Greater Functional Improvement Research Articles

Do MRI findings identify patients with low back pain or sciatica who respond better to particular interventions? A systematic review.

Magnetic resonance imaging (MRI) can reveal a range of degenerative findings and anatomical abnormalities; however, the clinical importance of these remains uncertain and controversial. We aimed to investigate if the presence of MRI findings identifies patients with low back pain (LBP) or sciatica who respond better to particular interventions. MEDLINE, EMBASE and CENTRAL databases were searched. We included RCTs investigating MRI findings as treatment effect modifiers for patients with LBP or sciatica. We excluded studies with specific diseases as the cause of LBP. Risk of bias was assessed using the criteria of the Cochrane Back Review Group. Each MRI finding was examined for its individual capacity for effect modification. Eight published trials met the inclusion criteria. The methodological quality of trials was inconsistent. Substantial variability in MRI findings, treatments and outcomes across the eight trials prevented pooling of data. Patients with Modic type 1 when compared with patients with Modic type 2 had greater improvements in function when treated by Diprospan (steroid) injection, compared with saline. Patients with central disc herniation when compared with patients without central disc herniation had greater improvements in pain when treated by surgery, compared with rehabilitation. Although individual trials suggested that some MRI findings might be effect modifiers for specific interventions, none of these interactions were investigated in more than a single trial. High quality, adequately powered trials investigating MRI findings as effect modifiers are essential to determine the clinical importance of MRI findings in LBP and sciatica ( CRD42013006571).

Hidropesia ascitica gestosica

Los autores presentan dos excepcionales observaciones de ascitis generalizado en otros tantas pacientes toxémicas, la primera fue una secundigesta con antecedentes de gestosis hipertensiva en su embarazo anterior. En el embarazo actual toxemia hipertensiva severa (hipertensión elevada, grandes edemas, proteinuria franca). Con embarazo de 6 y medio meses se practica la interrupción del mismo por operación cesárea. Ascitis de más de 6 litros y cavidad peritoneal libre. La paciente se recupera rápida y definitivamente en cuanto a su complicación abdominal, con gran mejoría funcional. La segunda observación se refiere a una paciente primigesta con antecedentes personales y familiares de hipertensión. Embarazada de 5 meses y medio; hipertensión severa, edemas generalizados, proteinurias, uricemia alta, hipoprotidemia marcado. A pesar del severo tratamiento, el cuadro no mejoró y la gestación es interrumpida por operación cesárea a los 6 meses y tres semanas. Ascitis de 3 litros. El niño de 1,200 grs. fallece a las 48 horas. Se verifica la ausencia de proceso extraño en el vientre. La paciente mejora rápidamente. Se embaraza nuevamente a los ocho meses de la interrupción del primero y es internada. Cumple así con cortas salidas el curso de su segundo embarazo que transcurre sin complicaciones y normotensa, aunque con una disminuida depuración plasmática de la urea. Tiene su parto a los 8 meses y medio con un niño sano de 2,950 grs. Hacen referencia a la dificultad pronóstico en estos pacientes y ofrecen antecedentes bibliográficos de esta infrecuente complicación de la toxemia hipertensiva.

The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study

Cerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based. Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments. Children receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services. There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain. Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (p < .001) as compared to recipients of institution-based services. Long term caregiving leads to strain in caregivers and there is a need to design interventions to alleviate the burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findings from this study suggest that the provision of care within a community setting as part of a well-structured outreach programme may be preferable method of service delivery within a resource-constrained context. It was associated with a greater improvement in functioning, greater satisfaction with services and better compliance.

Is 25(OH)D Associated with Cognitive Impairment and Functional Improvement in Stroke? A Retrospective Clinical Study

In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment. The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status. A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients. High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.

Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy.

For children with upper-extremity cerebral palsy (CP) who meet standard indications for tendon transfer surgery, we hypothesized that surgical treatment would result in greater functional improvement than treatment with botulinum toxin injections or regular, ongoing therapy. Thirty-nine children with upper-extremity CP, who were four to sixteen years of age and surgical candidates for the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis, pronator teres release, and extensor pollicis longus rerouting with adductor pollicis release, were prospectively assigned, either randomly (twenty-nine patients) or by patient/family preference (ten patients), to one of three treatment groups: surgical treatment (Group 1); botulinum toxin injections (Group 2); or regular, ongoing therapy (Group 3). Seven centers participated. Assessment measurements included active range of motion, pinch and grip strength, stereognosis, and scores as measured with eight additional functional or patient-oriented outcome instruments. Thirty-four patients (twenty-five randomized and nine from the patient-preference arm) were evaluated twelve months post-treatment as the study cohort. For the primary outcome of the Shriners Hospital Upper Extremity Evaluation (SHUEE) dynamic positional analysis (DPA), significantly greater improvement was seen in Group 1 than in the other two groups (p < 0.001). Improvements in SHUEE DPA reflected improved supination and wrist extension during functional activities after surgical treatment. Group 1 showed more improvement in the Pediatric Quality of Life Inventory (PedsQL) CP module domain of movement and in the Canadian Occupational Performance Measure (COPM) score for satisfaction than Groups 2 and 3. Both Groups 1 and 3 showed more improvement in pinch strength than did Group 2. For children with upper-extremity CP who were candidates for standard tendon transfer, surgical treatment was demonstrated to provide greater improvement, of modest magnitude, than botulinum toxin injections or regular, ongoing therapy at twelve months of follow-up for the SHUEE DPA, the PedsQL CP module domain of movement, and COPM satisfaction.

Light-Emitting Diode Versus Sham in the Treatment of Plantar Fasciitis: A Randomized Trial

ObjectiveThe purpose of this preliminary study was to compare the application of the light emitting diode (LED) to sham LED in the treatment of plantar fasciitis. MethodsEighteen subjects met the inclusion criteria and were randomly assigned into 2 groups: light emitting diode or sham LED. The subjects received either the LED at 12 J/cm2 or sham LED along 2 points of the plantar fascia. Subjects in both groups received a 10 minute transverse friction massage and participated in 4 plantar fascia stretching exercises. All subjects received a total of 6 treatments over 3 weeks. Progress was assessed using the lower extremity functional and analog pain scale. ResultsNo significant difference was found between treatment groups (P = .845). There was a significant difference in pain and outcome scores over time within both groups (P < .35). ConclusionAmong patients with plantar fasciitis, the use of LED did not result in greater improvement in function or pain compared with sham treatment. The findings suggest that manual intervention and passive stretching activities may have provided significant pain relief and improvement in functional outcome scores.

WITHDRAWN: Exercise therapy for patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common problem among adolescents and young adults, characterised by retropatellar pain (behind the kneecap) or peripatellar pain (around the kneecap) when ascending or descending stairs, squatting or sitting with flexed knees. Etiology, structures causing the pain and treatment methods are all debated in literature, but consensus has not been reached so far. Exercise therapy to strengthen the quadriceps is often prescribed, though its efficacy is still debated. OBJECTIVES: This review aims to summarise the evidence of effectiveness of exercise therapy in reducing anterior knee pain and improving knee function in patients with PFPS. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group and Cochrane Rehabilitation and Related Therapies Field specialised registers, the Cochrane Controlled Trials Register, PEDro - The Physiotherapy Evidence Database, MEDLINE, EMBASE, CINAHL, up till December 2001 for controlled trials (randomised or not) comparing exercise therapy with control groups, or comparing different types of exercise therapy. SELECTION CRITERIA: Only trials focusing on exercise therapy in patients with PFPS were considered. Trials in patients with other diagnoses such as tendinitis, Osgood Schlatter syndrome, bursitis, traumatic injuries, osteoarthritis, plica syndrome, Sinding-Larssen-Johansson syndrome and patellar luxations were excluded. DATA COLLECTION AND ANALYSIS: From 750 publications 12 trials were selected. All included trials studied quadriceps strengthening exercises. Outcome assessments for knee pain and knee function in daily life were used in a best evidence synthesis to summarise evidence for effectiveness. MAIN RESULTS: One high and two low quality studies used a control group not receiving exercise therapy. Significantly greater pain reduction in the exercise groups was found in one high and one low quality study, though at different time points. Only one low quality study reported significantly greater functional improvement with exercise. Five studies compared exercise therapies that could be designated closed kinetic chain exercise (foot in contact with a surface) versus open kinetic chain exercise (foot not in contact with a surface). Two of these studies were of high quality, but no significant differences in improvement of function or reduction of pain were apparent between the types of exercise in any of the studies. The remaining four studies, all of which were of low quality, focused on other treatment comparisons. AUTHORS' CONCLUSIONS: The evidence that exercise therapy is more effective in treating PFPS than no exercise was limited with respect to pain reduction, and conflicting with respect to functional improvement. There is strong evidence that open and closed kinetic chain exercise are equally effective. Further research to substantiate the efficacy of exercise treatment compared to a non-exercising control group is needed, and thorough consideration should be given to methodological aspects of study design and reporting.

Ultrasound-Guided Epi® Technique, New Treatment for Degenerative Tendinopathy

Tendinopathy is a common, painful, overuse disorder, and is associated with a failure of the tendon repair process they have a low potential for healing with the usual techniques. Although many different treatment methods have been described, there is no consensus regarding the optimal treatment for this condition. Therefore, new treatments for tendinopaties drawn from the existing literature as well as from their own experience dealing with this condition to deal with this delicate pathology have been developed over recent past decades. This brief review aims to update recent information on the treatment with the EPI® technique and tendinopathy resulted in a great improvement in function and a rapid return to the previous level of activity.

Ultrasound-Guided EPI® Technique and Eccentric Exercise, New Treatment for Achilles and Patellar Tendinopathy Focused on the Region-Specific of the Tendon

Treatment of tendon injuries is a subject of frequent debate in sports medicine and physiotherapy. Achilles and patellar tendinopathy is a common, painful, overuse disorder, and is associated with a failure of the tendon repair process they have a low potential for healing with the usual techniques. Therefore, new treatments for tendinopaties drawn from the existing literature as well as from their own experience dealing with this condition to deal with this delicate pathology have been developed over recent past decades. This brief review aims to update recent information on the treatment with the ultrasound-guided EPI® technique and eccentric exercise in Achilles and patellar tendinopathy resulted in a great improvement in function and a rapid return to the previous level of activity.

Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial.

Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

Conservative treatment of lateral epicondylitis: The impact of psychosocial factors on perceived treatment efficacy

BACKGROUND: The relationship of pain, function, and treatment in lateral epicondylitis is not fully understood. Improved understanding of this interrelationship may be required to optimize treatment strategies, particularly with regard to bracing and activity modification. METHODS: A cohort of 36 patients diagnosed by a fellowship-trained hand surgeon over a 25-month period that received treatment in the form of a cock-up wrist splint (CUWS) and recommendations of activity modification was identified. The patients’ function was defined by the QuickDash Outcome measure and pain by the Numeric Pain Rating. Retrospective analysis of prospectively collected pre-treatment data were compared to those obtained following treatment using Wilcoxon signed-rank test. Changes in QuickDash Outcome measures and Numeric Pain Rating following treatment were compared between those individuals that stated the treatment helped and those that stated it did not. RESULTS: Following treatment with a CUWS and activity modification, the median QuickDash score was 8 compared to 40 prior to treatment (95% CI: -32 ~ -20, p-value < 0.0001) indicating statistically significant functional improvement. All 36 of 36 (100%) patients stated that they were able to return to a normal activity level at the time of follow-up. Numeric Pain Rating values improved from 6 to 1 following treatment (95% CI: -6 ~ -4, p-value < 0.0001) The Kendall’s Tau-b correlation coefficient between Numeric Pain Ratings and QuickDash Outcome measure was 0.296 (p-value = 0.018) and 0.473 (p-value = 0.001) before and after treatment, respectively, suggesting a weak to moderate correlation. Patients who stated that the treatment was effective experienced a median change in their QuickDash outcome score of -23 compared to -37 for those whom did not think it was an effective treatment; the estimated difference between the two groups was 14 (CI: 2, 30, p-value 0.019) indicating that patients who thought treatment was not effective actually experienced greater functional improvement. CONCLUSIONS: These results indicate that use of a CUWS and recommendations of activity modification is an effective strategy to help improve patient function and pain levels. However, low to moderate correlation between pain and disability both before and after treatment indicate that other factors such as coping skills and psychosocial influences may effect the disease and treatment course. Furthermore, patients may still make gains in function while questioning the effectiveness of their treatment, which may make assessment of therapeutic response difficult. Future research should be directed at identifying which factors other than pain may influence disability and devising strategies to address them.

Enduring Poststroke Motor Functional Improvements by a Well–Timed Combination of Motor Rehabilitative Training and Cortical Stimulation in Rats

Background. In animal stroke models, peri-infarct cortical stimulation (CS) combined with rehabilitative reach training (RT) enhances motor functional outcome and cortical reorganization, compared with RT alone. It was unknown whether the effects of CS + RT (a) persist long after treatment, (b) can be enhanced by forcing greater use of the paretic limb, and (C) vary with treatment onset time. Objective. To test the endurance, time sensitivity, and the potential for augmentation by forced forelimb use of CS + RT treatment effects following ischemic stroke. Methods. Adult rats that were proficient in skilled reaching received unilateral ischemic motor cortical lesions. RT was delivered for 3 weeks alone or concurrently with 100-Hz cathodal epidural CS, delivered at 50% of movement thresholds. In study 1, this treatment was initiated at 14 days postinfarct, with some subgroups receiving an overlapping period of continuous constraint of the nonparetic forelimb to force use of the paretic limb. The function of the paretic limb was assessed weekly for 9 to 10 months posttreatment. In study 2, rats underwent CS, RT, and the combination during the chronic postinfarct period. Results. Early onset CS + RT resulted in greater functional improvements than RT alone. The CS-related gains persisted for 9 to 10 months posttreatment and were not significantly influenced by forced use of the paretic limb. When treatment onset was delayed until 3 months post-infarct, RT alone improved function, but CS + RT was no more effective than RT alone. Conclusion. CS can enhance the persistence, as well as the magnitude of RT-driven functional improvements, but its effectiveness in doing so may vary with time postinfarct.

The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study

BackgroundCerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based.MethodQuestionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments.ResultsChildren receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services.There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain.Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (p < .001) as compared to recipients of institution-based services.ConclusionLong term caregiving leads to strain in caregivers and there is a need to design interventions to alleviate the burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findings from this study suggest that the provision of care within a community setting as part of a well-structured outreach programme may be preferable method of service delivery within a resource-constrained context. It was associated with a greater improvement in functioning, greater satisfaction with services and better compliance.

Endoplasmic reticulum protein 29 protects cortical neurons from apoptosis and promoting corticospinal tract regeneration to improve neural behavior via caspase and Erk signal in rats with spinal cord transection.

Following spinal cord injury (SCI), limit spontaneous functional recovery often emerged. However, the neuronal mechanisms associated with this phenomenon still remains obscure. By using proteomics analysis, endoplasmic reticulum protein 29 (ERp29) was discovered to increase in the motor cortexes of spinal cord transection (SCT) rats for 28 days post-operation (dpo) compared with in 14dpo. Then, the change in the expression of ERp29 was confirmed by using reverse transcription polymerase chain reaction (RT-PCR) and Western blot. To determine the role of ERp29 in the recovery of locomotor functions following SCT, lentiviral vectors were used to up- and downregulate the expression level of ERp29. Here, we found that cortical neurons in vitro with high level of ERp29 expression exhibited a significant proliferation, characterized by smaller size of soma and more extensive axon outgrowth, compared with neurons used as control, while ERp29 silence got the opposite results. In vivo, Lentivirus was inject into the cerebral cortex following SCT at thoracic level 10, which resulted in an increase number of neuronal nuclei(NeuN)-positive cells and less apoptotic cells. Moreover, increased PKC-γ immunoreactivity density was also found in the spinal cord T9 level compared with control rats. This was associated with a great functional improvement, indicated by Basso, Beattie, Bresnahan (BBB) locomotor rating scale. Lastly, we verified that ERp29 acts as a regulator by regulating a group of genes related with cell survival and apoptosis, involving in caspase and Erk, but not PI3K. Our findings showed that ERp29 can improve locomotor function by promoting neuronal survival and axonal regeneration in SCT rats via caspase and Erk signal pathway.

The effect of glutamine, glutathione and glutamine plus glutathione as substrates for the preservation of the isolated perfused rabbit kidney (1063.3)

Rabbit kidneys were perfused with a high K+ and Mg++ solution as previously described (J S R 21(3);169,1976), with addition of substrates. Briefly the animals were anesthetized with urethane and sodium pentobarbital and the left kidney perfused at 37ºC with a previously dialyzed solution (4g% albumin) in an artificial heart‐lung machine. Several functional physiological parameters were evaluated such as perfusate and urine flow, GFR, %TNa, %TK, perfusion pressure and vascular resistance. The experiments lasted 2 hours. To measure kidney function creatinine was added to the perfusate and Na,K, and osmolarities were measured every ten minutes. Urinary flow increased 2.5‐fold in the Glutamine group when compared to control. This parameter increased 3 times in the Glutathione group and 2.1‐fold in the Glutamine + Glutathione group when compared to control. The same trend was observed with GFR that was enhanced 2.3 times in the Glutamine group, 4.1 times in the Glutathione group and 3 times in the Glutamine + Glutathione group. The fractional sodium reabsorption increased 5.0% with Glutamine, 13.0% with Glutathione and 17.0% with Glutamine + Glutathione. No changes were observed in the fractional transport of potassium. We conclude that these 2 substrates, isolated or combined, promote a great improvement in kidney function in this ex vivo model. These substrates could be important metabolic support when perfusing kidneys for transplantation.Grant Funding Source: CNPq/Brazil

Physiotherapist-delivered exercise and pain coping skills training is more effective than either intervention alone in knee osteoarthritis

K. Bennell 1,∗, Y. Ahamed1, C. Bryant2, G. Jull 3, M. Hunt4, J. Kenardy5, A. Forbes6, M. Akram6, A. Harris7, M. Nicholas8, B. Metcalf1, T. Egerton1, F. Keefe9 1 Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia 2 Psychological Sciences, University of Melbourne, and Centre for Women’s Mental Health, Royal Women’s Hospital, Melbourne, Australia 3 Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Australia 4 Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada 5 Centre of National Research on Disability and Rehabilitation Medicine, School of Psychology and Medicine, University of Queensland, Australia 6 Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Australia 7 Centre for Health Economics, Monash University, Australia 8 Pain Management and Research Centre, University of Sydney, Australia 9 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Introduction: Pain is the primary symptom in knee osteoarthritis (OA) and results from a complex interaction between structural changes, physical impairments and psychological factors. Evidence supports strengthening exercises and psychologist-delivered pain coping skills training (PCST), a form of cognitive behavioural therapy, to improve pain and physical function in this patient population. Though typically provided separately, there are symptom-, resourceand practical-advantages of exercise and PCST being delivered together by a single healthcare professional. This multisite RCT primarily aimed to investigate whether an integrated 12-week exercise and PCST treatment program delivered by physiotherapists is more efficacious than either program alone. Methods: Participants with symptomatic and radiographic knee OA were recruited from Melbourne and Brisbane, Australia and randomized to one of three groups (i) Exercise; (ii) PCST; and (iii) Exercise plus PCST. The intervention included 10 sessions with a physiotherapist over 12 weeks and participants performed home practice over the trial duration. Measurements were taken by a blinded assessor at baseline, 12, 32 and 52 weeks. Primary outcomes were overall average pain in the past week (VAS) and self-reported physical function (WOMAC) at all time points. Secondaryoutcomes includedglobal ratingof change,muscle strength, functional performance, physical activity levels, health-related quality-of-life and psychological factors. Results: 222 participants were randomized and 184 (82%) completed the 12-month trial. All groups showed improved pain following treatment with no difference between groups. However, the integrated program resulted in significantly greater improvements in physical function compared to either intervention alone at all time points (p<0.05). Benefits of the integrated program over both programs alonewere also seen for self-efficacy andquality-oflife at all time points (p<0.05). The integrated program generally showed greater improvements in psychological parameters compared to exercise alone and greater improvements in functional performance compared to PCST alone. Discussion: Results of this novel study provide strong evidence of the benefits of an integrated exercise and PCST program for physical function and a range of physical and psychological outcomes in the shortand longer-term for people with knee OA. They highlight the potential for a new model of care involving physiotherapists. Advantages of using physiotherapists to deliver PCST may include better integrationwith exercise, increased availability of PCST treatment to those who may not have access to a psychologist, reduced time and cost for patients and reduced overall costs to the health care system.

Changes of Functional Ability in Patients With Spinal Cord Injury With and Without Falls During 6 Months After Discharge

Ambulatory patients with spinal cord injury (SCI) encounter a high risk of falls. However, most of the fall data in the literature were subjectively reported, without evidence to confirm the functional ability of those with and without falls. The purpose of this study was to prospectively evaluate changes in functional ability relating to falls in participants with SCI who fell and those who did not fall during the 6-month period after discharge. A 6-month prospective design was used in the study. Fifty independent ambulatory participants with SCI were assessed for their functional ability using the Timed "Up & Go" Test, 10-Meter Walk Test, Berg Balance Scale, and Six-Minute Walk Test (6MWT) prior to discharge and 6 months afterward. After discharge, the participants' fall data were monitored monthly to categorize them into faller (≥1 fall in 6 months) and nonfaller (no fall) groups. Twenty-seven participants (54%) fell, and their baseline functional abilities were obviously lower than those who did not fall. After 6 months, the functional ability of these participants showed significant improvement for every test, whereas those who did not fall demonstrated a significant improvement only for the 6MWT. After adjusting for the baseline data, the functional ability at 6 months showed no significant differences between the groups. The study did not monitor physical activities of the participants during the follow-up period. The findings on fear of falling were subjectively reported by the participants. Participants with SCI are commonly characterized as being active and enthusiastic, which may drive their physical activities. However, sensorimotor impairments following SCI hinder their ability to move safely, particularly in those with more functional deterioration. Therefore, greater functional improvement is accompanied by a higher risk of falls. Because falls can induce serious consequences, rehabilitation professionals may need to seek strategies to improve safety issues during movement for these patients, particularly in their own environments.

Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) and eccentric exercise in the treatment of patellar tendinopathy

To investigate the outcome of ultrasound (US)-guided intratissue percutaneous electrolysis (EPI(®)) and eccentric exercise in the treatment of patellar tendinopathy during a long-term follow-up. Forty patients with patellar tendinopathy were prospectively evaluated over a 10-year follow-up period. Pain and function were evaluated before treatment, at 3months and at 2, 5 and 10years using the Victorian Institute of Sport Assessment-Patella (VISA-P) score, the Tegner score and Blazina's classification. According to VISA-P score at baseline, patients were also dichotomized into Group 1 (<50 points) and Group 2 (≥50 points). There were 21 patients in Group 1 and 19 in Group 2. Patient satisfaction was measured according to the Roles and Maudsley score. The VISA-P score improved globally by 41.2 points (p<0.01) after a mean 4.1 procedures. In Group 1, VISA-P score improved from 33.1±13 to 78.9±14.4 at 3-month and to 88.8±10.1 at 10-year follow-up (p<0.001). In Group 2, VISA-P score improved from 69.3±10.5 to 84.9±9 at 3-month and to 96.0±4.3 at 10-year follow-up (p<0.001). After 10years, 91.2% of the patients had a VISA-P score >80 points. The same level (80% of patients) or the Tegner score at no more than one level lower (20% of patients) was restored, and 97.5% of the patients were satisfied with the procedure. Treatment with the US-guided EPI(®) technique and eccentric exercises in patellar tendinopathy resulted in a great improvement in knee function and a rapid return to the previous level of activity after few sessions. The procedure has proved to be safe with no recurrences on a long-term basis. Therapeutic study, Level IV.

Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial, comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise

Aims:To compare in a randomized controlled clinical trial (RCT) the application of the TheraBite® (TB) Jaw Motion Rehabilitation System with a standard physical therapy (PT) exercise regimen for the treatment of myogenic temporomandibular disorder (TMD).Methodology:Myogenic TMD patients were randomized for the use of the TB device or for standard PT. Mandibular function was assessed with the mandibular function impairment questionnaire (MFIQ). Pain was evaluated using a visual analog scale, and maximum inter-incisor (mouth) opening (MIO) was measured using the disposable TB range of motion scale.Results:Of the 96 patients randomized (46 TB, 50 standard PT exercises), 38 actually started with the TB device and 41 with the standard PT exercises. After six-week follow-up, patients using the TB device reported a significantly greater functional improvement (MFIQ score) than the patients receiving regular PT exercises (P = 0·0050). At 6 weeks, no significant differences in pain, and active or passive MIO were found between the two groups. At 3 months, patients in both treatment groups did equally well, and showed a significant improvement in all parameters assessed.Conclusions:This RCT on myogenic TMD treatment, comparing standard PT with passive jaw mobilization using the TheraBite Jaw Motion Rehabilitation System®, shows that both treatment modalities are equally effective in relieving myogenic TMD symptoms, but that the use of the TB device has the benefit of achieving a significantly greater functional improvement within the first week of treatment.

Physiotherapist-delivered exercise and pain coping skills training is more effective than either intervention alone in knee osteoarthritis

K. Bennell 1,∗, Y. Ahamed1, C. Bryant2, G. Jull 3, M. Hunt4, J. Kenardy5, A. Forbes6, M. Akram6, A. Harris7, M. Nicholas8, B. Metcalf1, T. Egerton1, F. Keefe9 1 Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia 2 Psychological Sciences, University of Melbourne, and Centre for Women’s Mental Health, Royal Women’s Hospital, Melbourne, Australia 3 Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Australia 4 Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada 5 Centre of National Research on Disability and Rehabilitation Medicine, School of Psychology and Medicine, University of Queensland, Australia 6 Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Australia 7 Centre for Health Economics, Monash University, Australia 8 Pain Management and Research Centre, University of Sydney, Australia 9 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Introduction: Pain is the primary symptom in knee osteoarthritis (OA) and results from a complex interaction between structural changes, physical impairments and psychological factors. Evidence supports strengthening exercises and psychologist-delivered pain coping skills training (PCST), a form of cognitive behavioural therapy, to improve pain and physical function in this patient population. Though typically provided separately, there are symptom-, resourceand practical-advantages of exercise and PCST being delivered together by a single healthcare professional. This multisite RCT primarily aimed to investigate whether an integrated 12-week exercise and PCST treatment program delivered by physiotherapists is more efficacious than either program alone. Methods: Participants with symptomatic and radiographic knee OA were recruited from Melbourne and Brisbane, Australia and randomized to one of three groups (i) Exercise; (ii) PCST; and (iii) Exercise plus PCST. The intervention included 10 sessions with a physiotherapist over 12 weeks and participants performed home practice over the trial duration. Measurements were taken by a blinded assessor at baseline, 12, 32 and 52 weeks. Primary outcomes were overall average pain in the past week (VAS) and self-reported physical function (WOMAC) at all time points. Secondaryoutcomes includedglobal ratingof change,muscle strength, functional performance, physical activity levels, health-related quality-of-life and psychological factors. Results: 222 participants were randomized and 184 (82%) completed the 12-month trial. All groups showed improved pain following treatment with no difference between groups. However, the integrated program resulted in significantly greater improvements in physical function compared to either intervention alone at all time points (p<0.05). Benefits of the integrated program over both programs alonewere also seen for self-efficacy andquality-oflife at all time points (p<0.05). The integrated program generally showed greater improvements in psychological parameters compared to exercise alone and greater improvements in functional performance compared to PCST alone. Discussion: Results of this novel study provide strong evidence of the benefits of an integrated exercise and PCST program for physical function and a range of physical and psychological outcomes in the shortand longer-term for people with knee OA. They highlight the potential for a new model of care involving physiotherapists. Advantages of using physiotherapists to deliver PCST may include better integrationwith exercise, increased availability of PCST treatment to those who may not have access to a psychologist, reduced time and cost for patients and reduced overall costs to the health care system.