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Karanasios S, Mertyri D, Karydis F, Gioftsos G. Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Healthcare (Basel) 2024; 12:823. [PMID: 38667585 PMCID: PMC11049805 DOI: 10.3390/healthcare12080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: -21.91; 95% confidence interval [CI]: -36.59, -7.24; p = 0.003) and wrist disability (MD: -8.1, 95% CI: -4.6, -11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: -0.76; 95% CI: -1.30, -0.21; p = 0.007) and short-term (SMD: -0.93; 95% CI: -1.86, -0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: -0.94; 95% CI: -1.68, -0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 122 43 Aigaleo, Greece;
- Hellenic OMT eDu, 116 31 Athens, Greece; (D.M.); (F.K.)
| | | | - Fotis Karydis
- Hellenic OMT eDu, 116 31 Athens, Greece; (D.M.); (F.K.)
| | - George Gioftsos
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 122 43 Aigaleo, Greece;
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Karanasios S, Mavridis I, Paraskevopoulos E, Sotiralis Y, Diamantopoulos N, Gioftsos G. The Western Ontario Shoulder Instability Index (WOSI) was successfully translated to the Greek language. J Hand Ther 2024; 37:157-160. [PMID: 37777440 DOI: 10.1016/j.jht.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/12/2023] [Accepted: 05/01/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Stefanos Karanasios
- Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece.
| | - Ioannis Mavridis
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | | | | | | | - George Gioftsos
- Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
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Karanasios S, Baglatzis G, Lignos I, Billis E. Manual Therapy and Exercise Have Similar Outcomes to Corticosteroid Injections in the Management of Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e48907. [PMID: 38111394 PMCID: PMC10726085 DOI: 10.7759/cureus.48907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
Subacromial pain syndrome (SAPS) is the most frequent diagnosis in patients with shoulder pain presenting with persistent pain and significant functional decline. Although exercise and manual therapy (EMT) and corticosteroid injections provide first-line treatment options, evidence for the best management of SAPS remains inconclusive. We aimed to evaluate the effectiveness of EMT compared with corticosteroid injections on disability, recovery rates, and pain in patients with SAPS through a systematic review and meta-analysis approach. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), ScienceDirect, the Cochrane Library, and grey literature databases were searched. Only randomized controlled trials evaluating the effectiveness of EMT alone or as an additive intervention compared to corticosteroid injections were included. Methodological quality was evaluated with the PEDro score and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. In total, 8 trials with 946 patients were included. EMT presented no difference in disability compared with corticosteroid injections at very short- (standardized mean difference {SMD}: 0.19; 95%CI: -0.20, 0.58), short- (SMD: -0.16; 95%CI: -0.58, 0.25), mid- (SMD: -0.14; 95%CI: -0.44, 0.16), and long-term (SMD: 0.00; 95%CI: -0.25, 0.25) follow-up. No difference was found between the comparators in self-perceived recovery at very short- (risk ratio: 0.93; 95%CI: 0.71, 1.21) and mid- (risk ratio: 0.98; 95%CI: 0.90, 1.07) follow-up and in pain rating at very short- (SMD: -0.18; 95%CI: -0.73, 0.38), short- (SMD: 0.05; 95%CI: -0.26, 0.37), and long-term (SMD: 0.04; 95%CI: -0.26, 0.34) follow-ups. The addition of corticosteroid injections to EMT provided no better results in shoulder disability compared with EMT (SMD: 0.45; 95%CI: -0.47, 1.37) or corticosteroid injections alone (MD: 2.70; 95%CI: -7.70, 13.10) in the mid-term. Based on very low to moderate certainty of evidence, EMT has similar effects to corticosteroid injections on improving all outcomes in patients with SAPS at all follow-up periods. Based on low certainty of evidence the combination of both interventions does not change the treatment outcome compared with each intervention alone.
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Affiliation(s)
| | | | - Ioannis Lignos
- Department of Physiotherapy, University of Patras, Patras, GRC
| | - Evdokia Billis
- Department of Physiotherapy, University of Patras, Patras, GRC
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Paraskevopoulos E, Karanasios S, Gioftsos G, Tatsios P, Koumantakis G, Papandreou M. The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis. Physiother Theory Pract 2023; 39:2037-2076. [PMID: 35481794 DOI: 10.1080/09593985.2022.2068097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). METHODS Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. RESULTS Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = -2.36, 95% CI -4.31 to -0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = -1.27 95% CI -1.60 to -0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. CONCLUSION Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.
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Affiliation(s)
- Eleftherios Paraskevopoulos
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Stefanos Karanasios
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Georgios Gioftsos
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Petros Tatsios
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Georgios Koumantakis
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Maria Papandreou
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
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Karanasios S, Martzoukos N, Zampetakis N, Paleta D, Sampsonis T, Vasilogeorgis I, Gioftsos G. Cross-Cultural Adaptation and Measurement Properties of the Expectations for Treatment Scale (ETS) for Greek-Speaking Patients. Cureus 2023; 15:e46457. [PMID: 37927658 PMCID: PMC10623487 DOI: 10.7759/cureus.46457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Patients' treatment expectations are key factors influencing the health outcomes in various medical conditions. Using validated measures to capture these expectations has been strongly suggested to improve the prognosis of the health outcome and promote research investigations. The Expectations for Treatment Scale (ETS) is a well-established questionnaire designed to accurately measure treatment expectations in patients with low back pain; however, it is not available in Greek yet. We aimed to translate and cross-culturally adapt the ETS in Greek (ETS-Gr) and evaluate its reliability and validity in a Greek-speaking population with musculoskeletal disorders. Methods We followed published recommendations for the translation and cross-cultural adaptation process of the scale. Face and content validity were evaluated using interviews with patients and experts. Internal consistency, test-retest reliability, and measurement error were evaluated in 52 patients with musculoskeletal conditions. Results During forward and backward translation minor linguistic discrepancies were detected and effectively adapted for Greek-speaking patients. The ETS-Gr presented a high level of content validity (item content validity index: 0.88-1; and average scale content validity index: 0.90), acceptable internal consistency (Cronbach's alpha: 0.84), and excellent test-retest reliability (intraclass correlation coefficient: 0.96, 95% confidence interval: 0.93-0.98). Conclusions The ETS-Gr is a short, reliable, and valid instrument to measure pre-treatment expectations in patients with musculoskeletal disorders. Future investigations including other medical conditions are required.
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Affiliation(s)
| | | | | | - Danai Paleta
- Physiotherapy, University of West Attica, Athens, GRC
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Chamogeorgakis G, Karanasios S, Theotokatos G, Vasilogeorgis I, Korakakis V. Cross-Cultural Adaptation and Measurement Properties of the Upper Limb Functional Index (ULFI) for Greek-Speaking Patients. Cureus 2023; 15:e40029. [PMID: 37425611 PMCID: PMC10323981 DOI: 10.7759/cureus.40029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION The upper limb functional index (ULFI) is a widely used outcome measure for patients with upper limb musculoskeletal disorders (ULMSDs) that is available in several languages. Our purpose was to develop the Greek version of the ULFI and test its test-retest reliability, validity, and responsiveness in a cohort of patients with ULMSD. METHODS We used a merged methodology of published guidelines and recommendations for the translation and cross-cultural adaptation process. One hundred patients with ULMSDs completed the ULFI-Gr on three occasions: baseline, 2-7 days later to evaluate repeatability, and 6 weeks later to assess responsiveness. Participants completed the quick disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and a numerical pain rating scale (NPRS) to evaluate convergent validity. Also, a global rating of change (GROC) scale was used to evaluate responsiveness. RESULTS Minor wording adaptations were required during the translation and cross-cultural adaption of the questionnaire. Factor analysis resulted in two main factors explaining 40.2% of the total variance. The ULFI-Gr was found to be reliable (intraclass correlation coefficient: 0.97, 95% confidence interval: 0.95-0.99) with a small measurement error (standard error of measurement: 3.34%, minimal detectable change: 7.79%). The ULFI-Gr showed a strong negative correlation with the Quick-DASH (-0.75), a moderate to strong negative correlation with the NPRS (-0.56), and a good level of responsiveness (standardized response mean: 1.31, effect size: 1.19). CONCLUSIONS The ULFI-Gr can be used as a reliable, valid, and responsive patient-reported outcome measure to evaluate the functional status of patients with ULMSDs.
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Affiliation(s)
| | | | - Georgios Theotokatos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, GRC
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Karanasios S, Lignos I, Gioftsos G. Wrist Extensor Training With Blood Flow Restriction for the Management of Lateral Elbow Tendinopathy: A Case Report. Cureus 2023; 15:e35468. [PMID: 36999107 PMCID: PMC10043636 DOI: 10.7759/cureus.35468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/01/2023] Open
Abstract
Lateral elbow tendinopathy (LET) is a common overuse injury with complex underlying pathophysiological mechanisms. Although several modes of exercise with or without passive interventions have been recommended as the first-line treatment option of the condition, their effectiveness remains inconclusive. The aim of this case report is to evaluate the effect of wrist extensor exercises with blood flow restriction (BFR) as an add-on intervention to a multi-modal physiotherapy programme to improve outcomes in a patient with LET. A 51-year-old male patient presented with a history of right LET for six months. Interventions included wrist extension exercise with BFR, a two-stage progressive loading training programme of the upper limb, soft-tissue massage, education and a home exercise programme for six weeks (12 visits). A substantial improvement in pain intensity, pain-free grip strength, Patient Rated Tennis Elbow Evaluation score and self-perceived recovery was reported at three-, six-, and 12-week follow-up measurements. A 21% reduction in pressure pain thresholds at the lateral epicondyle was found immediately after wrist extensor exercise with BFR. Based on our findings, adding wrist extensor exercises with BFR to a multimodal physiotherapy programme seems a promising approach to improve the treatment outcome in LET. Nonetheless, further research is needed to confirm the present results.
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Karanasios S, Korakakis V, Diochnou A, Oikonomou G, Gedikoglou IA, Gioftsos G. Cross cultural adaptation and validation of the Greek version of the Western Ontario Rotator Cuff (WORC) index. Disabil Rehabil 2022:1-10. [PMID: 35680400 DOI: 10.1080/09638288.2022.2083704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE We aimed to translate and cross-culturally adapt the Western Ontario Rotator Cuff index into Greek (WORC-GR) and evaluate its reliability and validity in a Greek speaking population with rotator cuff (RC) disorders. MATERIALS AND METHODS Translation and cross-cultural adaptation process followed published guidelines. Content and face validity were assessed by 9 experts and 16 patients with RC pathologies, respectively. Internal structure, reliability, measurement error, and convergent validity (correlation with the Disability of the Arm, Shoulder and Hand - DASH, Shoulder Pain and Disability Index - SPADI, and Short Form-36) of the index were evaluated in 104 participants (44.2% women, mean age ± SD: 44.9 ± 15.01 years) with RC related pain. RESULTS The WORC-GR showed excellent item and scale content validity index (0.875-1.00 and 0.975, respectively), internal consistency (Cronbach's alpha range 0.749 - 0.903) and test-retest reliability (intraclass correlation coefficient: 0.942, 95% CI: 0.913-0.961). Factorial validity testing revealed a 4-factor structure explaining 69.7% of the total variance. High positive correlations were found with DASH (r = 0.806) and SPADI (r = 0.852). CONCLUSIONS WORC-GR is a reliable and valid instrument to assess symptoms in patients with RC disorders. Further research on the content validity, internal structure, and responsiveness of the tool is required. Implications for rehabilitationThe Greek version of WORC (WORC-GR) is a clear and comprehensible patient reported outcome measure.WORC-GR has excellent internal consistency, test-retest reliability and with no floor and ceiling effects.WORC-GR is a valid outcome measure for patients with rotator cuff disorders.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, Laboratory of Advanced Physiotherapy (LAdPhys), School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - Vasileios Korakakis
- Hellenic OMT eDu, Athens, Greece.,Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | | | - George Gioftsos
- Physiotherapy Department, Laboratory of Advanced Physiotherapy (LAdPhys), School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
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Samaras P, Karanasios S, Stasinopoulos D, Gioftsos G. Greek physiotherapists' contemporary knowledge and practice for lateral elbow tendinopathy: An online survey. Musculoskelet Sci Pract 2022; 57:102502. [PMID: 35030537 DOI: 10.1016/j.msksp.2022.102502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate physiotherapists' current knowledge and practice in the management of patients with lateral elbow tendinopathy, to explore associations between the participants' education and management preferences and to identify potential evidence-to-practice gaps by making comparisons with recent research recommendations. DESIGN An on-line cross-sectional survey. SUBJECTS Registered physiotherapists working in Greece with previous experience in the management of lateral elbow tendinopathy. RESULTS Three hundred and seventy eight responses met the inclusion criteria. Most responders (70.4%-91.5%) use pain provocation tests for the diagnosis of the condition, while a limited proportion uses patient rated outcome measures (6.9%-13%). Supervised exercise is the mainstay of rehabilitation (92.6%), followed by adjunctive research recommended treatment techniques such as manual therapy (72%) and advice (59.5%). Up to 83.6% of participants use adjunctive treatment techniques that are not recommended or without research recommendation (such as electrophysical agents, ice etc.). Physiotherapists with post-graduate education in musculoskeletal physiotherapy are almost three times more likely to choose only research recommended treatment approaches. There is a lack of consensus in an optimal exercise programme (type, volume, duration etc.) in patients with lateral elbow tendinopathy. CONCLUSION Despite research recommendations a limited use of patient rated outcome measures in lateral elbow tendinopathy is recorded. Supervised exercise is the first line treatment option for most physiotherapists, although the optimal application is still unclear. A large proportion of physiotherapists apply adjunctive treatment techniques that are either ineffective or poorly researched suggesting a substantial evidence-to-practice gap. Better access to knowledge, organisational and peer-support can potentially help to bridge this gap.
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Affiliation(s)
| | - Stefanos Karanasios
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Greece
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Neuromuscular & Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica, Greece
| | - George Gioftsos
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Greece
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Karanasios S, Koutri C, Moutzouri M, Xergia SA, Sakellari V, Gioftsos G. The Effect of Body Position and the Reliability of Upper Limb Arterial Occlusion Pressure Using a Handheld Doppler Ultrasound for Blood Flow Restriction Training. Sports Health 2021; 14:717-724. [PMID: 34515589 DOI: 10.1177/19417381211043877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The precise calculation of arterial occlusive pressure is essential to accurately prescribe individualized pressures during blood flow restriction training. Arterial occlusion pressure in the lower limb varies significantly between different body positions while similar reports for the upper limb are lacking. HYPOTHESIS Body position has a significant effect in upper limb arterial occlusive pressure. Using cuffs with manual pump and a handheld Doppler ultrasound can be a reliable method to determine upper limb arterial blood flow restriction. STUDY DESIGN A randomized repeated measures design. LEVEL OF EVIDENCE Level 3. METHODS Forty-two healthy participants (age mean ± SD = 28.1 ± 7.7 years) completed measurements in supine, seated, and standing position by 3 blinded raters. A cuff with a manual pump and a handheld acoustic ultrasound were used. The Wilcoxon signed-rank test with Bonferroni correction was used to analyze differences between body positions. A within-subject coefficient of variation and an intraclass correlation coefficient (ICC) test were used to calculate reproducibility and reliability, respectively. RESULTS A significantly higher upper limb arterial occlusive pressure was found in seated compared with supine position (P < 0.031) and in supine compared with standing position (P < 0.031) in all raters. An ICC of 0.894 (95% CI = 0.824-0.939, P < 0.001) was found in supine, 0.973 (95% CI = 0.955-0.985, P < 0.001) in seated, and 0.984 (95% CI = 0.973-0.991, P < 0.001) in standing position. ICC for test-retest reliability was found 0.90 (95% CI = 0.814-0.946, P < 0.001), 0.873 (95% CI = 0.762-0.93, P < 0.001), and 0.858 (95% CI = 0.737-0.923, P < 0.001) in the supine, seated, and standing position, respectively. CONCLUSION Upper limb arterial occlusive pressure was significantly dependent on body position. The method showed excellent interrater reliability and repeatability between different days. CLINICAL RELEVANCE Prescription of individualized pressures during blood flow restriction training requires measurement of upper limb arterial occlusive pressure in the appropriate position. The use of occlusion cuffs with a manual pump and a handheld Doppler ultrasound showed excellent reliability; however, the increased measurement error compared with the differences in arterial occlusive pressure between certain positions should be carefully considered for the clinical application of the method. STRENGTH OF RECOMMENDATIONS TAXONOMY (SORT) B.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - Sofia A Xergia
- Physiotherapy Department, University of Patras, Aigio, Greece
| | - Vasiliki Sakellari
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
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Karanasios S, Tsamasiotis GK, Michopoulos K, Sakellari V, Gioftsos G. Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis. Clin Rehabil 2021; 35:1383-1398. [PMID: 33813913 DOI: 10.1177/02692155211006860] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of extracorporeal shockwave therapy compared with other interventions on pain, grip strength and disability in patients with lateral elbow tendinopathy. DATA SOURCES MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library and clinical trial registries. REVIEW METHODS We included randomized controlled trials assessing the effectiveness of extracorporeal shockwave therapy alone or as an additive intervention compared with sham or other interventions. Pain intensity, grip strength and elbow disability were used as primary outcome measures. We assessed methodological quality with the PEDro score and quality of evidence with the GRADE approach. RESULTS Twenty-seven studies with 1871 patients were finally included. Extracorporeal shockwave therapy reduced pain intensity at mid-term follow-up (standardized mean difference: -1.21, 95% confidence interval:-1.53, -0.89, P < 0.001) and improved grip strength at very short- (mean difference:3.92, 95% confidence interval: 0.91, 6.94, P = 0.01) and short-term follow-up (mean difference:4.87, 95% confidence interval:2.24, 7.50, P < 0.001) compared with sham treatment. However, no clinically significant results were found between comparators in all outcomes and follow-up times. Extracorporeal shockwave therapy presented clinically better compared to Laser in grip strength at short-term (mean difference:3.50, 95% confidence interval:2.40, 4.60, P < 0.001) and ultrasound in pain intensity at very-short-term follow-up (standardized mean difference: -1.54, 95% confidence interval: -2.60, -0.48, P = 0.005). CONCLUSION Low to moderate certainty of evidence suggests that there are no clinical benefits of extracorporeal shockwave therapy compared to sham interventions or corticosteroid injections. Based on very-low and moderate certainty of evidence, extracorporeal shockwave therapy outperforms against Laser and ultrasound, respectively.Level of Evidence: Therapy, level 1a.
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Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, Tsepis E, Gioftsos G. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review. J Hand Ther 2021; 35:541-551. [PMID: 33814224 DOI: 10.1016/j.jht.2021.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. PURPOSE To review the diagnostic accuracy of examination tests used in LET. DESIGN Systematic review following PRISMA-DTA guidelines. METHODS We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. RESULTS Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). CONCLUSIONS Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020160402.
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Affiliation(s)
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | - Eleni Drakonaki
- Medical School of the European University Cyprus, Engomi, Nicosia Cyprus
| | - Klaudia Koci
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | | | - Elias Tsepis
- Physiotherapy Department, University of Patras, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Egaleo, Greece
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Karanasios S, Korakakis V, Whiteley R, Vasilogeorgis I, Woodbridge S, Gioftsos G. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. Br J Sports Med 2020; 55:477-485. [DOI: 10.1136/bjsports-2020-102525] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/30/2023]
Abstract
ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.
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Korakakis V, O'Sullivan K, O'Sullivan PB, Evagelinou V, Sotiralis Y, Sideris A, Sakellariou K, Karanasios S, Giakas G. Physiotherapist perceptions of optimal sitting and standing posture. Musculoskelet Sci Pract 2019; 39:24-31. [PMID: 30469124 DOI: 10.1016/j.msksp.2018.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/28/2018] [Accepted: 11/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Assessment of, and advice about, spinal posture is common when people with spinal pain present to physiotherapists. Most descriptions regarding optimal spinal posture have been qualitative in nature. OBJECTIVES To determine the beliefs of physiotherapists regarding optimal sitting and standing posture. DESIGN Online survey. METHOD 544 Greek physiotherapists selected an optimal sitting (choice of seven) and standing (choice of five) posture, while providing justification for their choice. RESULTS Education regarding optimal sitting and standing posture was considered "considerably" or "very" important by 93.9% of participants. Three different sitting postures, and two different standing postures, were selected as the optimal posture by 97.5% and 98.2% of physiotherapists respectively. While this reflects a lack of complete consensus on optimal posture, the most commonly selected postures were all some variation of upright lordotic sitting, in contrast slouched spinal curves (sitting) or forward head posture (sitting and standing) almost never being selected as optimal. Interestingly, participants used similar arguments (e.g. natural curves, muscle activation) to justify their selection regardless of the spinal configuration of each selected posture. CONCLUSIONS These results reinforce previous data suggesting that upright lordotic sitting postures are considered optimal, despite a lack of strong evidence that any specific posture is linked to better health outcomes. While postural re-education may play a role in the management of spinal pain for some patients, awareness of such widespread and stereotypical beliefs regarding optimal posture may be useful in clinical assessment and management.
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Affiliation(s)
- Vasileios Korakakis
- Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece; Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece.
| | - Kieran O'Sullivan
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Faculty of Education and Health Sciences, University of Limerick, School of Allied Health, Limerick, Ireland
| | - Peter B O'Sullivan
- School of Physiotherapy, Curtin University, Perth, Western Australia, Australia; Bodylogic Physiotherapy, Private Practice, Perth, Western Australia, Australia
| | | | - Yiannis Sotiralis
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | - Alexandros Sideris
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | | | | | - Giannis Giakas
- Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
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Korakakis V, O’Sullivan K, Sotiralis Y, Karanasios S, Sideris V, Sideris A, Sakellariou K, Giakas G. Evaluation of the within- and between-day intra-tester and inter-tester reliability of positioning subjects into neutral and lordotic sitting postures. European Journal of Physiotherapy 2018. [DOI: 10.1080/21679169.2018.1503719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vasileios Korakakis
- Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | - Kieran O’Sullivan
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Faculty of Education and Health Sciences, University of Limerick, School of Allied Health, Limerick, Ireland
| | - Yiannis Sotiralis
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | | | - Vasilis Sideris
- Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Alexandros Sideris
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | | | - Giannis Giakas
- Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
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