Significant Difference In Pain Research Articles

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Unicompartmental knee arthroplasty and total knee arthroplasty are well established treatment options for end-stage osteoarthritis, UKA still remains infrequently used if you take all knee arthroplasties into account. An important factor following knee arthroplasty is pain control in the perioperative experience, as high postoperative pain level is associated with persistent postsurgical pain. There is little literature which describes pain values and the need for pain medication following UKA and/or TKA. So far, no significant difference in pain has been found between UKA and TKA. The aim of the study was to evaluate differences in the postoperative course in unicompartmental knee arthroplasty vs. total knee arthroplasty regarding the need for pain medication and patient-reported outcomes including pain scores and side effects. We hypothesized that unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of postoperative pain values and the need of pain medication. In this project, we evaluated 2117 patients who had unicompartmental knee arthroplasty and 3798 who had total knee arthroplasty performed, from 2015 to 2018. A total of 4144 patients could be compared after performing the matched pair analysis. A professional team was used for data collection and short patient interviews to achieve high data quality on the first postoperative day. Parameters were compared after performing a 1:1 matched pair analysis, multicenter-wide in 14 orthopedic departments. Pain scores were significantly lower for the UKA group than those of the TKA group (p < 0.001 respectively for activity pain, minimum and maximum pain). In the recovery unit, there was less need for pain medication in patients with UKA (p = 0.004 for non-opioids). The opiate consumption was similarly lower for the UKA group, but not statistically significant (p = 0.15). In the ward, the UKA group needed less opioids (p < 0.001). Patient subjective parameters were significantly better for UKA. After implantation of unicompartmental knee arthroplasty, patients showed lower pain scores, a reduced need for pain medication and better patient subjective parameters in the early postoperative course in this study.

Ultrasound-guided vs conventional arthrocentesis for management of temporomandibular joint disorders: A systematic review and meta-analysis

ABSTRACT Objective This systematic review and meta-analysis aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of temporomandibular joint disorders (TMDs). Methods PubMed, Embase, Scopus, BioMed Central, CENTRAL, and Google scholar databases were searched up to April 1 2020 for randomized control trials (RCTs) comparing US-guided and conventional arthrocentesis. Results Four RCTs were included. Pooled analysis did not demonstrate any statistically significant difference in pain or maximal mouth opening (MMO) scores after 1 week and 1 month of follow-up between US-guided and conventional arthrocentesis. Studies also reported data on intra-operative needle relocations and operating time but with conflicting results. Conclusion This study indicates that the use of US during arthrocentesis may not improve postoperative pain and MMO in the short term. Data on intra-operative outcomes are scarce and conflicting for any definitive conclusions. Further high-quality adequately powered RCTs are required to strengthen current evidence.

Quality of life in a real-world study of patients with metastatic colorectal cancer treated with trifluridine/tipiracil.

Quality of life (qol) is important for oncology patients, especially for those with late-stage disease. The present study was initiated to address the lack of published prospective data about the qol benefits of trifluridine/tipiracil (ftd/tpi) compared with best supportive care (bsc) in patients with refractory metastatic colorectal cancer (mcrc). This prospective, cross-sectional, non-interventional study used multidimensional validated scales to evaluate patient-reported qol in two study cohorts of patients and also to measure differences in mcrc-related symptoms and pain in a real-world clinical setting. Our findings demonstrate that patients with refractory mcrc report better overall qol when treated with ftd/tpi than with bsc alone. In that population, statistically significant differences in mean qol measures favoured ftd/tpi over bsc for physical symptom distress, psychological distress, activity impairment, overall valuation of life, and symptomatology. The overall better qol for patients receiving ftd/tpi implies that treatment was well tolerated and was associated with a lower symptom burden. No significant differences for pain were observed between the groups. This study suggests that ftd/tpi is a well-tolerated option for the treatment of patients with refractory mcrc, showcasing the value of capturing real-world qol data in routine clinical practice.

Evaluating Prospective Patient-Reported Pain and Function Outcomes after Ankle and Hindfoot Arthrodesis

Category:Hindfoot; AnkleIntroduction/Purpose:Hindfoot and ankle arthritis and deformity constitute a significant disease burden upon affected patients. Surgical hindfoot and ankle arthrodesis procedures are indicated for pain and instability in such patients and include ankle arthrodesis, tibitalocalcaneal (TTC) fusion, subtalar arthrodesis, and triple arthrodesis. Long-term patient-reported outcomes, including postoperative pain, function, and overall satisfaction, of these procedures have not yet been well-studied. The purpose of this study was to assess the outcomes and prognosis of various hindfoot fusion subtypes along with ankle fusion by using two validated patient-reported outcome measures: The Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs).Methods:The sample consisted of 68 patients presenting to a tertiary care facility for ankle and hindfoot fusion surgeries, including ankle arthrodesis (n= 16), TTC fusion (n= 9), subtalar arthrodesis (n= 25), and triple fusion (n= 18), who had completed preoperative, 12-month postoperative, and 24-month postoperative PROMIS PF and PI CATs. Differences in CAT T-scores were calculated for each patient to create a prognostic estimation of pain and physical function at one and two years postoperative. Mean absolute T-scores for each procedure were also calculated and compared to PROMIS reference population mean (SD) T- scores of 50 (10). The distribution of PROMIS PF and PI T-scores were assessed via a Shapiro-Wilk test, and then paired t-tests were used to compare mean differences in T-scores.Results:Importantly, no statistically significant difference was found between 12-month mean PI scores for patients undergoing any fusion procedure and PROMIS reference population mean. Moreover, triple fusion patients had significantly decreased pain at 12 (delta-T-score= -11.10, p= 0.02) and 24 months (delta-T-score= -12.72, p= 0.01) relative to preoperative T-scores along with increased physical function at 12 (delta-T-score= 6.67, p= 0.04) and 24 months (delta-T-score= 8.70, p= 0.04). PF differences after 12 months were not statistically significant for ankle (delta-T-score= -1.67, p= 0.73), TTC (delta-T-score= 0.04, p= 0.99), or subtalar arthrodesis (delta-T-score= 0.37, p= 0.72). PI decreased after 12 months for ankle (delta-T-score= -14.57, p= 0.16), TTC (delta-T-score =-4.08, p= 0.21), and subtalar arthrodesis (delta-T-score= -0.64, p= 0.53); however, these differences did not achieve statistical significance.Conclusion:Overall, at 12 months after an ankle or hindfoot arthrodesis, patients experienced a similar level of pain to the reference population mean. Following a triple fusion procedure, patients can be provided with an accurate prognosis that they can expect reduced pain and increased physical function that will progressively improve from 12 to 24 months postoperative. No statistically significant difference in pain or physical function at 12 or 24 months for ankle, TTC, or subtalar arthrodesis was found.

Comparison of pain during intravitreal dexamethasone, ranibizumab and aflibercept injection

BackgroundThis study aimed to compare pain scores of patients during intravitreal aflibercept, ranibizumab or dexamethasone implant injection procedures.MethodsThis study included 162 eyes of 162 patients, who received intravitreal ranibizumab, aflibercept or dexamethasone implant injections at our clinic. Following the injection, patients were asked to rate their pain from 0 (no pain) to 10 (worst pain) using a visual analogue pain score survey (VAS). VAS was evaluated according to age, sex, indication for the injection, number of previous intravitreal injections, and lens status in the study eye.ResultsThe mean VAS in the ranibizumab, aflibercept or dexamethasone implant groups was 3.38 ± 2.31, 3.82 ± 2.46, and 3.61 ± 2.94, respectively. Female patients reported a higher average pain score than male patients (p = 0.02). Also, phakic patients reported a higher average pain score than pseudophakic patients (p = 0.01). Pain did not significantly correlate with indication for the injection, number of injections, and injection drugs (p > 0.05).ConclusionPain associated with intravitreal injection is generally mild and associated with sex, age, and lens status. There was no significant difference in pain between intravitreal injections of dexamethasone implant, ranibizumab or aflibercept.

Kompres Air Hangat dalam Mengurangi Nyeri Persalinan Kala I

Every prespective mother has different intensity and level of pain during a labor. The greatest pain happens in the end of the first phase on servix opening, contraction and maximum uterus. Labor pain causes an uncomfortable feeling during labor process. There are many ways to resolve the pain, but the most effective way have not found yet. The purpose of this research is to measure the warm water compresses efectivity in resolving labor pain on the first phase. Design research with quasi experiment. The sample of this research are 28 giving birth mothers on the first active phase. The study was conducted by compressing warm water on the mother's back for 20 minutes by measuring pain scale. The results showed that mothers who entered labor in the first active phase had pain with a mean of 3.28 higher than mothers after warm water compresses with a mean of 1.54. The results of the dependent T-test analysis is P-value 0.0001 (P &lt;0.05). There is a significant difference in pain of mothers entering labor on the first active phase before being given warm water compresses than after being given warm water compresses.

Orthosis in Thoracolumbar Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Systematic review and meta-analysis of randomized controlled trial (RCT). The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization. Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery. Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed. Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35-5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months. Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies. 3.

Hyaluronidase to Reduce Pain from Local Anaesthetic Infiltration for Carpal Tunnel Decompression.

Abstract Aims: The aim of this prospective cohort study is to investigate the effect of hyaluronidase on pain experienced during local anaesthetic infiltration for carpal tunnel decompression. Methods: Two cohorts of twenty consecutive patients each underwent carpal tunnel release by a single surgeon over a five-month period. The first twenty patients received a local anaesthetic solution of lignocaine and adrenaline whilst the second group received a mixture of lignocaine, adrenaline and hyaluronidase (Hyalase®). All consecutive patients booked for simple open carpal tunnel decompression under local anaesthesia were included. Patients with other compressive neuropathies, generalised neuropathies or other concomitant hand pathologies were excluded from the study. The primary outcome measurement was pain experienced during local anaesthetic infiltration. Patients were asked to indicate the level of pain felt using a visual analogue scale (VAS) between 0 (no pain) to 10 (maximum pain they can imagine). Secondary outcome measures were operating time, measured as tourniquet time and early complication rates. Results: Patients administered local anaesthesia with hyaluronidase experienced significantly less pain on infiltration of the proximal palm (p &lt; 0.05) and distal palm (p &lt; 0.05) compared to those that did not receive hyaluronidase. Infiltration of the palm was the most painful part of the procedure for both groups. There was no statistically significant difference in pain reported on initial needle insertion (p = 0.95) or on infiltration of the distal forearm (p = 0.10). No patients in either group required additional local anaesthetic. The mean tourniquet time for the group receiving local anaesthesia without hyaluronidase was 3.79 minutes (range 3 to 5 minutes, SD 0.71) versus to 3.65 minutes (range 3 to 5 minutes, SD 0.67) for the hyaluronidase group. There was therefore no significant difference in operating time between the two cohorts (p = 0.53). No early complications were observed in either groups. Conclusion: This study finds that hyaluronidase is effective at reducing pain during local anaesthetic infiltration for carpal tunnel release. We therefore recommend its routine use.

Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial.

Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3). Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval. Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00). Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.

Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery.

To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes. Prospective cohort. Tertiary academic hospital. Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0-100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2-week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors. A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required. Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.

Impact of physical therapists’ instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial

BackgroundTo investigate the impact of physical therapists’ instructions on the perception of post dry needling (DN) soreness and function in patients with mechanical neck pain. MethodsSeventy-five patients with neck pain were randomly assigned to three groups: “positive” group (n = 25) received positive verbal input; “negative” group (n = 25) received negative verbal input, and control group (n = 25) did not receive any input about post-needling soreness. All three groups received DN of a trigger point in the upper trapezius muscle. The subjective pain experience, pressure pain threshold (PPT), and neck disability Index (NDI) were assessed before and after DN. ResultsPatients in all groups showed improvement in pain, PPT and NDI. There were no significant differences in pain (P = 0.41) and PPT (P = 0.68) in the positive and negative groups compared with the control group. Significant difference in function was seen with the NDI after DN of patients in the positive and negative groups compared with the control group (P = 0.011, standard error: 1.08–1.5). ConclusionConsidering that the power of our study may be too low to draw more definitive conclusions, DN appears to be an effective technique to improve pain and mechanical hyperalgesia. The experience of post-needling soreness does not appear to influence the outcome of DN on pain, PPT, and NDI. Post-needling soreness does not seem to be a limiting factor in achieving acceptable outcomes, especially when clinicians offer DN within a therapeutic emphasizing a positive patient response. This study questions whether any treatments need to be offered to patients receiving DN.

What Is the Effect on Kinesio Taping on Pain and Gait in Patients With Patellofemoral Pain Syndrome?

IntroductionPatellofemoral pain syndrome (PFPS) is one of the leading causes of anterior knee pain treated by orthopedists and physical therapists. This syndrome predominantly affects young, active individuals, and remains a challenging syndrome to manage due to the lack of quantitative diagnostic criteria to monitor during treatment. The etiology of this syndrome is believed to be multifactorial, with the gait and movement patterns of a patient potentially contributing to pain due to increased stress on the knee. In this study, we investigated the gait of participants with PFPS using the GaitRite system (CIR Systems Inc., Clifton, NJ) before and after the application of Kinesio Tape in order to assess the impact of Kinesio Tape on cadence, stance time, and pain.MethodsA convenience sample of 10 participants were recruited for this study, with five participants without PFPS serving as controls, and five with PFPS in the Kinesio Tape group. Participants in the Kinesio Tape groups served as their own internal control, ambulating both before and after taping. All participants ambulated across the GaitRite carpet three times and completed a visual analogue scale pain score for each trip.ResultsThe results of our study found there to be no significant difference in the cadence for gait between the participants without PFPS and participants with PFPS (105.2 seconds vs. 105.1 seconds, p = 0.272), or in the stance time between the control and PFPS group (1.43 seconds vs. 1.44, p = 0.907). Similarly, no significant difference was found in participants with PFPS before and after Kinesio Taping in the cadence and stance times (105.1 seconds vs. 107.4 seconds, p =0.288, and 1.44 vs. 1.40, p = 0.272). There was a significant difference in pain in PFPS participants before and after taping, with a 112.5% reduction in pain reported after taping (3.4 vs. 1.6, p < 0.05).Discussion and conclusionThis study is one of the first studies to utilize the GaitRite system in order to analyze the impact of Kinesio Tape on gait in participants with PFPS. While our study failed to demonstrate a significant difference in the gait of participants with PFPS in comparison to those without PFPS, we did demonstrate a significant reduction in pain after the application of Kinesio Tape. These results suggest other variables addressed by the Kinesio Tape may be causing the pain associated with PFPS.

Comparison of the Effect of Custom Insole With CAD-CAM and Conventional Insole on FAOS Questionnaire Subscales in Patients With Plantar Fasciitis

Objective: One of the significant causes of foot pain is plantar fasciitis. The use of medical insoles is a conventional treatment for this condition. The purpose of this study was to compare the effect of the customized insole with the CAD-CAM and conventional insole on pain, symptoms, daily activity, exercise and recreational activity, and quality of life in patients with PF. Materials &amp; Methods: This quasi-experimental study was performed on 14 patients with plantar fasciitis (five women and nine men) with the mean age of 40 years. Fourteen patients have been diagnosed with orthopedic pain after being diagnosed with plantar fasciitis according to inclusion criteria. Diagnosis of the complication of plantar fasciitis by orthopedic physician, Patients with flexible flat foot. No neurological disorders or any foot pathology such as diabetes and osteoarthritis. Patients were randomly assigned into two groups of 7 using customized insole with CAD-CAM and conventional (prefabricated) insole. From the outset it was found to be one of two types of insole to be studied: first the patient was given a CNC insole, and the other 13 patients received the same insole and divided into two groups. The instrument of this study was the FAOS questionnaire (foot and ankle outcomes) which measures the five variables of pain, symptoms, daily activities, sports and recreational activities, and quality of life. Both groups completed the questionnaire before using the insole and again after six weeks. Compressive scan of both groups was accomplished using EMED foot pressure system. The custom-made insole was designed using Rhino Cross software and then shaved using EVA foam blocks with 50% shore using a CNC machine. In the conventional insoles group, patients received conventional polyurethane insoles based on the length measurements of the single leg. Patients completed the questionnaire again after six weeks. Data were analyzed by SPSS software v. 22. After checking the normality of the data by Shapiro-Wilk test, non-parametric Mann-Whitney and Wilcoxon tests were used to analyze the data. Results: In the pre-intervention phase, there was no significant difference in pain, symptoms, daily activities, recreational-sports activities, and quality of life in the two groups, and the two groups were homogeneous. After six weeks, there was a significant difference between the two groups in the FAOS questionnaire (P&lt;0.05). There was no significant difference between the two groups in pain score, symptoms, daily activities, recreational-sport activities, and quality of life (P &lt;0.05). Conclusion: According to the results of this study, both customized insoles with CAD-CAM and conventional insoles are effective in improving FAOS questionnaire subscales. There was no significant difference in the impact between the two types of insoles in foot and ankle.

Predicting Pain Trajectories in the One Year Following Breast Cancer Diagnosis-An Observational Study.

The impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified—“Transient Pain trajectory” (TP) (39/89 patients) and “Persistent Pain trajectory” (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, −0.82; 95% CI, −1.25 to −0.38; p < 0.001) and a higher score in “Persistent pain trajectory” (PP vs. TP: 0.12 ± 0.36 vs. −0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer.

Compression Stocking Length Effects on Oedema, Pain, and Satisfaction in Nursing Students: A Pilot Randomized Trial.

Professional practitioners who are required to stand for long periods of time frequently complain about vein-related symptoms. Compression stocking are effective for vein-related symptoms, but there is not enough evidence on the effect of the length of compression stockings for nursing students. To compare oedema, pain, and satisfaction according to different lengths of compression stockings worn by female nursing students. This study was conducted as a randomized clinical trial. The participants included 20 female nursing students in their first semester of clinical practice training. Compression stockings with 25–32 mmHg pressure were used in the study; the participants were divided into two groups based on the length of compression stocking: knee length and thigh length. Differences between groups regarding pain, oedema, and satisfaction were analysed using t-tests, paired t-tests, and Mann–Whitney U tests, when appropriate. There were no significant differences in pain, oedema, and satisfaction between the two groups. However, pain in right legs of the thigh-length stocking group significantly increased after clinical training shift compared with that before the shift (t = −2.377, p = 0.041). Both groups reported high satisfaction. There were no differences in pain, oedema, and satisfaction in both legs based on the length of compression stockings, but side effects appeared in participants wearing the thigh-length stockings; nevertheless, satisfaction was high in both groups. It may be important to suggest nursing students to wear knee-length compression stockings during clinical practice training.

Effectiveness of additional deep-water running for disability, lumbar pain intensity, and functional capacity in patients with chronic low back pain: A randomised controlled trial with 3-month follow-up

BackgroundAquatic exercise (AQE) programme is commonly used as an alternative to the chronic low back pain (CLBP) treatment. The addition of aquatic aerobic exercises to AQE may be beneficial to patients with CLBP. DesignRandomised controlled trial. ObjectivesTo assess the effectiveness of AQE with the addition of aerobic exercise - deep-water running (DWR) - compared to exclusive AQE in improving disability, lumbar pain intensity, and functional capacity in patients with CLBP. MethodsFifty-four adult patients with CLBP were randomised either to the experimental group (AQE + DWR) or the control group (AQE). An assessor who was blinded to the group allocation performed both pre- and post-interventions assessments. Both treatments lasted 9 weeks, with a 3-month follow-up. The primary outcome was disability, as evaluated using the Roland Morris Disability Questionnaire. The secondary outcomes were pain and functional capacity; pain was assessed using a visual analogue scale (VAS), and functional capacity (travelled distance) was measured using the 6-min walk test (6WT). ResultsA significant difference in pain was observed between groups after intervention in favour of DWR (mean difference −1.3 cm [95% confidence interval (CI) −2.17 to −0.45], d‾ = 0.80 [95% CI 0.22 to 1.33]). ConclusionTreatment with DWR was effective in the short term for achieving the desired outcome of pain reduction when compared with AQE only but not for disability and functional capacity.

Acupuncture is as Effective as Exercise for Improvement of Chronic Neck Pain: A Randomized Clinical Trial

Background: Exercise therapy is a standard method used for alleviation of chronic neck pain (CNP). However, few studies have compared the efficacy of acupuncture to exercise therapy on functional improvement and pain reduction. Acupuncture will cause more pain relief and functional improvement compared to exercise therapy in the patients with CNP. Methods: A randomized clinical trial was conducted in Rasool-e-Akram Hospital from September 2017 to October 2018. A total of 68 patients with CNP were randomized to receive either exercise therapy or acupuncture. Clinical outcome was documented at baseline, after 6 and 12 weeks based on the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPDS). Results: In patients treated with acupuncture, mean NPDS and NDI values were 56.309 and 20.35, respectively. In patients undergoing physical therapy these values were 52.912 and 21.50, respectively. No significant difference in pain and function was observed between the two groups at the final follow-up (P &gt; 0.05). Likewise, neck pain and function improved significantly in both groups at the follow-up points (P &lt; 0.001). Conclusions: In the patients with CNP and radicular neck pain, acupuncture and exercise therapy were equally effective on pain reduction and functional improvement.

Comparison of surgical outcomes between rotator cuff repair with and without rotator interval capsular release for rotator cuff tears to prevent and improve postoperative stiffness: a meta-analysis.

A common complication of rotator cuff (RC) repair is a postoperative stiffness. Postoperative stiffness may develop and lead to inferior functional outcomes. Rotator cuff repair with additional rotator interval (RI) capsular release can be done to prevent postoperative stiffness in rotator cuff tears. However, routine rotator interval capsular release in rotator cuff repair is controversial. Therefore, we conducted a systematic review and meta-analysis to compare the postoperative outcomes between RC repair with and without RI capsular release for RC tears with and without concomitant stiffness. We searched all comparative studies that compared postoperative outcomes (VAS, CS, ASES, complications and ROM at 3, 6 and 12months) of RC repair with and without RI capsular release for RC tears with and without concomitant stiffness from PubMed and Scopus databases from inception to the February 1, 2020. Seven of 255 studies (six comparative studies and one RCT) (N = 803 patients) were eligible; 2 and 5 studies were included in the pooling of RC repair and RI release without concomitant stiffness and stiffness, respectively; 2, 6, 3, 6, 3, 5, 7, 7, and 7 studies were included in pooling of VAS, CS, ASES at 6 and 12months and range of motion (internal, external rotation and forward flexion) at 3, 6 and 12months, respectively. The UMD of VAS, CS and ASES scores at 6- and 12-month follow-up for the RC repair and RI release group was 0.48 (95% CI: 0.05, 0.90), 0.93 (-1.70, 3.56), -2.27 (-5.30, 0.76), -0.04 (-0.24, 0.15), 1.66 (0.77, 2.55) and 1.58 (0.21, 2.96) scores when compared to RC repair alone with and without concomitant stiffness. In terms of ROM, forward flexion for the RC repair and RI release group was -4.60 (-10.61, 1.41), -7.11 (-15.47, 1.25) and -0.70 (-2.51, -1.11) degrees at 3, 6 and 12months, respectively, when compared to RC repair alone. For external rotation, RC repair and RI release were -0.12 (-8.27, 8.03), -3.98 (-12.09, 4.14) and -2.65 (-5.35, 0.04) degrees at 3, 6 and 12months, respectively, when compared to RC repair alone. For internal rotation in RC repair and RI release, the values were -1.22 (-1.97, -0.48), -1.01 (-1.79, -0.23) and -0.19 (-1.13, 0.74) degrees at 3, 6 and 12months, respectively, when compared to RC repair alone. There were no differences with a RR of 0.92 (0.46, 1.84) between the two groups in terms of complications. After subgroup analysis, RC repair with RI release had no clinically significant differences for pain, function and ROM when compared to RC repair alone in RC tear patients with and without preoperative stiffness. RC repair with RI release in patients with and without preoperative stiffness had no statistically significant differences for pain, function (CS and ASES) and range of motion (FF, ER and IR) when compared to RC repair alone in RC injury patients. II.

Effectiveness of Conventional Physiotherapy Exercises Versus Kinesiotaping in Recreational Football Players with Plantar Fasciitis

Background: Plantar fasciitis is a disorder in which there is non-inflammatory structural breakdown of the plantar fascia. It is more common in sports that involve running and long- distance walking. Many of the literature suggest that there is 21.7 % of prevalence rate of plantar fasciitis in individuals who play sports, especially in football players who uses studs/cleats shoes. Attachment of the cleats place the foot in a dorsiflexed position throughout the stance phase of running which produces and increases pressure upon the calcaneus. This creates a pull from soft tissue attachments such as plantar fascia which further leads to disorders like plantar fasciitis which needs to be treated early and by more advanced techniques to prevent further overuse injuries. Objective: To find the effect of conventional physiotherapy exercises versus kinesiotaping in football players with plantar fasciitis. Material and Method: In this pre-post intervention study 40 football players having plantar fasciitis were included. They were randomly divided into 2 groups with 20 individuals each. Group A was treated with conventional exercises and Group B with kinesiotaping along with conventional exercises for two weeks. After pre-post assessment, data was analysed with help of appropriate statistical methods. Results: According to the result, in Group A and Group B there is significant difference in pain and measures of foot function index with p value &lt; 0.0001. Conclusion: The results obtained by studying both the groups in this study suggests that in treatment of plantar fasciitis, Conventional Therapy along with Kinesiotaping is more effective than Conventional Therapy alone.

Sequence of Pelvic Examination Does Not Affect Patients With Baseline Vulvovaginal Syndromes: A Randomized Clinical Trial.

The purpose of this study is to determine the optimal sequence in performing a pelvic examination to reduce discomfort in patients with baseline vaginal pain. A randomized controlled trial of women presenting for a new appointment at the Drexel Vaginitis Center was conducted. Women were assigned to either group A, a Q-tip touch test, speculum examination, then bimanual examination, or group B, a Q-tip touch test, bimanual examination, then speculum examination. The primary outcome was visual analog scales to assess pain at baseline and after each portion of the examination. Secondary outcomes were responses to questionnaires for self-esteem, quality of life, and sexual function. Two hundred women were enrolled in the trial. For both group A and group B, each portion of the examination was similarly scored regardless of whether the speculum examination was performed before or after bimanual examination. Pain during the speculum examination was higher than pain during the other components of the examination, although not significant (P = 0.65).When looking at reported pain outcomes, outcomes did not differ as a whole or between groups in relation to sexual activity, sexual orientation, and previous hysterectomy. The data were not significantly different between groups for self-esteem scores, sexual dysfunction, or quality of life scores. In women with baseline vaginal pain, there was no difference in pain scores between the different components of the pelvic examination, nor is there a significant difference in pain during the examination compared with their baseline pain. Most patients reported minimal pain during each component.