To provide a summary of available literature on the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) after hip arthroscopy for femoroacetabular impingement (FAI).

A systematic review was conducted via the Cochrane Library, PubMed, Ovid MEDLINE, and Embase to identify studies that calculated MCID, SCB, or PASS for patient-reported outcome measures after hip arthroscopy for FAI. The electronic search strategy used was as follows: hip AND arthroscopy AND (MCID OR "minimal clinically important difference" OR SCB OR "substantial clinical benefit" OR PASS OR "patient acceptable symptom state"). Inclusion criteria were English-language studies published from 1980 to 2023 reporting clinical outcome scores and calculated values of MCID, PASS, or SCB for patients undergoing hip arthroscopy for FAI.

Forty-two studies (5 Level II, 19 Level III, and 18 Level IV) met inclusion and exclusion criteria. The most commonly used outcome measures across MCID, SCB, and PASS were the Hip Outcome Score sports-specific subscale and the activities of daily living subscale, the modified Harris Hip Score, and the 12-item international Hip Outcome Tool. The range of MCID values for Hip Outcome Score sports-specific subscale, Hip Outcome Score activities of daily living subscale, modified Harris Hip Score, and 12-item international Hip Outcome Tool were 7.2-15.7, 7.3-15.4, 7.2-16.8, and 8.8-16.2 respectively. Similarly, for SCB the values ranged from 77.9-96.9, 90.4-98.5, 20.0-98.4, and 66.7-87.5, respectively. Lastly, the PASS values ranged from 63.9-80.9, 85.9-99.2, 74.0-97.0, and 59.5-86.0, respectively.

MCID, SCB, and PASS values for patient-reported outcome measures after hip arthroscopy for the management of FAI are highly dependent on their associated study including study population and calculation methods.

IV, systematic review of Level II-IV studies.

The high-power pain threshold ultrasound (HPPTUS) technique is one of the ultrasound modifications used to treat trigger points and is strongly recommended for patients with mechanical neck pain because this method has excellent benefits but the clinical significance of this method is unclear.

To investigate the influence of adding High power pain threshold ultrasound technique to traditional therapy on axioappendicular muscles amplitude and fatigue of patients with mechanical neck pain.

Single-blind, Randomized clinical trial.

Outpatient clinic.

Sixty patients (19-38 years old) with mechanical neck pain participated in this study and were recruited from the outpatient clinic at the faculty of physical therapy after a referral from an orthopedist.

Patients were randomly assigned by the opaque sealed envelope to two treatment groups: Group A Received High power pain threshold ultrasound (HPPTUS), traditional therapy in form of (active range of motion, stretching exercises, and postural correction exercises (PCES), whereas Group B Received traditional therapy only; therapeutic sessions were performed Twice/week for 4 weeks. The visual analog scale, pressure pain threshold, neck disability index, upper trapezius and Levator scapulae median frequency, and root mean square were used to evaluate the patients' pre-treatment and post-treatment status.

Multiple pairwise comparisons within each group revealed statistically significant differences in all outcome variables in both groups with favor to the HPPTUS group as p = 0.0001. Between group analysis at post treatment revealed statistical significant difference between both groups in all outcome variables as p = 0.0001.

The High-power Pain Threshold Ultrasound technique combined with traditional therapy is an effective method more than traditional therapy alone for management the patients with MNP.

The present study has implications, especially for clinical decision-making with regard to the therapy of choice in MNP to reduce pain, improve function and muscle activity through HPPTUS technique, and its impact on normal lifestyle and highlight the need for active intervention.

IntroductionAlthough there is growth in the approach to telerehabilitation (TLRH) in different pathologies, research on TLRH for the management of low back pain is scarce and controversial. Thus, the purpose of this study was to analyze whether a TLRH program is as effective as a clinical exercise program in improving pain and different functional variables in patients with nonspecific low back pain (NLBP).MethodA single-blind, two-armed randomized controlled trial was carried out with 68 individuals with chronic NLBP. Participants were randomly allocated to either the TLRH group (TG) (n = 34) or the clinic group (CG) (n = 34). The TG received an exercise-based TLRH video and an educational program on the neurophysiology of pain. The CG received the same pain education and exercise program at the clinic facility supervised by a clinician. Both groups performed 2 weekly sessions for 8 weeks. Active movements of the lumbar spine, pain and range of motion, and kinesiophobia were assessed at baseline, at the end of 8 weeks of treatment, and at 3 months.ResultsStatistically significant differences for time-by-group interaction were identified in range of motion of right (F = 11.668; p = 0.001) and left (F = 4.219; p = 0.042) legs when knee extended test is performed; as well as in pain intensity when the same test (F = 5.176; p = 0.043). Moreover, higher pain level during flexion (F = 5.133; p = 0.009) and extension movements (F = 6.335; p = 0.003) in patients with bilateral pain location than those with unilateral or central pain location has been appreciated.ConclusionA TLRH rehabilitation program via mobile app is as effective as the same exercise program supervised in a clinic.

The aim has been to translate and cross-culturally adapt the Exercise Adherence Rating Scale (EARS) for Mexican Spanish speaking population with non-specific chronic low back pain and assess its psychometric properties.

The study had two phases: translation and cultural adaptation, followed by psychometric validation. Reliability was assessed with internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient); validity with construct validity (Spearman's correlation) and factor analysis; sensitivity to change with effect size and standardized response mean difference; feasibility by completion time in seconds; and ceiling/floor effects were calculated.

A total of 161 subjects were included. Cronbach's alpha (0.93; 95% CI 0.92-0.95) indicated good internal consistency, and intraclass correlation (0.95; 95% CI: 0.89-0.97) showed excellent test-retest reliability. Weak correlations between the EARS vs. the Visual Analogue Pain Rating Scale and the Roland Morris Disability Questionnaire were found (r = -0.29 and r = 0.00 respectively). All effect size values indicated that the scale presented a significant sensitivity to change. The average time to complete the EARS-Mx was 219 s. No ceiling or floor effect was detected.

The EARS-Mx showed semantic, conceptual, idiomatic, content and operational equivalence with respect to the original scale, and appropriate metric properties of reliability, validity, sensitivity to change and feasibility.

As no other investigators have holistically addressed kinesiotaping (KT) effects on physical and psychological measures in patients with chronic low back pain (CLBP). Our aim in the present study was to investigate the effects of KT application on pain, flexibility, function, back awareness, fear-avoidance, anxiety, and depression in patients with CLBP. We conducted a single-blind, randomized controlled trial with 52 patients with CLBP who were randomized to either or an electrotherapy (ET) group (n = 26) or a KT + ET group (n = 26). The ET group received only conventional electrophysical interventions for two weeks, while the KT + ET group received kinesiotaping plus the electro-physical interventions. At baseline, after the second week (post-treatment), and at an eighth-week follow-up, participants were given the Visual Analogue Scale (VAS) for self-reported pain, the Fremantle Low Back Awareness Questionnaire (FreBAQ), the Five Times Sit-to-Stand Test (FTST), the Timed Up and Go Test (TUG), the Roland Morris Disability Questionnaire (RMDQ), the Modified Schober Test (mST), the Hospital Anxiety and Depression Scale (HADS), and the Fear Avoidance Beliefs Questionnaire (FABQ). The KT + ET group showed greater improvement than the ET group on the VAS, TUG, FTST, FreBAQ, and FABQ and was significantly improved at both the second and eighth weeks (p < .05). The subjective function (RMDQ) score of the KT group was better at the eighth week (p < .05). There was no significant difference between the groups on the mST, HADS-D, and HADS-A (p > .05). However, both the KT + ET and ET groups showed significant improvement on the HADS-D and HAD-S-A (p < .05). These results show that the KT application provided additional benefits relative to ET alone in participants' perceived pain, and their objective and subjective functioning, low back awareness, and fear avoidance.

BackgroundCervical stenosis is an important problem in patients with cervical pain, which may cause proprioception problems.ObjectiveThis study aims to evaluate the effect of the degree of cervical stenosis on cervical proprioception and cervical range of motion (ROM).MethodA total of 111 patients presenting with cervical pain and undergoing cervical magnetic resonance imaging were included in the study. The ROM of the patients was measured with the Pa Cervical Range of Motion (CROM) device. Proprioception was evaluated with measurement of joint position error (JPE). JPE was assessed with neutral head position and target head position tests. The severity of stenosis was detected according to the Kang grading system. The Kruskal-Wallis test is used to compare joint position error in patients with different cervical stenosis stages.ResultsTwenty nine(%26) patients had no stenosis, 31 (28%) had mild stenosis, 31 (28%) had moderate stenosis, and 20 (18%) had severe stenosis. According to the neutral head positioning test, there was a significant difference in right lateral flexion between patients with different degrees of stenosis (grade 0: 1.67[0.67-4.67] vs. grade 2: 4.67[2.3-10.0], p = 0.009) and in flexion (grade 0: 8.0[2.67-10.0] vs. grade 3: 12.66[8.33-17.67], p = 0.011). There was also a significant difference in head-to-target JPEs in all motion planes(p < 0.05).ConclusionDegree of cervical stenosis significantly affects cervical proprioception and cervical ROM. The study's findings may guide clinicians in developing effective rehabilitation programs for proprioception in cervical stenosis and encourage further research on intervention effects at different stages of the disease.

Sedentary office workers (SOWs) often adopt prolonged sitting postures, which potentially disrupt the lumbar-pelvic rhythm (LPR) and contribute to lower back pain (LBP). This study aimed to clarify the group differences in LPR and related physical factors between SOWs with and without LBP.

Sixty-three SOWs were divided into LBP (n = 30) and non-LBP (n = 33) groups. The lumbar flexion angle (LF) and lumbar-hip angle difference (LHD), which are indicators of LPR, were measured using inertial sensors during trunk flexion. Hip flexion muscle strength (HFMS) and hip-extension muscle strength (HEMS) were assessed using handheld dynamometry. Hip joint range of motion (ROM) was measured using a goniometer. Lumbar proprioception was evaluated via active joint repositioning, and pain and perception were assessed using the Visual Analog Scale, Oswestry Disability Index, and Fremantle Back Awareness Questionnaire.

Multiple regression analysis showed significantly greater LF (estimated regression coefficient [ERC]: -2.9, p < 0.05) and LHD (ERC: -5.5, p < 0.05) during early trunk flexion (ETF) in the LBP group. In the LBP group, LHD during ETF and late trunk flexion were positively correlated with HFMS, and HFMS was correlated with HEMS.

HFMS may contribute to an altered LPR in SOWs with LBP.

Pain from subacromial pain syndrome (SAPS) can limit individuals' daily activities and reduce physical performance. The effectiveness of graded motor imagery (GMI) training for this condition remains unexplored. This prospective, randomized controlled trial aimed to determine the effects of GMI training in patients with chronic painful SAPS.

Forty-two patients with SAPS were randomly assigned to the GMI (n = 21) and the control (n = 21) groups. Primary measures were the visual analogue scale (VAS), and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary measures were Active Range of Motion (AROM), muscle strength, lateralization performance and Kinesthetic and Visual Imagery Questionnaire (KVIQ). Evaluations occurred at baseline, postintervention (6 weeks), and after a 6-week follow up.

The GMI group showed significantly greater improvements in both primary and secondary outcomes compared to the control group (p < 0.001). Significantly larger effect sizes were found in favor of the GMI group for VAS, DASH, abduction, external rotation AROM, muscle strength, lateralization performance, and KVIQ (ηp2 < 0.14, p < 0.05, for all).

The integration of GMI training into conventional physiotherapy for SAPS rehabilitation provides more effective clinical results in improving pain intensity and increasing functionality.

We pilot-tested movement breaks lasting < 1 min at the University of Southern Denmark (SDU) with an initiative called PauseNørd. Our mixed-methods feasibility study explored the acceptability, practicality, expansion, and limited efficacy of the PauseNørd breaks (PN breaks) via observation, questionnaires, and short interviews. Three groups of students tested lectures with and without the PN breaks. The PN breaks were well accepted by students and lecturers, and they were practically easy to implement. Suggestions to improve practicality related to timing and frequency. Potential barriers to expansion were identified in relation to student familiarity with exercise and lecturer comfort in leading the breaks. Preliminary data on effectiveness indicated that the PN breaks could support alertness, concentration, enjoyment, motivation, positive mood, and the social interactions within the class. The learning from the pilot study will be used to inform future PN research.

Background/Objectives: This study aimed to analyze the relationship between emotional functioning and health status in long-term breast cancer survivors (LTBCSs). Additionally, it sought to identify factors that could influence emotional functioning in this population at least five years after cancer diagnosis. Methods: This cross-sectional observational study included 80 LTBCSs, classified into the following two groups, according to their emotional functioning: those experiencing psychological distress (≤90) and those with satisfactory psychological well-being (≥91). The study examined various factors at least five years post-diagnosis, including sociodemographic and clinical characteristics, health-related quality of life (HRQoL), mood state, self-perceived physical fitness, physical activity (PA) level, pain, and cancer-related fatigue (CRF). ANOVA, Mann-Whitney U, and Chi-square tests were conducted, along with correlation and multiple regression analysis. Effect sizes were calculated using Cohen's d. Results: Among the 80 LTBCSs, 47.50% reported psychological distress, while 52.50% maintained satisfactory psychological well-being. Participants in the psychological distress group exhibited significantly poorer HRQoL, lower mood, and reduced self-perceived physical fitness, as well as higher levels of physical inactivity, pain, and CRF (p < 0.05). Regression analysis revealed that "role functioning" (β = 0.59; p < 0.01), "cognitive functioning" (β = 0.26; p < 0.01), "self-perceived physical fitness" (β = 0.20; p = 0.02), and "sadness-depression" (β = 0.18; p = 0.04) were significant predictors of emotional functioning (r2 adjusted = 0.642). Conclusions: These results emphasize the association between emotional functioning and health status in LTBCSs. Role functioning, cognitive functioning, self-perceived physical fitness, and mood state were identified as relevant factors influencing emotional well-being in this population. Considering these relationships, integrating psychological and physical assessments into survivorship care could support the early detection of at-risk individuals. This approach could also guide interventions to improve their long-term well-being and HRQoL.

Determine (a) utility of a shoulder referral algorithm, (b) patients improving ≥15% on the Western Ontario Rotator Cuff(WORC) score with standardized Physical Therapy(PT) +home exercises, and (c) presenting characteristics among PT-Only, PT + Surgical Consult and Surgery participants.

Prospective cohort study of patients 30-65 years old with shoulder pain. A standardized PT program assessed pain, ROM, strength and exercise tolerance (i.e., referral algorithm) at 2-, 6- and 12-weeks to determine if a surgical consultation might be beneficial. A blinded research assessor evaluated pain, ROM, strength and WORC score at 6-, 12-weeks and 6-months. The proportion improving WORC scores ≥15% and group differences were also evaluated.

32/128 (25%) participants underwent consultation with 16 (12.5%) undergoing surgery. WORC scores improved ≥15% by 12-weeks in most PT-Only/PT + Surgical Consult participants (n = 77[70%]) and was maintained at 6-months. Surgery participants used more NSAIDs (p = 0.01), injections (p = 0.002) and trended to higher opioid use (p = 0.06). PT + Surgical Consult/Surgery participants (n = 16/32; 50%) knew diagnostic imaging results more than PT-Only (n = 26; 31%) (p = 0.02). Surgery participants presented with worse pain, ROM, strength and WORC scores than PT-Only (p < 0.05).

The algorithm identified those with worse symptomology (25%), 50% of whom underwent surgery. WORC scores improved ≥15% in most participants (70%). Presenting characteristics were significantly worse between PT-Only and Surgery participants.

BackgroundLumbar multifidus (LM) and transverse abdominis (TrA) muscle activation deficits have been reported in patients with chronic low back pain (CLBP). These activation deficits could be related to poor functional capacity and self-reported clinical outcomes.ObjectiveTo determine the associations between lumbopelvic muscle activation and functional capacity, as well as self-reported clinical outcomes in individuals with CLBP.MethodsThirty individuals with CLBP were recruited. Ultrasound imaging was used to measure muscle activation. Participants performed a functional reach test (FRT), 5-time sit-to-stand test (5STS), 2-min step test (2MST), prone trunk extension test (PTET), and abdominal curl test (ACT). Self-reported clinical outcomes including visual analog scale (VAS), duration of low back pain (DLBP), modified Oswestry disability questionnaire (MODQ), and short-form health survey (SF-36) were also collected.ResultsLM activation was significant associated (P < 0.05) with functional capacity (5STS and PTET) and self-reported clinical outcome (SF-36) were observed. Results also demonstrated TrA activation was significant associated (P < 0.05) with ACT, VAS, and DLBP.ConclusionOur findings suggest that clinicians should focus on LM activation to potentially improve functional capacity and quality of life, as well as minimize the chronicity. In addition, pain duration can influence TrA activation, while TrA activation training may be able to modulate pain.

The purpose of this study was to explore how Spanish physiotherapists manage Achilles tendinopathy and to evaluate the alignment of their practices with established clinical guidelines.

A cross-sectional online survey of Spanish physiotherapists.

Clinical environment.

Four hundred thirty-four physiotherapists completed the survey.

An online survey was administered to Spanish physiotherapists between March and April 2024. The survey collected data on clinicians' demographics, treatment approaches, and preferences. Descriptive analysis was performed, with nominal and ordinal data analyzed through frequency counts.

Valid responses were received from 434 physiotherapists with a mean age of 32 years (IQR = 15, range 22-60). Exercise and education were the most used treatments (94 % and 78 % of respondents respectively), although there was variability in their implementation. However, a significant proportion of Spanish physiotherapists (64 %) reported using invasive techniques, which may reduce the time spent on evidence-based interventions (p = 0.001) for the management of Achilles tendinopathy.

Spanish physiotherapists generally follow clinical guidelines for managing AT, with exercise and education as the main interventions. Despite the limited evidence, invasive techniques and manual therapy (74 %) are widely used. Future research should clarify the impact of this practice in the Spanish population.

This study is planned to examine the effect of a virtual reality-based operating room tour on nursing students' anxiety, stress and self-confidence levels experienced in the operating room setting.

It is important to know whether the impact of virtual reality-based applications on nursing students' anxiety and stress levels during clinical education.

A Randomized Controlled Trial METHOD: This study was conducted with 82 students. The students in the intervention group (n = 41) were given to experience the operating room environment through a virtual reality-based operating room tour following theoretical training. The students in the control group (n = 41) proceeded directly to clinical practice after the theoretical training. The data were collected after theoretical training, in the clinical simulation training laboratory and during clinical practice.

The mean state anxiety score of the students in the intervention group (39.02 SD 4.76) was found to be statistically significantly lower than that of the students in the control group (41.68 SD 5.72) (p = 0.025). When examining stress levels, the average score of the perceived stress scale subdimension related to ''Stress from the environment'' was lower in the intervention group (5.04 SD 2.09) compared with the control group (7.19 SD 3.43) (p = 0.001). Furthermore, the self-confidence level of the students in the intervention group in the operating room (7.93 SD 1.09) was found to be higher than that of the students in the control group (6.72 SD 1.20) (p < 0.001).

Before clinical practice, it was observed that the virtual reality-based operating room tour reduced students' stress and anxiety related to the environment, while also increasing their self-confidence levels.

To identify the available Patient-reported Outcome Measures (PROMs) for assessing musculoskeletal complaints in para-athletes and to evaluate their psychometric properties, ultimately providing recommendations for their use.

PubMed, Embase, Scopus, Cochrane Library, Web of Science, ProQuest, and COSMIN Database were searched until October 2024. Full report studies evaluating psychometric properties of PROMs in para-sport participants with musculoskeletal pain were included. The methodology followed the Consensus-based Standards for selection of Health Measurement Instruments (COSMIN) and PRISMA-COSMIN for OMIs 2024 Guidelines.

Six articles reported information on Wheelchair User's Shoulder Pain Index (WUSPI); Shoulder Pain Scale for Wheelchair Basketball (SPS-WB); and, Shoulder Pain Index for Wheelchair Basketball (SPI-WB). Content validity was inconsistent for WUSPI and SPS-WB. Structural validity was indeterminate for SPS-WB. Internal consistency was sufficient for SPS-WB but indeterminate for WUSPI and SPI-WB. Reliability was sufficient for WUSPI and SPI-WB. Convergent validity was sufficient for WUSPI but indeterminate for SPS-WB and SPI-WB. Discriminative validity was insufficient for WUSPI and SPI-WB and indeterminate for SPS-WB.

Evidence on PROMs for musculoskeletal complaints in para-sports focuses on shoulder pain in wheelchair basketball, showing low to very low-quality evidence. The WUSPI and SPS-WB can be used considering their limitations.

Despite the similar knee osteoarthritis (KOA) prevalence among races and ethnicities, Hispanic patients with KOA are 30%-40 % less likely to receive treatments compared with their White counterparts. Tai Chi (TC) could be an accessible and affordable intervention for Hispanic individuals with KOA. This case series explored the effect of four optimal TC forms (OTC) on reducing KOA pain in Hispanic individuals.

Seven Hispanic adults with mild to moderate KOA were recruited. Their knee pain level during walking was evaluated before and after a two-week OTC training using the Visual Analog Scale and compared between assessments.

The 2-week OTC training course was well received by our participants. The training reduced pain with a large effect size (4.14 ± 1.21 vs. 1.29 ± 1.70 cm, p < 0.027, Wilcoxon's r = -0.833).

Our pilot results suggested that the 2-week, 4-form-based OTC program can significantly reduce the knee pain in Hispanic people with KOA. Our OTC program appears to be about 20% more effective in reducing knee pain than the existing TC-based program, which uses 10 TC forms over 12 weeks (1.27 vs. 1.06 in Hedge's g). The findings implied that the OTC program could be a promising alternative paradigm for Hispanic people with KOA to lower their pain. This case series could provide vital information for the design and execution of future large-scale and rigorous clinical trials to further test the effects of the OTC program in altering pain for Hispanic people with KOA.

NCT03621631.

Robotic technologies have been developed for motor rehabilitation and such robots have shown favourable results when compared with equivalent doses of usual clinical therapy. Recently, robotic interventions have been suggested to be applied in orthopaedic rehabilitation with upper extremity disorders, especially those related to hand and wrist. This study aims to determine the effectiveness of combined conventional therapy and HAL-SJ robotic therapy in restoring the wrist functionality following the fractures as compared to the standard conventional therapy solely.

Workers with wrist fractures will be randomized in two groups, i.e., the control group (conventional therapy) and intervention group (combination of conventional therapy and robotic HAL-SJ intervention). All participants will receive 5-day/week therapy sessions for four weeks. Primary outcomes of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and secondary outcomes of range of motion, grip and pinch strengths, fine and gross hand dexterity as well as pain and the Lam Assessment of Stages of Employment Readiness (LASER) will be assessed at baseline assessment and upon completion of the therapy program after 4 weeks. Data from the baseline and post intervention outcome measures will be analysed using a Repeated Measures ANOVA to compare the therapy effectiveness of both control and intervention groups.

Participants recruitment and data collection are in progress.

Wrist fractures can produce some residual disability and pain that may impact the functionality of a person. The application of robotic technology in facilitating upper limb movement and functional recovery training is extensive and shows positive outcomes in the field of neurorehabilitation. However, there is a lacking of published evidence about the effectiveness of robotic intervention in orthopaedic rehabilitation, especially in the field of hand therapy.

Participants recruitment and data collection are still ongoing.

This trial is registered with the Australian New Zealand Clinical Trials Registry (registration number: ACTRN12622000413729).

The most common cause of muscle pain is myofascial pain syndrome. Myofascial pain syndrome caused by sensitive areas called trigger points (TrP). Some physiotherapy modalities have acceptable effects for this disorder, but it is necessary to check the effects of placebo, appropriate dose, and long-term effects for each intervention. The aim of this study is to investigate the effect of intramuscular electrical stimulation (IMES) compared to dry needling (DN) on sonographic and clinical parameters in upper trapezius muscle TrP.

This is a randomized, single-blind control trial. The study period was from December 2, 2020, to April 10, 2021. Thirty volunteer patients with active upper trapezius TrP were randomly allocated into two groups: (1) IMES, (2) DN. Participants received interventions in three sessions. Primary outcome measurements were neck range of motion (ROM) and TrP circumference. Secondary outcome measurements were pain by visual analog scale (VAS), pain pressure threshold (PPT), disability, TrP longitudinal and transverse diameter, TrP stiffness, and muscle blood flow by vascular resistance index (RI). All outcome measurements were evaluated before, after, and one month after the intervention. If the data were normal, the repeated measure ANOVA test was used; if data were not normal, the Friedman test and the Kruskal-Wallis test was used. A significance level of 0.05 has considered.

ROM increment was significantly more in the IMES group. TrP circumference decrement was significantly more in the IMES group. VAS changes did not show significant difference between two groups. The PPT improvement was significantly more in the IMES group. Disability changes were not significant. Longitudinal diameter changes were significantly more in the IMES group. TrP stiffness changes were not significant. The vascular RI decreased significantly in IMES group.

It seems that both IMES and DN have promising effects for improving upper trapezius TrPs. However, IMES is more effective in some clinical and ultrasound parameters. In order to investigate the effects of this intervention more precisely more studies are necessary.

This study was prospectively registered at Iranian registry of clinical trials (IRCT: IRCT20170616034567N2).

The first objective of this study is to examine the relationship between different levels of physical activity (PA) and the health status of long-term breast cancer survivors (LTBCSs) who have survived ≥5 years beyond diagnosis. The second aim is to identify potential predictors of long-term PA levels in this population.

An 80-participant cross-sectional study categorized LTBCSs by PA levels: insufficiently active (very low ≤3 metabolic equivalent task (MET), low 3.1-7.4 MET) and sufficiently active (≥7.5 MET). Variables assessed included PA, pain, self-perceived physical fitness, cancer-related fatigue (CRF), comorbidities, mood, and health-related quality of life (HRQoL). ANOVA, Mann-Whitney U, and Chi-square tests were performed, along with Spearman's correlation and multiple regression analysis. Cohen's d and Cramér's V were used to calculate effect sizes.

66.25% of LTBCSs were insufficiently active, with 17.25% classified as sedentary (≤1.5 MET). In the first objective, and compared to sufficiently active survivors, insufficiently active LTBCSs reported higher levels of pain, breast symptoms, dyspnea, moderate-to-severe CRF, sadness/depression, and anger, along with lower levels of happiness, general fitness, speed/agility, role functioning, and HRQoL (p < 0.05). In the second objective, the regression analysis found "future perspective" (β = 0.314; p < 0.01) and "insomnia" (β = -0.288; p = 0.02) to be significant predictors of higher PA levels (r2 = 0.224).

Insufficiently active LTBCSs had higher pain, symptoms, CRF, and mood disturbances, with decreased happiness, self-perceived physical fitness, and HRQoL. Future research should focus on interventions that target improving PA levels and managing factors such as "future perspective" and "insomnia," as they are significant predictors of PA adherence. These findings underscore the importance of incorporating PA into rehabilitation programs to enhance overall well-being and HRQoL in LTBCSs.

The objective of this research was to assess the immediate effects of high-intensity laser therapy (HILT) on nonspecific neck pain (NNP) by evaluating outcome measures such as pain intensity, cervical active range of motion (ROM), stiffness of neck muscles, and functional disability.

This clinical trial, which was conducted in a double-blind and randomized manner, involved patients diagnosed with NNP who were allocated either to either a HILT group (HILT + exercise) or a placebo group (placebo-laser therapy + exercise). The primary outcome measures encompassed pain intensity via the visual analogue scale (VAS), cervical active ROM, stiffness of neck muscles (splenius capitis, semispinalis capitis, and neck fascia), as well as functional disability via the neck disability index (NDI). Statistical evaluations were carried out using SPSS version 25.0, with a significance threshold established at p < 0.05.

A total of 28 individuals diagnosed with NNP were randomly allocated to either the HILT group (n = 14) or the placebo group (n = 14). Upon initial comparison, no significant differences (p > 0.05) were observed between the two groups. After treatment, both groups showed notable improvements in all outcome measures compared to baseline (p < 0.05); moreover, the HILT group demonstrated greater efficacy compared to the placebo group in terms of VAS scores (29.64 ± 8.43 mm, p = 0.001), cervical lateral flexion (right 22.46 ± 3.62°, p = 0.011; left 22.34 ± 2.74°, p = 0.034) and neck muscle shear modulus (splenius capitis muscle 22.48 ± 4.03 kPa, p = 0.001; semispinalis capitis muscle 23.50 ± 5.59 kPa, p = 0.028); however, no statistically significant differences (p > 0.05) were identified between the groups in cervical flexion, extension, rotation, neck fascia stiffness and NDI scores.

HILT has immediate efficacy for NNP and may be considered as one of the alternative interventions for NNP.

http://www.chictr.org.cn/, identifier ChiCTR2200061008.

Lumbar hyperlordosis and foot overpronation are associated with low back pain with extension pattern. This study examined if standing and walking on inclined surface or gluteus maximus activation alleviates the extent of lumbar lordosis and foot pronation amongst individuals with LBP who were classified with extension pattern. Eighteen adults with foot overpronation (LBP group, n = 9 and non-LBP group, n = 9) participated in this cross-sectional and case-control comparison study. Lumbar lordotic angle and rearfoot angle were measured using surface tomography, during standing and walking on treadmill at inclinations of 0°, 6° and 9°, and voluntary gluteus maximus activation at 20%, 40% and 60% of maximal contraction in standing at 0° inclination. The lumbar lordosis angle and rearfoot angle were compared within-group and between two groups across the listed trials in standing and walking. Results indicated no significant change in lumbar lordosis or rearfoot angle in LBP group when standing or walking on 6°or 9°inclined surface (p > 0.05). However, voluntary gluteus maximus activation in standing at the level of 20%, 40% and 60% of maximal effort reduced lumbar lordotic angle (p < 0.05) but not rearfoot angle (p > 0.05) in LBP group. Our findings provide a novel approach to address the hyperlordosis in LBP group with extension pattern, for which voluntary gluteus maximus activation of ≥ 20% of maximal effort could effectively reduce the extent of the lumbar lordosis in level-ground standing in the LBP group. Such modified lumbar posture may alleviate the compressive loading on the spine associated with static upright standing at our daily activities. Increased gluteus maximus activation found during inclined walking may be beneficial to those with LBP and extension pattern.

To delineate the key factors associated with treatment success or failure for patients undergoing lower extremity osteotomies to address a spectrum of lower extremity joint and limb deformities at an Integrated Limb Preservation Center (ILPC).

Design: Retrospective cohort study. Setting: Level I Academic Trauma Center. Patient selection criteria: Patients of the ILPC with at least 1-year of follow-up data regarding previous surgery to correct trauma-or developmental-related deformities between January 1, 2005, and October 1, 2022. Outcome measures and comparisons: Patients were categorized first based on etiology (developmental vs. traumatic) and then based on the nature of deformity (joint, limb, nonunion). Treatment data, demographics including age, sex, body mass index (BMI), tobacco use history, insurance status, marital status, mental health history, and history of comorbidities, concurrent procedures, and post-operative infection, revision, reoperation, and bone healing status were extracted from the medical record and compared. Treatment failure was defined as conversion of the limb preservation surgery (ies) to amputation of any type.

139 patients were included for analysis; 47 patients in the developmental-related cohort, and 92 patients in the trauma-related cohort. The treatment success rate in terms of preserving the affected limb for patients undergoing lower extremity osteotomies was 94.7 % for the developmental-related cohort and 92.4 % for the traumatic-related cohort. 57.4 % of patients in the developmental-related cohort and 59.8 % of patients in the trauma-related underwent unplanned secondary procedures Concurrent osteomyelitis debridement (p = 0.01) and postoperative infection (p = 0.049) were the only factors measured significantly associated with conversion to amputation.

Patients undergoing osteotomies at an ILPC to address developmental-related or trauma-related joint and/or limb deformities experienced high short-term success (>90 %) with respect to preserving the affected limb. However, 56 % of patients required subsequent unplanned surgeries and improvements in PROMs were only statistically significant in patients with trauma-related deformities.

III.

High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated.

To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO.

Case series; Level of evidence, 4.

Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if P < .05.

A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; P = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS (P = .015; coefficient = -0.13).

HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.

To investigate the effectiveness of radial extracorporeal shock wave therapy (rESWT) on pain, lumbar range of motion (ROM) and F-wave minimal latency and F-chronodispersion in patients with post laminectomy epidural fibrosis.

Sixty patients complaining of low back pain and sciatica secondary to lumbar post laminectomy epidural fibrosis were allocated to one of the two equal groups (study and control groups). Pain intensity, lumbar ROM, and F-wave latency and F-chronodispersion were assessed pre- and posttreatment using visual analogue scale (VAS), Back ROM II device, and Neuro-MEP-Micro electromyography device, respectively.

Posttreatment mean values showed statistically significant decrease in VAS mean scores in both groups, with more significant decrease posttreatment in favor of the study group. There was statistically significant increase in all lumbar ROM mean scores and statistically significant decrease in F-minimal latency and F-chronodispersion for both peroneal and tibial nerves in the study group only posttreatment. Also, the results showed that significant positive moderate correlation between VAS scores and F-chronodispersion for peroneal nerve, strong negative correlation between right side bending scores and F-wave minimal latency for peroneal nerve and moderate negative correlation between left side bending scores and F-wave minimal latency for peroneal nerve after treatment.

It was concluded that rESWT is a new and convenient modality, that would be beneficial if added to the conventional physical therapy protocols in managing patients with lumbar post-laminectomy epidural fibrosis.

The purpose of this pilot study was to examine the preliminary efficacy of an 8-week qigong intervention in managing biopsychosocial outcomes in veterans with chronic low back pain (CLBP).

The study design was a longitudinal randomized controlled trial (RCT).

Multimodal assessments (e.g., biomarkers and psychological and social measures) over multiple time points to assess the preliminary efficacy of an 8-week qigong intervention versus wait-list control group in veterans with CLBP.

Participants in the qigong intervention group showed greater improvement in pain intensity (p = .047), pain interference (p = .040), pain-related disability (p = .027), and sleep disturbance (p = .002). Other psychosocial outcomes were nonsignificant. A statistically significant relationship between biological outcomes (pro-inflammatory cytokines) and psychosocial outcomes was identified (e.g., tumor necrosis factor [TNF] and physical function [p < .001], pain-related disability and IL 8 [p = .049], and posttraumatic stress disorder symptoms and IL 8 [p = .043]).

The results indicated that all pain-related outcomes (pain intensity, low back pain-related disability, and pain interference) and sleep disturbance decreased significantly in the qigong group compared to the control group.

The combination of gentle, slow-paced movements, along with the focused mindfulness of qigong, may improve physiological and psychosocial health. Charged with this information, healthcare providers (e.g., nurses, physical therapists) should consider non-pharmacological interventions such as qigong for veterans with CLBP.

According to the latest international consensus in 2018, sleep bruxism is the activity of the masticatory muscles during sleep characterized by rhythmic or non-rhythmic teeth clenching or grinding. Regarding its harmful effects, bruxism is considered one of the predisposing factors of tooth wear and temporomandibular joint diseases. Occlusal splint therapy is the most frequently used treatment for minimizing these harmful effects.

This study compared the volumetric wear loss and pain scores between digitally and conventionally manufactured occlusal splints for individuals with sleep bruxism.

A total of 30 individuals diagnosed with sleep bruxism were selected following the inclusion criteria and randomly divided into two groups. Pain scores were subjectively reported using a visual analog scale. Volumetric wear loss of the occlusal splint surface was measured using the Geomagic software. Data were analyzed with SPSS version 25.0.

At the six-month follow-up, conventionally manufactured splints (103.53±41.23) showed a volumetric loss significantly higher than that the digital ones (62.33±26.29) (p=0.005). We found no significant difference between the two splint types regarding VAS scores.

Occlusal splint wear can gradually alter the balance of occlusal contact and potentially reduce its therapeutic effectiveness, highlighting the importance of using wear-resistant materials. Our findings indicate that digital manufacturing processes provide advantages due to their long-term clinical outcomes.

BackgroundOzone (O2-O3) therapy, is a novel and increasingly utilized intervention in musculoskeletal medicine. This therapeutic approach has gained attention for its potential in managing conditions such as chronic pain, arthritis, and soft tissue injuries, offering a minimally invasive alternative to conventional treatments.ObjectiveThis study aims to explore the effectiveness of multiple-dose ozone injections in subacromial impingement syndrome (SAIS) and to compare it with single-dose ozone and corticosteroids regarding patient-related clinical outcomes.MethodsThis single-center prospective randomized controlled clinical trial comprised 108 SAIS patients divided into three groups: Group 1, multiple-dose ozone (50 mcg ozone/ week for five weeks); Group 2, single-dose ozone (50 mcg ozone) and Group 3, single-dose corticosteroid (40 mg triamcinolone). The pain, functionality, and quality of life of the patients were evaluated via the Visual Analogue Scale (VAS), Constant-Murley score (CMS), University of California Los Angeles Shoulder Scale (UCLA), and 36-Item Survey Short-Form (SF-36) in three, six and twelve months. ANOVA/Friedman's test was applied to evaluate the statistical differences between the groups for each outcome measure at each time point.ResultsThe mean age of the study population was 53.3 ± 3.1 years, and 52.8% of them were female. In the first week, the steroid group scored less than the other two groups (p < 0.001) in VAS. At 3, 6, and 12 months, CMS was significantly higher in the multiple ozone group compared to the other two groups (p < 0.001 for all). UCLA scores increased in all groups, with the greatest improvement observed in the multiple ozone group. After 12 months, all groups differed significantly in SF-36 scores (65.0 [11.0] in the multiple-ozone group, 43.5 [4.8] in the ozone group, and 40.0 [11.0] in the steroid group, p < 0.001).ConclusionsMultiple ozone (O2-O3) injections had better patient-related outcomes regarding pain, functioning, and quality of life in patients with SAIS in 3-m, 6-m, and one-year follow-up periods.

BackgroundSacroiliac joint dysfunction (SJD) is often recognized as a contributing factor to chronic low back pain. Nevertheless, studies evaluating the connection between SJD and kinesiophobia are currently lacking.ObjectiveIt aims to examine the occurrence of kinesiophobia and its impact on emotional well-being, spinal flexibility, disability, quality of life and pain in individuals with SJD.MethodsThe study assessed the occurrence of kinesiophobia and its clinical effects in 55 patients with SJD. The Tampa Scale of Kinesiophobia (TSK) was utilized to measure kinesiophobia. Clinical parameters were evaluated using Oswestry Disability Index (ODI), 36-Item Short Form Survey (SF-36), Hospital Anxiety and Depression Scale (HADS), finger-to-floor distance test (FTF), Visual Analogue Scale (VAS) and the modified Schober Test (MST).ResultsParticipants were grouped based on their TSK scores. SJD symptom duration was longer in patients with kinesiophobia compared to those without (p = 0.002) and a positive relationship was identified between symptom duration and TSK scores (p < 0.001). Higher mean VAS score (p = 0.047), ODI (p = 0.003) and HADS-Depression sub-scores (p = 0.024) were determined in kinesiophobic group. Although HADS-Anxiety sub-scores were higher in the kinesiophobic group, these scores did not exceed the cut-off value in both groups. A significant association was identified between ODI and TSK scores (ρ=0.467 p = 0.002), and between FTF distance and TSK scores in the kinesiophobic group (ρ=0.307 p = 0.046).ConclusionKinesiophobia has the potential to elevate the risk of developing chronic pain. Therefore, identifying kinesiophobia in individuals with SJD and incorporating it into treatment strategies may enhance rehabilitation outcomes.

Rotator cuff disease treatment typically involves manual therapy and exercise as part of physical therapy.

This study aims to investigate the effects of Mulligan and Maitland mobilization methods on pain, functionality, quality of life, and proprioception in individuals with rotator cuff lesions. STUDY DESIGN: This was a single-blinded randomized clinical trial.

The study included 45 individuals with rotator cuff lesions. Participants were randomly divided into three groups: conventional exercise, Maitland mobilization, and Mulligan mobilization. All participants were assessed pretreatment and post treatment using the Visual Analog Scale, Disabilities of the Arm, Shoulder, and Hand, Rotator Cuff Quality of Life, range of motion (ROM), and proprioception.

All parameters, except proprioception, improved significantly in all three groups post treatment (p < 0.05). Mulligan group (MG) and Maitland mobilization group (MMG) had higher improvements to the conventional exercise group (CG) in terms of flexion ROM (p = 0.05, effect size = 0.22), abduction ROM (p = 0.02, effect size = 0.26), Disabilities of the Arm, Shoulder, and Hand (p < 0.001, effect size = 0.56). Also, the MG group had greater improvements to the MMG and CG groups in terms of Rotator Cuff Quality of Life/symptoms (p < 0.001, effect size = 0.43), job (p < 0.001, effect size = 0.61), lifestyle (p < 0.001, effect size = 0.42), emotional parameters (p < 0.001, effect size = 0.29). MG was more effective than the MMG in Visual Analog Scale activity (p < 0.001, effect size = 0.32), external rotation (p = 0.012, effect size = 0.19), and abduction ROM (p = 0.002, effect size = 0.26). However, no improvement in proprioception was observed across all groups (p > 0.05).

This study concluded that, in addition to conventional treatment, both Mulligan and Maitland mobilization therapy effectively improve range of motion, functionality, and quality of life.

SIGRs (single-item global ratings) are gaining popularity among clinicians and health researchers as efficient tools to assess patient-reported outcomes. There has been no systematic assessment of domains explored, methodological aspects, and validation efforts of SIGRs in epilepsy. We aimed to critically appraise and provide recommendations on the use and reporting of SIGRs in epilepsy research. We performed a systematic scoping review using the Joanna Briggs Institute's recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) method was used to search five electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials) from 1980 to present day. We included English-language studies utilizing SIGRs that assessed health aspects (concept) in people with epilepsy of all ages (participants), in all settings (context), containing ≥30 patients, and using SIGRs with continuous or categorical responses in any study design. Abstract and full-text review was conducted independently by two reviewers; disagreements were resolved through consensus. Standardized data abstraction was used. Of 16 417 citations, we included 289 studies, involving 114 584 patients who underwent 747 unique measurements using SIGRs. Use increased over time; 30% were published in the last 4 years, and 51% used 1 SIGR (range 1-23 SIGRs). Commonly assessed domains were overall health (24.2%) and seizure-related aspects (23.5%), whereas 37% measured perceived change. Most studies used SIGRs descriptively (80.1%). Numerous SIGR formats were used (most commonly Likert-like, 73.3%). Ad hoc SIGRs without validation occurred frequently (45.6%). Stem questions were absent in 9.5% of measures, and only 6.5% reported SIGR measurement properties. SIGRs are widely used and increasingly prevalent in epilepsy research to assess diverse domains across various formats. However, many SIGRs suffer from poor reporting and methodological limitations. We provide a comprehensive catalog of SIGRs and offer recommendations to improve their use in research and clinical practice.

Muscle cramps are among the common debilitating complications of liver cirrhosis. Since this complication lacks effective treatments, we aimed to evaluate the effectiveness of L-carnitine supplementation in reducing the frequency, duration, and severity of muscle cramps in patients with liver cirrhosis.

The present retrospective cohort was conducted on adult patients referred between November 2022 and December 2023 to a tertiary referral hospital in Shiraz, Iran. Patients with confirmed liver cirrhosis who had muscle cramps ≥ 4 times per month without other secondary etiologies for muscle cramps were evaluated for inclusion. They were included if they had taken an oral L-carnitine supplement of 1000 mg/day for one month and had available medical records of the assessment of their cramps before and one month after starting the supplement.

From the 702 patients screened, 195 (27.8%) had muscle cramps, and 91 (13.0%) met the inclusion criteria. The respective median age and cirrhosis duration (interquartile range (IQR)) of the included patients were 61.0 (16.0) and 2.0 (3.0) years, and 48 (53%) were male. Median daily, weekly, and monthly cramp frequency and severity were higher in females (P-values < 0.05). We noted reduced daily, weekly, and monthly frequency of the cramps, their severity, and their mean duration following L-carnitine supplementation (respective median (IQR) of absolute percentage change: 100 (100.0), 60 (88.33), 50 (75.0), 50 (77.5), and 40.0 (44.58); P-values < 0.001). Additionally, daily, weekly, and monthly cramps completely resolved in 29 (31.9%), 21 (23.1%), and 13 (14.3%) after supplementation. BMI correlated with the percentage change of all the mentioned cramp indices (P-values < 0.05), and age correlated with the percentage change in the monthly frequency of cramps (P-value = 0.042). Changes in cramp indices did not differ significantly between males and females.

L-carnitine supplementation seems to be a promising therapeutic option for cramps in liver cirrhosis. Further studies with control groups and larger samples are required to confirm this finding.

Dexamethasone has been shown to alleviate pain, yet the optimal dosing and safety profiles remain unclear. This study aimed to evaluate the analgesic efficacy and impact on sleep quality of three different doses of intravenous dexamethasone in patients undergoing total knee arthroplasty (TKA).

In this randomized, triple-blind, clinical trial, we assessed the analgesic effects of three doses of intravenous dexamethasone (four, eight, and 16 mg) in adult patients who underwent TKA. Pain was measured using the visual analog scale at one, 12, 24, and 48 hours postoperatively, and sleep quality was assessed two weeks postsurgery.

A total of 90 participants were enrolled in the study, with 30 participants in each dosing group. The mean visual analog scale scores at 12, 24, and 48 hours postoperatively showed significant improvement from baseline in all groups. Notably, the 16 mg and eight mg dexamethasone groups demonstrated significantly greater pain reduction compared to the four mg group (P < 0.05). Additionally, sleep quality significantly improved in the 16 mg and eight mg groups (P < 0.05).

Dexamethasone at doses of four, eight, and 16 mg effectively reduces pain and enhances sleep quality in patients undergoing TKA, with the 16 mg dose showing the most pronounced effects at 12, 24, and 48 hours postoperatively.

Understanding the molecular mechanism underlying the pathogenesis of knee osteoarthritis (KOA) may be beneficial in fetching new therapeutics. Our study aims to investigate the implication of Wnt/ β-catenin pathway in development of KOA by detection of the downstream target genes and their crosstalk with miR-214 in patients with KOA and to correlate that with the clinical findings.

Sixty participants were involved in the study. The levels of miR-214, β-catenin, Wnt4, matrix metalloproteinase 3 (MMP3), Bax, caspase 3, and phosphorylated glycogen synthase kinase-3 beta (pGSK3β) were determined. All participants were assessed clinically and radiologically regarding knee joint pain, stiffness, range of motion, and knee medial cartilage thickness. Besides, a correlation between Western Ontario and McMaster Universities (WOMAC) score, clinical, and radiological data, and the measured parameters was conducted.

Patients with KOA showed downregulated miR-214 with upregulated β-catenin, Wnt4, MMP3, Bax, caspase 3, and pGSK3β compared to healthy individuals. Statistically significant positive correlation between WOMAC score, knee joint pain regarding Visual Analogue Scale (VAS) with β-catenin, pGSK3β, Wnt4, MMP3, Bax, and caspase 3, and significant negative relationship between them and knee joint medial cartilage thickness; while there was a statistically significant negative correlation between WOMAC, and clinical findings of osteoarthritis and miR-214 and significant positive relationship between it and knee joint medial cartilage thickness. This study provides valuable insights into involvement of the Wnt/β-catenin and miR-214 in KOA pathogenesis. By targeting these molecular components, future therapeutics may modulate their activity and mitigate chondrocyte apoptosis and matrix degradation, potentially halting KOA progression.

Although chronic neck pain (CNP) is associated with impairments in balance, the effects of muscle stabilization training are unknown. In this study, we compared the effects of core stabilization (CS) and scapular stabilization (SS) training via telerehabilitation on balance, functionality, pain, and depression in young adults with CNP. In this two-armed, randomized controlled study, we assigned 41 participants with CNP to either a CS (n = 21) or SS (n = 20) group. Both groups underwent stabilization training via telerehabilitation for eight weeks. We evaluated postural stability (PS), limits of stability (LOS), functionality (Neck Disability Index), pain (Visual Analog Scale), and depression (Beck Depression Inventory). Time × Group interactions were significant on VAS, NDI, PS overall, LOS overall, LOS forward, LOS backward, and LOS right (p < .05). Both groups showed significant improvements over time. However, the SS group demonstrated significantly greater improvements than the CS group in VAS (p < .001) and NDI (p = .001). On the other hand, the CS group showed significantly greater improvements in PS overall, as well as in various measures of LOS, including overall, forward, backward, and right (p < .05). While both groups showed significant improvements, there were notable differences between them. These findings suggest that SS training is more effective in pain management and functional improvement, while CS training has a stronger impact on balance and stability in young adults with CNP.

Background and Objectives: This meta-analysis aimed to compare the efficacy of polydioxanone (PDO) suture, a non-surgical treatment for knee osteoarthritis, with intra-articular hyaluronic acid (HA) injections. Materials and Methods: A comprehensive literature search was conducted using major databases including MEDLINE, EMBASE, Cochrane Library, KoreaMed, KMBASE, and RISS. Randomized controlled trials (RCTs) published up to 30 April 2024, focusing on knee osteoarthritis, pain, PDO suture, and intra-articular injections, were included. A total of 10 RCTs were analyzed, with participants having Kellgren & Lawrence Grade II-III knee osteoarthritis. This study compared the pain relief effects of PDO suture and HA injections. Results: The meta-analysis results showed that PDO suture demonstrated consistent and significant pain reduction over a 30-week observation period (p < 0.05), while HA injections did not exhibit statistically significant pain relief. Conclusions: PDO sutures offer the potential for long-term pain management in patients with knee osteoarthritis. However, this study has limitations such as the heterogeneity among studies, and given that the efficacy of PDO sutures is based on a single study, further research is needed to establish the long-term safety profile of polydioxanone sutures and to ensure the generalizability of the findings.

Dry needling (DN) and Extracorporeal shock wave therapy (ESWT) are common in calcaneal epin treatment.

The aim of the study was to compare the effects of both treatments on proprioception, balance, pain, and functional status.

90 patients which consist of 45 patients as DN + self stretching and 45 patients as ESWT + self stretching. Patients in each group were treated 1 session per week for 4 weeks. Assessments of 15° ankle dorsiflexion and plantar flexion proprioception, one leg standing test (OLST), foot function index (FFI), visual analog scale (VAS) (first step, resting, activity), quality of life scale (SF-36) were performed. The outcomes were recorded at pre-treatment, post-treatment, and 4 weeks after the post-treatment.

Statistically significant differences were determined in VAS (resting, first step, activity) and FFI values in both treatment methods (p < 0.05). In OLST, SF-36, and FFI evaluations, DN was statistically more effective than the ESWT method (p < 0.001). In the 15° proprioception evaluations, a significant difference was observed in the patient's ankle in both methods, while the DN method is more effective in the indicated stages of evaluation.

Both methods applied to epin calcanei patients were effective, but the DN method is a more effective treatment method than the ESWT method in terms of balance, proprioception, foot function, and quality of life.

Objective: Cognitive impairments are one of the most common and disabling symptoms associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Here, we address the possibility of a specific cognitive profile inherent to ME/CFS. Due to the occurrence of cognitive deficits, fatigue, and pain in both pathologies, multiple sclerosis (MS) is a relevant comparison model. For this purpose, we carried out a comparative study between cognitive profiles of patients with ME/CFS and patients suffering from MS. Methods: In total, 40 ME/CFS and 40 MS patients were included. A complete screening of all cognitive functions was carried out through an extensive battery of tests routinely used in clinical practice. Results: ME/CFS and MS patients showed deficits in episodic memory retrieval, visual selective attention and reading speed. ME/CFS patients also elicited a lower level of performance than MS patients regarding consolidation. For both groups, levels of performance on these cognitive tests did not correlate with levels of fatigue, pain, and depression. Conclusions: This study highlighted both similarities and differences in the cognitive profiles of ME/CFS and MS patients. While both groups exhibited deficits in episodic memory retrieval, visual selective attention, and reading speed, ME/CFS patients showed distinct impairment in consolidation processes. These cognitive deficits were not correlated with fatigue, pain, or depression, reinforcing the hypothesis of intrinsic cognitive dysfunction in ME/CFS. These findings define a specific cognitive phenotype for ME/CFS, which could improve diagnostic accuracy and therapeutic strategies. Future research, particularly in functional imaging, may elucidate the neurobiological mechanisms underlying these impairments.

Treatment of rotator cuff (RTC) tears commonly involves manual therapy, exercise, and injection methods. These treatments are typically administered together as components of a physical therapy intervention. However, it is not known which intervention is more effective.

The objective of this study was to examine the impact of mobilization with movement (MWM) mobilization, a technique from Mulligan approaches, and corticosteroid (CS) injection on pain, functionality, and proprioception in cases of RTC tears.

This was a single-blinded randomized clinical trial.

Participants with RTC tears (n = 60) were divided into Mulligan mobilization (MM) and CS groups. The participants in the MM group performed mobilization with movement and a conventional exercise program; the CS group received a CS injection in addition to conventional exercises. The Visual Analog Scale, The Disabilities of the Arm, Shoulder, and Hand questionnaire, active range of motion (AROM), and joint position sense (JPS) were evaluated. The outcomes were analyzed using effect size, minimum clinically important difference, minimal detectable change, Wilcoxon test, and Mann-Whitney U test.

Both groups significantly improved in all measured outcomes at 3 weeks. The MM group showed significantly better (p < 0.05, Cohen d range 0.82-3.2) results in pain, AROM (Flexion, abduction, extension, external rotation, internal rotation), and proprioception (30° and 60° of flexion and abduction). Between-group differences in AROM were also clinically meaningful as they exceeded their MDC90 and minimum clinically important difference values.

Although both of these treatment methods may be successful in the short-term management of chronic RTC, the MM approach combined with conventional exercises seems to be a more effective approach for improving shoulder pain, function, and proprioception in this patient population.

NCT05933382.

Background and Objectives: Low back pain (LBP) is highly prevalent and often associated with altered muscle function, including in the quadratus lumborum (QL) muscle. While some studies have highlighted the clinical relevance of QL muscle stiffness in LBP, the findings remain inconsistent, and the role of this parameter in relation to clinical severity indicators is not well understood. Considering the high prevalence of myofascial trigger points among patients, objectively and reliably quantifying QL stiffness and its association with other clinical parameters could improve the identification of early stages of the condition before other alterations become apparent. Therefore, this study aimed to explore the association between QL stiffness and multiple indicators of LBP severity. Materials and Methods: A cross-sectional observational study was conducted involving the participation of seventy-six patients suffering from chronic LBP. An ultrasound scanner with shear-wave elastography (SWE) was used to determine the participants' QL stiffness. Additional information was collected on LBP-associated pain intensity, disability, central sensitization, and quality of life. Results: QL muscle stiffness was negatively correlated with pain intensity (p < 0.01) and central sensitization (p < 0.01), and it was positively correlated with physical quality of life (p < 0.01). Muscle stiffness influenced the variance in pain intensity along with physical quality of life, central sensitization, and chronicity (together explaining 49% of the variance) but did not explain the variance in central sensitization. Conclusions: Assessing QL muscle stiffness in patients with LBP is recommended, as greater muscle softness is linked to higher pain intensity, central sensitization, and poorer physical quality of life. Regression analyses further highlighted that QL stiffness helps explain the variance in pain intensity, physical quality of life, central sensitization, and chronicity, but it did not directly affect the central sensitization variance.

Aerobic exercise is recommended to alleviate pain and protect the joint for patients with advanced knee osteoarthritis, however, its clinical implementation is challenging due to the potential for exacerbating pain.

The study aimed to compare the effects of anti-gravity treadmill training with traditional treadmill training in patients with advanced knee osteoarthritis.

This single-blinded randomized-controlled trial included 30 women with knee osteoarthritis. All participants received hotpack, transcutaneous electrical nerve stimulation, and therapeutic ultrasound. Additionally, group 1 received anti-gravity treadmill, while group 2 received traditional treadmill training. Group 3 served as the control. The interventions were administered three-times a week for eight-weeks. The visual analogue scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), six-minute-walk-test distance (6MWD), and femoral cartilage thickness were evaluated at baseline and weeks 4 and 8.

VAS-pain significantly reduced over time in both anti-gravity (P < 0.001) and control (P = 0.004) groups. The anti-gravity group also showed significant improvements in WOMAC-pain (P = 0.008), WOMAC-total (P = 0.048), and 6MWD (P < 0.001). Post-hoc analysis indicated significant time (P < 0.001, effect size, ηp2 = 0.682) and interaction (P = 0.006, ηp2 = 0.271) effects on VAS, with no significant between-group differences. Femoral cartilage thickness showed no significant between-group differences, except within-group differences in the treadmill group (P = 0.037).

Anti-gravity treadmill training significantly improved pain, functionality, and functional capacity in patients with knee osteoarthritis, while traditional treadmill resulted in a reduction in femoral cartilage thickness. Further research should investigate long-term outcomes and more diverse populations.

NCT05319964.

Background This study aims to compare the efficacy of ultrasound (US)-guided subacromial bursa steroid injection (SABSI), suprascapular nerve block (SSNB), and combined injection therapy (SABSI + SSNB) on pain and shoulder function in patients with subacromial impingement syndrome who either did not respond to physical medicine and rehabilitation (PM&R) or reported being unable to attend the PM&R unit regularly. Methodology In this prospective, comparative cohort study, patients were randomly assigned using the envelope method to ensure an unbiased distribution. In total, 95 patients with subacromial impingement syndrome were divided into three groups according to the injection technique applied. All injections were applied to Group 1 (SABSI), Group 2 (SSNB), and Group 3 (SABSI + SSNB) under US guidance. Pain and shoulder function levels of the groups before and after treatment at one month and three months were evaluated using the Visual Analog Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) scale, respectively. For statistical analysis, the Shapiro-Wilk test was used to assess the normality of continuous data. One-way analysis of variance with Bonferroni correction was applied for normally distributed variables, while the Kruskal-Wallis test was used for non-normally distributed data. Pearson's chi-square test was performed to compare categorical variables. Results Between pre-treatment and one month post-treatment, there were statistically significant differences in the percentage change of VAS rest, VAS activity, and DASH scores among the groups (p = 0.004, <0.001, and <0.001, respectively). These significant differences persisted over the period from pre-treatment to three months post-treatment, with all p-values being ≤0.002. Throughout both assessment intervals, Groups 1 and 2 displayed statistically similar percentage changes across all parameters; however, these changes were significantly lower than those observed in Group 3. Patients unable to attend PM&R units displayed a longer symptom duration compared to patients who were non-responders to PM&R (p = 0.015). The distribution of these three injection techniques across the two groups was similar (p = 0.831), and both groups showed similar responses to US-guided injections in terms of pain and functionality (all p > 0.05). Conclusions US-guided SABSI combined with SSNB in patients with shoulder impingement was found to be superior compared to their sole applications in terms of improvement in shoulder pain and function. These findings suggest that the combined approach is a promising alternative for managing shoulder impingement syndrome, particularly in patients facing barriers to PM&R access.

Neck pain is a prevalent global health concern often accompanied by musculoskeletal symptoms. This randomized controlled trial attempted to contrast the impacts of non-thrust Maitland mobilization and Autogenic inhibition muscle energy technique on chronic mechanical neck pain associated with cervico-thoracic junction hypo-mobility.

Sixty participants (24 males and 36 females, aged 18-45 years) were allocated randomly into three equally sized groups (A, B, C). Group A: Maitland mobilization plus conventional treatment, Group B: Autogenic Muscle energy technique plus conventional treatment, while; Group C solely received conventional treatment. Treatment was administered for four weeks, three times a week. Outcome measures: neck pain (The primary outcome measure) assessed by Visual Analog Scale (VAS), disability evaluated through Neck Disability Index (NDI), active range of motion (AROM), and joint position error (JPE) as an indicator of cervical proprioception. All measures were assessed both at baseline and after four weeks of intervention.

Results showed significant improvements in VAS, NDI, and increased ROM across all groups post-treatment (p < 0.001). While Groups A and B demonstrated superior outcomes compared to Group C, differences between Groups A and B were not statistically significant (p > 0.05). For VAS and NDI, Cohen-d between Groups A and B was 0.31 and 0.31, and for ROM, Cohen-d was 0.37, 0.16, 0.07, 0.29, 0.36, and 0.53 for flexion, extension, right rotation, left rotation, right bending, and left bending, respectively. Furthermore, all groups experienced a significant decrease in JPE, with Groups A and B showing greater improvement than Group C (p < 0.01). Group B exhibited significantly greater improvement in reducing JPE related to specific motions compared to Group A (p < 0.05).

Cervico-thoracic junction mobilization and the Autogenic muscle energy technique offer enhanced management for mechanical neck pain by improving pain, function, ROM, and cervical proprioception.

The most common cause of rotator cuff injury is supraspinatus tendon tears (STTs). High-intensity laser therapy (HILT) has recently emerged as an important conservative treatment option. This study was designed as a randomised controlled trial in patients with partial STTs to compare the effects of HILT with those of ultrasound (US) therapy. Fifty patients between the ages of 18-75, who were diagnosed with partial STT were randomised into two groups using the closed envelope method. They were blinded to group assignment. Group-1 received 3-week HILT program. Group-2 received 3-week US therapy program. HILT and US therapy were carried out by the same physiotherapist. The primary outcome measure was VAS. Secondary outcome measures were Shoulder Pain and Disability Index (SPADI) and supraspinatus tendon thickness (SP) by ultrasonography. Nine patients dropped out of the study leaving 41 (Group-1, n = 20; Group-2, n = 21) patients for analysis. There was no significant difference between the groups before treatment in terms of age, body mass index values, gender, affected side, smoking, comorbidities, STT, VAS and SPADI values. VAS and SPADI values ​​decreased significantly in both groups at the 4th and 12th weeks. However, VAS and SPADI values ​​at the 4th and 12th weeks were significantly lower in the HILT group than in the US group. Cohen's d analysis revealed large effect sizes at the 4th and 12th weeks favoring the HILT group. There was no significant change in SP within and between groups at any time points. The findings show that HILT is superior to US treatment in reducing pain and improving function and quality of life in the long term. Both treatment methods did not affect SP. Clinical Trials ID: NCT06637410.