The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review

Utilisation of Deep Neural Networks for Estimation of Cajal Cells in the Anal Canal Wall of Patients with Advanced Haemorrhoidal Disease Treated by LigaSure Surgery

Interstitial cells of Cajal (ICCs) play a key role in gastrointestinal smooth muscle contractions, but their relationship with anal canal function in advanced haemorrhoidal disease (HD) remains poorly understood. This study uses deep neural network (DNN) models to estimate ICC presence and quantity in anal canal tissues affected by HD. Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device. A YOLOv11-based machine learning model, trained on 376 immunohistochemical images, automated ICC detection using the CD117 marker, achieving a mean average precision (mAP50) of 92%, with a recall of 86% and precision of 88%. The DNN model accurately identified ICCs in whole-slide images, revealing that one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density. Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery. A significant decrease in bleeding (p < 0.0001) was also noted postoperatively. Notably, patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041), suggesting a potential link between ICC density and HD severity. This AI-driven model, alongside clinical data, may enhance outcome prediction and provide insights into HD pathophysiology.

Use of commercially available wearable devices for physical rehabilitation in healthcare: a systematic review

OBJECTIVES

To evaluate whether commercially available 'off-the-shelf' wearable technology can improve patient rehabilitation outcomes, and to categorise all wearables currently being used to augment rehabilitation, including the disciplines and conditions under investigation.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement checklist, and using the Grading of Recommendations, Assessment, Development and Evaluation approach.

DATA SOURCES

Embase, MEDLINE, Web of Science and the Cochrane Library were searched up to and including July 2023.

ELIGIBILITY CRITERIA

We included trials and observational studies evaluating the use of consumer-grade wearables, in real patient cohorts, to aid physical therapy or rehabilitation. Only studies investigating rehabilitation of acute events with defined recovery affecting adult patients were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used a standardised protocol to search, screen and extract data from the included studies. Risk of bias was assessed using the Cochrane Methods Risk of Bias in Randomised Trials V.2 and Risk of Bias in Non-Randomised Studies of Interventions tools for randomised controlled trials (RCTs) and observational studies, respectively.

RESULTS

Eighteen studies encompassing 1754 patients met eligibility criteria, including six RCTs, six quasi-experimental studies and six observational studies. Eight studies used wearables in Orthopaedics, seven in Stroke Medicine, two in Oncology and one in General Surgery. All six RCTs demonstrated that wearable-driven feedback increases physical activity. Step count was the most common measure of physical activity. Two RCTs in orthopaedics demonstrated non-inferiority of wearable self-directed rehabilitation compared with traditional physiotherapy, highlighting the potential of wearables as alternatives to traditional physiotherapy. All 12 non-randomised studies demonstrated the feasibility and acceptability of wearable-driven self-directed rehabilitation.

CONCLUSION

This review demonstrates that consumer-grade wearables can be used as adjuncts to traditional physiotherapy, and potentially as alternatives for self-directed rehabilitation of non-chronic conditions. Better designed studies, and larger RCTs, with a focus on economic evaluations are needed before a case can be made for their widespread adoption in healthcare settings.

PROSPERO REGISTRATION ID

CRD42023459567.

[Pain therapy in urology-overview of current S3 guideline recommendations]

Dealing efficiently with patients suffering from pain is a central medical task. Pain, as an important function in developmental physiology, warns against damage to the body caused by external noxious agents as well as internal malfunctions and requires special attention in modern medicine. Peri- and postoperative pain is known to have a negative influence on postoperative convalescence. Treatment of tumor-related pain represents another relevant challenge in uro-oncology and palliative medicine. The updated guideline on perioperative pain therapy and palliative medicine for patients with incurable diseases or cancer is dedicated to these two topics.

Acute Pain Services and pain-related patient-reported outcomes in Hungarian hospitals

BACKGROUND

Postoperative pain management is an important part of surgical care, where Acute Pain Service offers added value in terms of patient outcomes and costs. The technology, however, has hardly been adopted in Hungary, with only two hospitals operating Acute Pain Service and whose performance has not been evaluated yet. This research compared pain management outcomes of surgical, orthopedic, and traumatology patients in Hungarian hospitals with and without Acute Pain Service.

METHODS

We recruited 348 patients, 120 in the APS group and 228 in the control group, whose experience was surveyed with an adapted version of the American Pain Society Patient Outcome Questionnaire. The questionnaire covered pain intensity, pain interference with physical and emotional functions, side effects, patient satisfaction, information received, and participation in treatment decisions. The differences were analyzed by Fisher's exact test and Mann-Whitney U test.

RESULTS

The APS group showed better results with lower pain intensity scores regarding worst postoperative pain (χ2 = 18.919, p = 0.0043). They reported less pain interference with activities in bed (χ2 = 21.978, p = 0.0006) and out of bed (χ2 = 14.341, p = 0.0129). Furthermore, patients in the APS group experienced fewer pain-management-related side effects, like nausea (χ2 = 15.240, p = 0.0101), drowsiness (χ2 = 26.965, p = 0.0001), and dizziness (χ2 = 13.980, p = 0.0124). However, patient information (χ2 = 3.480, p = 0.0945) and patient satisfaction (χ2 = 5.781, p = 0.2127) did not differ significantly between the two groups.

CONCLUSIONS

Our findings confirm earlier international evidence on the benefits of Acute Pain Service in postoperative pain management and support the wider adoption of the technology in Hungarian hospitals. Nevertheless, close attention should be paid to patient information and involvement as better outcomes alone do not necessarily increase patient satisfaction.

Effect of Video-Assisted Isometric Strengthening Exercise Program on Pain and Muscle Strength Poststabilization of Lower Limb Fracture

The benefits of isometric strengthening exercises (ISEs) are compromised when patient teaching on ISEs is delayed and/or ineffectively delivered due to healthcare resources constraint, especially when health resources are stretched, as occurred during the COVID-19 pandemic. This study aims to examine the effect of a video-assisted ISE program on pain and muscle strength of patients following surgical stabilization of lower limb fracture. A quasi-experimental study with repeated measures was employed. Primary study outcomes were assessed using the Brief Pain Inventory and Manual Muscle Test. Effects over time were analyzed using generalized estimating equations. In comparison with usual care group (n = 32), the intervention group (n = 33) showed better pain reduction over time (p < .001, effect size [ES] = 0.39-1.77) and muscle strength preservation (p < .05; ES = 0.8-0.9). Patient acceptance of the intervention was favorable. Integration of video clips into patient teaching on ISEs is potentially beneficial in managing pain and muscle strength; it can be easily deployed to aid early ISE initiation.

Effects of a single exercise session on pain intensity in adults with chronic pain: a systematic review and meta-analysis

BACKGROUND

Chronic pain is prevalent amongst society, making it necessary to find strategies to manage chronic pain. Regular exercise is efficacious; however, pain is a barrier to initiating exercise. A single exercise session is also believed to acutely reduce pain, however, the evidence for this is less robust.

OBJECTIVES

This systematic review and meta-analysis aimed to identify the effect of a single exercise session on pain intensity in adults with chronic pain.

METHODS

We searched eight databases and trial registries to identify randomised controlled trials evaluating the effect of a single exercise session on pain intensity in adults with chronic pain compared to a non-exercise control. Literature screening, data extraction, risk of bias (Cochrane 2.0) and quality assessment (GRADE) were conducted independently and in duplicate. Random-effects meta-analyses were performed using the metafor package in R.

RESULTS

We included 17 trials (46 study arms with 664 adults [44% female]). There were no significant differences in pain intensity (mean difference on a 0-10 scale) immediately post-exercise -0.02 (95% CI = -0.06, 0.62; I² = 77.1%) or up to 45-min post-exercise -0.17 (95% CI = -0.49, 0.16; I² = 34.2%). All trials were at high risk of bias and the overall confidence in these findings was very low.

CONCLUSION

A single exercise session did not reduce pain intensity up to 1-h post-exercise. Notably, increases in pain were not observed either, suggesting that while pain can be a barrier to initiating exercise, clinicians can educate patients on the unlikelihood of exercise acutely increasing pain intensity.

Ways to improve surgical outcomes in low- and middle-income countries

Global surgery initiatives such as the Lancet Commission on Global Surgery have highlighted the need for increased investment to enhance surgical capacity in low- and middle-income countries. A neglected issue, however, is surgery-related rehabilitation, which is known to optimize functional outcomes after surgery. Increased investment to enhance surgical capacity therefore needs to be complemented by promotion of rehabilitation interventions. We make the case for strengthening surgery-related rehabilitation in lower-resource countries, outlining the challenges but also potential solutions and policy directions. Proposed solutions include greater leadership and awareness, augmented by recent global efforts around the World Health Organization's Rehabilitation 2030 initiative, and professionalization of the rehabilitation workforce. More research on rehabilitation is needed in low- and middle-income countries, along with support for system approaches, notably on strengthening and integrating rehabilitation within the health systems. Finally, we outline a set of policy implications and recommendations, aligned to the components of the national surgical plan proposed by the Lancet Commission: infrastructure, workforce, service delivery, financing, and information management. Collaboration and sustained efforts to embed rehabilitation within national surgical plans is key to optimize health outcomes for patients with surgical conditions and ensure progress towards sustainable development goal 3: health and well-being for all.

Role of Manual Therapy for Neck Pain and Quality of Life in Head and Neck Cancer Survivors: A Systematic Review

Background:

Pain is the one the most dreadful side effects of head and neck cancers and cancer related treatments affecting patients during and after the treatment adding to the problems affecting their ability to speak, swallow, breath and feeding. Manual therapy is standard set of physiotherapy treatments used for alleviating neck pain. It has found to be effective in small subset of cancer patients for relieving pain.

Objectives:

To highlight the use of various manual therapy techniques focusing in decreasing neck pain and improving quality of life in Head and Neck Cancer survivors that may suggest its safe utilisation in oncology rehabilitation.

Materials and Methods:

Electronic search was conducted in PubMed, Google Scholar, CINAHL, Pedro, and COCHRANE databases. Reference lists of the included studies and relevant reviews were manually searched. Studies that met the inclusion criteria were evaluated using McMaster critical review form for quantitative studies. A descriptive synthesis was undertaken due to the heterogeneity of the included studies.

Results:

Seven studies were assessed for risk of bias that comprised of three clinical trials, one case series and three case reports that applied Maitland’s mobilisation, Myofascial release, Muscle Energy Techniques to head and neck cancer survivors in various clinical settings. The outcomes highlighted decrease in pain, improvement in cervical range of motion and quality of life.

Conclusion:

This review recommends application of manual therapy to head and neck cancer survivors. However, authors caution application of manual therapy in terms of choosing a particular technique. Further, well designed larger sample size with randomisation and double blinding would help to generate better evidence for head and neck cancer survivors.

Twelve tips to maximise medical student exposure during surgical placements

Surgery is a highly competitive specialty that offers a wide range of subspecialties. The presence of surgical education and rotations in the medical school curriculum is often lacking, and for this reason many medical students have little experience of surgery during their time in medical school. This paper presents twelve tips for medical students who are interested in pursuing a career in surgery, offering different ways of exposure into activities related to surgical care. Understanding the practice of surgery and self-reflecting on one's personality and suitability for a career in surgery are key. Moreover, surgical care is not only limited to the surgeon's table-other opportunities to learn more about surgery exist outside of the operating room. Extra-curricular activities in research and leadership are also vital in developing an interest in surgery and competitive edge in medical students.

Association of Occupational and Physical Therapy With Duration of Prescription Opioid Use After Hip or Knee Arthroplasty: A Retrospective Cohort Study of Medicare Enrollees

OBJECTIVE

To establish whether nonpharmacologic interventions, such as occupational and physical therapy, were associated with a shorter duration of prescription opioid use after hip or knee arthroplasty.

DESIGN

This retrospective cohort study used data from a national 5% Medicare sample database between January 1, 2010 and December 31, 2015.

SETTING

Home health or outpatient.

PARTICIPANTS

Adults 66 years or older with an inpatient total hip (n=4272) or knee (n=9796) arthroplasty (N=14,068).

INTERVENTIONS

We dichotomized patients according to whether they had received any nonpharmacologic pain intervention within 1 year after hospital discharge (eg, occupational or physical therapy evaluation). Using Cox proportional hazards, we treated exposure to nonpharmacologic interventions as time dependent to determine if skilled therapy was associated with duration of opioid use.

MAIN OUTCOME MEASURES

Duration of prescription opioid use.

RESULTS

Median time to begin nonpharmacologic interventions was 91 days (95% confidence interval [CI], 74-118d) for hip and 27 days (95% CI, 27-28d) for knee arthroplasty. Median time to discontinue prescription opioids was 16 days (hip: 95% CI, 15-16d) and 30 days (knee: 95% CI, 29-31d). Nonpharmacologic interventions delivered with home health increased the likelihood of discontinuing opioids after hip (hazard ratio [HR], 1.15; 95% CI, 1.01-1.30) and knee (HR, 1.10; 95% CI, 1.03-1.17) arthroplasty. A sensitivity analysis found these estimates to be robust and conservative.

CONCLUSIONS

Occupational and physical therapy with home health was associated with a shorter duration of prescription opioid use after hip and knee arthroplasty. Occupational and physical therapy can address pain and sociobehavioral factors associated with postsurgical opioid use.