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Zhu GC, Chen KM, Belcastro F. Comparing Different Stretching Exercises on Pain, Stiffness, and Physical Function Disability in Older Adults With Knee Osteoarthritis. Arch Phys Med Rehabil 2024; 105:953-962. [PMID: 37467937 DOI: 10.1016/j.apmr.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess and compare the effects of different stretching exercise programs on pain, stiffness, and physical function disability in older adults with knee osteoarthritis (KOA). DATA SOURCES This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for network meta-analysis (NMA). Relevant randomized controlled trials were identified by searching 7 databases up to December 2022. STUDY SELECTION Inclusion criteria included (1) older adults with KOA; (2) intervention included stretching exercises; (3) control groups received no stretching exercise; and (4) outcome measurements included pain, stiffness, or physical function disability. Methodological quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. DATA EXTRACTION NMA was performed using R and MetaInsight, with results presented as a standardized mean difference (SMD) with 95% confidence interval (CI). DATA SYNTHESIS We examined 17 studies, and NMA results indicated that proprioceptive neuromuscular facilitation (PNF) stretching, mind-body exercises, and multi-component exercise programs were effective in mitigating pain in older adults with KOA (SMD=2.54 [95% CI: 1.23; 3.84], SMD=1.09 [95% CI: 0.27; 1.92], SMD=0.57 [95% CI: 0.06; 1.09]). Moreover, mind-body exercises and multi-component exercises were the most effective programs in reducing stiffness (SMD=1.31 [95% CI: 0.12; 2.51]) and physical function disability (SMD=1.67 [95% CI: 0.01; 3.33]) in older adults with KOA, respectively. CONCLUSION Findings suggest that PNF stretching, mind-body exercises, and multi-component exercises can be incorporated into exercise programs to better mitigate pain, stiffness, and physical function disability in older adults with KOA.
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Affiliation(s)
- Guan-Cheng Zhu
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, Dubuque, IA
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Tanaka R, Umehara T, Kawabata Y, Sakuda T. Effect of Continuous Compression Stimulation on Pressure-Pain Threshold and Muscle Spasms in Older Adults With Knee Osteoarthritis: A Randomized Trial. J Manipulative Physiol Ther 2019; 41:315-322. [PMID: 29751849 DOI: 10.1016/j.jmpt.2017.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/29/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the effect of continuous compression stimulation on pressure-pain threshold and muscle spasms in older adults with knee osteoarthritis. METHODS Thirty-two older adults with knee osteoarthritis on outpatient visits were randomly divided into 2 groups. Those in the treatment group (n = 16) received 5-minute massage therapy (continuous compression stimulation), and those in the control group (n = 16) received sham massage therapy (touch without compression). Immediately before and after single-intervention sessions, the pressure-pain threshold, muscle spasm, and pain were quantified. RESULTS The change in pain on walking in the treatment group exceeded 1.9 cm, corresponding to the minimum clinically important difference. In the treatment group, the pressure-pain threshold improved significantly for pain both at rest and while walking, but the improvement in muscle spasm was not significant. CONCLUSIONS Massage therapy resulted in minimal clinically important changes for pain relief. There was an increase in the pressure-pain threshold in the older adults with knee osteoarthritis. We propose that the improvements in pain may be related to the medial thigh muscle rather than knee osteoarthritis.
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Affiliation(s)
- Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
| | - Takuya Umehara
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Yuuki Kawabata
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Tomohiko Sakuda
- Department of Orthopedic Surgery, Saiseikai Kure Hospital, Hiroshima, Japan
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Abstract
BACKGROUND Hip osteoarthritis (OA) is a major cause of pain and functional limitation. Few hip OA treatments have been evaluated for safety and effectiveness. Acupuncture is a traditional Chinese medical therapy which aims to treat disease by inserting very thin needles at specific points on the body. OBJECTIVES To assess the benefits and harms of acupuncture in patients with hip OA. SEARCH METHODS We searched Cochrane CENTRAL, MEDLINE, and Embase all through March 2018. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, another active treatment, or no specific treatment; and RCTs that evaluated acupuncture as an addition to another treatment. Major outcomes were pain and function at the short term (i.e. < 3 months after randomization) and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Six RCTs with 413 participants were included. Four RCTs included only people with OA of the hip, and two included a mix of people with OA of the hip and knee. All RCTs included primarily older participants, with a mean age range from 61 to 67 years, and a mean duration of hip OA pain from two to eight years. Approximately two-thirds of participants were women. Two RCTs compared acupuncture versus sham acupuncture; the other four RCTs were not blinded. All results were evaluated at short term (i.e. four to nine weeks after randomization).In the two RCTs that compared acupuncture to sham acupuncture, the sham acupuncture control interventions were judged believable, but each sham acupuncture intervention was also judged to have a risk of weak acupuncture-specific effects, due to placement of non-penetrating needles at the correct acupuncture points in one RCT, and the use of penetrating needles not inserted at the correct points in the other RCT. For these two sham-controlled RCTs, the risk of bias was low for all outcomes.The combined analysis of two sham-controlled RCTs gave moderate quality evidence of little or no effect in reduction in pain for acupuncture relative to sham acupuncture. Due to the small sample sizes in the studies, the confidence interval includes both the possibility of moderate benefit and the possibility of no effect of acupuncture (120 participants; Standardized Mean Difference (SMD) -0.13, (95% Confidence Interval (CI) -0.49 to 0.22); 2.1 points greater improvement with acupuncture compared to sham acupuncture on 100 point scale (i.e., absolute percent change -2.1% (95% CI -7.9% to 3.6%)); relative percent change -4.1% (95% CI -15.6% to 7.0%)). Estimates of effect were similar for function (120 participants; SMD -0.15, (95% CI -0.51 to 0.21)). No pooled estimate, representative of the two sham-controlled RCTs, could be calculated or reported for the quality of life outcome.The four other RCTs were unblinded comparative effectiveness RCTs, which compared (additional) acupuncture to four different active control treatments.There was low quality evidence that addition of acupuncture to the routine primary care that RCT participants were receiving from their physicians was associated with statistically significant and clinically relevant benefits, compared to the routine primary physician care alone, in pain (1 RCT; 137 participants; mean percent difference -22.9% (95% CI -29.2% to -16.6%); relative percent difference -46.5% (95% CI -59.3% to -33.7%)) and function (mean percent difference -19.0% (95% CI -24.41 to -13.59); relative percent difference -38.6% (95% CI -49.6% to -27.6%)). There was no statistically significant difference for mental quality of life and acupuncture showed a small, significant benefit for physical quality of life.The effects of acupuncture compared with either advice plus exercise or NSAIDs are uncertain.We are also uncertain whether acupuncture plus patient education improves pain, function, and quality of life, when compared to patient education alone.In general, the overall quality of the evidence for the four comparative effectiveness RCTs was low to very low, mainly due to the potential for biased reporting of patient-assessed outcomes due to lack of blinding and sparse data.Information on safety was reported in four RCTs. Two RCTs reported minor side effects of acupuncture, which were primarily minor bruising, bleeding, or pain at needle insertion sites. Four RCTs reported on adverse events, and none reported any serious adverse events attributed to acupuncture. AUTHORS' CONCLUSIONS Acupuncture probably has little or no effect in reducing pain or improving function relative to sham acupuncture in people with hip osteoarthritis. Due to the small sample size in the studies, the confidence intervals include both the possibility of moderate benefits and the possibility of no effect of acupuncture. One unblinded trial found that acupuncture as an addition to routine primary physician care was associated with benefits on pain and function. However, these reported benefits are likely due at least partially to RCT participants' greater expectations of benefit from acupuncture. Possible side effects associated with acupuncture treatment were minor.
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Affiliation(s)
| | - Ke Cheng
- Shanghai University of Traditional Chinese MedicineSchool of Acupuncture‐Moxibustion and Tuina1200, Cailun RDShanghaiChina201203
| | - L. Susan Wieland
- University of Maryland School of MedicineCenter for Integrative Medicine520 W. Lombard StreetBaltimoreUSA21201
| | - Xueyong Shen
- Shanghai University of Traditional Chinese Medicine, Shanghai Research Center of Acupuncture & Meridians, Shanghai Key Laboratory of acupuncture mechanism and acupoint functionSchool of Acupuncture‐Moxibustion and Tuina1200, Cailun RDShanghaiChina201203
| | - Lixing Lao
- The University of Hong KongSchool of Chinese Medicine10 Sassoon RoadPokfulam RdHong KongChina
| | - Menghu Guo
- Shanghai University of Traditional Chinese MedicineSchool of Acupuncture‐Moxibustion and Tuina1200, Cailun RDShanghaiChina201203
| | - Brian M Berman
- University of Maryland School of MedicineCenter for Integrative Medicine520 W. Lombard StreetBaltimoreUSA21201
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Pan RY, Hsu YC, Wong CS, Lin SL, Li TY, Cherng CH, Ko SC, Yeh CC. Comparing complementary alternative treatment for chronic shoulder pain of myofascial origin: Collateral meridian therapy versus local tender area-related meridians therapy. Medicine (Baltimore) 2016; 95:e4634. [PMID: 27583882 PMCID: PMC5008566 DOI: 10.1097/md.0000000000004634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to compare the short-term outcomes between 2 different treatments for unilateral chronic shoulder pain of myofascial origin, that is, local tender area related meridians (LTARMs) treatment and collateral meridian therapy (CMT), which were performed 6 times over a period of 4 weeks.Seventy patients with unilateral shoulder pain of chronic myofascial origin were enrolled. The patients were randomly assigned to 2 different treatment groups: 1 group received CMT (n = 35) and the other received LTARM (n = 35). Before and after the 2 treatment processes, all patients rated their overall pain intensity on a visual analogue scale (VAS) and a validated 13-question shoulder pain and disability index (SPADI) questionnaire was used to measure shoulder pain and functional impairment after therapy for 4 weeks.After CMT, the pain intensity was reduced after CMT. VAS score is reduced from 5.90 ± 2.07 (a mean of 5.90 and standard deviation of 2.07) to 3.39 ± 1.2. This was verified by the SPADI pain subscale scores (from 0.58 ± 0.193 to 0.33 ± 0.14). The pain-relief effect of CMT was significantly better than that of LTARM (VAS score from 5.78 ± 1.64 to 4.58 ± 1.40; P < 0.005; SPADI pain subscale score from 0.58 ± 0.16 to 0.45 ± 0.14, P < 0.001). In addition, the VAS scores of patients changed considerably in the CMT group after 4 weeks of treatment, where 63% of patients felt no or mild pain, whereas the VAS scores for moderate pain were even higher in the LTARM group in 75% of patients (P < 0.001). Moreover, the SPADI disability subscale scores improved significantly in the CMT group because of their greater mobility associated with shoulder impairment (disability score: from 0.58 ± 0.20 to 0.35 ± 0.14) than those in the LTARM group (disability score: from 0.55 ± 0.17 to 0.44 ± 0.14, P < 0.001).CMT may be more effective in reducing chronic shoulder pain of myofascial origin than the LTARM treatment, where treatment with the former resulted in better functional recovery after 4 weeks than the latter.
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Affiliation(s)
- Ru-Yu Pan
- Department of Orthopedics, Tri-Service General Hospital and National Defense Medical Center
| | - Yung-Chi Hsu
- Department of Anesthesiology and Integrated Pain Management Center
| | - Chih-Shung Wong
- Department of Anesthesiology and Integrated Pain Management Center
- Department of Anesthesiology, Cathay General Hospital
| | - Shinn-Long Lin
- Department of Anesthesiology and Integrated Pain Management Center
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Hwan Cherng
- Department of Anesthesiology and Integrated Pain Management Center
| | | | - Chun-Chang Yeh
- Department of Anesthesiology and Integrated Pain Management Center
- Correspondence: Chun-Chang Yeh, Department of Anesthesiology and Integrated Pain Management Center, Tri-Service General Hospital and National Defense Medical Center, No. 325, Section 2, Cheng-gung Road, 114, Taipei, Taiwan 24205, Republic of China (e-mail: )
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Yuan QL, Wang P, Liu L, Sun F, Cai YS, Wu WT, Ye ML, Ma JT, Xu BB, Zhang YG. Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Sci Rep 2016; 6:30675. [PMID: 27471137 PMCID: PMC4965798 DOI: 10.1038/srep30675] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/07/2016] [Indexed: 12/30/2022] Open
Abstract
The aims of this systematic review were to study the analgesic effect of real acupuncture and to explore whether sham acupuncture (SA) type is related to the estimated effect of real acupuncture for musculoskeletal pain. Five databases were searched. The outcome was pain or disability immediately (≤1 week) following an intervention. Standardized mean differences (SMDs) with 95% confidence intervals were calculated. Meta-regression was used to explore possible sources of heterogeneity. Sixty-three studies (6382 individuals) were included. Eight condition types were included. The pooled effect size was moderate for pain relief (59 trials, 4980 individuals, SMD -0.61, 95% CI -0.76 to -0.47; P < 0.001) and large for disability improvement (31 trials, 4876 individuals, -0.77, -1.05 to -0.49; P < 0.001). In a univariate meta-regression model, sham needle location and/or depth could explain most or all heterogeneities for some conditions (e.g., shoulder pain, low back pain, osteoarthritis, myofascial pain, and fibromyalgia); however, the interactions between subgroups via these covariates were not significant (P < 0.05). Our review provided low-quality evidence that real acupuncture has a moderate effect (approximate 12-point reduction on the 100-mm visual analogue scale) on musculoskeletal pain. SA type did not appear to be related to the estimated effect of real acupuncture.
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Affiliation(s)
- Qi-ling Yuan
- Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Peng Wang
- Xi’an 521 Hospital, Xi’an 710065, Shaanxi, China
| | - Liang Liu
- Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Fu Sun
- Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
- Department of Orthopaedics of the First Affiliated Hospital of Xi’an Medical College, Xi’an 710077, Shaanxi, China
| | - Yong-song Cai
- Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Wen-tao Wu
- Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Mao-lin Ye
- Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China
| | - Jiang-tao Ma
- Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China
| | - Bang-bang Xu
- Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China
| | - Yin-gang Zhang
- Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
- Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China
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Maly MR, Robbins SM. Osteoarthritis year in review 2014: rehabilitation and outcomes. Osteoarthritis Cartilage 2014; 22:1958-88. [PMID: 25456293 DOI: 10.1016/j.joca.2014.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/09/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To highlight research studies examining rehabilitation for hip and knee osteoarthritis (OA), as well as the outcome measures used to assess treatment efficacy, published in 2013. DESIGN A systematic search was performed in Medline, CIHAHL and Embase databases from January to December 2013. The search was limited to 2013, human studies, and English. Rehabilitation intervention studies included were prospective controlled designs. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the quality of evidence. First, individual articles were rated for quality. Second, articles were grouped based on outcome: OA disease markers, pain, physical function (self-reported, performance), and health. RESULTS Of 503 titles reviewed, 36 studies were included. The outcome measures related to OA disease markers were organized into subthemes of anthropometrics, biomechanics and physiology. The quality of evidence was of moderate, high, and low quality for anthropometric, biomechanical and physiological measures respectively. These studies supported the use of diet for weight loss combined with exercise. Bodies of evidence that showed the efficacy of exercise and passive strategies (thermal/electrical modalities, traction, manual therapy) for reducing pain were of low and moderate quality respectively. The evidence supporting diet and exercise, physiotherapy, and passive strategies to improve physical function was of moderate quality. Evidence supporting exercise to improve psychological factors was of moderate quality. CONCLUSIONS Exercise combined with diet for weight loss should be the mainstays of rehabilitation for people with knee and hip OA to provide benefit to OA disease markers, pain, physical function, and health.
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Affiliation(s)
- M R Maly
- School of Rehabilitation Science, McMaster University, Canada.
| | - S M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, School of Physical and Occupational Therapy, McGill University, Canada.
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Lee SH, Lu WA, Lee CS, Wang JC, Lin TC, Yang JL, Chan RC, Ko SC, Kuo CD. The therapeutic effect of collateral meridian therapy is comparable to acupoint pressure therapy in treating myofascial pain syndrome. Complement Ther Clin Pract 2014; 20:243-50. [DOI: 10.1016/j.ctcp.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/31/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
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Evaluation of genotoxicity of Trois through Ames and In vitro chromosomal aberration tests. Asian Pac J Trop Biomed 2013. [DOI: 10.1016/s2221-1691(13)60176-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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