Non-exercise physical therapies for musculoskeletal conditions

Heat therapy for different knee diseases: expert opinion

Musculoskeletal pain is a major burden in our society. Management of musculoskeletal pain or injuries includes both pharmacological and non-pharmacological approaches, including heat therapy (HT). HT is a well-established treatment option due to its ability to promote muscle relaxation, enhance blood circulation, and modulate nociceptors with a good safety profile. The main focus of this paper is to review the available literature about HT in knee pathologies (i.e., arthrosis, arthritis, traumatic pathologies in the subacute phase, muscle and tendon pathologies linked to fatigue, muscle tension and distractions) and to provide an expert opinion in case of lack of data.

The Efficiency of Kinesiotherapy versus Physical Modalities on Pain and Other Common Complaints in Fibromyalgia

Due to its variety of signs and symptoms, there have been numerous attempts to treat fibromyalgia (FM), but a cure has yet to be established. The aim of this study was to evaluate the effects of a complex kinetic therapy program and a combined physical modality program on pain and other common symptoms of FM. Patients and methods: A total of 78 female patients were included in this study; 39 subjects underwent a kinesiotherapy (KT) intervention (combining aerobic and Pilates exercises), and 39 participated in a physical modality (PM) program (including electrotherapy (TENS and low-laser therapy) and thermotherapy). Results: Regarding the parameter of pain assessment, kinesiotherapy demonstrated its superiority both during the treatment period and in the evaluation 3 months after therapy cessation. Both in terms of patient-reported pain (inter-group comparisons: p = 0.000 at T3) and the examination of tender points (inter-group comparisons: p = 0.000 at T3), as well as the algometric assessment, pain was alleviated by the two forms of applied kinetic therapy. The observed functional impairment was statistically significantly influenced (p = 0.001) at the end of the kinetic program application, while for the perceived functional impairment, neither therapy proved superiority over the other at any point of evaluation (inter-group comparisons: p = 0.715 at T3). Regarding the influence of the emotional consequences implied by fibromyalgia, neither the forms of kinesiotherapy nor the chosen physical modalities proved superiority at any point of evaluation (HAQ anxiety inter-group comparisons: p = 0.000 at T3). In conclusion, even though kinesiotherapy had superior influences on fibromyalgia pain in the studied group, the current research lends credence to the significance of non-pharmacological therapy in managing fibromyalgia. Participants demonstrated positive advancements in subjective and objective pain assessments, as well as improvements in functional and emotional well-being.

Ultrastretchable Electrically Self-Healing Conductors Based on Silver Nanowire/Liquid Metal Microcapsule Nanocomposites

Stretchable conductive nanocomposites are essential for deformable electronic devices. These conductors currently face significant limitations, such as insufficient deformability, significant resistance changes upon stretching, and drifted properties during cyclic deformations. To tackle these challenges, we present an electrically self-healing and ultrastretchable conductor in the form of bilayer silver nanowire/liquid metal microcapsule nanocomposites. These nanocomposites utilize silver nanowires to establish their initial excellent conductivity. When the silver nanowire networks crack during stretching, the microcapsules are ruptured to release the encased liquid metal for recovering the electrical properties. This self-healing capability allows the nanocomposite to achieve ultrahigh stretchability for both uniaxial and biaxial strains, minor changes in resistance during stretching, and stable resistance after repetitive deformations. The conductors have been used to create skin-attachable electronic patches and stretchable light-emitting diode arrays with enhanced robustness. These developments provide a bioinspired strategy to enhance the performance and durability of conductive nanocomposites.

Ultrasensitive and ultrastretchable electrically self-healing conductors

Self-healing is a bioinspired strategy to repair damaged conductors under repetitive wear and tear, thereby largely extending the life span of electronic devices. The self-healing process often demands external triggering conditions as the practical challenges for the widespread applications. Here, a compliant conductor with electrically self-healing capability is introduced by combining ultrahigh sensitivity to minor damages and reliable recovery from ultrahigh tensile deformations. Conductive features are created in a scalable and low-cost fabrication process comprising a copper layer on top of liquid metal microcapsules. The efficient rupture of microcapsules is triggered by structural damages in the copper layer under stress conditions as a result of the strong interfacial interactions. The liquid metal is selectively filled into the damaged site for the instantaneous restoration of the metallic conductivity. The unique healing mechanism is responsive to various structural degradations including microcracks under bending conditions and severe fractures upon large stretching. The compliant conductor demonstrates high conductivity of ∼12,000 S/cm, ultrahigh stretchability of up to 1,200% strain, an ultralow threshold to activate the healing actions, instantaneous electrical recovery in microseconds, and exceptional electromechanical durability. Successful implementations in a light emitting diode (LED) matrix display and a multifunctional electronic patch demonstrate the practical suitability of the electrically self-healing conductor in flexible and stretchable electronics. The developments provide a promising approach to improving the self-healing capability of compliant conductors.

Efficacy of Cold Tumescent for Prevention of Intraoperative Bleeding in Patients Undergoing Liposuction: A Double-Blind Randomized Controlled Trial-Half-Side Comparison

BACKGROUND

Bleeding, a common intraoperative complication of liposuction, often causes pain and discomfort during recovery. Because of the vasoconstrictive effect of adrenaline in the tumescent solution, bleeding can be reduced; however, reports of postoperative bleeding persist. Cold temperatures also have a vasoconstrictive effect.

OBJECTIVES

This study aimed to determine the efficacy of cold tumescent solution in preventing and reducing intraoperative bleeding.

METHODS

This prospective randomized controlled trial was conducted between June 2018 and June 2019. The liposuction areas in each participant were divided into left and right sides; one side received operative room temperature tumescent solution (25 °C), and the other side received low-temperature tumescent solution (4 °C). The areas of ecchymosis, pain scores, and patient and surgeon satisfaction scores were compared and analyzed.

RESULTS

Ten patients with 36 pairs of liposuction areas were enrolled in the study. Cold tumescent liposuction resulted in a significantly lower lipocrit than was obtained on the standard tumescent side (1.56 ± 0.69 vs 2.92 ± 0.94; P < .001). The ecchymosis area and pain score were significantly lower in the cold tumescent group on days 2, 4, 7, and 14. The satisfaction evaluation scores did not differ between patients and surgeons at 12 months postoperatively.

CONCLUSIONS

The use of cold tumescent anesthesia significantly improved liposuction outcomes by reducing the intraoperative blood loss and the postoperative ecchymosis and pain, with no immediate or short-term complications in low-volume liposuction (<1000 mL) procedures. Furthermore, it generated a standard outcome and good patient satisfaction scores.

LEVEL OF EVIDENCE: 2

Effects of capacitive and resistive electric transfer and hot pack interventions on the autonomic nervous system in young women

The effects of thermotherapy on autonomic nervous system activity and subjective sensations of fatigue and arousal are unclear. This study compared the effects of capacitive and resistive electric transfer (Cret) interventions (deep thermotherapy) and hot packs (superficial thermotherapy) on autonomic nervous system activity in healthy young women (n = 16). Heart rate and RR interval were measured using electrocardiography, and the coefficient of variation (CV) of the RR interval was used to evaluate autonomic nervous system activity. The subjective relaxation effect was evaluated using the Roken Arousal Scale (RAS) - a fatigue arousal index. The intervention was performed on the lumbar region for 20 minutes for both Cret and hot pack. After each intervention, the CV values increased only in the Cret condition, whereas the heart rate decreased in both conditions. This suggests that parasympathetic activity was enhanced in the Cret condition. In contrast, the subjective relaxation evaluation observed a psychological relaxation effect under both conditions. Our results suggest that Cret application in the lumbar region has greater relaxation effects than hot pack application in the same region.

Photothermal conversion and transfer in photothermal therapy: From macroscale to nanoscale

Photothermal therapy (PTT) is a promising alternative therapy for benign or even malignant tumors. To improve the selective heating of tumor cells, target-specific photothermal conversion agents are often included, especially nanoparticles. Meanwhile, some indirect methods by manipulating the radiation and heat delivery are also adopted. Therefore, to gain a clear understanding of the mechanism, and to improve the controllability of PTT, a few issues need to be clarified, including bioheat and radiation transfer, localized and collective heating of nanoparticles, etc. In this review, we provide an introduction to the typical bioheat transfer and radiation transfer models along with the dynamic thermophysical properties of biological tissue. On this basis, we reviewed the most recent advances in the temperature control methods in PTT from macroscale to nanoscale. Most importantly, a comprehensive introduction of the localized and collective heating effects of nanoparticle clusters is provided to give a clear insight into the mechanism for PPT from the microscale and nanoscale point of view.

Patients' satisfaction with physiotherapy management of chronic mechanical neck pain in physiotherapy departments of public hospitals in Ibadan, Nigeria: A mixed-method study

INTRODUCTION

The study was aimed at determining patients' satisfaction level with physiotherapy in the management of chronic mechanical neck pain (CMNP) in physiotherapy departments of the 3 public hospitals in Ibadan, Nigeria.

METHODS

A mixed-method design that involved 51 and five both purposively selected participants for the cross-sectional survey (CSS) and qualitative study, respectively. For the CSS, data was collected using the MedRisk instrument and analyzed using the Chi-square test at p ≤ .05. For the qualitative study, patients' satisfaction was explored through a focus group discussion (FGD) and analyzed using thematic analysis.

RESULTS

For CSS, 49.0% and 7.8% of the participants reported excellent and fair satisfaction, respectively, with physiotherapy in the management of CMNP. There was no significant association of patients' satisfaction level with: age (p = .588); sex (p = .851); and marital status (p = .409). For the FGD, three themes (patients' experience with physiotherapists; patient satisfaction with physiotherapy services; patient satisfaction with other health care services) that emerged further explained that participants were satisfied with physiotherapy management of their CMNP. However, they were not satisfied with the attitude of the record officers, constancy of the same treating physiotherapists, and unavailability of resources.

CONCLUSION

Patients with CMNP are satisfied with the physiotherapy care they received.

Feasibility of patient-focused behavioral interventions to support adults experiencing chronic noncancer pain during opioid tapering: a systematic literature review

Guidelines for chronic noncancer pain prioritize behavioral treatments. In clinical practice transition from opioids to behavioral treatments is often not endorsed by patients or providers. Feasible interventions to support opioid tapering are needed, particularly in primary care. The objectives of this paper is to review the feasibility of behavioral interventions to support opioid tapering. Electronic databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched from inception to June 2019 to identify original studies reporting feasibility (consent rates; completion rates; patient-reported acceptability; integration into clinical practice; and adverse events) of opioid tapering and transition to behavioral treatments for adults experiencing chronic noncancer pain. Google scholar and contents tables of key journals were also searched. Two authors independently extracted data and assessed methodological quality using The Quality Assessment Tool for Quantitative Studies. Eleven publications met inclusion criteria, of which three were conducted in primary care. Consent rates ranged from 27% to 98% and completion rates from 6.6% to 100%. Four studies rated at least one component of patient acceptability: helpfulness from 50%-81%; satisfaction 71%-94%, and "recommend to others" 74%-91%. Three studies reported provider perspectives and two studies reported adverse events. Quality assessment indicated all 11 studies were moderate or weak, primarily due to selection bias and lack of assessor blinding. There was also considerable heterogeneity in study design. The limited available data suggest that attempts to translate opioid tapering interventions into practice are likely to encounter substantial feasibility challenges. One possible way to ameliorate this challenge may be a clear policy context, which facilitates and support opioid reduction.

Coplanar arrangement of shortwave diathermy is the most effective in skin temperature change: A randomized crossover trial

INTRODUCTION

Continuous shortwave diathermy (CSWD) efficacy relies on change in temperature, which had been evaluated previously. However, the studies are not comparable enough, consequently the primary goal of this study was to analyze which SWD capacitive technique arrangement is the most effective in skin temperature change.

METHOD

A randomized, single-blinded crossover trial conducted in a university research laboratory. Twenty young healthy male subjects were randomly allocated using a website to receive 20 min of CSWD application to the anterior aspect of the thigh through coplanar, contraplanar and longitudinal arrangement. Skin temperature was collected under the proximal electrode and at the thigh center over 25 min after electrodes removal, using an infrared thermography camera.

RESULTS

There were two losses to follow up, remaining 18 subjects for analysis (age = 21.4 ± 2.09 years, BMI = 23.6 ± 2.46 kg/m²). Under the electrode all arrangements achieved vigorous heating (coplanar = 7.9 ± 1.76 °C; contraplanar = 6.52 ± 2.68 °C; longitudinal = 7.46 ± 1.8 °C) immediately after electrodes removal and temperature decreased with a similar rate across arrangements. At the thigh center, coplanar arrangement achieved mild heating (1-2 °C) until 17 min after electrodes removal; meanwhile, the other arrangements did not increase temperature sufficiently for post intervention therapeutic effects. No unintended effect was detected.

CONCLUSIONS

Coplanar arrangement increased skin temperature the most, heated the greatest area, and had the slowest temperature decay. If the body part accommodates any of the capacitive technique arrangements, coplanar should be used to treat superficial tissues.

Manual Therapy as Treatment for Chronic Musculoskeletal Pain in Female Breast Cancer Survivors: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this systematic review was to investigate the effectiveness of manual therapy (MT) for chronic musculoskeletal pain (CMP) in the upper limbs and thorax of female breast cancer survivors and to investigate the changes in the quality of life and function of these patients.

METHODS

Systematic searches were performed in the databases MEDLINE/PubMed, Cumulative Index of Nursing and Allied Health/EBSCO, Web of Science, and Physiotherapy Evidence Database, through March 2018, to identify randomized controlled trials investigating whether MT was effective to treat CMP pain in female breast cancer survivors (PROSPERO number CDR42017074175).

RESULTS

The database searches retrieved 1562 titles, and after screening, 5 papers were included for full analysis. The manual therapy techniques described in the included studies involved myofascial induction, myofascial release, classic massage, ischemic compression of trigger points, and myofascial therapy. A meta-analysis, using a fixed-effects model, found that MT decreased CMP intensity (standardized mean difference: 0.32; 95% CI 0.06-0.57), but no significant difference was observed in quality of life after the MT intervention in comparison with a control condition (standardized mean difference: 0.14; 95% CI 0.17-0.46).

CONCLUSION

Current evidence suggests that MT is considered effective for treating CMP in the upper limbs and thorax of female breast cancer survivors.

Highly conductive, stretchable and biocompatible Ag-Au core-sheath nanowire composite for wearable and implantable bioelectronics

Wearable and implantable devices require conductive, stretchable and biocompatible materials. However, obtaining composites that simultaneously fulfil these requirements is challenging due to a trade-off between conductivity and stretchability. Here, we report on Ag-Au nanocomposites composed of ultralong gold-coated silver nanowires in an elastomeric block-copolymer matrix. Owing to the high aspect ratio and percolation network of the Ag-Au nanowires, the nanocomposites exhibit an optimized conductivity of 41,850 S cm^-1 (maximum of 72,600 S cm^-1). Phase separation in the Ag-Au nanocomposite during the solvent-drying process generates a microstructure that yields an optimized stretchability of 266% (maximum of 840%). The thick gold sheath deposited on the silver nanowire surface prevents oxidation and silver ion leaching, making the composite biocompatible and highly conductive. Using the nanocomposite, we successfully fabricate wearable and implantable soft bioelectronic devices that can be conformally integrated with human skin and swine heart for continuous electrophysiological recording, and electrical and thermal stimulation.

Therapeutic heat and cryotherapy increases knee range of movement on hamstring muscles of healthy volunteers

Purpose:

To investigate the effects of heat (surface and deep) and cold on the range of motion of the knee.

Methods:

A total of 40 volunteers were randomly allocated into four groups, with 10 participants in each group. The control group had no intervention, the infrared group received an application of surface heat conducted through an infrared device, the shortwave group received deep heating through a shortwave device, and the cryotherapy group had ice packs placed on them. A blind measurer performed the flexibility evaluation using a goniometer coupled to a board that evaluated range of movement of the knee. Data were statistically analysed by one-way analysis of variance and Tukey's comparison (for comparison between groups) and paired t-student tests (for before and after comparisons) to determine differences between groups, with a significance level of p<0.05.

Findings:

The infrared, cryotherapy and shortwave groups showed an increase in the range of motion compared with the control group. It was observed that the control and infrared groups showed no significant differences before and after application (p>0.05). However, the cryotherapy and shortwave groups demonstrated an effective increase (p<0.05).

Conclusions:

The three heating and cooling techniques caused a favourable increase of range of movement compared with no intervention. However, the shortwave and cryotherapy interventions were more effective in increasing the knee joint's range of motion.

Reconceptualising manual therapy skills in contemporary practice

With conflicting evidence regarding the effectiveness of manual therapy calls have arisen within some quarters of the physiotherapy profession challenging the continued use of manual skills for assessment and treatment. A reconceptualisation of the importance of manual examination findings is put forward, based upon a contemporary understanding of pain science, rather than considering these skills only in terms of how they should "guide" manual therapy interventions. The place for manual examination findings within complex, multidimensional presentations is considered using vignettes describing the presentations of five people with low back pain. As part of multidimensional, individualised management, the balance of evidence relating to the effectiveness, mechanisms of action and rationale for manual skills is discussed. It is concluded that if manual examination and therapeutic skills are used in a manner consistent with a contemporary understanding of pain science, multidimensional patient profiles and a person-centred approach, their selective and judicious use still has an important role.

A INFLUÊNCIA DA TERMOTERAPIA NO GANHO DE FLEXIBILIDADE DOS MÚSCULOS ISQUIOTIBIAIS

RESUMO Introdução: A flexibilidade muscular é descrita como a capacidade do músculo realizar a extensão de suas fibras, influenciando a mobilidade articular. A diatermia aplicada à musculatura prepara o corpo para atividades físicas, por acelerar o metabolismo das fibras musculares e diminuir a resistência intramuscular, aumentando assim a variedade de movimento e a eficiência mecânica. A crioterapia tem diversas funções fisiológicas quando aplicada ao corpo humano, as quais, em conjunto, propiciam o relaxamento muscular. Objetivo: Avaliar o comportamento da flexibilidade dos músculos isquiotibiais frente à aplicação de alongamento passivo associado a termoterapias quente e fria. Métodos: Este estudo foi composto de 24 voluntários, de ambos os sexos, distribuídos aleatoriamente em três grupos, sendo eles: grupo alongamento passivo (G1), grupo crioterapia precedendo alongamento passivo (G2) e grupo diatermia precedendo alongamento passivo (G3). Os voluntários foram submetidos a avaliações de amplitude de movimento através da goniometria da flexão de quadril com o joelho estendido, sendo uma avaliação inicial realizada antes de iniciar o protocolo e reavaliações ao final de cada uma das quatro semanas de intervenção. Resultados: Verificou-se aumento significativo da flexão de quadril no G2 e G3 com relação ao G1. Não houve diferença estatística entre G2 e G3. Conclusão: O uso da diatermia, assim como da crioterapia, associado ao alongamento passivo é favorável para o ganho de flexibilidade muscular e, consequentemente, de amplitude de movimento em jovens saudáveis.

Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review

INTRODUCTION

Ayurveda has described about the pathogenesis and the treatment of various disorders, the incidence of some of which have increased in the present scenario. Janu Sandhigata Vata correlated with osteoarthritis (OA) of the knee joint is one such chronic, degenerative, inflammatory disease which has a great impact on the quality of the life of an individual. Different modalities of treatment have been explained in the classics to tackle the condition effectively.

METHODOLOGY

In the present study, an attempt has been made to review the various clinical research works done in the management of OA of the knee, which are registered in various research portal. In AYUSH Research Portal using the keywords Ayurveda-clinical research-musculoskeletal disorders-osteoarthrosis of knee-Janu Sandhigata Vata and in PubMed using clinical research - Ayurveda-OA. The studies reviewed were categorized depending on the treatment used in the management of the condition.

RESULTS

Fifty three research works were registered under AYUSH Research Portal with 34 full papers. There were 12 research papers in PubMed, out of which 6 papers which dealt with OA of the knee were reviewed. Among these six, three already existed in AYUSH Research Portal. The results were discussed by categorizing the studies as per the treatment used.

CONCLUSION

Among the papers reviewed, most of them dealt with few modalities of treatment rather than the complete classical line of the treatment. The evidence-based research involving multimodality treatment with long-term follow-up covering various aspects of prevention and cure has to be conducted which is the need of the hour.

Effect of therapeutic infra-red in patients with non-specific low back pain: a pilot study

The purpose of this study was to investigate the effect of infra-red (IR) in patients with chronic non-specific low back pain (NSLBP). Ten patients with NSLBP (5 men and 5 women) and disease duration of 21.7 ± 11.50 months participated in this pilot study. Patients had a mean age of 36.40 ± 10.11 years (range = 25-55). Patients were treated with infra-red (IR) for 10 sessions, each for 15 min, 3 days per week, for a period of 4 weeks. Outcome measures were the Numerical Rating Scale (NRS), the Functional Rating Index (FRI), the Modified-Modified Schober Test (MMST), and the Biering-Sorensen test to assess pain severity, disability, lumbar flexion and extension range of motion (ROM), and back extensor endurance, respectively. Data were collected at: baseline - study entry (T0); end of 5th treatment session after 2 weeks (T1); and end of the treatment after 4 weeks (T2). The results of the ANOVA demonstrated a statistically significant main effect of IR on all outcomes of pain, function, lumbar flexion-extension ROM, and back extensor endurance. The treatment effect sizes ranged from large to small. IR was effective in improving pain, function, lumbar ROM, and back extensor endurance in a sample of patients with NSLBP. Treatment effect sizes ranged from large to small indicating clinically relevant improvements primarily in pain and function for patients with NSLBP.

The use of physiotherapy tools in medical treatment. The use of heat, light, electric, magnetic, ultrasound and shock wave therapy as well as medical massage in Hungarian medical practice

The authors overview the possible use of different modalities of passive physiotherapy in the Hungarian medical practice. These modalities can be used in most of the medical specialities as well as family practice, not only in the treatment of the musculoskeletal disorders and medical rehabilitation. Orv. Hetil., 154(48), 1905–1911.

Associations between treatment processes, patient characteristics, and outcomes in outpatient physical therapy practice

OBJECTIVE

To identify how treatment processes are related to functional outcomes for patients seeking treatment for musculoskeletal impairments while controlling for demographic and health characteristics at intake.

DESIGN

Prospective, observational cohort study. Treatment processes were not altered. Data were collected continuously from June 2005 to January 2008. Descriptive statistics were applied to compare patient characteristics, interventions, and outcomes between impairment categories. Ordinary least-squares multiple regressions were used to examine associations between patient characteristics at intake, treatment processes, and functional outcomes.

SETTING

Fifty-four community-based outpatient physical therapy clinics of Maccabi Healthcare Services, a public health plan in Israel.

PARTICIPANTS

A consecutive sample of 22,019 adult patients (mean age 51.2 y, standard deviation=15.7, range 18-96, 58% women) seeking treatment due to lumbar spine, knee, cervical spine, or shoulder impairments with functional measurements at intake and discharge.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Functional status at discharge.

RESULTS

Explanatory power ranged from 30% to 39%. Better outcomes were associated with patient compliance with self-exercise and therapy attendance, application of therapeutic exercise and manual therapy, and completion of 3 or more functional surveys during the episode of care. Worse outcomes were associated with women, electrotherapy for pain management, and therapeutic ultrasound for shoulder impairments. Mixed results were found for group exercise programs.

CONCLUSIONS

The study of associations between treatment processes, patient characteristics, and outcomes helps to describe practice and can be used to suggest ways to improve outcomes in outpatient physical therapy practice.