Extracorporeal Shock Wave Therapy Combined With Oral Medication and Exercise for Chronic Low Back Pain: A Randomized Controlled Trial

OBJECTIVE

To compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP).

DESIGN

Randomized controlled trial.

SETTING

Outpatient clinic at a university hospital.

PARTICIPANTS

Eligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration.

INTERVENTION

The intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program.

MAIN OUTCOME MEASURES

Visual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months.

RESULTS

The pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P<.0001) and 1.8 after 3 months (P<.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P<.0001), and 1.1 after 3 months (P<.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P<.001, third month: P<.05). The mean ODI score did not differ significantly between the groups (P=.942).

CONCLUSION

Extracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain.

Extracorporeal Shockwave Therapy in Pillar Pain after Carpal Tunnel Release: A Prospective Randomized Controlled Trial

Background

The aim of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pillar pain after carpal tunnel release.

Materials and Methods

In this prospective randomized controlled trial, forty patients with pillar pain for at least 1 month after carpal tunnel release surgery were randomly assigned in two groups. ESWT group received four sessions of ESWT at weekly intervals, and patients in the control group received sham ESWT treatment at the same intervals, involved sound but no energy. At baseline, 1^st month, and 3^rd month, hand function (using Brief-Michigan Hand Outcome Questionnaire) and pain score were assessed and compared between groups.

Results

At baseline, pain score and hand function score were similar in both groups. After 1^st month, pain score in ESWT and control groups was 3.7 versus 4.7, respectively (P = 0.066), and hand function score was 60.7 versus 52.2, respectively (P = 0.032). After 3 months, pain score in ESWT group was significantly lower than the control group (1.6 versus 3.6, respectively, P < 0.0001), hand function score in ESWT group was significantly better than the control group (75.4 vs. 63.7, respectively, P < 0.0001). Trend of decrease in pain score between groups was significantly different, but trend of increase in hand function score was not significantly different.

Conclusion

After ESWT, hand function and pain score in patients with pillar pain improved faster compared to control patients. Hence, ESWT can be used as a safe and effective noninvasive technique in patients with pillar pain after carpal tunnel release.

Survey of medical students' attitude and knowledge toward physical medicine and rehabilitation in Isfahan University of Medical Sciences

CONTEXT

Physical medicine and rehabilitation (PMR) is a specialized clinical field of musculoskeletal diseases and physical impairment that is unknown for most of the medical students.

AIMS

This study aimed to assess medical students' attitude and knowledge toward PMR and its role in the diagnosis and treatment of musculoskeletal diseases.

SETTING AND DESIGN

This cross-sectional study was done on 175 medical students of Isfahan University of Medical Sciences from 2015 to 2016. Sample population was selected by random sampling among 350 students.

MATERIALS AND METHODS

Participants were evaluated by a research-made questionnaire with confirmed validity and reliability. This questionnaire included 36 questions divided in four parts including demographic data, knowledge, attitude, and performance ranking.

STATISTICAL ANALYSIS USED

Data were analyzed using SPSS 20. Statistical test for quantitative and qualitative variables was carried out by mean ± standard deviation and percentage or number, respectively. For analyzing variables, Student's t-test and Chi-square test were used.

RESULTS

In this study, 150 medical students with a mean age of 24.48 ± 1.48 years participated of which 40% of them were male. The mean score of Student's knowledge about PMR and its role in diagnosis and treatment of disorders was 5.16 ± 1.90, and 91.3% had low level of knowledge. The mean score of student's attitude toward PMR and its role in the diagnosis and treatment of musculoskeletal problems was 3.33 ± 0.46, and 69.3% had attitude level above the average. Evaluation of student's performance showed that when they manage patients with musculoskeletal problems as general physician, they refer the patients to physiatrists at the first step if it is necessary.

CONCLUSION

Understanding the factors influencing the attitudes and knowledge of medical students is prime to help establishing the roles, providing proper facilities, carrying out successful planning to train expert physicians and create a motivated environment in medical schools.

Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients

PURPOSE

The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients.

METHODS

This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery.

RESULTS

Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training.

CONCLUSION

Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

Median-radial sensory latencies comparison as a new test in carpal tunnel syndrome

Median and radial distal sensory latencies (DSL) were compared in 50 patients with carpal tunnel syndrome (CTS) and 50 healthy subjects by stimulating each nerve separately and recording sensory nerve action potential (SNAP) from standard anatomical locations for stimulation and recording sites. The range of difference between median DSL and radial DSL was 0.18 -1.18 msec in control group and 1.12-4.46 msec in CTS patients with a mean of 0.69 msec and 1.99 msec respectively (P < or = 0.0001). We found the value of 1 msec as a good cut-off point for diagnosis of CTS. The test described here seems to be an effective and simple criteria for increasing the sensitivity of nerve conduction studies in CTS.