Group-based exercice training programs for military members presenting musculoskeletal disorders - protocol for a pragmatic randomized controlled trial

BACKGROUND

Musculoskeletal disorders are a leading cause of morbidity and the most prevalent source of disability among soldiers. Their high prevalence in armed forces and limited ressources have led to problems related to access to physical rehabilitation care. To increase access, supervised group-based exercise programs for the most prevalent musculoskeletal disorders (low back pain, patellofemoral pain, rotator cuff-related shoulder pain or lateral ankle sprain) have been developed at a Canadian Armed forces (CAF) base, but their effectiveness has not been evaluated. The primary objective of this randomized controlled trial is to evaluate the mid- and long-term effects of these group-based training programs on pain severity and functional limitations, in comparison with usual individual physiotherapy care. Secondary objectives include comparing both interventions in terms of health-related quality of life, pain-related fear, and patients' satisfaction.

METHODS

One hundred and twenty soldiers with a new medical referral for physiotherapy services for one of the four targeted musculoskeletal disorders will be consecutively recruited. They will be randomly assigned to either group-based training program or usual individual physiotherapy care, and will take part in the assigned 12-week intervention. There will be four evaluation sessions over 26 weeks (baseline, week 6, 12 and 26). At each follow-up, functional limitations, pain severity, health-related quality of life and pain-related fears will be assessed. Patients satisfaction with treatment will also be evaluated at the end of the intervention period. Either two-way repeated measures ANOVA will be used to analyse and compare the effects of the interventions.

DISCUSSION

This RCT will determine the effectiveness of group-based training programs compared to usual individual physiotherapy care. This new intervention model could represent an efficient, and more pro-active approach to manage a higher number of soldiers with musculoskeletal disorders. It could improve access to physical rehabilitation care and improve the health of soldiers.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT05235152 ), February 11th 2022.

Influence of symptom frequency and severity on hip abductor strength and endurance in individuals with patellofemoral pain

OBJECTIVE

To compare clinical measures of hip abductor strength and endurance of individuals with patellofemoral pain with more severe symptoms to those with less severe symptoms.

DESIGN

Cross-sectional.

SETTINGS

Laboratory.

PARTICIPANTS

Sixty participants with patellofemoral pain were divided three times into 2 groups according to three symptomatology criteria: functional capacity, pain frequency and pain severity.

MAIN OUTCOME MEASURES

Isometric strength evaluated using a hand-held dynamometer, endurance using maximum number of repetitions and maximum holding time, functional capacity using the Anterior Knee Pain Scale, pain frequency using a 2-category scale ("Less frequent" = 1-2 times a week; "More frequent" = >3 times a week) and pain severity using Numeric Pain Rating Scales.

RESULTS

Participants with more frequent symptoms and with more severe pain were significantly weaker (10%, p = 0.04 and 16%, p = 0.001, respectively), and had less isometric (17%, p = 0.02 and 24%, p = 0.002, respectively) and dynamic (13%, p = 0.02 and 23%, p = 0.007, respectively) endurance compared to those with less pronounced symptoms.

CONCLUSION

Our study highlighted that hip abductor strength and endurance deficits are more pronounced in individuals with more severe and frequent pain.

Impact of online visual feedback on motor acquisition and retention when learning to reach in a force field

When subjects learn a novel motor task, several sources of feedback (proprioceptive, visual or auditory) contribute to the performance. Over the past few years, several studies have investigated the role of visual feedback in motor learning, yet evidence remains conflicting. The aim of this study was therefore to investigate the role of online visual feedback (VFb) on the acquisition and retention stages of motor learning associated with training in a reaching task. Thirty healthy subjects made ballistic reaching movements with their dominant arm toward two targets, on 2 consecutive days using a robotized exoskeleton (KINARM). They were randomly assigned to a group with (VFb) or without (NoVFb) VFb of index position during movement. On day 1, the task was performed before (baseline) and during the application of a velocity-dependent resistive force field (adaptation). To assess retention, participants repeated the task with the force field on day 2. Motor learning was characterized by: (1) the final endpoint error (movement accuracy) and (2) the initial angle (iANG) of deviation (motor planning). Even though both groups showed motor adaptation, the NoVFb-group exhibited slower learning and higher final endpoint error than the VFb-group. In some condition, subjects trained without visual feedback used more curved initial trajectories to anticipate for the perturbation. This observation suggests that learning to reach targets in a velocity-dependent resistive force field is possible even when feedback is limited. However, the absence of VFb leads to different strategies that were only apparent when reaching toward the most challenging target.

Efficacy of transcutaneous electrical nerve stimulation for rotator cuff tendinopathy: a systematic review

OBJECTIVE

To perform a systematic review on the efficacy of transcutaneous electrical nerve stimulation (TENS) for the treatment of rotator cuff tendinopathy in adults.

METHODS

A literature search was conducted in four databases (CINAHL, Embase, PubMed and PeDRO) for randomised controlled trials published from date of inception until April 2015, comparing the efficacy of TENS for the treatment of rotator cuff tendinopathy with placebo or any other intervention. Risk of bias was evaluated using the Cochrane risk of bias tool. Results were summarised qualitatively.

RESULTS

Six studies were included in this review. The mean methodological score was 49% (standard deviation 16%), indicating an overall high risk of bias. One placebo-controlled trial reported that a single TENS session provided immediate pain reduction for patients with rotator cuff tendinopathy, but did not follow the participants in the short, medium or long term. Two trials that compared ultrasound therapy with TENS reported discrepancy and contradictory results in terms of pain reduction and shoulder range of motion. Corticosteroid injections were found to be superior to TENS for pain reduction in the short term, but the differences were not clinically important. Other studies included in this review concluded that TENS was not superior to heat or pulsed radiofrequency.

CONCLUSION

Due to the limited number of studies and the overall high risk of bias of the studies included in this review, no conclusions can be drawn on the efficacy of TENS for the treatment of rotator cuff tendinopathy. More methodologically sound studies are needed to document the efficacy of TENS. Until then, clinicians should prefer other evidence-based rehabilitation interventions proven to be efficacious to treat patients with rotator cuff tendinopathy.

Congenital absence of one tonsil without any other congenital abnormality: a rare presentation

DOI: http://dx.doi.org/10.3329/bmrcb.v38i1.10451Bangladesh Med Res Counc Bull 2012; 38: 39-40

Post hysterectomy inflammatory myofibroblastic tumor: a rare presentation

DOI: http://dx.doi.org/10.3329/bmrcb.v37i3.9124 BMRCB 2011; 37(3): 111-112

Comparative study between Pap smear and visual inspection using acetic acid as a method of cervical cancer screening

This prospective study was done for the comparison of visual inspection using acetic acid (VIA) and Pap smear as a method of cervical cancer screening. This study was also done to determine the proportion of women screened positive with VIA and proportion of women screened positive with Pap smear. Another aim was to compare the sensitivity and specificity of VIA and Pap smear. A total of 300 women attended to the outpatient gynecologic clinic and cervical cancer screening programme at Bangabandhu Sheikh Mujib Medical University (BSMMU) were included. On VIA, 23 out of 300 women screened had aceto-white lesions. On Pap smear, 14 out of the 300 women had ASCUS or worse lesions. Of the 300 enrolled women, 11 were positive on both VIA and cytology; 12 were positive on VIA only; and 3 were positive on cytology only. Those women (n=26) who showed positive test result with either VIA or Pap smear or both tests were further subjected to colposcopy directed biopsy. Histology was taken as gold standard to compare the performance of VIA and cytology (Pap's smear). Histological diagnosis of CIN/cancer was made in 18 Positive cases out of the total 26 patients who underwent biopsy. Pap smear picked up 10 out of the 18 biopsy-proven cases whereas VIA could identify 17 out of the 18 CIN/carcinoma cervices. VIA was more sensitive (94.44%) than pap smear (55.55%), which was statistically significant. However, the specificity of VIA was slightly lower (97.87%) than that of cytology (98.58%). The PPV of VIA was 73.91% versus 71.42 % for Pap smear.

The anesthetic management of a case of tracheogastric fistula

IMPLICATIONS

A 68-yr-old man developed a tracheogastric fistula after esophageal resection with gastric interposition. We report the anesthetic management of this patient undergoing tracheal repair and fistula closure.

Report of the first human case of lobomycosis in the United States

We describe the first human case of lobomycosis caused by Lacazia loboi in a 42-year-old white male resident of Georgia. The patient had traveled to Venezuela 7 years earlier, where he had planned to rappel down Angel Falls in Canaima. Although he never actually rappelled the falls, he did walk under the falls at least three times, exposing himself to the high water pressures of the falls. He noticed a small pustule with surrounding erythema developing on the skin of his right chest wall. The lesion gradually increased in size and had an appearance of a keloid. For cosmetic reasons, the patient sought medical treatment to remove the lesion. After an uncomplicated excision of the lesion, the patient recovered completely. The excised tissue was fixed in formalin for pathologic examination. Tissue sections stained by hematoxylin and eosin, periodic acid-Schiff stain, and Gomori methenamine silver stain procedures showed numerous histiocytes, multinucleated giant cells, and numerous globose or subglobose, lemon-shaped cells producing multiple blastoconidia connected by narrow tube-like connectors and catenate chains of various lengths characteristic of L. loboi.