The reliability in determining the deep fascia displacement of the upper trapezius during cervical movement: A pilot study

BackgroundRestricted shoulder fascia displacement may be an etiological factor for myofascial pain syndrome. A diagnostic ultrasound video can follow deep fascia displacement during active cervical movements. Trackers can be applied to videos to convert deep fascia displacement into data points. This study reports on assessors' reliability in evaluating direction and quantifying upper trapezius' deep fascia displacement during active cervical movements.MethodsPT-Sonographer 1 recorded deep fascia displacement of upper trapezius for three sets using HS1 Konica Minolta diagnostic ultrasound. The recording sequence used was cervical flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation. The three assessors used the tracker to determine direction of deep fascia displacement. PT-Sonographer 1 used the tracker three times in quantifying deep fascia displacement. Intraclass correlation coefficient and Kappa determined the assessors' intra-tester and inter-tester reliability.ResultsTen participants were included in the study with a mean±(SD) age of 37±(6). All the assessors had acceptable intra-tester reliability in determining deep fascia displacement on tracker (ICC≥0.40). All assessors had clinically unacceptable inter-tester reliability in determining deep fascia displacement when tracking right rotation (ICC < 0.40). PT-Sonographer 1 had clinically unacceptable intra-tester reliability in determining deep fascia displacement when tracking left rotation (ICC<0.40).ConclusionWe report clinically acceptable assessors' reliability in determining direction and total deep fascia displacement when tracking diagnostic ultrasound videos of cervical flexion, extension, and lateral flexion. Checking for reliable deep fascia displacements may distinguish MPS from non-MPS individuals increasing the utility of diagnostic ultrasound machine and tracker in clinical practice.     

Electromyographic comparison of vastus medialis obliquus facilitatory versus vastus lateralis inhibitory kinesio taping in athletes with patellofemoral pain: A randomized clinical trial

BackgroundPatellofemoral pain (PFP) is among the most common orthopedic complications afflicting active young people. Diminished coordination of the vastii, delayed activation of the vastus medialis obliquus (VMO), and decreased VMO-to-vastus lateralis (VL) activity ratio are well documented as underlying causes of PFP. This study compares the effects of VMO facilitatory kinesio tape (KT) versus VL inhibitory KT on electromyographic (EMG) activity of the vastii, balance, and pain in athletes with PFP.MethodsIn this single-blind randomized clinical trial, thirty-two female athletes with PFP (mean age 26.33 ± 5.93 years) were randomly assigned to VMO facilitatory KT (n = 16) or VL inhibitory KT (n = 16) groups. In the facilitatory group, a Y-shaped strip of KT at 25% of its available tension was attached from the origin of the VMO to its insertion and in the inhibitory group, an insertion-to-origin Y-shaped strip of KT at 15% of its available tension was applied on the VL. Pain intensity, dynamic balance, and EMG data were assessed respectively with a visual analogue scale, the modified Star Excursion Balance Test, and an EMG telemetry system, before and immediately after KT application.ResultsPain intensity decreased and dynamic balance improved significantly after taping in both groups, and VMO: VL activity ratio increased significantly in the VL group. However, none of the parameters differed significantly between groups.ConclusionsBoth VMO facilitatory and VL inhibitory KT can improve pain and balance, while the inhibitory technique might be more effective in regulating the VMO to VL activity ratio in athletes with PFP.     

弹性抗阻运动对慢性阻塞性肺疾病康复疗效的Meta分析

目的 系统评价弹性抗阻运动(弹力带/弹力管)对慢性阻塞性肺疾病(COPD)患者康复疗效的影响。方法 检索Cochrane Library、PubMed、Web of Science、中国知网、维普、万方和生物医学文献数据库中关于弹性抗阻运动治疗COPD患者的临床随机对照试验,检索时限自建库至2020年9月。最后纳入文献11篇,其中英文9篇,中文2篇,共485例患者。采用Cochrane风险偏倚评估工具及物理治疗证据数据库量表进行质量评价,采用RevMan 5.2软件进行分析。这一系统评价在PROSPERO(CRD42020208659)上登记。结果 弹性抗阻运动组与传统抗阻运动组(如举重训练机、体重训练) 6 min步行试验距离(6WMD) (MD = 1.19, 95%CI -7.02~9.39, P = 0.78)、COPD患者自我评估测试(CAT) (MD = -0.43, 95%CI -2.42~1.57, P = 0.68)和肌力(MD = 0.23, 95%CI -1.06~1.52, P = 0.73)无显著性差异,两组间异质性不高。弹性抗阻运动组与非抗阻运动组6MWD (MD = 18.30, 95%CI -8.92~45.52, P = 0.19)和CAT (MD = -0.59, 95%CI -3.78~2.60, P = 0.72)无显著性差异,研究间异质性较高。结论 弹性抗阻运动也许是一种潜在的替代传统抗阻训练的方法,但弹性抗阻运动对运动耐力、生活质量、肺功能的影响尚不明确。     

Adherence to Chronic Kidney Disease Screening Guidelines Among Patients With Type 2 Diabetes in a US Administrative Claims Database

ObjectiveTo examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database.Patients and MethodsThis cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results.ResultsA total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period.ConclusionPhysicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.     

针刺治疗慢性疼痛的功能磁共振研究述评＊

目的基于针刺治疗慢性疼痛的功能磁共振(Functional magnetic resonance imaging,fMRI)文献进行述评,为针刺治疗慢性疼痛的机制研究提供思路和借鉴。方法对近10年针刺治疗慢性疼痛的fMRI研究进行回顾,依据病种选择、样本量计算、试验设计、研究结果四方面内容进行述评,分析并总结当前研究现状。结果偏头痛、膝骨关节炎和下腰痛是目前研究中涉及频次最高的3个病种。受试者的疾病亚型、年龄段、利手习惯及fMRI禁忌症在研究中基本都保证了一致性和规范性。但多数研究仍存在样本量计算方式不明确的问题。对照组设置主要包括标准对照、无效对照和安慰对照。针刺效应因素在各研究间存在较大差异。研究中结局指标包括疾病特异性量表、疼痛评分及心理、精神状态的评估。fMRI设计以静息态和单一任务态设计为主,多任务fMRI研究相对较少。研究证实针刺可调节疼痛处理网络的功能连接,有效建立心理物理疼痛稳态。结论运用fMRI探讨针刺治疗慢性疼痛作用机制的研究成果丰硕,未来可通过扩大病种的选择,完善质量控制,关注针刺效应影响因素,丰富数据处理手段,借鉴多学科任务设计方式等方式,促进针刺疗慢性疼痛机制研究的进一步发展。     

Drezotomía en el tratamiento del dolor por desaferentización: revisión de resultados y análisis de factores predictores de éxito

Background and objectivesThe treatment of deafferentation pain by spinal DREZotomy is a proven therapeutic option in the literature. In recent years, use of DREZotomy has been relegated to second place due to the emergence of neuromodulation therapies. The objectives of this study are to demonstrate that DREZotomy continues to be an effective and safe treatment and to analyse predictive factors for success.Patients and methodsA retrospective study was conducted of all patients treated in our department with spinal DREZotomy from 1998 to 2018. Bulbar DREZotomy procedures were excluded. A visual analogue scale (VAS) and the reduction of routine medication were used as outcome variables. Demographic, clinical and operative variables were analysed as predictive factors for success.ResultsA total of 27 patients (51.9% female) with a mean age of 53.7 years underwent DREZotomy. The main cause of pain was brachial plexus injury (BPI) (55.6%) followed by neoplasms (18.5%). The mean time of pain evolution was 8.4 years with a mean intensity of 8.7 according to the VAS, even though 63% of the patients had previously received neurostimulation therapy. Favourable outcome (≥ 50% pain reduction in the VAS) was observed in 77.8% of patients during the postoperative period and remained in 59.3% of patients after 22 months average follow-up (mean reduction of 4.9 points). This allowed for a reduction in routine analgesic treatment in 70.4% of them. DREZotomy in BPI-related pain presented a significantly higher success rate (93%) than the other pathologies (41.7%) (p = .001). No association was observed between outcome and age, gender, DREZ technique, duration of pain or previous neurostimulation therapies. There were six neurological complications, four post-operative transient neurological deficits and two permanent deficits.ConclusionDorsal root entry zone surgery is effective and safe for treating patients with deafferentation pain, especially after brachial plexus injury. It can be considered an alternative treatment after failed neurostimulation techniques for pain control. However, its indication should be considered as the first therapeutic option after medical therapy failure due to its good long-term results.     

Higher Preimplantation Opioid Doses Associated With Long‐Term Spinal Cord Stimulation Failure in 211 Patients With Failed Back Surgery Syndrome

ObjectiveSpinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). We studied the effect of preimplantation opioid use on SCS outcome and the effect of SCS on opioid use during a two-year follow-up period.Materials and methodsThe study cohort included 211 consecutive FBSS patients who underwent an SCS trial from January 1997 to March 2014. Participants were divided into groups, which were as follows: 1) SCS trial only (n = 47), 2) successful SCS (implanted and in use throughout the two-year follow-up period, n = 131), and 3) unsuccessful SCS (implanted but later explanted or revised due to inadequate pain relief, n = 29). Patients who underwent explantation for other reasons (n = 4) were excluded. Opioid purchase data from January 1995 to March 2016 were retrieved from national registries.ResultsHigher preimplantation opioid doses associated with unsuccessful SCS (ROC: AUC = 0.66, p = 0.009), with 35 morphine milligram equivalents (MME)/day as the optimal cutoff value. All opioids were discontinued in 23% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.004). Strong opioids were discontinued in 39% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.04). Mean opioid dose escalated from 18 ± 4 MME/day to 36 ± 6 MME/day with successful SCS and from 22 ± 8 MME/day to 82 ± 21 MME/day with unsuccessful SCS (p < 0.001).ConclusionsHigher preimplantation opioid doses were associated with SCS failure, suggesting the need for opioid tapering before implantation. With continuous SCS therapy and no explantation or revision due to inadequate pain relief, 39% of FBSS patients discontinued strong opioids, and 23% discontinued all opioids. This indicates that SCS should be considered before detrimental dose escalation.     

Subtypes of insomnia and the risk of chronic spinal pain: the HUNT study

ObjectiveTo examine the association between subtypes of insomnia and the risk of chronic spinal pain.MethodsThe study comprised 16,401 participants without chronic spinal pain at baseline who were followed for ∼11 years. People were categorized into ‘no insomnia symptoms’, ‘subthreshold insomnia’, and ‘insomnia’. Insomnia was defined according to the diagnostic classification system requiring both daytime and nighttime symptoms, and further categorized into subtypes based on nighttime symptoms (ie, sleep onset latency [SOL-insomnia], wake after sleep onset [WASO-insomnia], early morning awakening [EMA-insomnia], or combinations of these). Subthreshold insomnia comprised those with only daytime impairment or one or more nighttime symptoms. Chronic spinal pain was defined as pain in either ‘neck’, ‘low back’, or ‘upper back’, or a combination of these.ResultsIn multivariable regression analysis using people without insomnia as reference, people with subthreshold insomnia or insomnia had relative risks (RRs) of chronic spinal pain of 1.29 (95% confidence interval [CI] 1.21–1.38) and 1.50 (95% CI 1.34–1.68), respectively. The RRs for people with one nighttime symptom were 1.30 (95% CI 0.83–2.05) for WASO-insomnia, 1.32 (95% CI 1.06–1.65) for EMA-insomnia, and 1.70 (95% CI 1.32–2.18) for SOL-insomnia, respectively. Combinations of nighttime insomnia symptoms gave RRs from 1.45 (95% CI 1.08–1.94) for WASO + EMA-insomnia to 1.72 (95% CI 1.36–2.19) for all nighttime symptoms (SOL + WASO + EMA-insomnia).ConclusionsThese findings suggest that the risk of chronic spinal pain is highest among persons with insomnia subtypes characterized by sleep onset latency or among those having insomnia symptoms in all parts of the sleep period.