Significant Improvement In Pain Research Articles

Topical fosaprepitant for the treatment of ocular pain and inflammation

PurposeTo assess whether topical administration of fosaprepitant improves intractable chronic ocular pain and inflammation. MethodsWe report three clinical cases of female patients with drug-resistant ocular pain associated with inflammatory diseases of the ocular surface. The patients were treated for 3 (case 1) and 4 (cases 2–3) weeks with fosaprepitant eyedrops (0.1 mg/mL for case 1; 10 mg/mL for case 2–3). Patients were then followed up for at least 3 weeks. We measured ocular pain with the Visual Analogue Scale (VAS), the Ocular Surface Disease Index (OSDI), and corneal sensitivity with the Cochet-Bonnet esthesiometry. Slit-lamp photography and corneal confocal imaging were used to assess ocular surface integrity/conjunctival hyperemia and corneal nerve morphology, respectively. ResultsAll three patients had severe ocular pain (score higher than 6/10 VAS scale). All patients reported a significant improvement in ocular pain after 1 week of treatment. We also observed reduced corneal epitheliopathy (case 1) and conjunctival hyperemia (cases 1–2). In two patients (cases 2–3) the treatment was repeated after 1 year and 9 weeks, respectively, and pain reduction was similar in magnitude to what we observed after the first administration. ConclusionsTopical administration of fosaprepitant ameliorates ocular pain and clinical symptoms in three patients with intractable ocular pain associated with inflammatory diseases of the ocular surface, without adverse effects. ImportanceFosaprepitant instillation holds promise as a treatment of chronic ocular pain, an area of unmet medical need.

Effectiveness of an Educational Booklet for the Management of Patients with Chronic Low Back Pain

Introduction: The aim of the present study was to assess the effectiveness of provision of an educational booklet for the management of patients with chronic low back pain. Material and Methods: A Randomized controlled clinical trial was conducted from January 2018 to June 2018 among 80 patients attending at Physical Medicine and Rehabilitation outpatient department of the Shaheed Suhrawardy Medical College and Hospital after obtaining requisite consent from the patients. 80 Patients were divided into two groups (Group A and Group B). Group A contains Patients educational booklet group + exercises + analgesics (Case group). Group B contains Physicians advice only group + exercises + analgesics (control group). Data were collected through interviewing and examining of the patients. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the effectiveness of provision of an educational booklet for the management of patients with chronic low back pain. The study was approved by the institutional ethical committee. Results: In a pool of 80 patients, the range of age was 18-55 years in case group and control group. There was no significant difference found in age between case and control group (p value is 0.383). Among the patients of case group 28 (70.0%) were male and 12 (30.0%) were female. Among the patients of control group 17 (42.5%) were male and 23 (57.5%) were female. Visual analogue score (VAS) score of group A patient was 5.4±1.0 and group B was 5.7±1.1 (p=0.143). At the first follow up the mean VAS score of group A was 4.5±1.0 and group B was 4.8±0.9 (p=0.111). At the second follow up the mean VAS score of group A was 3.1±0.9 and group B was 3.5±0.8 (p=0.077). And at the final (third) follow up the mean VAS score of group A was1.9±0.8 and group B was 2.4±0.6 (p=0.002). Conclusion: There was significant improvement of pain of case group than control group. At the end of study we can tell that, educational booklet is effective for the management of patients with chronic low back pain. Medicine Today 2023 Vol.35(2): 87-90

Effectiveness of a specific strength program of the gluteus maximus muscle to improve dynamic postural control in female basketball players. A randomized controlled trial

BackgroundBasketball is a team sport in which players perform multidirectional movements, jumps and landings, experiencing abrupt accelerations and decelerations and numerous changes of rhythm. In this sport, speed and intensity are two key factors that are associated with an increased risk of injury. The aim of this randomized controlled trial was to determine the effectiveness of a specific gluteus maximus strength programme as preventive work for young female basketball players, to improve dynamic postural stability and to observe its impact in the rate of lower limb injuries, vertical jump, dynamic knee valgus and pain. Research questionIs effective a strength programme to improve dynamic postural stability, vertical jump and dynamic valgus in female basketball players? MethodsA hundred and thirteen female basketball players that play in professional clubs were recruited, reaching the final stage 92 (46 per group). One group (CG) received conventional injury prevention training while the experimental group (EG) added to the conventional team prevention program, a gluteus maximus strength programme of 5 months composed of 4 exercises/2 days per week/2 sets of 10 repetitions per leg. ResultsThe total injury incidence decreased from 0.33 to 0.16 cases (control group pre=0.43 to post=0.14 cases, EG pre=022 to post=0.19). The EG improved overall (p = 0.000), posterior (p = 0.001), posteromedial (p = 0.001) and posterolateral (p = 0.000) dynamic stability of the right leg; anterior (p = 0.024), medial (p = 0.07) and posteromedial (p = 0.01) of the left leg. Both groups improved vertical jump (GC: p = 0.045 and GE: p = 0.000). There was no significant improvement in pain or valgus. SignificanceThis strength programme is effective in improving dynamic stability especially of the dominant leg and jump height.

Twenty-four-month interim results from a prospective, single-arm clinical trial evaluating the performance and safety of cellular bone allograft in patients undergoing lumbar spinal fusion

BackgroundAutologous bone grafts are the gold standard for spinal fusion; however, harvesting autologous bone can result in donor site infection, hematomas, increased operative time, and prolonged pain. Cellular bone allografts (CBAs) are a viable alternative that avoids the need for bone harvesting and may increase fusion success alone or when used as an adjunct material. The present study examined the efficacy and safety of CBA when used as an adjunct graft material to lumbar arthrodesis.MethodsA prospective, single-arm, multicenter clinical trial (NCT 02969616) was conducted in adult subjects (> 18 years of age) undergoing lumbar spinal fusion with CBA graft (CBA used as primary (≥ 50% by volume), with augmentation up to 50%). Radiographic fusion status was assessed by an independent review of dynamic radiographs and CT scans. Clinical outcomes were assessed with the Oswestry Disability Index (ODI), and Visual Analog Scales (VAS) score for back and leg pain. Adverse events were assessed through the 24-month follow-up period. The presented data represents an analysis of available subjects (n = 86) who completed 24 months of postoperative follow-up at the time the data was locked for analysis.ResultsPostoperative 24-month fusion success was achieved in 95.3% of subjects (n = 82/86) undergoing lumbar spinal surgery. Clinical outcomes showed statistically significant improvements in ODI (46.3% improvement), VAS-Back pain (75.5% improvement), and VAS-Leg pain (85.5% improvement) (p < 0.01) scores at Month 24. No subject characteristics or surgical factors were associated with pseudoarthrosis. A favorable safety profile with a limited number of adverse events was observed.ConclusionsThe use of CBA as an adjunct graft material showed high rates of successful lumbar arthrodesis and significant improvements in pain and disability scores. CBA provides an alternative to autograft with comparable fusion success rates and clinical benefits.Trial registrationNCT 02969616.

Instrumental Gait Analysis and Tibial Plateau Modelling to Support Pre- and Post-Operative Evaluations in Personalized High Tibial Osteotomy

High tibial osteotomy (HTO) is intended to treat medial knee osteoarthritis by realigning the joint such that the loading in the knee during functional activity shifts laterally. The aim of this study was to use a novel methodology combining motion analysis and 3D modelling to assess the efficacy of this surgery in changing the loading location in the knee in a cohort of 25 patients treated with personalized HTO. Pre-operatively and at 6 months post-surgery, weight-bearing CT and gait analysis during level walking were performed on all patients, as well as clinical evaluations using KOOS and VAS scores. CT scans were used to generate a knee bone model and a virtual tibial plateau plane; the intersection pattern between this plane and the ground reaction force (GRF) vector was calculated in the pre- and post-operative gait analyses. Clinical scores improved significantly (p &lt; 0.001) after surgery (pre-/post-operative KOOS and VAS: 56.2 ± 14.0/82.0 ± 8.3 and 6.3 ± 1.7/1.5 ± 1.7). Post-operative GRF-to-tibial plateau intersection patterns were significantly (p &lt; 0.001) more lateral (31.9 ± 19.8% of tibial plateau width) than the pre-operative patterns. Personalized HTO successfully and consistently lateralizes the GRF at the knee, in association with significant improvements in function and pain. The novel combination of 3D bone modelling and motion analysis also has the potential to further aid HTO surgical planning.

A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain.

The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion. In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed. There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility. Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period. www.isrctn.com, ISRCTN88098928.

Arthroscopic Lysis of Adhesions for Stiffness After Surgical Management of Proximal Humerus Fractures Leads to Satisfactory Outcomes in Most Patients

To report patient-reported outcomes (PROs), range of motion (ROM), and satisfaction, in patients who underwent arthroscopic lysis of adhesions for stiffness after open reduction with internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) for fracture. A retrospective review was performed to identify patients with stiffness who underwent arthroscopic lysis of adhesions following ORIF or RSA for proximal humerus fracture at a single institution between 2012 and 2021 with minimum 1-year follow-up. PROs including visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value (SSV), as well as active ROM including forward flexion (FF), external rotation (ER), internal rotation (IR), were collected pre- and postoperatively. Attempted nonoperative treatment before arthroscopic lysis of adhesions was documented. Complications and satisfaction were also recorded. A total of 21 patients met the study criteria (4 RSA, 17 ORIF), with an average age of 66.7 ± 8 years. The study sample comprised mostly of female patients (90%). The mean time from the index surgery to arthroscopy was 9 months, and mean follow-up post-lysis was 17 months. Patients with ORIF reported significant pain relief (VAS, Δ -3.2) and improvement in range of motion (FF, Δ 36°; ER, Δ 20°; IR Δ 3 spinal levels) and PROs (ASES, Δ 34.7; SSV Δ 44.8) (P < .01) after lysis. Patients with RSA had significant improvement in ASES (Δ 21.8; P= .04), SSV (Δ 8.8; P= .04), and FF (Δ38; P= .02) but did not have significant improvement in VAS (Δ -2; P= .2), ER (Δ 0°; P= 1.0), and IR (Δ 1 spinal level; P= .2). Satisfaction was 100% in the RSA cohort and 82% in the ORIF cohort. No complications were observed. Arthroscopic lysis of adhesions for stiffness after surgical management of proximal humerus fracture leads to satisfactory outcomes in most patients. Post-ORIF, patients may achieve improvement in PROs and global ROM, whereas post-RSA, patients may achieve improvement in PROs and FF but do not necessarily improve in rotational ROM. Level IV, therapeutic case series.

Effects of mirror therapy on pain, sensitivity and functionality in patients with unilateral carpal tunnel syndrome. Randomised control trial

Purpose To investigate the effects of mirror therapy (MT) and therapeutic exercise (TE) with the unaffected hand, on pain, sensitivity and functionality in individuals with unilateral carpal tunnel syndrome (CTS). Material and methods A randomized controlled trial was carried out. Thirty-nine adults with unilateral CTS were included and randomly allocated to a six-week training programme based on MT (n = 20) or TE (n = 19). Visual Analogue Scale, Semmes-Weinstein monofilament test, Two-point discrimination (2PD), Disabilities of the Arm, Shoulder and Hand (DASH) and Boston Carpal Tunnel Questionnaire (BCTQ) were assessed before (T0) and after the intervention (T1), and at one-month follow-up (T2). Results At T1, MT and TE showed significant improvements in pain (p = 0.001 and p = 0.03, respectively), however, only MT maintained the achieved effects at T2 (p = 0.01). In addition, 2PD significantly improved in MT in the first (p = 0.04) and fourth fingers (p = 0.02) at T1. The DASH score decreased at T1 in MT (p < 0.001) and TE (p = 0.01). Additionally, the BCTQ score improved in MT (p < 0.001), and TE (p < 0.001) at T1. The effects were maintained at T2 for DASH and BCTQ scores. Conclusions Training of the unaffected hand resulted in a significant improvement of the affected hand in both groups; nevertheless, MT achieved a longer duration of the effects.

Clinical efficacy of "Sancai therapy" for hyperplasia of the mammary glands: A systematic review and meta-analysis.

Hyperplasia of the mammary glands (HMG) is the most prevalent breast disease and can become malignant if left untreated. Although "Sancai therapy" has been widely used to treat HMG, its efficacy has not yet been systematically reviewed. This study aims to systematically evaluate the clinical efficacy of Sancai therapy for HMG treatment and provide a clinical basis for its future use. PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, CBM, VIP, and Wanfang databases were reviewed for related data collection. Chinese and English databases were searched for randomized controlled trials on Sancai therapy for HMG. The retrieval date was February 27, 2023. Exclusion criteria: (1) Non-HMG patients; (2) case reports, literature reviews, animal experiments, systematic reviews; and (3) full text could not be obtained. Data obtained after literature screening were imported into the RevMan 5.4.1 software for meta-analysis, and the included literature was assessed for methodological quality using the "bias risk assessment" tool within the software. The meta-analysis included 11 studies. Compared to the control group, the Sancai therapy treatment group exhibited an overall increased efficacy (relative risk = 1.36, 95% confidence interval [CI] [1.18, 1.58], P < .0001), an increased cure rate (relative risk = 3.74, 95% CI [1.70, 8.25], P = .001), a significant improvement in breast pain (standard mean difference = -2.68, 95% CI [-3.41, -1.96], P < .00001), and a reduction in breast masses (standard mean difference = -2.87, 95% CI [-3.75, -1.99], P < .00001). Sancai therapy significantly improved the overall efficacy, cure rate, and breast pain and reduced breast mass compared with the control groups. However, further large-sample, high-quality, double-blind randomized controlled trials are required to increase the level of evidence. INPLASY202380124.

The impact of being overweight or obese on 12 month clinical recovery in patients following lumbar microdiscectomy for radiculopathy

BACKGROUND CONTEXTThe proportion of patients who undergo lumbar microdiscectomy due to lumbar radiculopathy who are also overweight or obese is high. However, whether high body mass index (BMI) affects clinical outcomes is not well-studied. PURPOSETo investigate the difference in the clinical course between normal weight, overweight, and obese patients with radiculopathy who underwent lumbar microdiscectomy followed by physical therapy and to evaluate whether high BMI is associated with poor recovery. STUDY DESIGN/SETTINGA prospective cohort study with a 12-month follow-up was conducted in a multidisciplinary clinic. PATIENT SAMPLEWe included 583 patients (median [IQR] age: 45 [35–52] years; 41% female) with clinical signs and symptoms of lumbar radiculopathy, consistent with magnetic resonance imaging findings, who underwent microdiscectomy followed by postoperative physical therapy. OUTCOME MEASURESOutcomes were leg pain and back pain intensity measured with a visual analogue scale, disability measured with the Roland Morris Disability Questionnaire at 3 and 12-month follow-ups, and complications. METHODSPatients were classified as being normal weight (46.9%), overweight (38.4%), or obese (14.7%). A linear mixed-effects model was used to assess the difference in the clinical course of pain and disability between the three BMI categories. The association between BMI and outcomes was evaluated using univariable and multivariable logistic regression analyses. RESULTSAll three patient groups experienced a significant improvement in leg pain, back pain, and disability over 3 and 12-month follow-up. Patients who were overweight, obese, or normal weight experienced comparable leg pain (p=.14) and disability (p=.06) over the clinical course (p=.14); however, obese patients experienced higher back pain (MD=−6.81 [95%CI: −13.50 to −0.14]; p=.03). The difference in back pain scores was not clinically relevant. CONCLUSIONSIn the first year following lumbar microdiscectomy, patients demonstrated clinical improvements and complications that were unrelated to their preoperative BMI.

Efficacy and safety of percutaneous cement discoplasty in the management of degenerative spinal diseases: A systematic review and meta-analysis.

Percutaneous cement discoplasty (PCD) is a minimally invasive procedure. We aim to explore the efficacy and indication(s) of PCD in patients with degenerative disc disease (DDD). The search was conducted across Ovid MEDLINE, Ovid Embase, and PubMed. Data on study design, patient demographics, pre- and post-procedure Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores, and complications were extracted. Inclusion criteria focused on adult patients with degenerative spinal diseases treated with cement discoplasty. The overall effect size was evaluated using a forest plot, and heterogeneity was assessed using the I2 statistic and chi-squared test. The search strategy yielded six studies, which included 336 patients (73.8% female, 26.2% male) with a mean average age of 74.6 years. VAS scores were reported in all studies, showing a significant difference between pre- and post-PCD pain scores (Weighted Mean Difference [WMD]: -3.45; 95% CI: -3.83, -3.08; I2 = 15%; P < .001). ODI scores were reported in 83% of studies, with a significant difference between pre- and post-PCD scores (WMD: -22.22; 95% CI: -25.54, -18.89; I2 = 61%; p < .001). Complications reported included infections, thrombophlebitis, vertebral fractures, disc extrusion, and the need for further operations. The analysis showed clinically significant improvements in pain and functional disability based on VAS and ODI scores. However, due to methodological limitations and a high risk of bias, the validity and generalizability of the findings are uncertain. Despite these issues, the results provide preliminary insights into PCD's potential efficacy and can guide future research to address current limitations.

SAS-PRP Study: A Real-Life Satisfaction Assessment in Patients with Cartilage Lesions of the Knee Treated by Platelet-Rich Plasma.

Platelet-rich plasma (PRP) is a rising therapy treating locomotor system lesions such as knee osteoarthritis. The objective of this study was to evaluate patients' satisfaction 6 to 12 months after a PRP injection for cartilage lesions of their knee under real-life conditions. Patients' satisfaction was assessed by a specific questionnaire named SATMED-Q©, which explores six different dimensions of a given treatment. In addition, pain and function were assessed thanks to VAS pain, WOMAC, and IKDC scores. Responders were identified through the OMERACT-OARSI criteria. We observed excellent satisfaction after a PRP injection with a SATMED-Q© score of 80.81% 6 to 12 months after the procedure. Even when there was no significant improvement in pain and function scores, 52% of the evaluated population fulfilled the OMERACT-OARSI criteria and were considered responders. According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren-Lawrence grades 1-2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee.

Effect of Vastus Medialis Oblique Strengthening Versus Mulligan Knee Taping Technique (Mcconnell Tape) on Patellofemoral Pain Syndrome: A Comparative Study.

This study aims to determine the effectiveness of Vastus medialis oblique (VMO) strengthening and conventional therapy treatment (group A) andMulligan knee taping technique(McConnell tape) and conventional therapy treatment (group B) in patients with patellofemoral pain syndrome by VAS for pain andKPS for anterior knee pain scale is to compare VMO strengthening Versus Mulligan knee taping technique using McConnell tape in patellofemoral pain syndromeusing VAS for assessing pain and Kujala patellofemoral scale to assess knee pain and function. The most frequent cause of knee discomfort with retro patellar orperipatellar pain is patellofemoral pain syndrome (PFPS). The need for further studies to better understand the causes and treatment of PFPS is essential to provideoptimal care for individuals experiencing pain in the knee. Physical therapy is considered the most effective treatment for PFPS, but more research is needed todetermine each individual's best course of action. Proper diagnosis is the key to successful treatment and prevention of PFPS. Early intervention is also important forbetter outcomes. Patellofemoral pain syndrome (PFPS), which is often used interchangeably with "anterior knee pain" or "runner's knee," is the clinical entity ofstiffness or pain or both on prolonged sitting with the knees flexed and pain with activities that load the patellofemoral joint, such as climbing or descending stairs,squatting, running and kneeling. Varieties of conservative treatments are suggested, like quadriceps strengthening, stretching, braces and straps, electrotherapy, footorthosis, patellar taping, etc. Hence, a comparison between the vastus medialis obliqus muscle strengthening and patellar taping was undertaken to determine theireffectiveness concerning pain and function. A well-organized research study was conducted over 12 months to investigate the impact of strengthening the vastusmedialis oblique muscle and applying conventional therapy treatment. Group A received this combination of treatments, while Group B was assigned a treatmentprotocol involving the use of McConnell tape along with conventional therapy treatment. After taking informed and written consent, 30 subjects diagnosed withunilateral or bilateral PFPS were randomly selected and allocated into two groups - Group A (VMO muscle strengthening and conventional therapy treatment) andGroup B (Mulligan knee taping technique (McConnell tape) and conventional therapy treatment). Both groups received 6 therapy sessions every alternate day for 6weeks. The visual analog scale (VAS) and Kujala patellofemoral scale (KPS) measured pre and post-pain and function. "T-Test" was used for statistical analysis. Therewas a significant improvement in pain and function in patients with Patellofemoral pain syndrome at the end of 6 weeks regarding VAS and KPS within both groups,i.e., groups A and B (p&lt;0.01). But there was no significant difference regarding improvement in pain and functional status in patients with Patellofemoral painsyndrome at the end of 6 weeks in terms of VAS and KPS between groups. The effect of conventional therapy treatment along with VMO muscle strengthening issimilar to the conventional therapy treatment along with patellar taping in improving pain and functional level in patients with patellofemoral pain syndrome at theend of 6 weeks.

A randomized controlled study on systematic nursing care based on health empowerment theory and its effect on the self-care and functional abilities of patients with spinal fractures

ObjectiveIn this study, we aimed to explore the effectiveness of systematic nursing care based on health empowerment theory on the self-care and functional abilities of patients with spinal fractures.MethodsWe selected a total of 50 patients with spinal fractures from our hospital and randomly divided them into the control group and the observation group, with 25 patients in each group. Patients in the control group received conventional nursing care, while those in the observation group received systematic nursing care grounded in the health empowerment theory. We recorded and compared the self-care ability, functional ability, knowledge about the condition, and pain scores of patients in the two groups before and after the nursing intervention.ResultsThere was no significant difference in the baseline characteristics between the two groups (P > 0.05), and there was no significant difference in self-care ability, functional ability, knowledge about the condition, or the visual analog scale (VAS) score between the two groups before treatment (P > 0.05). After treatment, outcomes in the observation group in terms of self-care ability, functional ability, and knowledge about the condition were significantly better than those in the control group (P < 0.05), while the VAS score in the observation group was significantly lower than that in the control group (P < 0.05).ConclusionCompared with conventional nursing care, patients with spinal fractures who received systematic nursing inputs based on health empowerment theory reported significant improvements in pain, self-care, functional ability, and knowledge of the condition, and this is an approach that is worthy of promotion in clinical use.

Cuidados de las zonas donantes de injertos de piel de espesor parcial. Umbrella review

ObjectivesTo summarize the current evidence and develop recommendations on the most effective management of partial-thickness graft donor sites in adults to improve re-epithelialization, pain, and infection. MethodologyUmbrella review. A systematic search of Pubmed, CUIDEN, Cochrane Library, CINHAL Plus, SCOPUS, and LILACS databases was conducted between October and December 2021, including systematic reviews published in the last 10 years that inquired about the effectiveness of any partial-thickness graft donor site healing strategy. Reviews with very low critical appraisal according to AMSTAR 2 were excluded. Included reviews were scored using the SIGN scale to determine their level of evidence and grade of recommendation. ResultsFive systematic reviews with meta-analysis were included. A statistically significant improvement in re-epithelialization and pain was observed in platelet-rich plasma and human amniotic membrane in relation to the control group. In addition, wound infection also decreased in platelet-rich plasma. A decrease in re-epithelialization time was also observed in recombinant human growth hormone. ConclusionsThe use of platelet-rich plasma is recommended to improve re-epithelialization, pain, and infection in partial-thickness graft donor sites in adults. The application of human amniotic membrane is recommended to accelerate re-epithelialization and reduce pain, and recombinant human growth hormone is recommended to accelerate the time to completely heal these wounds.

Improving Patient Access to Musculoskeletal Treatments and Medical Student Musculoskeletal Education via Free Clinic Services.

Introduction Homeless patients are at higher risk for musculoskeletal conditions but have limited access to treatments. Physical therapy (PT) and osteopathic manual therapy (OMT) are treatments for acute and chronic musculoskeletal conditions. Here, we outline establishing a free specialty clinic to provide PT and OMT to underserved patients. Methods At Eastern Virginia Medical School's Health Outreach Partnership of EVMS Students (HOPES) free clinic, we established a volunteer student, resident, and attending-led specialty clinic to provide exercise therapy, manual therapy, and injections to underserved patients. Results Student volunteering resulted in significant improvement in student confidence with musculoskeletal physical exam skills and their ability to diagnose musculoskeletal conditions. Patients of the clinic reported significant improvement in pain and mobility. Discussion This clinic is a novel activity that improves student musculoskeletal medical education and patient access to musculoskeletal condition treatments. Exposing students to PT and OMT services increased student awareness of the PT scope of practice, OMT's use as a component for patient treatment increased confidence in the appropriate applications of OMT for patient care. Implementing a free PT and OMT clinic at an established free clinic can improve musculoskeletal medical education and enhance patient care for underserved populations.

Comparison of the effects of manual therapy and scapular stabilization exercises on pain, functional status, and quality of life in subacromial impingement syndrome

Aims: This study aimed to determine the effects of manual therapy and scapular stabilization exercises combined with conventional physiotherapy on pain, functional status, and quality of life, and whether they are superior in individuals with subacromial impingement.&#x0D; Methods: 30 patients between the ages of 25-65 who were diagnosed with subacromial impingement syndrome were included in the study. Individuals were randomized 1:1 to "conventional physiotherapy+scapular stabilization" and "conventional physiotherapy+manual therapy" groups. Individuals' age, gender, medication use, and presence of chronic disease were recorded. The presence of pain was measured by the Visual Analogue Scale, shoulder range of motion was measured by a goniometer, quality of life was measured by Short Form-12 Quality of Life Survey, and functional status was evaluated with the Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems. The conventional physiotherapy program applied to both groups included electrotherapy, passive and active assisted range of motion exercises, and rotator cuff strengthening exercises. Both groups received a total of 12 sessions of physiotherapy, 3 days per week, for 4 weeks.&#x0D; Results: 19 females and 11 males, participated in the study. There were no statistically significant differences between the groups at baseline assessment for pain at rest, activity, and night (p=0,37; 0,39; 0,17, respectively), range of motion of shoulder flexion, abduction, internal rotation, and, external rotation (p=0,5; 0,1; 0,91; 0,9, respectively), Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems score (p: 0,09) and Short Form-12 Quality of Life Survey scores physical and mental component (p=0,23; 0,98, respectively). After treatment, both groups observed positive improvements in pain at rest, activity, and night (p=0,001), range of motion of shoulder flexion, abduction, internal rotation, and, external rotation (p=0,001), Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems score (p=0,001) and Short Form-12 Quality of Life Survey scores physical and mental component (Group1; p=0,001; 0,001, Group 2; p=0,001; 0,005, respectively). There was no statistically significant advantage among the treatment methods except for shoulder abduction and internal rotation range of motion parameters (p=0,04; 0,009, respectively).&#x0D; Conclusion: When applied with traditional physiotherapy, both treatment methods provided significant improvements in pain, functional condition, quality of life, and joint motion clarity compared to before treatment. However, the methods applied are not superior to each other. It is important to choose the appropriate technique for the patient in the treatment of subacromial impingement syndrome, and it is useful to prepare personalized, combined programs. It is envisaged that researching more effective exercise methods for patients with subacromial impingement syndrome in the future will increase the usefulness of the treatment.

Medium-term Results After Femoral Head Resection and Subtrochanteric Valgus Osteotomy in Children and Adolescents With Neuromuscular Disorders.

Various salvage surgical procedures for painful hip dislocation in adolescent patients with cerebral palsy exist. To date, no significant differences among these surgical techniques have been described. In our institution the McHale procedure is the standard of care for painful chronically dislocated hips with or without deformity of the femoral head in patients with cerebral palsy. This study focuses on mid-term results after surgical treatment. Surgical reports and patient charts were analyzed retrospectively. All x-rays were evaluated and migration of the proximal femur and heterotopic ossification according to Brooker were recorded. In addition, we conducted a telephone interview with the caretakers with special reference to pain preoperatively and postoperatively and after implant removal, sitting tolerance, range of motion, mobility, quality of life, and personal hygiene. Fifty-two patients (65 hips) with a mean age of 13.5 ± 3.6 years (range: 4 to -20y) were included. Mean surgery time was 178.4 ± 63.4 minutes (range: 45 to 380min) and mean follow-up was 45.17 ± 30.6 months (range: 12 to 204mo). A significant difference between preoperative and postoperative pain levels was found, P<0.001. Personal hygiene (P=0.02) and quality of life (P=0.013) improved significantly. Eighty-five percent of the caregivers would have the surgery performed on their child again and 81% of the caregivers would recommend the surgery to others. The removal of implants leads to a significant improvement in pain (P=0.011). A total of 22 complications in 65 McHale procedures (33.9%) were related to the procedures. A significant reduction in pain and a significant improvement of hygiene as well as quality of life can be achieved with the McHale procedure in painful chronically dislocated hips in patients with cerebral palsy. Overall, the procedure is predominantly experienced as helpful by the caregivers and recommended to others. The removal of the implants improves pain significantly, but complications may occur in one third of the patients. IV.

Pulsed Electromagnetic Field Stimulation in Lumbar Spine Fusion for Patients With Risk Factors for Pseudarthrosis.

Lumbar spinal fusion surgeries are increasing steadily due to an aging and ever-growing population. Patients undergoing lumbar spinal fusion surgery may present with risk factors that contribute to complications, pseudarthrosis, prolonged pain, and reduced quality of life. Pulsed electromagnetic field (PEMF) stimulation represents an adjunct noninvasive treatment intervention that has been shown to improve successful fusion and patient outcomes following spinal surgery. A prospective, multicenter study investigated PEMF as an adjunct therapy to lumbar spinal fusion procedures in patients at risk for pseudarthrosis. Patients with at least 1 of the following risk factors were enrolled: prior failed fusion, multilevel fusion, nicotine use, osteoporosis, or diabetes. Fusion status was determined by radiographic imaging, and patient-reported outcomes were also evaluated. A total of 142 patients were included in the analysis. Fusion status was assessed at 12 months follow-up where 88.0% (n = 125/142) of patients demonstrated successful fusion. Fusion success for patients with 1, 2+, or 3+ risk factors was 88.5%, 87.5%, and 82.3%, respectively. Significant improvements in patient-reported outcomes using the Short Form 36, EuroQol 5 Dimension (EQ-5D) survey, Oswestry Disability Index, and visual analog scale for back and leg pain were also observed compared with baseline scores (P < 0.001). A favorable safety profile was observed. PEMF treatment showed a positive benefit-risk profile throughout the 6-month required use period. The addition of PEMF as an adjunct treatment in patients undergoing lumbar spinal surgery provided a high rate of successful fusion with significant improvements in pain, function, and quality of life, despite having risk factors for pseudarthrosis. PEMF represents a useful tool for adjunct treatment in patients who have undergone lumbar spinal surgery. Treatment with PEMF may result in improved fusion and patient-reported outcomes, regardless of risk factors. NCT03176303.

Foveal triangular fibrocartilage complex pathology: a potentially under-recognized injury.

The primary aim of the present study was to present a case series of 24 patients with foveal triangular fibrocartilage complex (TFCC) injuries that were treated with arthroscopically assisted TFCC foveal repair. In total, 19 patients had a stable distal radioulnar joint (DRUJ) and five had an unstable DRUJ. Despite this, all patients were found to have a foveal tear upon DRUJ arthroscopy. Magnetic resonance imaging (MRI) scans detected only eight out of 23 patients with foveal injuries. In addition to their foveal injury, 19 of the 24 patients had additional pathology that required treatment. At a mean follow-up of 18 months, there was a statistically significant improvement in pain, range of motion, grip strength and functional scores. In this study, we demonstrate that having a stable DRUJ upon clinical examination and normal MRI findings does not rule out foveal TFCC injury and a high index of clinical suspicion is needed when managing patients with ulnar sided wrist pain.Level of evidence: IV.