were measured preoperatively and at postoperative D4, D7, D14, D21 and, three weeks after discontinuing MSI, on D42. Efficacy of MSI was calculated with Hedge's g effect size estimates using the SF-BIA ratios for MSI versus CONTROL (N = 56; mean age 64.3 ± 9.3y) at key post operative time points.

RESULTS

Patient satisfaction was 93% with no adverse events. Adherence to CG, MLD, and HEP were 85%, 99%, and 97% respectively. Peak swelling reduction with MSI was at D21 (Hedges' g = 1.60 at D21 (95% CI 0.99, 2.21)). Minimal change in swelling was observed three weeks after cessation of MSI on D42.

CONCLUSIONS

The self-administered MSI program is feasible and demonstrated strong initial efficacy to control swelling after TKA. Minimal rebound swelling was observed once MSI was withdrawn at D21. Future studies should examine the efficacy of inelastic adjustable compression in a randomized controlled trial.

Inhibiting the Musculoskeletal Pathological Processes in Post-knee Replacement Surgery With Osteopathic Manipulative Treatment: A Systematic Review

Total knee arthroplasty (TKA) is a very common surgical treatment approach for severe osteoarthritis. Complications of TKA include loss of range of motion and prolonged analgesic requirement for pain control. Osteopathic manipulative techniques (OMT) have been utilized to address localized muscular stiffness to improve range of motion; however, limited studies directly correlate OMT and TKA recovery. This review highlights the therapeutic benefits OMT can have in the postoperative management of arthroplasty with respect to range of motion, edema, pain perception, and ability to perform activities of daily living. This review revealed the use of OMT would positively influence range of motion by manipulation of localized musculature and can result in decreased demand for analgesics. This can, in turn, shorten hospital stay and return the ability of patients to perform activities of daily living earlier than without OMT. Increased research is needed to strengthen these findings on the benefits of OMT in the postoperative management of arthroplasty.

Lymphedema Is a Significant Risk Factor for Failure After Primary Total Hip Arthroplasty

BACKGROUND

Lymphedema is a chronic disease characterized by fluid buildup and swelling that can lead to skin and soft-tissue fibrosis and recurring soft-tissue infections. Literature with regard to the increased risk of complications following a surgical procedure in patients with lymphedema is emerging, but the impact of lymphedema in the setting of primary total hip arthroplasty (THA) remains unknown. The purpose of this study was to review outcomes following primary THA performed in patients with lymphedema compared with a matched cohort without lymphedema.

METHODS

Using our institutional total joint registry and medical records, we identified 83 patients (57 were female and 26 were male) who underwent THA with ipsilateral lymphedema. For comparison, these patients were matched 1:6 (based on sex, age, date of the surgical procedure, and body mass index [BMI]) to a group of 498 patients without lymphedema who underwent primary THA for osteoarthritis. Subsequently, postoperative complications and implant survivorship were evaluated for each group. The mean follow-up for each group was 6 years. Survivorship was compared between cohorts using Kaplan-Meier methodology and included both survivorship free of infection and survivorship free of reoperation or revision. Univariate Cox regression analysis was utilized to assess the association between patient factors for the time to event outcomes noted above.

RESULTS

In patients with a history of lymphedema, there was an increased risk of complications (hazard ratio [HR], 1.97; p < 0.01), including reoperation for any cause (HR, 3.16; p < 0.01) and postoperative infection (HR, 4.48; p < 0.01). The 5-year infection-free survival rate was 90.3% for patients with lymphedema compared with 97.7% for patients without lymphedema (p < 0.01).

CONCLUSIONS

Patients with lymphedema are at increased risk for complications, including reoperation and infection, following primary THA. These data emphasize the importance of appropriate preoperative counseling in this population and should encourage efforts to identify methods to improve outcomes, including further investigation of the effects of preoperative optimization of lymphedema prior to THA and methods for improved perioperative management.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment of perioperative swelling by rest, ice, compression, and elevation (RICE) without and with additional application of negative pressure (RICE+) in patients with a unilateral ankle fracture: study protocol for a monocentric, evaluator-blinded randomized controlled pilot trial

Background

Edema is commonly seen after surgical fixation of ankle fractures. Rest, ice, compression, and elevation (RICE) is an established combination to prevent swelling but hardly able to stimulate lymphatic resorption. Recently, an epicutaneously applied negative pressure suction apparatus (LymphaTouch®) has been introduced to stimulate lymphatic flow. While postoperative recovery, soft tissue, and osseous healing as well as functional outcome are probably linked to the amount of postoperative swelling, estimates on this relative to prevention (RICE) or prevention + stimulated resorption (RICE⁺) of fluid are scarce.

Methods and analysis

This is a single-center, evaluator-blinded randomized pilot trial to investigate postoperative swelling in adults requiring surgical fixation of a closed unilateral ankle fracture. A total of 50 patients will be recruited and randomly assigned to RICE or RICE⁺ prior to surgery. All patients will undergo evaluator-blinded measurements of the ankle volume the day before surgery and subsequently from the evening of the 2nd postoperative day every 24 h until discharge. RICE will be initiated right after surgery and continued until discharge from the hospital in all patients. Additional application of negative pressure therapy (RICE⁺) will be initiated on the morning of the 2nd postoperative day and repeated every 24 h until the time of discharge from the hospital. Outcome measures are (i) the relative amount and the time course of the postoperative swelling, (ii) the demand for analgesic therapy (type and amount) together with the perception of pain, (iii) the rate of complications, and (iv) mobility of the ankle joint and the recovery of walking abilities during a 12-weeks follow-up period. Serum and urine samples taken prior to sugery and during postoperative recovery will allow to evaluate the ratio of naturally occurring stable calcium isotopes (δ^44/42Ca) as a marker of skeletal calcium accrual.

Ethics and dissemination

The protocol was approved by the institutional Ethics Committee (Rostock University Medical Center, Rostock, Germany) in accordance with the Declaration of Helsinki (approval number: A 2020-0092). The results of this study will be actively disseminated through scientific publications and conference presentations.

Trial registration

DRKS, DRKS00023739. Registered on 14 December 2020

Modified Robert Jones Bandage in reducing blood loss in total knee arthroplasty: A meta-analysis of randomized controlled trials

BACKGROUND

The purpose of this meta-analysis was to assess the effects of Modified Robert Jones Bandage (MRJB) in primary total knee arthroplasty (TKA).

METHODS

PubMed, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were systematically searched for randomized controlled trials (RCTs). All RCTs were compared to receive either MRJB (study group) or conventional wound dressing (control group) in TKA. Statistical analysis was assessed using RevMan 5.3 software.

RESULTS

A total of 5 RCTs involving 362 patients were included in the meta-analysis. No significant difference between the 2 groups was found in terms of total blood loss (Mean difference [MD], -25.41; 95% confidence interval [CI], -90.52 to 39.70; P = .44), intra-operative blood loss (MD, -13.77; 95% CI, -31.84 to 4.29; P = .14), drain blood loss (MD, 0.83; 95% CI, -30.07 to 31.72; P = .96), and transfusion rate (risk ratio, 0.95; 95% CI, 0.55-1.64; P = .86); There was also no significant difference in terms of range of motion (MD, -0.93; 95% CI, -3.64 to 1.79; P = .50), visual analog scale pain sores (MD, -0.02; 95% CI, -0.34 to 0.30; P = .90), and operative time (MD, -3.12; 95% CI, -13.42 to 7.18; P = .55), without increasing the risk of wound-related complications (risk ratio, 0.75; 95% CI, 0.27-2.08; P = .58) in both groups. No deep venous thrombosis occurred in all studies.

CONCLUSIONS

The current meta-analysis of the available evidence indicates patients with MRJB had not required the additional advantage compared to the conventional wound dressing for TKA. However, more high-quality studies are needed to confirm the above conclusions.

LEVEL OF EVIDENCE

Level I, therapeutic study.

The use of manual lymphatic drainage on clinical presentation of musculoskeletal injuries: A systematic review

The aim of this study was to provide a systematic review on the applicability of manual lymphatic drainage (MLD) in improving edema and clinical presentation postmusculoskeletal injuries. A review of the literature was performed in CINAHL, MANTIS, Medline, SPORTDiscus and Google Scholar, yielding a total of 8 articles. Half of the studies showed a strong quality assessment. Results from our work support the use of MLD for reducing edema reduction and pain as well as enhancing range of motion and patients' quality of life and satisfaction. Further research is needed to apply these findings to a broader range of musculoskeletal injuries and conditions.

Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review

Objective

The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation.

Design: Scoping review

Literature search

A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library.

Study selection criteria

All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included.

Data synthesis

The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool.

Results

There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT.

Conclusion

The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER).

Pre-registration

OSF:https://osf.io/9ku8a/

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04460-w.

Effects of lymphatic drainage therapy on autonomic nervous system responses in healthy subjects: A single blind randomized controlled trial

OBJECTIVES

This study aimed to determine effects of lymphatic drainage therapy (LDT) on autonomic nervous system (ANS) responses by comparing including Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and muscle tone (via straight leg raise (SLR)) in healthy participants.

METHODS

A single blind randomized controlled trial evaluating sixty-six healthy participants including 58 females and 8 males aged between 40 and 65 years. All participants were blinded and randomized to either experimental group (EXP: LDT) or control group (CT: rest). LDT was applied to participants 45 min in experimental group. The LDT is light movement applied by an experienced physical therapist, starting from neck, deep abdomen, and along to the leg. While for the control group, participants received 45 min supine on the treatment table. Tests for evaluating ANS such as Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and straight leg raise (SLR) were assessed at pre and post intervention.

RESULTS

The findings demonstrated that H reflex decreased significantly after applying LDT; within and between groups (p < 0.05). Whereas, it increased significantly in control group. First tension (R1) indicated by participants during SLR significantly improved within both groups. However, there were no significant differences of HRV and sAA in either LDT or control groups.

CONCLUSION

This study demonstrated that LDT decreased autonomic activity via decreased spinal reflex excitability and tension in healthy participants.

Lymphatic treatments after orthopedic surgery or injury: A systematic review

BACKGROUND

Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement limitations, decreased function and occasionally, prolonged edema, which can delay or interfere with the healing process. Lymphatic and compression therapy have become increasingly common, intending to reduce edema and pain, thus, promoting the recovery process.

AIMS

To examine the efficacy of methods commonly used to reduce edema after orthopedic injury or surgery, i.e. decongestive therapy, manual lymphatic drainage, and compression bandaging.

METHODS

English literature search was undertaken in January 2019, in the following databases: Cochrane Library, MEDLINE, PEDro.

INCLUSION CRITERIA

randomized controlled or quasi-controlled trials in adults who have edema or pain after recent limb trauma or surgery. Two independent assessors rated study quality and risk of bias using the PRISMA recommendations and PEDro score.

RESULTS

We evaluated 71 papers. After excluding duplicated and irrelevant papers, 15 met the eligibility criteria (6 on lymphatic treatment and 9 on compression). Quality of papers ranged from 3 to 7 on PEDro score; of them, 13 were 1b Level of Evidence and two were 1c.

CONCLUSION

After elective surgeries, when the significant edema appears or persists beyond recovery time, complex decongestive therapy and manual edema mobilization should be recommended in addition to conventional physical therapy. In acute injuries such as ankle or distal radius fractures, lymphatic treatments and compression bandaging should be considered as part of the therapeutic protocol. Nine studies evaluated different compression modalities found that only multilayer and long stretch compression significantly reduce edema.

Orthopedic treatment for open fracture of lower extremities and soft tissue defects in young children and rapid rehabilitation after operation

Objective: This study aims to explore the clinical features of open fracture of lower extremities with soft tissue injury in young children, and its surgical and postoperative rehabilitation methods.Methods: A total of 32 children with open fracture of lower extremities and soft tissue injury treated in our department from January 2010 to December 2016 were included into this study. An individualized treatment plan was established according to the characteristics of each patient's condition, and rapid rehabilitation procedures were carried out after the operation to promote the healing of the wound, and shape and function recovery.Results: In the present study, four children developed superficial infection after the operation, and healed after proper management. Furthermore, two children were found to have osteomyelitis during follow-up after discharge, and healed after they returned to the hospital for debridement. All patients were followed up until fracture healing, and the follow-up duration ranged within 6-15 months, with an average duration of 8.5 months. All patients achieved bony union, and none of the patients had bone exposure. In the curative effect assessment, 24 children were classified as excellent, six children were classified as good, one child was classified as moderate, and one child was classified as poor. The excellent and good rate was 93.75%.Conclusions: Open fracture of the lower extremities commonly occur in the middle and lower segment of the tibia and fibula in children, and is usually combined with soft tissue injury. The correct treatment of fractures, and skin and soft tissue injuries, as well as the rapid rehabilitation of children, are the keys to achieving a good clinical effect.

Effect of manual lymph drainage for up to 10 days after total knee arthroplasty: Arandomized controlled trial

OBJECTIVE

To assess the effect of manual lymph drainage (MLD) on pain in Japanese patients up to 10 days after a total knee arthroplasty (TKA).

METHODS

This study was a randomized controlled trial performed at a University Medical Center. Patients who underwent unilateral TKA and received once daily MLD for 20 minutes prior to standard physical therapy up to 10 days after TKA were investigated. Pain at rest, knee extension muscle contraction, and maximum load were assessed using the visual analog scale (mm) before surgery, after drain removal, and after the fifth MLD. As secondary outcomes, the circumference, range of motion, muscle strength, walking speed, and walking rate were evaluated.

RESULT

Forty-one patients aged 45-85 participated in this study, 21 of whom were assigned to the intervention (MLD group) and 20 who were not (control group). Ten days after TKA, no significant difference was evident between the MLD and control groups for resting pain [4.5 mm (1.6-10.8) vs 7.0 mm (1.8-25.5), respectively, p=0.17], pain during knee extension muscle contraction [12.3 mm (4.5-24.8) vs 20.8 mm (6.4-31.8), p=0.41], and pain at maximum load [13.0 mm (8.3-39.8) vs 16.0 mm (4.6-32.5), p=0.73]. There were no significant differences between groups in terms of secondary outcomes.

CONCLUSION

This study shows that MLD up to 10 days after TKA does not affect pain.

Kinesiotaping for postoperative oedema - what is the evidence? A systematic review

BACKGROUND

Postoperative oedema is a common condition affecting wound healing and function. Traditionally, manual lymphatic drainage is employed to reduce swelling. Kinesiotaping might be an alternative resource-sparing approach. This article explores current evidence for the effectiveness of kinesiotaping for the reduction of oedema in the postoperative setting.

METHODS

A systematic literature search was performed on the basis of five databases (Pubmed, CINAHL, Embase, Cochrane Library, and Clinicaltrials.gov) for studies published between January 2000 and October 2019.Only prospective controlled trials were included. Case studies, uncontrolled case series, studies on oedema caused by other etiologies than by surgery, as well as studies on malignant disease related oedema (especially breast cancer related oedema) were excluded.Articles were screened by title, abstract, and full text and the references were searched for further publications on the topic. A narrative and quantitative (using STATA) analysis was performed.

RESULTS

One thousand two hundred sixty-three articles were screened, twelve were included in the analysis. All studies evaluated either oedema after extremity surgery or maxillofacial interventions, and showed relevant methodological flaws. Only three studies employed an active comparator. Of the twelve included studies ten found positive evidence for kinesiotape application for the reduction of swelling and beneficial effects on secondary outcome parameters such as pain and patient satisfaction. The available trials were heterogenic in pathology and all were compromised by a high risk of bias.

CONCLUSION

There is some evidence for the efficacy of kinesiotaping for the treatment of postoperative oedema. This evidence is, however, not yet convincing given the limitations of the published trials. Methodologically sound comparison to standard of care or an active comparator is indispensable for an evaluation of effectiveness. In addition, assessments of patient comfort and cost-benefit analyses are necessary to evaluate the potential relevance of this novel technique in daily practice.

SYSTEMATIC REVIEW REGISTRATION NUMBER

International prospective register of systematic reviews (PROSPERO) ID 114129).

Reduction of postoperative swelling with a negative pressure treatment-A prospective study

PURPOSE

Perioperative swelling and edema are the main factors that influence the time to definitive operative care, healing rate, as well as postoperative infection rate. Device-based negative pressure treatment is a new method to reduce post-traumatic and postoperative swelling of the upper extremities. The objective of this study was to evaluate a new negative pressure treatment with LymphaTouch® (Helsinki, Finland) to reduce perioperative swelling in upper extremity injuries.

METHODS

We analyzed 45 patients (26 female and 19 male) after operative treatment of upper extremity injuries. A predefined treatment algorithm of 30 min using LymphaTouch® was performed on the patients every day for five consecutive days. Swelling was measured according to the neutral-zero method with six points of measurement.

RESULTS

A total of 16 patients underwent an operation on their upper arm. An average of 3.5 measurements was performed per patient, with the start of therapy at a mean of 5.13 days after the operation. All of the measured circumferences except the elbow and 10 cm below the elbow were reduced from day 0 to 3. The percent reduction of swelling (relative to day 0) was 10.36%, 11.35%, 17.34%, and 3.25% for days 1-4, respectively. The greatest reduction of circumference was obtained in the metacarpus (-51.6%) and wrist (-33.1%).

CONCLUSION

The LymphaTouch® system and a 30-min treatment program can reduce postoperative swelling of the upper arm, wrist, and hand on the first 5 days after surgery. The ease of learning and self-applicability of LymphaTouch® makes it interesting for further controlled randomized trials.

[Physical therapy in the rehabilitation of patients after endoprosthetic replacement of major joints in the lower extremities: a scientometric analysis of evidence-based studies]

BACKGROUND

In recent decades, the volume of high-tech medical care in the field of orthopedics and traumatology, including endoprosthetic replacement of major joints (MJs) (the hip joint and/or the knee joint) in the lower extremities (LE) (LEMJ), has substantially increased. In this connection, there are an increasing number of patients in need of medical rehabilitation, to solve the problems of which needs the effective physical and rehabilitation medicine (PRM) techniques proven during researches to be introduced into practice.

OBJECTIVE

To analyze evidence-based studies containing sound data on the use of PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs, to identify the most effective PRM technologies and to formulate recommendations for their use for practitioners, which are based on the evidence obtained during the analysis.

MATERIAL AND METHODS

The paper is based on the scientometric analysis of 241 studies conducted in 2000 to 2018, which were devoted to the use of physical exercises and PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs.

RESULTS

Over the past decade, there has been a tangible rise in the number of studies on endoprosthetic replacement of LEMJs. Some of the most studied PRM technologies having the proven effect are physical exercises in combination with neuromuscular electrical stimulation, kinesiotherapy, cryotherapy, and pressure therapy that is effective in preventing thromboembolism after surgery.

CONCLUSION

The use of PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs should be based on the results of high-quality randomized controlled clinical trials, which serve as the basis for the development of clinical recommendations. The process of analyzing the data of studies should be regular.

Rationale and design of the theRapeutic effects of peroneal nerve functionAl electrical stimuLation for Lower extremitY in patients with convalescent poststroke hemiplegia (RALLY) study: study protocol for a randomised controlled study

INTRODUCTION

Increasing evidence supports the utilisation of functional electrical stimulation (FES) to improve gait following stroke; however, few studies have focused exclusively on its use in the convalescent phase. In addition, its efficacy in patients with a non-Western life style has not been evaluated.

METHODS AND ANALYSIS

This is a randomised, controlled, open-label multicentre study, comparing rehabilitation with and without FES. The purpose of our study is to test the hypothesis that the FES system improves walking ability in Japanese patients with hemiplegia during the convalescent phase. Two hundred patients aged 20-85 years who had an initial stroke ≤6 months prior to the enrolment, are in a convalescent phase (after the end of acute phase treatment, within 6 months after the onset of stroke) with functional ambulation classification 3 or 4 and have a hemiplegic gait disorder (drop foot) due to stroke have been recruited from 21 institutions in Japan. The patients are randomised in 1:1 fashion to usual gait rehabilitation or rehabilitation using FES (Walkaide). The trial duration is 8 weeks, and the primary outcome measured will be the change in maximum distance from baseline to the end of the trial, as measured with the 6 min walk test (6-MWT). The 6-MWT is performed barefoot, and the two treatment groups are compared using the analysis of covariance.

ETHICS AND DISSEMINATION

This study is conducted in accordance with the principles of the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects and is approved by the ethics committee of all participating institutions. The published results will be disseminated to all the participants by the study physicians.

TRIAL REGISTRATION NUMBER

The University Hospital Medical Information Network-Clinical Studies Registry (UMIN000020604).

Improving Orthopedic-Related Postoperative Edema Management in a Rehabilitative Nursing Setting

PURPOSE

The aim of the study was to reduce postoperative edema in total knee and hip arthroplasty rehabilitation patients.

DESIGN

A pre- and posttest design was used for this quality improvement project at a rehabilitation facility.

METHODS

Staff and patient edema education was standardized. Staff pre- and posttests were administered. Patients were interviewed to assess for knowledge of edema management. Chart audits were assessed for edema management and length of stay.

FINDINGS

Average staff knowledge scores (n = 50) increased pre- to posteducational video (64% vs. 70%). Of patients interviewed posteducation (n = 24), 38% were able to list two characteristics of edema. Two chart audits completed pre- and posteducation demonstrated that the majority of patients (n = 30 per group) had edema upon admission (96% vs. 97%). However, length of stay decreased by 3 days (19.2 vs. 16.3).

CONCLUSION

Standardized postoperative edema education can improve staff and patient edema knowledge and management.

CLINICAL RELEVANCE

Edema education is recommended for orthopedic patients in rehabilitation facilities.

Three-Dimensional Evaluation of the Effects of Kinesio Taping on Postoperative Swelling and Pain after Surgically Assisted Rapid Palatal Expansion

Objectives

The purpose of the present study was to evaluate the effects of kinesio taping on pain and swelling after surgically assisted rapid palatal expansion.

Material and Methods

A total of 21 (12 male and 9 female) patients with transverse maxillary deficiency were enrolled in the study. Kinesio taping (KT) was applied unilaterally in each patient, whereby sides of the face with KT application were included into the (a) KT group and the other sides were included into the (b) non-KT group. Changes in facial volume were evaluated on digital images using the 3dMD Face System. Pain scores were assessed at postoperative days 1, 2, 3, 4, 5, 6, and 7 using the visual analog scale (VAS). Two-way repeated measures analysis of variance and Mann Whitney U test were used for statistical analyses.

Results

Swelling was significantly lower in the KT group compared to the non-KT group from T0 to T1 (36.42 [SD 19.71] mm³ vs. 183.84 [SD 49.33] mm³) and was significantly greater in the non-KT group compared to the KT group from T0 to T2 (70.88 [SD 15.73] mm³ vs. 21.46 [SD 13.39] mm³) (P < 0.001 for both). The VAS scores were significantly lower in the KT group compared to the non-KT group at all time points (P < 0.05).

Conclusions

The application of kinesio taping after maxillofacial surgery reduced the pain and swelling in the postoperative period. Kinesio taping can be used as an alternative to other methods that are used for the reduction of postoperative complaints.

Erysipelas or cellulitis with a prosthetic joint in situ

We describe a case of a 60-year old male who developed an acute prosthetic joint infection (PJI) of the knee, secondary to erysipelas of the lower leg due to beta-hemolytic Group G streptococci. As it is unknown how often this phenomenon occurs in patients with prosthetic implants and which patients are most prone to develop this complication, we analyzed: i) the incidence of the development of a PJI in these patients and ii) the clinical characteristics of streptococcal PJI during an episode of erysipelas/cellulitis. Based on a retrospective analysis of patients with a prosthetic implant in situ presenting at the emergency department with erysipelas/cellulitis, 1 out of 10 patients developed a PJI. An additional analysis within a multicenter cohort on streptococcal PJI demonstrated in 22 patients that a secondary PJI due to erysipelas/cellulitis mostly develops in young implants (<5 years old). In 20 cases (91%), the skin infection was in the same limb as the joint prosthesis suggesting contiguous spread of bacteria. These data emphasizes the importance of preventive measures to reduce the occurrence of skin infections in patients with prosthetic implants, and if an erysipelas or cellulitis does occur, to monitor patients carefully.

Rehabilitation Medicine Approaches to Pain Management

Rehabilitation medicine offers strategies that reduce musculoskeletal pain, targeted approaches to alleviate movement-related pain, and interventions to optimize patients' function despite the persistence of pain. These approaches fall into four categories: modulating nociception, stabilizing and unloading painful structures, influencing pain perception, and alleviating soft tissue musculotendinous pain. Incorporating these interventions into individualized, comprehensive pain management programs offers the potential to empower patients and limit pain associated with mobility and required daily activities. Rehabilitative approach may be particularly helpful for patients with refractory movement-associated pain and functional vulnerability, and for those who do not wish for, or cannot, tolerate pharmacoanalgesia.

Osteopathic manipulative treatment improves function and relieves pain in knee osteoarthritis: A single-blind, randomized-controlled trial

Objectives

In this study, we aimed to compare the efficacy of osteopathic manipulative treatment (OMT) to exercise treatment in the knee osteoarthritis (OA).

Patients and methods

A total of 100 patients (9 males, 76 females; mean age 54.8±8.5 years; range, 40 to 70 years) with Stage II-III bilateral knee OA enrolled to the study and randomized into two groups between January 2015 and June 2015. Group 1 performed exercise and received OMT and Group 2 performed exercise alone. We assessed the clinical parameters with Western Ontario MacMaster Questionnaire (WOMAC) pain score, WOMAC joint stiffness score, WOMAC physical function score, Visual Analog Scale (VAS) and 50-m walking time. All patients were assessed at the beginning of the study, just after the treatment, and four weeks after the treatment.

Results

There was no significant difference between groups in terms of physical examination and clinical assessment parameters before treatment. Functional improvement (p<0.05) and pain relief (p<0.05) were significantly higher in the exercise + OMT group.

Conclusion

Based on our study results, OMT is a particular treatment used by osteopathic physicians to complement conventional treatment of OA of the knee. In addition to the conservative treatment, OMT can be used.

Effective therapy to reduce edema after total knee arthroplasty Multi-layer compression therapy or standard therapy with cool pack - a randomized controlled pilot trial

Background: After total knee arthroplasty (TKA) efficient control and reduction of postoperative edema is of great importance. Aim: The aim of this pilot study (EKNZ 2014 – 225 DRKS00006271) was to investigate the effectiveness of multi-layer compression therapy (MLCT) to reduce edema in the early period after surgery compared to the standard treatment with Cool Pack. Methods: In this randomized controlled pilot trial, sixteen patients after TKA were randomized into an intervention group (IG) or a control group (CG). Circumferential measurements were used to assess edema. Secondary outcomes were range of motion (ROM), pain (numeric rating scale, NRS) and function as measured with the fast Self Paced Walking Test (fSPWT). Results: Clinically relevant differences in edema reduction between the two groups were found in the early postoperative period and at the six weeks follow up. Six days postoperatively the group time interaction (IE) in favor of the IG were −3.8 cm (95 % CI: −5.1; −2.4) when measured 10 cm proximal to the joint space and −2.7 cm (CI: −4.1; −1.3) when measured 5 cm proximally. We further observed differences in secondary outcomes in favor of the CG. Six days postoperatively the IE for knee flexion was –8.3 ° (CI: −22.0; 5.4) and for the fSPWT it was 12.8 seconds (CI: −16.4; 41.3). Six weeks postoperatively these differences diminished. Conclusions: The findings suggest that MLCT could be an alternative treatment to reduce postoperative edema in patients after total knee arthroplasty. Eventually possible negative effects on early knee flexion and function must be considered.

Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients

Background

In spite of the improvement of many aspects around Total knee arthroplasty (TKA), there is still a group of 10% to 34% of patients who is not satisfied with the outcome. The therapy of chronic pain after TKA remains a medical challenge that requires an interdisciplinary therapy concept. The aim of this prospective pilot study was to evaluate the efficacy of a multimodal pain therapy in chronic complaints after TKA.

Methods

In a prospective cohort pilot study, we included patients with chronic pain after TKA who obtained in-patient care, especially multimodal pain therapy (MMPT), for at least 10 days. Essential elements of this therapy concept were physiotherapy, pain medication therapy, topical application of ketamine, local infiltration and Traditional Chinese Medicine. Patients with varying causes of complaints were excluded in advance. Before the start of the study all test persons were informed and gave their written consent. Moreover, each patient was examined and questioned at hospital admission, discharge and at its first as well as second follow-up. Additionally, knee joint mobility and stability were investigated at all examination times.

Results

From 03/07/2016 to 07/14/2016, 21 patients were included in the pilot study. 52% of the considered population were female (11 persons). The median age was 65 years (45–79 years) and the median stay in hospital amounted 9 days (8–14 days). The first follow-up was scheduled after six weeks (median: 38 days, 30–112 days) and the second one after six months (median: 8 months, 7–12 months). The number of patients of the first follow-up was 17 out of 21 (19% drop out). The drop out of the last follow-up accounted for 33%. All patients benefit from the presented applications and therapies with regard to pain, function and range of motion. Especially, during the period of in-patient treatment, nearly all patients have improved in all terms. However, during the first follow-up clear deteriorations occurred in all areas, which stagnated up to the second follow-up. The range of motion has even worsened slightly.

Conclusions

With the presented pilot study on multimodal in-patient therapy of chronic complaints due to TKA, the improvement of pain, function and mobility could be verified, especially during the stationary stay. Even though the results deteriorate during the follow-up period, they did never relapse to their initial level. In order to ensure an effective treatment, a clear diagnostic algorithm is essential, by which treatable causes, such as low-grade infections or loosenings, are safely excluded. Further prospective studies are necessary to obtain precise statements on prospects of success of our therapy plan.

Pain management in total knee arthroplasty: efficacy of a multimodal opiate-free protocol

PURPOSE

this study was conducted to identify the most effective method of postoperative pain management, comparing the intravenous opiate infusion protocol with the use of a single periarticular local anesthetic infiltration (LAI) in patients undergoing total knee arthroplasty (TKA) surgery.

METHODS

50 patients submitted to TKA surgery between 2013 and 2015 were divided into two groups. Buprenorphine was administered intravenously to the patients in Group A, while the Group B patients received a single periarticular LAI (ropivacaine and ketorolac) during surgery. Pain was assessed using a visual analog scale (VAS) and the knee injury and osteoarthritis outcome score. Hemoglobin and hematocrit were measured in the early postoperative period and at 40 days post-surgery. Range of motion and inflammatory markers were also assessed. Statistical analysis was performed using Student's t-test.

RESULTS

student's t-test showed no significant difference between the groups in functional outcomes or blood values, but a difference in VAS score on the day of surgery was found (p < 0.0001), in favor of Group B.

CONCLUSIONS

LAI considerably reduces postoperative pain, allowing rapid mobilization and accelerating functional recovery.

LEVEL OF EVIDENCE

Level I, prospective single-blind randomized trial.

Lower Extremity Acute Bacterial Skin and Soft Tissue Infection Following Total Knee Arthroplasty

BACKGROUND

Although total knee arthroplasty (TKA) is one of the most common orthopedic procedures, its association with subsequent acute bacterial skin and soft tissue infections (ABSSTIs) in the ipsilateral limb has not been studied.

METHODS

This was a retrospective study of patients with prior unilateral TKA who were diagnosed with ABSSTI 4 weeks or more postoperatively in the absence of surgical site infection. The odds of ABSSTI in the TKA limb was compared to that of the contralateral "control" limb in the same patient in the presence or absence of local predisposing factors for ABSSTI in the lower extremities (e.g., chronic venous insufficiency).

RESULTS

Of 94 patients studied, 58 (62%) were women; mean age was 74.5 years. The mean body mass index was 33.1kg/m(2). One or more local predisposing factors were present in 53 (56.4%) patients. The mean interval between TKA and ABSSTI was 65.1 months (range: 1-239 months), with cellulitis alone diagnosed in 88 (94%) patients. ABSSTI involved the TKA limb of 68 (72.3%) patients and was significantly more likely to be diagnosed in the same limb in the absence of local predisposing factors (36 of 41 patients, odds ratio = 7.2, 95% CI: 2.8-23.5); the odds of TKA limb involvement was also higher in the presence of such factors but did not quite reach statistical significance (odds ratio = 1.5, 95% CI: 0.8-2.8).

CONCLUSIONS

TKA appears to predispose to ABSSTIs in the ipsilateral lower extremity often years after the procedure, particularly in the absence of other local factors.

Myofascial Pain Syndrome in the Elderly and Self-Exercise: A Single-Blind, Randomized, Controlled Trial

OBJECTIVE

This study aimed to demonstrate the effect of self-exercise with a therapeutic inflatable ball (SEIB) in elderly patients with myofascial pain syndrome.

DESIGN

Single-blind, randomized, controlled noninferiority trial.

SETTING

University campus.

PARTICIPANTS

Forty elderly patients with myofascial pain syndrome completed the study. They were randomly allocated to SEIB (n = 22; mean age, 70.23 ± 6.11 years) or ultrasound (US) therapy (n = 18; mean age, 67.99 ± 5.64 years).

INTERVENTION

SEIB and US therapy (twice weekly for 4 consecutive weeks).

OUTCOME MEASURES

Visual analog scale (VAS), pressure pain threshold (PPT), and cervical lateral flexion (CLF) were measured at baseline and at 1, 2, 3, and 4 weeks.

RESULTS

The noninferiority test indicated that SEIB was not inferior to US for VAS, PPT, and CLF. Between-group comparisons showed no significant differences in the VAS (F = 2.579; p = 0.117), the PPT (F = 0.245; p = 0.624), and the CLF (F = 2.072; p = 0.159). In within-group comparisons, both groups presented significant differences in VAS (SEIB after 1 week and US after 1 week), PPT (SEIB after 3 weeks and US after 4 weeks), and CLF (SEIB after 4 weeks and US after 4 weeks) compared with baseline values.

CONCLUSIONS

SEIB for 4 weeks has an effect similar to that of US for desensitizing myofascial pain and increasing joint flexibility. High accessibility and low cost would make SEIB a practical self-treatment method in elderly patients with myofascial pain syndrome.

The effect of mechanical massage on early outcome after total knee arthroplasty: a pilot study

[Purpose] The aim of this study was to evaluate the efficacy of mechanical massage via Endermologie^® after total knee arthroplasty in reducing edema and pain and improving knee range of motion, in the early postoperative period. [Subjects and Methods] Eighteen patients with knee edema following total knee arthroplasty were randomly assigned to the intervention group (n=8) or the control group (n=10). The intervention group received mechanical massage therapy using Endermologie^® and the control group received conventional physical therapy for 20 minutes a day, 5 times a week from the seventh day postsurgery. Clinical assessments included active knee flexion and extension range of motion, knee pain using a numeric rating scale, the operated limb circumference, the soft tissue cross-sectional area using ultrasonography, the extracelluar fluid volume, and single frequency bioimpedance analysis at 5 kHz using bioelectrical impedance spectroscopy. [Results] Both groups showed significant reduction in edema and pain, and improvement in active knee flexion at the end of treatment. There were no significant inter-group differences before or after treatment. [Conclusion] Mechanical massage could be an alternative way of managing knee edema after total knee arthroplasty in early postoperative recovery.

Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study

BACKGROUND

The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA.

METHODS

The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated.

RESULTS

BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8.

CONCLUSION

Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00627770.

Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain

PURPOSE

To provide an overview of rehabilitation medicine- and physical modality-based approaches to cancer pain management, and to highlight the fact that these approaches are generally used in conjunction and that a majority are focused on minimizing pain during periods of mobility and the performance of activities of daily living.

METHODS

We performed a nonsystematic literature review and provide a description of the current standard of care.

RESULTS

Rehabilitative and physical modalities used to manage pain can be grouped into four categories: those that modulate nociception, stabilize or unload painful structures, influence physiological processes that indirectly influence nociception, or alleviate pain arising from the overloading of muscles and connective tissues that often occurs after surgery or with sarcopenia in late-stage cancer. Most modalities have been pragmatically refined over the years, and many have an evidence base, although few have been explicitly validated in the oncologic setting. With few exceptions, they are patient controlled and free of adverse effects.

CONCLUSION

Physical modalities and rehabilitation medicine offer a range of pain management approaches that may serve as beneficial adjuncts to the conventional systemic and interventional analgesic strategies used to control cancer-related pain. These approaches may be particularly beneficial to patients with movement-associated pain and those who are ambivalent regarding pharmacoanalgesia.