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Dymarek R, Kuberka I, Walewicz K, Taradaj J, Rosińczuk J, Sopel M. Is Shock Wave Application Effective on Various Chronic Wounds in the Geriatric Population? Preliminary Clinical Study. Clin Interv Aging 2024; 19:665-679. [PMID: 38706636 PMCID: PMC11069372 DOI: 10.2147/cia.s448298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Extracorporeal shock wave therapy (ESWT) is a beneficial adjunct modality for chronic wounds. Limited research has been conducted on pressure ulcers (PUs), while the majority of studies have focused on diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). This study aimed to evaluate the short-term effects of radial ESWT in older adults with chronic wounds. Patients and Methods This study involved a total of 31 wounds: PUs (n=22), VLUs (n=7), and DFUs (n=2). A single radial ESWT was performed with 300 + 100 shocks per cm2, pressure of 2.5 bar, energy of 0.15 mJ/mm2, and frequency of 5 Hz. Assessments using digital planimetry and clinical methods, utilizing the Wound Bed Score (WBS) and the Bates-Jansen Wound Assessment Tool (BWAT) were performed before the radial ESWT application (M0) and one week after (M1). Results A significant wound decrease in planimetry was noted (pre-ESWT vs post-ESWT), with wound area from 9.4 cm2 to 6.2 cm2, length from 6.4 cm to 3.9 cm, and width from 2.8 cm to 2.1 cm (p<0.001). Additionally, a substantial clinical improvement was noted in both the WBS with a 31.25% increase and the BWAT with a 20.00% increase (p<0.001). It was also found a significant correlation between the planimetric and clinical outcomes for both tools: WBS (r=-0.446, p=0.012) and BWAT (r=0.327, p=0.073). Conclusion The ESWT application yields substantial immediate clinical effects that support the healing of chronic wounds in older adults. Even a single ESWT session can prove to be clinically effective and beneficial in the management of chronic wounds.
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Affiliation(s)
- Robert Dymarek
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Kuberka
- Division of Anaesthetic and Surgical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Walewicz
- Medical Institute, Jan Grodek State University in Sanok, Sanok, Poland
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Joanna Rosińczuk
- Division of Internal Medicine Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Mirosław Sopel
- Faculty of Medicine, Wrocław University of Science and Technology, Wroclaw, Poland
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Rajfur J, Rajfur K, Matusz T, Malarska M, Walewicz K, Ptaszkowski K, Dymarek R, Taradaj J. Dry Needling with the Use of FRSc Technique in Addition to Standard Rehabilitation Program for Chronic Low Back Pain: A Randomized Controlled Trial Using Both PROMs and Measurement Tools. J Pain Res 2024; 17:1041-1053. [PMID: 38510562 PMCID: PMC10950681 DOI: 10.2147/jpr.s450119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/02/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose Dry needling (DN) has gained popularity for musculoskeletal conditions, but its commercial use often surpasses scientific evidence. The novel Five Regulatory Systems Concept (FRSc) of DN shows potential therapeutic mechanisms, including chronic low back pain (LBP). However, rigorous clinical assessment with patient-reported outcome measures (PROMs) and objective measures are necessary. This study aimed to evaluate the effect of DN according to pain levels, postural control and selected gait parameters in patients with chronic LBP. Patients and Methods This prospective, double-blinded, randomized controlled study involved 30 patients with LBP allocated in the experimental (n=15, rehabilitation+ FRSc DN) or control group (n=15, rehabilitation + sham DN). The Roland-Morris questionnaire (RMQ) and Visual Analog Scale (VAS) were used as PROMs. Moreover, the posturography method for posture and balance control and the treadmill for gait analysis were used as objective tools. Measurements were taken before and immediately after the intervention and during 1- and 3-month follow up. Results There was a statistically significantly greater improvement in the RMQ in the experimental group compared to the controls (p=0.923 before and p<0.001 after treatment, as well as p<0.001 after 1 and 3 months). Despite the favorable analgesic effect, a significant advantage of the experimental group over the controls in this respect is worth noting (p=0.001 in favor of DN in all intergroup comparisons concerning results from the subjective assessment of pain (VAS). A statistically insignificant post-treatment improvement in balance and postural stability was noted in both groups, although the effects appeared to be short-term. Surprisingly, again, DN had no advantage over sham interventions. In both groups, all changes in the swing phase were statistically insignificant (p=0.201 for the dominant and p=0.283 for the non-dominant side) for the initial swing phase. In both groups, all changes in the stance phase were statistically insignificant (p=0.480 for the dominant and p=0.410 for the non-dominant side of the body). Conclusion DN based on the FRSc appears promising as an effective adjunct to standard rehabilitation for LBP, showing improvements in functional performance and pain reduction.
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Affiliation(s)
- Joanna Rajfur
- Institute of Health Sciences, University of Opole, Opole, 45-040, Poland
| | - Katarzyna Rajfur
- Institute of Health Sciences, University of Opole, Opole, 45-040, Poland
| | - Tomasz Matusz
- Institute of Health Sciences, University of Opole, Opole, 45-040, Poland
| | - Maria Malarska
- Department of Clinical Genetics, Medical University of Lodz, Lodz, 90-419, Poland
| | - Karolina Walewicz
- Department of Physiotherapy, Jan Grodek State University, Sanok, 38-500, Poland
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Robert Dymarek
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, 40-065, Poland
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Dymarek R, Kuberka I, Rosińczuk J, Walewicz K, Taradaj J, Sopel M. The Immediate Clinical Effects Following a Single Radial Shock Wave Therapy in Pressure Ulcers: A Preliminary Randomized Controlled Trial of The SHOWN Project. Adv Wound Care (New Rochelle) 2022; 12:440-452. [PMID: 35996355 DOI: 10.1089/wound.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Recent preliminary reports indicate that extracorporeal shock wave therapy (ESWT) might be useful for chronic wounds, especially venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). However, there is limited evidence for the utility and safety of ESWT in pressure ulcers (PUs). Therefore, this randomized controlled trial (RCT) aimed to assess immediate planimetric and clinical effects following a single radial ESWT session in PUs. APPROACH A group of 40 patients with PUs was randomly assigned into two groups: active ESWT (n=20), which underwent a single treatment with radial ESWT (300+100 impulses per 1 cm2, 2.5 bars, 0.15 mJ/mm2, and 5 Hz) and placebo ESWT (n=20) which was exposed to sham-radial ESWT. All patients continued standard wound care procedures. The planimetric assessment and clinical outcomes using Wound Bed Score (WBS) and Bates-Jansen Wound Assessment Tool (BWAT) were assessed before (M0) and after ESWT sessions (M1). RESULTS There was a significant planimetric enhancement observed after active ESWT reported as a reduction in all metric parameters: wound area from 11.51 cm2 to 8.09 cm2 (p<0.001), wound length from 4.97 cm to 4.41 cm (p<0.001), and wound width from 3.15 cm to 2.49 cm (p<0.0001). Also, there was a significant beneficial clinical improvement observed with a WBS as an increased score from 3.85 to 9.65 points (p<0.001) and with the BWAT as a decreased score from 45.45 to 30.70 points (p<0.001). In turn, a regression in the placebo ESWT group was observed in all studied outcomes. INNOVATION This study is the first RCT to provide the positive and immediate clinical effects of radial ESWT in promoting the healing of PUs. CONCLUSION This preliminary RCT showed that even a single session of ESWT is a promising and clinically effective modality in managing PUs. However, there is still limited data regarding the usefulness of ESWT in PUs, and further studies are in demand.
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Affiliation(s)
- Robert Dymarek
- Wroclaw Medical University, Department of Physiotherapy, Wroclaw, Poland;
| | - Izabela Kuberka
- Wroclaw Medical University, Division of Anaesthetic and Surgical Nursing, Wroclaw, Poland;
| | - Joanna Rosińczuk
- Wroclaw Medical University, Division of Internal Medicine Nursing, Wroclaw, Poland;
| | | | - Jakub Taradaj
- Jerzy Kukuczka Academy of Physical Education In Katowice, Institute of Physiotherapy and Health Sciences, Katowice, Poland;
| | - Mirosław Sopel
- Wroclaw Medical University, Department of Basic Sciences, Wroclaw, Poland;
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Rajfur K, Rajfur J, Matusz T, Walewicz K, Dymarek R, Ptaszkowski K, Taradaj J. Efficacy of Focused Extracorporeal Shock Wave Therapy in Chronic Low Back Pain: A Prospective Randomized 3-Month Follow-Up Study. Med Sci Monit 2022; 28:e936614. [PMID: 35689370 PMCID: PMC9199449 DOI: 10.12659/msm.936614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Material/Methods Results Conclusions
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Affiliation(s)
- Katarzyna Rajfur
- Institute of Health Sciences, University of Opole, Opole, Poland
| | - Joanna Rajfur
- Institute of Health Sciences, University of Opole, Opole, Poland
| | - Tomasz Matusz
- Institute of Health Sciences, University of Opole, Opole, Poland
| | | | - Robert Dymarek
- Department of Physiotherapy, Institute of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wrocław Medical University, Wrocław, Poland
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland
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Ptaszkowska L, Gorecka J, Paprocka-Borowicz M, Walewicz K, Jarzab S, Majewska-Pulsakowska M, Gorka-Dynysiewicz J, Jenczura A, Ptaszkowski K. Immediate Effects of Kinesio Taping on Rectus Abdominis Diastasis in Postpartum Women-Preliminary Report. J Clin Med 2021; 10:jcm10215043. [PMID: 34768563 PMCID: PMC8584338 DOI: 10.3390/jcm10215043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rectus abdominis diastasis (RAD) is an excessive divarication of the rectus abdominis muscle with concurrent stretching and thinning of the linea alba, which occurs due to mechanical and functional disturbances in the anterior abdominal wall and the whole body. The primary objective of this study is a palpation assessment of RAD in postpartum women before and after the application of KT tapes and a subsequent comparison of the results with those from a sham intervention group. METHODS A randomized clinical trial was conducted in the Physical Therapy Department at Wroclaw Medical University. The participants were randomly assigned to one of two groups: the KT group (intervention), in which KT tapes were applied (48 h intervention) and the sham KT group (control, sham intervention), in which non-stretch tapes were used (cloth surgical tape, 48 h intervention). In all participants, a palpation assessment of RAD was conducted and the inter-recti distance was measured using a digital caliper at three sites: at the umbilicus and 4.5 cm above and below it. Measurements were taken before and after the intervention. RESULTS The gathered results show a statistically significant reduction in rectus abdominis diastasis at each of the observed sites after the application of KT tapes in the intervention group (p < 0.05). In the intergroup comparison, a statistically significantly lower RAD (at umbilicus) was found after the intervention (p = 0.005) in KT group. CONCLUSIONS the application of KT tapes using the corrective technique can contribute to reducing RAD in women up to 12 months after delivery.
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Affiliation(s)
- Lucyna Ptaszkowska
- Institute of Health Science, University of Opole, Katowicka 68, 45-060 Opole, Poland; (L.P.); (K.W.); (A.J.)
| | - Justyna Gorecka
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland;
| | - Malgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland; (S.J.); (M.M.-P.); (K.P.)
- Correspondence: ; Tel.: +48-7744-23-550
| | - Karolina Walewicz
- Institute of Health Science, University of Opole, Katowicka 68, 45-060 Opole, Poland; (L.P.); (K.W.); (A.J.)
| | - Slawomir Jarzab
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland; (S.J.); (M.M.-P.); (K.P.)
| | - Marta Majewska-Pulsakowska
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland; (S.J.); (M.M.-P.); (K.P.)
| | - Joanna Gorka-Dynysiewicz
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland;
| | - Anna Jenczura
- Institute of Health Science, University of Opole, Katowicka 68, 45-060 Opole, Poland; (L.P.); (K.W.); (A.J.)
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland; (S.J.); (M.M.-P.); (K.P.)
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Kowal M, Winiarski S, Gieysztor E, Kołcz A, Walewicz K, Borowicz W, Rutkowska-Kucharska A, Paprocka-Borowicz M. Symmetry function in gait pattern analysis in patients after unilateral transfemoral amputation using a mechanical or microprocessor prosthetic knee. J Neuroeng Rehabil 2021; 18:9. [PMID: 33468184 PMCID: PMC7816420 DOI: 10.1186/s12984-021-00810-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Above-knee amputations (AKAs) contribute to gait asymmetry. The level of asymmetry is affected by the type of knee prosthetic module. There is limited evidence suggesting that more technically advanced solutions (microprocessor modules; MicPK) are superior to less advanced ones (mechanical modules; MechPK). The study aimed to evaluate the variable range of hip and pelvic joint movements during gait and look for differentiating areas with an increased level of asymmetry of the gait cycle in individuals who underwent an AKA and are equipped with MicPK or MechPK. METHODS Twenty-eight individuals participated in the study; 14 were assigned to a study group of individuals who underwent a unilateral AKA, and the other 14 were healthy participants as a control group. The movement task was recorded using the optoelectronic SMART-E system following the standard Davis protocol (the Newington model). A new method of quantifying gait symmetry using the symmetry function (SF) is proposed. SF is an integral measure of absolute differences in time-standardized signals between sides throughout the whole cycle of motion variability. RESULTS In the frontal plane, there were significant differences between groups in the asymmetry of the range of movement in the hip joint of the intact limb. In the middle of the support phase, the intact limb was more adducted in individuals with MicPK and less abducted in people with MechPK (differences in mean 180%, p < 0.000; max 63%, p < 0.000; min 65%, p < 0.000). In the sagittal plane, the range of asymmetry of the flexion and thigh extension of the intact limb was similar to and only slightly different from the physiological gait. In the transverse plane, higher asymmetry values were noted for individuals with MicPK. In the final stage of the swing phase, the thigh was more rotated both externally and internally. The size of the asymmetry, when compared to gait of healthy individuals, reached 50% (differences in mean 115%, p < 0.232; max 62% p < 0.26; min 50, p < 0.154). CONCLUSIONS In the study group, the assessed ranges of pelvic and thigh movement in the hip joint differed only in the frontal plane. Individuals who underwent a unilateral above-knee amputation may gain less from using MicPK than anticipated.
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Affiliation(s)
- Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
| | - Sławomir Winiarski
- Department of Biomechanics, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Ewa Gieysztor
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
| | - Anna Kołcz
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
- Laboratory of Ergonomics and Biomedical Monitoring, Wroclaw Medical University, Wroclaw, Poland
| | | | - Wojciech Borowicz
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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Abstract
Background: Extracorporeal Shock Wave Therapy (ESWT) has become a popular tool to treat musculoskeletal disorders and chronic low back pain.
Aim of the study: To review the current scientific literature and assess the utility of ESWT in treating chronic low back pain.
Methods: This systematic review was conducted from November 2019 to January 2020. Its purpose was to determine what the effectiveness is of the various forms of ESWT for the treatment of chronic low back pain. The critical review of the literature on the use of ESWT in chronic low back was made using the scientifically recognized medical databases PubMed, MEDLINE, Physiotherapy Evidence Database (PEDro) and Web of Science Core Collection. There was no restriction by date. Exclusion criteria were experimental, in vitro, animal, review, case reports, non-randomized clinical trials or studies with healthy participants. All articles written in languages other than English have also been excluded.
Results: Six studies were included in the final analysis. According to the applied PEDro classification, the average scoring for the studies was 4.83, which indicates overall low quality of the presented reports. However, this result appeared closer to the moderate (acceptable) quality range (6-8 points) than to the unacceptable range (0-2 points).
Conclusion: Based on the findings in the analyzed articles, ESWT promises to be an efficient and useful procedure in chronic low back pain treatment. Unfortunately, the level of evidence is relatively weak because there are a limited number of published studies related to ESWT and the final score in the PEDro classification was low. Together, these results indicate the need for further high quality randomized clinical trials.
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Walewicz K, Taradaj J, Dobrzyński M, Sopel M, Kowal M, Ptaszkowski K, Dymarek R. Effect of Radial Extracorporeal Shock Wave Therapy on Pain Intensity, Functional Efficiency, and Postural Control Parameters in Patients with Chronic Low Back Pain: A Randomized Clinical Trial. J Clin Med 2020; 9:jcm9020568. [PMID: 32092987 PMCID: PMC7074373 DOI: 10.3390/jcm9020568] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 01/10/2023] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide, placing a significant economic burden on healthcare systems. Radial extracorporeal shock wave therapy (rESWT) is useful in the rehabilitation of orthopedic diseases; however, there is still limited evidence for patients with LBP. The aim of this study was to assess the effect of rESWT on pain level, functional efficiency, and parameters of postural control in patients with LBP. Participants were randomized into group A (n = 20) treated with rESWT and group B (n = 20) treated with sham rESWT (placebo). Both groups received conventional physiotherapy, including core stability exercises. The following tests were performed: the Laitinen Pain Scale (LPS), the Roland–Morris Questionnaire (RMQ), the original Schober Test (OST), and a stabilometric platform for the assessment of postural sway, including total sway path (TSP). We found that the analgesic effect was higher after rESWT, especially in the follow-up’s (p < 0.05). Similar results were found for functional efficiency and range of motion (p < 0.05). The improved posture stability in placebo group B was not statistically significant (p > 0.05). The stabilometric parameters in group A were still gradually improved and statistically significant, even in follow-ups (p < 0.05). In conclusion, the rESWT had a significant effect on the reduction of pain and the improvement of functional condition compared to a conventional physiotherapy program. Also, rESWT with core stability exercises led to significant improvements in postural sway compared with conventional physiotherapy in patients with LBP.
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Affiliation(s)
- Karolina Walewicz
- Faculty of Physiotherapy, Opole Medical School, 45-060 Opole, Poland;
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland;
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, R106-771 MB, Canada
| | - Maciej Dobrzyński
- Department of Conservative Dentistry and Pedodontics, Wroclaw Medical University, 50-425 Wroclaw, Poland;
| | - Mirosław Sopel
- Department of Nervous System Diseases, Wroclaw Medical University, 61-618 Wroclaw, Poland;
| | - Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, 51-355 Wroclaw, Poland; (M.K.); (K.P.)
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, 51-355 Wroclaw, Poland; (M.K.); (K.P.)
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, 61-618 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-71-784-18-39
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Walewicz K, Taradaj J, Rajfur K, Ptaszkowski K, Kuszewski MT, Sopel M, Dymarek R. The Effectiveness Of Radial Extracorporeal Shock Wave Therapy In Patients With Chronic Low Back Pain: A Prospective, Randomized, Single-Blinded Pilot Study. Clin Interv Aging 2019; 14:1859-1869. [PMID: 31806944 PMCID: PMC6857735 DOI: 10.2147/cia.s224001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose This prospective, randomized and single-blinded study assesses the influence of radial extracorporeal shock wave therapy (rESWT) in patients with low back pain (LBP). Methods A total of 52 patients with LBP were enrolled in the study, out of which a homogeneous group of 40 patients with mean age of 53.45±4.9 years was included. Patients were randomized into group A (n=20) treated with rESWT (2000 pulses; 2.5 bars; 5 Hz, 7 mins) performed twice a week for five weeks (10 sessions) and stabilization training, as well as group B (n=20) treated with sham rESWT and stabilization training. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1 and 3 months follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) Laitinen Pain Scale (LPS), and (3) Oswestry Disability Index (ODI). Results The control group had a statistically significant advantage over the rESWT group (4.4 vs. 3.1 points on the VAS; p=0.039). However, in long-term observations, group A gradually experienced more pain relief than group B (2.7 vs. 3.5 points, p>0.05, at one month and 2.0 vs. 4.4 points at three months after treatment; p<0.0001). Similar findings can be seen in the analysis of changes in pain sensations measured with the LPS. The functional state (ODI) was better in rESWT group, especially in follow-up observation (9.3 vs. 14.6 points, p=0.033, at one month and 9.3 vs. 17.8 points, p=0.004, at three months after treatment). Conclusion The rESWT combined with stabilization training is particularly effective in the long-term and achieves a stable beneficial effect for patients with LBP. The use of rESWT has a significant long-term influence on the reduction of pain and the improvement of the general functional state in relation to the conventional motor improvement program.
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Affiliation(s)
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Tomasz Kuszewski
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland
| | - Mirosław Sopel
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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Taradaj J, Rajfur K, Shay B, Rajfur J, Ptaszkowski K, Walewicz K, Dymarek R, Sopel M, Rosińczuk J. Photobiomodulation using high- or low-level laser irradiations in patients with lumbar disc degenerative changes: disappointing outcomes and remarks. Clin Interv Aging 2018; 13:1445-1455. [PMID: 30174418 PMCID: PMC6109659 DOI: 10.2147/cia.s168094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Laser therapy seems to be a beneficial physical agent for chronic low back pain (LBP), and it is commonly used in the clinical rehabilitation practice. However, there are still no indisputable and clearly defined protocols and practical guidelines, and further, the methodology of the previous reports leaves many unsatisfied and raises some reservations. Objective The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in patients with lumbar disc degenerative changes based on the analysis of the short- and long-term results and in comparison with the placebo effect. Design This study was a prospective and placebo-controlled clinical trial. Materials and methods A group of 68 participants were qualified for the therapy and were assigned to four comparative groups in the order they volunteered: HILT of 1,064 nm, 60 J/cm2, 10 minutes (HILT); sham (HILT placebo); LLLT of 785 nm, 8 J/cm2, 8 minutes; and sham (LLLT placebo). The following tests were used to assess the effectiveness of treatment: 1) the visual analogue scale; 2) the Laitinen Questionnaire Indicators of Pain; 3) the Oswestry Disability Index; 4) the Roland–Morris Disability Questionnaire; 5) Lasegue test; and 6) Schober’s test. All measurements were carried out before and after irradiations (3 weeks) and in follow-ups (1 and 3 months). Results After applying verum or placebo laser irradiation, therapeutic progress was observed in all comparative groups; however, no statistically significant differences were observed among the procedures. Conclusion The high- and low-energy laser therapy methods used in the present article are ineffective in relation to patients with lumbar disc degenerative changes in both the short- and long-term perspectives and do not show a significant advantage over the placebo effect.
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Affiliation(s)
- Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Barbara Shay
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Joanna Rajfur
- Public Higher Medical Professional School, Opole, Poland
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Wroclaw, Poland
| | | | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland,
| | - Mirosław Sopel
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland,
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland,
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Taradaj J, Ozon M, Dymarek R, Bolach B, Walewicz K, Rosińczuk J. Impact of selected magnetic fields on the therapeutic effect in patients with lumbar discopathy: A prospective, randomized, single-blinded, and placebo-controlled clinical trial. ADV CLIN EXP MED 2018; 27:649-666. [PMID: 29616749 DOI: 10.17219/acem/68690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Interdisciplinary physical therapy together with pharmacological treatment constitute conservative treatment strategies related to low back pain (LBP). There is still a lack of high quality studies aimed at an objective evaluation of physiotherapeutic procedures according to their effectiveness in LBP. OBJECTIVES The aim of this study is to carry out a prospective, randomized, single-blinded, and placebocontrolled clinical trial to evaluate the effectiveness of magnetic fields in discopathy-related LBP. MATERIAL AND METHODS A group of 177 patients was assessed for eligibility based on inclusion and exclusion criteria. In the end, 106 patients were randomly assigned into 5 comparative groups: A (n = 23; magnetic therapy: 10 mT, 50 Hz); B (n = 23; magnetic therapy: 5 mT, 50 Hz); C (n = 20; placebo magnetic therapy); D (n = 20; magnetic stimulation: 49.2 μT, 195 Hz); and E (n = 20; placebo magnetic stimulation). All patients were assessed using tests for pain intensity, degree of disability and range of motion. Also, postural stability was assessed using a stabilographic platform. RESULTS In this study, positive changes in all clinical outcomes were demonstrated in group A (p < 0.05). The most effective clinical effect was observed for pain reduction (p < 0.05), improvement of the range of motion (p < 0.05) and functional ability of the spine (p <0.05). It is also worth noting that the effects in the majority of the measured indicators were mostly short-term (p > 0.05). CONCLUSIONS It was determined that the application of magnetic therapy (10 mT, 50 Hz, 20 min) significantly reduces pain symptoms and leads to an improvement of functional ability in patients with LBP.
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Affiliation(s)
- Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education in Katowice, Poland
- College of Rehabilitation Sciences, University of Manitoba in Winnipeg, Canada
| | - Marcin Ozon
- Private Physiotherapy Practice "OzonMedica Clinic", Gorlice, Poland
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Poland
| | - Bartosz Bolach
- Department of Sport Didactics, University School of Physical Education in Wroclaw, Poland
| | - Karolina Walewicz
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Poland
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Poland
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Taradaj J, Shay B, Dymarek R, Sopel M, Walewicz K, Beeckman D, Schoonhoven L, Gefen A, Rosińczuk J. Effect of laser therapy on expression of angio- and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers. Int J Med Sci 2018; 15:1105-1112. [PMID: 30123047 PMCID: PMC6097266 DOI: 10.7150/ijms.25651] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/25/2018] [Indexed: 01/14/2023] Open
Abstract
Objective: To evaluate the effect of laser irradiation at different wavelengths on the expression of selected growth factors and inflammatory mediators at particular stages of the wound healing process. Methods: Sixty-seven patients were recruited, treated, and analyzed (group A - 940 nm: 17 patients; group B - 808 nm: 18 patients; group C - 658 nm: 16 patients; group D - sham therapy: 17 patients). Patients received a basic treatment, including repositioning and mobilization, air pressure mattress and bed support surfaces, wound cleansing and drug therapy. Additionally, patients received laser therapy once a day, 5 times a week for 1 month in use of a semiconductor lasers (GaAlAs) which emitted a continuous radiation emission at separate wavelengths of 940 nm (group A), 808 nm (group B) and 658 nm (group C). In group D (sham therapy), laser therapy was applied in the same manner, but the device was off during each session (only the applicator was switched on to scan pressure ulcers using none coherent red visible light). Results: The positive changes in the measured serum (IL-2, IL-6 and TNF-α) and wound tissue (TNF-α, VEGF and TGFβ1) parameters appeared to be connected only with the wavelength of 658 nm. The significant change in pro-inflammatory mediator levels [interleukin 2 (IL-2) with p=0.008 and interleukin 6 (IL-6) with p=0.016] was noticed after two weeks of laser therapy. In the other groups, the inflammation was also reduced, but the process was not as marked as in group C. Similarly, in the case of tumor necrosis factor (TNF-α) concentration, where after two weeks of treatment with irradiation at a wavelength of 658 nm, a rapid suppression was observed (p=0.001), whereas in the other groups, these results were much slower and not as obvious. Interestingly, again in the case of group C, the change in TNF-α concentration in wound tissue was most intensive (≈75% reduction), whereas the changes in other groups were not as obvious (≈50% reduction). After irradiation (658 nm), the VEGF expression increased significantly within the first two weeks, and then it decreased and maintained a stable level. In contrast, the TGFβ1 activity remained level, but always higher in comparison to other groups Conclusions: The effective healing of pressure ulcers is connected with laser irradiation at a wavelength of 658 nm. We believe that this effect is related to the inhibition of inflammatory processes in the wound and stimulation of angiogenesis and fibroblast proliferation at this specific radiation (based both on concentration of interleukins and TNF-α serum level and VEGF, TGFβ1, TNF-α activities in wound biopsies). Laser therapy at wavelengths of 940 and 808 nm does not significantly affect the above-mentioned repair processes, which explains its low effectiveness in the treatment of pressure ulcers.
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Affiliation(s)
- Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education, 72B Mikolowska St, 40-065 Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, McDermot Av, R106 - 771, Winnipeg, Canada
| | - Barbara Shay
- College of Rehabilitation Sciences, University of Manitoba, McDermot Av, R106 - 771, Winnipeg, Canada
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, 5 Bartla St, 51-618, Wroclaw, Poland
| | - Mirosław Sopel
- Department of Nervous System Diseases, Wroclaw Medical University, 5 Bartla St, 51-618, Wroclaw, Poland
| | - Karolina Walewicz
- Faculty of Physiotherapy, Public Higher Medical Professional School, 68 Katowicka St, 45-060, Opole, Poland
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, De Pintelaan 185 5K3 B-9000, Ghent, Belgium
| | - Lisette Schoonhoven
- Faculty of Health Sciences, University of Southampton, University Rd SO17 1BJ, Southampton, United Kingdom
| | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, 5 Bartla St, 51-618, Wroclaw, Poland
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Rajfur J, Pasternok M, Rajfur K, Walewicz K, Fras B, Bolach B, Dymarek R, Rosinczuk J, Halski T, Taradaj J. Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study. Med Sci Monit 2017; 23:85-100. [PMID: 28062862 PMCID: PMC5240899 DOI: 10.12659/msm.899461] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background In the currently available research publications on electrical therapy of low back pain, generally no control groups or detailed randomization were used, and such studies were often conducted with relatively small groups of patients, based solely on subjective questionnaires and pain assessment scales (lacking measurement methods to objectify the therapeutic progress). The available literature also lacks a comprehensive and large-scale clinical study. The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods. The study assesses the influence of individual electrotherapeutic treatments on reduction of pain, improvement of the range of movement in lower section of the spine, and improvement of motor functions and mobility. Material/Methods The 127 patients qualified for the therapy (ultimately, 123 patients completed the study) and assigned to 6 comparison groups: A – conventional TENS, B – acupuncture-like TENS, C – high-voltage electrical stimulation, D – interferential current stimulation, E – diadynamic current, and F – control group. Results The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain, and an improvement of functional ability of patients suffering from low back pain on the basis of an analysis of both subjective and objective parameters. The TENS currents and high voltage were helpful, but not as effective. The use of diadynamic currents appears to be useless. Conclusions Selected electrical therapies (interferential current, TENS, and high voltage) appear to be effective in treating chronic low back pain.
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Affiliation(s)
- Joanna Rajfur
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Opole, Poland
| | - Małgorzata Pasternok
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Opole, Poland
| | - Katarzyna Rajfur
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Opole, Poland
| | - Karolina Walewicz
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Opole, Poland
| | - Beata Fras
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Opole, Poland
| | - Bartosz Bolach
- Department of Sports Training, Academy School of Physical Education in Wrocław, Wrocław, Poland
| | - Robert Dymarek
- Department of Nervous System Diseases, Wrocław Medical University, Wrocław, Poland
| | - Joanna Rosinczuk
- Department of Nervous System Diseases, Wrocław Medical University, Wrocław, Poland
| | - Tomasz Halski
- Institute of Physiotherapy, Public Higher Medical Professional School in Opole, Opole, Poland
| | - Jakub Taradaj
- Department of Physiotherapy Basics, Academy School of Physical Education in Katowice, Katowice, Poland
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