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Yuan H, Dong L, Zhang O, Wang X, Chen Z, Li Y, He H, Lü G, Li J, Kuang L. A comparison of interferential current efficacy in elderly intervertebral disc degeneration patients with or without sarcopenia: a retrospective study. BMC Musculoskelet Disord 2024; 25:214. [PMID: 38481194 PMCID: PMC10935844 DOI: 10.1186/s12891-024-07337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Intervertebral disc degeneration and sarcopenia are both age-related diseases without effective treatments. Their comorbidities may worsen the prognosis, and further studies on interaction and therapy are needed. The purpose of the study was to investigate the prevalence of sarcopenia in intervertebral disc degeneration, and to compare the characteristics of intervertebral disc degeneration with and without sarcopenia and effects of interferential current. METHODS One hundred twenty disc degeneration patients were included from 2021 to 2022 in a single institute. Medical records, examination results and radiological reports were reviewed. Patients with sarcopenia were screened and grouped according to Asian Working Group for Sarcopenia 2019. VAS, ODI, SARC-F, SMI, gait speed (GS), grip strength, disc Pfirrmann grading, standard cross-sectional area (SCSA), degree of fatty infiltration (DFF), and nerve conduction velocity (NCV) were assessed before and after treatment. RESULTS The prevalence of sarcopenia in intervertebral disc degeneration was 28.3%. The difference of VAS, ODI, disc Pfirrmann grading, SCSA, DFF and NCV between two groups were significant before intervention (P < 0.05), SCSA and DFF were related to the degree of disc degeneration. The improvement of SMI, GS, grip strength, VAS, SARC-F and ODI in intervertebral disc degeneration with sarcopenia group was significant after intervention, as well as SMI, GS, grip strength, VAS and ODI in those without sarcopenia (P < 0.05). The improvement of grip strength, GS, ODI and SARC-F in intervertebral disc degeneration with sarcopenia group were greater than the one without sarcopenia (P < 0.05), whereas there was no significance in improvement degree of other indicators between the two groups (P > 0.05). CONCLUSION The prevalence of sarcopenia was high in intervertebral disc degeneration, and paravertebral muscles degeneration correlated with the degree of disc degeneration. Compared to those without sarcopenia, intervertebral disc degeneration patients with sarcopenia have more severe pain, poorer mobility and neurological function. Interferential current is effective in intervertebral disc degeneration patients and sarcopenia patients.
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Affiliation(s)
- Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Lini Dong
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Ou Zhang
- Medical Education and Microbiology, California University of Science and Medicine, 1501 Violet Street, Colton, CA, 92324, USA
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Jing Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China.
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China.
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Elabd AM, Elabd OM. Effect of aerobic exercises on patients with chronic mechanical low back pain: A randomized controlled clinical trial. J Bodyw Mov Ther 2024; 37:379-385. [PMID: 38432832 DOI: 10.1016/j.jbmt.2023.12.001] [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: 05/06/2022] [Revised: 06/05/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Chronic mechanical low back pain (CMLBP) is one of the most prevalent and costly disorders. Determining its most effective treatment approach is a priority for researchers. PURPOSE To examine the effects of including aerobic exercise within a conventional therapy regimen for young adults with CMLBP. METHODS Fifty CMLBP patients (22 males and 28 females) were randomly and equally assigned to one of two groups to receive the prescribed treatment for 8 weeks. The control group received the traditional program only (infrared, ultrasound, burst TENS, and exercises); for the experimental group, an aerobic training program using a stationary bicycle was added. Back pain intensity was the primary outcome. Secondary outcomes included the Oswestry disability index, back extensor endurance measured by the Sorensen test, and physical performance indicated by the back performance scale and the 6-min walk test. A Two-way MANOVA was used for data analysis. RESULTS Multivariate tests revealed statistically significant effects of group (p = 0.002, partial η2 = 0.182), time (p < 0.001, partial η2 = 0.928), and group-by-time interaction (p = 0.01, partial η2 = 0.149). Univariate group-by-time interactions were significant for back disability (p = 0.043), extensor endurance (p = 0.023) and results of the 6-min walk test (p = 0.023) showing greater improvement in the experimental group. However, back pain intensity and the back performance scale revealed no significant group-by-time interactions. Within-group comparisons were significant for all measured variables in both groups (p < 0.001). CONCLUSION Although a traditional program of infrared, ultrasound, TENS, and exercises is beneficial for CMLBP treatment, adding aerobic exercises to the program leads to more beneficial outcomes.
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Affiliation(s)
- Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt; Basic Science Department, Faculty of Physical Therapy, Pharos University in Alexandria, Egypt.
| | - Omar M Elabd
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt; Department of Physical Therapy, Aqaba University of Technology, Aqaba, Jordan
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Rampazo ÉP, Júnior MAL, Corrêa JB, de Oliveira NTB, Santos ID, Liebano RE, Costa LOP. Effectiveness of interferential current in patients with chronic non-specific low back pain: a systematic review with meta-analysis. Braz J Phys Ther 2023; 27:100549. [PMID: 37801776 PMCID: PMC10562668 DOI: 10.1016/j.bjpt.2023.100549] [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: 05/10/2022] [Revised: 07/06/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND There is no systematic review assessing the effectiveness of interferential current (IC) in patients with low back pain. OBJECTIVE To investigate the effectiveness of IC in patients with chronic non-specific low back pain. METHODS The databases PUBMED, EMBASE, PEDro, Cochrane Library, CINAHL, and SCIELO were searched. Randomized controlled trials reporting pain intensity and disability in patients with chronic non-specific low back pain, in which IC was applied were included. Methodological quality was assessed using the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of evidence. RESULTS Thirteen RCTs were considered eligible for this systematic review (pooled n = 1367). Main results showed moderate-quality evidence and moderate effect sizes that IC probably reduces pain intensity and disability compared to placebo immediately post-treatment (Pain: MD = -1.57 points; 95% CI -2.17, -0.98; Disability: MD = -1.51 points; 95% CI -2.57, -0.46), but not at intermediate-term follow-up. Low-quality evidence with small effect size showed that IC may reduce pain intensity (SMD = -0.32; 95% CI -0.61, -0.03, p = 0.03) compared to TENS immediately post-treatment, but not for disability. There is very low-quality evidence that IC combined with other interventions (massage or exercises) may not further reduce pain intensity and disability compared to the other interventions provided in isolation immediately post-treatment. CONCLUSION Moderate-quality evidence shows that IC is probably better than placebo for reducing pain intensity and disability immediately post-treatment in patients with chronic non-specific low back pain.
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Affiliation(s)
- Érika P Rampazo
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Maurício A Luz Júnior
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo SP, Brazil
| | - Juliana B Corrêa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo SP, Brazil
| | - Naiane T B de Oliveira
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo SP, Brazil
| | - Irlei Dos Santos
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo SP, Brazil
| | - Richard E Liebano
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil; Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo SP, Brazil
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Wolfe D, Rosenstein B, Fortin M. The Effect of Transcutaneous Electrotherapy on Lumbar Range of Motion and Paraspinal Muscle Characteristics in Chronic Low Back Pain Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4680. [PMID: 37510796 PMCID: PMC10380811 DOI: 10.3390/jcm12144680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic low back pain (CLBP) affects paraspinal muscle size, quality (e.g., fatty infiltration), range of motion (ROM), and strength. Although transcutaneous electrotherapies are used to treat CLBP, their effects on paraspinal-related outcomes are not fully known. The aim of this systematic review and meta-analysis was to assess the overall effect of transcutaneous electrotherapies on trunk/lumbar ROM, paraspinal muscle morphology, and trunk muscle function (including strength and endurance) in CLBP patients. A systematic search of four databases and two study registers was conducted between 1 February 2022 and 15 September 2022. Two reviewers were responsible for screening and data extraction. Of the 3939 independent records screened, 10 were included in the systematic review and 2 in the meta-analysis. The results suggest there is limited evidence that both EMS and EMS plus exercise are superior to passive and active controls, respectively, for improving trunk muscle endurance. There is limited evidence that neither TENS nor mixed TENS are superior to controls for improving trunk muscle endurance. There is limited evidence that NMES is superior to passive controls for improving trunk muscle strength. The effect of transcutaneous electrotherapy on the other investigated outcomes was inconclusive. Future transcutaneous electrotherapy studies should focus on paraspinal-based outcomes that are under-studied.
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Affiliation(s)
- Daniel Wolfe
- Department Health Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Brent Rosenstein
- Department Health Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Maryse Fortin
- Department Health Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada
- PERFORM Centre, Concordia University, Montreal, QC H4B 1R6, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC H4B 1T3, Canada
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Tamartash H, Bahrpeyma F, Dizaji MM. The effect of transcutaneous electrical nerve stimulation on pain and electrical stimulation muscle thickness in patients with non-specific chronic low back pain-based ultrasonographic evaluation. Pain Manag 2023; 13:87-94. [PMID: 36621774 DOI: 10.2217/pmt-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aim: The existing mechanisms of transcutaneous electrical nerve stimulation (TENS) focuses more on the effect of neural tissue. This study investigated the effect of TENS on the thickness of the erector spinae muscles and reducing pain. Patients & methods: 56 individuals with low back pain participated in this single-blind, pre/post-test study. For 2 weeks, participants underwent ten sessions of TENS. The ultrasound evaluations examined the thickness of the erector spinae muscle, and the visual analog scale measured the severity of low back pain. Results: There was a decrease in pain score and muscle thickness after the interventions (p ≤ 0.004). There was also a strong correlation between reducing pain and decreasing muscle thickness (R = 0.709; p = 0.000). Conclusion: Following TENS in the lumbar, in addition to reducing pain, the thickness of the erector spinae muscles also decreased. Clinical Trial Registration: IRCT20200423047173N1 (ClinicalTrials.gov).
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Affiliation(s)
- Hassan Tamartash
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Manijhe Mokhtari Dizaji
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Quaranta M, Riccio I, Oliva F, Maffulli N. Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence. Sports Med Arthrosc Rev 2022; 30:102-110. [PMID: 35533062 DOI: 10.1097/jsa.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.
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Affiliation(s)
- Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Ivano Riccio
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London
- Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Stoke-on-Trent, England
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Paley CA, Wittkopf PG, Jones G, Johnson MI. Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1060. [PMID: 34684097 PMCID: PMC8539683 DOI: 10.3390/medicina57101060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors' conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with 'sufficient data' demonstrating benefit. There were no examples of meta-analyses with 'sufficient data' demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with 'insufficient data' and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.
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Affiliation(s)
- Carole A. Paley
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Research and Development Department, Airedale National Health Service (NHS) Foundation Trust, Skipton Road, Steeton, Keighley BD20 6TD, UK
| | - Priscilla G. Wittkopf
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Gareth Jones
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Mark I. Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
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Kato S, Inaki A, Murakami H, Kurokawa Y, Mochizuki T, Demura S, Yoshioka K, Yokogawa N, Yonezawa N, Shimizu T, Kinuya S, Tsuchiya H. Reliability of the muscle strength measurement and effects of the strengthening by an innovative exercise device for the abdominal trunk muscles. J Back Musculoskelet Rehabil 2020; 33:677-684. [PMID: 31658038 DOI: 10.3233/bmr-181419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We developed an innovative exercise device for the abdominal trunk muscles (ATMs) that has a built-in system to measure muscle strength. We aimed to examine the reliability of the strength measurement as well as the effect of strengthening using the device. METHODS Twenty healthy adults participated in a reliability study of the muscle strength measurement. The first and second measurement were done in one day with an hour rest interval by raters 1 and 2, and the third by rater 1 following a one-week interval. We calculated the intraclass correlation coefficient (ICC). Another seven healthy men participated in a training program using the device, consisting of strengthening twice a week for 5 weeks. ATM strength was measured before and after the training period, and a positron emission tomography (PET) scan series was performed, consisting of examinations during rest before training (control condition) and during exercise after training (training condition). RESULTS The intra-rater (ICC = 0.95) and inter-rater (ICC = 0.99) reliability of the strength measurement were excellent. ATM strength was significantly higher after training than before. 18F-fluorodeoxyglucose accumulation within the diaphragm, abdominal rectus, abdominal external and internal oblique, transverse abdominal, and levator ani muscles was significantly higher in the training condition than in the control. CONCLUSIONS Our innovative device showed excellent reliability to quantify ATM strength. Strengthening using the device increased strength and activated the abdominals, diaphragm, and pelvic floor muscles.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Anri Inaki
- Department of Nuclear Medicine/Biotracer Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuki Kurokawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | | | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noritaka Yonezawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine/Biotracer Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Ebadi S, Henschke N, Forogh B, Nakhostin Ansari N, van Tulder MW, Babaei-Ghazani A, Fallah E. Therapeutic ultrasound for chronic low back pain. Cochrane Database Syst Rev 2020; 7:CD009169. [PMID: 32623724 PMCID: PMC7390505 DOI: 10.1002/14651858.cd009169.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This is an update of a Cochrane Review published in 2014. Chronic non-specific low back pain (LBP) has become one of the main causes of disability in the adult population around the world. Although therapeutic ultrasound is not recommended in recent clinical guidelines, it is frequently used by physiotherapists in the treatment of chronic LBP. OBJECTIVES The objective of this review was to determine the effectiveness of therapeutic ultrasound in the management of chronic non-specific LBP. A secondary objective was to determine the most effective dosage and intensity of therapeutic ultrasound for chronic LBP. SEARCH METHODS We performed electronic searches in CENTRAL, MEDLINE, Embase, CINAHL, PEDro, Index to Chiropractic Literature, and two trials registers to 7 January 2020. We checked the reference lists of eligible studies and relevant systematic reviews and performed forward citation searching. SELECTION CRITERIA We included randomised controlled trials (RCTs) on therapeutic ultrasound for chronic non-specific LBP. We compared ultrasound (either alone or in combination with another treatment) with placebo or other interventions for chronic LBP. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of each trial and extracted the data. We performed a meta-analysis when sufficient clinical and statistical homogeneity existed. We determined the certainty of the evidence for each comparison using the GRADE approach. MAIN RESULTS We included 10 RCTs involving a total of 1025 participants with chronic LBP. The included studies were carried out in secondary care settings in Turkey, Iran, Saudi Arabia, Croatia, the UK, and the USA, and most applied therapeutic ultrasound in addition to another treatment, for six to 18 treatment sessions. The risk of bias was unclear in most studies. Eight studies (80%) had unclear or high risk of selection bias; no studies blinded care providers to the intervention; and only five studies (50%) blinded participants. There was a risk of selective reporting in eight studies (80%), and no studies adequately assessed compliance with the intervention. There was very low-certainty evidence (downgraded for imprecision, inconsistency, and limitations in design) of little to no difference between therapeutic ultrasound and placebo for short-term pain improvement (mean difference (MD) -7.12, 95% confidence interval (CI) -17.99 to 3.75; n = 121, 3 RCTs; 0-to-100-point visual analogue scale (VAS)). There was also moderate-certainty evidence (downgraded for imprecision) of little to no difference in the number of participants achieving a 30% reduction in pain in the short term (risk ratio 1.08, 95% CI 0.81 to 1.44; n = 225, 1 RCT). There was low-certainty evidence (downgraded for imprecision and limitations in design) that therapeutic ultrasound has a small effect on back-specific function compared with placebo in the short term (standardised mean difference -0.29, 95% CI -0.51 to -0.07 (MD -1.07, 95% CI -1.89 to -0.26; Roland Morris Disability Questionnaire); n = 325; 4 RCTs), but this effect does not appear to be clinically important. There was moderate-certainty evidence (downgraded for imprecision) of little to no difference between therapeutic ultrasound and placebo on well-being (MD -2.71, 95% CI -9.85 to 4.44; n = 267, 2 RCTs; general health subscale of the 36-item Short Form Health Survey (SF-36)). Two studies (n = 486) reported on overall improvement and satisfaction between groups, and both reported little to no difference between groups (low-certainty evidence, downgraded for serious imprecision). One study (n = 225) reported on adverse events and did not identify any adverse events related to the intervention (low-certainty evidence, downgraded for serious imprecision). No study reported on disability for this comparison. We do not know whether therapeutic ultrasound in addition to exercise results in better outcomes than exercise alone because the certainty of the evidence for all outcomes was very low (downgraded for imprecision and serious limitations in design). The estimate effect for pain was in favour of the ultrasound plus exercise group (MD -21.1, 95% CI -27.6 to -14.5; n = 70, 2 RCTs; 0-to-100-point VAS) at short term. Regarding back-specific function (MD - 0.41, 95% CI -3.14 to 2.32; n = 79, 2 RCTs; Oswestry Disability Questionnaire) and well-being (MD -2.50, 95% CI -9.53 to 4.53; n = 79, 2 RCTs; general health subscale of the SF-36), there was little to no difference between groups at short term. No studies reported on the number of participants achieving a 30% reduction in pain, patient satisfaction, disability, or adverse events for this comparison. AUTHORS' CONCLUSIONS The evidence from this systematic review is uncertain regarding the effect of therapeutic ultrasound on pain in individuals with chronic non-specific LBP. Whilst there is some evidence that therapeutic ultrasound may have a small effect on improving low back function in the short term compared to placebo, the certainty of evidence is very low. The true effect is likely to be substantially different. There are few high-quality randomised trials, and the available trials were very small. The current evidence does not support the use of therapeutic ultrasound in the management of chronic LBP.
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Affiliation(s)
- Safoora Ebadi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Bijan Forogh
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Arash Babaei-Ghazani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Fallah
- Department of Orthopedics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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10
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Batistella CE, Bidin F, Giacomelli I, Nunez MA, Gasoto E, Albuquerque CED, Flores LJF, Bertolini GRF. Effects of the Russian current in the treatment of low back pain in women: A randomized clinical trial. J Bodyw Mov Ther 2020; 24:118-122. [PMID: 32507136 DOI: 10.1016/j.jbmt.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Low back pain (LBP) is a high impact condition that affects the working population, generating social and economic repercussions, the most relevant symptoms being pain and functional disability. Conservative treatment is often based on stabilizing spinal muscles with exercises: the Russian current (RC) is reported as an alternative, because it promotes muscle contraction, providing muscle strengthening and hypertrophy. OBJECTIVE To assess the effectiveness of the RC in aiding the treatment of low back pain. METHODS This randomized study included 23 women aged 18-30 years, divided into two groups: the control group (CG) and the Russian current group (RCG), for four weeks. Pain (visual analogue scale, VAS; pressure algometer, PA), function (Oswestry Low Back Disability Index), resistance (trunk resistance [TR] test) and thickness changes in the muscle (ultrasound image) were evaluated before and after the RC protocol and at one-month follow-up. RESULTS There were significant VAS reductions in both groups, but at follow-up these had only been maintained in the RCG, which presented lower values than the CG in the second evaluation. For PA, Oswestry and TR, there were differences only in the RCG. In a comparison of LBP between the groups, the initial difference disappeared in subsequent evaluations; TR presented higher values in evaluation 2 and 3 in the RCG group. In terms of thickness changes, differences between the groups were reduced after treatment. CONCLUSION The proposed treatment was effective in the reduction of LBP, with short-term improvement in resistance and thickness changes of the multifidus.
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Affiliation(s)
- Carla Elis Batistella
- Universidade Estadual Do Oeste Do Paraná - UNIOESTE, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
| | - Fernanda Bidin
- Universidade Estadual Do Oeste Do Paraná - UNIOESTE, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
| | - Isabela Giacomelli
- Universidade Estadual Do Oeste Do Paraná - UNIOESTE, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
| | - Milena Aparecida Nunez
- Universidade Estadual Do Oeste Do Paraná - UNIOESTE, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
| | - Eduardo Gasoto
- Universidade Estadual Do Oeste Do Paraná - UNIOESTE, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
| | | | - Lucinar Jupir Forner Flores
- Universidade Estadual Do Oeste Do Paraná - UNIOESTE, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
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Kato S, Demura S, Kurokawa Y, Takahashi N, Shinmura K, Yokogawa N, Yonezawa N, Shimizu T, Kitagawa R, Tsuchiya H. Efficacy and Safety of Abdominal Trunk Muscle Strengthening Using an Innovative Device in Elderly Patients With Chronic Low Back Pain: A Pilot Study. Ann Rehabil Med 2020; 44:246-255. [PMID: 32475095 PMCID: PMC7349035 DOI: 10.5535/arm.19100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/11/2019] [Indexed: 11/05/2022] Open
Abstract
Objective To examine the efficacy and safety of an innovative, device-driven abdominal trunk muscle strengthening program, with the ability to measure muscle strength, to treat chronic low back pain (LBP) in elderly participants. Methods Seven women with non-specific chronic LBP, lasting at least 3 months, were enrolled and treated with the prescribed exercise regimen. Patients participated in a 12-week device-driven exercise program which included abdominal trunk muscle strengthening and 4 types of stretches for the trunk and lower extremities. Primary outcomes were adverse events associated with the exercise program, improvement in abdominal trunk muscle strength, as measured by the device, and improvement in the numerical rating scale (NRS) scores of LBP with the exercise. Secondary outcomes were improvement in the Roland-Morris Disability Questionnaire (RDQ) score and the results of the locomotive syndrome risk test, including the stand-up and two-step tests. Results There were no reports of increased back pain or new-onset abdominal pain or discomfort during or after the device-driven exercise program. The mean abdominal trunk muscle strength, NRS, RDQ scores, and the stand-up and two-step test scores were significantly improved at the end of the trial compared to baseline. Conclusion No participants experienced adverse events during the 12-week strengthening program, which involved the use of our device and stretching, indicating the program was safe. Further, the program significantly improved various measures of LBP and physical function in elderly participants.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuki Kurokawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuya Shinmura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noritaka Yonezawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Ryo Kitagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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12
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13
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Daia C, Bumbea AM, Badiu CD, Ciobotaru C, Onose G. Interferential electrical stimulation for improved bladder management following spinal cord injury. Biomed Rep 2019; 11:115-122. [PMID: 31423306 DOI: 10.3892/br.2019.1227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/21/2019] [Indexed: 11/06/2022] Open
Abstract
Patients with spinal cord injury (SCI) with neurogenic bladder (NB) represent a major medical problem, which initiated the search for a non-invasive and effective treatment that is easy to apply and without side effects. A study was performed using interferential medium frequency current electrical stimulation (IMFC ES) on 332 patients shortly after SCI diagnosed with NB dysfunction. All subjects received standard care and patients of the experimental group additionally received IMFC ES. Urinary management results included volitional control of voiding, intermittent catheterization, post-voidance residuum (PVR) quantity and quantity of urine lost (LOSS). Results were assessed based on the American spinal cord injury association impairment scale (AIS). The IMFC ES included two channels of medium frequency stimulation that were marginally different. Within the body, a low frequency field was generated through the interaction of the medium frequencies, which stimulated the urinary structures. In the IMFC ES group, interference stimulation was applied for 10 min with frequencies cycling from 0-100 Hz and back in 10 sec intervals. The strength of the low frequency stimulation, achieved by the interference of the two medium-frequency fields, was adjusted to the patients' vibration sensation. The intensities triggering vibration sensation were between 20-80 mA for patients with AIS levels B, C and D. For patients with AIS level A intensities <20 mA were used for therapeutic effects without causing skin injuries. Safety of IMFC ES was based on occurrence of adverse events of which none were recorded in the experimental group. IMFC ES was effective in patients with AIS levels B and C, significantly decreasing PVR and LOSS compared with patients receiving standard care No significant improvements in urinary management were observed following IMFC ES treatment of patients with AIS level A. Patients with SCI and NB classed as AIS levels B and C that exhibit preserved sensitivity were the best beneficiaries of IMFC ES therapy.
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Affiliation(s)
- Cristina Daia
- Department of Medical Rehabilitation, University of Medicine and Pharmacy 'Carol Davila', Bucharest 4192910, Romania.,Neuromuscular Department, Clinical Emergency Hospital 'Bagdasar Arseni', Bucharest 041914, Romania
| | - Ana Maria Bumbea
- Department of Medical Rehabilitation, University of Medicine and Pharmacy, Craiova 200349, Romania.,Neurorehabiltation Department, Clinical Neuropsychiatry Hospital, Craiova 200473, Romania
| | - Cristinel Dumitru Badiu
- Department of General Surgery, University of Medicine and Pharmacy 'Carol Davila', Bucharest 4192910, Romania.,Department of General Surgery, Clinical Emergency Hospital 'Bagdasar Arseni', Bucharest 041914, Romania
| | - Camelia Ciobotaru
- Department of Medical Rehabilitation, Faculty of Medicine, University 'Ovidius', Constanta 900527, Romania
| | - Gelu Onose
- Department of Medical Rehabilitation, University of Medicine and Pharmacy 'Carol Davila', Bucharest 4192910, Romania.,Neuromuscular Department, Clinical Emergency Hospital 'Bagdasar Arseni', Bucharest 041914, Romania
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14
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Nascimento PRD, Costa LO, Araujo AC, Poitras S, Bilodeau M. Effectiveness of interventions for non-specific low back pain in older adults. A systematic review and meta-analysis. Physiotherapy 2019; 105:147-162. [DOI: 10.1016/j.physio.2018.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
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15
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Ellis JM, Wells Y, Ong JSM. Non-Pharmacological Approaches to Pain Management in Residential Aged Care: a Pre-Post-Test Study. Clin Gerontol 2019; 42:286-296. [PMID: 29240534 DOI: 10.1080/07317115.2017.1399189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The project aimed to evaluate a pain management program (PMP) using non-pharmacological approaches at five residential aged care facilities (RACFs) in Australia. METHODS The PMP involved a physiotherapist implementing four sessions per week of treatments (massage therapy, TENS, exercises and stretching, or combinations of these). Ninety-five participants were recruited (average age, 83 years; SD = 7.6; 38% men, 62% women; 56% with dementia). Sessions lasted approximately 10 minutes, and residents' levels of pain were recorded using a 5-point scale before and after each treatment. The intervention period for each participant was the first consecutive 8 weeks in which they received the intervention. RESULTS Data analyses showed: (1) a small but statistically significant decrease in the number of as required (PRN) medications; and (2) a decrease in average pain ratings from pre-session to post-session from 2.4 (some to moderate pain) to 1.1 (a little pain). Notably, residents with dementia received lower pain ratings than those without. CONCLUSIONS Non-pharmacological approaches to pain in residential care settings are effective, especially when two or more are combined. Staff working in residential care settings should rely on best practice to recognise pain in residents with dementia. CLINICAL IMPLICATIONS Non-pharmacological interventions may be effective in reducing pain and reliance on PRN medications in residential care settings, especially when two or more are used. Staff working in residential aged care settings should be provided with training in pain assessment and management, with particular attention to residents with dementia.
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Affiliation(s)
- Julie M Ellis
- a La Trobe University School of Nursing and Midwifery , Bundoora , Australia
| | - Yvonne Wells
- a La Trobe University School of Nursing and Midwifery , Bundoora , Australia
| | - June Su Ming Ong
- b Physiotherapy Department , Werribee Mercy Health , Melbourne , Australia
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16
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Filiz MB, Firat SC. Effects of Physical Therapy on Pain, Functional Status, Sagittal Spinal Alignment, and Spinal Mobility in Chronic Non-specific Low Back Pain. Eurasian J Med 2019; 51:22-26. [PMID: 30911251 DOI: 10.5152/eurasianjmed.2018.18126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the effects of physical therapy (PT) on pain, functional status, sagittal spinal alignment, and spinal mobility in chronic non-specific low back pain (NSLBP). Materials and Methods The study population consisted of 100 patients with chronic NSLBP. The study group comprised 60 patients to whom a PT program including superficial heat, transcutaneous electrical nerve stimulation, and ultrasound for 10 sessions was assigned. The control group was composed of 40 patients who received no PT. Home exercise programs were applied to both groups. Pain severity was determined using a Visual Analog Scale (VAS), and functional status was evaluated using the Oswestry Disability Index (ODI). Spinal sagittal alignment in regard to lumbosacral, lumbar lordosis, and thoracic kyphosis angles and spinal mobility regarding lumbar and thoracic flexion and extension degrees were assessed using a digital inclinometer. Lumbar flexion was also assessed using the modified lumbar Schober test (mLST). Evaluations were performed at baseline and after completing the therapy sessions. Results There were significant decreases in VAS scores in each group upon therapy completion. However, significant improvements in ODI, mLST, and all inclinometric evaluations in terms of sagittal spinal alignment and spinal mobility were noted only in the study group compared with baseline values (p<0.05). Conclusion Despite the short course of treatment, PT was found to have significant positive effects on pain severity, functional status, sagittal spinal alignment, and spinal mobility. PT was determined to be an effective treatment option for chronic NSLBP.
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Affiliation(s)
- Meral Bilgilisoy Filiz
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Sibel Cubukcu Firat
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
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17
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Tapia González I, Esteve Simó V, Moreno Guzman F, Fulquet Nicolás M, Duarte Gallego V, Saurina Solé A, Pou Potau M, Ramírez de Arellano Serna M. Thermotherapy: Improving the vascular access cannulation procedure. J Vasc Access 2018; 20:386-391. [DOI: 10.1177/1129729818809013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Irati Tapia González
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
- Functional Unit of Vascular Access (FUVA), Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Vicent Esteve Simó
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
- Functional Unit of Vascular Access (FUVA), Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Fátima Moreno Guzman
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Miquel Fulquet Nicolás
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Verónica Duarte Gallego
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Anna Saurina Solé
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Mónica Pou Potau
- Department of Nephrology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
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18
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Franco YR, Franco KF, Silva LA, Silva MO, Rodrigues MN, Liebano RE, Cabral CM. Does the use of interferential current prior to pilates exercises accelerate improvement of chronic nonspecific low back pain? Pain Manag 2018; 8:465-474. [PMID: 30394194 DOI: 10.2217/pmt-2018-0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To evaluate whether active interferential current (AIC) before pilates exercises improves pain faster than placebo interferential current (PIC) in patients with chronic nonspecific low back pain (CNLBP). METHODS A total of 142 patients with CNLBP were treated with AIC or PIC before pilates exercises. Pain intensity was measured daily before and after treatment by Pain Numerical Rating Scale. Statistical analysis was performed using survival analysis for Kaplan-Meier method. RESULTS The AIC group presented 30% reduction of pain one session, 50% reduction of pain two sessions and 100% reduction of pain three sessions faster than the PIC group and these improvements were statistically significant (p < 0.05). CONCLUSION The AIC before pilates exercises can reduce pain faster than PIC in patients with CNLBP.
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Affiliation(s)
- Yuri Rs Franco
- Master's & Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, Brazil
| | - Katherinne Fm Franco
- Master's & Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, Brazil
| | - Letícia A Silva
- Physical Therapy Department, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Macilene O Silva
- Physical Therapy Department, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Michele N Rodrigues
- Physical Therapy Department, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Richard E Liebano
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Cristina Mn Cabral
- Master's & Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, Brazil
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19
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Jangi M, Ferandez-de-Las-Penas C, Tara M, Moghbeli F, Ghaderi F, Javanshir K. A systematic review on reminder systems in physical therapy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2018; 9:7-15. [PMID: 29387313 PMCID: PMC5771354 DOI: 10.22088/cjim.9.1.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background The main goal of physical therapy is to help the patient gain a better health status. Several studies have investigated the use of reminders to prevent such failures on the patients' side. This article presents a systematic review of the literature concerning reminders in physical therapy. Methods Databases were searched until May 2017 and literatures were found from April 1992 until 2017. The literature recruitment strategy was based on applying several keywords and Medical Subject Heading (MeSH) combination running against title and abstract, including concepts such as reminder, physical therapy. The finally selected articles were categorized through reminder aspects such as how, who feedback. Data were extracted according to PRISMA guidelines. Results In 47% of studies, the reminder was sent to the patients, 29% to the physical therapists and 12% to the caretaker team. In 24% of the studies, paper-based letters were main medium for reminders while the rest were various types of media like emails and SMS mobile text messages. 35% of the articles showed positive effects of the reminders. Conclusions Many reminder methods consisted of SMS, phone calls, letters, emails and notices on the wall were used in physical therapy. Reminders may be used to improve patients' adherence to exercise programs.
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Affiliation(s)
- Majid Jangi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Cesar Ferandez-de-Las-Penas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Mahmoud Tara
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fateme Moghbeli
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghaderi
- Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khodabakhsh Javanshir
- Mobility Impairment Research Center, Health Research Institate, Babol University of Medical Sciences, Babol Iran
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20
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Resende L, Merriwether E, Rampazo ÉP, Dailey D, Embree J, Deberg J, Liebano RE, Sluka KA. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. Eur J Pain 2017; 22:663-678. [PMID: 29282846 DOI: 10.1002/ejp.1168] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 11/11/2022]
Abstract
We conducted a systematic review and meta-analysis analysing the existing data on transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) for chronic low back pain (CLBP) and/or neck pain (CNP) taking into account intensity and timing of stimulation, examining pain, function and disability. Seven electronic databases were searched for TENS or IFC treatment in non-specific CLBP or CNP. Four reviewers independently selected randomized controlled trials (RCTs) of TENS or IFC intervention in adult individuals with non-specific CLBP or CNP. Primary outcomes were for self-reported pain intensity and back-specific disability. Two reviewers performed quality assessment, and two reviewers extracted data using a standardized form. Nine RCTs were selected (eight CLBP; one CNP), and seven studies with complete data sets were included for meta-analysis (655 participants). For CLBP, meta-analysis shows TENS/IFC intervention, independent of time of assessment, was significantly different from placebo/control (p < 0.02). TENS/IFC intervention was better than placebo/control, during therapy (p = 0.02), but not immediately after therapy (p = 0.08), or 1-3 months after therapy (p = 0.99). Analysis for adequate stimulation parameters was not significantly different, and there was no effect on disability. This systematic review provides inconclusive evidence of TENS benefits in low back pain patients because the quality of the studies was low, and adequate parameters and timing of assessment were not uniformly used or reported. Without additional high-quality clinical trials using sufficient sample sizes and adequate parameters and outcome assessments, the outcomes of this review are likely to remain unchanged. SIGNIFICANCE These data highlight the need for additional high-quality RCTs to examine the effects of TENS in CLBP. Trials should consider intensity of stimulation, timing of outcome assessment and assessment of pain, disability and function.
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Affiliation(s)
- L Resende
- Physiological Science Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil
| | - E Merriwether
- Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, IA, USA
| | - É P Rampazo
- Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - D Dailey
- Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, IA, USA
| | - J Embree
- Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, IA, USA
| | - J Deberg
- Hardin Library User Services, University of Iowa, IA, USA
| | - R E Liebano
- Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - K A Sluka
- Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, IA, USA
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21
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Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil 2017; 13:477-485. [PMID: 29114516 PMCID: PMC5667628 DOI: 10.12965/jer.1734972.486] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/28/2017] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to compare three different forms of exercises namely lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain (LBP) in terms of pain, range of motion, core strength and function. In this study, 44 subjects suffering from non-specific LBP for more than 3 months were randomly allocated into the lumbar stabilization group, the dynamic strengthening group, and the Pilates group. Ten sessions of exercises for 3 weeks were prescribed along with interferential current and hot moist pack. Pain was assessed by visual analog scale, functional affection by modified Oswestry Disability Questionnaire, range of motion by assessing lumbar flexion and extension by modified Schober test and core strength was assessed by pressure biofeedback on day 1 and day 10 of the treatment. There was reduction of pain, improvement in range of motion, functional ability and core strength in all the 3 exercise groups. The improvement was significantly greater in the lumbar stabilization group for all the outcome measures, when compared the posttreatment after 10th session. Pairwise comparison showed that there was greater reduction of disability in the Pilates group than the dynamic strengthening group. It was concluded that the lumbar stabilization is more superior compared to the dynamic strengthening and Pilates in chronic nonspecific LBP. However, long-term benefits need to be assessed and compared with prospective follow-up studies.
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Affiliation(s)
- Esha A Bhadauria
- Department of Orthopaedics Physiotherapy, KLE University's Institute of Physiotherapy, Belagavi, India
| | - Peeyoosha Gurudut
- Department of Orthopaedics Physiotherapy, KLE University's Institute of Physiotherapy, Belagavi, India
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22
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Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2017; 30:211-219. [PMID: 27472855 DOI: 10.3233/bmr-160735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neck pain is an important cause of disability. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Stabilization exercise has been the topic of many studies. OBJECTIVE To compare the effects of stabilization and routine exercises on chronic neck pain. METHODS Forty patients were randomly assigned into either stabilization or routine exercise groups and undertook a 10-week training program. Electromyographic (EMG) activity was recorded from Sternocleidomastoid (SCM), Anterior Scalene (AS) and Splenius Capitis (SC) muscles bilaterally. Endurance time of deep flexor muscles was measured by chronometer.Pain and disability were measured using Visual Analogue Scale (VAS) and neck disability index (NDI) questionnaire, respectively before and after training period. RESULTS Findings revealed significant decreased pain and disability in both groups after intervention (P< 0/001). Flexor muscles endurance of stabilization group was significantly increased compared with that of routine (P< 0/001). Also EMG activity of SCM, AS and SC muscles were significantly decreased in stabilization group compared with routine (P< 0/001). CONCLUSION Increased deep flexor endurance and decreased EMG activity of SCM, AS and SC muscles suggest an important role for stabilizing exercises on reducing the activity of superficial muscles in chronic neck pain.
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Affiliation(s)
- Fariba Ghaderi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khodabakhsh Javanshir
- Mobility Impairment Research Center, Physiotherapy Department, Babol University of Medical Sciences, Babol, Iran
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Tousignant-Laflamme Y, Laroche C, Beaulieu C, Bouchard AJ, Boucher S, Michaud-Létourneau M. A randomized trial to determine the duration of analgesia following a 15- and a 30-minute application of acupuncture-like TENS on patients with chronic low back pain. Physiother Theory Pract 2017; 33:361-369. [PMID: 28379056 DOI: 10.1080/09593985.2017.1302540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acupuncture-like TENS (AL-TENS) has been shown to produce prolonged pain relief, but no study has yet investigated its duration on a population suffering from chronic low back pain (CLPB). OBJECTIVE Our objective was to quantify the duration and magnitude of analgesia induced by a 15- or 30-minute application of AL-TENS. METHODOLOGY We recruited a sample of 11 participants presenting with CLBP and conducted a randomized, crossover study, where participants were given AL-TENS for 15 and 30 minutes on two separate occasions. The pain intensity of their CLBP was assessed with a visual analogue scale before, during, and after AL-TENS applications. Magnitude and duration of analgesia were determined for each subject and for both AL-TENS application times. RESULTS The AL-TENS applications induced a clinically and statistically significant (p = 0.003) analgesia in all participants. Median duration of analgesia was 9 hours and 10 hours 30 minutes following the 15- and 30-minute AL-TENS applications, respectively; this 1.5-hour difference was not statistically significant (p = 0.55). Furthermore, we observed no significant difference in the magnitude of analgesia between both applications of AL-TENS (p > 0.56), suggesting that the duration of application of AL-TENS does not influence the magnitude of analgesia. CONCLUSION Our results suggest that clinicians could use a 15-minute AL-TENS application to provide significant analgesia in patients presenting with low back pain since if provides a comparable analgesia versus a 30-minute application.
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Affiliation(s)
- Yannick Tousignant-Laflamme
- a Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada.,b Centre de Recherche Clinique du CHUS , Sherbrooke , QC , Canada
| | - Claudia Laroche
- a Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada
| | - Christine Beaulieu
- a Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada
| | - Ann-Julie Bouchard
- a Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada
| | - Sabrina Boucher
- a Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada
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Kato S, Murakami H, Inaki A, Mochizuki T, Demura S, Nakase J, Yoshioka K, Yokogawa N, Igarashi T, Takahashi N, Yonezawa N, Kinuya S, Tsuchiya H. Innovative exercise device for the abdominal trunk muscles: An early validation study. PLoS One 2017; 12:e0172934. [PMID: 28235060 PMCID: PMC5325572 DOI: 10.1371/journal.pone.0172934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/13/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exercise is one of the few treatments that provide significant improvements in chronic low back pain (CLBP). We developed an innovative exercise device for abdominal trunk muscles. This device can be used in a sitting or standing position and contains a built-in system to measure abdominal trunk muscle strength. We examined whether subjects can adequately use the device to perform the exercises and measure their abdominal trunk muscle strength. METHODS We collected data on the body height, body weight, body mass index, and girth of 30 healthy male volunteers, and measured their grip power and trunk extensor muscle strength using a dynamometer. The volunteers performed a sit-up test as an indicator of trunk flexor muscle strength, and we measured their abdominal muscle strength using the device. We then evaluated the correlations between abdominal trunk muscle strength and anthropometric parameters as well as the strength of other muscles. In subsequent tests, 5 of the 30 subjects participated in two positron emission tomography (PET) series consisting of examinations after a resting period (control study) and during exercise (exercise study). For the exercise study, the subjects performed 2 sets of exercises for 20 minutes using the device before and after an injection of 18F-fluorodeoxyglucose (FDG). PET-computed tomography images were obtained 60 minutes after FDG injection in each study. We compared the skeletal muscle metabolism of the participants in both studies using the standardized uptake value. RESULTS The muscle strength measured by the device and the 30-second sit-up frequency were correlated. FDG accumulation within the diaphragm and abdominal rectus muscles was significantly higher in the exercise study. CONCLUSION Our innovative exercise device facilitates a coordinated contraction of the abdominal trunk muscles at the anterior aspect and the roof of the core, and enables subjects to measure the strength of these muscles.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
- * E-mail:
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Anri Inaki
- Department of Nuclear Medicine/Biotracer Medicine, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | | | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Takashi Igarashi
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Naoki Takahashi
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Noritaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine/Biotracer Medicine, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, 13–1 Takara-machi, Kanazawa, Japan
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Albornoz-Cabello M, Maya-Martín J, Domínguez-Maldonado G, Espejo-Antúnez L, Heredia-Rizo AM. Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized controlled trial. Clin Rehabil 2016; 31:242-249. [DOI: 10.1177/0269215516639653] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To assess the short-term efficacy of transregional interferential current therapy on pain perception and disability level in chronic non-specific low back pain. Design: A randomized, single-blinded (the assessor collecting the outcome data was blinded), controlled trial. Setting: A private physiotherapy research clinic. Subjects: A total of 64 individuals, 20 men and 44 women, mean (SD) age was 51 years (11.93), with low back pain of more than three months, with or without pain radiating to the lower extremities above the knee, were distributed into a control ( n = 20) or an experimental group ( n = 44). A 2:1 randomization ratio was used in favour of the latter. Interventions: A transregional interferential current electrotherapy protocol was performed for participants in the experimental group, while the control group underwent a ‘usual care’ treatment (massage, mobilization and soft-tissue techniques). All subjects received up to 10 treatment sessions of 25 minutes over a two-week period, and completed the intervention and follow-up evaluations. Outcome measures: Self-perceived pain was assessed with a Visual Analogue Scale. Secondary measure included the Oswestry Low Back Disability Index. Evaluations were collected at baseline and after the intervention protocol. Results: Significant between-group differences were found for interferential current therapy on pain perception ( p = 0.032) and disability level ( p = 0.002). The observed differences in the between-group mean changes were of 11.34 mm (1.77/20.91) and 13.38 points (4.97/21.78), respectively. Conclusions: A two-week transregional interferential current treatment has shown significant short-term efficacy, when compared with a ‘usual care’ protocol, on self-perceived pain and functionality in subjects with chronic low back pain.
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Affiliation(s)
| | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, University of Extremadura, Badajoz, Spain
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Barakat O, Cagigas MN, Bozorgui S, Ozaki CF, Wood RP. Proximal Roux-en-y Gastrojejunal Anastomosis with Pyloric Ring Resection Improves Gastric Emptying After Pancreaticoduodenectomy. J Gastrointest Surg 2016; 20:914-23. [PMID: 26850262 PMCID: PMC4850182 DOI: 10.1007/s11605-016-3091-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/21/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is a common complication of pancreaticoduodenectomy. We determined the efficiency of a new reconstruction technique, designed to preserve motilin-secreting cells and maximize the utility of their receptors, in reducing the incidence of DGE after pancreaticoduodenectomy. METHODS From April 2005 to September 2014, 217 consecutive patients underwent pancreaticoduodenectomy at our institution. Nine patients who underwent total pancreatectomy were excluded. We compared outcomes between patients who underwent pancreaticoduodenectomy with resection of the pyloric ring followed by proximal Roux-en-y gastrojejunal anastomosis (group I, n = 90) and patients who underwent standard pancreaticoduodenectomy with the orthotopic reconstruction technique (group II, n = 118). RESULTS Overall and clinically relevant rates of DGE were significantly lower in group I than in group II (10 and 2.2 % vs. 57 and 24 %, respectively; p < 0.05). Length of hospital stay as a result of DGE was shorter in group I than in group II. In univariate analysis, older age, comorbidities, ASA grade 4, operative time, preoperative diabetes, standard reconstruction technique, and postoperative complications were significant risk factors for DGE. In multivariate analysis, older age, standard technique, and postoperative complications were independent risk factors for DGE. CONCLUSION Our new reconstruction technique reduces the occurrence of DGE after pancreaticoduodenectomy.
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Affiliation(s)
- Omar Barakat
- Department of Hepatobiliary and Pancreatic Surgery, CHI St. Luke’s Health–Baylor St. Luke’s Medical Center, 6624 Fannin, Suite 2180, Houston, TX 77030 USA
| | - Martha N. Cagigas
- Department of Hepatobiliary and Pancreatic Surgery, CHI St. Luke’s Health–Baylor St. Luke’s Medical Center, 6624 Fannin, Suite 2180, Houston, TX 77030 USA
| | - Shima Bozorgui
- Department of Hepatobiliary and Pancreatic Surgery, CHI St. Luke’s Health–Baylor St. Luke’s Medical Center, 6624 Fannin, Suite 2180, Houston, TX 77030 USA
| | - Claire F. Ozaki
- Department of Hepatobiliary and Pancreatic Surgery, CHI St. Luke’s Health–Baylor St. Luke’s Medical Center, 6624 Fannin, Suite 2180, Houston, TX 77030 USA
| | - R. Patrick Wood
- Department of Hepatobiliary and Pancreatic Surgery, CHI St. Luke’s Health–Baylor St. Luke’s Medical Center, 6624 Fannin, Suite 2180, Houston, TX 77030 USA
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Zeng C, Li H, Yang T, Deng ZH, Yang Y, Zhang Y, Lei GH. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage 2015; 23:189-202. [PMID: 25497083 DOI: 10.1016/j.joca.2014.11.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/15/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the efficacy of different electrical stimulation (ES) therapies in pain relief of patients with knee osteoarthritis (OA). METHOD Electronic databases including MEDLINE, Embase and Cochrane Library were searched through for randomized controlled trials (RCTs) comparing any ES therapies with control interventions (sham or blank) or with each other. Bayesian network meta-analysis was used to combine both the direct and indirect evidence on treatment effectiveness. RESULTS 27 trials and six kinds of ES therapies, including high-frequency transcutaneous electrical nerve stimulation (h-TENS), low-frequency transcutaneous electrical nerve stimulation (l-TENS), neuromuscular electrical stimulation (NMES), interferential current (IFC), pulsed electrical stimulation (PES), and noninvasive interactive neurostimulation (NIN), were included. IFC is the only significantly effective treatment in terms of both pain intensity and change pain score at last follow-up time point when compared with the control group. Meanwhile, IFC showed the greatest probability of being the best option among the six treatment methods in pain relief. These estimates barely changed in sensitivity analysis. However, the evidence of heterogeneity and the limitation in sample size of some studies could be a potential threat to the validity of results. CONCLUSION IFC seems to be the most promising pain relief treatment for the management of knee OA. However, evidence was limited due to the heterogeneity and small number of included trials. Although the recommendation level of the other ES therapies is either uncertain (h-TENS) or not appropriate (l-TENS, NMES, PES and NIN) for pain relief, it is likely that none of the interventions is dangerous. LEVEL OF EVIDENCE LevelⅡ, systematic review and network meta-analysis of RCTs.
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Affiliation(s)
- C Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - H Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - T Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Z-h Deng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - G-h Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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Fiori A, Cescon CLC, Galesky JDF, Santos TACD, Brancalhão RMC, Bertolini GRF. Comparison between bipolar and tetrapolar of the interferential current in nociceptive threshold, accommodation and pleasantness in healthy individuals. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.3109/21679169.2014.933875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain. Spine (Phila Pa 1976) 2014; 39:997-1003. [PMID: 24732860 DOI: 10.1097/brs.0000000000000338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized prevention trial. OBJECTIVE To compare the long-term effect of strengthening versus flexibility exercises and to evaluate the additional effect of abdominal bracing in recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA No conclusions could be made regarding appropriate exercise types or parameters in recurrent LBP. Abdominal bracing increases trunk stiffness; however, its long-term effect has not been evaluated in recurrent LBP yet. METHODS Six hundred patients with recurrent LBP participated. They were randomized into 4 groups-150 patients (age: 42.5 ± 12.7) performed strengthening exercises; 150 patients (age: 41.3 ± 11.5) performed flexibility exercises; 150 patients (age: 41.0 ± 13.2) performed strengthening exercises and used abdominal bracing in daily activities/exercises; and 150 patients (age: 40.6 ± 12.3) performed flexibility exercises and used abdominal bracing in daily activities/exercises. At the beginning of the study and at the end of 10 consecutive years were recorded 6 outcomes-frequency, intensity, and duration of pain, as well as frequency, intensity, and duration of exercises. RESULTS Regarding the first 4 outcomes-all groups showed improvement from the beginning to the second year, but worsening from the second to the 10th year; there was no difference between strengthening and flexibility groups; bracing groups showed better results versus nonbracing groups. Intensity, frequency, and duration of the pain correlated with each other and with frequency of the exercises, but not with exercise duration or intensity. CONCLUSION The exercise frequency is more important than the type, duration, or intensity of the exercise. Abdominal bracing adds to the exercise effect. It could be considered as a "preliminary muscle back belt on demand" increasing the trunk stiffness and the frequency of the trunk muscle contractions/cocontractions without interruption of daily activities, which may remind/convince the patients to exercise more frequently. Frequent exercising and bracing seems effective long-term prevention advices in recurrent LBP. LEVEL OF EVIDENCE 2.
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Cheville AL, Basford JR. Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain. J Clin Oncol 2014; 32:1691-702. [PMID: 24799472 PMCID: PMC5569680 DOI: 10.1200/jco.2013.53.6680] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide an overview of rehabilitation medicine- and physical modality-based approaches to cancer pain management, and to highlight the fact that these approaches are generally used in conjunction and that a majority are focused on minimizing pain during periods of mobility and the performance of activities of daily living. METHODS We performed a nonsystematic literature review and provide a description of the current standard of care. RESULTS Rehabilitative and physical modalities used to manage pain can be grouped into four categories: those that modulate nociception, stabilize or unload painful structures, influence physiological processes that indirectly influence nociception, or alleviate pain arising from the overloading of muscles and connective tissues that often occurs after surgery or with sarcopenia in late-stage cancer. Most modalities have been pragmatically refined over the years, and many have an evidence base, although few have been explicitly validated in the oncologic setting. With few exceptions, they are patient controlled and free of adverse effects. CONCLUSION Physical modalities and rehabilitation medicine offer a range of pain management approaches that may serve as beneficial adjuncts to the conventional systemic and interventional analgesic strategies used to control cancer-related pain. These approaches may be particularly beneficial to patients with movement-associated pain and those who are ambivalent regarding pharmacoanalgesia.
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Ebadi S, Henschke N, Nakhostin Ansari N, Fallah E, van Tulder MW. Therapeutic ultrasound for chronic low-back pain. Cochrane Database Syst Rev 2014:CD009169. [PMID: 24627326 DOI: 10.1002/14651858.cd009169.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic non-specific low-back pain (LBP) has become one of the main causes of disability in the adult population around the world. Therapeutic ultrasound is frequently used by physiotherapists in the treatment of LBP and is one of the most widely used electro-physical agents in clinical practice. OBJECTIVES The objective of this review is to determine the effectiveness of therapeutic ultrasound in the management of chronic non-specific LBP. SEARCH METHODS Electronic searches were performed using CENTRAL, MEDLINE, EMBASE, PEDro, and PsycLIT databases in October 2013. Reference lists of eligible studies and relevant systematic reviews were checked and forward citation searching was also performed. SELECTION CRITERIA Randomised controlled trials on therapeutic ultrasound for non-specific chronic LBP were included. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of each trial and extracted the data. When sufficient clinical and statistical homogeneity existed, a meta-analysis was performed. The quality of the evidence for each comparison was determined using the GRADE approach. MAIN RESULTS Seven small randomised controlled trials involving a total of 362 participants with chronic LBP were included. Two of the studies had a low risk of bias, meeting six or more of the 12 criteria used for assessing risk of bias. All studies were carried out in secondary care settings and most applied therapeutic ultrasound in addition to exercise therapy, at various intensities for six to 18 treatment sessions. There was moderate quality evidence that therapeutic ultrasound improves back-specific function (standardised mean difference (SMD) [95%CI] -0.45 [-0.84 to -0.05]) compared with placebo in the short term. There was low quality evidence that therapeutic ultrasound is no better than placebo for short-term pain improvement (mean difference (MD) [95%CI] -7.12 [-17.99 to 3.75]; zero to100-point scale). There was low quality evidence that therapeutic ultrasound plus exercise is no better than exercise alone for short-term pain improvement (MD [95%CI] -2.16 [-4.66 to 0.34]; zero to 50-point scale), or functional disability (MD [95%CI] -0.41 [-3.14 to 2.32]; per cent). The studies comparing therapeutic ultrasound versus placebo or versus exercise alone did not report on overall satisfaction with treatment, or quality of life. There was low quality evidence that spinal manipulation reduces pain and functional disability more than ultrasound over the short to medium term. There is also very low quality evidence that there is no clear benefit on any outcome measure between electrical stimulation and therapeutic ultrasound; and that phonophoresis results in improved SF-36 scores compared to therapeutic ultrasound. None of the included studies reported on adverse events related to the application of therapeutic ultrasound. AUTHORS' CONCLUSIONS No high quality evidence was found to support the use of ultrasound for improving pain or quality of life in patients with non-specific chronic LBP. There is some evidence that therapeutic ultrasound has a small effect on improving low-back function in the short term, but this benefit is unlikely to be clinically important. Evidence from comparisons between other treatments and therapeutic ultrasound for chronic LBP were indeterminate and generally of low quality. Since there are few high quality randomised trials and the available trials are very small, future large trials with valid methodology are likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
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Affiliation(s)
- Safoora Ebadi
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, Tehran, Tehran, Iran, 11489
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Galvanic zinc–copper microparticles inhibit melanogenesis via multiple pigmentary pathways. Arch Dermatol Res 2013; 306:27-35. [DOI: 10.1007/s00403-013-1369-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/29/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Thiese MS, Hughes M, Biggs J. Electrical stimulation for chronic non-specific low back pain in a working-age population: a 12-week double blinded randomized controlled trial. BMC Musculoskelet Disord 2013; 14:117. [PMID: 23537462 PMCID: PMC3626857 DOI: 10.1186/1471-2474-14-117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 03/20/2013] [Indexed: 12/30/2022] Open
Abstract
Background Non-invasive electrotherapy is commonly used for treatment of chronic low back pain. Evidence for efficacy of most electrotherapy modalities is weak or lacking. This study aims to execute a high-quality, double-blinded randomized controlled clinical trial comparing 1) H-Wave® Device stimulation plus usual care with 2) transcutaneous electrical nerve stimulation (TENS) plus usual care, and 3) Sham electrotherapy plus usual care to determine comparative efficacy for treatment of chronic non-specific low back pain patients. Methods/Design Patients- Chronic non-specific low back pain patients between ages of 18–65 years, with pain of at least 3 months duration and minimal current 5/10 VAS pain. Patients will have no significant signs or symptoms of lumbosacral nerve impingement, malignancy, spinal stenosis, or mood disorders. Study design- Double blind RCT with 3 arms and 38 subjects per arm. Randomization by permuted blocks of random length, stratified by Workers Compensation claim (yes vs. no), and use of opioids. The null hypothesis of this study is that there are no statistically significant differences in functional improvement between treatment types during and at the end of a 12-week week treatment period. Data collection- Subjective data will be collected using Filemaker Pro™ database management collection tools. Objective data will be obtained through functional assessments. Data will be collected at enrollment and at 1, 4, 8, and 12 weeks for each participant by a blinded assessor. Interventions- H-Wave® device stimulation (Intervention A) plus usual care, transcutaneous electrical nerve stimulation (TENS) (Intervention B) plus usual care, and sham electrotherapy plus usual care (control). Each treatment arm will have identical numbers of visits (4) and researcher contact time (approximately 15 hours). Outcomes- Primary outcome measure: Oswestry Disability Index. Secondary measures include: Rowland Morris Instrument, VAS pain score, functional evaluation including strength when pushing and pulling, pain free range of motion in flexion and extension. Outcome measures assessed at baseline, 1, 4, 8, and 12 weeks. Treatment failure will be defined if patient terminates assigned treatment arm for non-efficacy or undergoes invasive procedure or other excluded cointerventions. Data will be analyzed using intention-to-treat analysis and adjusted for covariates related to LBP (e.g. age) as needed. Discussion Study strengths include complex randomization, treatment group allocation concealment, double blinding, controlling for co-interventions, rigorous inclusion criteria, assessment of compliance, plans for limiting dropout, identical assessment methods and timing for each treatment arm, and planned intention-to-treat analyses.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108, USA.
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Pivetta KM, Bertolini GRF. Efeitos do ΔF sobre a acomodação da corrente interferencial em sujeitos saudáveis. REV BRAS MED ESPORTE 2012. [DOI: 10.1590/s1517-86922012000500009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar em quanto tempo ocorre acomodação da corrente interferencial (CI), e quantas vezes essa acomodação acontece em 10 minutos usando diferentes padrões de variações na frequência de estimulação: ∆F nulo = 0, ∆F baixo = 30% e ∆F alto = 70%. MATERIAIS E MÉTODOS: Ensaio clínico cruzado, com 15 voluntários saudáveis, com idade média de 22,53 ± 0,91 anos, de ambos os gêneros. Os pacientes foram submetidos a CI por 10 minutos na forma bipolar com os eletrodos longitudinalmente dispostos sobre as vértebras L1 e S1. OS PARÂMETROS DO EQUIPAMENTO FORAM: frequência base de 4.000Hz, AMF 100Hz, rampa de entrega do ΔF 1:1, ΔF dependendo do dia e do subgrupo, por 10 minutos. Foi avaliado o limiar de acomodação e quantas vezes a corrente acomodou no tempo total de estimulação. RESULTADOS: Para o tempo da primeira acomodação e pelo número de acomodações, não houve diferença significativa (p > 0,05). CONCLUSÃO: Observou-se que não houve efeito com a variação dos diferentes ∆F analisados.
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Tomé F, Ferreira CB, Cornelli RJB, Carvalho ARD. Lombalgia crônica: comparação entre duas intervenções na força inspiratória e capacidade funcional. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000200003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A dor lombar crônica apresenta alta incidência, grandes custos sociais e pessoais e esforços terapêuticos muitas vezes frustrantes. Faz-se necessário, então, avaliar os recursos fisioterapêuticos para entendê-los melhor e fundamentá-los cientificamente. OBJETIVOS: Comparar os efeitos entre duas intervenções fisioterapêuticas sobre a força muscular respiratória (FMR) e a capacidade funcional (CF) em pacientes com lombalgia crônica. MATERIAIS E MÉTODOS: Série de casos cuja amostra (n = 10), composta por portadores de dor lombar crônica, foi dividida aleatoriamente em grupo controle, que recebeu fisioterapia convencional (eletroanalgesia, massoterapia e flexibilização), e grupo experimental, que recebeu a cinesioterapia combinada (composta por técnicas de isostretching + treinamento sensório-motor aquático). A mensuração da CF, realizada pelo teste de caminhada de seis minutos (TC6), e da FMR, pelas pressões máximas inspiratória (Pimáx) e expiratórias (Pemáx) por meio de manuvacuometria, aconteceu antes (ΔINI) e após (ΔFIN) as intervenções, que duraram sete semanas, com três sessões semanais. As comparações foram feitas pelo Mann-Whitney e Wilcoxon (α = 0,05). RESULTADOS: No GE, observou-se melhora, intragrupo, na Pimáx (p = 0,0164), Pemáx (p = 0,0227) e TC6 (p = 0,0092), e, no GC, apenas no TC6 (p = 0,018). Nas comparações intergrupo, obteve-se Pimáx e Pemáx semelhantes na ΔINI, mas diferentes na ΔFIN (p = 0,0166; p = 0,0045); e no TC6, observou-se diferença significativa apenas na ΔINI (p = 0,0484). CONCLUSÃO: O isostretching e treinamento sensório-motor aquático foram eficazes na melhora da FMR e da CF, e o tratamento fisioterapêutico convencional foi efetivo apenas na melhora da CF.
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Rocha CS, Lanferdini FJ, Kolberg C, Silva MF, Vaz MA, Partata WA, Zaro MA. Interferential therapy effect on mechanical pain threshold and isometric torque after delayed onset muscle soreness induction in human hamstrings. J Sports Sci 2012; 30:733-42. [DOI: 10.1080/02640414.2012.672025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Rev Neurother 2011; 11:735-53. [PMID: 21539490 DOI: 10.1586/ern.11.48] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. Clinical experience suggests that TENS is beneficial providing it is administered at a sufficiently strong intensity, close to the site of pain. At present, there are too few randomized controlled trials on TENS for neuropathic pain to judge effectiveness. The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future.
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Affiliation(s)
- Mark I Johnson
- Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, LS1 3HE, UK.
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Pereira GD, Cassolato KM, Lazarin PH, Canto TO, Portolez JLM, Bertolini GRF. Efeito da corrente interferencial, 2000Hz, no limiar de dor induzida. REV BRAS MED ESPORTE 2011. [DOI: 10.1590/s1517-86922011000400009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi verificar a eficácia da corrente interferencial na diminuição da dor frente a um estímulo doloroso pressórico e ao frio, em indivíduos saudáveis, utilizando técnica de aplicação bipolar sobre a raiz nervosa. Quatorze voluntários participaram deste estudo e foram divididos em dois grupos. No primeiro dia, um grupo foi submetido à corrente interferencial enquanto o outro não realizou a terapia. No dia seguinte, os grupos foram trocados. Foram avaliados os limiares da dor por pressão, com um algômetro, e o da dor ao frio, além do desconforto pela Escala Visual de Escala da Dor (EVAD). Como forma de eletroestimulação, foi utilizada a corrente interferencial com os parâmetros 2.000Hz de corrente base, com AMF de 100Hz, ΔF 50%, slope 1/1. Os indivíduos foram reavaliados em três momentos: logo após eletroestimulação, 20 minutos após e uma hora depois. Quanto à comparação entre as avaliações com o algômetro de pressão e desconforto ao frio, os resultados não foram significativos, tanto no grupo placebo quanto no grupo eletroestimulado. Nas avaliações do limiar da dor ao frio houve diminuição do limiar de dor no grupo eletroestimulado. Conclui-se que o uso da corrente interferencial, com os parâmetros utilizados, não produziu alteração no limiar de dor à pressão nem no desconforto ao frio, mas produziu diminuição do limiar de dor ao frio.
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Maayah M, Al-Jarrah M. Evaluation of Transcutaneous Electrical Nerve Stimulation as a Treatment of Neck Pain due to Musculoskeletal Disorders. J Clin Med Res 2011; 2:127-36. [PMID: 21629525 PMCID: PMC3104641 DOI: 10.4021/jocmr2010.06.370e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2010] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND This study was designed to evaluate transcutaneous electrical nerve stimulation (TENS) as a treatment for neck pain due to musculoskeletal disorders within the context of a physiotherapy treatment. METHODS Thirty subjects with neck pain were randomly allocated to two groups, treated with either TENS (n = 15) or placebo (n = 15). Each subject received one session for one hour. All subjects were evaluated before, during treatment, after switch off and again a week after by using Myometer machine. All subjects completed the follow-up assessment. Subjects referred for out-subjects' physiotherapy department, fulfilling the inclusion and exclusion criteria, took part in the study. RESULTS The assessments were compared and used to measure outcome treatment. Improvement in their condition was measured in terms of a reduction in the individual's level of pain during the week after the end of the first session. At the end of the first session, the study showed that 11 subjects (73%) in the treatment and 7 subjects (43%) in the control groups had gained marked improvement. These results are statistically highly significant, (P = 0.01) at the end of the follow-up assessment. CONCLUSIONS A conclusion could be drawn that a single intense TENS treatment is an effective treatment for neck pain due to musculoskeletal disorders. On the other hand, TENS showed an effective pain relief with subjects who have a mild neck pain rather than those with severe symptoms. KEYWORDS Musculoskeletal disorders; Transcutaneous electrical nerve stimulation; Neck pain.
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Affiliation(s)
- Mikhled Maayah
- Department of Physiotherapy, Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Ebadi S, Ansari NN, Henschke N, Naghdi S, van Tulder MW. The effect of continuous ultrasound on chronic low back pain: protocol of a randomized controlled trial. BMC Musculoskelet Disord 2011; 12:59. [PMID: 21406117 PMCID: PMC3069953 DOI: 10.1186/1471-2474-12-59] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 03/16/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic non-specific low-back pain (LBP) is one of the most common and expensive musculoskeletal disorders in industrialized countries. Similar to other countries in the world, LBP is a common health and socioeconomic problem in Iran. One of the most widely used modalities in the field of physiotherapy for treating LBP is therapeutic ultrasound. Despite its common use, there is still inconclusive evidence to support its effectiveness in this group of patients. This randomised trial will evaluate the effectiveness of continuous ultrasound in addition to exercise therapy in patients with chronic LBP. METHODS AND DESIGN A total of 46 patients, between the ages 18 and 65 years old who have had LBP for more than three months will be recruited from university hospitals. Participants will be randomized to receive continuous ultrasound plus exercise therapy or placebo ultrasound plus exercise therapy. These groups will be treated for 10 sessions during a period of 4 weeks. Primary outcome measures will be functional disability and pain intensity. Lumbar flexion and extension range of motion, as well as changes in electromyography muscle fatigue indices, will be measured as secondary outcomes. All outcome measures will be measured at baseline, after completion of the treatment sessions, and after one month. DISCUSSION The results of this trial will help to provide some evidence regarding the use of continuous ultrasound in chronic LBP patients. This should lead to a more evidence-based approach to clinical decision making regarding the use of ultrasound for LBP. TRIAL REGISTRATION Netherlands Trial Register (NTR): NTR2251.
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Affiliation(s)
- Safoora Ebadi
- Rehabilitation Faculty, Tehran University of Medical Sciences, Iran
| | | | - Nicholas Henschke
- The George Institute for Global Health, Sydney, Australia and EMGO Institute for Health & Care Research, Amsterdam, the Netherlands
| | - Soofia Naghdi
- Rehabilitation Faculty, Tehran University of Medical Sciences, Iran
| | - Maurits W van Tulder
- Professor of Health Technology Assessment, Department of Health Sciences and EMGO Institute for Health & Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, the Netherlands
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Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Phys Ther 2010; 90:1219-38. [PMID: 20651012 DOI: 10.2522/ptj.20090335] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is widely used, the available information regarding its clinical efficacy is debatable. PURPOSE The aim of this systematic review and meta-analysis was to analyze the available information regarding the efficacy of IFC in the management of musculoskeletal pain. DATA SOURCES Randomized controlled trials were obtained through a computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010. DATA EXTRACTION Two independent reviewers screened the abstracts found in the databases. Methodological quality was assessed using a compilation of items included in different scales related to rehabilitation research. The mean difference, with 95% confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was performed. DATA SYNTHESIS A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3 articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were considered to be of moderate methodological quality, and 3 studies were considered to be of poor methodological quality. Fourteen studies were included in the meta-analysis. CONCLUSION Interferential current as a supplement to another intervention seems to be more effective for reducing pain than a control treatment at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions. Interferential current alone was not significantly better than placebo or other therapy at discharge or follow-up. Results must be considered with caution due to the low number of studies that used IFC alone. In addition, the heterogeneity across studies and methodological limitations prevent conclusive statements regarding analgesic efficacy.
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Pons T, Shipton EA. Multilevel lumbar fusion and postoperative physiotherapy rehabilitation in a patient with persistent pain. Physiother Theory Pract 2010; 27:238-45. [DOI: 10.3109/09593985.2010.483268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Can cost utility evaluations inform decision making about interventions for low back pain? Spine J 2009; 9:944-57. [PMID: 19748833 DOI: 10.1016/j.spinee.2009.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 06/26/2009] [Accepted: 07/30/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is associated with high health-care utilization and lost productivity. Numerous interventions are routinely used, although few are supported by strong evidence. Cost utility analyses (CUAs) may be helpful to inform decision makers. PURPOSE To conduct a systematic review of CUAs of interventions for LBP. STUDY DESIGN Systematic review. METHODS A search strategy combining medical subject headings and free text related to LBP and health economic evaluations was executed in MEDLINE. Cost utility analyses combined with randomized controlled trials for LBP were included. Studies that were published before 1998, non-English, decision analyses, and duplicate reports were excluded. Search results were evaluated by two reviewers, who extracted data independently related to clinical study design, economic study design, direct cost components, utility results, cost results, and CUA results. RESULTS The search produced 319 citations, and of these 15 met eligibility criteria. Most were from the United Kingdom (n=8), published in the past 3 years (n=12), studied chronic LBP or radiculopathy (n=13), and had a follow-up >12 months (n=13). Combined, there were 33 study groups who received a mean 2.1 interventions, most commonly education (n=17), exercise therapy (n=13), spinal manipulation therapy (n=7), surgery (n=7), and usual care from a general practitioner (n=7). Mean baseline utility was 0.57, improving to 0.67 at follow-up; the mean difference in utility improvement between study groups was 0.04. Based on available data and converted to US dollars, the cost per quality-adjusted life year ranged from $304 to 579,527 dollars, with a median of 13,015 dollars. CONCLUSIONS Few CUAs were identified for LBP, and there was heterogeneity in the interventions compared, direct cost components measured, indirect costs, other methods, and results. Reporting quality was mixed. Currently published CUAs do not provide sufficient information to assist decision makers. Future CUAs should attempt to measure all known direct cost components relevant to LBP, estimate indirect costs such as lost productivity, have a follow-up period sufficient to capture meaningful changes, and clearly report methods and results to facilitate interpretation and comparison.
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Kajbafzadeh AM, Baradaran N. Reply. Urology 2009. [DOI: 10.1016/j.urology.2009.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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