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Mertens MG, Meeus M, Noten S, Verborgt O, Fransen E, Lluch Girbés E, Aguilar Rodríguez M, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F, Dueñas L. Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study. BMJ Open 2022; 12:e056563. [PMID: 36410809 PMCID: PMC9680192 DOI: 10.1136/bmjopen-2021-056563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. The aim of the current study was to examine to what extent range of motion (ROM) limitation, metabolic factors (diabetes mellitus and thyroid disorders), autonomic symptoms and pain sensitivity may contribute to the prognosis in terms of shoulder pain and disability and quality of life in patients with FS. METHODS Patients with stage 1 or 2 FS were longitudinally followed-up during 9 months after baseline assessment. They completed six questionnaires and underwent quantitative sensory testing (pressure pain thresholds, temporal summation and conditioned pain modulation) and ROM assessment. RESULTS One hundred and forty-nine patients with FS were initially recruited and 121 completed at least one follow-up measurement. Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. Several domains of quality of life also improved over time and external rotation ROM, diabetes mellitus, thyroid disorder and autonomic symptoms were found to be prognostic factors for final outcome. These prognostic factors explained 2.5%-6.3% of the final outcome of shoulder pain and disability and quality of life. DISCUSSION AND CONCLUSION In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. Other variables not explored in this study might contribute to the prognosis of patients with FS, which should be investigated in future research. In clinical practice, baseline assessment of prognostic factors and focusing on a more holistic approach might be useful to inform healthcare practitioners about progression of patients with FS during a 9-month period.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Suzie Noten
- Department of Rehabilitation Medicine, Erasmus MC University medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerpen, Belgium
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium
| | - Enrique Lluch Girbés
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Marta Aguilar Rodríguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | | | | | - Filip Struyf
- Rehabilitation Sciences, Universiteit Antwerpen Campus Drie Eiken, Wilrijk, Belgium
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
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Clinical Efficacy of Epidural Injections of Local Anesthetic Alone or Combined with Steroid for Neck Pain: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8952220. [PMID: 35663039 PMCID: PMC9162875 DOI: 10.1155/2022/8952220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Aims To compare the effectiveness of cervical epidural injections of local anesthetic with vs. without a steroid. Methods Three databases (PubMed, Embase, and Cochrane library) were used to search and assess all clinical randomized controlled trials regarding the clinical efficacy of epidural injections from January 01, 2009, to October 31, 2020. Cochrane review criteria and the Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment instrument were used to evaluate the methodologic quality of the included studies. Qualitative and quantitative analyses were performed according to best evidence synthesis principles and by single-arm meta-analysis, respectively. Results Based on the search criteria, 4 RCTs were qualitatively and quantitatively analyzed in the single-arm meta-analysis. Treatment with lidocaine alone or with the steroid resulted in decreases of 4.46 and 4.29 points, respectively, in pain scores and of 15.8 and 14.46 points, respectively, in functional scores at 6 months. Similar trends were observed at the 1-year follow-up: pain scores decreased by 4.27 and 4.14 points, while functional scores decreased by 15.94 and 14.44 points in patients with neck pain who received lidocaine without or with the steroid, respectively. In the 3 studies that reported 2-year follow-up data, patients with neck pain treated with lidocaine or lidocaine + steroid showed 4.2- and 4.14-point decreases, in pain score and 15.92- and 14.89-point decreases, respectively, in functional scores. Conclusions The studies showed level I (strong) evidence for short- and long-term improvements in pain relief and functionality with cervical epidural injections of local anesthetic alone or with a steroid in the management of neck pain.
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Chrcanovic B, Larsson J, Malmström EM, Westergren H, Häggman-Henrikson B. Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. Scand J Pain 2022; 22:232-261. [PMID: 34561976 DOI: 10.1515/sjpain-2021-0064] [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: 03/31/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list. CONTENT The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers. SUMMARY The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability. OUTLOOK Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.
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Affiliation(s)
| | - Johan Larsson
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
| | - Hans Westergren
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Health Sciences, Lund University, Lund, Sweden
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Mertens MG, Meeus M, Verborgt O, Vermeulen EHM, Schuitemaker R, Hekman KMC, van der Burg DH, Struyf F. An overview of effective and potential new conservative interventions in patients with frozen shoulder. Rheumatol Int 2021; 42:925-936. [PMID: 34487209 DOI: 10.1007/s00296-021-04979-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 12/11/2022]
Abstract
Frozen shoulder (FS) is a pathology that is difficult to understand and difficult to manage. Over the last ten years, contradictory and new evidence is provided regarding the recovery and its natural course. This narrative review provides new information about the diagnosis and conservative treatment of patients with FS and ongoing research hypotheses that might provide new insights in the pathology and treatment options. FS has a characteristic course. People with Diabetes Mellitus and thyroid disorders have a higher risk of developing a FS. The diagnosis FS is based on pattern recognition and physical examination. Additionally, 'rule-in' and 'rule-out' criteria can be used to increase the likelihood of the frozen shoulder diagnosis. Recommended and most common physical therapy interventions are mobilization techniques and exercises, in which tissue irritability can guide its intensity. In addition, physical therapy is often complementary with patient education and pharmacotherapy. The latest evidence-based practice related to FS is proprioceptive neuromuscular facilitation and mirror therapy. In addition, interventions like pain neuroscience education, high-intensity interval training and lifestyle changes are still hypothetical. Finally, better insight in the involvement of biochemical processes, function of myofibroblasts and matrix metalloproteinases can provide better understanding in the pathophysiology and will be addressed in current review.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.,Pain in Motion International Research Group
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.,Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.,Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Eric H M Vermeulen
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruud Schuitemaker
- Schuitemaker en Van Schaik Fysiotherapie en Manuele Therapie, Amsterdam, The Netherlands
| | - Karin M C Hekman
- Medisch Centrum Jan Van Goyen, Amsterdam, The Netherlands.,Schoudercentrum IBC Amstelland, Amstelveen, The Netherlands
| | - Donald H van der Burg
- Fysiotherapie Oost Nederland (FYON), Enschede, The Netherlands.,Saxion Hogeschool, Enschede, The Netherlands
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.
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Peng B, Bogduk N. Cervical Discs as a Source of Neck Pain. An Analysis of the Evidence. PAIN MEDICINE 2019; 20:446-455. [PMID: 30520967 DOI: 10.1093/pm/pny249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVESBACKGROUND Objectives To determine the extent and strength of evidence that supports the belief that cervical intervertebral discs are a source of neck pain. DESIGN Design The evidence from anatomical, laboratory, experimental, diagnostic, and treatment studies was summarized and analyzed for concept validity, face validity, content validity, and construct validity. RESULTS Results Evidence from basic sciences shows that cervical discs have a nociceptive innervation, and experimental studies show that they are capable of producing neck pain. Disc stimulation has been developed as a diagnostic test but has rarely been used in a disciplined fashion. The prevalence of cervical disc pain has not been properly established but appears to be low. No treatment has been established that reliably achieves complete relief of neck pain in substantial proportions of patients. CONCLUSIONS Conclusions Basic science evidence supports the concept of cervical disc pain, but epidemiologic and clinical evidence to vindicate the clinical application of the concept is poor or lacking.
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing, Peoples Republic of China
| | - Nikolai Bogduk
- Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle, Australia
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Anderson C, Yeung E, Tong T, Reed N. A narrative review on cervical interventions in adults with chronic whiplash-associated disorder. BMJ Open Sport Exerc Med 2018; 4:e000299. [PMID: 29719724 PMCID: PMC5926568 DOI: 10.1136/bmjsem-2017-000299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method The Arskey and O'Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD.
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Affiliation(s)
- Charlotte Anderson
- Rehabilitation Sciences, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Concussion Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Euson Yeung
- Rehabilitation Sciences, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Tong
- Rehabilitation Sciences, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Concussion Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Nick Reed
- Concussion Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Svensson E, Nyström B, Goldie I, Landrø NI, Sidén Å, Staff P, Schillberg B, Taube A. Superior outcomes following cervical fusion vs. multimodal rehabilitation in a subgroup of randomized Whiplash-Associated-Disorders (WAD) patients indicating somatic pain origin-Comparison of outcome assessments made by four examiners from different disciplines. Scand J Pain 2018; 18:175-186. [PMID: 29794310 DOI: 10.1515/sjpain-2017-0180] [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] [Received: 12/11/2017] [Accepted: 02/01/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Whiplash-Associated Disorders (WAD) are characterized by great variability in long-term symptoms. Patients with central neck and movement-induced stabbing pain participated in a randomized study comparing cervical fusion and multimodal rehabilitation. As reported in our previous paper, more patients treated by cervical fusion than by rehabilitation experienced pain relief. Although patient reported outcome measures are a core component of outcome evaluation, independent examiner has been recommended. Because of the heterogeneity of WAD complaints the patients in our study were examined at baseline and follow-up by four experts representing neurology, orthopedics, psychology and physical medicine. The aim was to compare the professional assessments of change both regarding the possible impact of the different examiners' perspectives on individual patient's outcome, and also on the analysis of possible outcome differences between the treatment groups. METHODS WAD patients with long-term neck pain as the predominant symptom after a traffic accident were eligible. The neck pain origin should be in the midline and perceived as dull and aching, with sudden movement inducing midline stabbing pain. Of the 1,052 patients in contact with our team, 49 were eligible. The overall treatment effect was evaluated on a global outcome transitional scale. The criteria for the scale categories were defined by each expert's professional perspective on change in the whiplash complaints. Statistical methods that take account of the non-metric properties of ordered categorical data were used. Observed inter-expert disagreement was evaluated by the Svensson method that identifies and measures systematic group-related disagreement separately from disagreement caused by individual variation. Possible differences in the distributions of assessments on the expert-specific outcome scales between the treatment groups were analyzed by the Kruskal-Wallis test. RESULTS The per-protocol evaluation showed that a majority of the 18 patients who underwent fusion surgery were assessed as somewhat or much better, ranging from 67% to 78% depending on the expert. Corresponding proportions of improvement in the 17 patients treated by multimodal rehabilitation ranged from 29% to 53%. The statistical analyses confirmed better outcomes in the patients treated by fusion surgery, with p-values ranging from 0.003 to 0.04. The experts' assessments of intra-patient change disagreed more or less for all patients. The analyses of the paired comparisons confirmed that these disagreements could most probably be explained by the different profession-specific operational definitions of the outcome scales rather than by individual variations in data. CONCLUSIONS The multi-dimensional complexity of WAD-related complaints was comprehensively demonstrated by the inter-disciplinary disagreements in assessing intra-patient outcomes. The superiority of positive treatment effects in patients who underwent cervical fusion compared with multimodal rehabilitation was evident to all experts. IMPLICATIONS The results strengthen our previous opinion that neck pain in this subgroup of WAD patients has a somatic origin. More than one examiner is recommended for multi-dimensional outcome assessments.
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Affiliation(s)
- Elisabeth Svensson
- Department of Statistics, Örebro University, SE-70182 Örebro, Sweden;Present address: Sländvägen 6, SE-38634 Färjestaden, Sweden
| | - Bo Nyström
- Clinic of Spinal Surgery, Löt, SE-64595 Strängnäs, Sweden;Present address: Department of Neuroscience, Section of Neurosurgery, University Hospital, SE-75185 Uppsala, Sweden
| | - Ian Goldie
- Department of Orthopaedics, Karolinska University Hospital, Solna, SE-17176 Stockholm, Sweden
| | - Nils Inge Landrø
- Centre for the Study of Human Cognition, Department of Psychology, University of Oslo, NO-0373 Oslo, Norway;Present address: Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, NO-0373 Oslo, Norway
| | - Åke Sidén
- Department of Neurology, Karolinska University Hospital, Huddinge, SE-14186 Stockholm, Sweden
| | - Peer Staff
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, NO-0405 Oslo, Norway;Present address: Tråkka 1, NO-0774 Oslo, Norway
| | | | - Adam Taube
- Department of Statistics, Uppsala University, SE-75120 Uppsala, Sweden
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A surgical treatment for chronic neck pain after whiplash injury? Scand J Pain 2016; 12:43-44. [DOI: 10.1016/j.sjpain.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
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