Efficacy of transcranial direct current stimulation in patients with knee osteoarthritis: A systematic review

OBJECTIVE

Transcranial direct current stimulation (tDCS) has demonstrated its efficacy in alleviating pain among individuals with musculoskeletal disorders. This review focuses on the application of tDCS as a therapeutic intervention for managing knee osteoarthritis (OA), a prevalent musculoskeletal condition. The primary objective is to assess the effectiveness of tDCS(add-on tDCS and /or stand-alone tDCS), whether as an add-on to existing treatments or as a standalone therapy, in reducing pain and enhancing functional capacity in patients with knee OA.

METHODS

A comprehensive search was conducted across multiple databases, including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest, and Google Scholar, and Web of Science. The search terms employed were "Transcranial direct current stimulation" or "tDCS" in combination with "Osteoarthritis" or "OA" and "knee." After eliminating duplicates and studies that did not meet the inclusion criteria, a total of 14 relevant articles were identified for review.

RESULTS

Among the included studies, twelve reported statistically significant improvements in pain levels when comparing the active tDCS group to the sham tDCS group. Only two studies reported no significant difference in pain intensity between the active tDCS and sham tDCS groups. Findings regarding functional abilities were diverse, with some studies demonstrating a significant enhancement in functional outcomes in the active tDCS group, while others observed no statistically significant differences.

CONCLUSION

The results of this review suggest that tDCS holds promise as a pain management intervention for individuals with knee OA. Notably, anodal tDCS applied over the primary motor cortex (M1) appears to be particularly effective in alleviating pain in patients with knee OA. However, the impact of tDCS on functional performance appears to be limited.

Lumbopelvic-Hip Rhythm in People with Lumbar Flexion-with-Rotation Syndrome during Hip Internal Rotation

Background

According to previous research, hip internal rotation (HIR) aggravates low back pain (LBP) symptoms, especially in patients with lumbar flexion with rotation (F + R) syndrome. Therefore, the present study aimed to examine the lumbopelvic-hip rhythm during the HIR test in patients with this syndrome.

Methods

In this cross-sectional study, 20 men without LBP and 20 matched men with LBP, subcategorized in the F+R subgroup, participated. The participants performed the HIR test. Kinematics data were recorded using a motion analysis system. After processing the kinematics, a comparison was made in the hip and pelvic kinematics between the groups.

Results

A statistical analysis based on an independent t test revealed a significant increased (P < 0.05) pelvic rotation during the tests with the dominant ( P = 0.007) and nondominant limbs (P = 0.025) in those with LBP. The analysis also showed that during the test with the dominant lower limb, the pelvis and hip moved with a more synchronized pattern in patients with LBP (P = 0.001).

Conclusion

In the patients with lumbar F + R syndrome, there was a tendency for early pelvic rotation during the dominant HIR test. Moreover, LBP people also exhibited a greater pelvic rotation range of motion in the first half and whole pathways of the test. These impairments could be a risk factor for the development of LBP symptoms in these patients.

Kinematics of the Lumbar Spine and Hip Joints in People with Persistent Low Back Pain during Sit to Stand and Stand to Sit Activities

Background: To our knowledge, no study has examined the kinematics of lumbopelvic-hip complex of individuals with chronic low back pain (CLBP) who had lumbar flexion+rotation (F+R) syndrome during sit to stand (SiToSt) and stand to sit (StToSi) activities. Thus, this study aimed to examine movement patterns of the lumbopelvic-hip complex in participants with CLBP classified into F+R syndrome subgroup.

Methods:This was a cross sectional study. A 3-dimensional motion capture system was used to record movements of the lumbar spine and hips during SiToSt and StToSi. Participants were 20 patients with LBP classified in lumbar F+R subgroup, based on the movement impairment system model, and 20 asymptomatic individuals. The study was approved by Shahid Beheshti University of Medical Sciences (IR, SBMU.RETECH, and REC.1395.365).

Results:Greater and significant lumbar flexion, with SiToSt, and lumbar extension, with StToSi, were observed in the patients. In addition, the patients exhibited a greater magnitude of lumbar rotation during SiToSt. No significant difference was observed between the 2 groups in hip motions.

Conclusion: The patients with lumbar F+R syndrome tend to move their lumbopelvic region to a greater extent in sagittal and horizontal planes during SiToSt and StToSi compared with participants without low back pain.

Comparison of Lumbopelvic and Hip Movement Patterns During Passive Hip External Rotation in Two Groups of Low Back Pain Patients with and without Rotational Demand Activities

BACKGROUND

Because different groups of people with low back pain (LBP) engage in different tasks, their lumbopelvic-hip complex may move in different ways in those groups. The purpose of this study was to quantify the differences in lumbopelvic movement pattern during the passive hip external rotation (PHER) test in LBP patients with and without rotational demand activities (RDA).

MATERIAL AND METHODS

A total of 30 subjects with LBP, including 15 patients with-RDA and 15 patients without-RDA were enrolled. A passive hip external rotation test was performed. Pelvic and hip rotation over the full range of the test, timing of hip and pelvic motion, and pelvic rotation in the first half of the movement were measured using a 3-D motion analysis system.

RESULTS

Passive pelvic rotation during the test in the group with RDA was significantly greater than in the other group. However, there was no significant difference between the groups in other kinematic variables, including hip external rotation, timing of hip and pelvic motion and pelvic rotation in the first half of the movement (p > 0.05).

CONCLUSIONS

1. A greater lumbopelvic rotation ROM during the PHER existed in LBP patients who regularly participated in RDA. 2. Different groups of patients with LBP who engage in different specific activities may have a specific lumbopelvic movement pattern impairment. Therefore, each group of LBP patients in regard to their specific activities may need a different, specific plan of treatment.

Evaluation of differences between two groups of low back pain patients with and without rotational demand activities based on hip and lumbopelvic movement patterns

BACKGROUND

Excessive and earlier lumbopelvic motions during trunk and limb movements tests have been reported in both low back pain (LBP) patients with and without trunk and hip rotational demand activities. The aim of the present study was to determine differences in hip and lumbopelvic rotation during the active hip internal rotation (AHIR) test between two groups of LBP patients with and without regular trunk and hip rotational demand activities.

MATERIAL AND METHODS

A total of 35 LBP patients, including 15 males who regularly participated in rotational demand sports activities and 20 males not participating in sports and functional rotational demand activities, participated in study. The AHIR test was performed. The kinematic variables of hip and pelvic rotations were recorded by a Qualisys motion analysis system. Pelvic and hip rotations were calculated across time during the test. In addition, pelvic rotations in the first half of the test and pelvic-hip timing were calculated.

RESULTS

People with rotational demand activities had a higher pelvic rotation both during the test and in the first 50% of movement. Earlier pelvic rotation was observed in people with rotational demand activities compared to people with non-rotational demand activities.

CONCLUSION

1. The data of the current study suggests that lumbopelvic movement patterns in different groups of LBP patients in regard to their specific activities may vary. 2. LBP people with rotational demand sports activities have a greater tendency of pelvic rotation motion during the AHIR.

Nonlinear analysis of postural sway in subjects with below knee amputation during opened and closed eye conditions

OBJECTIVE

The aim of this study was to compare the structure of postural sway in healthy people and amputees with SACH foot (solid ankle cushion heel) and single axis foot during standing.

METHODS

Twenty healthy, 10 amputees with single axis foot, and 10 amputees with SACH foot participated in this study. The structure of postural sway of the subjects was evaluated using approximate entropy (ApEn).

RESULTS

People with SACH foot prosthesis exhibit increased regularity in postural sway compared to healthy people and people with single axis foot.

CONCLUSION

Amputees who used single axis prosthesis achieved appropriate adaptation to their prosthesis device.

Validity and Reliability of the Persian Version of Baecke Habitual Physical Activity Questionnaire in Healthy Subjects

BACKGROUND

Baecke Habitual Physical Activity Questionnaire (BHPAQ) has widely been employed in clinical and laboratorial studies as a tool for measuring subjects' physical activities. But, the reliability and validity of this questionnaire have not been investigated among Persian speakers.

OBJECTIVES

Therefore, the aim of the current study was examining the reliability and validity of the Persian version of the BHPAQ in healthy Persian adults.

MATERIALS AND METHODS

After following the process of forward-backward translation, 32 subjects were invited to fill out the Persian version of the questionnaire in two independent sessions (3 - 7 days after the first session) in order to determine the reliability index. Also, the validity of the questionnaire was assessed through concurrent validity by 126 subjects (66 males and 60 females) answering both the Baecke and the International Physical Activity Questionnaire (IPAQ).

RESULTS

An acceptable level of intraclass correlation coefficient (ICC of work score = 0.95, sport score = 0.93, and leisure score = 0.77) was achieved for the Persian Baecke questionnaire. Correlations between Persian Baecke and IPAQ with and without the score for sitting position were found to be 0.19 and 0.36, respectively.

CONCLUSIONS

The Persian version of the BHPAQ is a reliable and valid instrument that can be used to measure the level of habitual functional activities in Persian-speaking subjects.

Correlation between Hip Rotation Range-of-Motion Impairment and Low Back Pain. A Literature Review

BACKGROUND

Hip rotation range-of-motion (ROM) impairment has been proposed as a contributing mechanical factor in the development of low back pain (LBP) symptoms. There is a hypothesis which suggests that a limited range of hip rotation results in compensatory lumbar spine rotation. Hence, LBP may develop as the result. This article reviews studies assessing hip rotation ROM impairment in the LBP population.

MATERIAL AND METHODS

The MEDLINE and EMBASE databases were searched without time restriction. Two authors independently selected related articles using the same search strategy and key words.

RESULTS

Among 124 articles 12 met the review inclusion criteria. The results of the studies are assessed in three sections, investigating the relationship between low back pain and 1) hip internal rotation ROM, 2) hip external rotation ROM and 3) hip total rotation ROM. Asymmetrical (right versus left, lead versus non-lead) and limited hip internal rotation ROM were common findings in patients with LBP. Reduced and asymmetrical total hip rotation was also observed in patients with LBP. However, none of the studies explicitly reported limited hip external rotation ROM.

CONCLUSION

The precise assessment of hip rotation ROM, especially hip internal rotation ROM, must be included in the examination of patients with LBP symptoms.