Effects of lumbosacral orthosis on dynamical structure of center of pressure fluctuations in patients with non-specific chronic low back pain: A randomized controlled trial

BackgroundA few clinical trials have examined the effect of treatment interventions on postural control in patients with chronic low back pain, all of which have exclusively evaluated postural stability using traditional linear measures of postural sway. However, postural control improvement cannot be determined by exclusively relying on linear measurements, because these parameters provide no information on underlying motor control mechanisms.ObjectiveThis study aimed to compare the effect of using lumbosacral orthoses (LSO) together with routine physical therapy, compared to routine physical therapy alone on postural control, using nonlinear analysis techniques.MethodsForty-four patients with low back pain were randomly allocated to the intervention and control groups. Both groups underwent 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received LSO in addition to routine physical therapy. Before and after the intervention, non-linear dynamical features of center of pressure fluctuations were assessed during quiet standing at 3 difficulty levels of postural tasks, including eyes open while standing on a rigid surface, eyes closed while standing on a rigid surface, and eyes closed while standing on a foam surface.ResultsThe results of this study showed that a 4-week intervention consisting of LSO and routine physical therapy modalities did not affect the temporal structure of postural sways in patients with low back pain.ConclusionTreatment strategies, such as routine physical therapy modalities or LSO, which exclusively focus on the correction of peripheral mechanics, fail to affect the behavior of the postural control system.     

Effects of ear and body acupressure on labor pain and duration of labor active phase: A randomized controlled trial

ObjectivesThis study sought to compare the effects of multi-point ear and body acupressure on labor pain and the duration of labor active phase.DesignThree-armed randomized controlled trial.SettingKowsar Hospital, Qazvin, Iran.InterventionParticipants in the body acupressure group received acupressure on GB21, GB30, BL32, LI4, and SP6 points, each for two minutes, at cervical dilation of four, six, and eight centimeters. For participants in the ear acupressure group, adhesive auriculotherapy-specific Vaccaria seeds were attached to their auricles on the zero, genitalia, Shen Men, thalamic, and uterine 1 and 2 acupoints. The seeds were compressed every thirty minutes, each time for thirty seconds. Participants in the control group received routine care services.Main outcome measuresLabor pain intensity was assessed using a visual analogue scale at cervical dilation of four and ten centimeters.ResultsWhile there was no significant difference between mean scores of pain among three groups, mean score of labor pain in both acupressure groups was significantly less than that in the control group (P < 0.001). However, the difference between the acupressure groups was not statistically significant (P = 0.12). Moreover, the duration of labor active phase in the ear acupressure group was significantly less than those in the body acupressure and the control groups (P < 0.001).ConclusionEar acupressure was significantly effective in reducing labor pain and shortening labor active phase. However, body acupressure solely reduces labor pain. Therefore, ear acupressure can be used to reduce labor pain and shorten labor active phase.     

Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study

ObjectiveThe purpose of this study was to compare static maximal back extensor muscle force, endurance, and characteristics of flexion relaxation phenomenon (FRP) in older women with and without age-related hyperkyphosis.MethodsMaximum back extensor force and endurance measured in a sitting position with a designed load cell setup; appearance, onset, and offset angles of FRP; and extension relaxation ratio (ERR) during a dynamic flexion-extension task were compared between 24 older women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 65 ± 4.4 years, and 24 older women without hyperkyphosis (thoracic kyphosis angle ?50°), mean age 63 ± 4.3 years. Variables of force, endurance, angles of FRP, and ERR were analyzed using an independent sample t test. A χ² test was used to identify differences between groups in FRP appearance.ResultsStatic back extensor force and endurance were significantly lower among those with versus those without hyperkyphosis (P ? .001). Although the 2 groups did not differ in FRP appearance and ERR in the superficial erector spinal muscles (P ? .05), FRP in the hyperkyphosis group started sooner and ended later than in the group without hyperkyphosis (P ? .05).ConclusionOur study indicates that women with age-related hyperkyphosis had decreased static maximal force and endurance of the back extensor muscles and prolonged myoelectrical silence of the superficial erector spinal muscles. Reduced endurance of the superficial erector spinal muscles may trigger early onset of FRP and prolonged relaxation of these muscles.     

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: A randomised controlled trial

Background

In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans.

Objective

The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences.

Design

A randomised, single-blind controlled trial study design was used.

Settings

This study involved seven hospitals and 10 obstetricians in Taiwan.

Participants

Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n = 155) or control (n = 141) groups.

Methods

The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations.

Results

The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t = 2.48, p = 0.01). The experimental group also showed a higher degree of childbirth control (t = 9.60, p < 0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t = 2.63, p = 0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t = 3.74, p < 0.001) in the experimental group than in the control group.

Conclusions

The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.     

Validity of SMART-COP score in prognosis and severity of community acquired pneumonia in the emergency department

BackgroundDetermining prognosis in community acquired pneumonia (CAP), is very important. Many scores are introduced up to now for prediction of pneumonia prognosis like SMART-COP.ObjectiveTo evaluate validity of SMART-COP score in prognosis and severity of CAP in emergency department (ED).MethodsAll patients older than 18 years old with clinical suspicion of CAP (meeting the inclusion criteria), were enrolled in our study. In this prospective study, patients were admitted to the ED of a tertiary referral center. Hospital length of stay, rate of intensive care unit (ICU) admission, mortality rate, number of intensive respiratory or vasopressor support (IRVS) use, patients' SMART-COP scores and all demographic data were recorded. Validity of SMART-COP in the prediction of IRVS rate and its correlation with other variables were determined.ResultsIn this study, 47.6% and 52.4% of patients were females and males respectively. The mean age of patients was 68.13 ± 16.60 years old. The mean hospital length of stay was 13.49 ± 5.62 days. Of all patients entered in our study, 55 cases (38.5%) needed ICU admission, 29 cases (20.3%) were expired within 1 month and 44 cases (30.8%) needed IRVS during their treatment. SMART-COP ≥5 (high risk CAP) accurately predicted the rate of ICU admission, one-month mortality and IRVS need (p-value = 0.001).ConclusionsSMART-COP≥5 had a high sensitivity and specificity in the prediction of patients' prognosis with severe CAP in the ED.     

The effect of GB21 acupressure on pain intensity in the first stage of labor in primiparous women: A randomized controlled trial

IntroductionLabor pain is one of the most intensive pains experienced by women; it results in physical, emotional, and physiological changes in women’s body. The present study aimed to examine the effect of GB21 acupressure on labor pain.DesignIn this randomized clinical trial, 174 primiparous women in their first stage of labor were selected and assigned to three groups: GB21 acupressure group (n = 58), sham group (n = 58), and control group (n = 58).InterventionsThe acupressure and sham groups received routine labor care and acupressure in three different phases of cervical dilations to 3−5 cm, 6−7 cm, and 8−10 cm. The control group received routine care in labor.Main outcome measuresPain severity was measured using a pain scale ruler in three cervical dilations before and after intervention. The collected data were analyzed using the ANOVA, Kruskal–Wallis, paired-t test and Mann–Whitney tests.ResultsPain reduction was significantly higher in GB21 groups compared with sham and control groups (P = 0.001). No statistically significant difference was observed between the three groups in terms of delivery outcomes.ConclusionsIn this study, GB21 acupressure was effective in pain relief during labor, hence recommended as a practical, effective, inexpensive, and accessible method for labor pain management.     

Shoulder pain prevalence and risk factors in middle-aged women: A cross-sectional study

PurposeThe aim of the current study was to investigate the prevalence of shoulder pain and to explore the possible associated risk factors in middle-aged women.MethodsA total of 500 middle-aged women, aged 45–65 years, participated in this cross-sectional study. The point and lifetime prevalence of shoulder pain were calculated. Linear and logistic regressions were used to determine the possible associations between the risk factors and present shoulder pain.ResultsThe point and lifetime prevalence of shoulder pain were 18.6% and 27.6%, respectively. The logistic regression analysis demonstrated a significant association between present shoulder pain and history of shoulder pain and trauma, osteoporosis, trapezius muscle pain, and cervical radiculopathy (p < 0.05). However, there was no significant association between present shoulder pain and diabetes mellitus or postural deviation (p > 0.05).ConclusionThe results indicated that shoulder pain has considerable prevalence in middle-aged women. In addition, a history of shoulder pain and trauma, osteoporosis, trapezius muscle pain, and cervical radiculopathy were found to be associated with present shoulder pain. Future research should concentrate on longitudinal designs that explore preventive strategies and risk factors for shoulder pain.     

Application of Ultrasonography in the Assessment of Abdominal and Lumbar Trunk Muscle Activity in Participants With and Without Low Back Pain: A Systematic Review

ObjectiveThe purpose of this study was to systematically review the literature regarding which condition (task, position, or contraction type), changes in muscle thickness could be interpreted as muscle activity of trunk muscles.MethodsStudies that assessed the correlation between changes in muscle thickness measured with ultrasonography (US) and electromyography (EMG) activity were included. Only the data related to abdominal and lumbar trunk muscles in participants with or without low back pain were extracted. The PubMed, ScienceDirect, Ovid MEDLINE, Scopus, Springer, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception to August 2018. Two independent raters appraised the quality of the included studies using the Critical Appraisal Skills Program checklist.ResultsFourteen studies were included. The results revealed significant correlations between US and EMG measures for the lumbar multifidus and erector spinae muscle during most contraction levels and postures. For transverse abdominis and internal oblique, US and EMG measures were correlated during low load abdominal drawing or bracing. The correlations were influenced by trunk position for higher intensities of contraction. For the external oblique muscle, correlation was observed only during trunk rotation.ConclusionChanges in muscle thickness should not be interpreted as muscle activity for all tasks, positions, and contraction types. Only during prime movement tasks performed with isometric contraction could muscle thickness change be considered as muscle activity. Also, upright postures influenced the relationship between changes in muscle thickness and muscle activity for abdominal muscles.     

Effects of acupressure on chemotherapy-induced nausea and vomiting-a systematic review with meta-analyses and trial sequential analysis of randomized controlled trials

BackgroundAcupressure has been used as an effective way in treating with stomach upset. However the efficacy of acupressure in preventing chemotherapy-induced nausea and vomiting is uncertain.ObjectiveTo assess the effectiveness of acupressure on three categories of chemotherapy-induced nausea and vomiting.Data sourcesDatabases had been retrieved from inception through February 2016 for the randomized controlled trials in accordance with the inclusion criteria, including PubMed, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, Science Direct, CINAHL, China Biology Medicine, Chinese National Knowledge infrastructure, Wan Fang and Database for Chinese Technical Periodicals. Additional studies were identified through hand searches of bibliographies and Internet searches.DesignSystematic review with meta-analyses and trial sequential analysis of randomized controlled trials.Review methodsTwo reviewers selected relevant eligible articles, critical appraisal of the methodological quality was conducted on the basis of using Cochrane Handbook. A standardized Excel form was used to extract information. Meta-analysis and trial sequential analysis was performed using software RevMan 5.3 and TSA 0.9.ResultsTwelve studies with 1419 patients were included. Only three studies were assessed as high quality, one study was evaluated as moderate, and eight studies were evaluated as poor. The meta-analysis showed that acupressure reduced the severity of acute (SMD = −0.18, 95% CI −0.31 to −0.05, p < 0.01) and delayed (SMD = −0.33, 95% CI −0.64 to −0.01, p = 0.04) nausea. However, there was no benefit effect on the incidence or frequency of vomiting. No definitive conclusions were drawn from the trial sequential analysis.ConclusionThis systematic review suggested a protective effect of acupressure on chemotherapy-induced nausea and vomiting, while more well-designed clinical trials with larger sample size were needed to draw a definitive conclusion.     

Predictive performance of the SOFA and mSOFA scoring systems for predicting in-hospital mortality in the emergency department

BackgroundThe Sequential Organ Failure Assessment (SOFA) and modified SOFA (mSOFA) are risk stratification systems which incorporate respiratory, coagulatory, liver, cardiovascular, renal, and neurologic systems to quantify the overall severity of acute disorder in the intensive care unit.ObjectiveTo evaluate the prognostic performance of the SOFA and mSOFA scores at arrival for predicting in-hospital mortality in the emergency department (ED).MethodsAll adult patients with an Emergency Severity Index (ESI) of 1–3 in the ED of Imam Reza Hospital, northeast of Iran were included from March 2016 to March 2017. The predictive performance of the SOFA or mSOFA scores were expressed in terms of accuracy (Brier Score, BS and Brier Skill Score, BSS), discrimination (Area Under the Receiver Operating Characteristic Curve, AUC), and calibration.ResultsA total of 2205 patients (mean age 61.8 ± 18.5 years, 53% male) were included. The overall in-hospital mortality was 19%. For SOFA and mSOFA the BS was 0.209 and 0.192 and the BSS was 0.11 and 0.09, respectively. The estimated AUCs of SOFA and mSOFA models were 0.751 and 0.739, respectively. No significant difference was observed between the AUCs (P = 0.186). The Hosmer-Lemeshow test did not show that the predictions deviated from the true probabilities. Also, the calibration plots revealed good agreement between the actual and predicted probabilities.ConclusionThe SOFA and mSOFA scores demonstrated fair discrimination and good calibration in predicting in-hospital mortality when applied to ED. However, further external validation studies are needed before their use in routine clinical care.     

Effect of LI4 and BL32 acupressure on labor pain and delivery outcome in the first stage of labor in primiparous women: A randomized controlled trial

ObjectiveThis study examines and compares the effect of LI4 and BL32 acupressure with each other and control group on labor pain and delivery outcomes.DesignIn this randomized controlled trial, 105 primiparous women in active phase of first-stage of labor were equally assigned to two experimental groups [acupressure on LI4 (n = 35) or BL32 (n = 35)] and a control group (n = 35).InterventionsThe experimental groups received routine labor care and acupressure in LI4 or BL32 points in three cervical dilatations (4–5, 6–7, and 8–10 cm). The control group only received routine labor care.Main outcome measuresPain was assessed by numerical rating scale in three cervical dilatations, before and after intervention. Type of delivery (cesarean, vaginal or operative delivery) and neonatal Apgar score were considered as delivery outcomes, these data collected by a check list. Data were analyzed using Repeated Measurement, ANOVA, Chi-Square, Kruskal-Wallis, and Mann-Whitney tests.ResultsPain reduction was significantly greater in LI4 and BL32 groups compared with control in all periods of study. Also, acupressure on BL32 point was superior to LI4 point in pain relief in the first and second but not third intervention. No statistically significant difference was observed in terms of delivery outcomes.ConclusionAcupressure on BL32 and LI4 points are effective in reducing labor pain compared to control group with a slight superiority for BL32 points. Acupressure on these points could apply for relief pain in labor as an inexpensive and easy to administered method.     

From experiences to expectations: A quantitative study on the fear of childbirth among multigravida women

There is a strong relationship between women's previous birth experiences and their predetermined expectations. Childbirth expectations play an important role in the women's response to the birthing experience and postpartum period. The negative emotions and expectations, such as fear of childbirth, may result in negative experiences in subsequent childbirths. The aim of this study is to examine the relationship between previous birth experiences and the fear of childbirth in current pregnancy. A sample of 309 healthy women with normal pregnancies was recruited for this study. A chi-square test of independence and a multinomial logistic regression were used to explain the association between previous birth experiences and the fear of childbirth in current pregnancy. The level of childbirth fear that pregnant women feel appears to differ based upon their previous pregnancy experiences. Pregnant women who describe their previous births as happy and proud tend to experience a moderate level of childbirth fear about their current pregnancies, whereas pregnant women who remember their previous births as either fearful or painful have lower levels of childbirth fear. The level of childbirth fear tends to decrease as pregnant women have more children. Gestational week does not seem to be influential on the level of childbirth fear. According to the findings of this study, counterintuitively there is a negative relationship between the previous birth experience and childbirth fear. The level of childbirth fear is lower for pregnant women who remember their previous births as a negative experience compared to those who remember their previous births positively.