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Alacreu-Crespo A, Innamorati M, Courtet P, Fiorillo A, Pompili M. Are visual analogue scales valid instruments to measure psychological pain in psychiatric patients? J Affect Disord 2024; 358:150-156. [PMID: 38705528 DOI: 10.1016/j.jad.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The Psychological-Physical-Pain Visual Analogue Scale (PPP-VAS) was thought to probably help in identifying patients at risk of suicide. However, no data on its validity to measure psychological pain was available. Our main aim was to investigate the convergent validity of the PPP-VAS using two well-validated scales of psychological pain, the Orbach and Mikulincer Mental Pain scale (OMMP) and the Holden et al. Psychache Scale. METHODS This multicentre study recruited a total of 1618 adult psychiatric inpatients and outpatients in Italy. Psychological pain was evaluated using the OMMP, Holden et al., and PPP-VAS scales. Psychiatric status, suicidal status, physical pain, depression, and hopelessness were also assessed. RESULTS A structural equation model (SEM) using the items of psychological pain from the PPP-VAS showed that items loaded significantly on the psychological pain factor and showed good fit. Similarly, a second SEM model using the three scales of psychological pain showed acceptable fit and converged into a psychological pain construct. Correlations between the PPP-VAS and depression, hopelessness, and physical pain showed moderate correlations (r = 0.43 to r = 0.67). Finally, psychological pain evaluated with the PPP-VAS was significantly related with recent suicidal ideation in all patients (OR [95 % CI] = 1.07 [1.05, 1.09]) and recent suicide attempts in moderately to severely depressed patients, OR [95 % CI] = 1.01 [1.02, 1.03]. CONCLUSION The PPP-VAS showed good psychometric properties in evaluating psychological pain. The characteristics of the PPP-VAS makes this scale a great option for its use in clinical practice to detect patients at risk of suicide.
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Affiliation(s)
- Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, University of Zaragoza, Teruel, Spain.
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapieza University of Rome, Rome, Italy
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Butera KA, Chimenti RL, Alsouhibani AM, Berardi G, Booker SQ, Knox PJ, Post AA, Merriwether EN, Wilson AT, Simon CB. Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the "Pain-Movement Interface" to Guide Research and Clinical Care for Musculoskeletal Pain Conditions. THE JOURNAL OF PAIN 2024; 25:104486. [PMID: 38316243 PMCID: PMC11180580 DOI: 10.1016/j.jpain.2024.01.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the "Pain-Movement Interface" as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PERSPECTIVE: Movement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the "Pain-Movement Interface" as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.
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Affiliation(s)
- Katie A. Butera
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ali M. Alsouhibani
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Andrew A. Post
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ericka N. Merriwether
- Department of Physical Therapy, NYU Steinhardt School of Culture, Education, and Human Development, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Abigail T. Wilson
- School of Kinesiology & Rehabilitation Sciences, University of Central Florida, Orlando, Florida, USA
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Vuran BŞ, Altunalan T. Musculoskeletal pain intensity and perceptions during distance learning: A cross-sectional study. Clin Anat 2024; 37:578-586. [PMID: 38546148 DOI: 10.1002/ca.24163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/09/2024] [Accepted: 03/21/2024] [Indexed: 06/09/2024]
Abstract
Technological developments and the pandemic have popularized the distance learning model at universities. In this educational model, students spend more time in front of screens, and screen-related health conditions have become important. This cross-sectional study of 177 undergraduate students was designed to investigate the effect of block and traditional scheduling in online distance education (ODE) on their musculoskeletal pain and to investigate their perceptions of block scheduling. A two-stage method was used: a quantitative design to compare pain levels, and a qualitative design to determine the students' perceptions of block scheduling using an online survey. Pain intensity was assessed using the Numeric Rating Scale (NRS-11). Data were collected in the university health sciences department. Pain intensity following the block and traditional lessons was analyzed using a paired t-test. Students in the block schedule had significantly more pain, with a large effect size on the whole trunk and upper limbs. Pain levels were also clinically meaningful for the upper (5.73 ± 2.75), lower (5.59 ± 2.87), and neck (4.92 ± 2.60) regions. Students reported positive experiences with block scheduling in ODE such as saving time (43%) and maintaining subject integrity (26%), but also negative experiences such as distraction (56%), fatigue (33%), pain (17%), and boredom (11%). Block scheduling in ODE could cause clinically significant neck and back pain. In distance learning, keeping the course duration short and ensuring student mobility in the classroom are important.
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Affiliation(s)
- Burak Şevket Vuran
- Department of Physical Therapy and Rehabilitation, Uskudar University, İstanbul, Turkey
| | - Turgay Altunalan
- Department of Physical Therapy and Rehabilitation, Karadeniz Technical University, Üniversite Mah, Trabzon, Turkey
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Zhou X, Liu Y, Chen S, Xiang J, Li J, Li J, You T, Zhong Z, Zhang K. Increased water content in multifidus muscles of young adults with chronic nonspecific low back pain detected by dual-energy CT and MRI. Eur J Radiol 2024; 176:111515. [PMID: 38772163 DOI: 10.1016/j.ejrad.2024.111515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES To demonstrate the feasibility of better diagnosing young adults with chronic nonspecific low back pain (CNLBP) by measuring water content in paraspinal muscles using water-muscle decomposition technique in dual-energy CT (DECT) and T2-mapping in MRI. METHODS This prospective cross-sectional study included 110 young individuals (56 with CNLBP at age of 25.7 ± 2.0 years and 54 of asymptomatic at age of 25.1 ± 1.9 years) who underwent both MRI and DECT on the spine. T2 values on T2 mapping in MRI and water density (WD) value on water(muscle) images in DECT were generated at the L1-L4 levels for erector spinae muscle and L2-L5 for multifidus muscle. Pain duration time, Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) were recorded for CNLBP patients. Difference of T2 value and WD between the two patient groups, and correlations between T2 value and WD, and T2 value and WD with clinical indicators were analyzed. RESULTS Compared with asymptomatic participants, the mean WD of multifidus muscle at L4-L5 and mean T2 values of multifidus muscle at L5 were significantly higher in CNLBP patients (all P < 0.05). T2 values had moderate to strong positive correlations (r = 0.34-0.60, all P < 0.05) with DECT WD in CNLBP patients and healthy volunteers. There was a weak correlation between VAS and WD in L5-level multifidus muscle (r = 0.29, P < 0.05). CONCLUSIONS The T2 values in MRI and WD in DECT are higher in multifidus muscles of lower vertebra levels for young CNLBP patients, and there exists positive correlation between WD and T2 values, providing useful information for diagnosing CNLBP.
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Affiliation(s)
- Xiaona Zhou
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China; First Clinical College of Traditional Chinese Medicine, Hunan University of Traditional Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha, Hunan 410208, PR China
| | - Yinqi Liu
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Suping Chen
- GE Healthcare (Shanghai) Co., Ltd., Shanghai 201203, PR China
| | - Jian Xiang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China; First Clinical College of Traditional Chinese Medicine, Hunan University of Traditional Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha, Hunan 410208, PR China
| | - Jianying Li
- GE Healthcare (Shanghai) Co., Ltd., Shanghai 201203, PR China
| | - Jianyu Li
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Tian You
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Zeya Zhong
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Kun Zhang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China; College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China.
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Callen EF, Lutgen CB, Robertson E, Loskutova NY. Assessment and management patterns for chronic musculoskeletal pain in the family practice setting. J Bodyw Mov Ther 2024; 39:50-56. [PMID: 38876675 DOI: 10.1016/j.jbmt.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Chronic pain affects 11% of the US population. Most patients who experience pain, particularly chronic musculoskeletal pain, seek care in primary care settings. Assessment of the patient pain experience is the cornerstone to optimal pain management; however, pain assessment remains a challenge for medical professionals. It is unknown to what extent the assessment of pain intensity is considered in context of function and quality of life. OBJECTIVE To understand common practices related to assessment of pain and function in patients with chronic musculoskeletal disorders. DESIGN Cross-sectional survey. METHODS A 42-item electronic survey was developed with self-reported numeric ratings and responses related to knowledge, beliefs, and current practices. All physicians and non-physician clinicians affiliated with the AAFP NRN and 2000 AAFP physician members were invited to participate. RESULTS/FINDINGS Primary care clinicians report that chronic joint pain assessment should be comprehensive, citing assessment elements that align with the comprehensive pain assessment models. Pain intensity remains the primary focus of pain assessment in chronic joint pain and the most important factor in guiding treatment decisions, despite well-known limitations. Clinicians also report that patients with osteoarthritis should be treated by Family Medicine. CONCLUSIONS Pain assessment is primarily limited to pain intensity scales which may contribute to worse patient outcomes. Given that most respondents believe primary care/family medicine should be primary responsible for the care of patients with osteoarthritis, awareness of and comfort with existing guidelines, validated assessment instruments and the comprehensive pain assessment models could contribute to delivery of more comprehensive care.
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Affiliation(s)
- Elisabeth F Callen
- American Academy of Family Physicians, Leawood, KS, 66211, USA; DARTNet Institute, Aurora, CO, 80045, USA.
| | - Cory B Lutgen
- American Academy of Family Physicians, Leawood, KS, 66211, USA; DARTNet Institute, Aurora, CO, 80045, USA
| | - Elise Robertson
- American Academy of Family Physicians, Leawood, KS, 66211, USA; DARTNet Institute, Aurora, CO, 80045, USA
| | - Natalia Y Loskutova
- American Academy of Family Physicians, Leawood, KS, 66211, USA; University of Kansas Medical Center, Kansas City, KS, 66160, USA
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Suri P, Heagerty PJ, Timmons A, Jensen MP. Description and initial validation of a novel measure of pain intensity: the Numeric Rating Scale of Underlying Pain without concurrent Analgesic use. Pain 2024; 165:1482-1492. [PMID: 38189184 PMCID: PMC11189761 DOI: 10.1097/j.pain.0000000000003150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACT Although many individuals with chronic pain use analgesics, the methods used in many randomized controlled trials (RCTs) do not sufficiently account for confounding by differential post-randomization analgesic use. This may lead to underestimation of average treatment effects and diminished power. We introduce (1) a new measure-the Numeric Rating Scale of Underlying Pain without concurrent Analgesic use (NRS-UP (A) )-which can shift the estimand of interest in an RCT to target effects of a treatment on pain intensity in the hypothetical situation where analgesic use was not occurring at the time of outcome assessment; and (2) a new pain construct-an individuals' perceived effect of analgesic use on pain intensity (E A ). The NRS-UP (A) may be used as a secondary outcome in RCTs of point treatments or nonpharmacologic treatments. Among 662 adults with back pain in primary care, participants' mean value of the NRS-UP (A) among those using analgesics was 1.2 NRS points higher than their value on the conventional pain intensity NRS, reflecting a mean E A value of -1.2 NRS points and a perceived beneficial effect of analgesics. More negative values of E A (ie, greater perceived benefit) were associated with a greater number of analgesics used but not with pain intensity, analgesic type, or opioid dose. The NRS-UP (A) and E A were significantly associated with future analgesic use 6 months later, but the conventional pain NRS was not. Future research is needed to determine whether the NRS-UP (A), used as a secondary outcome may allow pain RCTs to target alternative estimands with clinical relevance.
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Affiliation(s)
- Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Patrick J. Heagerty
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Andrew Timmons
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Pires D, Duarte S, Rodrigues AM, Caeiro C, Canhão H, Branco J, Alves J, Marques M, Aguiar P, Fernandes R, Sousa RD, Cruz EB. MyBack - effectiveness and implementation of a behavior change informed exercise programme to prevent low back pain recurrences: a hybrid effectiveness-implementation randomized controlled study protocol. BMC Musculoskelet Disord 2024; 25:440. [PMID: 38840084 PMCID: PMC11151631 DOI: 10.1186/s12891-024-07542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a common health condition and the leading cause of years lived with disability worldwide. Most LBP episodes have a favourable prognosis, but recurrences within a year are common. Despite the individual and societal impact related to LBP recurrences, there is limited evidence on effective strategies for secondary prevention of LBP and successful implementation of intervention programmes in a real-world context. The aim of this study is to analyse the effectiveness of a tailored exercise and behavioural change programme (MyBack programme) in the secondary prevention of LBP; and evaluate acceptability, feasibility and determinants of implementation by the different stakeholders, as well as the implementation strategy of the MyBack programme in real context. METHODS This protocol describes a hybrid type I, randomized controlled trial to evaluate the effectiveness and implementation of MyBack programme in the context of primary health care. The Behaviour Change Wheel framework and FITT-VP principles will inform the development of the behaviour change and exercise component of MyBack programme, respectively. Patients who have recently recovered from an episode of non-specific LBP will be randomly assigned to MyBack and usual care group or usual care group. The primary outcome will be the risk of LBP recurrence. The secondary outcomes will include disability, pain intensity, musculoskeletal health, and health-related quality of life. Participants will be followed monthly for 1 year. Costs data related to health care use and the MyBack programme will be also collected. Implementation outcomes will be assessed in parallel with the effectiveness study using qualitative methods (focus groups with participants and health providers) and quantitative data (study enrolment and participation data; participants adherence). DISCUSSION To our knowledge, this is the first study assessing the effectiveness and implementation of a tailored exercise and behaviour change programme for prevention of LBP recurrences. Despite challenges related to hybrid design, it is expected that data on the effectiveness, cost-effectiveness, and implementation of the MyBack programme may contribute to improve health care in patients at risk of LBP recurrences, contributing to direct and indirect costs reduction for patients and the health system. TRIAL REGISTRATION NUMBER NCT05841732.
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Affiliation(s)
- Diogo Pires
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal.
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Susana Duarte
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- EpiDoC Unit, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
- Unidade de Reumatologia, Hospital dos Lusíadas, Lisboa, Portugal
| | - Carmen Caeiro
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- EpiDoC Unit, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
- Unidade de Reumatologia, CHULC Hospital Santo António dos Capuchos, Lisboa, Portugal
| | - Jaime Branco
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- EpiDoC Unit, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
- Serviço de Reumatologia do Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Marta Marques
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Pedro Aguiar
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Rita Fernandes
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- LBMF, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Dafundo, Portugal
| | - Rute Dinis Sousa
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Eduardo B Cruz
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Yan P, Duan X, Lei Y, Xing F, Cao R, Luo S, Chen Y, Liu Z, Wang K, Yang P, Tian R. Robot-assisted total knee arthroplasty system provides more precise control of the femoral rotation angle: A retrospective study. Int J Med Robot 2024; 20:e2635. [PMID: 38733580 DOI: 10.1002/rcs.2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/21/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Rotational alignment in total knee arthroplasty (TKA) is a crucial technical point that needs attention. We conducted a retrospective study to investigate whether a new robot-assisted TKA (RA-TKA) could improve the accuracy of rotational alignment and whether rotational alignment affects postoperative pain and functional evaluation of the knee. METHODS A total of 136 consecutive patients who underwent TKA were included in this study. Half of the patients underwent RA-TKA and the other half underwent conventional TKA (CON-TKA) by the same group of surgeons. Collect the relevant parameters. RESULTS The postoperative femoral rotation angle (FRA) was -0.72 ± 2.59° in the robot-assisted group and 1.13 ± 2.73° in the conventional group, and were statistically significantly different (p < 0.001). CONCLUSION This study provides preliminary evidence that the RA-TKA provides more precise control of FRA than CON-TKA, and verifies that tibial rotation angle and combined rotation angle affect postoperative knee pain and functional evaluation.
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Affiliation(s)
- Peng Yan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Xudong Duan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Yutian Lei
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Fangze Xing
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Sen Luo
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Yang Chen
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Zeyu Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, China
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Padilha Silva J, Gonzaga AA, Gonçalves RSDSA, Tavares LF, Maciel ÁCC, Figueiredo-Ribeiro KMOB. Craniocervical Pain, Sleep Quality, Depressive Symptoms, and Physical Activity in Healthcare Workers During COVID-19 Pandemic. Pain Manag Nurs 2024; 25:e230-e235. [PMID: 38429200 DOI: 10.1016/j.pmn.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/08/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND An increase in the workload and use of personal protective equipment by healthcare workers was observed during the COVID-19 pandemic. Due to the connections between craniocervical structures, symptoms such as neck pain and temporomandibular symptoms could be influenced by the use of PPE. AIMS To assess the prevalence of craniocervical pain, sleep quality, physical activity, and depressive symptoms and relationship among craniocervical symptoms in healthcare workers before and during the COVID-19 pandemic in Brazil. DESIGN Cross-sectional study. PARTICIPANTS Healthcare workers. SETTINGS An online questionnaire included a self-report of craniocervical pain intensity [orofacial pain, neck pain, and headache (Numerical Rating Scale)], sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Patient Health Questionnaire two items) and physical activity (self-report). METHODS The sample analysis was performed by descriptive statistics, the paired t-test was used to compare symptoms intensity before and during the pandemic. The relationship between dependent and independent samples was assessed through McNemar test, Pearson's chi-squared test, and Student's independent t-test. A value of p < .05 was adopted as statistical significance. RESULTS Overall, 147 participants replied the questionnaires. Headache, neck pain, and orofacial pain complaints increased during the pandemic in healthcare workers (p < 0.001). Craniocervical pain was correlated with poor sleep quality, probable depression, and physical activity during the pandemic (p < 0.05). CONCLUSION Healthcare workers self-reported more craniocervical pain during the COVID-19 pandemic compared to before the pandemic. In addition, poor sleep quality, depressive symptoms, and physical inactivity were associated with craniocervical symptoms during this period.
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Affiliation(s)
- Jade Padilha Silva
- From the Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Anita Almeida Gonzaga
- From the Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | - Luiz Felipe Tavares
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), Brazil
| | - Álvaro Campos Cavalcanti Maciel
- From the Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil; Postgraduate program in Physical Therapy (PPGFST), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Karyna Myrelly Oliveira Bezerra Figueiredo-Ribeiro
- From the Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil; Postgraduate program in Physical Therapy (PPGFST), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.
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10
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Studnicki R, Szymczyk P, Adamczewski T, Studzińska K, Hansdorfer-Korzon R, Silva AF, Kawczyński A. Manual traction is effective in alleviating lumbosacral spine pain: Evidence from a randomized controlled trial. Heliyon 2024; 10:e31013. [PMID: 38799754 PMCID: PMC11126845 DOI: 10.1016/j.heliyon.2024.e31013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background Manual traction, a therapeutic technique frequently employed in healthcare, involves applying controlled pulling force by hand, usually to the spine, to stretch muscles and decompress joints, thereby alleviating pain. This method can be particularly beneficial for addressing lumbosacral spine pain exacerbated by radicular symptoms, characterized by pain radiating from the lower back due to compression or irritation of spinal nerves. Purpose This study aimed to compare the effects of manual traction against control group in alleviating the lumbosacral spine pain caused by radicular symptoms. Methods A randomized controlled study design was utilized with a sample of 60 patients experiencing lumbosacral spine pain, evenly distributed between an experimental group (n = 30; receiving manual traction) and a control group (n = 30). Patients underwent assessments before and after six treatment sessions, which included the Straight Leg Raise test, modified Bragard's test, Kernig's test, and the visual analogue scale for pain perception. Results Between-group significant differences were found at post-intervention, favoring the experimental group on SLR - Left (°) (p = 0.004; medium effect size), SLR - Right (°) (p = 0.004; medium effect size), Modified Bragard test - Left (°) (p = 0.024; small effect size), Modified Bragard test - Right (°) (p = 0.003; medium effect size), Kernig's Test - Left (°) (p = 0.013; medium effect size) and Kernig's Test - Right (°) (p = 0.010; medium effect size). Additionally, between-group significant differences were found at post-intervention, favoring the experimental group on VAS scores at SLR left (p < 0.001; medium effect size), and right (p < 0.001); medium effect size, Modified Bragard test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size) and at Kernig's Test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size). Conclusions In conclusion, manual traction is recommended as an effective approach for alleviating lumbosacral spine pain in patients experiencing symptoms resulting from irritation or compression of a spinal nerve root.
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Affiliation(s)
- Rafał Studnicki
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Szymczyk
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Adamczewski
- Medical Rehabilitation Clinic, Chair of Rehabilitation, Faculty of Health Sciences, Medical University of Lódź, Łódź, Poland
| | | | | | - Ana Filipa Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, Viana do Castelo, Portugal
| | - Adam Kawczyński
- Wrocław University of Health and Sport Sciences, Departament of Paralympic Games, Wrocław, Poland
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11
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An B, Ren B, Liu Y, Han Z, Wu J, Mao K, Liu J. Clinical efficacy and complications of MIS-TLIF and TLIF in the treatment of upper lumbar disc herniation: a comparative study. J Orthop Surg Res 2024; 19:317. [PMID: 38807137 PMCID: PMC11134683 DOI: 10.1186/s13018-024-04806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The optimal treatment modality for upper lumbar disc herniation remains unclear. Herein, we compared the clinical efficacy and application value of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and transforaminal lumbar interbody fusion (TLIF) for upper lumbar disc herniation. We aimed to provide new evidence to guide surgical decisions for treating this condition. METHODS We retrospectively analyzed the clinical data of 81 patients with upper lumbar disc herniation admitted between January 2017 and July 2018, including 41 and 40 patients who underwent MIS-TLIF and TLIF, respectively. Demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared. We performed consecutive comparisons of visual analog scale (VAS) scores of the lumbar and leg regions, Oswestry disability index (ODI), Japanese Orthopaedic Association scores (JOA), and MacNab scores at the final follow-up, to assess clinical outcomes 5 years postoperatively. RESULTS VAS scores of the back and legs were significantly lower in the MIS-TLIF than the TLIF group at 3 months and 1 year postoperatively (P < 0.05). Intraoperative bleeding and postoperative hospitalization time were significantly lower, and the time to return to work/normal life was shorter in the MIS-TLIF than in the TLIF group (P < 0.05). The differences in JOA scores and ODI scores between the two groups at 3 months, 1 year, and 3 years postoperatively were statistically significant (P < 0.05). CONCLUSION The early clinical efficacy of MIS-TLIF was superior to that of TLIF, but no differences were found in mid-term clinical efficacy. Further, MIS-TLIF has the advantages of fewer medical injuries, shorter hospitalization times, and faster postoperative functional recovery.
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Affiliation(s)
- Bochen An
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Bowen Ren
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Yihao Liu
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Zhenchuan Han
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Jianhui Wu
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Keya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Jianheng Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
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12
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Osaki JD, Oliveira MAP. What Is Behind? Impact of Pelvic Pain on Perceived Stress and Inflammatory Markers in Women with Deep Endometriosis. J Clin Med 2024; 13:2927. [PMID: 38792467 PMCID: PMC11122144 DOI: 10.3390/jcm13102927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction/Objectives: Endometriosis affects 10% of women worldwide. It is noteworthy that this condition is often accompanied by pelvic pain and stress. Endometriosis is a debilitating gynecological condition where tissue similar to the uterine lining grows outside the uterus, often causing significant pain and reproductive issues. We aimed to study the relationship between the intensity of pelvic pain, and stress and inflammatory markers in women with deep endometriosis. Methods: This cross-sectional study analyzed women diagnosed with deep endometriosis through imaging, surgery, and/or biopsy. We assessed pain using the Numerical Rating Scale (NRS). Stress was assessed with the Perceived Stress Scale (PSS-10) questionnaire and the serum cortisol levels. Additionally, we analyzed inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Fifty-two women, with an average age of 37.8 ± 6.9 years, participated in this study. Forty-four percent of these participants demonstrated high levels of stress, as indicated by scores above 26 on the PSS-10. Those categorized with "high stress" on the PSS-10 questionnaire exhibited significantly higher pain levels compared to those with "low stress" (p < 0.05). Furthermore, patients experiencing more-severe pelvic pain (pain score > 7) had notably higher serum cortisol levels. Women with intense pelvic pain (scores above 7 on the NRS) had significantly elevated serum cortisol levels (Cohen's d = 0.72; p = 0.018). Conclusions: A positive association was found between stress levels and the intensity of pelvic pain in women with deep endometriosis, suggesting an interconnection between emotional aspects and biological responses.
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Affiliation(s)
- Jordana Diniz Osaki
- Núcleo Avançado de Endometriose e Robótica, Hospital DF Star, Brasília 70390-140, Brazil
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13
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Ekhammar A, Grimby-Ekman A, Bernhardsson S, Holmgren K, Bornhöft L, Nordeman L, Larsson MEH. Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care. Disabil Rehabil 2024:1-14. [PMID: 38738694 DOI: 10.1080/09638288.2024.2343424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. METHODS Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. RESULTS The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078-0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. CONCLUSIONS The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.
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Affiliation(s)
- Annika Ekhammar
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Primary Care Rehabilitation, Närhälsan Eriksberg, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- Chronic Pain, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Kristina Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Bornhöft
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
- Region Västra Götaland, Primary Care Rehabilitation, Närhälsan Torslanda, Gothenburg, Sweden
| | - Lena Nordeman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Borås, Sweden
| | - Maria E H Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
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14
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Truong K, Meier K, Ahrens LC, Wichmann TO, Zaer H, Tiroke LH, Arvin S, Bazys M, Duel P, Gudmundsdottir G, Carlsen JG, Nikolajsen L, van Tulder M, Sørensen JCH, Rasmussen MM. Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial. RMD Open 2024; 10:e004196. [PMID: 38724261 PMCID: PMC11086270 DOI: 10.1136/rmdopen-2024-004196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE A comparison of cryoneurolysis or radio frequency (RF) with placebo in patients with facetogenic chronic low back pain (LBP) for patient global impression of change (PGIC), pain intensity, function and quality of life, with 1-year follow-up. DESIGN Single-centre, single-blinded placebo-controlled randomised controlled trial. SETTING Single-centre study. PARTICIPANTS Inclusion from March 2020 to September 2022: consenting adults over 18 years of age, LBP>3 months, average Numeric Rating Scale LBP≥4 average last 14 days and a positive response to a diagnostic medial branch block (>50% pain reduction after 60 min). INTERVENTIONS 120 patients were block randomised 1:1:1 to cryoneurolysis, RF or placebo of the medial branch nerves. Physical therapy was added after 4 weeks for all groups. MAIN OUTCOME MEASURES Primary outcome was PGIC 4 weeks after the intervention. Secondary outcomes included pain intensity (Numeric Rating Scale, NRS), quality of life (Short Form 36, EQ-5D-5L), disability (Oswestry Disability Index), depression (Major Depression Inventory) and catastrophising (Pain Catastrophising Scale). Outcomes were measured at 4 weeks, 3, 6 and 12 months. RESULTS There was no statistically significant difference in PGIC at 4 weeks between cryoneurolysis and placebo (risk ratio (RR) 2; 95% CI 0.75 to 5.33, p=0.17) and RF and placebo (RR 1.6; 95% CI 0.57 to 4.49, p=0.37), except PGIC for cryoneurolysis at 6-month follow-up (RR 5.1; 95% CI 1.20 to 22.03, p=0.03). No statistically significant differences were found in secondary follow-up endpoints. CONCLUSIONS Denervation of the medial branch nerve by either cryoneurolysis or RF compared with placebo did not demonstrate significant improvement in PGIC, pain intensity, function and quality of life in patients with facetogenic chronic LBP at short-term or long-term follow-up. TRIAL REGISTRATION NUMBER NCT04786145.
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Affiliation(s)
- Kamilla Truong
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Meier
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Cramer Ahrens
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thea Overgaard Wichmann
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hamed Zaer
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lasse Hubertus Tiroke
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Arvin
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mindaugas Bazys
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Duel
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lone Nikolajsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Anesthesiology, Aarhus University, Aarhus, Denmark
| | - Maurits van Tulder
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikkel Mylius Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Flores HN, Tamujo AC, Cetolin T, Ribeiro-Alvares JB, de Noronha M, Baroni BM, Haupenthal A. Muscle Pain Code: a novel tool for screening the risk of time-loss muscle injury in professional male football players. PHYSICIAN SPORTSMED 2024:1-6. [PMID: 38651766 DOI: 10.1080/00913847.2024.2346463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To investigate the association of a novel post-match muscle pain map, named Muscle Pain Code (MPC), with the risk of subsequent time-loss muscle injury in a cohort of professional football (soccer) players. METHODS The MPC classifies pain in four codes: code 0, 'no pain;' code 1, 'generalized muscle pain;' code 2, 'diffused site muscle pain;' and code 3, 'specific site muscle pain.' Over four consecutive seasons, MPC was collected on the second post-match day and players were followed for occurrence of time-loss muscle injury over the next five days. Players exposed to at least 45 minutes in two consecutive matches within seven days were included as cases for analysis. RESULTS Eighty players participated in the study. Of 1,656 cases analyzed, 229 resulted in time-loss muscle injuries. Only 2% of cases with codes 0 and 1 resulted in time-loss muscle injuries. Conversely, 63% and 78% of codes 2 and 3 were followed by time-loss muscle injuries, respectively. Compared with the reference scenario (i.e. code 0 on MPC), the risk of subsequent time-loss muscle injury was significantly higher when players recorded code 2 (odds ratio, 4.29; 95%CI, 3.62 to 4.96) or code 3 (odds ratio, 5.01; 95%CI, 4.05 to 5.98) on MPC, but not when they recorded code 1 (odds ratio = -0.27; 95%CI, 1.05 to 0.56). CONCLUSIONS Players experiencing well-outlined pain area on the second post-match day were more likely to incur a time-loss muscle injury in the subsequent days compared to those experiencing spreading pain or no pain.
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Affiliation(s)
- Hebert Nunes Flores
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Augusto Camillo Tamujo
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Tiago Cetolin
- Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - João Breno Ribeiro-Alvares
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcos de Noronha
- Department of Community and Allied Health, La Trobe University, Melbourne, VIC, Autralia
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Alessandro Haupenthal
- Graduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil
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16
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Chen Z, Tirosh O, Han J, Adams R, El-Ansary D, Pranata A. Lower Limb Proprioception in Low Back Pain and Its Relationship With Voluntary Postural Control. J Mot Behav 2024:1-12. [PMID: 38697938 DOI: 10.1080/00222895.2024.2341712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
This study aimed to investigate whether patients with low back pain (LBP) had impaired lower limb proprioception and its association with somatosensory acuity. Thirty patients with LBP and 30 asymptomatic people volunteered, using Sway Discrimination Apparatus tests to assess somatosensory acuity during voluntary anteroposterior and mediolateral postural sway. Results showed significantly reduced somatosensory acuity in mediolateral sway in LBP patients (p = 0.005) with ankle, knee, and hip proprioception showing significantly impairment compared to asymptomatic controls (all p ≤ 0.012). Regression analysis showed that ankle and hip proprioception were significantly associated with somatosensory perception (0.001 ≤ p ≤ 0.026, 0.067 ≤ R2≤ 0.235). Overall, findings suggested a global deterioration of lower limb proprioception in LBP patients, with ankle and hip proprioception playing crucial role in somatosensory perception.
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Affiliation(s)
- Zhengquan Chen
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Oren Tirosh
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jia Han
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Roger Adams
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Doa El-Ansary
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Department of Surgery, Melbourne Medical School, Melbourne, VIC, Australia
| | - Adrian Pranata
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC, Australia
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17
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Desgagnés A, Côté-Picard C, Gaumond A, Langevin P, Piché M, Pagé G, Pinard AM, Tousignant-Laflamme Y, Massé-Alarie H. Efficacy of a Psychologically-Informed Physiotherapy Intervention in Patients with Chronic Low Back Pain at High Risk of Poor Prognosis: A Pilot and Feasibility Randomized Controlled Trial. Physiother Can 2024; 76:163-174. [PMID: 38725600 PMCID: PMC11078249 DOI: 10.3138/ptc-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 05/12/2024]
Abstract
Purpose To determine the feasibility of a randomized controlled trial (RCT) testing the efficacy of psychologically-informed physiotherapy (PIPT), which includes usual physiotherapy (UP) interventions, compared with UP, and to explore the preliminary effectiveness of the interventions. Method People with chronic low back pain at high risk of poor prognosis (using the STarT Back screening tool) were recruited and allocated to PIPT or UP. Effectiveness of recruitment strategies, adherence to intervention, risk of contamination, and specific challenges were assessed. Functional capacity, pain, quality of life, kinesiophobia, catastrophization, central sensitization, and self-efficacy were measured at baseline, 6-, 12- and 24-week follow-ups. Results Forty participants were recruited mainly by diffusing through Laval University's email list, and 10 physiotherapists treated the participants recruited. The retention rate of participants at 24 weeks was 72.5%. Adherence to treatment by participants and physiotherapists was very good. The risk of contamination was low, and the specific challenges identified were modifiable. Significant improvement over time in all clinical variables of interest, except self-efficacy, was observed with no difference between groups. Conclusions As most success criteria were met, conducting an RCT evaluating PIPT and PU is feasible with modifications. PIPT and UP appear to be similarly effective.
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Affiliation(s)
| | | | - Alain Gaumond
- Base militaire de Valcartier, Shannon, Quebec, Canada
| | - Pierre Langevin
- From the:
Cirris, Université Laval, Quebec City, Canada
- Chaire de recherche internationale en santé neuromusculosquelettique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mathieu Piché
- Chaire de recherche internationale en santé neuromusculosquelettique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Montréal, Quebec, Canada
| | - Anne-Marie Pinard
- From the:
Cirris, Université Laval, Quebec City, Canada
- Centre d’expertise en Gestion de la Douleur Chronique, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Hugo Massé-Alarie
- From the:
Cirris, Université Laval, Quebec City, Canada
- School of Rehabilitation Sciences, Université Laval, Quebec City
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18
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Farragher JB, Pranata A, Williams GP, El-Ansary D, Parry SM, Clark RA, Mentiplay B, Kasza J, Crofts S, Bryant AL. Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:1-10. [PMID: 38497906 DOI: 10.2519/jospt.2024.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349.
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Hung KKC, Lam RPK, Lee HKH, Choi YF, Tenney J, Zuo Z, Chong MKC, Hui TSI, Wong TK, Yiu TY, Chan SY, Mok CPY, Leung LY, Mak WK, Sun DTF, Cheng CH, Graham CA. Comparison of diclofenac with tramadol, tizanidine or placebo in the treatment of acute low back pain and sciatica: multi-center randomized controlled trial. Postgrad Med J 2024:qgae052. [PMID: 38679808 DOI: 10.1093/postmj/qgae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Low back pain (LBP) is a leading cause of disability worldwide and has posed numerous health and socioeconomic challenges. This study compared whether nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with tramadol, tizanidine or placebo would be the best treatment regime to improve the Roland Morris Disability Questionnaire (RMDQ) scores at 1 week. METHODS This was a multi-center, double-blind, randomized, and placebo-controlled trial including adult patients with acute LBP and sciatica in three emergency departments in Hong Kong. Patients were randomized to the receive tramadol 50 mg, tizanidine 2 mg, or placebo every 6 hours for 2 weeks in a 1:1:1 ratio. The RMDQ and other secondary outcomes were measured at baseline, Day 2, 7, 14, 21, and 28. Data were analyzed on an intention to treat basis. Crude and adjusted mean differences in the changes of RMDQ and NRS scores from baseline to Day 7 between tizanidine/tramadol and placebo were determined with 95% confidence intervals. RESULTS Two hundred and ninety-one patients were analyzed with the mean age of 47.4 years and 57.7% were male. The primary outcome of mean difference in RMDQs on Day 7 (compared with baseline) was non-significant for tizanidine compared with placebo (adjusted mean difference - 0.56, 95% CI -2.48 to 1.37) and tramadol compared with placebo (adjusted mean difference - 0.85, 95% CI -2.80 to 1.10). Only 23.7% were fully compliant to the treatment allocated. Complier Average Causal Effect analysis also showed no difference in the primary outcome for the tizanidine and tramadol versus placebo. CONCLUSION Among patients with acute LBP and sciatica presenting to the ED, adding tramadol or tizanidine to diclofenac did not improve functional recovery.
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Affiliation(s)
- Kevin K C Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Accident & Emergency Department, Prince of Wales Hospital, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Rex P K Lam
- Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, G06, G/F, University of Hong Kong the Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China, Hong Kong
| | - Herman K H Lee
- Accident & Emergency Department, United Christian Hospital, 130 Hip Wo St, Kwun Tong, Hong Kong SAR, Hong Kong
| | - Yu Fai Choi
- Accident & Emergency Department, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, Hong Kong
| | - Justin Tenney
- School of Pharmacy, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building Area 39, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, Hong Kong
- Pharmacy Department, Canberra Hospital, Yamba Drive Garran ACT 2605, Canberra, Australia
| | - Zhong Zuo
- School of Pharmacy, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building Area 39, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, Hong Kong
| | - Marc K C Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Theresa S I Hui
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Tak Kan Wong
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Tsz Ying Yiu
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Suet Yi Chan
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Catherine P Y Mok
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Wai Kit Mak
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - David T F Sun
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Chi Hung Cheng
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Accident & Emergency Department, Prince of Wales Hospital, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Accident & Emergency Department, Prince of Wales Hospital, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
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20
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Alayat MS, Takaroni A, Elsodany AM, AlMatrafi NA, Subahi MS, Battecha KH. Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis. Lasers Med Sci 2024; 39:116. [PMID: 38668764 DOI: 10.1007/s10103-024-04063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Photobiomodulation therapy (PBMT) is widely used in the treatment of patients with musculoskeletal and sports disorders with a lack of significance in patients with sprain ankle. PURPOSE This review investigated the effect of PBMT on pain, oedema, and function in patients with an ankle sprain. METHODS A systematic search of the databases (MEDLINE, PubMed, EBSCO, Web of Science, Wiley Online Library, Science Direct, Physiotherapy Evidence (PEDro), and the Cochrane Databases) was performed from inception to the end of 2023 to identify any clinical study investigating the effect of PBMT on ankle sprain. PBMT parameters and measured outcomes were extracted. The primary measured outcome was pain and function, and oedema were secondary measured outcomes. Methodological quality was assessed using the PEDro scale. The level of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random effect meta-analysis with forest plot was used to calculate standardized mean difference (SMD) at a 95% confidence interval and the overall effect size (ES). RESULTS Six studies (598 patients) were included in the review and five studies in the meta-analysis. There were two fair-quality and four good-quality studies, with a moderate level of evidence on pain, and a low level of evidence on oedema and function. The meta-analysis revealed a significant overall effect of PBMT on pain with high ES [SMD - 0.88 (-1.76, -0.00), p = 0.05], with a non-significant effect on oedema and function with a medium ES [SMD - 0.70 (-1.64, 0.24), p = 0.14] on oedema and low ES on function [SMD - 0.22 (-0.69, 0.24), p = 0.35]. Significant heterogeneity was observed in all measured outcomes with high heterogeneity (I2 > 75%) in pain and oedema and moderate heterogeneity in function. CONCLUSION PBMT is quite effective for patients with an ankle sprain. PBMT showed high effect size with a moderate level of evidence on pain intensity. The lack of significant effects of PBMT on function and edema with low level of evidence limit the confidence to the current results and recommend further large high-quality studies with higher PBMT intensity and fluency for standardisation of the irradiation parameters and treatment protocol. REGISTRATION PROSPERO registration number (CRD42021292930).
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Affiliation(s)
- Mohamed Salaheldien Alayat
- Physiotherapy and rehabilitation department, Faculty of Applied Medical science, Umm Al-Qura University, Mecca, Saudi Arabia.
| | - Abdullah Takaroni
- Physiotherapy and rehabilitation department, Faculty of Applied Medical science, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - Nahla Ahmad AlMatrafi
- Department of Rehabilitation, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Moayad Saleh Subahi
- Physiotherapy and rehabilitation department, Faculty of Applied Medical science, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Kadrya Hosney Battecha
- Physiotherapy and rehabilitation department, Faculty of Applied Medical science, Umm Al-Qura University, Mecca, Saudi Arabia
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Mujovic N, Nikolic D, Markovic F, Stjepanovic M, Zekovic M, Ali HSH, Zivanovic D, Savic M, Laban M. The Effects of Six Weeks Pulmonary Rehabilitation on Functional and Psychological Outcomes in Long-COVID Patients: Preliminary Results from Serbian Single Center Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:671. [PMID: 38674318 PMCID: PMC11052156 DOI: 10.3390/medicina60040671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: In this study, we aimed to evaluate the effects of six weeks of pulmonary rehabilitation on functional and psychological outcomes in long-COVID patients. Material and Methods: The prospective clinical study included 46 patients that were diagnosed with COVID-19. A respiratory rehabilitation program was implemented for six weeks. Further valuables were tested before the beginning of the rehabilitation program (admission) and six weeks after (discharge): SpO2, heart rate, respiratory rate, Visual Analogue Scale (VAS) score, Borg score, Sit-to-Stand (StS) test number of repetition, distance of 6-Minute Walking Test (6MWT), Patient Health Questionnaire (PHQ) 9 score and Generalized anxiety disorder (GAD) anxiety score. These parameters were tested before the rehabilitation program on admission and at discharge and after the rehabilitation program on admission and at discharge. The results were presented with standard descriptive and analytical methods. Differences between the continuous variables before and after physical rehabilitation intervention were tested using the Wilcoxon test. Graphical analysis is presented with a box plot. Results: On discharge, in comparison with admission, the values of SpO2 were significantly lower (p = 0.007) before the 6MWT, and VAS scores were significantly higher (p = 0.036), while after the 6MWT, VAS scores were significantly lower (p < 0.001) as were Borg scores (p = 0.016). On discharge, in comparison with admission, the respiratory rate was significantly higher (p = 0.005) before the StS test, and Borg scores were significantly lower (p = 0.001), while after the StS test, SpO2 levels were significantly higher (p = 0.036) and VAS scores were significantly lower (p < 0.001), as were Borg scores (p = 0.008). After discharge, the values of the StS test were significantly higher (p = 0.011), PHQ9 scores were significantly lower (p < 0.001) and GAD anxiety scores were significantly lower as well (p = 0.005), while the distances measured in meters on the 6MWT were significantly increased (p < 0.001). Conclusions: A structured rehabilitation program in our study was shown to have beneficial effects on physiological, psychological and functional improvements in patients with long-COVID, and therefore it is advisable for these patients.
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Affiliation(s)
- Natasa Mujovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Center for Physical Medicine and Rehabilitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Filip Markovic
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (F.M.); (M.L.)
| | - Mihailo Stjepanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (F.M.); (M.L.)
| | - Milica Zekovic
- Laboratory for Sports Medicine and Exercise Therapy, Institute of Medical Physiology “Rihard Burijan”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | | | - Dubravka Zivanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Clinic of Dermatology and Venerology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Clinic for Lung Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marija Laban
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (F.M.); (M.L.)
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Ye J, Fei H, Du J, Liu Y, He J, Li M, He Y, Ren P, Li J, Xu Y, Li J, Wang P, Zhang X, Li T. Exploring transvaginal sonographic characteristics of the levator ani muscle in women with postpartum pelvic floor myofascial pain. BMC Womens Health 2024; 24:245. [PMID: 38637819 PMCID: PMC11025161 DOI: 10.1186/s12905-024-03052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Pelvic floor myofascial pain is one of the pelvic floor dysfunction diseases disturbing women after delivery. There is a lack of objective standardization for the diagnosis of pelvic floor myofascial pain due to the various symptoms and the dependence on the palpating evaluation. Ultrasound imaging has the advantages of safety, simplicity, economy and high resolution, which makes it an ideal tool for the assistant diagnosis of pelvic floor myofascial pain and evaluation after treatment. METHODS This is a retrospective case-control study including women accepting evaluation of pelvic floor function at 6 weeks to 1 year postpartum. They were divided into pelvic floor myofascial pain group and normal control group. A BCL 10-5 biplane transducer was applied to observed their puborectalis. The length, minimum width, area, deficiency, deficiency length, deficiency width, deficiency area, rate of deficiency area, local thickening,angle between the tendinous arch of levator ani muscle and puborectalis of corresponding puborectalis in different groups were observed and measured. RESULTS A total of 220 postpartum women participated in the study, with 77 in the pelvic floor myofascial pain group and 143 in the normal control group. The Intraclass correlation coefficient value was over 0.750, and Kappa ranged from 0.600 to 0.800. puborectalis deficiency (adjusted odds ratio = 11.625, 95% confidence interval = 4.557-29.658) and focal thickening (adjusted odds ratio = 16.891, 95% confidence interval = 1.819-156.805) were significantly associated with higher odds of having postpartum pelvic floor myofascial pain. Grayscale or the angle between the arch tendineus levator ani and puborectalis measurements on the pain side tended to be smaller than on the non-pain side in patients with unilateral puborectalis or iliococcygeus pain (P < 0.05). CONCLUSIONS This study demonstrated that transvaginal ultrasound was a potentially efficient technique for evaluating postpartum pelvic floor myofascial pain due to its ability to assess various sonographic characteristics of the levator ani muscles.
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Affiliation(s)
- Juntong Ye
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Hui Fei
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Jingran Du
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yun Liu
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Juan He
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Mengxiong Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yunxia He
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Pinyu Ren
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Juanhua Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yang Xu
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Jing Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Pu Wang
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China.
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Province, Guangzhou, China.
| | - Tian Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China.
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Qi Y, Zhou M, Zheng W, Dong Y, Li W, Wang L, Xu H, Zhang M, Yang D, Wang L, Zhou H. Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:1189-1198. [PMID: 38645990 PMCID: PMC11032156 DOI: 10.2147/dddt.s449705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/07/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Postoperative nausea and vomiting (PONV) frequently occur in patients after surgery. In this study, the authors investigated whether perioperative S-ketamine infusion could decrease the incidence of PONV in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. Patients and Methods This prospective, randomized, double-blinded, controlled study was conducted a total of 420 patients from September 2021 to May 2023 at Xuzhou Central Hospital in China, who underwent elective VATS lobectomy under general anesthesia with tracheal intubation. The patients were randomly assigned to either the S-ketamine group or the control group. The S-ketamine group received a bolus injection of 0.5 mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine at a rate of 0.25 mg/kg/h. The control group received an equivalent volume of saline. All patients were equipped with patient-controlled intravenous analgesia (PCIA), with a continuous infusion rate of 0.03 mg/kg/h S-ketamine in the S-ketamine group or 0.03 μg/kg/h sufentanil in the control group. The primary outcome was the incidence of PONV. Secondary outcomes included perioperative opioid consumption, hemodynamics, postoperative pain, and adverse events. Results The incidence of PONV in the S-ketamine group (9.7%) was significantly lower than in the control group (30.5%). Analysis of perioperative opioid usage revealed that remifentanil usage was 40.0% lower in the S-ketamine group compared to the control group (1414.8 μg vs 2358.2 μg), while sufentanil consumption was 75.2% lower (33.1 μg vs 133.6 μg). The S-ketamine group demonstrated better maintenance of hemodynamic stability. Additionally, the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and postoperative day 3 (POD-3) were significantly lower in the S-ketamine group. Finally, no statistically significant difference in other postoperative adverse reactions was observed between the two groups. Conclusion The results of this trial indicate that perioperative S-ketamine infusion can effectively reduce the incidence of PONV in patients undergoing VATS lobectomy.
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Affiliation(s)
- Yu Qi
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Meiyan Zhou
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Wenting Zheng
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
| | - Yaqi Dong
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
| | - Weihua Li
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Long Wang
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
| | - Haijun Xu
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
| | - Miao Zhang
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Cardiothoracic Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
| | - Dunpeng Yang
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Cardiothoracic Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
| | - Liwei Wang
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Hai Zhou
- The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
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24
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Yoon KH, Kim JG, Wang JH, Lee JH, Park CH. Collagen Meniscal Scaffold Implantation Can Provide Meniscal Regeneration in Asian Patients with Partial Meniscal Defects: A Prospective Randomized Controlled Study with Three-Dimensional Volume Analysis of the Meniscus. Clin Orthop Surg 2024; 16:275-285. [PMID: 38562624 PMCID: PMC10973619 DOI: 10.4055/cios24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Background To date, the efficiency of collagen meniscal scaffold implantation in Asian patients with partial meniscal defects has not been evaluated. In addition, no study has quantitatively analyzed meniscal regeneration using three-dimensional (3D) volume analysis after collagen scaffold implantation. We aimed to compare meniscal regeneration using 3D volume analysis between Asian patients undergoing collagen-based meniscal scaffold implantation after partial meniscectomy and those undergoing only partial meniscectomy. Methods Nineteen patients who underwent collagen-based meniscal scaffold implantation and 14 who underwent partial meniscectomy were analyzed with a prospective randomized control design for 12 months postoperatively. The demographic characteristics, Kellgren-Lawrence grade, and location of the injury lesion (medial or lateral meniscus) were not significantly different between the groups. Using 3D volume analysis with magnetic resonance imaging (MRI), the meniscus-removing ratio during the operative procedure and the meniscus defect-filling ratio were measured during the 12-month postoperative period. Clinically, the visual analog scale, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score were evaluated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Genovese grade were also evaluated using MRI. Results In the 3D volume analysis, the average meniscus-removing ratio during surgery was not significantly different between the groups (-9.3% vs. -9.2%, p = 0.984). The average meniscus defect-filling ratio during the postoperative 12-month period was 7.5% in the scaffold group and -0.4% in the meniscectomy group (p < 0.001). None of the clinical results were significantly different between the scaffold and meniscectomy groups at 12 months postoperatively. The average change in the total WORMS score was not significantly different between the groups (0 vs. 1.9, p = 0.399). The Genovese grade of the implanted collagen scaffold did not significantly change during the follow-up period in terms of morphology and size (p = 0.063); however, the grade significantly improved in terms of signal intensity (p = 0.001). Conclusions Definite meniscal regeneration and stable scaffold incorporation were observed after collagen-based meniscal scaffold implantation in Asian patients during 12 months of follow-up. A long-term follow-up study with a larger cohort is required to determine the advantages of collagenous meniscal scaffold implantation in Asian patients.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Jun Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
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Schönnagel L, Camino-Willhuber G, Braun S, Zhu J, Tani S, Guven AE, Caffard T, Chiapparelli E, Arzani A, Haffer H, Muellner M, Shue J, Duculan R, Bendersky M, Cammisa FP, Girardi FP, Sama AA, Mancuso CA, Hughes AP. Association Between Osteoarthritis Burden and Intervertebral Disk Degeneration in Patients Undergoing Lumbar Spine Surgery for Degenerative Lumbar Spondylolisthesis. Spine (Phila Pa 1976) 2024; 49:478-485. [PMID: 37796191 DOI: 10.1097/brs.0000000000004847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
STUDY DESIGN A retrospective analysis of prospectively collected data. OBJECTIVE To assess the association between intervertebral disk degeneration and hip and knee osteoarthritis (OA) in patients with degenerative lumbar spondylolisthesis. BACKGROUND The co-occurrence of hip OA and degenerative spinal pathologies was first described as the "hip-spine syndrome" and has also been observed in knee OA. It remains unclear whether both pathologies share an underlying connection beyond demographic factors. MATERIALS AND METHODS Intervertebral disk degeneration was classified by the Pfirrmann Classification and intervertebral vacuum phenomenon. Intervertebral vacuum phenomenon was classified into mild (1 point), moderate (2 points), and severe (3 points) at each level and combined into a lumbar vacuum score (0-15 points). Similarly, a lumbar Pfirrmann grade was calculated (5-25 points). Patients with previous hip or knee replacement surgery were classified as having an OA burden. We used multivariable regression to assess the association between OA and disk degeneration, adjusted for age, body mass index, and sex. RESULTS A total of 246 patients (58.9% female) were included in the final analysis. Of these, 22.3% had OA burden. The multivariable linear regression showed an independent association between OA burden and lumbar vacuum (β = 2.1, P <0.001) and Pfirrmann grade (β = 2.6, P <0.001). Representing a 2.1 points higher lumbar vacuum and 2.6 points higher lumbar Pfirrmann grade after accounting for demographic differences. CONCLUSIONS Our study showed that OA burden was independently associated with the severity of the intervertebral disk degeneration of the lumbar spine. These findings give further weight to a shared pathology of OA of large joints and degenerative processes of the lumbar spine. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Sebastian Braun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopedics (Friedrichsheim), Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Mariana Bendersky
- Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Intraoperative Monitoring, Pediatric Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Wang D, Wang X, Wang Q, Xu Y, Xu Y. Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds. Int Wound J 2024; 21:e14548. [PMID: 38151911 PMCID: PMC10961044 DOI: 10.1111/iwj.14548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023] Open
Abstract
The clinical management of traumatic chest incisions accompanied by rib fractures presents the formidable challenge. The study was carried out to compare the outcomes of auscultatory triangle internal fixation (ATIF) and external fixation (EF) in such injuries. From June 2019 to June 2022, 105 patients with multiple rib fractures participated in the cohort study in which they were divided into two groups: 53 patients underwent ATIF and 52 patients underwent EF. The incidence of surgical site infection, wound healing time, incidence of wound dehiscence, number of dressing changes, pain as measured by the visual analogue scale (VAS), duration of hospitalization, period of return to work, pulmonary complications and functionality of the upper limbs as assessed by the Disability of Arm, Shoulder, and Hand (DASH) questionnaire were among the parameters evaluated. In comparison with EF, ATIF demonstrated the decreased incidence of wound dehiscence (1.9% vs. 9.6%) (p < 0.05), surgical site infection (3.8 vs. 11.5) and wound healing time (12.3 ± 2.1 vs. 18.5 ± 3.7 days) (p < 0.05). Furthermore, during their ATIF treatment, patients required fewer changes of dressing (3.5 ± 0.8 vs. 5.7 ± 1.2) and demonstrated enhanced pain management, reduced hospital stays and expedited return to work (p < 0.05). ATIF group demonstrated enhancements in both upper limb functionality and post-operative pulmonary function (p < 0.05). The utilization of ATIF as opposed to EF for the treatment of traumatic chest wounds accompanied by rib fractures yields superior outcomes in terms of wound healing, infection reduction and restoration of pulmonary and upper limb functionality.
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Affiliation(s)
- Dongdong Wang
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Xiaoqi Wang
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Qingqing Wang
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Yueping Xu
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Yongdong Xu
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
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Mu Y, Luo J, Shi C, Wang H, Tan H, Yang Z, Zhu B. Validity and reliability of the sleep health index among patients with spinal degenerative diseases. Sleep Med 2024; 116:1-6. [PMID: 38394739 DOI: 10.1016/j.sleep.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To test the validity and reliability of the Sleep Health Index (SHI) in a Chinese clinical sample, and thereby provide more evidence for the assessment of sleep health in future research and clinical practice. METHODS This study used a cross-sectional design. A convenient sample of 265 participants with spinal degenerative diseases was recruited from outpatient clinics. The SHI, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), Visual Analogue Scale (VAS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) were administered via REDCap. Structural, concurrent, convergent, known-group validity, internal consistency, and test-retest reliability were evaluated. RESULTS Confirmatory factor analysis confirmed a 3-factor structure (sleep duration, sleep quality, and disordered sleep). The overall SHI score had a high correlation with PSQI and ISI (r = -0.62 and -0.70, respectively) as well as a moderate correlation with PHQ-9 (r = -0.50, p<0.001). The overall SHI was significantly associated with VAS, ESS, and EQ-5D-5L (r = -0.15 to -0.23, p<0.05). Participants with pain had a lower score on the sleep quality sub-index than those without (p<0.001). Those with chronic diseases had a significantly lower score on the sleep duration sub-index than those without (p<0.05). Those with depression, poor sleep quality, and insomnia had lower scores on the overall scale and the three sub-indices than those without (p<0.05). The overall SHI showed acceptable internal consistency (Cronbach's α = 0.74) and test-retest reliability (intraclass correlation coefficient = 0.73). CONCLUSIONS The Chinese version of SHI showed good validity and acceptable reliability and could be used to assess sleep health among clinical populations.
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Affiliation(s)
- Yunping Mu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Luo
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Changgui Shi
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University of China, Shanghai, China
| | - Haotian Wang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University of China, Shanghai, China
| | - Hongsheng Tan
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Yang
- School of Basic Medicine, Chengdu Medical College, Chengdu, China.
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
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Nunes JC, Costa GPA, Weleff J, Rogan M, Compton P, De Aquino JP. Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations. Br J Clin Pharmacol 2024. [PMID: 38556851 DOI: 10.1111/bcp.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.
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Affiliation(s)
- Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Rogan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Connecticut, USA
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Kasimis K, Apostolou T, Kallistratos I, Lytras D, Iakovidis P. Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:556. [PMID: 38674202 PMCID: PMC11052486 DOI: 10.3390/medicina60040556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP.
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Affiliation(s)
- Konstantinos Kasimis
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus, P.O. Box 141, 57400 Thessaloniki, Greece; (T.A.); (I.K.); (D.L.); (P.I.)
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Cao B, Fang S, Wu Z, Zhou X, Kong L, Zhu Q, Zhu B, Tang C, Fang M. Efficacy and safety of traditional Chinese manual therapy (Tuina) in patients with non-specific chronic low back pain: a study protocol for a randomised controlled trial. BMJ Open 2024; 14:e081022. [PMID: 38531569 DOI: 10.1136/bmjopen-2023-081022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Non-pharmacological interventions play a crucial role in the management of non-specific chronic low back pain (NSCLBP). One prime example is Tuina, a traditional Chinese manual therapy that incorporates pressing, kneading and rubbing techniques to alleviate physical discomfort and enhance overall well-being. It serves as a widely used technique in China and other East Asian countries. However, the effectiveness and safety of Tuina for managing NSCLBP have not been substantiated through rigorous clinical research. We sought to carry out a randomised controlled trial with an open-label design, blinded assessors and parallel arms to assess the effectiveness and safety of Tuina as a treatment for NSCLBP. The trial aims to provide high-quality evidence regarding the efficacy and safety of Tuina in improving outcomes for patients with NSCLBP. METHODS AND ANALYSIS A total of 150 patients aged 18-60 years with NSCLBP will be recruited. Participants will be randomly assigned to one of the two groups. Both groups will receive standard health education. In addition, the treatment group will receive Tuina therapy, while the control group will participate in core stability exercises. Each group will undergo a total of 18 interventions over 6 weeks, with the interventions administered three times per week. The primary outcome measure is the patient's pain intensity, assessed using the Numerical Rating Scale, at week 6 following randomisation. Secondary outcomes encompass disability (measured by the Roland-Morris Disability Questionnaire), quality of life (assessed using the EuroQoL-5 dimensions questionnaire), adverse emotions (evaluated with the Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Depression Anxiety Stress Scale), biomechanical outcomes, socioeconomic indicators (medication use, healthcare utilisation and absenteeism), patient satisfaction, treatment adherence and other relevant factors.The statistical analysis will follow the intention-to-treat principle. Two-way repeated measures analysis of variance will be used to compare the clinical data across different time points within both groups. ETHICS AND DISSEMINATION The study protocol has received approval from the Ethics Committee of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine (2023-1366-133-01). All study participants will be required to give written informed consent. The findings of the study will be submitted to a peer-reviewed journal for publication and presented at scientific conferences. Additionally, the participants will receive copies of the results. TRIAL REGISTRATION NUMBER ChiCTR2300076257.
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Affiliation(s)
- Ben Cao
- Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
| | - Sitong Fang
- Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
| | - Zhiwei Wu
- Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
- Institute of Traditional Chinese Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xin Zhou
- Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
- Institute of Traditional Chinese Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Lingjun Kong
- Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
| | - Qingguang Zhu
- Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
- Institute of Traditional Chinese Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Bowen Zhu
- Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
| | - Cheng Tang
- Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
| | - Min Fang
- Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
- Institute of Traditional Chinese Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Zuo C, Zheng Z, Ma X, Wei F, Wang Y, Yin Y, Liu S, Cui X, Ye C. Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial. BMC Public Health 2024; 24:700. [PMID: 38443845 PMCID: PMC10913547 DOI: 10.1186/s12889-024-18177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Chronic low back pain (LBP) related to flight is a prevalent health issue in military aviation, impacting pilots. The objective of this investigation was to ascertain if the application of core muscle training in conjunction with interferential current (IFC) therapy results in a reduction in pain severity and associated disability, consequently enhancing core muscle functionality in Chinese Air Force high-performance fighter pilots experiencing chronic LBP. METHODS Fifty-three fighter pilots with chronic LBP were randomized into 3 groups: a core muscle exercise combined with IFC group (CG, n = 19), a core muscle exercise group (EG, n = 19), and an IFC group (IG, n = 15). The three groups underwent therapeutic intervention 5 times a week for 12 weeks. The primary outcomes were pain intensity, Oswestry Disability Index (ODI) score and SF-12 health-related quality of life (PCS and MCS) score. Secondary outcomes included evaluations of trunk muscle strength, endurance, and range of motion (ROM) during medial/lateral rotation to assess muscle functionality. Measurements were obtained both before and after the implementation of the intervention therapy. RESULTS After 12 weeks of intervention therapy, all the health condition parameters significantly improved among the three groups. However, the CG had a significant improvement in pain intensity compared to the EG (MD = - 0.84 scores; 95% CI = - 1.54 to - 0.15; p = 0.013) and the IG (MD = - 1.22 scores; 95% CI = - 1.96 to - 0.48; p = 0.000). Additionally, the CG led to greater conservation of ODI and improved SF-12 PCS scores than did the IG (p < 0.05). Finally, compared with those at baseline, the core muscle function parameters in the CG and EG improved significantly at the end of the study, but no statistically significant differences were observed between the two groups (p > 0.05). CONCLUSION Among participants with chronic LBP, three intervention therapies appear effective in reducing pain, diminishing disability, and enhancing quality of life. Also, combined therapy significantly improved pain and disability compared to the other two monotherapies; moreover, combined therapy and core muscle exercise provided similar benefits in terms of core muscle function after 12 weeks of intervention therapy.
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Affiliation(s)
- Chongwen Zuo
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Zhiyang Zheng
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
- Beijing Sports University, 100091, Beijing, China
| | - Xiaoyan Ma
- Tianjin University, 300072, Tianjin, China
| | - Fen Wei
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Yushui Wang
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Yi Yin
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Shuai Liu
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Xiaosong Cui
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Chaoqun Ye
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China.
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Reinstein M, Weisman A, Masharawi Y. Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101786. [PMID: 38118297 DOI: 10.1016/j.rehab.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND A lack of data exist about the effectiveness of active treatments for persistent plantar heel pain (PPHP). OBJECTIVES To compare short-term functional and clinical effects of a 4-week barefoot or shod treadmill walking program for people with PPHP. METHODS A single-blinded clinical trial randomized 52 participants with PPHP into either a barefoot walking group (BWG), or a shod walking group (SWG). All participants received therapeutic ultrasound. Outcomes were measured at baseline (t0), following 4 weeks of treatment (t1), and at 1-month follow-up (t2). The SF-36 functional questionnaire score was the main outcome. Secondary outcomes were self-reported and clinically-assessed pain provocation levels, pressure pain thresholds and pain tolerance. Treadmill walking time and speed were measured at t0 and t1; people also recorded the time spent walking each day in a diary. RESULTS The BWG exhibited significant improvements in all SF-36 items (except "emotional well-being") (P < 0.05), whereas the SWG exhibited improvements only in "pain" and "health change" items (P = 0.0001; effect size 0.13-0.94). Greater improvements were observed in the BWG than the SWG for "physical function" (P = 0.019) and "role limitations due to physical health" items (P = 0.035). Both groups demonstrated significant improvements in pain, with greater improvements in the BWG (P = 0.0001; effect size 0.89). Only the BWG showed significant improvements in pain pressure thresholds (P < 0.05; effect size 0.70) and pain tolerance (P < 0.001; effect size 0.67). Both groups significantly increased their speed and time spent walking on the treadmill (BWG Δ=19.7 min and Δ=1.7 km/h; SWG Δ=16.7 min and Δ=1.1 km/h) and time outdoors (SWG ∆=38.2 min/week; BWG mean ∆=48.5 min/week) (P < 0.001). All clinical tests of pain were significantly less positive in the BWG at all time points (P < 0.05). CONCLUSIONS Both walking programs benefited people with PPHP by alleviating pain and improving function and quality of life. Greater improvements were observed in the BWG than the SWG overall.
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Affiliation(s)
- Miriam Reinstein
- Mevaseret Zion and Bruchim Outpatient Clinics, Jerusalem District, Meuhedet Health Services, Jerusalem, Israel; Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel
| | - Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel.
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Okudan B, Çelik D, Koban O. The effectiveness of telerehabilitation-based exercise combined with pain neuroscience education for patients with facet joint arthrosis: A randomized controlled study. Eur J Pain 2024; 28:382-395. [PMID: 37747343 DOI: 10.1002/ejp.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES This study aimed to investigate the short-term effectiveness of exercise combined with PNE and exercise alone via telerehabilitation for patients with low back pain (LBP) caused by facet joint arthrosis (FJA). METHODS This is a prospective, single-blind, randomized-controlled clinical trial. Forty-five patients with LBP caused by FJA were randomly allocated into three groups. The exercise (n = 15) and the exercise with PNE (n = 15) groups were provided interventions twice a week for six weeks via telerehabilitation. The control group (n = 15) was placed on the waiting list. The primary outcome measures were the numeric pain-rating scale (NPRS) at rest and with activity, The Oswestry disability index (ODI), the pain beliefs questionnaire (PBQ), and secondary outcome measures were short form-12v2 (SF-12v2) and the global rating of change score (GROC). RESULTS The groups (52.00 ± 4.86, 46.7% female) were similar at baseline except for gender (p = 0.029). There was a significant group-by-time interaction for NPRS-rest (F = 4.276, p = 0.021), NPRS-activity (F = 12.327, p = 0.0001), the ODI (F = 23.122, p = 0.0001) and organic pain belief (F = 39.708, p = 0.0001). Further comparison with ANOVA showed that the exercise with PNE group showed better improvement in only organic pain belief (p = 0.0001). All groups reported improvements according to GROC, but it was higher in the intervention groups (p = 0.001). CONCLUSION The patients who received exercise combined with PNE and exercise alone significantly improved pain intensity, disability and organic pain beliefs via telerehabilitation for patients with LBP caused by FJA compared to the control group. The PNE in addition to exercise may exhibit greater benefit in improving organic pain beliefs in short term. SIGNIFICANCE This study highlights that combining exercise with PNE can lead to greater improvements compared to exercise alone or no intervention for FJA patients. The implementation of PNE in physiotherapy sessions has the potential to offer significant benefits. Furthermore, our results highlight the promising role of telerehabilitation as an effective method for delivering interventions to individuals with FJA.
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Affiliation(s)
- Begum Okudan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Derya Çelik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Lokman Hekim Istanbul Hospital, Istanbul, Turkey
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Chen Z, Tirosh O, Han J, Adams R, El-Ansary D, Pranata A. Kinematic changes of the trunk and lower limbs during voluntary lateral sway postural control in adults with low back pain. Front Bioeng Biotechnol 2024; 12:1351913. [PMID: 38476964 PMCID: PMC10927732 DOI: 10.3389/fbioe.2024.1351913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Voluntary lateral weight shifting is essential for gait initiation. However, kinematic changes during voluntary lateral weight shifting remain unknown in people with low back pain (LBP). This study aims to explore the differences in kinematics and muscle activation when performing a voluntary lateral weight shifting task between patients with LBP and asymptomatic controls without pain. Methods: Twenty-eight participants volunteered in this study (14 in both the LBP group and the control group). The Sway Discrimination Apparatus (SwayDA) was used to generate a postural sway control task, mimicking lateral weight shifting movements when initiating gait. Kinematic parameters, including range of motion (ROM) and standard deviation of ROM (Std-ROM) of the lumbar spine, pelvis, and lower limb joints, were recorded using a motion capture system during lateral weight shifting. The electroactivity of the trunk and lower limb muscles was measured through surface electromyography using root mean square (RMS). The significant level was 0.05. An independent t-test was employed to compare kinematic parameters, and muscle activation between the LBP group and the control group. A paired-sample t-test, adjusted with Bonferroni correction (significant level of 0.025), was utilized to examine differences between the ipsilateral weight shifting towards side (dominant side) and the contralateral side. Results: The results of kinematic parameters showed significantly decreased ROM and std-ROM of the ipsilateral hip in the transverse plane (tROM = -2.059, p = 0.050; tstd-ROM = -2.670, p = 0.013), as well as decreased ROM of the ipsilateral knee in the coronal plane (t = -2.148, p = 0.042), in the LBP group compared to the control group. For the asymptomatic controls, significantly larger ROM and ROM-std were observed in the hip and knee joints on the ipsilateral side in contrast to the contralateral side (3.287 ≤ t ≤ 4.500, 0.001 ≤ p≤ 0.006), but no significant differences were found between the two sides in the LBP group. In addition, the LBP group showed significantly lower RMS of the biceps femoris than the control group (tRMS = -2.186, p = 0.044). Discussion: Patients with LBP showed a conservative postural control pattern, characterized by reduced ROM of ipsilateral joints and diminished activation of the biceps femoris. These findings suggested the importance of voluntary postural control assessment and intervention to maximize recovery.
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Affiliation(s)
- Zhengquan Chen
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Oren Tirosh
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Jia Han
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Roger Adams
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Doa El-Ansary
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- Department of Surgery, Melbourne Medical School, Melbourne, VIC, Australia
| | - Adrian Pranata
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Schönnagel L, Caffard T, Zhu J, Tani S, Camino-Willhuber G, Amini DA, Haffer H, Muellner M, Guven AE, Chiapparelli E, Arzani A, Amoroso K, Shue J, Duculan R, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Decision-making Algorithm for the Surgical Treatment of Degenerative Lumbar Spondylolisthesis of L4/L5. Spine (Phila Pa 1976) 2024; 49:261-268. [PMID: 37318098 DOI: 10.1097/brs.0000000000004748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023]
Abstract
STUDY DESIGN A retrospective analysis of prospectively collected data. OBJECTIVE To report the decision-making process for decompression alone (DA) and decompression and fusion (DF) at a tertiary orthopedic center and compare the operative outcomes between both groups. BACKGROUND Controversy exists around the optimal operative treatment for DLS, either with DF or DA. Although previous studies tried to establish specific indications, clinical decision-making algorithms are needed. MATERIALS AND METHODS Patients undergoing spinal surgery for DLS at L4/5 were retrospectively analyzed. A survey of spine surgeons was performed to identify factors influencing surgical decision-making, and their association with the surgical procedure was tested in the clinical data set. We then developed a clinical score based on the statistical analysis and survey results. The predictive capability of the score was tested in the clinical data set with a receiver operating characteristic (ROC) analysis. To evaluate the clinical outcome, two years follow-up postoperative Oswestry Disability Index (ODI), postoperative low back pain (LBP) (Numeric Analog Scale), and patient satisfaction were compared between the DF and DA groups. RESULTS A total of 124 patients were included in the analysis; 66 received DF (53.2%) and 58 DA (46.8%). Both groups showed no significant differences in postoperative ODI, LBP, or satisfaction. The degree of spondylolisthesis, facet joint diastasis and effusion, sagittal disbalance, and severity of LBP were identified as the most important factors for deciding on DA or DF. The area under the curve of the decision-making score was 0.84. At a cutoff of three points indicating DF, the accuracy was 80.6%. CONCLUSIONS The two-year follow-up data showed that both groups showed similar improvement in ODI after both procedures, validating the respective decision. The developed score shows excellent predictive capabilities for the decision processes of different spine surgeons at a single tertiary center and highlights relevant clinical and radiographic parameters. Further studies are needed to assess the external applicability of these findings.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Dominik A Amini
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Timo Zippelius
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Trager RJ, Baumann AN, Rogers H, Tidd J, Orellana K, Preston G, Baldwin K. Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials. J Man Manip Ther 2024:1-12. [PMID: 38353102 DOI: 10.1080/10669817.2024.2316420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION This study examined the efficacy of manual therapy for pain and disability measures in adults with sacroiliac joint pain syndrome (SIJPS). METHODS We searched six databases, including gray literature, on 24 October 2023, for randomized controlled trials (RCTs) examining sacroiliac joint (SIJ) manual therapy outcomes via pain or disability in adults with SIJPS. We evaluated quality via the Physiotherapy Evidence Database scale and certainty via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) in post-treatment pain and disability scores were pooled using random-effects models in meta-regressions. RESULTS We included 16 RCTs (421 adults; mean age = 37.7 years), with 11 RCTs being meta-analyzed. Compared to non-manual physiotherapy (i.e. exercise ± passive modalities; 10 RCTs) or sham (1 RCT) interventions, SIJ manual therapy did not significantly reduce pain (SMD: -0.88; 95%-CI: -1.84; 0.08, p = 0.0686) yet had a statistically significant moderate effect in reducing disability (SMD: -0.67; 95% CI: -1.32; -0.03, p = 0.0418). The superiority of individual manual therapies was unclear due to low sample size, wide confidence intervals for effect estimates, and inability to meta-analyze five RCTs with a unique head-to-head design. RCTs were of 'good' (56%) or 'fair' (44%) quality, and heterogeneity was high. Certainty was very low for pain and low for disability outcomes. CONCLUSION SIJ manual therapy appears efficacious for improving disability in adults with SIJPS, while its efficacy for pain is uncertain. It is unclear which specific manual therapy techniques may be more efficacious. These findings should be interpreted cautiously until further high-quality RCTs are available examining manual therapy against control groups such as exercise. REGISTRATION PROSPERO (CRD42023394326).
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, NC, USA
| | - Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Rehabilitation Services, University Hospitals, Cleveland, OH, USA
| | - Hudson Rogers
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Joshua Tidd
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kevin Orellana
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, OH, USA
| | - Gordon Preston
- Department of Orthopedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | - Keith Baldwin
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, OH, USA
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Skibski A, Stout JR, Ingersoll CD, Mangum LC. Ultrasound Biofeedback Increases Abdominal Muscle Activation in Golfers With a History of Low Back Pain. Clin J Sport Med 2024:00042752-990000000-00174. [PMID: 38329285 DOI: 10.1097/jsm.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To compare activation ratios of the transverse abdominis (TrA) during an abdominal draw-in maneuver (ADIM) and abdominal obliques during a golf swing, with and without ultrasound biofeedback, and to determine intrarater reliability of these ultrasound thickness measures. DESIGN Single-session crossover study. SETTING Laboratory. PARTICIPANTS Sixteen adult golfers with 2 or more episodes of low back pain (LBP) in the past year. INTERVENTIONS Verbal cueing alone and verbal cueing with ultrasound biofeedback. MAIN OUTCOME MEASURES Bilateral TrA activation ratios were calculated during an ADIM with and without ultrasound biofeedback. Activation ratios of the abdominal obliques were calculated bilaterally during golf swings with and without ultrasound biofeedback. Intraclass correlation coefficients (ICCs) were calculated for average thickness across all muscles and conditions for the nonbiofeedback trials. RESULTS Transverse abdominis activation ratios were significantly higher when ultrasound biofeedback was provided bilaterally ( P < 0.001). Abdominal oblique activation ratios during the golf swing were also significantly higher with ultrasound biofeedback for the lead ( P = 0.014) and trail ( P < 0.001) sides. Intraclass correlation coefficient values ranged from 0.92 to 0.97 ( P < 0.001). CONCLUSIONS Ultrasound biofeedback can increase activation ratios of the TrA during a supine ADIM in adult golfers with a history of LBP. Postswing ultrasound biofeedback increases activation of the abdominal obliques during a golf swing in golfers with a history of LBP. Ultrasound thickness measures of the TrA and obliques have excellent intrarater reliability.
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Affiliation(s)
- Andrew Skibski
- Rehabilitation, Athletic Assessment, & DYnamic Imaging (READY) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida; and
| | - Jeffrey R Stout
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida; and
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Christopher D Ingersoll
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida; and
| | - L Colby Mangum
- Rehabilitation, Athletic Assessment, & DYnamic Imaging (READY) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida; and
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Walia A, Ani F, Maglaras C, Raman T, Fischer C. Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion. Global Spine J 2024:21925682241230926. [PMID: 38315111 DOI: 10.1177/21925682241230926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. RESULTS 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
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Affiliation(s)
- Arnaav Walia
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Fares Ani
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tina Raman
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla Fischer
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Liu M, Gu H, Hu J, Liu M, Luo Y, Yuan Y, Wu J, Zhou Y, Juan R, Cheng X, Zhuang S, Shen Y, Jin H, Chen J, Li K, Wang F, Liu C, Mao C. Higher cortical excitability to negative emotions involved in musculoskeletal pain in Parkinson's disease. Neurophysiol Clin 2024; 54:102936. [PMID: 38382137 DOI: 10.1016/j.neucli.2023.102936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE Changes in brain structure and neurotransmitter systems are involved in pain in Parkinson's disease (PD), and emotional factors are closely related to pain. Our study applied electroencephalography (EEG) to investigate the role of emotion in PD patients with chronic musculoskeletal pain. METHODS Forty-two PD patients with chronic musculoskeletal pain and 38 without were enrolled. EEG data were recorded under resting conditions, and while viewing pictures with neutral, positive, and negative content. We compared spectrum power, functional connectivity, and late positive potential (LPP), an event-related potential (ERP), between the groups. RESULTS PD patients with pain tended to have higher scores for the Hamilton Rating Scale for Depression (HRSD). In the resting EEG, mean β-band amplitude was significantly higher in patients with pain than in those without. Logistic regression analysis showed that higher HRSD scores and higher mean β-band amplitude were associated with pain. ERP analysis revealed that the amplitudes of LPP difference waves (the absolute difference between positive and negative condition LPP and neutral condition LPP) at the central-parietal region were significantly reduced in patients with pain (P = 0.029). Spearman correlation analysis showed that the amplitudes of late (700-1000 ms) negative versus neutral condition LPP difference waves were negatively correlated with pain intensity, assessed by visual analogue scale, (r = -0.393, P = 0.010) and HRSD scores (r = -0.366, P = 0.017). CONCLUSION Dopaminergic and non-dopaminergic systems may be involved in musculoskeletal pain in PD by increasing β-band activity and weakening the connection of the θ-band at the central-parietal region. PD patients with musculoskeletal pain have higher cortical excitability to negative emotions. The changes in pain-related EEG may be used as electrophysiological markers and therapeutic targets in PD patients with chronic pain.
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Affiliation(s)
- Ming Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China; The First People's Hospital of Zhangjiagang City, Suzhou, China
| | - Hanying Gu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingzhe Hu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Manhua Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yajun Luo
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuan Yuan
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiayu Wu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Zhou
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ru Juan
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoyu Cheng
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Zhuang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Shen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Jin
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fen Wang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Chunfeng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Chengjie Mao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Ritsuno Y, Morita M, Mukaino M, Otsuka K, Kanaji A, Yamada J, Saitoh E, Matsumoto M, Nakamura M, Otaka Y, Fujita N. Determinants of Gait Parameters in Patients With Severe Hip Osteoarthritis. Arch Phys Med Rehabil 2024; 105:343-351. [PMID: 37683907 DOI: 10.1016/j.apmr.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To investigate the characteristics and symptoms of patients with hip osteoarthritis that are associated with spatiotemporal gait parameters, including their variability and asymmetry. DESIGN A retrospective, cross-sectional study. SETTING University hospital. PARTICIPANTS The study analyzed the gait analysis data of 155 patients (N=155) with hip osteoarthritis who were admitted to a university hospital for total hip replacement and were able to walk on a treadmill without a handrail. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variables were gait parameters during treadmill walking. These included gait speed, stride length, cadence, coefficient of variation of stride length and stride time, swing time symmetry index, and step symmetry index. Single and multiple regression analyses were conducted using independent variables of the characteristics and symptoms of the patients, including age, sex, height, pain, leg-length discrepancy, and muscle strength of the affected and normal sides measured with a hand-held dynamometer (iliopsoas, gluteus medius, and quadriceps). RESULTS In the analysis, gait speed and stride were the dependent variables, whereas age, height, and muscle strength on the affected side were the significant independent variables (P<.05). Additionally, pain demonstrated a marginal association with gait speed (P=.053). Only the leg-length discrepancy correlated with cadence. When the coefficient of variation of the stride length was the dependent variable, age and muscle strength on the affected side were significant. For the swing time symmetry index, only the muscle strength on the affected side was significant. Furthermore, the step symmetry index only correlated with leg-length discrepancy. The muscle strength on the affected side was the only significant independent variable for the coefficient of variation of the stride time. CONCLUSIONS The results revealed that each of the frequent clinical symptoms of hip osteoarthritis, such as pain, muscle weakness, and leg-length discrepancy, can explain different aspects of gait performance.
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Affiliation(s)
- Yoshihiro Ritsuno
- Department of Orthopaedic Surgery, Fujita Health University School of Medicine, Aichi, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Aichi, Japan; Department of Rehabilitation Medicine, Hokkaido University Hospital, Hokkaido, Japan.
| | - Kei Otsuka
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University School of Medicine, Aichi, Japan
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Schönnagel L, Muellner M, Suwalski P, Guven AE, Camino-Willhuber G, Tani S, Caffard T, Zhu J, Haffer H, Arzani A, Chiapparelli E, Amoroso K, Shue J, Duculan R, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Association of abdominal aortic calcification and lower back pain in patients with degenerative spondylolisthesis. Pain 2024; 165:376-382. [PMID: 37856648 DOI: 10.1097/j.pain.0000000000003018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
ABSTRACT Abdominal aortic calcification (AAC) is hypothesized to lead to ischemic pain of the lower back. This retrospective study aims to identify the relationship between AAC and lower back pain (LBP) in patients with degenerative lumbar spondylolisthesis. Lower back pain was assessed preoperatively and 2 years after surgery using the numeric analogue scale. Abdominal aortic calcification was assessed according to the Kauppila classification and was grouped into no, moderate, and severe. A multivariable regression, adjusted for age, sex, body mass index, hypertension, and smoking status, was used to assess the association between AAC and preoperative/postoperative LBP as well as change in LBP after surgery. A total of 262 patients were included in the final analysis. The multivariable logistic regression demonstrated an increased odds ratio (OR) for preoperative LBP ≥ 4 numeric analogue scale (OR = 9.49, 95% confidence interval [CI]: 2.71-40.59, P < 0.001) and postoperative LBP ≥ 4 (OR = 1.72, 95% CI: 0.92-3.21, P = 0.008) in patients with severe AAC compared with patients with no AAC. Both moderate and severe AAC were associated with reduced improvement in LBP after surgery (moderate AAC: OR = 0.44, 95% CI: 0.22-0.85, P = 0.016; severe AAC: OR = 0.41, 95% CI: 0.2-0.82, P = 0.012). This study demonstrates an independent association between AAC and LBP and reduced improvement after surgery. Evaluation of AAC could play a role in patient education and might be considered part of the differential diagnosis for LBP, although further prospective studies are needed.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Phillip Suwalski
- Medical Heart Center of Charité CBF-Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
| | - Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Roland Duculan
- Hospital for Special Surgery, New York City, NY, United States
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY, United States
- Weill Cornell Medical College, New York, NY, United States
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
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Camino-Willhuber G, Schönnagel L, Caffard T, Zhu J, Tani S, Chiapparelli E, Arzani A, Shue J, Duculan R, Bendersky M, Zelenty WD, Sokunbi G, Lebl DR, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP, Sama AA. Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis. Clin Spine Surg 2024; 37:E1-E8. [PMID: 37651562 DOI: 10.1097/bsd.0000000000001510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN Retrospective study of prospective collected data. OBJECTIVE To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. METHODS We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. RESULTS A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. CONCLUSION Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
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Affiliation(s)
- Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires
- Intraoperative Monitoring, Department of Pediatric Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - William D Zelenty
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Gbolabo Sokunbi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Darren R Lebl
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Schönnagel L, Caffard T, Vu-Han TL, Zhu J, Nathoo I, Finos K, Camino-Willhuber G, Tani S, Guven AE, Haffer H, Muellner M, Arzani A, Chiapparelli E, Amoroso K, Shue J, Duculan R, Pumberger M, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Predicting postoperative outcomes in lumbar spinal fusion: development of a machine learning model. Spine J 2024; 24:239-249. [PMID: 37866485 DOI: 10.1016/j.spinee.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a prevalent spinal disorder, often requiring surgical intervention. Accurately predicting surgical outcomes is crucial to guide clinical decision-making, but this is challenging due to the multifactorial nature of postoperative results. Traditional risk assessment tools have limitations, and with the advent of machine learning, there is potential to enhance the precision and comprehensiveness of preoperative evaluations. PURPOSE We aimed to develop a machine-learning algorithm to predict surgical outcomes in patients with degenerative lumbar spondylolisthesis (DLS) undergoing spinal fusion surgery, only using preoperative data. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients with DLS undergoing lumbar spinal fusion surgery. OUTCOME MEASURES This study aimed to predict the occurrence of lower back pain (LBP) ≥4 on the numeric analogue scale (NAS) 2 years after surgery. LBP was evaluated as the average pain patients experienced at rest in the week before questioning. NAS ranges from 0 to 10, 0 representing no pain and 10 representing the worst pain imaginable. METHODS We conducted a retrospective analysis of prospectively enrolled patients who underwent spinal fusion surgery for degenerative lumbar spondylolistheses at our institution in the United States between January 2016 and December 2018. The initial patient characteristics to be included in the training of the model were chosen by clinical expertise and through a literature review and included demographic characteristics, comorbidities, and radiologic features. The data was split into a training and validation datasets using a 60/40 split. Four different machine learning models were trained, including the modern XGBoost model, logistic regression, random-forest, and support vector machine (SVM). The models were evaluated according to the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. An AUC of 0.7 to 0.8 was considered fair, 0.8 to 0.9 good, and ≥ 0.9 excellent. Additionally, a calibration plot and the Brier score were calculated for each model. RESULTS A total of 135 patients (66% female) were included. A total of 38 (28%) patients reported LBP ≥ 4 after 2 years, representing the positive class. The XGBoost model demonstrated the best performance in the validation set with an AUC of 0.81 (95% CI 0.67-0.95). The other machine learning models performed significantly worse: with an AUC of 0.52 (95% CI 0.37-0.68) for the SVM, 0.56 (95% CI 0.37-0.76) for the logistic regression and an AUC of 0.56 (95% CI 0.37-0.78) for the random forest. In the XGBoost model age, composition of the erector spinae, and severity of lumbar spinal stenosis as were identified as the most important features. CONCLUSIONS This study represents a novel approach to predicting surgical outcomes in spinal fusion patients. The XGBoost demonstrated a better performance compared with classical models and highlighted the potential contributions of age and paraspinal musculature atrophy as significant factors. These findings have important implications for enhancing patient care through the identification of high-risk individuals and modifiable risk factors. As the incorporation of machine learning algorithms into clinical decision-making continues to gain traction in research and clinical practice, our insights reinforce this trajectory by showcasing the potential of these techniques in forecasting surgical results.
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Affiliation(s)
- Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Tu-Lan Vu-Han
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Isaac Nathoo
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Kyle Finos
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Gaston Camino-Willhuber
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Roland Duculan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Timo Zippelius
- Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Carol A Mancuso
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Tesfa A, Petrosyan H, Fahmy M, Sexton T, Arvanian V. Spinal magnetic stimulation to treat chronic back pain: a feasibility study in veterans. Pain Manag 2024; 14:75-85. [PMID: 38314568 DOI: 10.2217/pmt-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Aim: Chronic low back pain represents a significant societal problem leading to increased healthcare costs and quality of life. This study was designed to evaluate the feasibility and effectiveness of non-invasive spinal electromagnetic simulation (SEMS) to treat nonspecific chronic low back pain (CLBP). Methods: A single-site prospective study was conducted to evaluate SEMS in reducing pain and improving disability. A total of 17 patients received SEMS two to three sessions a week. The Numeric Rating Scale and the Modified Oswestry Disability Questionnaire were used to assess pain and disability. Results: Participants receiving SEMS exhibited statistically significant reductions in pain and disability. Conclusion: Current results suggest that non-invasive SEMS can be an effective treatment in reducing pain and improving disability associated with CLBP.
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Affiliation(s)
- Asrat Tesfa
- Research & Development Service, Department of Veterans Affairs Medical Center, Northport, 11768, NY, USA
| | - Hayk Petrosyan
- Department of Physical Medicine & Rehabilitation, Hackensack Meridian, JFK Johnson Rehabilitation Institute, Edison, 08820, NJ, USA
| | - Magda Fahmy
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs Medical Center, Northport, 11768, NY, USA
| | - Thomas Sexton
- College of Business, Stony Brook University, Stony Brook, 11790, NY, USA
| | - Victor Arvanian
- Research & Development Service, Department of Veterans Affairs Medical Center, Northport, 11768, NY, USA
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Figas G, Kostka J, Pikala M, Kujawa JE, Adamczewski T. Analysis of Clinical Pattern of Musculoskeletal Disorders in the Cervical and Cervico-Thoracic Regions of the Spine. J Clin Med 2024; 13:840. [PMID: 38337534 PMCID: PMC10856133 DOI: 10.3390/jcm13030840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/31/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Cervical spine disorders (CSDs) are a common cause of neck pain. Proper diagnosis is of great importance in planning the management of a patient with neck pain. Hence, the aim of this study is to provide an overview of the clinical pattern of early-stage functional disorders affecting the cervical and cervico-thoracic regions of the spine, considering the age and sex of the subjects. Methods: Two hundred adult volunteers were included in the study. Manual examination of segments C0/C1-Th3/Th4 was performed according to the methodology of the Katenborn-Evjenth manual therapy concept and the spine curvatures were assessed (cervical lordosis and thoracic kyphosis). Results: The most common restricted movement was lateral flexion to the left, and the least disturbed movement were observed in the sagittal plane (flexion and extension). The most affected segment was C7/Th1 (71.5% participants had problems in this segment), and the least affected segment was Th3/Th4 (69.5% participants had no mobility disorders in this segment). The number of disturbed segments did not differ between men and women (p > 0.05), but increased with age (r = 0.14, p = 0.04). Conclusions: Cervical mobility in adult population is frequently restricted. The number of affected segments increased with age and was not sex-dependent.
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Affiliation(s)
- Gabriela Figas
- Clinic of Medical Rehabilitation, Medical University of Lodz, 92-213 Lodz, Poland; (G.F.); (J.E.K.); (T.A.)
| | - Joanna Kostka
- Department of Gerontology, Medical University of Lodz, 93-113 Lodz, Poland
| | - Małgorzata Pikala
- Department of Epidemiology and Biostatistics, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Jolanta Ewa Kujawa
- Clinic of Medical Rehabilitation, Medical University of Lodz, 92-213 Lodz, Poland; (G.F.); (J.E.K.); (T.A.)
| | - Tomasz Adamczewski
- Clinic of Medical Rehabilitation, Medical University of Lodz, 92-213 Lodz, Poland; (G.F.); (J.E.K.); (T.A.)
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Koszela K, Woldańska-Okońska M, Gasik R. Efficacy and Safety of Spinal Collagen Mesotherapy in Patients with Chronic Low Back Pain in a Three-Month Follow-Up-Retrospective Study. J Clin Med 2024; 13:787. [PMID: 38337483 PMCID: PMC10856190 DOI: 10.3390/jcm13030787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/18/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Low back pain syndrome is associated with muscular and myofascial pain and is linked with muscle overstrain or a lack of regular physical activity as well as a habitual bad posture, which cause the overload of perispinal soft tissues. One of the forms of therapy of LBP is the mesotherapy of the spine, which consists of multi-point micro-injections of drugs or medicine mixtures, which include preparations of collagen type I. The aim of the study was to assess the efficacy and safety of mesotherapy with collagen type I. Methods: A retrospective analysis of the results of the treatment of patients with chronic low back pain syndrome using mesotherapy was performed. A total of 130 patients (83 women and 47 men; mean age: 51 ± 14 years) were divided into two groups: group I (n = 65), treated with collagen type I, and group II (n = 65), treated with lignocaine 1%. Mesotherapy was performed weekly over five weeks. Patients were assessed using the following scales: the VAS, Laitinen Scale, and Revised Oswestry Low Back Pain Disability Scale before the start of the treatment, after five treatments, and at the three-month follow-up visit. Results: A statistically significant improvement was observed after the use of spinal mesotherapy both with collagen type I and lignocaine, with the collagen treatment having better results at the three-month follow-up visit. No adverse effects were observed after the procedures. Conclusions: Spinal mesotherapy using collagen type I and lignocaine seems to be an effective method in the treatment of chronic LBP. Collagen mesotherapy gives better results in the long term. Mesotherapy is a safe form of therapy.
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Affiliation(s)
- Kamil Koszela
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Marta Woldańska-Okońska
- Department of Internal Medicine, Rehabilitation and Physical Medicine, Medical University of Lodz, 90-419 Lodz, Poland
| | - Robert Gasik
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
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Meyer JA, Alton S, Seung H, Pahlavan A, Trilling AR, Coghlan M, Goetzinger KR, Cojocaru L. Enhanced recovery after cesarean from the patient perspective: a prospective study of the ERAC Questionnaire (ERAC-Q). J Perinat Med 2024; 52:14-21. [PMID: 37609844 DOI: 10.1515/jpm-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To evaluate the impact of an Enhanced Recovery After Cesarean (ERAC) protocol on the post-cesarean recovery experience using a validated ten-item questionnaire (ERAC-Q). METHODS This is a prospective cohort study of patients completing ERAC quality-of-life questionnaires (ERAC-Q) during inpatient recovery after cesarean delivery (CD) between October 2019 and September 2020, before and after the implementation of our ERAC protocol. Patients with non-Pfannenstiel incision, ICU admission, massive transfusion, bowel injury, existing chronic pain disorders, acute postpartum depression, or neonatal demise were excluded. The ERAC-Q was administered on postoperative day one and day of discharge to the pre- and post-ERAC implementation cohorts, rating aspects of their recovery experience on a scale of 0 (best) to 10 (worst). The primary outcome was ERAC-Q scores. Statistical analysis was performed with SAS software. RESULTS There were 196 and 112 patients in the pre- and post-ERAC cohorts, respectively. The post-ERAC group reported significantly lower total ERAC-Q scores compared to the pre-ERAC group, reflecting fewer adverse symptoms and greater perceived recovery on postoperative day one (1.6 [0.7, 2.8] vs. 2.7 [1.6, 4.3]) and day of discharge (0.8 [0.3, 1.5] vs. 1.4 [0.7, 2.2]) (p<0.001). ERAC-Q responses did not predict the time to achieve objective postoperative milestones. However, worse ERAC-Q pain and total scores were associated with higher inpatient opiate use. CONCLUSIONS ERAC implementation positively impacts patient recovery experience. The administration of ERAC-Q can provide real-time feedback on patient-perceived recovery quality and how healthcare protocol changes may impact their experience.
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Affiliation(s)
- Jessica A Meyer
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Suzanne Alton
- Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice & Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Autusa Pahlavan
- Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Ariel R Trilling
- Department of Obstetrics, Gynecology & Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martha Coghlan
- Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine R Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Liviu Cojocaru
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Anesthesia Critical Care, Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Staten Island University Hospital of Northwell Health, New York, NY, USA
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Chen Y, Wu M. Aitongping patch could alleviate cancer pain via suppressing microglia activation and modulating the miR-150-5p/CXCL12 signaling. Postgrad Med J 2024; 100:96-105. [PMID: 37978049 DOI: 10.1093/postmj/qgad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE We aimed to investigate the pharmacological effects and mechanisms of the Aitongping formula for treating cancer pain. METHODS We enrolled 60 cancer patients with Numeric Rating Scale above 4 and grouped them randomly as a Control group (N = 30) and a Patch group (N = 30). We also established bone cancer mice models via tumor implantation. And the animal groups were established as a Sham group, a tumor cell implantation (TCI) group, a TCI + Patch group, and a Patch group. RESULTS After the validation of successful tumor implantation, we identified candidate miRNAs and genes that were dysregulated in TCI mice and compared their expressions between different mice groups. We also observed the effect of Aitongping patch in vitro in mice primary microglia. The time to disease progression and cancer stability were prolonged by Aitongping patch in cancer patients. And the daily morphine dose was lower, and patients' quality of life was improved in the Patch group. Moreover, Aitongping patch alleviated cancer pain and inhibited microglia activation after the successful implantation of bone tumor in TCI mice. We also observed the dysregulation of miR-150-5p and chemokine CXC motif ligand 12 (CXCL12) mRNA in TCI mice. And CXCL12 was found to be targeted by miR-150-5p. Aitongping patch was found to upregulate miR-150-5p and downregulate CXCL12 in vivo and in vitro. CONCLUSION Aitongping patch could alleviate cancer pain via suppressing microglia activation, and the downregulation of miR-150-5p, as well as the upregulation of CXCL12 mRNA and protein, induced by tumor implantation or lipopolysaccharide stimulation, was restored by Aitongping treatment.
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Affiliation(s)
- Yunlong Chen
- Department of Oncology, Rudong County Hospital of Traditional Chinese Medicine, Rudong, Jiangsu 226400, China
| | - Mianhua Wu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210046, China
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Gao L, Chen W, Qin S, Yang X. The impact of preoperative interview and prospective nursing on perioperative psychological stress and postoperative complications in patients undergoing TACE intervention for hepatocellular carcinoma. Medicine (Baltimore) 2024; 103:e35929. [PMID: 38215108 PMCID: PMC10783411 DOI: 10.1097/md.0000000000035929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/12/2023] [Indexed: 01/14/2024] Open
Abstract
TACE has become one of the main methods for the treatment of liver cancer. The study aimed to investigate the effects of preoperative interview and prospective nursing in patients with hepatic carcinoma undergoing transcatheter chemoembolization (TACE). Eighty-six patients with hepatocellular carcinoma who underwent TACE intervention treatment at our hospital between 2020 and 2023 were selected and randomly assigned to 2 groups using computerized randomization. The control group (n = 43) received routine nursing care, while the study group (n = 43) received preoperative interviews in combination with prospective nursing during the procedure. The patients' heart rate, mean arterial pressure, and blood pressure variations were recorded, along with their mood changes after intervention. The postoperative pain and satisfaction levels were compared between the 2 groups of patients, and the incidence of postoperative complications was observed. The heart rate, systolic blood pressure, and diastolic blood pressure of the 2 groups of patients were compared 1 day before the operation (P > .05). Compared to 1 day before the operation, there was no significant change for the study group at 10 minutes after entering the room. However, the control group showed an increase. Both groups showed an increase in heart rate, systolic blood pressure, and diastolic blood pressure after the operation, with the study group having lower values than the control group (P < .05). The levels of tension, fatigue, anxiety, energy, anger, depression, self-esteem, and POMS index were compared between the 2 groups before intervention (P > .05). After intervention, there were significant differences between the 2 groups(P < .05). Immediately after the operation, the NRS scores of the 2 groups of patients were compared (P > .05). Compared to the control group, the study group showed a decrease in NRS scores at 12, 24, and 48 hours after the operation (P < .05). The nursing satisfaction rate of the study group patients was 97.67% (42/43), which was higher than the nursing satisfaction rate of the control group of 76.74% (33/43) (P < .05). Compared to routine nursing, preoperative visits and prospective nursing interventions can effectively alleviate patients' psychological stress reactions, relieve pain, reduce the incidence of complications, and improve patients' satisfaction with nursing care.
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Affiliation(s)
- Leilei Gao
- Department of Radiology, Xingtai People’s Hospital, Interventional Catheter Room, Xingtai, Hebei, People’s Republic of China
| | - Wei Chen
- Department of Radiology, Xingtai People’s Hospital, Interventional Catheter Room, Xingtai, Hebei, People’s Republic of China
| | - Shuaixin Qin
- Department of Neurosurgery, Xingtai People’s Hospital, Xingtai, Hebei, People’s Republic of China
| | - Xi Yang
- Department of Radiology, Xingtai People’s Hospital, Interventional Catheter Room, Xingtai, Hebei, People’s Republic of China
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Hu D, Wang N, Wang H, Fan D, Teng Q, Zheng X, Hou H. Clinical outcomes of arthroscopic all-inside anterior talofibular ligament suture augmentation repair versus modified suture augmentation repair for chronic ankle instability patients. BMC Musculoskelet Disord 2024; 25:48. [PMID: 38200504 PMCID: PMC10777501 DOI: 10.1186/s12891-023-07085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To compare the clinical efficacies of arthroscopic anterior talofibular ligament suture augmentation repair and modified suture augmentation repair in patients with chronic ankle instability (CAI). METHODS From October 2019 to August 2020, 100 patients with CAI were enrolled after propensity score matching analysis and observed for two years. Among them, 50 underwent modified suture augmentation repair and the other 50 underwent suture augmentation repair. The clinical efficacies of CAI treatments were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale, visual analog scale (VAS), and anterior drawer test scores. RESULTS The postoperative AOFAS score of the modified suture augmentation repair group (83.8 ± 11.3) was significantly higher than that of the suture augmentation repair group (76.3 ± 11.3; P = 0.001). The VAS (P = 0.863) and anterior drawer test (P = 0.617) scores were not significantly different between the two treatment groups. CONCLUSION Both the modified suture augmentation repair and suture augmentation repair demonstrated good clinical efficacies. The AOFAS score of the modified suture augmentation repair group was superior to that of the conventional suture augmentation repair group. Thus, modified suture augmentation repair is a feasible and practical surgical technique for CAI treatment.
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Affiliation(s)
- Dahai Hu
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
- International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Nan Wang
- Department of Clinical Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Huajun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Dongyi Fan
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Qiang Teng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Huige Hou
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
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