Conservative Treatment Options Research Articles

Hip Dysplasia in Adults: Surgical Correction vs. Conservative Treatment Options

Introduction: Developmental Dysplasia of the Hip (DDH) is an anatomical deformation resulting from abnormal formation of the structures that make up the hip joint. Due to abnormal biomechanics patients with hip dysplasia usually develop radiographic osteoarthritis. Aim of the study: Despite the introduction of screening tests in children, DDH remains an issue among adults. For this group of patients, it is essential to begin treatment as early as possible to prevent early-onset osteoarthritis of the hip joint. In adults it is often too late to implement non-invasive methods such as braces or orthoses. Therefore, in this study, we aim to describe other treatment options for adults with DDH, considering both surgical and non-surgical methods. In the following work, we present both the advantages and complications associated with these surgical methods. Additionally, we describe the non-surgical alternative method of progressive resistance training (PRT) and consider the possibilities of combining it with surgical techniques. We also discuss the potential for pharmacological treatment. Material and Methods: Review of studies available through open-access sources on PubMed, Google Scholar, and the National Library of Medicine. Conclusions: The decision to quickly implement an appropriate treatment plan is crucial for improving the patient's quality of life. The choice of treatment method should consider the patient's age and the severity of the disease. Adults with DDH are most often qualified for surgical procedures, which include periacetabular osteotomy (PAO) and total hip replacement (THR). However, for some patients, surgical procedures may be contraindicated or impossible, and in such cases, other non-invasive methods, such as resistance training or appropriate pharmacotherapy, should be considered. Keywords: hip joint, osteoarthritis, surgery, conservative therapy, hip, Surgical Correction

Physiotherapists working with pessaries

Pessaries and the physiotherapy profession have evolved over the past 10 years, and pelvic health physiotherapists can now prescribe vaginal pessaries. Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) is developing ways to support members with these skills. Globally, up to 50% of women will suffer from pelvic organ prolapse (POP) (Carroll et al. 2022), and this condition costs the UK National Health Service £45 million every year (PCWHF 2019). The most common symptom is a vaginal bulge. The National Institute for Health and Care Excellence guidelines recommend either doing nothing, or pelvic floor muscle exercises (PFMEs), vaginal pessaries or surgery (NICE 2019). Pessary services are provided in dedicated clinics, usually in general practice or secondary care. There has been an increase in physiotherapists delivering pessary care over the past decade: in 2013, it was reported that 1.4% were part of the pessary workforce compared to 5% in 2020 (Bugge et al. 2013; Brown et al. 2021). Currently, ineffective patient pathways, poor service provision and lack of training are barriers to treatment. Poorly designed patient pathways are frustrating, and women are often required to return to primary or secondary care to get a referral to a pessary clinic. Physiotherapists are well placed to offer a pessary alongside PFMEs since it is part of the range of conservative treatment options. They also build strong a rapport with their patients because of the therapeutic nature of the treatment sessions, and typically, offer longer appointments than postnatal period. A prospective multicentre trial demonstrated the acceptability of and compliance with using a pessary immediately after childbirth irrespective of any pelvic floor dysfunction or mode of delivery (Baessler et al. 2019). The majority of women used the pessary to treat the symptoms of POP. Further work is required to investigate pessary use and the prevention of pelvic floor dysfunction in this cohort of women. The results of the TOPSY [Treatment Of Prolapse with Self-care pessarY] trial (Hagen et al. 2023) highlighted that pessary self-management is cost-effective and reduces complications. This is excellent news because physiotherapists are well placed to teach women pessary self-management because of: generally longer appointments; and the well-established rapport built up over time while teaching PFMEs. Despite women reporting that pessary use during exercise relieves their symptoms, this is an under-researched area. The impact of exercise on POP, and whether there are any protective factors involved that prevent its progression, are not fully understood. There also remains a gap in the evidence with regard to the use of PFMEs and vaginal pessaries. Research proposals are currently in development to address this. A pessary course is being developed by POGP, and this will be launched in 2024 alongside a mentoring programme as part of the pessary accreditation scheme jointly written with the United Kingdom Continence Society. Further governance documents have been created by the Physiotherapists Working with Pessaries subgroup of POGP, including a standard operating procedure, emergency out-of-hours statement, note proformas and template letters (POGP 2024).

Femoroacetabular Impingement: A Literature Review

Femoroacetabular impingement (FAI) is a hip condition characterized by abnormal contact between the femoral head and the acetabulum, often leading to joint damage and osteoarthritis. This literature review explores the pathophysiology, diagnosis, and treatment options for FAI, synthesizing current research findings from clinical and biomechanical studies. FAI is classified into two primary types: cam impingement, caused by deformity of the femoral head, and pincer impingement, due to acetabular over-coverage. Mixed types involving both mechanisms are also common. Advancements in imaging modalities, such as MRI and CT, have improved diagnostic accuracy, allowing for earlier detection and better differentiation between types of FAI. Conservative treatment options, including physical therapy and anti-inflammatory medications, are often first-line therapies. However, surgical intervention, particularly arthroscopy, has gained prominence for symptomatic patients, demonstrating favorable outcomes in restoring hip function and delaying the progression of osteoarthritis. Despite the success of surgical interventions, challenges remain in understanding the long-term outcomes, particularly concerning the recurrence of symptoms and the risk of joint degeneration. This review also highlights controversies regarding the optimal management of asymptomatic FAI, as the risk-benefit balance of surgical treatment in such cases remains unclear. Overall, FAI remains a significant clinical issue requiring a multidisciplinary approach to optimize patient outcomes, and further longitudinal studies are necessary to assess the efficacy of treatment strategies over time. Keywords: Femoroacetabular, Impingement, Joint

ALTERNATIVAS NÃO INVASIVAS NO MANEJO DO GRANULOMA CENTRAL DE CÉLULAS GIGANTES DOS MAXILARES: UMA REVISÃO NARRATIVA DA LITERATURA

Introduction: The Central Giant Cell Granuloma of the jaws is described as an uncommon intraosseous lesion that can exhibit different clinical and imaging characteristics. It can present in an aggressive or non-aggressive manner. When aggressive, the lesion is typically expansive, painful, and associated with bone tissue destruction. The standard treatment is surgical removal, but the choice of the ideal therapeutic approach depends on factors such as the patient’s age, lesion behavior, and its extent. Objective: To explore the main conservative treatment options for the management of Central Giant Cell Granuloma of the jaws. Methods: This is a narrative literature review based on research in databases such as PubMed and Google Scholar, conducted between July and August 2024, using DeCS/MeSH descriptors in English, “calcitonin” OR “interferon” OR “denosumab” AND “central granuloma of giant cells in jaws” AND “central giant-cell lesion” OR “corticosteroids injections” AND “intralesional triamcinolone.” Literature Review: The drug class used for the treatment of Central Giant Cell Granuloma is corticosteroids, which show high rates of therapeutic success, followed by calcitonin, denosumab, and interferon. However, despite promising results, additional clinical trials are necessary to establish the true efficacy of these treatments. Conclusion: All non-invasive treatment modalities have been shown to be effective in reducing or achieving complete regression of Central Giant Cell Granuloma of the jaws, either alone or in combination. However, there are limitations, such as the risk of adverse effects and the limited number of published studies to date.

Spontaneous regression of a petroclival meningioma: illustrative case.

Spontaneous regression is relatively rare in meningiomas. Since meningiomas are known to have a relationship with sex-related hormones, spontaneous regression cases related to sex hormones have been reported. A 66-year-old man with a petroclival meningioma was radiologically followed up for 13 years. The tumor initially measured 2.535 cm3 and 2.521 cm3 on gadolinium-enhanced magnetic resonance imaging (MRI) and fast imaging employing steady-state acquisition MRI, respectively. However, the measurements decreased in the follow-up period to 0.977 cm3 and 0.98 cm3, respectively, demonstrating spontaneous regression of an asymptomatic meningioma located in a petroclival area. Continuous meticulous long-term follow-up revealed this phenomenon. It is important to retain the option of conservative treatment for patients ineligible for surgery for reasons such as advanced age and coexisting diseases. https://thejns.org/doi/10.3171/CASE24416.

FISIOTERAPIA PALIATIVA: ANÁLISE DE REVISÃO BIBLIOGRÁFICA INTEGRATIVA

With the arrival of Christianity, there was a transformation in patient care, enabling the creation of shelters and hospitals to offer assistance. This movement allowed the reception of people in vulnerable conditions, previously ignored by the health system at the time (RODRIGUES, 2018). By incorporating physiotherapy into a multidisciplinary or broad view of the association of life, quality of life and palliative care, it is possible to expand access to conservative, integrative and multidisciplinary therapeutic treatment options, less tense, aggressive, stressful and painful for those involved, accepting what the natural cycle of life really is like, where we are born, take care of each other and ourselves, and then die. This article carries out an integrative review on the role of physiotherapy in the context of palliative care with a focus on multidisciplinary and humanized assistance. Based on an analysis of studies published between 2004 and 2023, and data collection, carried out through research among patients and family members in the year 2024, the benefits of physiotherapy in relieving pain, improving quality of life and no emotional support for patients with chronic and terminal illnesses.

Factors affecting the therapeutic effects of multiple intra-articular injections of platelet-rich-plasma for knee osteoarthritis

BackgroundPlatelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I). MethodsThis is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added. ResultsAge, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy. ConclusionsAge, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA. Trial registrationRetrospectively registration.

Conservative treatment of adolescent idiopathic scoliosis (AIS): A narrative review of current evidence and implications for clinical practice

Introduction and purpose: Adolescent idiopathic scoliosis (AIS) is characterized by lateral curvature, vertebral rotation, and disruption of physiological curvature of the spine with the Cobb angle ≥10°. AIS affects 1-3% of children aged 10-16 years, representing the most common form of idiopathic scoliosis. Diagnosis of AIS is by exclusion and can be suspected based on Adams forward bend test and scoliometer. Untreated AIS can lead to serious consequences, such as progression of the deformity, back pain, reduced respiratory and cardiovascular function. The aim of this review is to update overview of conservative treatment options. Description of the state of knowledge: AIS treatment guidelines from the Scoliosis Research Society (SRS) and the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) advocate for observation, bracing, or surgery depending on curve severity, with a focus on avoiding spinal fusion when possible. Additionally, SOSORT recommends scoliosis-specific physiotherapy exercises for smaller curves or as an adjunct to bracing. Conservative treatment aims to prevent curve progression, manage respiratory and spinal complications, and improve quality of life. Conclusions: AIS can significantly impair the physical and psychosocial well-being of young patients, with potential long-term consequences extending into adulthood Individualized treatment plans and patient/parent education are crucial for optimal outcomes. Schroth exercises are superior to Core Stabilization (CS) exercises in reducing Cobb angle, trunk rotation and improving spinal mobility, cosmetic trunk deformities and quality of life. CS exercises are more effective in increasing peripheral muscle strength, reducing pain and correcting vertebral rotation.

Alternative methods for caries removal: A narrative review

Dental caries, commonly known as tooth decay, remains a significant global oral health concern. Traditional methods of caries removal, such as mechanical drilling, have proven effective but often result in the removal of healthy tooth structure and may cause patient discomfort.As,, 9a result, alternative methods for caries removal have emerged, aiming to preserve tooth structure, minimize pain, and provide more conservative treatment options. This review article explores various alternative methods for caries removal, including mechanical methods, chemomechanical methods, ultrasonic methods, laser-based techniques, cryotherapy, `silver diamine fluoride, sealants and ozone based approaches.The article summarizes the scientific literature surrounding these methods, including their efficacy, advantages, limitations, and potential applications. Additionally, the article discusses the potential challenges and future directions in the field of alternative caries removal methods. By providing a comprehensive overview of these innovative approaches, this review article aims to contribute to the growing body of knowledge on minimally invasive dentistry and enhance the understanding of alternative techniques for caries removal.

Options for conservative treatment of obesity

Options for conservative treatment of obesity

S2k guideline lipedema.

This S2k guideline was developed on the initiative and under the German Society of Phlebology and Lymphology (DGPL) leadership. The guideline aims to optimize the diagnosis and treatment of lipedema. It is intended to bring together the different approaches of the respective professional groups in a consensus-based manner and thus offer a basic concept for the best possible treatment of patients with lipedema. Sixty recommendations were formulated and agreed on in diagnostics, conservative and surgical treatment options, psychosocial factors and self-management. The guideline is intended to reflect the current scientific knowledge and be widely used for diagnosis and treatment recommendations for patients with lipedema. In particular, the guideline comments on diagnostic criteria, differential diagnoses, and coinciding clinical pictures, their influence on diagnosis and treatment, sensible treatment measures, and self-management options. The lipedema guideline summarizes the current national and international evidence and the German expert consensus and derives recommendations for the best treatment for patients with lipedema. The recommendations in the guideline are intended as an orientation aid in the sense of action and decision-making corridors from which deviations are possible in justified cases.

The Role of Sole Lift in Treating Pediatric Idiopathic Scoliosis with Mild Thoracolumbar/Lumbar Curve.

Lower limb discrepancy (LLD) was frequently observed in patients with idiopathic scoliosis (IS), potentially associated with etiopathogenesis. Although sole lifts had been proposed as a conservative treatment for IS, evidence supporting their efficacy was limited. This study aimed to assess the effects of sole lift intervention on pediatric patients with mild IS, specifically focusing on thoracolumbar/lumbar (TL/L) curvature. Twenty patients, with an average age of 12.3 ± 3.1 years and presenting mild TL/L curve (15.6° ± 6.2°), were selected from a pool of 267 pediatric IS patients in the outpatient of our spine center from February 2023 to August 2023. Inclusion criteria comprised a main TL/L curve ranging between 10° and 40°, the lower limb positioned at the convexity of the main curve, and LLD of less than 2 cm; individuals requiring bracing or surgical intervention were excluded. Custom sole lifts were used to address the shorter lower limb with the objective of leveling the pelvis. Radiographic evaluations were conducted both before and after intervention using standing full spine posteroanterior radiographs and full leg length radiographs. Statistical analysis was undertaken to evaluate curve correction and its associations with other influencing factors. The mean structural and functional LLD were 7.1 ± 4.5 mm and 7.1 ± 4.1 mm, respectively. Among the 20 patients, four exhibited structural LLD greater than 10 mm. The average follow-up duration was 6.4 ± 1.9 months (range: 3-8 months). Following sole lift intervention (7.0 ± 3.0 mm), a significant reduction was observed in the TL/L curve compared to the pre-sole lifting measurements (15.6° ± 6.2° vs. 12.1° ± 7.2°, p < 0.001), as well as a notable decrease in the thoracic curve (12.2° ± 4.0° vs. 8.6° ± 6.3°, p = 0.064). Nine patients experienced a significant curve reduction of ≥5°, while eight showed a reduction between 0° and 5°; however, two patients exhibited no change in curve magnitude. Furthermore, the correction rate of the TL/L curve correlated significantly with functional LLD (r = -0.484, p = 0.030) and pelvic obliquity (r = -0.556, p = 0.011), highlighting the active pelvic compensation in maintaining balance between the spine and lower limbs. Conversely, no significant correlation was observed between curve correction and structural LLD (p > 0.05). Additionally, even after adjusting for other influencing factors, the TL/L Cobb angle remained significantly different between pre- and post-sole lifting (p = 0.037). This study confirmed the effectiveness of sole lift intervention in correcting TL/L and thoracic curves among the mild IS children with a main TL/L curve, providing a supplementary conservative treatment option for patients with the lower limb at the convexity of the main curve. Moreover, our findings underscored the active compensation of the lower limbs and the pelvis in the etiopathogenesis of IS, highlighting the importance of considering their influence in treatment strategies.

Treatment of Plantar Warts with a Nitric-Zinc Complex Solution: A Review of 72 Cases.

There are multiple conservative treatment options for plantar warts, but none have proven to be universally effective. Nitric acid is often used empirically by podiatrists in the treatment of plantar warts. A novel medical device or topical solution of nitric-zinc complex solution (NZCS) could potentially offer an effective and safe alternative for the targeted treatment of plantar warts. To observe the rate of complete healing of NZCS in a series of plantar wart cases and to establish the minimum number of product applications and time needed for healing. This will help standardize and protocolize its use. A descriptive study was conducted involving 72 patients who exhibited symptoms of plantar warts. These patients underwent chemical treatment using a nitric-zinc complex. The cure rate with NZCS was 59.2%. The average number of NZCS applications was 5.9 ± 3.0 and the mean duration of treatment was 9.4 ± 7.1 weeks. A recurrence rate of 6.7% was observed. The topical solution of the nitric-zinc complex is an effective treatment for plantar warts, which can be considered a first-line treatment option in the general population.

Rising premature menopause and variations by education level in India

The proportion of women experiencing premature menopause is on the rise in India, particularly in the age groups of 30–39 years. Consequently, there is a need to understand the factors influencing the prevalence of premature menopausal status among women. Our study uses the data from 180,743 women gathered during the latest Indian version of the Demography Health Survey (National Family Health Survey-5). Our results suggest that close to 5% of women in rural areas and 3% of women in urban areas experience premature menopause, and this figure varies across Indian States. The regression results show that surgical menopause, lower levels of education, poorer wealth index, rural residence, female sterilization, and insurance coverage are key drivers of premature menopause. One of the striking factors is that the prevalence of premature menopause among those with the lowest levels of education (6.85%) is around seven times higher than those with the highest level of education (0.94%). We conducted a decomposition analysis to delve into the factors contributing to this inequality. The results show that undergoing a hysterectomy (surgical menopause) account for 73% of the gap in premature menopausal rates between women with the lowest and highest levels of education. This indicates that women with poor education are more likely to undergo hysterectomy at a younger age. This finding warrants further exploration as we would expect that women from lower socio-economic background would have limited access to surgical care, however, our results suggest otherwise. This perhaps indicates a lack of awareness, lack of alternative treatment options, and over-reliance on surgical care while neglecting conservative management. Our results have implications for addressing the diverse needs of the increasing number of women in their post-menopause phase and for focusing on conservative treatment options for these women.

Acute Phase Peyronie's Disease: Where Do We Stand?

Peyronie's disease (PD) is a common benign condition characterized by superficial fibrosis and scar formation at the tunica albuginea of the penis, eventually leading to penile curvature. It is believed that penile micro-traumas during intercourse and subsequent activation of inflammatory processes constitute the pathogenetic basis of the disease. Routinely, PD is divided into acute and chronic phases, with pain during erection or flaccid state being the hallmark of the former. Surgical intervention should be avoided during the acute phase, as the risk of recurrence or progression of penile deformity during this stage might affect the optimal outcomes of the procedure. During this stage, many conservative treatment options have been suggested, including oral, topical, and intralesional therapies, extracorporeal shock wave therapy (ESWT), and penile traction therapy (PTT). Currently, the optimal treatment consists of a combined treatment strategy with phosphodiesterase type 5 inhibitors (PDE5Is), ESWT for pain management, PTT, and intralesional therapies. Large, well-designed randomized controlled trials (RCTs) are necessary to further elucidate the most efficient treatment option for acute phase PD.

Membrane-free stem cell components suppress osteoclast differentiation: Implications for oral regenerative treatment

Background/purposeMembrane-free stem cell components (MFSCCs) have been developed by removing cell membranes with antigens to overcome the limitations associated with cell-based therapies and isolate effective peptides. MFSCCs have been reported to have effects on oral infection sites. Chronic inflammatory diseases cause excessive bone resorption. This study investigated the effects of MFSCCs on osteoclast differentiation in the context of the high prevalence of inflammatory bone resorption. Materials and methodsBone marrow macrophages (BMMs) were treated with macrophage colony-stimulating factor and receptor activator of nuclear factor kappa-B ligand. Osteoclast differentiation was assessed based on the MFSCC concentrations. Tartrate-resistant acid phosphatase (TRAP)-stained mature osteoclasts and multinucleated cells derived from BMMs were analyzed using light microscopy. The messenger RNA (mRNA) expression levels of genes related to osteoclast differentiation were measured using real-time polymerase chain reaction (RT-PCR). The relative expression levels of the key transcription factors c-fos and nuclear factor of activated T cells (NFATc1) were determined using quantitative RT-PCR and western blotting. ResultsAfter treatment with MFSCCs, the cell viability was similar, depending on the level of BMMs. As the MFSCC concentration increased, the number of TRAP-positive cells decreased. The mRNA and protein expression of cathepsin K, TRAP, dendritic cell-specific transmembrane protein, c-fos, and NFATc1 decreased as the MFSCC concentration increased. ConclusionOur findings demonstrate that MFSCCs suppress osteoclast differentiation by downregulating transcription factors, particularly, c-fos and NFATc1. Therefore, MFSCCs may serve as a conservative treatment option for chronic inflammatory bone resorption diseases of the oral cavity by suppressing excessive bone resorption.

Minimally invasive teeth whitening enhancements after orthodontic treatment with in-office bleaching: two case reports

Background: Teeth discoloration is one of the adverse effects of orthodontic treatment which causes aesthetic issues that effect on a person’s appearance. The management of teeth discoloration can be done with bleaching because it is easier to perform, faster, more effective, and more conservative than other treatments such as crowns and veneers. There are two types of bleaching techniques supervised by dentists: home bleaching and in-office bleaching. In-office bleaching is one of the most conservative and non-invasive treatment options to restore the aesthetics of discolored teeth. Purpose: This case report observes management of tooth discoloration after orthodontic treatment with in office bleaching using hydrogen peroxide 40%. Case 1: A 24-year-old woman came to Universitas Hasanuddin Dental and Oral Hospital with complaints of yellowish upper and lower teeth after removal of her fixed orthodontic appliance. Case 2: A 24 years old woman came to Universitas Hasanuddin Dental and Oral Hospital with complaints of upper and lower front teeth appearing yellowish in color, noticed from 2 years ago and had undergone orthodontic treatment for four years. Case Management: From clinical examination, both patients’ teeth have no history of caries, sensitive tooth and gingival recession. The Teeth were sensitive to vitality test. The discoloration was treated with external bleaching using 40% hydrogen peroxide. Conclusion: External Bleaching using 40% hydrogen peroxide have results in significant discoloration without changing the shape and arrangement of the patient’s teeth

The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options?

Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.

Effectiveness of McKenzie exercises plus stabilization exercises versus McKenzie exercises alone on disability, pain, and range of motion in patients with nonspecific chronic neck pain: A randomized clinical trial.

Chronic nonspecific neck pain is a common disorder that causes disability and reduced quality of life. Effective conservative treatment options are needed to manage this condition. This randomized trial compared the efficacy of McKenzie exercises alone versus McKenzie plus cervical and scapulothoracic stabilization training for patients with chronic nonspecific neck pain. A randomized controlled trial was conducted in an outpatient physical therapy clinic. 76 patients with chronic (> 3 months) neck pain were randomized to 6 weeks of either McKenzie exercises alone (n= 38) or McKenzie plus stabilization exercise (n= 38). The McKenzie protocol included posture correction, range of motion exercises, and lateral neck stretches. The stabilization program added targeted exercises for the neck and scapula. The combination of McKenzie plus stabilization exercises resulted in significantly greater reduction in current neck pain intensity compared to McKenzie alone at 6 weeks (mean difference: -1.2 points on 0-10 scale, 95% CI -1.8 to -0.6; p< 0.001). Neck disability improved in both groups. Cervical range of motion also improved more with the addition of stabilization, except for extension. Adding specific cervical and scapulothoracic stabilization exercises to a standard McKenzie protocol led to clinically meaningful reductions in neck pain compared to McKenzie therapy alone in patients with chronic nonspecific neck pain. This combined approach can improve outcomes.

The Management of Knee Osteoarthritis in the Real World: An Italian National Survey.

Background: Knee osteoarthritis is a degenerative and inflammatory disease causing pain and worsening patients' quality of life. Various conservative treatment options exist, but a gap between scientific evidence and clinical practice is still present. The aim of this prospective multicenter observational study is to describe the real outpatient territorial management of patients with knee osteoarthritis and to analyze the correlation between the anthropometric and clinical characteristics of the population of patients suffering from symptomatic knee osteoarthritis who were screened in the national survey. Methods: The educational national project was divided into three modules: the first and the last through webinars; and the second held in daily practice. The participants had to register structured observations, which were then stored in a national database and analyzed in order to identify correlations. The subgroups were stratified by body composition, radiological severity of knee osteoarthritis, pain, and functional ability. Results: The project has been joined by 155 physicians, and 2.656 observations about real-world outpatients being treated for knee osteoarthritis in Italy were collected. Data relating to real-world pharmacological and rehabilitation therapies in correlation with body composition, the radiological severity of knee osteoarthritis, pain, and functional ability were reported. Conclusions: Currently, there are no standardized protocols using effective combinations of therapeutic exercises, physical agents, and medications to control the progression of knee osteoarthritis. This real-word national survey proved to be useful for describing the current state of the art of therapeutic management of knee osteoarthritis and for emphasizing the need to fill the gap between scientific evidence and clinical practice.