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Life (Basel, Switzerland) Oct 2022Osteoarthritis is one of the most common degenerative joint diseases. The main symptoms of the osteoarthritis have been linked to the presence of myofascial trigger... (Review)
Review
BACKGROUND
Osteoarthritis is one of the most common degenerative joint diseases. The main symptoms of the osteoarthritis have been linked to the presence of myofascial trigger points in the soft tissues. Dry needing (DN) is the most investigated technique for the treatment of myofascial trigger points. Thus, the aim of this study was to evaluate the effectiveness of DN in pain and physical function in patients with osteoarthritis in the short-, medium- and long-term.
METHODS
PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in September 2022. Randomized controlled trials involving DN compared to non-pharmacological interventions, sham techniques or no additional treatment were selected. Quality of the studies was assessed with PEDro scale and risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using fixed or random effects models according to the Cochrane handbook for systematic reviews of interventions.
RESULTS
Seven studies were included in the meta-analysis involving 291 patients with osteoarthritis. The methodological quality of the included studies ranged from fair to high. DN showed significant improvements in pain intensity (SMD = -0.76; 95% CI: -1.24, -0.29; I: 74%) and physical function (SMD = -0.98; 95% CI: -1.54, -0.42; I: 75%) in the short-term. No differences were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence to very low.
CONCLUSIONS
Very low-quality evidence suggests a positive effect of DN for reducing pain intensity and improving physical function in the short term in patients with osteoarthritis. Further investigation is needed to determine a medium- and long-term effects.
PubMed: 36295010
DOI: 10.3390/life12101575 -
American Journal of Physical Medicine &... Mar 2021The aim of this review was to examine biopsychosocial factors associated with an increased risk of attention problems after a traumatic brain injury in children.
OBJECTIVE
The aim of this review was to examine biopsychosocial factors associated with an increased risk of attention problems after a traumatic brain injury in children.
DESIGN
A systematic review of the literature was conducted using data sources of MEDLINE, PsycINFO, and CINAHL up to August 30, 2020. Literature primarily examined pediatric patients with traumatic brain injury and attention problems. Risk factors for attention problems posttraumatic brain injury examined in all articles were identified and grouped into broad categories of biological, psychological, and social factors. Methodological quality of each study was assessed using the modified Downs and Black checklist. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines from 2009 were used in completing this review.
RESULTS
Forty articles met inclusion criteria for this study. Overall findings were mixed but suggested that younger age at injury, presence of preinjury attention-deficit/hyperactivity disorder, poorer preinjury adaptive functioning, lower socioeconomic status, and poorer family functioning were associated with increased risk of developing attention problems posttraumatic brain injury.
CONCLUSIONS
Development of attention problems after pediatric traumatic brain injury is complex and influenced by an array of biologic, environmental/social, injury-related, and host factors. Evidence is mixed, and further study is needed to better understand the relationships between these factors and how they influence attention after traumatic brain injury. Nonetheless, screening for attention problems in children with risk factors may allow for earlier identification and intervention, minimizing negative impacts of attention problems after traumatic brain injury in children. Limitations of this study included heterogeneity of studies and overall low to moderate methodological quality of studies included as measured by the modified Downs and Black checklist.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
CME OBJECTIVES
Upon completion of this article, the reader should be able to: (1) Describe the importance of recognizing and identifying attention problems after traumatic brain injury in children; (2) Identify risk factors for development of attention problems after pediatric traumatic brain injury; and (3) Recognize gaps in existing literature regarding predictors of attention problems after pediatric traumatic brain injury.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Age Factors; Attention; Attention Deficit Disorder with Hyperactivity; Brain Injuries, Traumatic; Child; Humans; Risk Factors; Sex Factors; Socioeconomic Factors
PubMed: 33229886
DOI: 10.1097/PHM.0000000000001643 -
American Journal of Physical Medicine &... May 2019This review article evaluated the efficacy of autologous blood-derived products, including whole blood and platelet-rich plasma, in reducing pain and improving function... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This review article evaluated the efficacy of autologous blood-derived products, including whole blood and platelet-rich plasma, in reducing pain and improving function compared with corticosteroids for plantar fasciopathy patients.
DESIGN
Literature comparing autologous blood-derived product and corticosteroids for the treatment of plantar fasciopathy was systematically reviewed. Twelve randomized controlled trials and four quasi-experimental studies were included. The visual analog scale pain score and American Orthopedic Foot and Ankle Society hindfoot score were evaluated at 1.5, 3, and 6 mos' follow-up. Subgroup analyses were performed concerning platelet-rich plasma preparation techniques, injection regiments, and study designs.
RESULTS
Corticosteroids were found to reduce pain more effectively than whole blood at 1.5 and 3 mos, but the effect disappeared at 6 mos. Platelet-rich plasma reduced pain more effectively at 6 mos' postinjection than corticosteroids. However, there was no significant difference in the American Orthopedic Foot and Ankle Society score between platelet-rich plasma and corticosteroids injections at any time point. In the subgroup analyses, pain was significantly reduced at 6 mos by self-prepared platelet-rich plasma, one-step separation platelet-rich plasma, platelet-rich plasma of more than 3 ml, and platelet-rich plasma without local analgesics.
CONCLUSIONS
The results of this meta-analysis suggest that platelet-rich plasma may provide a long-term effect in relieving pain in plantar fasciopathy patients.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Compare the efficacy of whole blood (WB), platelet-rich plasma (PRP), and corticosteroid (CS) in short-term pain reduction in patients with plantar fasciopathy (PF); (2) Compare the efficacy of WB, PRP, and CS in long-term pain reduction in patients with PF; (3) Identify the potential complication of corticosteroid injection for plantar fasciopathy; and (4) Identify the components of whole blood that might influence the growth factors in healing process.
LEVEL
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Adrenal Cortex Hormones; Blood Transfusion, Autologous; Fasciitis, Plantar; Female; Humans; Male; Pain Management; Platelet-Rich Plasma; Randomized Controlled Trials as Topic
PubMed: 30362977
DOI: 10.1097/PHM.0000000000001070 -
Neurourology and Urodynamics Jun 2024Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the...
INTRODUCTION
Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI.
MATERIALS AND METHODS
A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients.
RESULTS
The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis.
CONCLUSIONS
Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.
Topics: Humans; Delphi Technique; Urodynamics; Urinary Tract Infections; Antibiotic Prophylaxis; Consensus; Female; Male; Italy; Anti-Bacterial Agents; Risk Factors; Urology
PubMed: 38587242
DOI: 10.1002/nau.25463 -
American Journal of Physical Medicine &... Jul 2022The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury.
DESIGN
Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software.
RESULTS
Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies.
CONCLUSIONS
Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
CME OBJECTIVES
Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Extracorporeal Shockwave Therapy; Humans; Motor Neurons; Muscle Spasticity; Pain
PubMed: 35152251
DOI: 10.1097/PHM.0000000000001977 -
Complementary Therapies in Medicine Feb 2019The purpose of this review was to identify the effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild... (Meta-Analysis)
Meta-Analysis
Effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review.
OBJECTIVE
The purpose of this review was to identify the effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis.
DESIGN
A systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
SETTING
We searched MEDLINE, PEDro, Scopus and the Cochrane Library databases for randomized controlled trials related to non-pharmacological conservative treatments for hip osteoarthritis with the following keywords: "hip osteoarthritis," "therapeutics," "physical therapy modalities," and "combined physical therapy". The PEDro scale was used for methodological quality assessment and the Oxford Centre of Evidence-Based Medicine scale was used to assess the level of evidence. Outcomes measures related to pain, hip range of motion and physical function were extracted from these studies.
RESULTS
Twelve studies met the inclusion criteria. Most of the studies showed high level of evidence and only two showed low level of evidence. High quality of evidence showed that manual therapy and exercise therapy are effective in improving pain, hip range of motion and physical function. However, high quality studies based on combined therapies showed controversy in their effects on pain, hip range of motion and physical function.
CONCLUSIONS
Exercise therapy and manual therapy and its combination with patient education provides benefits in pain and improvement in physical function. The effects of combined therapies remain unclear. Further investigation is necessary to improve the knowledge about the effects of non-pharmacological conservative treatments on pain, hip range of motion and physical function.
Topics: Conservative Treatment; Exercise; Exercise Therapy; Humans; Musculoskeletal Manipulations; Osteoarthritis, Hip; Pain; Pain Management; Randomized Controlled Trials as Topic; Range of Motion, Articular
PubMed: 30670244
DOI: 10.1016/j.ctim.2018.11.021 -
American Journal of Physical Medicine &... Oct 2022The aims of the study were to assess the effectiveness of long-term exercise therapy (≥12 wks) for patients with Parkinson disease and to derive specific suggestions... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aims of the study were to assess the effectiveness of long-term exercise therapy (≥12 wks) for patients with Parkinson disease and to derive specific suggestions on how the motor symptom improvements can be optimized by exercise type and exercise dose.
DESIGN
The PubMed, Web of Science, Cochrane Central Register, Embase, Scopus, and CNKI databases were searched up to January 2021 for randomized controlled trials focusing on the effects of long-term exercise for Parkinson disease. Two researchers independently evaluated the quality of papers using the PEDro scale. Twenty-six studies with a total of 1243 participants were included.
RESULTS
Tai Chi, resistance training, and dance provide significant improvements in physical function and functional mobility. Furthermore, Tai Chi and dance result in balance benefits. However, walking capacity outcomes did not improve after Tai Chi and resistance training but did improve after dance. With an increase in the intervention duration or length of each session, the effect sizes of exercise on these outcomes increased; higher benefits of exercise on these outcomes were observed at a frequency of 2 times/wk.
CONCLUSIONS
Long-term exercise therapy is an effective treatment for improving motor symptoms, with dance being an ideal exercise choice.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
CME OBJECTIVES
Upon completion of this article, the reader should be able to: (1) Recognize that long-term exercise slows clinical progression of motor symptoms in patients with Parkinson disease; (2) Acquire knowledge regarding the effectiveness of long-term exercise therapy on motor symptoms in Parkinson disease; and (3) Incorporate specific suggestions on dose-response relationships of different exercise therapy on motor symptoms in Parkinson disease.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Exercise Therapy; Humans; Parkinson Disease; Quality of Life; Randomized Controlled Trials as Topic; Tai Ji
PubMed: 35695530
DOI: 10.1097/PHM.0000000000002052 -
American Journal of Physical Medicine &... Nov 2018The aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke.
DESIGN
MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability.
RESULTS
Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (standardized mean difference, 0.64; 95% confidence interval [CI], 0.32-0.95), particularly ipsilesional stimulation (standardized mean difference, 0.80; 95% CI, 0.36-1.24). No significant effects were found for balance function (standardized mean difference, 0.10; 95% CI, -0.26 to 0.45), motor function (mean difference, 0.50, 95% CI: -0.68 to 1.68), or cortical excitability (motor-evoked potentials of the affected hemisphere: mean difference, 0.21 mV; 95% CI, -0.11 to 0.54; motor-evoked potentials of the unaffected hemisphere: mean difference, 0.09 mV; 95% CI, -0.16 to -0.02).
CONCLUSION
These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: 1) Understand the potential neurophysiologic effects of rTMS; 2) Appreciate the potential benefits of rTMS on stroke recovery; and 3) Identify indications for including rTMS in a stroke rehabilitation program.
LEVEL
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Aged; Female; Humans; Male; Middle Aged; Postural Balance; Recovery of Function; Stroke; Stroke Rehabilitation; Transcranial Magnetic Stimulation; Treatment Outcome; Walking
PubMed: 29734235
DOI: 10.1097/PHM.0000000000000948 -
American Journal of Physical Medicine &... Nov 2020The aims of this study were to understand the clinical significance of balance training in degenerative cerebellar disease and to analyze inconsistencies among published...
OBJECTIVE
The aims of this study were to understand the clinical significance of balance training in degenerative cerebellar disease and to analyze inconsistencies among published data.
DESIGN
Five databases were searched from inception to October 8, 2019. Cochrane guidelines informed review methods, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The Australian National Health and Medical Research Council Evidence Hierarchy, PEDro scale, and Joanna Briggs Institute Critical Appraisal Tools were used to evaluate methodological quality. Outcome measures examined included ataxia severity, gait speed, and balance.
RESULTS
Fourteen articles were identified that met inclusion criteria. The quality of evidence was moderate to high, with recent articles being of higher quality. Nine of 12 articles showed statistical improvements in ataxia severity (reduction ranging from 1.4 to 2.8 in the Scale for the Assessment and Rating of Ataxia points), three of eight showed statistical improvements in gait speed (average increase of 0.1 m/sec), and six of nine showed improvements in balance measures (average increase of 1.75 in Berg Balance Scale and 1.5 in Dynamic Gait Index).
CONCLUSION
Most studies showed statistical and clinically significant ataxia severity improvements in subjects who performed balance training. The amount of balance challenge and frequency of training were important factors in determining the extent of training benefit. Gait speed may also improve if walking exercises are included in the balance training, but more studies need to be conducted. Balance measures statistically improved with training, but these improvements did not meet criteria for clinical significance.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the cause(s) of discrepancies in the literature regarding the benefits of balance training in degenerative cerebellar disease; (2) Determine if benefits from balance training are clinically meaningful for individuals with cerebellar degeneration; and (3) Understand the best practices gleaned from the current literature regarding balance training for these diseases.
LEVEL
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Ataxia; Bias; Biomedical Research; Cerebellar Diseases; Humans; Neurodegenerative Diseases; Neurological Rehabilitation; Postural Balance; Treatment Outcome; Walking Speed
PubMed: 32467491
DOI: 10.1097/PHM.0000000000001476 -
American Journal of Physical Medicine &... Aug 2020The goal of this systematic review was to provide guidelines for treatment parameters regarding electrical stimulation by investigating its efficacy in improving muscle...
OBJECTIVE
The goal of this systematic review was to provide guidelines for treatment parameters regarding electrical stimulation by investigating its efficacy in improving muscle strength and decreasing pain in patients with knee osteoarthritis.
DESIGN
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard, three electronic databases (CINAHL, PubMed, and PEDro) and gray literature were used. Randomized control trials comparing electrical stimulation and conservative physical therapy were critically appraised using the 2005 University of Oxford standard.
RESULTS
Nine randomized control trials were included in our review. First, our review confirmed that neuromuscular electrical stimulation is the most effective electrical stimulation treatment in the management of knee OA, and its efficiency is higher when combined with a strengthening program. Second, frequency of at least 50 Hz and no more than 75 Hz with a pulse duration between 200 and 400 μs and a treatment duration of 20 mins is necessary for successful treatment.
CONCLUSIONS
For the first time, our review provides standardized clinical treatment parameters for neuromuscular electrical stimulation to be included in a strengthening program for the adult patient with knee OA.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Recall the impact of quadriceps femoris weakness on joint stability; (2) Summarize the mechanism of action of neuromuscular electrical stimulation (NMES) on reducing pain and increasing muscle strength; and (3) Plan the clinical treatment parameters of NMES to be included in a strengthening program for an adult patient with knee osteoarthritis.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Electric Stimulation Therapy; Humans; Muscle Strength; Osteoarthritis, Knee; Randomized Controlled Trials as Topic
PubMed: 32167955
DOI: 10.1097/PHM.0000000000001409