VAS Index Research Articles

INVESTIGATION OF THE EFFECTIVENESS OF ACUPUNCTURE IN THE TREATMENT OF FROZEN SHOULDER.

Background:Adhesive capsulitis is a common disease that causes pain and reduced range of motion, but vague on the shoulder. Woman are affected fewer than men, but there is no known racial or genetic tendency. Most patients with adhesive capsulitis will improve with nonsurgical treatment. Acetaminophen and nonsteroidal anti-inflammatory drugs for pain relief in patients without contraindication are first-line options. Acupuncture considered being safe and effective in reducing pain. The aim of this study was to Investigation of the effectiveness of acupuncture in the treatment of frozen shoulder.Materials and Methods:In a controlled clinical trial, patients referred to the Baqiatallah clinic in 91 years with shoulder pain, frozen shoulder diagnosed based on history and physical exam, they have been enrolled. Indicators measured in the study was included the involved joint pain, range of motion and quality of life. Patients, first at baseline, one and a half months later (end of session) and then 3 months after the examination information about each individual entered in the from of questionnaires were pre-determined and data were analyzed by SPSS 17 software.Results:In this clinical trial study total 40 patients with frozen shoulder (20 interference with the acupuncture and 20 people control) study that patients average age 55/54. Age maximum 71 years and minimum 44 years. Acupuncture in the treatment of frozen shoulder with the results achieved in the general case acupuncture may improve shoulder motion in patients. VAS index at three months after treatment compared with the control group had a greater improvement.Conclusion:In the case of acupuncture and ultimately improve the overall look of all the movement of flexion and adduction of the shoulder, but the movement has been further improved, VAS index at three months after treatment compared with the control group had a greater improvement and finally, we perform acupuncture as a way to improve shoulder motion in patients with frozen shoulder offered.

Effectiveness of myofascial release technique and taping technique on pain and disability in patients with chronic plantar fasciitis: Randomized Clinical trial

BACKGROUND: Planter fasciitis is one of the most common musculoskeletal pathologies of the foot and estimated to affect 10% of population at some time in their life. Although the exact etiology is not known it generally involves an inflammatory reaction of the planter fascia at its origin in calcaneus. Even though both mayofascial release and tapping technique gives better effectiveness in relief of chronic plantar fasciitis, there is no clear evidence to prove the comparative effect of mayofascial release and taping in treatment of chronic planter fasciitis. So this study is taken up to compare the effectiveness of mayofascial release technique and taping technique in patients with chronic plantar fasciitis. METHOD: a total of 30 patients suffering from chronic planter fascitis were randomized and divided into two groups. 15 patients underwent myofacial release technique and 15 patients underwent taping technique; administered for one week making total of 07 treatment sessions. Outcome of interest including VAS and foot function index were collected at baseline and 1-week after initiation of therapy. RESULTS: the data was analysed using statistical test which was performed using SPSS 17 software package. Result revealed significant improvement for all outcome measures in each group (p<0.05). Additionally significantly greater improvements were detected in favor of the myofacial release group (p < 0.05). CONCLUSION: The findings of the present study indicate a potential benefit after giving myofacial release technique in patients with chronic planter fasciitis

ISOMETRIC EXERCISE VERSUS COMBINED CONCENTRIC-ECCENTRIC EXERCISE TRAINING IN PATIENTS WITH OSTEOARTHRITIS KNEE

Background: Osteoarthritis is a slowly evolving articular disease, which appears to originate in the cartilage and affects the underlying bone and soft tissues. OA results in pain and functional disability. The purpose of this study was to determine the effect of isometric exercises and combined concentric-eccentric exercises in reducing pain and functional disability in patients with osteoarthritis of knee.Methods: Forty individuals who were diagnosed as osteoarthritis by qualified orthopaedics and orthopaedic surgeons were chosen and were randomly divided into 2 groups Group A (N=20) and Group B (N=20). Group A was treated with isometric exercises and Group B was treated with combined concentric-eccentric exercises. The intervention lasted eight weeks and the physical activity was carried out for 3 days a week. Both the groups were assessed for pain and functional disability of knee joint by using WOMAC osteoarthritis index and VAS.Results: Between group analysis of pre and post study data reveals that VAS and WOMAC osteoarthritis index revealed significant findings (P=0.00). Group B performs significantly better on both the scales after the treatment.Conclusion: Both the groups showed significant improvement in decreasing pain and functional disability. But mean scores of Group B showed greater improvement in reducing pain and functional disability as compared to Group A in patients with knee osteoarthritis.Thus the results suggest that a combined concentric-eccentric exercise is more effective than isometric exercises in reducing pain and functional disability in knee osteoarthritis.

COMPARING THE EFFECTS OF CERVICAL TRACTION AND CERVICAL MOBILIZATION IN THE TREATMENT OF CERVICOGENIC HEADACHE

OBJECTIVES The purpose of this study is to ferret out the immediate results of traction or mobilization in neck pain patients and to determine which one is more effective. STUDY DESIGN An Experimental study. STUDY SETTINGS &amp; PARTICIPANTS The study was conducted in outpatient departments of tertiary care hospitals and clinics having well developed physiotherapy center. The participants include individuals having upper extremity pain and numbness and have three out of four cervical nerve compression test positive. INTERVENTIONS Treatment was given for three days in a week for a consecutive period of two weeks which includes traction and cervical mobilization techniques of Mulligan. OUTCOME MEASURES The outcome was measure using VAS and Neck Disability index scale. The data was analyzed by using SPSS version 20 RESULTS Patients (N=50) were screened out of which 30 were found eligible. The effect of traction and mobilization in the treatment of cervical radiculopathy patient was same. Both the interventions were found to be equally effective in reducing the disability and pain of the patient. CONCLUSIONS This study has concluded that the effects of traction and mobilization in the treatment of cervical radiculopathy patient were same. Both the interventions were found to be equally effective in reducing the disability and pain of the patient. Keywords: Cervical Spine, Neck Disability Index, NDI, Visual Analog Scale, Natural Apophyseal Glides, NAGS, Sustained Natural Epiphyseal, Manual Traction

Quest physiotherapy post lumbar discectomy: pilot and feasibility study to inform the development of a randomised controlled trial

treatment over conventional physiotherapy treatment in plantar fasciitis. Methods: Ethical approval for study was taken from Institutional ethical committee – Government Physiotherapy college – Ahmedabad. Patients diagnosed as plantar fasciitis who fulfilled inclusion criteria, with age 18–50 years, both male and female were included after gettingwritten informed consent. Patients havingmajormedical illness and lower limb trauma were excluded. They were divided into two groups. GROUP A (CONTROL GROUP) was given conventional physiotherapy treatment. GROUP B (INTERVENTIONAL GROUP) was given eccentric loading exercises of calf muscles in addition to conventional physiotherapy treatment. All patients were treated once daily, 6 days a week for four weeks and were assessed at the beginning and at the end of four weeks for pain and function. Data analyzed for VAS and Foot Function Index were compared. Results:Wilcoxon’s signed rank test and Mann Whitney U test was applied to evaluate the data. There was significant improvement noted in VAS and Foot function index “within” both the group (p< 0.05). VAS and Foot function index both improved significantly in Eccentric group as compared to the conventional group (p< 0.05). Conclusion(s): Eccentric loading exercises of calf muscles in addition to conventional physiotherapy results in greater improvement in pain and foot function index in plantar fasciitis. Implications:Conventional physiotherapy includes ultrasound, plantar fascia stretching, calf muscle stretching and intrinsic muscles strengthening. Including Eccentric loading exercises as a treatment program in plantar fasciitis results in better functional outcome. Hence it should be considered a part of treatment program for plantar fasciitis.

Correlation of Hypertension with the severity of Osteoarthritis of Knee.

Objective : To analyze the correlation between hypertension with the clinico-radiological profile and severity of OA knee. Method: In this cohort study, total 120 cases of osteoarthritis knee patients of either sex or age > 40 years were enrolled. The entire study was conducted in department of Orthopedic Surgery, King Georges Medical University. Cases were selected as per the diagnostic criteria of the American College of Rheumatology. A detailed history was taken and thorough examination of the affected joints and related regions was done. For the clinical severity, VAS and Lequesne Index was used. To assess the radiological severity of the disease, K.L grading was used and X-ray bilateral knee was done to see the radiological changes of the disease. Blood pressure was measured in both the arms via auscultatory method following American Heart Association guidelines.The Blood Pressure was measured thrice in both the arms and the average was calculated. If the average was more than 140/90 mm Hg in any side; then the subject was labeled as hypertensive. Result : The correlation of hypertension with the clinical and radiological severity of OA knee was found to be statistically significant. Conclusion : The significant correlation of hypertension with osteoarthritis will not only bridge the information gap, but will also modify our approach towards the management of hypertension, heart diseases and osteoarthritis. We may be able to find out the new possible risk factors of these diseases hence it should be further investigated.

Quality of life in patients with type 2 diabetes in Poland - comparison with the general population using the EQ-5D questionnaire.

Complications of type 2 diabetes (T2D) lead to increased mortality and reduced quality of life (QOL). The aim of the study was to compare health-related quality of life (HRQoL) in Polish patients with type 2 diabetes (T2D) and in a matched sample from the general population. Data on HRQoL came from two non-interventional studies: a prospective study of patients with T2D and an EQ-5D study of Polish general population norms. The HRQoL analysis was conducted in four separate age groups: 32-44, 45-54, 55-64 and over 65 years old. We analyzed both subjective and objective assessment of HRQoL (EQ VAS and EQ-5D index) and the presence of restrictions within five dimensions of the EQ-5D descriptive part. A total of 274 patients with T2D and 214 representatives from the study of population norms were included. EQ VAS was systematically lower in diabetic patients as compared to the general population and decreased with age (68.2 vs 83.9, 62.4 vs 79.2; 54.9 vs 78.1, 50.2 vs 69.8 in consecutive age groups). A similar relationship was observed with the EQ-5D index. The largest mean differences were observed among subjects aged 55-64 years (EQ VAS: 23.2, EQ-5D index: 0.085). In three domains, i.e. self-care, usual activities and anxiety/depression, patients with diabetes who were over 45 years of age reported significantly more problems than respondents from the general population. Both subjective and objective HRQoL in patients with T2D was lower than in respondents similar in age from the general population. Compared with type 2 diabetic populations from other countries, Polish patients are characterized by relatively high HRQoL objective assessment and very low subjective assessment.

COMPARATIVE EFFICACY OF INTRAARTICULAR THERAPY OF GONARTHROSIS WITH HYALURONIC ACID OF DIFFERENT MOLECULAR WEIGHT (A DOUBLE-BLIND RANDOMI7ED STUDY)

Objectives. To study the comparative efficacy and safety of intra-articular treatment of knee osteoarthritis (OA) with hyaluronic acid (HA) of different molecular weights (MW). Material and methods. Randomized double-blind controlled study included 50 patients with osteoarthritis of the knee stage II-III, weight-bearing pain more 40 mm on VAS and Lequesne index score &gt; 4 and &lt; 12. 25 patients received HA with MW 3500 kDa (Rusvisk group) and 25 patients were treated with HA with MW 1200-1400 kDa (Ostenil group) injected at 3-weekly intervals. During the 22-week observation period we assessed dynamics of pain on VAS (weightbearing pain, pain at rest), index WOMAC, and recorded the overall assessment of the effectiveness of therapy by patient and physician, OMERACT-OARSI criteria and the need for NSAIDs. Results. One week after the last injection, a significant decrease in weight-bearing pain (in the group Rusvisk by 69% in the group Ostenil 55%) and the total index WOMAC (group Rusvisk by 63% in the group Ostenil 60%), continuing until the end of observation. A significant decrease in pain at rest observed in the group Rusvisk at all visits and in the group Ostenil only at 6 and 10 weeks of therapy. The overall evaluation of effectiveness of therapy by patient and physician yielded the benefits observed in high molecular HA group. A high percentage of responses to therapy using OMERACT-OARSI criteria and reduced need for NSAIDs were observed in both groups. Tolerability was satisfactory and did not differ significantly between the groups. Most common adverse reactions were mild pain at the injection site. Conclusion. Intra-articular therapy with HA of different molecular weight Rusvisk and Ostenil resulted in pain reduction and improved joint function in patients with knee OA with satisfactory tolerability.

Physiotherapy triage assessment of patients referred for orthopaedic consultation – Long-term follow-up of health-related quality of life, pain-related disability and sick leave

IntroductionThe literature indicates that physiotherapy triage assessment can be efficient for patients referred for orthopaedic consultation, however long-term follow up of patient reported outcome measures are not available. AimTo report a long-term evaluation of patient-reported health-related quality of life, pain-related disability, and sick leave after a physiotherapy triage assessment of patients referred for orthopaedic consultation compared with standard practice. MethodsPatients referred for orthopaedic consultation (n = 208) were randomised to physiotherapy triage assessment or standard practice. The randomised cohort was analysed on an intention-to-treat (ITT) basis. The patient reported outcome measures EuroQol VAS (self-reported health-state), EuroQol 5D-3L (EQ-5D) and Pain Disability Index (PDI) were assessed at baseline and after 3, 6 and 12 months. EQ VAS was analysed using a repeated measure ANOVA. PDI and EQ-5D were analysed using a marginal logistic regression model. Sick leave was analysed for the 12 months following consultation using a Mann–Whitney U-test. ResultsThe patients rated a significantly better health-state at 3 after physiotherapy triage assessment [mean difference −5.7 (95% CI −11.1; −0.2); p = 0.04]. There were no other statistically significant differences in perceived health-related quality of life or pain related disability between the groups at any of the follow-ups, or sick leave. ConclusionThis study reports that the long-term follow up of the patient related outcome measures health-related quality of life, pain-related disability and sick leave after physiotherapy triage assessment did not differ from standard practice, indicating the possible benefits of implementation of this model of care.

Is Unilateral Kyphoplasty as Effective and Safe as Bilateral Kyphoplasties for Osteoporotic Vertebral Compression Fractures? A Meta-analysis

An osteoporotic vertebral compression fracture is a common condition in elderly people, especially women. The percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Controversy remains regarding whether a unilateral or a bilateral approach is superior, and to our knowledge, there have been no large studies comparing these two approaches, therefore a meta-analysis synthesizing the data on this question is warranted. We asked the following questions: (1) Is there evidence to suggest a benefit in clinical outcome as assessed by the VAS and Oswestry Disability Index of a unilateral kyphoplasty or bilateral kyphoplasties? (2) Are the complications associated with the two approaches different? (3) Do the procedures result in different kyphosis angle reduction or anterior vertebral height restoration? (4) Is the surgical time for the procedures different? We searched the Cochrane Library, PubMed MEDLINE, EMBASE, Web of Knowledge MEDLINE (January 1980 to June 2013), and reference lists of eligible prospective studies. The levels of the evidence and recommendations were assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Five studies encompassing 253 patients met the inclusion criteria. The short- and long-term clinical outcomes as assessed by the VAS and Oswestry Disability Index showed no differences between unilateral and bilateral kyphoplasties (p = 0.41, p = 0.60 for VAS; p = 0.10, p = 0.36 for Oswestry Disability Index). There were no differences in complications such as cement leakage and adjacent vertebral fractures associated with the two approaches (p = 0.43 and p = 0.95). The kyphosis angle reduction and anterior vertebral height restoration showed no difference between the two approaches (p = 0.34 and p = 0.46). The unilateral approach was shorter in terms of surgical time (mean difference, -24.98; p < 0.0001). The overall GRADE system evidence quality was very low, with only high evidence for operation time, which lessens our confidence in recommendations. Unilateral and bilateral percutaneous kyphoplasties appear to be safe and effective for treating osteoporotic vertebral compression fractures. No clinically important differences were found between them. Considering less operation time and less cost, we suggest that a unilateral percutaneous kyphoplasty is advantageous, but because of the poor quality of the evidence, high-quality randomized controlled trials are required to resolve this issue.

Comparison of a new medicinal plant extract and triamcinolone acetonide in treatment of recurrent aphthous stomatitis

The aim of this study was to evaluate the effectiveness of a new medicinal plant extract (Ankaferd Blood Stopper®, ABS) on the healing process of aphthous ulcers. A total of 50 patients with recurrent aphthous stomatitis (RAS) who have had currently a single oral ulcer in the mouth were included in the study. Patients were randomly divided in 2 groups: ABS group and Kenacort group (triamcinolone acetonid). Data were collected by questionnaire regarding age, gender, RAS history including the number of ulcer episodes in 1 month, the number of ulcers in each episode, mean healing time of previous ulcers and the mean disease duration. Ulcer size, ulcer related pain, evaluated by VAS and effectiveness index (EI), was noted in each clinical examination. In the present study, no significant differences were seen in demographic and RAS related data between the 2 groups. In ABS and Kenacort group, the mean ulcer size and VAS scores were statistically reduced at day 3 and day 7 compared to baseline values, yet no significant difference was observed between the 2 groups in these time points. The effects of ABS in RAS treatment were found similar to that of Kenacort-A orabase cream in this study. Since our study is a preliminary one, additional studies with larger number of subjects, investigating the antibacterial and immunologic effect of this unique medicinal product will help to understand the treatment mechanism of ABS and evaluate clinical benefits and any possible adverse effects of the application of ABS spray.

Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis

IntroductionThere is increasing awareness of adult degenerative or de novo scoliosis, and its surgical treatment when indicated can be challenging and resource intense. Surgical randomized controlled trials are rare, and observational studies pose limitations because of the heterogeneity of surgical practices, techniques, and patient populations. Pooled analysis of current literature may identify effective treatment strategies and guide future efforts at prospective clinical research. This study aimed to synthesize existing data on the outcomes of surgical intervention for adult degenerative scoliosis. MethodsPubMed, Medline, Cochrane, and Web of Science databases were searched using key words and were limited to the English language. Spine surgeons reviewed abstracts and evaluated whether they contained surgically treated cohorts of adults (more than 18 years of age) with degenerative scoliosis. Full-text articles were reviewed in detail and data were abstracted. All meta-analyses were conducted using random effects models and heterogeneity was estimated with I2. Random-effects meta-regression models were used to investigate the association of treatment effects with baseline levels of each outcome. ResultsOf 482 articles, 24 (n = 805) met inclusion criteria Available outcomes included Cobb angle correction, coronal and sagittal balance, visual analog scale for pain (VAS), and Oswestry Disability Index. Despite significant heterogeneity among studies, random-effects meta-analysis showed significant improvements in Cobb angle (−11.1°; 95% confidence interval [CI], −13.86° to −8.40°), coronal balance (7.674 mm; 95% CI, −10.5 to −4.9), VAS (−3.24; 95% CI, −4.5 to −1.98), and Oswestry Disability Index (−27.18%; 95% CI, −34.22 to −20.15) postoperative treatment (p < .001). Meta-regression models showed that preoperative values for Cobb angle, coronal balance, and VAS were significantly associated with surgical treatment effect (p < .05). Changes in sagittal balance did not reach statistical significance although only 6 articles were included. ConclusionsExhaustive literature review yielded 24 studies reporting preoperative and postoperative data regarding the surgical treatment of adult degenerative scoliosis. No randomized clinical trials (RCTs) were identified. Despite heterogeneity, a limited meta-analysis showed significant improvement in Cobb angle, coronal balance, and VAS after surgical treatment of adult degenerative scoliosis.

AB0591 Influence of hand osteoarthritis on the magnitude of knee synovial effusion and hypertrophy in patients with knee osteoarthritis

BackgroundA significant proportion of patients with knee osteoarthritis (OA) show local features of inflammation such as synovial effusion and synovial hypertrophy. On the other hand, in recent years it has...

Normal Range of Peak Nasal Inspiratory Flow and Its Role in Nasal Septal Surgery

Nasal obstruction can be evaluated by objective and subjective methods. We sought to determine normative peak nasal inspiratory flow meter (PNIF) measurements of a healthy population in Turkey and to investigate the importance of PNIF in surgery for nasal septal deviation as well as to investigate the correlation of PNIF with subjective methods. In a total of 269 patients, 50 patients underwent septoplasty and 219 control subjects were enrolled in the study. Data on preoperative and postoperative PNIF measurements, nasal septal indices, and subjective measurements (visual analogue scale, VAS) were recorded. Mean PNIF value was 137.8 L/min in control subjects. Postoperative PNIF, VAS, and nasal septal index data were statistically significantly higher in the study group as compared with those of preoperative data. We found PNIF, VAS, and nasal septal indices of the control group to be consistent with postoperative data and to be higher than preoperative data of the study group. We identified a normal PNIF range for the healthy Turkish population and we saw that the data were compatible with VAS scores. PNIF seems to be a very effective method in the evaluation of nasal obstruction and in deciding operation.

Total Hip Arthroplasty in Young Females With Congenital Dislocation of the Hip, Radically Improves Their Long-Term Quality of Life

Eighty-two female patients with low dislocation (67 hips) or high dislocation (48 hips) were assessed using clinical scores and EQ-5D quality of life (QoL) questionnaire. Assessment was performed at the first to secondyear postoperatively and at the final follow-up, after a minimum of 12years (12–37). Patients reported with a high EQ-5D health state VAS scale, VAS index and TTO index at 1 to 2years follow-up (94,21/0,907/0,931) that remained considerably high despite the long-term follow-up (73,8/0,721/0,746). The scores for pain and range of motion presented with a statistically significant improvement at 1 to 2years postoperatively and at the time of final follow-up. Function scores have declined with age. Total hip arthroplasty in CHD patients radically improves QoL for a long period of time.

More prominent inflammatory features in knee osteoarthritis in the presence of concomitant hand osteoarthritis

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S142 infection within 2years of their surgery, but did not differ in terms of risk for DVT/PE, early revision, infection, peri-prosthetic fracture or death following TKA. To our knowledge, this is the first study that has utilized a validated algorithm to identify TKA recipients with RA, thereby increasing the validity of our findings, and aiding patientphysician decision-making around joint replacement in patients with RA. Further research is required to elucidate potential explanations for the higher rates of infection in RA versus OA, including the use of biologic agents. 261 MORE PROMINENT INFLAMMATORY FEATURES IN KNEE OSTEOARTHRITIS IN THE PRESENCE OF CONCOMITANT HAND OSTEOARTHRITIS C. Orellana, N. Navarro, J. Calvet, M. Garcia-Manrique, J. Gratacos, M. Larrosa. CSiU Parc Tauli. Hosp. de Sabadell, Sabadell, Spain Background: In recent years it has been recognized the existence of a link between hand osteoarthritis and systemic inflammation. On the other hand, a significant proportion of patients with knee osteoarthritis show local clinically evident inflammatory features such as synovial effusion and synovial hypertrophy. Purpose: To evaluate if patients with knee osteoarthritis show more inflammatory signs as measured by ultrasound when hand osteoarthritis is concomitantly present. Methods: Patients aged 50 years or more with symptomatic osteoarthritis of the knee and joint effusion, Kellgren-Lawrence II-III. Demographics, BMI, disease duration, pain assessed by VAS (0-100 mm) and algofuncional Lequesne index were assessed. Knee ultrasound was performed evaluating and measuring the presence of effusion and synovial hypertrophy (defined as > 4 mm synovial thickening) at the suprapatellar midline. Results: In a cross-sectional study we analyzed 50 patients, F/M 39/11, age 61.8 10.1 years, disease duration 50.8 6.3 months, BMI 28 1.4 kg/cm2. Ten patients (20%) had concomitant hand osteoarthritis. There were no significant differences in age, disease duration, BMI or radiological grade between patients with knee and hand osteoarthritis compared with those with only knee osteoarthritis. On ultrasound examination patients with concomitant hand osteoarthritis showed a clear trend to have a more prominent joint effusion (7.39 3 vs. 6.7 2.8 mm) and synovial hypertrophy (3.6 2.6 vs. 2.7 1.8 mm), although not statistically differences were found. Patients with concomitant hand osteoarthritis also had a non-significant trend to experience greater knee pain (VAS 70.3 12.5 vs. 61 18.5 mm) and Lesquesne index scores (11.4 3.3 vs. 9.8 2.9). Conclusions: Although results were not statistically significant probably in relation to small size sample, in this study the presence of hand osteoarthritis appeared to be associated with greater inflammatory features in patients with symptomatic knee osteoarthritis. 262 NETWORKING TO CAPTURE PATIENT-REPORTED OUTCOMES DURING ROUTINE ORTHOPAEDIC CARE ACROSS TWO DISTINCT INSTITUTIONS R. Karia y, J. Slover y, C. Hauer z, Z. Gelber y, P. Band y, J. Graham z. yNew York Univ. Sch. of Med., NY, USA; zGeisinger Med. Systems, Danville, PA,

S133 COPD, Occupation and Quality of Life Among Residents of a Historically Industrialised Area

IntroductionCOPD is known to significantly affect health and quality of life, and is increasingly recognised to have a significant contribution from occupational exposures, particularly vapours, gases, dusts and fumes (VGDF)....

Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial

BackgroundAlthough recent advances in knee osteoarthritis (OA) treatment and evaluation were achieved, to the best of our knowledge, few studies have evaluated the longitudinal effect of therapeutic modalities on the functional exercise capacity of patients with knee OA. The purpose was to investigate the effects of kinesiotherapy and electrotherapy on functional exercise capacity, evaluated using the six-minute walk test (6-MWT) in patients with bilateral knee OA. Secondary measurements included range of motion (ROM), severity of knee pain (VAS), and a measure of perceived health and physical function, evaluated using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index.MethodsA total of 40 women with bilateral knee OA were assigned to three groups: kinesiotherapy (KIN, n = 16), transcutaneous electrical nerve stimulation (TENS, n = 12), or ultrasound (US, n = 10). The groups underwent 12 weeks of intervention twice per week. The participants were subjected to the 6-MWT, ROM, VAS and WOMAC index. These tests were performed before and after the intervention. The study was focused on outpatients and was carried out at Universidade Estadual de Campinas, Brazil.ResultsAt follow-up, the KIN and US groups had significantly higher 6-MWT distances (19.8 ± 21.7 and 14.1 ± 22.5%, respectively) compared with their respective pre-intervention values. All treatments were effective for reducing pain and improving the WOMAC index.ConclusionsWe demonstrated that the 6-MWT is a tool that can be used to evaluate improvements in the functional exercise capacity of patients submitted to a clinical intervention.

Transforaminal Lumbar Interbody Fusion (TLIF) for Revision of Failed Posterolateral Spinal Fusion

Introduction: Posterolateral fusion is commonly used for managing many degenerative spinal problems. Reported pseudarthrosis rate varies between 5-56%. Several approaches have been used for revision, including re-grafting, ALIF, PLIF, and TLIF. Purpose: The aim of this work is to evaluate the radiographic and functional results of TLIF for the management of symptomatic lumbar pseudarthrosis and to compare between revising posterolateral fusion by re-grafting and by TLIF using autogenous iliac bone graft. Study Design: This is prospective comparative study Methods: Forty-three patients with symptomatic pseudarthrosis after previous posterolateral fusion were revised using TLIF technique and were prospectively evaluated and followed for a minimum of 2 years (Range=2-5.6 years). The clinical and radiological outcomes were recorded and compared to a different group of another 21 patients treated earlier with refreshing the same fusion bed and re-grafting. Only autogenous iliac grafts were used in all cases. VAS and Oswestry Disability Index (ODI) were used for the clinical assessment. Radiographs were obtained at 2, 6, 12 and 24 months.Results: There was no significant difference in the mean amount of blood loss between both groups. However, the mean operative time for TLIF was significantly shorter than the revision PLF. At 2 years follow-up, the TLIF group showed significantly better improvement in the mean VAS score and ODI scores (42 and 43 in TLIF group versus 8 and 21 in the PLF group) and the fusion rate was also significantly higher. Complications included incidental dural tear (2 patients) in the TLIF group that was recognized intraoperatively and successfully repaired, superficial infection (1 patient)in the posterolateral group, and donor site discomfort (2 patients in each group). Conclusion: The significantly higher success of TLIF for revising pseudarthrosis after posterolateral fusion is attributed to the fact of placing the graft in a wide fresh bed under compression. The approach is relatively easy and safe for the neural tissue because it avoids any fibrosis from previous surgery and its use is therefore encouraged. (2012ESJ014)

Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation.

This study reviews the presentation, etiology, imaging characteristics and reasons for missed diagnosis of Andersson lesion (AL) and analyzes the surgical results of short segment fixation in the thoracolumbar region. This is a retrospective single center study. Fourteen patients (15 lesions) who were operated for AL were analyzed. The study was designed in two parts. The first part consisted of analysis of clinical and radiological features (MRI and radiographs) to highlight, whether definitive characteristics exist. The second part consisted of analysis of outcome of short segment fixation as measured by VAS, Frankel score, AsQoL index, and union, with assessment of complications. The follow-up was 42.33 ± 19.29 months (13 males and 1 female) with a mean age of 61.13 ± 19.74 years. There was predisposing trauma in five patients. There was a delay in presentation of the patients by 5.86 ± 2.50 months. There was misdiagnosis in all the cases, at primary orthopedic level (ten cases were put on anti-tuberculous treatment due to its MRI resemblance to infection) and all but one case at radiologist level. Radiographs and MRI had characteristic features in all cases, and MRI could detect posterior element affection in 14 lesions as against only 8 posterior lesions detected in radiographs. In all patients, there was a patient's delay and/or physician's delay to arrive at a diagnosis. Spinal fusion was seen in all the cases. Outcome measures of VAS, Frankel score, and AsQoL index showed significant improvement (P < 0.002). No major complications occurred. There is a lack of awareness of AL leading to misdiagnosis. Definite clinico-radiological features do exist in AL and short segment fixation is effective.