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Objective Several reports in literature have identified sensitization as a possible basis for the enhanced pain reactions associated with osteoarthritis (OA). The aim of this current systematic review is to summarize functional and structural brain changes associated with surrogate sensitization parameters assessed in patients with OA-related pain. Design Systematic review. Subjects Patients with OA related pain. Methods A literature search was conducted systematically in MEDLINE, CINAHL, EMBASE databases for human studies up to December 2019. Articles were included if they assessed brain imaging and sensitization parameters (quantitative sensory testing and questionnaires) in adults with OA-related pain. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. Results Five studies reporting on 138 patients were included in this review. The MINORS scale yielded mean scores of 8.5/16 and 12.3/24, for the cohort and case-control studies respectively. Four low-quality studies suggest a greater pain matrix activation associated with clinical measures of sensitization in patients with OA, while another study underlined the presence of structural changes (reduced gray matter volume) in the cortical areas involved in the nociceptive processing possible also related to sensitization. Conclusions This review shows conflicting evidence for structural and functional neuroplastic brain changes related to sensitization proxies in patients with OA.

OBJECTIVE To evaluate the effectiveness of the neurodynamic mobilization techniques compared with passive robotic physiologic movement in patients with hand osteoarthritis (OA). METHODS We conducted a randomized controlled trial. A total of 72 patients (mean ± SD age 71 ± 11 years) with dominant symptomatic hand OA were randomized in 2 groups, and both received 12 treatment sessions over 4 weeks. The experimental group received neurodynamic mobilization of the median, radial, and ulnar nerves, and the control group received robotic-assisted passive movement treatment. Both groups also participated in a program of hand stability exercises. Outcome measures included pain intensity, pressure pain thresholds (PPTs), and strength measurements. Group-by-time effects were compared using mixed-model analyses of variance. RESULTS After the intervention, the experimental group had statistically significant, higher PPTs than the control group at the thumb carpometacarpal joint by 0.7 kg/cm2 (95% confidence interval [95% CI] 0.6, 0.8), the median nerve by 0.7 kg/cm2 (95% CI 0.6, 0.7), and the radial nerve by 0.5 kg/cm2 (95% CI 0.3, 0.6); however, the difference was not statistically significant at 3 months postintervention. Although mean values in the experimental group were higher than in the control group at all PPT sites at both assessments, these differences were not statistically significant. The experimental group experienced a statistically significant reduction in pain immediately postintervention, but this was not present at the 3-month follow-up. There were no statistically significant differences in pinch or grip strength between groups. CONCLUSION We found that neurodynamic mobilizations decreased hypersensitivity in patients with hand OA immediately after the intervention; however, differences were no longer present at 3 months. The results suggest that these techniques may have some limited value in the short term but do not have lasting effects.

Objectives This study aims to examine the effects of probiotics on pain hypersensitivity at the end of a six-week intervention program in patients with osteoarthritis (OA)-related pain. Patients and methods This double-blind randomized controlled clinical trial with two parallel arms will be conducted between January 2021 and July 2022. At least 30 participants (age range, 50 to 90 years) of both sexes with a diagnosis of symptomatic hip or knee (Kellgren-Lawrence scale ≥3) will be recruited in each arm (total n=60) to achieve adequate statistical power in the analyses. The intervention will be administered for six weeks followed by a four-week follow-up period. The experimental group will receive a probiotic product plus the usual medical care. The control group will receive a probiotical sham plus the usual medical care. Assessment points will be measured at baseline, end of intervention, and one-month post-intervention. The outcomes of this intervention will be a change in visual analog scale pain and the gut microbiota composition. Group by time effects will be compared using mixed-model analysis of variance. Conclusion A reduction in pain hypersensitivity in patients with knee OA-related pain could suggest an involvement of microbiota, or part of it, in chronic pain state mechanisms.

DETAILS OF THE CLINICAL CASE: A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60. DISCUSSION: Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient. SUMMARY: Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.

Gait impairments are among the main issues for stroke survivors as they are often linked with a lack of endurance capacity, balance impairments and functional limitations. These conditions can be carefully assessed by combining an endurance capacity test, the 6-minute walk test (6MWT), with the analysis of gait performed by an inertial measurement unit (IMU). We investigated the evolution of gait spatiotemporal and kinematic parameters during the 6MWT and compared it with age-matched healthy subjects. Moreover, gait parameters and 6MWT distance were associated with clinical outcome scales. In a postacute rehabilitation general hospital, we performed an observational study. Subjects with a single cortical stroke were recruited into the stroke group (SG). An age-matched healthy group (HG) was also recruited. All participants performed a 6MWT while wearing an IMU. The outcomes considered were 6MWT distance, gait spatiotemporal and kinematic parameters, and symmetry. Before the test at each subject, in the SG was administered Berg balance scale, Canadian neurological stroke scale and motricity index. 32 subjects were recruited into the SG, and 12 into the HG. Between the paretic and nonparetic limbs of the SG, there were differences in the stance phase and single support phase (P < 0.05). SG gait speed and stride length strongly correlated with balance, strength and disability scales. The SG walked fewer meters than the HG (Δ = -260.90 m; P < 0.001). Adopting an IMU during a 6mwt resulted valuable and effective in providing meaningful information regarding both the disability and functional capabilities of SG subjects.

The gut microbiome constitutes the largest reservoir of the human microbiome and probably the one most capable of influencing the health of the whole body through multiple system-level interactions. Composed mainly of bacteria but also fungi and viruses, this microbial ecosystem is highly diverse and complex, functionally redundant, individual specific, plastic, and resilient. An alteration of its structure, i.e., dysbiosis, has been shown to participate in the onset and progression of various metabolic and inflammatory diseases. This is mainly due to the increase of opportunistic pathogens or pathobionts and/or the depletion of health-associated taxa, such as short-chain fatty acid producers, with impaired intestinal permeability (i.e., leaky gut) and altered immune signaling [1]. It is therefore not surprising that the gut microbiome can also be a crucial factor in the management of osteoarthritis (OA). Exposure to stress and pain may lead to alterations in the interactions between the brain and the intestine (i.e., the gut–brain axis) by changing gastrointestinal secretion, gut motility and permeability, and microbial gene expression and quorum-sensing signals, thus contributing to dysbiosis and increasing the rate of translocation of bacterial products or even bacteria, thereby eliciting systemic inflammation [2] (Figure 1). It has been hypothesized that patients with OA-related pain will exhibit an imbalance of the gut microbiota associated with pain intensity [3].

Subacromial impingement syndrome (IS) is a common disorder associated with functional impairment and disability of the shoulder. The aim of this study was to evaluate the efficacy of Vojta therapy (VT) techniques compared with standard therapy (ST) in patients with subacromial IS. A randomized controlled trial was performed, with 60 patients with IS (mean age, 61±12 years) randomized into two groups: ST (n=30) and ST plus Vojta therapy (SVT, n=30). Both received 15 treatment sessions over 4 weeks. Outcome measures included pain intensity, functionality, joint range of motion (RoM), strength, and quality of life measurements. The efficacy of both treatments was analysed, both comparatively and separately, immediately after completion of treatment and after 3 months. After the intervention, both groups showed statistically significant differences in visual analogue scale (P=0.001), RoM (P

Background: Osteoporosis (OP) is a systemic disease that is characterized by decreased bone density and quality. Purpose: The purpose of this systematic review was to determine the effects of muscle strengthening exercise in postmenopausal women with OP. Methods: A literature search was conducted systematically in MEDLINE, CINAHL, EMBASE databases for human studies up to 31 March 2021. Two researchers screened the articles against predefined inclusion criteria; a third resolved discrepancies. Articles were included if they assessed the effects of muscle strengthening exercise in postmenopausal women with OP. The protocol for this systematic review was registered on PROSPERO (CRD42021207917) and a qualitative systematic review was carried out following the PRISMA statement. Methodological quality was evaluated through the scientific validity scales PEDro. Finally, RTCs and NRCTs risk of bias was assessed with the Cochrane risk of bias tool (Risk of Bias-ROB 2.0) and ROBINS-1, respectively. Results: A total of 16 studies (1028 subjects) that met the different eligibility criteria previously established were selected. There is evidence of good methodological quality and a low to moderate risk of bias that supports that muscle strengthening exercise alone or in combination with other therapeutic modalities improves BMD (9, n = 401) in proximal femur and lumbar vertebra body, muscle strength (10, n = 558), balance (4, n = 159), functionality (7, n = 617), and quality of life (5, n = 291). Conclusions: Exercise programs focused on muscle strengthening have benefits for all variables studied in postmenopausal women with OP.

Background and objectives Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. Material and methods A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. Results In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. Discussion and conclusions There are no common criteria in the techniques used after surgical decompression of the median nerve.

The purpose of this pilot study was to determine the effects of strength training of the knee muscles on perceived pain and static knee angles in young subjects with patellofemoral pain syndrome (PFPS). Ten patients, 100% female (mean age, 18.2±3.8 years), with unilateral PFPS (anterior knee pain for at least 3 months), received muscle strengthening of the hip and knee (10 sessions over a period of 3 weeks). The outcome measures were perceived pain (visual analogue scale, VAS) and static knee angles (knee rotation measurer). All measures were collected at pre-, postintervention, and at 1-month follow-up (VAS). Muscle strengthening reduced perceived pain after intervention in 90.8% in subjects and this result was maintained at 1-month follow-up (all, P=0.001). Regarding changes in static knee angles, no significant improvements were found in internal and external rotation; valgus and varus; flexion and recurvatum (all, P>0.05). There was no significant difference between the symptomatic and healthy sides (all, P>0.05). Analyses of the correlation coefficients indicated no significant associations between changes in perceived pain and static knee angles. The current study found that muscle strengthening addressed to the symptomatic knee reduced pain; however, perceived pain was not associated with static knee angles in young subjects with unilateral PFPS. ispartof: JOURNAL OF EXERCISE REHABILITATION vol:15 issue:3 pages:454-459 ispartof: location:Korea (South) status: published

The purpose of this study was to investigate the test-retest reliability of the Phi angle in patients undergoing total ankle replacement (TAR) for end stage ankle osteoarthritis (OA) to assess the rotational alignment of the talar component.Retrospective observational cross-sectional study of prospectively collected data. Post-operative anteroposterior radiographs of the foot of 170 patients who underwent TAR for the ankle OA were evaluated. Three physicians measured Phi on the 170 randomly sorted and anonymized radiographs on two occasions, one week apart (test and retest conditions), inter and intra-observer agreement were evaluated.Test-retest reliability of Phi angle measurement was excellent for patients with Hintegra TAR (ICC=0.995; p0.001) and Zimmer TAR (ICC=0.995; p0.001) on radiographs of subjects with ankle OA. There were no significant differences in the reliability of the Phi angle measurement between patients with Hintegra vs. Zimmer implants (p0.05).Measurement of Phi angle on weight-bearing dorsoplantar radiograph showed an excellent reliability among orthopaedic surgeons in determining the position of the talar component in the axial plane.Level II, cross sectional study.

Several reports in the literature have suggested a causative association between oral occlusion and spinal deformity such as scoliosis and Scheuermann's disease or kyphosis. Based on these findings, a growing number of adolescents with spinal deformity receive orthodontic treatment, supposing a beneficial effect on the spine.The aim of this study was to verify the association between spinal deformity and malocclusion in the orthopedic population and potential effect of orthodontic treatment on the spinal deformity.The databases: MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect were searched up to August 2017 for studies reporting on associations between spinal and occlusal conditions. Case series, cohort, case-control studies and randomized clinical trials were considered for analysis. Two reviewers independently selected studies, conducted quality assessment and extracted results. Methodological quality was assessed using MINORS score.Nine publications reporting on 1424 patients were included. Studies were two case series, five case-control studies, one cohort study and one randomized clinical trial. The methodological quality was poor in 8/9 studies.Evidence from three low-quality studies suggests an increased prevalence of occlusal dysfunction in patients with known spinal deformity, but the conclusions have a high risk of bias. No evidence of beneficial effects of orthodontic treatment on spinal deformity was found. These slides can be retrieved under Electronic Supplementary Material.

Background: Thumb carpometacarpal osteoarthritis (CMC OA) is a common disorder that interferes with the ability to perform the activities of daily life. The purpose of this study was to investigate the immediate effects of ischemic compression on myofascial trigger points (MTrPs) in the first dorsal interosseous (FDI) muscle in patients with the diagnosis of thumb CMC OA. Methods: In a quasi-experimental clinical trial, thirty-one patients, 87% female (age: 82 ± 9.4 years), with thumb CMC OA, were consecutively assigned to either an experimental treatment that included the ischemic compression of the FDI MTrP or a sham treatment of the FDI MTrP for one session. The main outcome considered in the study was the pressure pain threshold (PPT). Measurements were taken pre- and post-treatment and at a 1-week follow-up period. Results: The PPT over the right (affected) FDI muscle showed statistically significant differences between groups at 1-week follow up (F = 3.518, p = 0.04) in favor of the experimental group. Conclusions: The ischemic compression of FDI-MTrPs is an appropriate part of a multimodal treatment to decrease local pain sensitivity in patients with CMC OA.

ObjectiveThis study aims to define appropriate domains and items for the development of a self-administered questionnaire to assess the risk of developing work-related musculoskeletal disorder (WMSD) and the risk of its progression to chronicity.DesignLiterature review and survey study.Setting and participantsA literature review and a two-round interview with 15 experts in musculoskeletal pain were performed to identify the available domains for WMSD assessment.Interventions and outcomeTo ensure quality, only validated questionnaires were included for the Delphi process. A three-round Delphi method, with three round steps, was used to select the most pertinent and relevant domains and items.ResultsNine questionnaires were identified through the expert discussion and literature review, comprising 38 candidate domains and 504 items. In the first round of the Delphi group, 17 domains reached more than 70% agreement and were selected. In the second round, 10 domains were rejected, while 11 were selected to complete the pool of domains. In the third and final round, 89 items belonging to 28 domains were defined as significant to develop a WMSDs risk assessment questionnaire.ConclusionsNo specific risk assessment questionnaires for WMSDs were identified from the literature. WMSD risk of presence and chronicity can be defined by an assessment tool based on the biopsychosocial model and the fear-avoidance components of chronic pain. The present study provides the formulation and operationalisation of the constructs in domains and items needed for developing and validating the questionnaire.

Background: manual therapy (MT) has been shown to have positive effects in patients with osteoarthritis (OA)-related pain, and its use in clinical settings is recommended. However, the mechanisms of action for how these positive effects occur are not yet well understood. The aim of the present study was to investigate the influence of MT treatment on facilitatory nociception and endogenous pain modulation in patients with knee OA related pain. Methods: Twenty-eight patients with knee OA were included in this study. Pain intensity using the numerical pain rating scale (NPRS), temporal summation (TS), conditioned pain modulation (CPM), and local (knee) and distant (elbow) hyperalgesia through the pressure pain threshold (PPT), were assessed to evaluate the pain modulatory system. Patients underwent four sessions of MT treatments within 3 weeks and were evaluated at the baseline, after the first session and after the fourth session. Results: the MT treatment reduced knee pain after the first session (p = 0.03) and after the fourth session (p = 0.04). TS decreased significantly after the fourth session of MT (p = 0.02), while a significant increase in the CPM assessment was detected after the fourth session (p = 0.05). No significant changes in the PPT over the knee and elbow were found in the follow-ups. Conclusions: The results from our study suggest that MT might be an effective and safe method for improving pain and for decreasing temporal summation. European University of Madrid, Villaviciosa de Odón, Madrid 2.838 Q2 JCR 2021 0.507 Q2 SJR 2021 No data IDR 2021 UEM

[Abstract] The Italian Self care diabetic foot questionnaire, (SDFQ-IT) is considered a dia-betic foot self-care evaluation tool with 16 questions for assessing diabetic foothealth disorders. To date, SDFQ has been validated in different languages, butan Italian version was lacking. Consequently, the purpose of this study was totranslate and validate the Italian version of the SDFQ-I T (SDFQ-IT). A suitablemethod was developed for the translation protocol and cross-cultural valida-tion from Spanish to Italian. Regarding the total marks from each sub-scale,agreement degrees, and confidence were analysed using the Cronbach's α andintraclass correlation coefficient (IC C), respectively. In addition, the mean± SD differences between pre and post-tests were calculated and completedusing the Bland and Altman distribution plots. Excellent agreement betweenthe two versions based on Cronbach's α was demonstrated. Three sub-scalesconsisting of knowledge of foot hygiene, the appropriate use of footwear andsocks, and podiatric self-care were added together to obtain the total score.Excellent retest reliability was shown for the total score. Test/retest reliabilitywas excellent for the self-care domain, and shock and shoe sub-scales. Therewere no significant differences among any domain (P > .05). There were nostatistically significant differences (P = .000) for the mean ± SDs differencesbetween pre-and post-tests (92.9200 ± 12.914) [89.25-96.59] and 92.9200± 13.012 [89.22-96.62] points, respectively). Bland and Altman plots or clini-cally pertinent variations were not statistically significantly different. TheSDFQ-IT is considered a strong and valid questionnaire with adequate repeat-ability in the Italian community. This research was funded by Generalitat Valenciana, grant number GV/2020/061 and the APC was funded by Universitat de València Generalitat Valenciana; GV/2020/061

Background: Osteoarthritis (OA) is the most common form of chronic pain in Europe (34%), representing a great economic and social cost to society. There are studies that suggest an intestine–brain–articulation axis and hint at the existence of low-grade intestinal inflammation in OA, which would be related to an alteration of the microbiota and to the impairment of the epithelial barrier, with leakage of the microbial components. Purpose: The purpose of this study was to review the association between gut microbiome and pain in the OA population through a review of the literature. Methods: A literature search was conducted to identify all available studies on the association between the gut microbiome and pain in the OA population, with no publication date limit until September 2020 and no language limit, in the MEDLINE, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials databases. Results: Only three of 2084 studies detected and analyzed by performing the proposed searches in the detailed databases, were finally selected for this review, of which one was with and two were without intervention. These studies only weakly support a relationship between the gut microbiome and OA, specifically a correlation between certain taxa or microbial products and the inflammatory landscape and severity of OA symptoms, including knee pain. Conclusions: Despite encouraging results, this review highlights the paucity of high-quality studies addressing the potential role of the gut microbiome in OA-related pain, along with the disparity of the techniques used so far, making it impossible to draw firm conclusions on the topic.

Two acute respiratory failure secondary to SARS-CoV-2 subjects were admitted to the Hospital Universitario Vall d´Hebron ICU and Hospital Universitario Nuestra Senora de Candelaria ICU. The ICU respiratory physiotherapy (RP) plays an essential role during all phases of ventilatory care. Still, regarding the lack of information about RP effects in this context, these data are crucial to demonstrate its feasibility to treat SARS-CoV-2 subjects in ARDS. First case: An asthmatic 38 yr woman, sedated and intubated. Second case: Woman, with cardiac arrest, 43 yr, septic shock, hypoxemic encephalopathy, and seizures tracheostomized after ten days in IMV, pleural effusion drained during IMV. Both subjects SARS-CoV-2 positive during Hospital admission. RP goals: to improve WOB, gas exchange, recruit collapsed area, remove lung secretions, IMV wean, muscle strength. Figure 2 shows the RP protocol. Closed system airway suctioning removed abundant semi-thick and yellowish secretion. Early mobilization to upper and lower limbs was performed. Before the successful weaning, the patient presented X-ray, IMV settings, gas exchange, and muscle strength improvements (fig 1).

Background The aim of this study was to determine the effects of magnetically controlled growing rods surgery (MCGRS) of the scoliosis on pulmonary function in children with neuromuscular scoliosis. Methods Seven patients, 85.7% female (mean±SD age: 6.7±1.2 years), with neuromuscular scoliosis (4 SMA II, 2 congenital myopathies and 1 VACTER syndrome), received MCGRS of the spine in the thoraco-lumbar area. The outcome measures were clinical features and pulmonary function (forced vital capacity [FVC] and forced expiratory volume in 1st second [FEV1], were collected. All measures were collected at pre-, post-intervention and follow-up (short-term [0-6 months], mid-term [7-12 months], and long-term [13-24 months]). Results MCGRS reduced Cobb angle after intervention in 100% in subjects and this result was maintained at 24-month follow-up (all, P=0.001). There was no significant difference in FVC or FEV1 between preoperative and each postoperative period, (P>0.05). Analyses of the correlation coefficients indicated no significant associations between changes in pulmonary function and scoliosis. Conclusions The current study found that MCGRS addressed to the scoliosis maintained pulmonary function during long-term follow-up; However, pulmonary function was not associated with scoiosis in children with neuromuscular scoliosis.

The radial nerve is a commonly injured upper extremity peripheral nerve. The inability to extend the wrist results in a loss of hand function and dexterity that affects patients' ability to perform their activities of daily living. There is no strong evidence to support a particular splint design for improving dexterity. This cohort study compared whether a static or dynamic splint can improve hand dexterity when assessed with the 9-hole peg test (9-HPT) after radial nerve injury. Thirty-four subjects with radial nerve palsy participated in the study. The test was repeated three times for each subject, first without the splint, and then while wearing the control static wrist splint, and finally while wearing the dynamic splint. The 9-HPT was used as the outcome measure. The 9-HPT times were 36.4±4.8seconds without a wrist splint and improved when using the static and the dynamic splints to 33.5±4.5seconds (P

Objective: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between the number of MTrPs and pain and function in patients presenting knee pain osteoarthritis (OA). Methods: This was a secondary analysis of data from a cross-sectional study. The prevalence of MTrPs located in tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles was studied in 114 patients (71 men and 43 women) with knee OA. Pain and functionality were assessed with a numerical pain rating scale (NPRS), the Western Ontario, McMaster Universities Osteoarthritis Index (WOMAC) score, the Barthel Index, and the timed up and go test. Results: The prevalence of latent MTrPs was detected via palpation and was estimated to be 50%, 35%, 25%, 29%, 33%, and 12% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. The prevalence of active MTrPs was estimated to be 11%, 17%, 30%, 18%, 25%, and 17% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. Pain was measured with the NPRS scale and was poorly correlated with the prevalence of latent MTrPs (r = 0.2, p = 0.03) and active MTrPs (r = 0.23, p = 0.01) in the hamstrings. Disability was moderately correlated with the number of latent MTrPs in the tensor fasciae latae muscle (Barthel, r = 0.26, p = 0.01 and WOMAC, r = 0.19, p = 0.04). Conclusions: This secondary analysis found that the prevalence of the MTrPs varied from 11% to 50% in different muscles of patients with mild to moderate painful knee osteoarthritis. Pain was correlated poorly with the prevalence of latent and active MTrPs in the hamstring muscles, and disability correlated moderately with the number of latent MTrPs in tensor fasciae latae.

Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases-PubMed, MEDLINE and CENTRAL-a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field. Sin financiación 2.430 JCR (2020) Q2, 80/167 Medicine, General & Internal 0.530 SJR (2020) Q3, 1255/2446 Medicine (miscellaneous) No data IDR 2020 UEM

Objective To examine the effects of high-intensity laser therapy (HILT) on pain sensitivity and motor performance in patients with thumb carpometacarpal (CMC) osteoarthritis (OA). Design Prospective, triple-blinded, randomized, placebo-controlled trial. Setting Private practice, Malaga, Spain. Subjects Forty-three patients (mean ± SD age = 71 ± 12 years) with a diagnosis of thumb CMC OA grade 1–2 were randomized to the control group (N = 21) or experimental group (N = 22). Methods The experimental group (ExpG) received high-intensity laser therapy (HILT), and the control group (ConG) received a placebo treatment. The outcome measures were pain intensity (visual analog scale) and key pinch strength measurements (dynamometer). All outcome measures were collected at baseline, immediately following the intervention, at four weeks, and at 12 weeks following the intervention. Results Analysis of variance revealed a group × time interaction (F = 40.8, P Conclusions HILT effectively diminishes pain intensity when used as an isolated treatment for patients with thumb CMC OA, but the effect of treatment decreases after 12 weeks.

The main goal of this study was to determinate the extent of the relationship between shoulder pain and time of wrist and thumb immobilization required after injury. One hundred twenty-three consecutive subjects presenting to the practice of different Orthopedic Specialist hospitals with a diagnosis of distal radius or scaphoid fracture that required wrist and thumb immobilization were screened for eligibility criteria. Upper extremity pain and the need for shoulder rehabilitation were assessed using the visual analogue scale (VAS) at baseline after immobilization period (T0) 1- and 3-month follow-up (1-FU/2-FU). More than 35% patients had shoulder pain (VAS>40 mm) after immobilization of the wrist. Shoulder pain intensity after immobilization and at follow-up (1 and 3 months) was strongly correlated with the duration of the immobilization. Immobilization for 3.5 weeks or longer was the strongest predictor for the need of subsequent shoulder rehabilitation. An increased the time of immobilization of the wrist is associated with an increase in shoulder pain and need for shoulder rehabilitation in patients after wrist fracture.

To review the incidence of perioperative and late complications of surgery for spinal deformity (ASD). Review of the literature. We reviewed recent literature in English to investigate the incidence of complications in ASD surgery in the perioperative (≤ 3 months post-operative) and late (> 3 months post-operative) periods. Randomized-controlled trials, non-randomized trials, cohort studies, case–control studies, and case series published in 2005 or later were included. We divided articles according to surgical technique: open procedures (OP), minimally invasive surgery (MIS), and hybrid procedures (HP). Complications were recorded, grouped by surgical technique, and then classified according to a proposed Grading of Incidence of Complications (IOC). Ninety-six publications reporting on 12,168 patients were included; 68 were level IV of evidence studies, 24 were level III, and 4 level II. Perioperative IOC was 26.5% in OP, 36.4% in HP, and 24.2% in MIS. Late IOC was 11.1% in OP, 15.4% in HP, and 14.0% in MIS. IOC was significantly higher for hybrid procedures compared to both open and MIS procedures. Reported complications of surgery for ASD in the recent literature are frequent (24–36% perioperative plus 11–15% late). Open procedures were the most extensively reported in the literature. Complication rates are similar for OP and MIS. HP presented higher IOC likely due to the combination of OP and MIS respective complications. Small number of studies and heterogeneity in reporting could result in risk of bias in these results. Large-scale registry-based studies can fill this gap in the future. These slides can be retrieved under Electronic Supplementary Material.

Study Design A quasi-experimental trial. Introduction Orthoses are effective to decrease pain and improve function in patients with carpometacarpal osteoarthritis (CMC OA). However, current research does not support one design of an orthosis as more effective and/or more favorable than another. Purpose of the Study The aim of this study was to compare the effectiveness of 2 different static orthosis on pain and functional abilities on CMC OA. Methods Eighty-four patients, 91.7% females (mean ± standard deviation age, 60.1 ± 9.6 years), with thumb CMC OA were randomized into 1 of 2 groups. For group A, a Ballena orthotic was constructed, and for group B, a Colditz orthotic was constructed. Both static orthoses were worn for 3 months. The outcome measures included pain with activity measured with the visual analog scale and functional abilities assessed with the Disabilities of the Arm, Shoulder and Hand. Results Both orthoses improved pain level and functional abilities ( F [1.0] = 413.327 and F [1.0] = 211.742; both P F [1.0] = 0.075 and F [1.0] = 7.248; both P > .05). Discussion The main purpose was to compare the effect of 2 different thermoplastic thumb orthoses. Previous studies support the use of CMC orthoses to decrease hand pain and improve hand function, but different orthoses have been described and in most cases, orthotic interventions were accompanied by other medical treatments. Conclusions A clinically significant reduction in pain intensity and improvement in functional abilities was achieved with both orthoses in patients with thumb CMC OA. Level of Evidence 2. Trial Registration ClinicalTrials.gov registration number: NCT02780999.

Objective The aim is to present a case series that illustrates possible benefits from combining minimally invasive plate osteosynthesis (MIPO), plastic surgery and antibiotic therapy, in order to treat and eradicate infection in patients with tibial pilon or calcaneal fractures. Methods Eleven consecutive patients with dehiscence of the surgical wound in outcomes MIPO using a Locking Compression Plate (LCP) for tibial pilon, or calcaneus fractures. The patients had developed a documented infection of the surgical wound. All patients were treated and followed-up by the multidisciplinary team with the orthopedic surgeon, the plastic surgeon and the infectious disease physician. All patients were followed by the plastic surgeon to treat the wound dehiscence, as well as by the orthopedic surgeon until fracture consolidation. The duration of the antibiotic therapy was from 4 to 6 months. After 6 weeks, the intravenous treatment was replaced by oral administration. The follow-up intervals were 15 days, 40 days, and 3 months. Results The average time of wound closure was 109 ± 60 days. The antibiotics used were chosen according to the antibiogram. The antibiotic therapy had a duration of 4–6 months, and after 6 weeks, the therapy switched to oral administration. At the 3-month follow-up, all patients had excellent outcomes and had returned to their normal activity of daily living. Conclusion The patients in this study responded positively to a combination of MIPO, plastic surgery and antibiotic therapy, confirming that multidisplinary treatment in association with titanium devices are able to eradicate infection in short time.

This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8–12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs’ maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2–3 days a week for 8–12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice.

Osteoarthritis (OA) is not simply a matter of mechanical damage and several risk factors are involved in the manifestation of the OA phenotype. OA-related pain management needs a multidisciplinary approach involving various treatment options including nonpharmacological and pharmacological ones. Due to the low number of high-quality studies related to OA related pain treatment, which conservative or non-conservative procedure should be chosen?

BACKGROUND Whiplash Associated Disorders (WAD) is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. OBJECTIVE To examine the effectiveness of a cognitive behavioral exercises approach (CBEA) for self-training of the neck relative to usual care in individuals with WAD in acute phase. METHODS Forty-one patients, 65.9% female (mean ± SD age: 41 ±11 years), with WAD were recruited immediately after the accident (within 48 hours) and assigned according to patient choice to receive a CBEA self-training of the neck or usual care for 15 days. The primary outcome measure was pain intensity and disability as measured with the Neck Disability Index (NDI). Secondary outcome measures included the presence of headaches, dizziness, nausea, and difficulties with concentration and memory. Measurements were taken at pre-treatment, 2 weeks post-treatment and 4- and 12- weeks after the injury. RESULTS Patients receiving the CBEA intervention experienced a greater reduction in pain as compared to those receiving the usual care at the end as well as 4 and 12 weeks after the intervention (P< 0.001), for the Neck Disability Index (NDI) decreased more in the CBEA than controls over the 15 days and (F=[3.0] 552.383; P= 0.001), and in both groups at all follow-up periods (all, P= 0.001). CONCLUSIONS This quasi-experimental clinical trial provides evidence that a CBEA for self-training of the neck may be more beneficial in treating pain than usual care in patients with WAD. However, the CBEA had limited value in improving NDI. Future studies should include several therapists, a measure of a long-term outcomes and randomize patients to groups.

Background: Conservative treatments are commonly performed therapeutic interventions for the management of carpometacarpal (CMC) joint osteoarthritis (OA). Physical and occupational therapies are starting to use video-based online content as both a patient teaching tool and a source for treatment techniques. YouTube is a popular video-sharing website that can be accessed easily. The purpose of this study was to analyze the quality of content and potential sources of bias in videos available on YouTube pertaining to thumb exercises for CMC OA. Methods: The YouTube video database was systematically searched using the search term thumb osteoarthritis and exercises from its inception to March 10, 2017. Authors independently selected videos, conducted quality assessment, and extracted results. Results: A total of 832 videos were found using the keywords. Of these, 10 videos clearly demonstrated therapeutic exercise for the management of CMC OA. In addition, the top-ranked video found by performing a search of “views” was a video with more than 121 863 views uploaded in 2015 that lasted 12.33 minutes and scored only 2 points on the Global Score for Educational Value rating scale. Conclusions: Most of the videos viewed that described conservative interventions for CMC OA management have a low level of evidence to support their use. Although patients and novice hand therapists are using YouTube and other online resources, videos that are produced by expert hand therapists are scarce.

[Purpose] The aim of the present study is to detail the protocol for a randomised controlled trial (RCT) of neural manual vs. robotic assisted on pain in sensitivity as well as analyse the quantitative and qualitative movement of hand in subjects with hand osteoarthritis. [Subjects and Methods] Seventy-two patients, aged 50 to 90 years old of both genders, with a diagnosis of hand Osteoarthritis (OA), will be recruited. Two groups of 36 participants will receive an experimental intervention (neurodynamic mobilization intervention plus exercise) or a control intervention (robotic assisted passive mobilization plus exercise) for 12 sessions over 4 weeks. Assessment points will be at baseline, end of therapy, and 1 and 3 months after end of therapy. The outcomes of this intervention will be pain and determine the central pain processing mechanisms. [Result] Not applicable. [Conclusion] If there is a reduction in pain hypersensitivity in hand OA patients it can suggest that supraspinal pain-inhibitory areas, including the periaqueductal gray matter, can be stimulated by joint mobilization.

Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. Methods: A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy) , and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale, Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.

This study aimed to describe the perceptions of decision-makers in major orthopedic centers regarding the value, implementation and use of spine surgery registries. A 33-item survey was sent to CEOs and heads of spine surgery of the International Society of Orthopedic Centers (ISOC). ISOC includes 21 hospitals worldwide with a special focus on high-quality musculoskeletal care. Twelve out of 20 member centers (60%) replied to the survey. Seven have working registries; 5 in Europe and 2 in North America. The estimations for the cost/year were distributed more evenly: $10,000 [2], $20,000 [1], $50,000 [1]. Society cannot afford unnecessary surgery nor renounce to cure patients with effective treatments. Spine surgery registries provide high levels of evidence. The cost of implementing a registry is limited in comparison to RCTs. Spine registries can pragmatically fill our knowledge gap by turning every operated patient into a study participant.

Background Recent studies suggest that osteoarthritis (OA) is a mixed pain state and that in some patients’ central nervous system factors can play an important role. Objectives In this study, we showed some preliminary dataon the effectiveness of neural manual mobilization vs robotic assisted mobilization, on reduce pain sensitivity in subjects with dominant hand OA. Methods A pilot randomized controlled trial was conducted. 50 patients (50 to 90 years old) with a diagnosis of dominant hand OA were randomized into two groups of 25 participants. The experimental group received an intervention of neurodynamic mobilization of median, radial and ulnar nerves plus exercise, the control one received a robotic assisted passive mobilization treatment (Gloreha Workstation, Idrogenet srl, Brescia, Italy) plus exercise. Both groups received 12 treatment sessions over 4 weeks. Pressure pain thresholds (PPTs) were assessed bilaterally over the Radial, Median and Ulnar nerves, first Carpometacarpal (CMC) joint, Hamate bone and in the C5-C6 zygapophyseal joint. Intensity of pain (Visual analogue scale, VAS), Quick-DASH scale, grip and pinch strength were also measured bilaterally. Patients were assessed at beginning, at the end of therapy and after a period of 1 and 3 months. Results In comparison with pre-treatment values, the experimental treatment increased the PPTs in the first CMC joint, radial and median nerves (P Conclusion Neurodynamic mobilization by sliding technique decreases pain in the hand joints in patients with hand OA, suggesting alternative therapies to surgery or to the use of analgesic. This research suggests alternative therapies to surgery or the use of analgesic therapy. References [1] Kroon FPB, Carmona L, Schoones JW, Kloppenburg M. Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis. RMD open 2018; 4(2): e000734. [2] Villafane JH, Valdes K, Pedersini P, Berjano P. Osteoarthritis: a call for research on central pain mechanism and personalized prevention strategies. Clinical rheumatology2018. [3] Villafane JH, Bishop MD, Fernandez-de-Las-Penas C, Langford D. Radial nerve mobilisation had bilateral sensory effects in people with thumb carpometacarpal osteoarthritis: a randomised trial. Journal of physiotherapy2013; 59(1): 25-30. [4] Villafane JH, Silva GB, Bishop MD, Fernandez-Carnero J. Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. Archives of physical medicine and rehabilitation2012; 93(3): 396-403. [5] Villafane JH, Cleland JA, Fernandez-de-Las-Penas C. The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. The Journal of orthopaedic and sports physical therapy2013; 43(4): 204-13. Acknowledgement This study was supported by a grant from the Ministry of Health, Italy, 2016 (project code: GR-2013-02358472). Disclosure of Interests None declared

Summary Objective Several reports in the literature have identified an association between cortisol levels and the presence of chronic pain in conditions such as rheumatoid arthritis, low back pain or whiplash. In contrast, few have examined the association of cortisol and pain in people with osteoarthritis (OA). The purpose of this systematic review was to verify the association between cortisol and pain in the OA population. Design The databases MEDLINE, CINAHL, EMBASE were searched systematically for human studies written in English up to December 2018. Two researchers screened titles and abstracts against predefined inclusion criteria; a third resolved discrepancies. Articles were included if they measured the cortisol levels in adults with pain in the OA population. Methodological quality was assessed using Methodological Index for non-randomized Studies (MINORS) score. Results Seven studies reporting on 415 patients were included in this review. The MINORS scale yielded mean scores of 8.6 of 16 and 17.5 of 24, for the cohort and case–control studies respectively. In general, the studies were of poor quality. A discrepancy of noteworthy associations between cortisol level comparison and pain was found. Conclusions This study shows that there is a discrepancy in the relationship between cortisol and pain dependent on how and when cortisol is measured. Evidence from three low-quality studies suggest increased cortisol levels in patients with pain but the conclusions have a high risk of bias. It was not possible to make a quantitative analysis comparing the relationship between cortisol and pain in the OA population.

Background: In patients with stroke, hemiplegic shoulder pain can be a major problem. One source of shoulder pain can be myofascial trigger points (MTrPs). Objective: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between MTrPs and pain and function in patients presenting with shoulder pain following a stroke. Design: Cross-sectional study. Setting: Department of Physical Therapy. Patients: Fifty patients with stroke with shoulder pain. Intervention: Not applicable. Main Outcome Measurements: The prevalence of the MTrPs located in infraspinatus, supraspinatus, teres minor, and upper trapezius was studied, using the diagnosis criteria recommended by Simons et al. The pressure pain threshold was also evaluated. Pain and function were assessed with the Visual Analogue Scale (VAS) and the Disability of the Arm, Shoulder and Hand (DASH) scale, respectively. Results: The prevalence of latent MTrPs was 68%, 92%, 40%, and 62% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. The prevalence of active MTrPs was 34%, 50%, 12%, and 20% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. Pain was moderately correlated with the prevalence of latent MTrPs (r = 0.35; P =.01) and active MTrPs (r = 0.31; P =.03) in the supraspinatus muscle. Disability was measured with the DASH scale and was moderately correlated with latent MTrPs in the infraspinatus (r = 0.31; P =.03) and active MTrPs of the supraspinatus (r = 0.32; P =.02). Conclusions: This study shows that the prevalence of MTrPs is high in patents following a stroke. MTrPs in this population are moderately associated with pain and function. Level of Evidence: II.

This paper has attempted to compare the effects of Bobath’s concept with control’s session on the improvement of visual attention in children with cerebral palsy. A 10 children sample (7 girls and 3 boys) aged 6 to 16 years (median, 12 years) was collected. The group who had received Bobath-based treatment crossed-over to control treatment and the previous control group received Bobath-based treatment for once a week. Measures were assessed at pre- and posttreatment. Outcome measure included the visual attention, we used Conners’ Kiddie Continuous Performance Test (K-CPT). Bobath’s session targeted to crossed-over participants produced greater improvements in K-CPT(RT) (difference=33.1, P

Purpose: To present preliminary clinical results of the effects of a new treatment with percutaneous electrolysis directed to peripheral tendon and therapeutic resistance exercise, with or without the presence of degenerative zone. Methods: 3 patients with patellar tendinopathy aged 37-45 years with diagnostic of patellar tendinopathy with pain since 5-8 weeks were treated with a novel, less invasive electrolysis technique. Pain severity was measured by Numerical Pain Rating Scale (NPRS). Lower limb functionality was measured by a Victorian Institute of Sport Assessment questionnaire (VISA-P). A clinical interview and ultrasonography assesment were performed before study protocol were carried out. Each participants received 4 to 7 sessions of percutaneous electrolysis (350 μA, 80 s) leaving at least one week between sessions during a total of 8 weeks. During this time, subjects also were undergone a therapeutic exercise protocol of lower limbs resistance training. Results: Pain severity decreased after 3 weeks treatment (p = 0.01) and was practically abolished after 4-7 sessions at 8 weeks (p = 0.2). The lower limb functionality (VISA-P) increased after 3 weeks treatment and the major difference was found at 8 weeks post-intervention (p = 0.001). Thickness of the patellar tendon decreased after 8 weeks treatment (p = 0.01). Conclusions: The present work provides the first evidence that percutaneous electrolysis with a least invasive physiotherapy treatment targeted to peripheral tendon in combination with therapeutic resistance exercise diminished pain, improved funcitonality and showed a tendency to decreased thickness in subjects with patelallar tendinopathy.

Background: To evaluate the effectiveness of non-invasive neuro-adaptive electrostimulation (NAE) therapy for treating chronic pain and disability in patients with fibromyalgia. Method/design: A prospective, randomized, sham-controlled study was conducted in 37 women with fibromyalgia. Participants were randomly assigned to receive either active NAE (n = 20) or stimulation with a sham device (n = 17). Participants in the experimental arm received eight 30-minute sessions over 4 weeks (2 sessions per week). The sham group received eight 30-minute sessions of sham stimulation. Therapeutic effects on pain relief, disability, and quality of life were evaluated using outcome measures at baseline, at 4 weeks, and after 3 months’ follow-up. Results: The findings indicated a significant reduction of pain in the active NAE group compared with the sham group immediately post-intervention, with a difference on the Visual Analog Scale (VAS) of 3 points (P = .001), and at 3 months’ follow-up (P = .02). There were significant intragroup differences between the groups (P < .05) at post-intervention. After the intervention, both groups presented significant reductions on the Fibromyalgia Impact Questionnaire (FIQ) with respect to baseline (P = .004), but not at the 3-month follow-up. In the conditioned pain modulation (CPM) in thumb variable we found significant differences between the groups at the 3-month follow-up (P = .02). No additional benefits for conditioned pain modulation and disability were observed between groups at the 3-month follow-up. Furthermore, anxiety/depression and catastrophizing improved in both groups, but no differences between groups were found. Conclusions: In this fibromyalgia cohort, NAE therapy significantly improved pain and quality of life at 4 weeks, but not at 3-month follow-up, compared with the sham stimulation group. Future investigations are needed in larger populations to confirm these findings. post-print 364 KB

To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up. Outcomes and knee arthritis severity were evaluated at final follow-up. Mean follow-up was 11.2 ± 1.2. At final follow-up, 85 and 57% of tibial and femoral tunnels, respectively, developed some degree of enlargement. Frontal tibial angle (mean) was 72°, sagittal tibial angle 63°, frontal femoral angle 47°, sagittal femoral angle 20°, and tunnels divergence angle 36°. Preoperatively, KT-1000 30L and Lachman test scores were 5.52 and 5.79 respectively. In the last follow-up, 30L and manual Lachman test scores were 0.97 and 1.13, respectively (p

Background Global postural re-education (GPR) has shown positive results for patients with musculoskeletal disorders, but no previous randomized controlled trial (RCT) has investigated its effectiveness as the sole procedure for adult patients with chronic nonspecific neck pain (NP). Objective The purpose of this study was to evaluate the effectiveness of applying GPR compared with a manual therapy (MT) intervention to patients with chronic nonspecific NP. Design An RCT was conducted. Patients Ninety-four patients with chronic nonspecific NP (72 women and 22 men; average age=47.5 years, SD=11.3) were randomly assigned to receive either a GPR intervention or an MT intervention. Outcome Measures Pain intensity (visual analog scale), disability (Neck Disability Index), cervical range of motion, and kinesiophobia (Tampa Scale of Kinesiophobia) were assessed. Methods The experimental group received GPR, and the reference group received MT. Both groups received nine 60-minute-long sessions with one-to-one supervision from physical therapists as the care providers. All participants were asked to follow ergonomic advice and to perform home exercises. Measures were assessed before treatment, following treatment, and at a 6-month follow-up. Results No important baseline differences were found between groups. The experimental group exhibited a statistically significant reduction in pain following treatment and in disability 6 months after the intervention compared with the reference group. Limitations Randomization did not lead to completely homogeneous groups. It also was noted that the time spent integrating the movements practiced during the session into daily routines at the end of each session was requested only of participants in the GPR group and may have had an impact on patient adherence that contributed to a better outcome. Conclusions The results suggest that GPR was more effective than MT for reducing pain after treatment and for reducing disability at 6-month follow-up in patients with chronic nonspecific NP.

[Purpose] In this study, we sought to evaluate the relationship between the Barthel Index and the Mini Nutritional Assessment Short Form in a cohort of elderly patients hospitalized in the General Rehabilitation Center. [Subjects and Methods] Three hundred and forty-four patients underwent an extensive evaluation, which included the following tests: 1) a Mini Nutritional Assessment Short Form to evaluate nutritional status; and 2) a Barthel Index assessment to evaluate functional status. We categorized patients into three age groups (65–74 yrs, 75–84 yrs, and >85 yrs). Barthel Index cutoff scores were defined as ≥45 out of 100 for better functional status and

In an attempt to decrease pain and increase function in patients with CMC OA, these authors have described the combination of two techniques that can be performed to treat this common problem. Before applying the techniques, each therapist must determine if the application of the technique falls within their scope of practice. - KristinValdes, OTD, OT, CHT, Practice Forum Editor.

[Purpose] The purpose of this case series was to determine the effects of robot-assisted hand rehabilitation with a Gloreha device on skeletal muscle perfusion, spasticity, and motor function in subjects with poststroke hemiparesis. [Subjects and Methods] Seven patients, 2 women and 5 men (mean ± SD age: 60.5 ±6.3 years), with hemiparesis (>6 months poststroke), received passive mobilization of the hand with a Gloreha (Idrogenet, Italy), device (30 min per day; 3 sessions a week for 3 weeks). The outcome measures were the total hemoglobin profiles and tissue oxygenation index (TOI) in the muscle tissue evaluated through near-infrared spectroscopy. The Motricity Index and modified Ashworth Scale for upper limb muscles were used to assess mobility of the upper extremity. [Results] Robotic assistance reduced spasticity after the intervention by 68.6% in the upper limb. The Motricity Index was unchanged in these patients after treatment. Regarding changes in muscle perfusion, significant improvements were found in total hemoglobin. There were significant differences between the pre- and posttreatment modified Ashworth scale. [Conclusion] The present work provides novel evidence that robotic assistance of the hand induced changes in local muscle blood flow and oxygen supply, diminished spasticity, and decreased subject-reported symptoms of heaviness and stiffness in subjects with post-stroke hemiparesis.

The aim of this study was to describe the association between scoliosis and sagittal balance parameters in Parkinson disease patients.This is a cross-sectional study.Fifty percent of the cohort presented a scoliosis larger than 11 degrees; 84% of the patients with scoliosis presented a thoracolumbar curve, 10% presented a thoracic one, and 6% presented a lumbar one. The group with scoliosis curves presented a lower spinosacral angle (111.6 [21.9] degrees vs. 121.7 [9.8] degrees, P0.05), whereas thoracic kyphosis, lumbar lordosis, and spinopelvic angle were similar. Pelvic incidence, pelvic tilt, and sacral slope were not statistically different. In the scoliosis group, the authors found negative correlations for lumbar lordosis/spinopelvic angle, sacral slope/spinosacral angle, and lumbar lordosis/pelvic tilt. Moreover, the sacral slope/pelvic tilt correlation was positive in patients without scoliosis and negative in others. The two groups did not present differences regarding age, years of disease, Hoehn-Yahr score, and Unified Parkinson Disease Rating Scale-motor section.Pelvic parameters were similar in the two groups, whereas spinosacral angle was lower in patients with scoliosis. The prevalence of scoliosis in Parkinson disease was higher than what was previously described and the thoracolumbar spine was the mostly affected.