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Aguilar García M, González Muñoz A, Pérez Montilla JJ, Aguilar Nuñez D, Hamed Hamed D, Pruimboom L, Navarro Ledesma S. Which Multimodal Physiotherapy Treatment Is the Most Effective in People with Shoulder Pain? A Systematic Review and Meta-Analyses. Healthcare (Basel) 2024; 12:1234. [PMID: 38921347 PMCID: PMC11203989 DOI: 10.3390/healthcare12121234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
The study aimed to determine if combined physiotherapy treatments offer additional benefits over exercise-only programs for shoulder pain and to identify the most effective combined treatment. A systematic review, registered in PROSPERO (CRD42023417709), and meta-analyses were conducted. Quality analysis was performed using the PEDro scale on randomized clinical trials published from 2018 to 2023. Twenty articles met the inclusion criteria. The most commonly used combination was exercise plus manual therapy, without being statistically superior to exercise alone. The meta-analysis indicated that combining exercise with low-level laser therapy (mean difference of -1.06, 95% CI: -1.51 to -0.60) and high-intensity laser therapy (mean difference of -0.53, 95% CI: -1.12 to 0.06) resulted in the greatest reduction in SPADI scores. Adding manual therapy provided limited additional benefit (mean difference of -0.24, 95% CI: -0.74 to 0.27). Progressive exercise with advice or telerehabilitation yielded modest improvements. The multimodal meta-analysis for DASH scores showed significant improvement (mean difference of -1.06, 95% CI: -1.51 to -0.60). In conclusion, therapeutic exercise is the cornerstone of shoulder pain treatment, with the addition of laser therapy showing substantial benefits. Manual therapy and educational interventions offer some benefits but are not consistently superior. More rigorous studies are needed.
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Affiliation(s)
- Maria Aguilar García
- Biomedicine PhD Program, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Ana González Muñoz
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.G.M.); (J.J.P.M.); (D.H.H.)
| | - José Javier Pérez Montilla
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.G.M.); (J.J.P.M.); (D.H.H.)
| | - Daniel Aguilar Nuñez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
| | - Dina Hamed Hamed
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.G.M.); (J.J.P.M.); (D.H.H.)
| | - Leo Pruimboom
- University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, 52004 Melilla, Spain;
| | - Santiago Navarro Ledesma
- University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, 52004 Melilla, Spain;
- Department of Physical Therapy, Faculty of Health Sciences of Melilla, University of Granada, 52004 Melilla, Spain
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Soliño S, Mignone F, Policastro P, Vuoto T, Pierobon A, Porollan JC. [Prognostic factors for substantial clinical benefit from musculoskeletal pathologies of the shoulder]. ACTA ORTOPEDICA MEXICANA 2024; 38:142-148. [PMID: 38862143 DOI: 10.35366/115808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
INTRODUCTION shoulder plain is a common cause of complain, however a precise diagnosis is hard to achieve. This is why finding factors associated to a good prognosis could help to improve our clinical practice. OBJECTIVE to identify demographic and clinical characteristics from the initial assessment associated with substantial clinical benefit (SCB) in patients with shoulder pain one month after treatment or at patient's discharge. MATERIAL AND METHODS this was a secondary analysis of a prospective cohort of patients with shoulder pain. Demographic and clinical (self-reported scales) factors associated with SCB at discharge or four weeks after the initial assessment, were analyzed. SCB was defined as a score +5 on a Global Rating of Change. A logistic regression model was made in order to identify predictors of SCB. The area under the curve ROC was used to assess the performance of the model with its independent variables. RESULTS 101 patients of 138 were analyzed. The median age was 55 (RIQ 37-61) years old, there were 55 (54.5%) women in the sample. The variables independently associated to SCB were fracture as a reason for admission [adjusted OR 11.8 (95% CI 1.4-101.8); p = 0.024], and durations of shoulder symptoms shorter than seven months [adjusted OR 4.63 (95% CI 1.9-11.1); p = 0.001]. CONCLUSION the diagnosis of fracture and durations of shoulder symptoms shorter than seven months were independently associated with a SCB after one month of treatment or at the patient's discharge.
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Affiliation(s)
- S Soliño
- Unidad de Kinesiología, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
| | - F Mignone
- Unidad de Kinesiología, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
| | - P Policastro
- Unidad de Kinesiología, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
| | - T Vuoto
- Unidad de Kinesiología, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
| | - A Pierobon
- Department of Primary Health Care and General Practice, University of Otago. Wellington, Nueva Zelanda
| | - J C Porollan
- Unidad de Kinesiología, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
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Janeiro J, Barreira S, Martins P, Sarmento M, Campos J, Fonseca JE. Ultrasound findings and prognosis of shoulder pain: A role for Doppler signal? JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:837-844. [PMID: 36715681 DOI: 10.1002/jcu.23436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/02/2023]
Abstract
PURPOSE To find ultrasound prognostic factors for shoulder pain. METHODS This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant. RESULTS A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome. CONCLUSION A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease.
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Affiliation(s)
- João Janeiro
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia Barreira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Marco Sarmento
- Serviço de Ortopedia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Jorge Campos
- Serviço de Imagiologia Neurológica, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Hernández-Lázaro H, Mingo-Gómez MT, Jiménez-del-Barrio S, Lahuerta-Martín S, Hernando-Garijo I, Medrano-de-la-Fuente R, Ceballos-Laita L. Researcher's Perspective on Musculoskeletal Conditions in Primary Care Physiotherapy Units through the International Classification of Functioning, Disability, and Health (ICF): A Scoping Review. Biomedicines 2023; 11:biomedicines11020290. [PMID: 36830831 PMCID: PMC9953260 DOI: 10.3390/biomedicines11020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Background: Musculoskeletal disorders are the second cause of disability in the world. The International Classification of Functioning Disability and Health (ICF) is a tool for systematically describing functioning. Outcome measures for musculoskeletal disorders and functioning concepts embedded in them have not been described under the ICF paradigm. The objective of this scoping review was to identify ICF categories representing the researcher's perspective and to compare them with the ICF core set for post-acute musculoskeletal conditions. (2) Methods: This review was conducted as follows: (a) literature search using MEDLINE/PubMed, CINAHL, Web of Science, and Scopus databases; (b) study selection applying inclusion criteria (PICOS): musculoskeletal conditions in primary care, application of physiotherapy as a treatment, outcome measures related to functioning, and experimental or observational studies conducted in Western countries during the last 10 years; (c) extraction of relevant concepts; (d) linkage to the ICF; (e) frequency analysis; and (f) comparison with the ICF core set. (3) Results: From 540 studies identified, a total of 51 were included, and 108 outcome measures were extracted. In the ICF linking process, 147 ICF categories were identified. Analysis of data showed that 84.2% of the categories in the ICF core set for post-acute musculoskeletal conditions can be covered by the outcome measures analyzed. Sixty-eight relevant additional ICF categories were identified. (4) Conclusion: Outcome measures analyzed partially represent the ICF core set taken as a reference. The identification of additional categories calls into question the applicability of this core set in primary care physiotherapy units.
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Affiliation(s)
- Héctor Hernández-Lázaro
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
- Ólvega Primary Care Health Center (Soria, Spain), Soria Health Care Management, Castilla y León Regional Health Management (SACYL), 47007 Valladolid, Spain
| | - María Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Sandra Jiménez-del-Barrio
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
- Correspondence:
| | | | - Ignacio Hernando-Garijo
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Ricardo Medrano-de-la-Fuente
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
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Claes A, Mertens MG, Verborgt O, Baert I, Struyf F. Factors associated with better treatment outcome of physical therapy interventions after shoulder arthroplasty: A systematic review. Clin Rehabil 2022; 36:1369-1399. [PMID: 35698750 DOI: 10.1177/02692155221106627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize factors that are associated with a better treatment outcome after post-operative physical therapy in patients with shoulder arthroplasty. DATA SOURCES PubMed, Cochrane, and Web of Science. REVIEW METHODS Studies examining factors that are associated with a better outcome after post-operative physical therapy interventions in patients with shoulder arthroplasty were included. Two independent reviewers performed screening, extracted data, and assessed the risk of bias and level of evidence, using the Quality In Prognosis Studies tool and Evidence-Based Guideline Development checklist. PRISMA guidelines were followed. RESULTS In total, 460 articles were found and 14 studies were included. Two of the included articles had a moderate risk of bias, 12 high. The overall number of patients in the included studies varied from 20 to 2053. Patients had either a reverse (N = 1863), an anatomic total shoulder arthroplasty (N = 1029) or, a hemiarthroplasty (N = 133). Anatomic total shoulder arthroplasty patients with a neutral rotation sling position showed less night pain and greater range of motion, which was awarded moderate evidence. Other modifiable and non-modifiable factors such as telemedicine, immediate range of motion exercises, and pre-operative function were only awarded preliminary or conflicting evidence. CONCLUSION Mainly preliminary and conflicting evidence was found. The possible causes of the conflicting evidence were the different measurement methods, implant types, and follow-up times used. The methodological quality was low and physical therapy protocols differed greatly. More high-quality research with standardized protocols is needed to determine the association of various factors with treatment outcomes after post-operative physical therapy in patients with shoulder arthroplasty.
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Affiliation(s)
- Anke Claes
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Michel Gcam Mertens
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Olivier Verborgt
- Department of Orthopaedic Surgery and Traumatology, University of Antwerp, Wilrijk, Belgium.,Antwerp Orthopedic Center, 158103AZ Monica, Deurne, Belgium.,MORE Foundation, Antwerp Orthopedic Center, 158103AZ Monica, Deurne, Belgium
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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Mertens MGCAM, Struyf F, Meert L, Lauwers M, Schwank A, Verborgt O, Meeus M. Factors influencing treatment outcome of physical therapy in frozen shoulder patients: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2020.1827029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michel G. C. A. M. Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Magalie Lauwers
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Ariane Schwank
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Physiotherapy, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Pitts G, Custer M, Foister RD, Uhl T. The hand therapist's role in the prevention and management of upper extemity injuries in the modern mass production industrial setting. J Hand Ther 2021; 34:237-249. [PMID: 34034914 DOI: 10.1016/j.jht.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This case study presents the role of an onsite hand therapist (Certified Hand Therapist, Occupational Therapist, Physical Therapist) in an industrial setting and the services that can be provided in this comprehensive care model. Onsite hand therapists can impact on Occupational Safety and Health Administration (OSHA) first aid programs and can provide state of the art treatment for the injured worker in both a direct and indirect capacity. PURPOSE The purpose of this case study article is to review the many potential services the hand therapist can offer to facilitate the return-to-work of injured employees and provide employers with a proactive case management and state-of-the-art ergonomic prevention, improving profit margins and facilitating safe work environments. STUDY DESIGN A Case Study design demonstrating the diverse and positive impact of hand therapy on the mass production industrial setting. METHODS Novel to this approach is a description of outcome instruments (QuickDASH) administered in a periodic manner to understand the trajectory of change in patient-level disability throughout the rehabilitation process. The Optimal Screening for Prediction of Referral and Outcome (OSPRO-YF) is utilized to help predict the functional outcome for the injured worker. Case studies on common upper extremity pathologies will be discussed, demonstrating the benefits of onsite hand therapy with enhanced treatment and case management. RESULTS The utilization of the QuickDASH and the OSPRO-YF creates a process to determine the progression of injured workers in therapy, the trajectory of change in patient-level disability and to observe when changes occurred. An example of the periodic assessment approach is described in a case study to identify when the most significant change occurred and creating a mechanism to determine if patients were progressing as expected. CONCLUSIONS Inherent in this case study process is a fluidity in which the therapist can monitor patient progress and adjust the rehabilitation process that benefits both the patient and the industrial setting. A hierarchical functional level system is presented to describe an appropriate intervention strategy to coincide with a patient's progression of wound healing which can be provided by a hand therapist with specialized knowledge.
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Affiliation(s)
- Greg Pitts
- Commonwealth Hand Therapy, Lexington Kentucky 40504, Auerbach School of Occupational Therapy, Spalding University, Louisville, KY, USA.
| | - Melba Custer
- Auerbach School of Occupational Therapy, Spalding University, Chair, Research Ethics Committee REC, Louisville, KY, USA
| | | | - Tim Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Vallés-Carrascosa E, Gallego-Izquierdo T, Jiménez-Rejano JJ, Plaza-Manzano G, Pecos-Martín D, Hita-Contreras F, Achalandabaso Ochoa A. Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome. J Hand Ther 2019; 31:227-237. [PMID: 29329890 DOI: 10.1016/j.jht.2017.11.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/23/2017] [Accepted: 11/27/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized clinical trial. INTRODUCTION Eccentric exercise (EE) was shown to be an effective treatment in tendinopathies. However, the evidence of its effectiveness in subacromial syndrome (SS) is scarce. Moreover, consensus has not been reached on whether best results for SS are obtained by means of EE with or without pain. PURPOSE OF THE STUDY The purpose of this is to compare the effect on pain, active range of motion (AROM), and shoulder function of an exercise protocol performed with pain <40 mm Visual Analog Scale (VAS) and without pain, in patients with SS. METHODS Twenty-two subjects (mean age: 59 years [Q1 = 48.50-Q3 = 70], 54.5% women) were randomized into a not-painful EE group (NPEE; G0: n = 11) and a painful EE group (PEE; G1: n = 11). The intervention lasted 4 weeks. Pain was recorded using VAS; AROM was measured using a goniometer; and shoulder function using the modified Constant-Murley Score (CMS) before and after intervention. RESULTS All dependent variables improved significantly in both groups (P < .05): NPEE VAS median: pretest = 55.0 posttest = 28.0; CMS median: pretest = 36.0 posttest = 65.0. PEE VAS median: pretest = 37.0 posttest = 12.0; CMS median: pretest = 35.0 posttest = 59.0. The comparison between groups showed no significant differences, with small effect size values (VAS = 0.09; CMS = 0.21; AROM = 0.12-0.43). DISCUSSION In contrast to the previous findings, our results suggest that PEE do not add benefit in SS patients compared to NPEE. CONCLUSION Our results suggest that both interventions are effective in terms of pain, function, and shoulder AROM. Furthermore, PEE does not provide greater benefits. Further studies are needed with long-term follow-up to reinforce these results.
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Affiliation(s)
| | | | | | - Gustavo Plaza-Manzano
- Department of Physical Medicine and Rehabilitation, Universidad Complutense de Madrid, Spain
| | - Daniel Pecos-Martín
- Department of Physical Therapy and Nursing, Universidad de Alcalá de Henares, Spain
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Associations between interim patient-reported outcome measures and functional status at discharge from rehabilitation for non-specific lumbar impairments. Qual Life Res 2019; 29:439-451. [PMID: 31571028 DOI: 10.1007/s11136-019-02314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Identify impact of frequency and timing of interim Patient-Reported Outcome Measures (PROMs) assessments during episodes of care for rehabilitation services in outpatient clinical settings on functional status (FS) outcomes at discharge for patients with low back pain. METHODS FS outcomes of patients who had no interim PROMs were compared to outcomes of six patient groups defined by interim timing (early, mid, late) and frequency (1, 2 or more). For each comparison, patients were matched using propensity score matching for variables known to be associated with FS outcomes and for episode duration (days) and number of visits. FS was assessed using the lumbar computerized adaptive test (LCAT) where scores range from 0 to 100 with higher scores representing better physical function. RESULTS A sample of 140,336 patients was considered for matching (mean age = 58 [SD = 17] range 18-89; 60% females) with 83,101 patients (59%) having no interim PROMs. Patients who had only one interim PROM, administered during early (first 2 weeks), mid (weeks 3-4), or late (week 5 or later) timing, had 4.6, 2.7, and 1.0 additional FS score points at discharge compared to those without an interim PROM, respectively (p < 0.001). Having two or more interim PROMs was associated with an additional 1.2 FS points compared to having only one interim assessment, but only if the first interim was administered early. CONCLUSIONS Optimal utilization of interim PROM assessment during clinical practice to enhance treatment outcomes was related to administering the first interim PROM within the first 2 weeks after the initial evaluation.
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Anodal Transcranial Direct-Current Stimulation to Enhance Rehabilitation in Individuals With Rotator Cuff Tendinopathy: A Triple-Blind Randomized Controlled Trial. J Orthop Sports Phys Ther 2018; 48:541-551. [PMID: 29747540 DOI: 10.2519/jospt.2018.7871] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Anodal transcranial direct-current stimulation (a-tDCS) has been shown to enhance the effects of sensorimotor training in neurological populations. Sensorimotor training leads to reduced pain and increased function in the treatment of rotator cuff tendinopathy. The addition of a-tDCS during a rehabilitation program centered on sensorimotor training may improve treatment outcomes in individuals with rotator cuff tendinopathy. Objective To compare 2 groups of individuals with rotator cuff tendinopathy, one receiving a rehabilitation program centered on sensorimotor training with a-tDCS and the other receiving the same rehabilitation program with sham a-tDCS. Methods In this triple-blind, parallel-group randomized controlled trial, 40 adults with rotator cuff tendinopathy participated in a 6-week rehabilitation program (8 treatments with home exercises and including sensorimotor training, patient education, and strengthening). They were randomly assigned to 1 of 2 groups to receive either real a-tDCS (stimulation, 1.5 mA for 30 minutes) or sham a-tDCS during the first 5 treatments. Symptoms and functional limitations (Disabilities of the Arm, Shoulder and Hand questionnaire, Western Ontario Rotator Cuff index) of all participants were evaluated at baseline and at 3, 6, and 12 weeks. Acromiohumeral distances (ultrasonographic measurement at 0°, 45°, and 60° of arm elevation) were assessed at baseline and 6 weeks. Two-way or 3-way repeated-measures analyses of variance were used for statistical analyses. Results Both groups showed statistically significant improvement in Disabilities of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff index scores at 3, 6, and 12 weeks, and in acromiohumeral distance at 45° and 60° at 6 weeks (P<.05). No significant group-by-time interaction was observed for all outcomes (P>.43). Conclusion Results do not demonstrate any improved treatment outcomes from the addition of a-tDCS during a rehabilitation program for individuals with rotator cuff tendinopathy. Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(7):541-551. Epub 10 May 2018. doi:10.2519/jospt.2018.7871.
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