Physiotherapy management of patients with chronic pelvic pain (CPP): A systematic review

Introduction: Chronic pelvic pain (CPP) is a common pain condition. However, treatment remains challenging. Musculoskeletal findings are frequent; therefore physiotherapy might be helpful. The purpose of this review was to evaluate the current evidence on physiotherapy in patients with CPP (PROSPERO registration number CRD42016037516). Methods: Six databases were searched and additional hand searches were performed. Two reviewers independently conducted the database search and selected studies using a two-step approach. The methodological quality was assessed applying the Critical Review Form – Quantitative Studies. Results: A total of eight studies were included. Trigger point therapy was examined in four studies; two of which were randomized controlled trials. All studies indicate a significant change in pain measurement. The other four studies evaluated the effect of biofeedback, Thiele massage, Mensendieck somatocognitive therapy and aerobic exercises, whereas the last two were tested in controlled trials. All studies showed significant improvements in pain assessment. Conclusions: The evidence currently available is sparse with methodological flaws, making it difficult to recommend a specific physiotherapy option. There is an urgent need for high-quality randomized controlled trials to identify the most effective physiotherapy management strategy for patients with CPP.     

Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review

A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.     

Acupuncture for the relief of cancer-related pain--a systematic review.

AIMS: This systematic review summarises the existing evidence on acupuncture for cancer-related pain. METHODS: Literature searches were conducted in seven databases. All clinical studies of acupuncture, electroacupuncture and ear acupuncture in cancer patients with the main outcome measure of pain were included. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed using the Jadad scale. RESULTS: Of the seven studies included, one high quality randomised clinical trial of ear acupuncture showed statistically significant pain relief in comparison with placebo ear acupuncture. All the other studies were either non-blinded (n=2) or uncontrolled clinical trials (n=4). Most investigations suffered from methodological flaws such as inadequate study design, poor reporting of results, small sample size and overestimation of the results. CONCLUSIONS: The notion that acupuncture may be an effective analgesic adjunctive method for cancer patients is not supported by the data currently available from the majority of rigorous clinical trials. Because of its widespread acceptance, appropriately powered RCTs are needed.     

A systematic review of physiotherapy for spondylolysis and spondylolisthesis

The purpose of this systematic review was to assess the evidence concerning the effectiveness of physiotherapy intervention in the treatment of low back pain related to spondylolysis and spondylolisthesis. A literature search of published and unpublished articles resulted in the retrieval of 71 potential studies on the subject area. Fifty-two of the 71 articles were studies, and these studies were reviewed using preset relevance criteria. Given the inclusion and exclusion criteria chosen for this systematic review, there were very few acceptable studies and only two studies met the relevance criteria for the critical appraisal. Both studies provide evidence to suggest that specific exercise interventions, alone or in combination with other treatments, have a positive effect on low-back pain due to spondylolysis and spondylolisthesis; however, the type of exercise used was different in the two studies. In this review, very few prospective studies were found that examined the efficacy of physiotherapy on the topic area; therefore, few conclusions can be made, and further research is warranted.     

Manual therapy in the treatment of ankle hemophilic arthropathy. A randomized pilot study

Abstract

Purpose: Although physiotherapy has demonstrated effectiveness in preventing ankle arthropathy compared to prophylaxis treatment from early ages, there have been no conclusive studies examining physiotherapy intervention once hemophilic arthropathy of the ankle has been established. The aim of this study was to evaluate the effectiveness of two physiotherapy interventions, in patients with hemophilic arthropathy of the ankle that had not been operated on previously. Method: Nine patients with hemophilia (mean age of 35.7 SD 11.9 years) were randomized to a mobilization group (n?=?5) and manual therapy group (n?=?4). The two physiotherapy interventions were: (1) passive mobilization and stretching; and (2) manual orthopaedic therapy, both with proprioception training. The study lasted for six weeks, with two sessions a week. Ankle mobility and pain perception, lower limb proprioception and quality of life were the outcome measures. Results: Both treatments improved all ankle movements (p?<?0.05). The treatment with passive mobilizations also improved the perception of pain and quality of life. Six months later, both groups still had improved articular movement with the exception of plantar flexion and continued to perceive less pain. Conclusions: Both physiotherapy interventions improved the range of movement and lessened pain in patients with ankle arthropathy. No haemarthrosis was recorded during treatment or during the follow-up period.     

Physiotherapy,Steroid Injections,or Rest for Lateral Epicondylosis? What the Evidence Suggests

Objective: To identify effective lateral epicondylosis interventions and assess the quality of research over time. Methods: Relevant MEDLINE and EMBASE searches respectively yielded 226 and 187 potential studies. Additional citations were extracted from bibliographies. Thirty controlled trials met inclusion criteria. The Cochrane Collaboration guidelines “quality score” served to rate studies. Results: In the short term (<2 to 3 months) steroid injections and physiotherapy outperformed relative rest. Physiotherapy appears efficacious regardless of time frame. After 3 months, active physiotherapy outperforms injections, but does not appear significantly better than rest. Evidence was neutral or insufficient regarding ultrasound, splinting, or manipulation. Nonsignificant correlations between publication year and study quality score were found. Conclusions: Overall research quality has not improved with time. Steroid injections appear the most successful short‐term intervention for pain relief. Active physiotherapy appears efficacious regardless of time frame.     

Effect of aromatherapy on sleep quality of adults and elderly people: A systematic literature review and meta-analysis

PurposeThe purpose of this study was to characterize studies on aromatherapy and sleep quality and to identify the measurable effects of aromatherapy on the sleep quality of adults and elderly people.MethodsWe searched eight electronic databases for relevant studies published between January 2011 and December 2019 using the medical subheadings, “adult or elderly,” “aromatherapy or aroma intervention,” and “sleep quality or sleep satisfaction.” Statistical analyses of the combined effect sizes, homogeneity, heterogeneity, and trim-and-fill method were performed using MIX 2.0 Pro.ResultsBased on the combined results of the 30 included studies, the overall effect size of sleep quality was 0.74, which was statistically significant. A subgroup analysis was performed to assess the overall improvement in sleep quality based on country, study design, and type of intervention: the effect size of aromatherapy in East Asia, quasi-experimental studies, and aroma massage therapy studies was 1.02, 1.24, and 1.30, respectively, with higher sleep quality in each subgroup. The effect size was 0.86 and 0.80 for ≤12 interventions and for an intervention period of ≤4 weeks, respectively. Aromatherapy interventions lasting >20 min per session had an effect size of 1.28, with no significant difference in sleep quality. Quality evaluation revealed that the sleep quality after aromatherapy was significantly high in studies with methodological quality scores >8, with an effect size of 0.93. Moreover, significant combined effects of aromatherapy were observed with other variables such as stress, pain, anxiety, depression, and fatigue.ConclusionAromatherapy improves sleep quality and reduces stress, pain, anxiety, depression, and fatigue in adults and elderly people.     

Dry needling for the management of spasticity,pain, and range of movement in adults after stroke: A systematic review

ObjectiveTo summarise the available evidence about the effectiveness of deep dry needling (DN) on spasticity, pain-related outcomes, and range-of-movement (ROM) in adults after stroke.DesignA computer search of Web of Science, Scopus, Medline, Cochrane Library, Cinahl, and Physiotherapy Evidence Database (PEDro) was conducted. A hand search of the reference lists of the selected studies and other relevant publications was also undertaken. Studies were assessed by two independent reviewers and included if they complied with the following criteria: (1) participants were adults after a stroke, (2) use of DN alone or within a multimodal approach, compared to no intervention or other treatments; (3) assessment of spasticity, pain, or joint ROM as a primary or secondary outcome. We included randomised controlled trials (RCTs), case series, and case reports. Data were extracted using a standardised protocol. The methodological quality of the studies was assessed with the Checklist for Measuring quality.ResultsA total of sixteen studies, 7 of which were RCTs, were selected. All studies generally reported an improvement of spasticity level, pain intensity, and ROM after the use of DN, alone or combined with other interventions, in stroke survivors.ConclusionThe management of adults after stroke with DN may impact positively on spasticity, pain, and ROM. However, there was significant heterogeneity across trials in terms of sample size, control groups, treated muscles, and outcome measures, and a meta-analysis was not feasible. Further research should include proper blinding, sham placebo DN as control intervention, and investigate long-term effects.     

Work Motivating Factors in Rehabilitation: A Brief Review

Abstract

Background: Back pain is a common condition for which chiropractic treatment is often recommended.

Aim: To evaluate critically the evidence for or against the effectiveness of chiropractic spinal manipulation for back pain.

Data sources: Five independent literature searches were carried out and bibliographies were searched.

Study selection: Only randomised clinical trials of chiropractic spinal manipulation with patients suffering from back pain were included.

Data extraction: The authors extracted data on trial design, methodological quality, sample size, patient characteristics, nature of intervention, outcome measures, follow-up and results.

Main results: Twelve studies could be included. They related to all forms of back pain. Many trials had significant methodological shortcomings. Some degree of superiority of chiropractic spinal manipulation over control interventions was noted in 5 studies. More recent trials and those with adequate follow-up periods tended to be negative.

Conclusions: The effectiveness of chiropractic spinal manipulation is not supported by compelling evidence from the majority of randomised clinical trials.     

The Effects of Graded Motor Imagery and Its Components on Chronic Pain: A Systematic Review and Meta-Analysis

Graded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesize all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomized controlled trials (RCTs) of GMI, left/right judgment training, motor imagery, and mirror therapy used as a treatment for chronic pain were included. Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria, and the methodological quality was generally low. No effect was seen for left/right judgment training, and conflicting results were found for motor imagery used as stand-alone techniques, but positive effects were observed for both mirror therapy and GMI. A meta-analysis of GMI versus usual physiotherapy care favored GMI in reducing pain (2 studies, n = 63; effect size, 1.06 [95% confidence interval, .41, 1.71]; heterogeneity, I² = 15%). Our results suggest that GMI and mirror therapy alone may be effective, although this conclusion is based on limited evidence. Further rigorous studies are needed to investigate the effects of GMI and its components on a wider chronic pain population.PerspectiveThis systematic review synthesizes the evidence for GMI and its constituent components on chronic pain. This review may assist clinicians in making evidence-based decisions on managing patients with chronic pain conditions.     

Exercise and chronic low back pain: what works?

The aim of this review was to investigate current evidence for the type and quality of exercise being offered to chronic low back pain (CLBP) patients, within randomised controlled trials (RCTs), and to assess how treatment outcomes are being measured. A two-fold methodological approach was adopted: a methodological assessment identified RCTs of 'medium' or 'high' methodological quality. Exercise quality was subsequently assessed according to the predominant exercise used. Outcome measures were analysed based on current recommendations. Fifty-four relevant RCTs were identified, of which 51 were scored for methodological quality. Sixteen RCTs involving 1730 patients qualified for inclusion in this review based upon their methodological quality, and chronicity of symptoms; exercise had a positive effect in all 16 trials. Twelve out of 16 programmes incorporated strengthening exercise, of which 10 maintained their positive results at follow-up. Supervision and adequate compliance were common aspects of trials. A wide variety of outcome measures were used. Outcome measures did not adequately represent the guidelines for impairment, activity and participation, and impairment measures were over-represented at the expense of others. Despite the variety offered, exercise has a positive effect on CLBP patients, and results are largely maintained at follow-up. Strengthening is a common component of exercise programmes, however, the role of exercise co-interventions must not be overlooked. More high quality trials are needed to accurately assess the role of supervision and follow-up, together with the use of more appropriate outcome measures.     

Preventive measures for the prophylaxis of contractures in geriatric nursing. A systematic review

Contractures constitute a health problem in mobility-restricted geriatric patients. Contractures are clinically important due to their impact on functional outcome. Prophylactic interventions seem to be indispensable. We performed a systematic review studying the interventions used to prevent immobility-related contractures in the geriatric long-term care. The efficacy and safety of preventive methods was assessed. Electronic literature searches covered the databases PubMed, PEDro, CINAHL and the Cochrane Library (May 2010). Eligibility criteria for studies were: Investigation of an intervention aimed to prevent contractures, conducted in a geriatric and long-term care setting, inclusion of participants aged>65 years. The primary search focused on RCTs, systematic reviews und meta-analysis published between 1990 and May 2010 in English or German. The included studies were analysed and evaluated by one author while a second author checked the results. Methodological quality was critically evaluated using internationally accepted criteria. Eight studies met the inclusion criteria. Prophylactic interventions comprise mobility-encouraging and position-supportive interventions. Mobility-encouraging interventions aim to prevent contractures and immobility, for example offering range-of-motion exercises. Position-supportive interventions are transformations of motion and position, which are conducted with nurses' support. Due to limited methodological quality of these studies, the efficacy of certain measures remains unclear. Further studies on contracture prophylaxis investigating patient-relevant outcomes, interventions' adverse effects and costs are required.     

家庭干预对精神分裂症患者康复作用的系统性评价

目的：探讨家庭干预对精神分裂症患者康复作用的临床研究质量及疗效。方法：计算机检索中国生物医学文献数据库（CBMdisk）和中文科技期刊数据库（VIP，1989—2005），收集有关家庭干预对精神分裂症患者康复作用与常规药物治疗相比较的随机对照试验文献．由两名评价者独立评价纳入研究的文献质量，并进行了Meta分析。结果：符合纳入标准的随机对照实验（randomized control trial，RCT）共9个，但其方法学质量均欠佳（C级）。与对照组相比，家庭干预对精神分裂症患者的服药依从性有明显的增效作用[RR1．69，95％CI（1．21，2．37），P=0．0021，敏感性分析后得到的结果略有下降[RR1．46，95％CI（1．22，1．75），P〈0．0001]。结论：目前有关家庭干预对精神分裂症患者康复作用的临床研究在科研方法学的应用方面仍有差距。本研究提示，家庭干预可能对精神分裂症患者的服药依从性有一定的增效作用，但不排除与实验方法学质量低下及发表性偏倚有关。     

The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review

The study design is a systematic review of randomised clinical trials (RCTs). The objectives of the present study are to assess the effectiveness of physiotherapy and (spinal) manipulation in patients with tension-type headache (TTH). No systematic review exists concerning the effectiveness of physiotherapy and (spinal) manipulation primarily focussing on TTH. Literature was searched using a computerised search of MEDLINE, EMBASE and the Cochrane library. Only RCTs including physiotherapy and/or (spinal) manipulation used in the treatment of TTH in adults were selected. Two reviewers independently assessed the methodological quality of the RCTs using the Delphi-list. A study was considered of high quality if it satisfied at least six points on the methodological quality list. Twelve publications met the inclusion criteria, including three dual or overlapping publications resulting in eight studies included. These studies showed a large variety of interventions, such as chiropractic spinal manipulation, connective tissue manipulation or physiotherapy. Only two studies were considered to be of high quality, but showed inconsistent results. Because of clinical heterogeneity and poor methodological quality in many studies, it appeared to be not possible to draw valid conclusions. Therefore, we conclude that there is insufficient evidence to either support or refute the effectiveness of physiotherapy and (spinal) manipulation in patients with TTH.     

Safety and effectiveness of fascial therapy in adult patients with hemophilic arthropathy. A pilot study

Background: The primary clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. Fascial therapy is one of the most used physiotherapy techniques today to improve joint dysfunctions and chronic pain. Objective: To assess the safety and efficacy of fascial therapy treatment in patients with hemophilic arthropathy of ankle and knee. Design: Non-randomized, controlled clinical trial. Intervention: Sixteen patients with hemophilia were allocated to an experimental group or to a control group. The physiotherapy intervention was performed through three sessions (one per week), for 60 min per session. Patients received a physiotherapy treatment using a fascial therapy protocol for patients with hemophilia. Main Outcome Measures: The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analogue Scale; the range of movement was evaluated using a universal goniometer; the flexibility of the hamstring muscles was assessed with the fingertip-to-floor, and the lumbar mobility through the Schöber test. Results: We observed significant differences in the experimental group for both quality of life and illness behavior. There was no significant improvement in the joint status; however, an improvement was noted in terms of perception of pain in the ankle. Conclusions: A physiotherapy program based on fascial therapy is safe in patients with hemophilia. Fascial therapy may improve joint status, pain, and mobility in patients with hemophiliac arthropathy of the knee and ankle.     

Physical agents for perineal pain following childbirth: a review of systematic reviews

Abstract

The objective of this review was to examine the evidence from controlled trials investigating the use of therapeutic ultrasound, pulsed electromagnetic energy, ice or cold for the relief of perineal pain following childbirth. MEDLINE and CINAHL CD-ROM were searched for trial reports (1977–1996 inclusive), then methodological quality assessment of trials was carried out. Two trials of ultrasound, one of pulsed electromagnetic energy and four of ice or cold were included. Main outcome measures considered were methodological quality score and the effect of intervention on perineal pain. Quality assessments ranged from 3–8 points (maximum 10 points). None of the included studies indicated that ultrasound, pulsed electromagnetic energy, ice or cold, was effective for perineal pain. We suggest that the small number, and variable quality, of trials means that no conclusions can be drawn about the effectiveness of ultrasound, pulsed electromagnetic energy, ice or cold for perineal pain. Further large scale, good quality, clinical trials are needed.     

Impact of random assignment on study outcome: an empirical examination.

Sixty research investigations published in the biomedical literature were analyzed to examine the effect of design attributes on outcome. All 60 studies included a controlled trial involving a pretest, a therapeutic intervention, and a posttest across at least two groups. Thirty of the trials used random assignment of participants to treatment or control conditions and 30 trials employed some nonrandom method of subject assignment. Trial results were aggregated and evaluated by comparing effect sizes for the primary statistical test of the hypothesis. Data analysis revealed that the trial results, as measured by effect size, did not vary across therapeutic trials using random assignment versus those using nonrandom allocation of subjects. The impact of design attributes in the interpretation of multiple clinical trials addressing a similar research question is examined. The argument is made that various design attributes frequently associated with methodological quality should be considered as important moderator variables and their influence on trial outcome should not be assumed a priori but rather examined empirically.     

Virtual reality as a chemotherapy support in treatment of anxiety and fatigue in patients with cancer: A systematic review and meta-analysis and future research directions

ObjectiveThe aim of this systematic review was to analyse the effectiveness of virtual reality intervention as an aid for treatment-related anxiety and fatigue in cancer patients undergoing chemotherapy. The term chemotherapy was assumed without distinction regarding type.MethodsThe inclusion criteria were (1) randomised controlled trials or crossover studies, (2) adult cancer patients undergoing chemotherapy, (3) treatment with VR scenarios providing distraction during chemotherapy, and (4) with pain, anxiety, fatigue, fear, or symptom distress as the measured outcomes. Articles in English, Polish, and Italian were sought. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.4 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase.ResultsFrom a total of 2543 records, 6 studies met the inclusion criteria for qualitative analysis. At the end of the process, 3 studies remained for quantitative analysis. The systematic review includes three randomised, controlled studies and three crossover studies with an overall sample size of 453 patients. The analysis of the primary outcomes chosen for each study revealed no significant differences between the control and experimental conditions. Moreover, an important factor influencing the results of the review and meta-analysis was the poor quality of the publications available on the topic of distraction during chemotherapy.ConclusionDue to the low research standards, the results do not provide an unambiguous answer to the research question. The most important limitations result from the small number of trials, the generally small sample sizes, and the differences in study design.     

Taking a new course in research on the effectiveness of interventions. A study of physiotherapy interventions for people with musculoskeletal complaints

Physiotherapy is a commonly employed intervention for people with musculoskeletal complaints. However, due to (methodological) limitations in previous research, the effectiveness of physiotherapy interventions has not yet been proven. The aim of the present study is twofold. First we try to solve some of the methodological problems, of which the most important are selection and endogeneity biases and state dependence. Secondly, the effect of a physiotherapy intervention on recovery from musculoskeletal complaints is investigated. The probability of receiving a physiotherapy intervention is estimated, as well as the probability of recovery as a result of this intervention. A longitudinal design is used. Analyses are performed using secondary data on a populational level. The analytical framework is provided by a Markov model. We use a logit model to estimate transition probabilities of this Markov model. Results show that experience with physiotherapy in the past is an important predictor for receiving physiotherapy in the future. Other predictors of the chance of receiving an intervention are also identified. Furthermore, results indicate that the effect of a physiotherapy intervention on recovery is negative. It is concluded that both the latter effect and the effect of intervention experience can partly be explained by medicalization, in spite of a presence of "severe" cases in the intervention group.