Terms Of Pain Improvement Research Articles

Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis

ObjectiveUnilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). MethodsWe collected retrospectively 65 patients’ data who met the inclusion criteria (July 2019–June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. ResultsAge, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. ConclusionBoth the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.

Efficacy and safety of duloxetine in painful diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials

BackgroundPainful diabetic peripheral neuropathy (PDPN) is a key concern in clinical practice. In this systematic review and meta-analysis, we compared duloxetine and placebo treatments in terms of their efficacy and safety in patients with PDPN.MethodsFollowing the PRISMA guidelines, we searched the Cochrane Library, PubMed, and Embase databases for relevant English articles published before January 11, 2021. Treatment efficacy and safety were assessed in terms of pain improvement, patient-reported health-related performance, and patients’ quality of life.ResultsWe reviewed a total of 7 randomized controlled trials. Regarding pain improvement, duloxetine was more efficacious than placebo (mean difference [MD] − 0.89; 95% confidence interval [CI] − 1.09 to − 0.69; P < .00001). Furthermore, duloxetine significantly improved the patients’ quality of life, which was assessed using the Clinical Global Impression severity subscale (MD − 0.48; 95% CI − 0.61 to − 0.36; P < .00001), Patient Global Impression of Improvement scale (MD − 0.50; 95% CI − 0.64 to − 0.37; P < .00001), and European Quality of Life Instrument 5D version (MD 0.04; 95% CI 0.02 to 0.07; P = .0002). Severe adverse events were rare, whereas nausea, somnolence, dizziness, fatigue, constipation, and decreased appetite were common; approximately, 12.6% of all patients dropped out because of the common symptoms.ConclusionsDuloxetine is more efficacious than placebo treatments in patients with PDPN. The rarity of severe adverse events indicates that duloxetine is safe. When a 60-mg dose is insufficient, 120 mg of duloxetine may improve PDPN symptoms. Our findings may help devise optimal treatment strategies for PDPN.Systematic review registrationPROSPERO CRD42021225451

Chronic lateral elbow tendinopathy with a supervised graded exercise protocol

Study DesignProspective Case Series. BackgroundVariety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ongoing and very much needed due to the uncertainty of the subject. PurposeWe aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function. MethodsThis study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks. ResultsInvestigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56). ConclusionsThe basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.

Long-Term Results of a Phase I/II Clinical Trial of Autologous Mesenchymal Stem Cell Therapy for Femoral Head Osteonecrosis

(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim of this study is to evaluate the clinical improvement in terms of pain and quality of life, as well as the safety of the procedure during the follow-up of patients. (2) Methods: A Phase I-II Open-Label Non-Randomized Prospective clinical trial was conducted. Eight patients with idiopathic ONFH and stage < IIC in the ARCO classification were included. Four weeks before therapy, 40 mL of autologous bone marrow was obtained, and MSCs were expanded under Good-Manufacturing-Practice (GMP) standards. Study medication consisted of a suspension of autologous BM-derived MSCs (suspended in a solution of 5-10 mL of saline and 5% human albumin) in a single dose of 0.5-1 × 106 cells/kg of the patient, administered intraosseously with a trocar and under radioscopic control. Per-protocol monitoring of patients included a postoperative period of 12 months, with a clinical and radiological assessment that included the visual analog scale (VAS), the Harris scale, the SF-36, and the radiological evolution of both hips. In addition, all patients were further followed up for eight years to assess the need for long-term total hip replacement (THR) surgery. (3) Results: Median age of patients included was 48.38 ± 7.38 years, and all patients were men. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell administration. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 12.5% of patients improved at the end of follow-up, whereas 50% improved clinically. No adverse effects related to the procedure were recorded, and none of the patients needed THR surgery within the first year after MSC therapy. (4) Conclusions: The use of autologous MSCs for patients with ONFH disease is feasible, safe in the long term, and potentially effective.

Estudio de la malrotación del componente femoral como causa de dolor tras la implantación de una artroplastia total de rodilla

IntroductionThe total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. Material and methodWe have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. ResultsThe total was 133 patients that was divided in two groups. A control group and pain group. The control group was made up of 70 patients with a mean age of 69.59years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48years (13 men and 50 women). We did not found difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. The analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. ConclusionThe results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.

Efficacies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis

BackgroundVarious conservative treatment methods can be administered in the early stages of plantar fasciitis (PF). The aim of the treatment is to enable the patient to return to the physical activity as soon as possible. AimIn this study it was aimed to compare efficacies of Extracorporeal Shockwave Therapy (ESWT) and Low-Level Laser Therapy (LLLT) on patients with PF. DesignA local prospective cross-sectional study SettingDepartment of Physical Medicine and Rehabilitation Outpatient Clinic of Sakarya University, Faculty of Medicine PopulationPatients aged 18–70 years, having ongoing heel pain for at least 3 months, and not using oral and/or parenteral corticosteroids in the last 6 months. MethodsA total of 40 patients with PF included in the current study. Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), American Orthopedic Foot and Ankle Association Score (AOFAS) and Foot Function Index (FFI) questionnaire were performed for all patients. ESWT and LLLT groups comprised of 22 (55%) and 18 (45%) patients, respectively. ResultsWe found significant improvements in scores based on the VAS, RMS, AOFAS, FFI in patients with PF and it was sustained for 3 months (p = 0.001, for all scores). While decrease in scores based on the VAS and FFI in LLLT group was statistically more significant compared to ESWT group (p = 0.014, p = 0.013), there was statistically less significant decrease in scores on the AOFAS in LLLT group than that of ESWT group (p = 0.032). ConclusionsThe results of this study indicated significant improvements in terms of pain, functional status and daily life activities following the administration of either of the treatments. Furthermore, LLLT was found to be significantly more effective for alleviating pain than ESWT in the treatment of PF.

Primary bone lymphoma of proximal tibia presenting with pathological fracture: A case report

Abstract Primary bone lymphoma (PBL) is an uncommon tumor accounting for approximately 4%–5% of extranodal lymphoma and less than 2% of all non-Hodgkin’s lymphoma. Diffuse large B-cell lymphoma is the most common pathological type, comprising nearly 80% of PBL. We report a case of a 35-year-old male presented to outpatient department with a pathological fracture of the left proximal tibia secondary to primary B-cell lymphoma. Initially, the clinical presentation simulated chronic osteomyelitis, but on further workup, it comes to be a case of histopathological and immunohistochemistry confirmed primary B-cell lymphoma of the left proximal tibia. He was managed with chemotherapy. There is clinical improvement in terms of pain and swelling with no preternatural adverse effects of chemotherapy. Although the incidence of PBL is very rare, in view of good treatment response to the chemotherapy, as in our case, PBL should be kept in mind as a differential diagnosis; workup should be done accordingly by applying appropriate immunohistological markers for early diagnosis and treatment.

Роль пропріоцептивної нейром’язової фасилітації у фізичній терапії пацієнтів з адгезивним капсулітом плечового суглобу

The purpose of the study was to perform an analysis of the results of studies devoted to the study of the effectiveness of proprioceptive neuromuscular facilitation in patients with adhesive capsulitis of the shoulder joint. Materials and methods. This work is the result of an analysis of studies devoted to the study of the effect of proprioceptive neuromuscular facilitation as monotherapy and as a part of a complex physical therapy or rehabilitation program on the range of motion in the shoulder joint, pain on the visual analog scale, and the shoulder pain and disability index. During the search in scientific databases, the data of 11 studies, which are devoted to the specified issues, were selected. Results and discussion. Studies examining the immediate effects of interventions have found both benefits and no benefits on amplitude measures in groups of patients who received proprioceptive neuromuscular facilitation in addition to physical therapy or as a component of adjunctive therapy. Thus, it is not possible to draw unequivocal conclusions in the question of advantages regarding the immediate effect. Analysis of the effectiveness of programs and courses of treatment for adhesive capsulitis of the shoulder joint established that in the vast majority of studies, the results in the proprioceptive neuromuscular facilitation groups were better at the end of the treatment (3-4 weeks). At the same time, in most studies, scientists noted a significant improvement in pain, amplitude, and functioning indicators in control groups, that is, without the use of proprioceptive neuromuscular facilitation. All of the reviewed papers that analyzed the effectiveness of adding only proprioceptive neuromuscular facilitation to physical therapy programs or adding proprioceptive neuromuscular facilitation as a part of adjunctive therapy found advantages in such groups in terms of pain improvement on a visual analog scale or a pain subscale in questionnaires. Only one such study did not indicate a benefit of proprioceptive neuromuscular facilitation in external rotation. In addition, in most cases, proprioceptive neuromuscular facilitation or combined therapy with proprioceptive neuromuscular facilitation had a better effect on the amplitude of abduction and flexion at the shoulder joint. Conclusion. The developed Ukrainian versions of the questionnaires can be used to assess the level of therapeutic alliance and patient satisfaction in the field of physical therapy and occupational therapy

Effects of Sciatic Nerve Mobilization on Pain, Disability and Range in Patients with Lumbar Radicular Pain

Background: Lumbar radicular pain is one of the leading causes of musculoskeletal disability. Variety of conventional treatment options are available. Aim: To find the effectiveness of sciatic nerve mobilization on disability and range of straight leg raise in patients with lumbar radicular pain. Study Design: Randomized control trail. Methodology: In this single blinded randomized control trial eighty patients were randomly divided in two groups. The experimental group received sciatic nerve mobilization along with routine physical therapy treatment whereas control group only received routine treatment in form of moist hot pack and back exercises. Outcomes were pain, disability and straight leg raise range measured through numeric pain rating scale, Modified Oswestry disability index MODI and inclinometer. The outcomes were assessed at baseline and at 4th and at 6th weeks of the treatment. Data was analyzed by SPSS software, version 20 as qualitative variables were expressed as mean ± SD. Paired sample t-test was applied. Results: Between groups analysis showed a significant difference in mean in both groups. Within group analysis was done using paired sample t test showed significant improvement (p &lt;0.05) occurred in all variables in terms of pain, disability and straight leg raise range but sciatic nerve group had better improvement in terms of pain and disability as compared to conventional group. Conclusion: We concluded that sciatic nerve mobilization was an effective treatment for pain and disability in patients with lumbar radicular pain. Keywords: Lumbar Radicular Pain, Lumbar Radiculopathy, Sciatic Nerve Mobilization and Sciatic Nerve Neurodynamics.

Comparison of Efficacy of Acupuncture-Related Therapy in the Treatment of Postherpetic Neuralgia: A Network Meta-Analysis of Randomized Controlled Trials.

Background Postherpetic neuralgia (PHN) is the most common sequela of herpes zoster, and the efficacy of the treatment regimens recommended in the guidelines is not entirely reliable. Acupuncture and moxibustion are widely used complementary alternative therapies that have a positive effect on the treatment of PHN. However, there are various forms of acupuncture and moxibustion, and there are differences in efficacy between the different forms. Methods The retrieval work of randomised controlled trials (RCTs) of acupuncture for PHN in English databases (including PubMed, Cochrane Library, Embase, Web of Science) and Chinese databases (including China National Knowledge Infrastructure (CNKI), WeiPu database, WanFang database, and China Biomedical Literature Database) were conducted from the time of database creation to June 2022. Literature screening, data extraction, and evaluation of risk of bias for the included studies were carried out independently by two researchers, and data analysis was performed using Stata 14.2 software. Results A total of 30 RCTs including 2138 patients with PHN were included. In terms of pain improvement, acupoint embedding + Western medicine group, bloodletting-cupping group, and bloodletting-cupping + Western medicine group ranked top. In terms of total efficiency, acupuncture + Western medicine group, bloodletting-cupping + Western medicine group, and acupoint embedding group ranked top. There were no statistically significant differences in the incidence of adverse events between treatment regimens. Conclusions In a comprehensive comparison of the outcome indicators of 14 different treatment regimens, we considered acupoint injection + Western medicine and bloodletting-cupping + Western medicine to be the best combinations for the treatment of PHN. Due to the limitations of the study, the above conclusions still need to be validated in further multi-centre, large-sample prospective randomised controlled clinical trials.

Clinical Outcomes of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: an Analysis of Injury Location, Age, and Body Mass Index

Category: Sports; Other Introduction/Purpose: Extracorporeal Shock Wave Therapy (ESWT) is one of the major advances in orthopedics over the last 20 years as a method for orthopedic surgeons to conservatively treat tendon pathologies such as Achilles tendinopathy (AT). Unfortunately, previous studies involve only a small number of cases, relatively short duration of symptoms, and simple measures of pain. The purpose of this study is to evaluate the impact of age, body mass index (BMI), and location of AT (Insertional (IAT) or Non-Insertional (nIAT)) on clinical outcomes and return to sport (RTS) time after ESWT. Methods: This is a retrospective cohort study that included existing clinical data from 40 patients from a single academic institution. Patients greater than 18 years of age who underwent ESWT for Achilles tendinopathy in the office setting between 8/1/2019 to 8/30/2021 were included. Clinical outcomes of patients were evaluated through the self-reported Visual Analogue Scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores for assessing pain and functional outcomes of Achilles Tendinopathy. Descriptive statistics were used to provide an overview of the patient characteristics, including sex, age, laterality of injury, BMI, duration of symptoms, RTS time, and follow-up. For these data, mean and standard deviation were calculated, and paired samples T-tests and Welch's T-tests were performed on clinical outcome scores. Results: This study included 48 patients (62 heels), with an average age of 50.8+-14.2 years, BMI of 27.3+-5.3, follow-up of 6.41+- 6.9 months, and RTP time of 5.39+-5.3 weeks. Patients with a BMI &lt;25.0 had significantly higher post-operative VISA-A scores (p=0.007) compared to those with a BMI &gt;25.0, and post-operative VAS scores displayed this trend without significance (p=0.07). Patients &lt;=50 years old had significantly higher post-operative VISA-A scores (p=0.02) compared to those &gt;50 years old, and post-operative VAS scores displayed this trend without significance (p=0.1). Pre- and post-operative VISA-A scores, and post- operative VAS scores, were not significantly different between IAT and nIAT cohorts, except for pre-operative VAS scores where nIAT was higher (p=0.03). Additionally, we found significant improvements in pre-operative to post-operative scores for VAS scores for IAT and nIAT cohorts (p&lt;0.0001), as well for VISA-A for the IAT cohort (p=0.008), but no significant improvement in VISA for the nIAT cohort (p=0.119). Conclusion: Increased BMI and age are determinant factors that significantly adversely affect functional scores (VISA-A) in patients with AT treated with ESWT, but no significant differences were found for these risk factors in terms of pain improvement (VAS). Additionally, we found that the nIAT cohort had significantly higher pre-operative pain than IAT, and no significant improvement in VISA-A scores (though there was a trend of functional improvement). This aligns with the fact that the mid- substance of the Achilles tendon is a watershed area with relatively low vascularity compared to the insertional portion, where lower perfusion weakens the healing benefits of ESWT.

Effect of Pilates based exercises for improving pain and physical function in symptomatic knee osteoarthritis –a randomized controlled clinical trial

Background and Objective: Osteoarthritis (OA) a common wear and tear pathology of joints occurring among females. There is need of exercises regimen is known to be the most appropriate conventional treatment that stop the progression of degeneration. Pilates based exercises are recommended for reduction of the pain and strengthen the peripheral muscles. The Objective was to determine the effects of Pilates based exercises on pain and physical function in women with knee OA.&#x0D; Methodology: This randomized clinical trial was conducted on 40 female patients with knee OA grade II and III, selected randomly and divided into two groups. After baseline evaluation using WOMAC scale, both groups received interventions for 8 weeks, 3 times per week and each session lasting for an hour. Statistical analysis using analysis of variance and independent sample t test significance at p &lt; 0.1 were used.&#x0D; Results: In the study, 20 females in each group with mean age in Pilates group 57.60 ± 6.34 and in isometrics group was 55.65 ± 7.28. The results showed that both groups differed significantly over the time period of 8 weeks and showed significant improvement for pain and physical function; p &lt; 0.1. When comparing Pilates with isometrics, patients in Pilates group showed significantly better improvement in terms of pain and physical function; p &lt; 0.1.&#x0D; Conclusion: Pilates based exercises had significant effects in improving physical function and reduction of pain with statistically significant difference compared to Isometric exercises in symptomatic knee OA. Trial Registration Number: Chi CTR 2000030486&#x0D; Abbreviations: OA – Osteoarthritis; WOMAC - Western Ontario &amp; McMaster University Osteoarthritis Index; ROM - range of motion; QoL - quality of life; PBE - Pilates based exercises&#x0D; Key Words: Exercise; Isometrics; Knee osteoarthritis; Pilates; Pain; Physical Functions; WOMAC&#x0D; Citation: Saleem N, Waseem I, Batool F, Mahmood T, Mahmood W. Effect of Pilates based exercises on symptomatic knee osteoarthritis for improving pain and physical function –a randomized controlled clinical trial. Anaesth. pain intensive care 2022;26(3): 291-296; DOI: 10.35975/apic.v26i3.1894&#x0D; Received: November 21, 2021, Reviewed: February 8, 2022, Accepted: March 7, 2022&#x0D;

Effect of Pilates based exercises on symptomatic knee osteoarthritis: A Randomized Controlled Trial.

To determine the effects of Pilates exercises on pain, knee range of motion and functional disability in women with knee osteoarthritis. The double-blind randomised controlled trial was conducted at the National Orthopaedic Hospital, Bahawalpur, Pakistan, from April to September 2018, and comprised female patients with knee osteoarthritis. The subjects were selected and randomised into control group A receiving isometrics and intervention group B receiving Pilates exercises. Both groups received one-hour sessions 3 times per week for 8 weeks. The groups were assessed at baseline and at the end of the 8th week using numeric pain rating scale and Western Ontario and McMaster Universities osteoarthritis index for pain and functionality level respectively. Data was analysed using SPSS 23. Of 44 patients, there were 22(50%) in each of the two groups. Mean age of group B was 57.60±6.34 years, and it was 55.65±7.28 in group B. Mean body mass index of group B was 25.812±4.16, and it was 26.93±4.4 in group A. The study was completed by 40(91%) patients; 20(50%) in each of the two groups. Both groups showed significant improvement for pain, range of motion and physical function post-intervention (p<0.05). Group B showed significantly more improvement in terms of pain and physical function compared to group A (p<0.05). Pilates exercises were found to be more effective in the treatment of patients with knee osteoarthritis. Chi CTR 2000030486.

Combination of Cervical Traction with Transcutaneous Electrical Nerve Stimulation on Patient with Cervical Radiculopathy:A Case Report

Cervical radiculopathy is the result of cervical nerve root pathology with the sensory, motor and reflexes changes that may lead to chronic pain and disability. Although, conservative interventions including cervical traction, TENS and exercises have been previously shown to be effective in reducing pain and disability caused by cervical radiculopathy, the combined effect of the same has not been documented. The purpose of this study is to present the effect of cervical traction combined with TENS followed by exercises on pain and disability in a patient with cervical radiculopathy. A 34-year-old man presented with an acute history of neurological cervicobrachial pain and whose diagnosis was confirmed with cervical radiculopathy as per the clinical prediction rule. Cervical traction and TENS was applied simultaneously followed by exercises to reduce the patient’s pain and disability measured at baseline and after 1 week using the Numeric Pain Rating Scale, the Neck Disability Index and the PatientSpecific Functional Scale. Improvements in all outcome measures were noted over a period of one week. Results showed that the patient’s pain had almost disappeared and he was able to return to job without difficulties and limitations. In conclusion, the findings of this study support that the application of cervical traction combined with TENS can produce significant improvements in terms of pain and disability in cervical radiculopathy.

Early outcomes with the vantage total ankle prosthesis

The Vantage total ankle replacement is a modern prosthetic design not well investigated in the literature. The aim of the present study was to analyze the early outcomes and complications of the Vantage total ankle system. Twenty-two Vantage total ankle implants were included in this retrospective study. Survivorship, complication rate, patient satisfaction, postoperative brace use, and pain levels were evaluated. At a mean follow up of 24.6 months (range 24 to 32 months). there was a 4.54% (1/22) overall complication rate and 100% implant survivorship. Patient-reported pain scores decreased from an average 7.4 (range 5-10).preoperatively to 0.66 (range 0-3). postoperatively. Only 9.09% (2/22) of patients required a brace postoperatively, and there was a 100% patient-reported satisfaction rate. The Vantage total ankle system was associated with a low complication rate and positive early outcomes in terms of pain improvement and patient-reported satisfaction.

RENaBack: low back pain patients in rehabilitation—study protocol for a multicenter, randomized controlled trial

BackgroundMillions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.MethodsThe aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program.The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).DiscussionAn improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.Trial registrationDRKS, DRKS00020373. Registered on 15 April 2020

Impact of strengthening exercises with and without blood flow restriction on quadriceps of knee osteoarthritis patients.

To determine the effect of blood flow restriction with strengthening exercises on knee osteoarthritis patients. The case-control study was conducted at the Department of Physical Medicine and Rehabilitation, Combined Military Hospital, Okara, Pakistan, from June to December 2018, and comprised knee osteoarthritis patients who were assigned to two equal groups. The cases in Group A received strengthening exercises with blood flow restriction, while the controls in Group B received strengthening exercises without blood flow restriction. Both groups were given 4 sessions of treatment per week with 5-minute warm-up on a stationary bike for 4 weeks. Outcome was measured using visual analogue scale, Kujala scoring questionnaire and muscle girth measurement. Data was analysed using SPSS 20. Of the 30 patients, 15(50%) were in each of the two groups. There were 20(66.7%) females and 10(33.3%) men with an overall mean age of 66.5}6.5 years. Also, 18(60%) subjects were overweight on the basis of body mass index. There were significant improvement in terms of pain and disability in both the groups (p<0.05)), but only Group A showed significant improvement in muscle girth (p<0.05). Overall there was no significant difference between the groups (p>0.05). Strengthening exercises reduced pain and disability, but the addition of blood flow restriction had no significant impact except in terms of muscle size.

Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design.

Background:Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined.Purpose:To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group.Results:Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms (P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups.Conclusion:Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain

Objective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement.&#x0D; Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &amp;post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ?3) was considered after 12 months.&#x0D; Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value &lt; 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement.&#x0D; Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF.

Revision Reverse Shoulder Arthroplasty for Anatomical Glenoid Component Loosening Was Not Universally Successful: A Detailed Analysis of 127 Consecutive Shoulders.

Glenoid component loosening is a primary cause of failure of anatomical total shoulder arthroplasty (TSA) and is commonly associated with glenoid bone loss. The purpose of the present study was to evaluate the outcome and survival following revision to a reverse total shoulder arthroplasty (RSA) for the treatment of loosening of a polyethylene cemented glenoid component in the setting of failed TSA. Between 2010 and 2017, 151 shoulders underwent revision to RSA for the treatment of loosening of an anatomical polyethylene glenoid component. Shoulders with staged reconstruction for the treatment of infection were excluded. One hundred and twenty-seven patients (67 women and 60 men) had a single-stage reconstruction and were available for follow-up. The mean age at the time of surgery was 70 years (range, 41 to 93 years). In all cases, the humeral component was revised and a standard glenoid baseplate was utilized. Bone graft was used at the discretion of the treating surgeon. Medical records and radiographs were reviewed to collect demographic, intraoperative, and postoperative data; to quantify glenoid bone loss; and to determine the radiographic outcome. The mean duration of follow-up was 35 months (range, 24 to 84 months). Revision to RSA resulted in significant improvements in terms of pain and motion. Sixteen shoulders (13%) underwent revision surgery for the treatment of baseplate loosening. Radiographic baseplate loosening was present in 6 additional shoulders (overall rate of baseplate loosening, 17%). Intraoperative fracture or fragmentation of the greater tuberosity occurred in 30 shoulders (24%). Other reoperations included resection for deep infection (3 shoulders), arthroscopic biopsies for unexplained persistent pain (2 shoulders), humeral tray exchange for dislocation (2 shoulders), revision for humeral loosening (1 shoulder), irrigation and debridement for hematoma (1 shoulder), and internal fixation of periprosthetic fracture (1 shoulder) (overall reoperation rate, 20%). Among shoulders with surviving implants at the time of the most recent follow-up, pain was rated as none or mild in 83 shoulders (65.4%) and the average active elevation and external rotation were 132° and 38°, respectively. With the numbers available, no risk factors for failure could be identified. Revision RSA for the treatment of loosening of an anatomical polyethylene component was associated with a 17% glenoid mechanical failure rate. Although this procedure resulted in improvements in terms of pain and function, it was not universally successful and thus needs further refinement in order to improve outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.