Effects of Motor Control Exercises in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

OBJECTIVE

The primary objective of this systematic review is to assess whether motor control exercises consisting of the methodology described by Richardson and Hodges improve the pain and disability of patients with nonspecific low back pain.

DESIGN

Systematic review and a meta-analysis.

SETTING

A literature review was conducted using PubMed, PEDro, Scielo, CINAHL, Web of Science, Dialnet, Scopus, and MEDLINE from inception to November 2021.

PATIENTS

Patients with chronic nonspecific low back pain.

INTERVENTIONS

Randomized controlled trials assessing motor control exercises versus inactive control, placebo or minimal intervention, and other exercises.

MAIN OUTCOME MEASURES

Pain intensity, disability, and physical activity were considered as primary outcomes.

RESULTS

Eighteen studies with 1356 patients were finally included in the systematic review, of which only 13 randomized clinical trials could be meta-analyzed. Statistically significant results were found in favor of the motor control group for the comparison with other exercises in disability at postintervention term (Mean Difference, 95% Confidence Interval [CI], -3.13 [-5.87 to -0.38], P = 0.03); for the comparison with inactive control, placebo, or minimal intervention in pain at postintervention term (MD, 95% CI, -18.10 [-30.79 to -5.41], P = 0.008); and for comparison with general exercises (MD, 95% CI, -12.70 [-20.80 to -4.60], P = 0.002).

CONCLUSIONS

Moderate-quality evidence regarding the effectiveness of motor control exercises to reduce pain intensity and disability exists, but the reduction should be interpreted with caution.

Effects of a supervised exercise program in addition to electrical stimulation or kinesio taping in low back pain: a randomized controlled trial

Chronic low back pain it is one of the most common health problems worldwide. Usually is accompanied by a complex set of symptoms and generates significant direct and indirect socioeconomic and health costs. From a therapeutic point of view, there are a wide variety of methods to address the treatment of this pathology, however, these therapies have not been shown definitive efficacy. To investigate the effect of a mixed treatment with exercise and electrical stimulation versus exercise and kinesio taping in patients with non-specific chronic low back pain. A total of 58 patients participated in this single-blinded randomised clinical trial. Participants were assigned to the exercises- kinesio taping group, or exercises- analgesic current group, both received 12 treatment sessions. Disability, fear of movement, anxiety, depression, sleeps quality, pain, lower limb mechanosensitivity and pressure-pain thresholds were recorded at baseline and after 4 weeks of treatment. The 2 × 2 mixed analysis of covariance test showed statistically significant differences between groups for pain (P = 0.046). Pair-wise comparisons with baseline demonstrated significant differences for both groups in pain (P ≤ 0.001), disability (P ≤ 0.001), pressure-pain thresholds (P ≤ 0.044), lower limb mechanosensitivity, (P ≤ 0.047), anxiety (P ≤ 0.001), depression (P ≤ 0.001) and sleep quality (P ≤ 0.010). Patients with chronic low back pain who received a combined treatment of exercises and kinesio taping or analgesic current showed an improvement in pain, disability, anxiety, depression and sleep pattern. Moreover, exercises combined with electrotherapy produces greater improvements over these variables.

Trial registration: NCT02812459.

Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: A double blind randomized controlled trial

OBJETIVE

We conducted a randomized double blind clinical trial, to compare the effectiveness of McKenzie exercises and electroanalgesia via an e-Health program versus a home rehabilitation program on functionality, pain, fear of movement and quality of life in patients with non-specific chronic low back pain.

METHODS

Seventy-four participants with non-specific chronic low back pain were randomized to either the e- Health program group (n = 39) or the home rehabilitation program group (n = 35). The interventions consisted of the e-Health program group performing McKenzie exercises and received transcutaneous electrical nerve stimulation, while the home rehabilitation group attended an information session to explain the exercises, which they then performed at home with printed instructions. Both groups performed 3 weekly sessions for 8 weeks. The following were analyzed main measures: pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline and at 2 months.

RESULTS

Independent samples Student's t-tests showed that although the patients who followed the e-Health program showed significantly greater improvement than those who followed the home disability rehabilitation program in terms of intensity of pain, lumbar flexion mobility (P < 0.001), and the following dimensions of quality of life (P < 0.005), both groups improved significantly in the immediate post-treatment follow up compared with baseline scores.

CONCLUSIONS

Patients with chronic low back pain who followed an unsupervised home intervention supported by an individualized video exercise program showed greater post-treatment improvement than those who followed the same program with printed instructions.

Comparison of efficacy of a supervised versus non-supervised physical therapy exercise program on the pain, functionality and quality of life of patients with non-specific chronic low-back pain: a randomized controlled trial

OBJECTIVE

To compare the effectiveness of supervised physical therapy program versus non-supervised on pain, functionality, fear of movement and quality of life in patients with non-specific chronic low back pain.

DESIGN

A randomized double-blind clinical trial.

SETTING

Clinical outpatient unit; home.

SUBJECTS

A total of 64 participants with non-specific chronic low back pain were randomized into either supervised exercise group (n = 32) or non-supervised home exercise group (n = 32).

INTERVENTIONS

The supervised group was treated with therapy exercises (strengthen lumbopelvic musculature), while the non-supervised received an informative session of the exercises, which were performed un-supervised at home. Both groups received three weekly sessions for eight weeks.

MAIN MEASURES

Pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline, two, and six months of follow-up.

RESULTS

Although analysis of variance (ANOVA) test showed statistically significant differences between groups for pain (P = 0.028; supervised: 2.5 ± 2.1; non-supervised: 3.5 ± 1.5) and disability for Roland-Morris Disability Questionnaire (P = 0.004; supervised: 3.1 ± 2.2; non-supervised: 5.1 ± 3.0) and for Oswestry Disability Index (P = 0.034; supervised: 14.5 ± 7.1; non-supervised: 19.2 ± 10.0) at 8 weeks immediately posttreatment, there were no differences between the groups in patient-rated pain, functionality, fear of movement and quality of life at six months of follow-up.

CONCLUSION

Patients with chronic low back pain who received supervised exercise showed more improvement in both the short and long term in all patient-rated outcomes over the non-supervised group, but the differences were small and not clinically significant.

Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial

OBJECTIVE

To evaluate the effect of adding interferential current stimulation to exercise on pain, disability, psychological status and range of motion in patients with neck pain.

DESIGN

A single-blinded randomized controlled trial.

SETTING

Primary care physiotherapy units.

SUBJECTS

A total of 84 patients diagnosed with non-specific mechanical neck pain. This sample was divided into two groups randomly: experimental (n = 42) versus control group (n = 42).

INTERVENTIONS

Patients in both groups had a supervised therapeutic exercise programme, with the experimental group having additional interferential current stimulation treatment.

MAIN MEASURES

The main measures used were intensity of neck pain according to the Visual Analogue Scale; the degree of disability according to the Neck Disability Index and the CORE Outcome Measure; anxiety and depression levels according to the Goldberg scale; apprehension as measured by the Personal Psychological Apprehension scale; and the range of motion of the cervical spine. The sample was evaluated at baseline and posttreatment (10 sessions/two weeks).

RESULTS

Statistically significant differences between groups at posttreatment were observed for Visual Analogue Scale (2.73 ± 1.24 vs 4.99 ± 1.56), Neck Disability Index scores (10.60 ± 4.77 vs 18.45 ± 9.04), CORE Outcome Measure scores (19.18 ± 9.99 vs 35.12 ± 13.36), Goldberg total score (6.17 ± 4.27 vs 7.90 ± 4.87), Goldberg Anxiety subscale, Personal Psychological Apprehension Scale scores (28.17 ± 9.61 vs 26.29 ± 11.14) and active and passive right rotation.

CONCLUSIONS

Adding interferential current stimulation to exercise resulted in better immediate outcome across a range of measures.

Spanish validation of the Exercise Therapy Burden Questionnaire (ETBQ) for the assessment of barriers associated to doing physical therapy for the treatment of chronic illness

BACKGROUND AND OBJETIVE

To validate the Spanish version of the Exercise Therapy Burden Questionnaire (ETBQ) for the assessment of barriers associated to doing physical therapy for the treatment of chronic ailments.

PATIENTES AND METHODS

A sample of 177 patients, 55.93% men and 44.07% women, with an average age of 51.03±14.91 was recruited. The reliability of the questionnaire was tested with Cronbach's alpha coefficient, and the validity of the instrument was assessed through the divergent validation process and factor analysis.

RESULTS

The factor analysis was different to the original questionnaire, composed of a dimension, in this case determined three dimensions: (1) General limitations for doing physical exercise. (2) Physical limitations for doing physical exercise. (3) Limitations caused by the patients' predisposition to their exercises. The reliability of the test-retest was measured through the intraclass correlation coefficient (ICC) and the Bland-Altman plot. Cronbach's alpha was 0.8715 for the total ETBQ. The ICC of the test-retest was 0.745 and the Bland-Altman plot showed no systematic trend.

CONCLUSION

We have obtained the translated version in Spanish of the ETBQ questionnaire.

A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement

OBJECTIVE

The purpose of this study was to investigate changes in pain, disability, and range of movement after cervicothoracic manipulation plus exercise therapy in individuals with unilateral shoulder impingement syndrome.

METHODS

Forty-one patients (30 men, 11 women; aged 47 ± 9) diagnosed with unilateral shoulder impingement syndrome attended 10 sessions for 5 weeks (2 sessions/wk). Eligible patients were randomly allocated to 2 study groups: cervicothoracic manipulation plus exercise therapy (n = 21) or home exercise program (n = 20). The outcomes measures included the visual analog scale (VAS); the Disabilities of the Arm, Shoulder, and Hand score; Shoulder Disability Questionnaire; subacromial impingement syndrome (Hawkins-Kennedy Test and Neer Test); and shoulder active range of motion (movements of flexion, extension, rotation, adduction, and abduction). Assessments were applied at baseline and 24 hours after completing 5 weeks of related interventions.

RESULTS

After 5 weeks of treatment significant between-group differences were observed in the Disabilities of the Arm, Shoulder, and Hand score (P = .012); however, no statistically significant differences were achieved for Shoulder Disability Questionnaire (P = .061) and pain intensity (P = .859). Both groups improved with regard to disability and clinical tests for detecting subacromial impingement syndrome.

CONCLUSIONS

This clinical trial suggests that cervicothoracic manipulative treatment with mobilization plus exercise therapy may improve intensity of pain and range of motion compared with the home exercise group alone; the home exercise group had significant changes for flexion, extension, adduction, and abduction, but not for external and internal rotation movement in patients with shoulder impingement.

Benefits of Craniosacral Therapy in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effects of craniosacral therapy on disability, pain intensity, quality of life, and mobility in patients with low back pain.

DESIGN

A single-blinded randomized controlled trial.

PATIENTS

Sixty-four patients with chronic nonspecific low back pain (mean age ± SD, 50 ± 12 years; 66% female) who were referred for physical therapy at a clinical unit of the Health Science School of the University of Almeria (Spain).

INTERVENTIONS

Participants were randomly assigned to an experimental group (10 sessions of craniosacral therapy) or a control group (10 sessions of classic massage).

OUTCOME MEASURES

Disability (Roland Morris Disability Questionnaire [RMQ, primary outcome] and Oswestry Disability Index), pain intensity (10-point numeric pain rating scale), kinesiophobia (Tampa Scale of Kinesiophobia), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion, hemoglobin oxygen saturation, systolic blood pressure, diastolic blood pressure, hemodynamic measures (cardiac index), and biochemical estimation of interstitial fluid. These outcomes were registered at baseline, after treatment, and 1-month follow-up.

RESULTS

No statistically significant differences were seen between groups for the main outcome of the study, the RMQ (p = 0.060). However, patients receiving craniosacral therapy experienced greater improvement in pain intensity (p ≤ 0.008), hemoglobin oxygen saturation (p ≤ 0.028), and systolic blood pressure (p ≤ 0.029) at immediate- and medium-term and serum potassium (p = 0.023) level and magnesium (p = 0.012) at short-term than those receiving classic massage.

CONCLUSIONS

Ten sessions of craniosacral therapy resulted in a statistically greater improvement in pain intensity, hemoglobin oxygen saturation, systolic blood pressure, serum potassium, and magnesium level than did 10 sessions of classic massage in patients with low back pain.

A randomized controlled trial of a mixed Kinesio taping–compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency

Objectives:

To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency.

Design:

A double-blinded randomized clinical trial.

Setting:

Clinical setting.

Participants:

One hundred and twenty postmenopausal women with mild–moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping.

Main outcomes variables:

Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment.

Results:

The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness ( F = 22.99, p = 0.002), claudication ( F = 8.57, p = 0.004), swelling ( F = 22.58, p = 0.001), muscle cramps ( F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity ( F = 18.47, p = 0.001), physical function ( F = 9.15, p = 0.003) and body pain ( F = 3.36, p = 0.043). Both groups reported significant reduction in pain.

Conclusion:

Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

[Effectiveness of aquatic biodance on sleep quality, anxiety and other symptoms in patients with fibromyalgia]

BACKGROUND AND OBJECTIVE

To analyze the effects of an aquatic biodance based therapy on sleep quality, anxiety, depression, pain and quality of life in fibromyalgia patients.

PATIENTS AND METHOD

Randomized controlled trial with 2 groups. Fifty-nine patients were assigned to 2 groups: experimental group (aquatic biodance) and control group (stretching). The outcome measures were quality of sleep (Pittsburgh questionnaire), anxiety (State Anxiety Inventory), depression (Center for Epidemiologic Studies Depression Scale), pain (visual analogue scale, pressure algometry and McGill) and quality of life (Fibromyalgia Impact Questionnaire) before and after a 12-week therapy.

RESULTS

After treatment, we observed significant differences in the experimental group (P<.05) on sleep quality (49.7%), anxiety (14.1%), impact of fibromyalgia (18.3%), pain (27.9%), McGill (23.7%) and tender points (34.4%).

CONCLUSIONS

Aquatic biodance contributed to improvements in sleep quality, anxiety, pain and other fibromyalgia symptoms.

[Comparison between aquatic-biodanza and stretching for improving quality of life and pain in patients with fibromyalgia]

OBJECTIVE

To determine the level of improvement, as regards pain, impact on fibromyalgia and depression, achieved by patients with fibromyalgia by comparing aquatic biodanza and stretching exercises.

DESIGN

Randomised controlled trial with two intervention groups.

LOCATION

Five health centres (Almeria).

PATIENTS

A total of 82 fibromyalgia patients between 18 and 65 years old, diagnosed by American College of Rheumatology criteria, were included, with 12 patients declining to take part in the study. The 70 remaining patients were randomly assigned to two groups of 35 patients each: aquatic biodanza and stretching exercises. Those who did not attend in at least 14 sessions or changed their treatment during the studio were excluded. The final sample consisted of 19 patients in aquatic biodanza group and 20 in stretching group. The limitations of the study included, the open evaluation design and a sample size reduced by defaults.

MAIN MEASURES

The outcome measures were sociodemographic data, quality of life (Fibromyalgia Impact Questionnaire), pain (McGill-Melzack questionnaire; and Visual Analogue Scale), pressure algometry (Wagner FPI10 algometer) and depression (Beck Inventory). These were carried out before and after a 12-week therapy.

RESULTS

The mean age of the sample was 55.41 years. The mean period from diagnosis was 13.44 years. The sample consisted mainly of housewives. There were significant differences (P<.05) between groups, in pain (P<.01), fibromyalgia impact (P<.01), and depression (P<.04) after the treatment.

CONCLUSIONS

The biodanza aquatic exercises improve pain and quality of life in fibromyalgia patients.

Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: a randomized controlled trial

OBJECTIVES

To analyse the effectiveness of a combined procedure of massage and electrotherapy with interferential current in individuals with chronic non-specific low back pain of mechanical aetiology.

DESIGN

A single blinded randomized controlled trial.

SETTING

Clinical setting.

PARTICIPANTS

Sixty-two individuals with chronic non-specific low back pain were randomly assigned to an experimental or control group. For 10 weeks the experimental group underwent treatment comprising 20 sessions (twice a week) of massage with interferential current in the lumbar and dorsal-lumbar area, and the control group received superficial lower back massage (effleurage, superficial pressure and skin rolling).

MAIN OUTCOME VARIABLES

Oswestry Disability Index, pain visual analogue scale, Tampa Scale for Kinesiophobia, Roland Morris Disability Questionnaire, McQuade Test, Side Bridge Test, quality of life scores and the range of trunk anteflexion motion, which were all assessed before the treatment and immediately after the last treatment session.

RESULTS

The 2 × 2 mixed model ANOVA with repeated measurements showed statistically significant group * time interactions for the visual analogue scale (F = 12.839; P = 0.001), Oswestry Disability Index (F = 5.850; P = 0.019), Roland Morris Disability Questionnaire (F = 8.237; P = 0.006) and quality of life (physical function (F = 16.792; P = 0.001), physical role (F = 14.839; P = 0.001) and body pain (F = 11.247; P = 0.001)).

CONCLUSIONS

In individuals with chronic non-specific low back pain, interferential current electro-massage achieved a significantly greater improvement in disability, pain and quality of life in comparison to superficial massage after 20 treatment sessions.

Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: a randomised trial

QUESTION

Does Kinesio Taping reduce disability, pain, and kinesiophobia in people with chronic non-specific low back pain?

DESIGN

Randomised trial, with concealed allocation, assessor blinding, and intention-to-treat analysis.

PARTICIPANTS

Sixty adults with chronic non-specific low back pain.

INTERVENTION

The experimental intervention was Kinesio Taping over the lumbar spine for one week; the control intervention was sham taping.

OUTCOME MEASURES

The following outcomes were measured at baseline, immediately after the week with the tape in situ, and four weeks later: Oswestry Disability Index, Roland- Morris Low Back Pain and Disability Questionnaire, pain on a 10-cm visual analogue scale, Tampa kinesiophobia scale, trunk flexion range of motion, and the McQuade test of trunk muscle endurance.

RESULTS

At one week, the experimental group had significantly greater improvement in disability, by 4 points (95% CI 2 to 6) on the Oswestry score and by 1.2 points (95% CI 0.4 to 2.0) on the Roland-Morris score. However, these effects were not significant four weeks later. The experimental group also had a greater decrease in pain than the control group immediately after treatment (mean between-group difference 1.1cm, 95% CI 0.3 to 1.9), which was maintained four weeks later (1.0cm, 95% CI 0.2 to 1.7). Similarly trunk muscle endurance was significantly better at one week (by 23 sec, 95% CI 14 to 32) and four weeks later (by 18 sec, 95% CI 9 to 26). Other outcomes were not significantly affected.

CONCLUSION

Kinesio Taping reduced disability and pain in people with chronic non-specific low back pain, but these effects may be too small to be clinically worthwhile.

TRIAL REGISTRATION

ACTRN12612000402842.

[Preventing lymphoedema after breast cancer surgery by elastic restraint orthotic and manual lymphatic drainage: a randomized clinical trial]

BACKGROUND AND OBJECTIVE

Secondary lymphoedema is considered one of the most common complications after breast cancer surgery. The aim of the present study was to analyze the effectiveness of containment elastic orthosis and manual lymphatic drainage in the prevention of lymphoedema secondary to mastectomy.

PATIENTS AND METHOD

An experimental study was performed with a control group. Forty-eight patients were randomly assigned to experimental (containment elastic orthosis and manual lymphatic drainage) and control (postural measures) groups. Outcomes measures were quality of life, body composition, temperature, functional assessment of the shoulder, pain and limb volume. Measures were performed at baseline and after 8-months intervention.

RESULTS

After the intervention period, the experimental group showed significant differences (P<.05) in the quality of life, extracellular water, and functional assessment of the volume of the limb of the mastectomized side.

CONCLUSIONS

The application of containment elastic orthosis and manual lymphatic drainage contribute to prevent secondary lymphoedema after breast cancer surgery, improving the quality of life in these patients.

Influence of craniosacral therapy on anxiety, depression and quality of life in patients with fibromyalgia

Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy) or placebo group (simulated treatment with disconnected ultrasound). The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.

Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial

Objective: To determine the effect of myofascial release techniques on pain symptoms, postural stability and physical function in fibromyalgia syndrome.

Design: A randomized, placebo-controlled trial was undertaken.

Subjects: Eighty-six patients with fibromyalgia syndrome were randomly assigned to an experimental group and a placebo group.

Interventions: Patients received treatments for 20 weeks. The experimental group underwent 10 myofascial release modalities and the placebo group received sham short-wave and ultrasound electrotherapy.

Main measures: Outcome variables were number of tender points, pain, postural stability, physical function, clinical severity and global clinical assessment of improvement. Outcome measures were assessed before and immediately after, at six months and one year after the last session of the corresponding intervention.

Results: After 20 weeks of myofascial therapy, the experimental group showed a significant improvement ( P  <  0.05) in painful tender points, McGill Pain Score (20.6 ± 6.3, P < 0.032), physical function (56.10 ± 17.3, P < 0.029), and clinical severity (5.08 ± 1.03, P < 0.039). At six months post intervention, the experimental group had a significantly lower mean number of painful points, pain score (8.25 ± 1.13, P < 0.048), physical function (58.60 ± 16.30, P < 0.049) and clinical severity (5.28 ± 0.97, P < 0.043). At one year post intervention, the only significant improvements were in painful points at second left rib and left gluteal muscle, affective dimension, number of days feeling good and clinical severity.

Conclusion: The results suggest that myofascial release techniques can be a complementary therapy for pain symptoms, physical function and clinical severity but do not improve postural stability in patients with fibromyalgia syndrome.

Connective tissue reflex massage for type 2 diabetic patients with peripheral arterial disease: randomized controlled trial

The objective of this study was to evaluate the efficacy of connective tissue massage to improve blood circulation and intermittent claudication symptoms in type 2 diabetic patients. A randomized, placebo-controlled trial was undertaken. Ninety-eight type 2 diabetes patients with stage I or II-a peripheral arterial disease (PAD) (Leriche-Fontaine classification) were randomly assigned to a massage group or to a placebo group treated using disconnected magnetotherapy equipment. Peripheral arterial circulation was determined by measuring differential segmental arterial pressure, heart rate, skin temperature, oxygen saturation and skin blood flow. Measurements were taken before and at 30 min, 6 months and 1 year after the 15-week treatment. After the 15-week program, the groups differed (P < .05) in differential segmental arterial pressure in right lower limb (lower one-third of thigh, upper and lower one-third of leg) and left lower limb (lower one-third of thigh and upper and lower one-third of leg). A significant difference (P < .05) was also observed in skin blood flow in digits 1 and 4 of right foot and digits 2, 4 and 5 of left foot. ANOVA results were significant (P < .05) for right and left foot oxygen saturation but not for heart rate and temperature. At 6 months and 1 year, the groups differed in differential segmental arterial pressure in upper third of left and right legs. Connective tissue massage improves blood circulation in the lower limbs of type 2 diabetic patients at stage I or II-a and may be useful to slow the progression of PAD.

Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial

Objective: To compare the benefits of initiating rehabilitation treatment within 24 hours versus 48–72 hours after total knee arthroplasty for osteoarthritis.

Design: Experimental study with clinical trial design.

Subjects: Patients undergoing primary total knee arthroplasty for osteoarthritis were randomly assigned to experimental (n = 153) and control (n = 153) groups.

Interventions: Rehabilitation was started within 24 hours post surgery in the experimental group and between 48 hours and 72 hours post surgery in the controls.

Main measures: Measurement variables included joint range of motion, muscle strength, pain, autonomy, gait and balance.

Results: In comparison with the controls, the experimental group showed significantly shorter hospital stay (by (mean ± standard deviation) 2.09 ± 1.45 days; P < 0.001), fewer rehabilitation sessions until medical discharge (by 4.95 ± 2.34; P < 0.001), lesser pain (by 2.36 ± 2.47 points; P < 0.027), greater joint range of motion in flexion (by 16.29 ± 11.39 degrees; P < 0.012) and extension (by 2.12 ± 3.19; P < 0.035), improved strength in quadriceps (by 0.98 ± 0.54; P < 0.042) and hamstring muscles (by 1.05 ± 0.72; P < 0.041), and higher scores for gait (P < 0.047) and balance (P < 0.045).

Conclusion: Initiation of rehabilitation within 24 hours after total knee arthroplasty reduces the mean hospital stay and number of sessions required to achieve autonomy and normal gait and balance.

Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia

Fibromyalgia is a chronic syndrome characterized by generalized pain, joint rigidity, intense fatigue, sleep alterations, headache, spastic colon, craniomandibular dysfunction, anxiety, and depression. The purpose of the present study was to determine whether massage-myofascial release therapy can improve pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. A randomized controlled clinical trial was performed. Seventy-four fibromyalgia patients were randomly assigned to experimental (massage-myofascial release therapy) and placebo (sham treatment with disconnected magnotherapy device) groups. The intervention period was 20 weeks. Pain, anxiety, quality of sleep, depression, and quality of life were determined at baseline, after the last treatment session, and at 1 month and 6 months. Immediately after treatment and at 1 month, anxiety levels, quality of sleep, pain, and quality of life were improved in the experimental group over the placebo group. However, at 6 months postintervention, there were only significant differences in the quality of sleep index. Myofascial release techniques improved pain and quality of life in patients with fibromyalgia.

A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients

CONTEXT

Fibromyalgia is a prevalent musculoskeletal disorder associated with widespread mechanical tenderness, fatigue, non-refreshing sleep, depressed mood and pervasive dysfunction of the autonomic nervous system: tachycardia, postural intolerance, Raynaud's phenomenon and diarrhoea.

OBJECTIVE

To determine the effects of craniosacral therapy on sensitive tender points and heart rate variability in patients with fibromyalgia.

DESIGN

A randomized controlled trial.

SUBJECTS

Ninety-two patients with fibromyalgia were randomly assigned to an intervention group or placebo group.

INTERVENTIONS

Patients received treatments for 20 weeks. The intervention group underwent a craniosacral therapy protocol and the placebo group received sham treatment with disconnected magnetotherapy equipment.

MAIN MEASURES

Pain intensity levels were determined by evaluating tender points, and heart rate variability was recorded by 24-hour Holter monitoring.

RESULTS

After 20 weeks of treatment, the intervention group showed significant reduction in pain at 13 of the 18 tender points (P < 0.05). Significant differences in temporal standard deviation of RR segments, root mean square deviation of temporal standard deviation of RR segments and clinical global impression of improvement versus baseline values were observed in the intervention group but not in the placebo group. At two months and one year post therapy, the intervention group showed significant differences versus baseline in tender points at left occiput, left-side lower cervical, left epicondyle and left greater trochanter and significant differences in temporal standard deviation of RR segments, root mean square deviation of temporal standard deviation of RR segments and clinical global impression of improvement.

CONCLUSION

Craniosacral therapy improved medium-term pain symptoms in patients with fibromyalgia.

[Efficacy of a massage and exercise programme on the ankle-brachial index and blood pressure in patients with diabetes mellitus type 2 and peripheral arterial disease: a randomized clinical trial]

BACKGROUND AND OBJECTIVE

Type 2 diabetes mellitus is a highly prevalent disease that can favour the development of peripheral arterial disease. The objective of this study was to analyse the efficacy of a massage and exercise programme on the ankle-brachial index and arterial pressure of patients with diabetes mellitus type 2 and peripheral arterial disease.

MATERIAL AND METHODS

An experimental study with placebo control group was performed. Sixty-six type 2 diabetes patients with Leriche-Fontaine stage II peripheral arterial disease were randomly assigned to an intervention (exercise and massage) or placebo control (simulated magnetotherapy) group. Study variables were arterial pressure and ankle-brachial index.

RESULTS

After 10 weeks of treatment, significant (P<0.05) differences between the intervention and placebo groups were found in right and left ankle-brachial index values and in systolic and diastolic pressures in right and left lower extremities.

CONCLUSIONS

A combined programme of exercise and massage improves arterial blood pressure and ankle brachial index values in type 2 diabetics with peripheral arterial disease.