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1.
【目的】前瞻性对比研究侧卧位与俯卧位椎间盘切除术治疗老年腰椎间盘突出症的临床效果差别。【方法】对47例65岁以上老年腰椎间盘突出症患者行单节段小切口开窗椎间盘切除手术,23例行俯卧位手术（俯卧组）,24例无法耐受俯卧位者行侧卧位手术（侧卧组）。比较两组手术时间、术中出血量、手术疗效的差异,术前及术后3个月、6个月、12个月、24个月、48个月进行VAS、ODI评分,末次随访按改良Macnab标准评价疗效。【结果]45例获得术后4年随访。侧卧组比俯卧组术中出血量少（P〈0．01）,术后各时间点两组VAs及0DI均无统计学差异。术后4年两组优良率无统计学差异（91．4％VS91．0％,P〉0．05）。【结论】对于不能耐受俯卧体位的老年患者,侧卧位椎间盘切除术仍能取得满意的中期疗效。 相似文献
2.
Murat Kara Levent Özçakar Didem Gökçay Erol Özçelik Mehmet Yörübulut Sinem Güneri Bayram Kaymak Ay?en Ak?nc? Alp Çetin 《Archives of physical medicine and rehabilitation》2010,91(8):1160-1165
Kara M, Özçakar L, Gökçay D, Özçelik E, Yörübulut M, Güneri S, Kaymak B, Ak?nc? A, Çetin A. Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study.
Objective
To evaluate the effects of transcutaneous electric nerve stimulation (TENS) by using functional magnetic resonance imaging (fMRI) in patients with carpal tunnel syndrome (CTS).Design
Randomized controlled trial.Settings
University medical center and an outpatient imaging center.Participants
Female patients with CTS (n=20) were randomized into 2 groups receiving either TENS (n=10) or sham TENS (n=10). In both groups, an initial baseline fMRI session was performed via stimulating digits 2, 5, and 3 in turn, 1 scan run for each. TENS versus sham TENS treatment was given, and a repeat imaging was performed starting 20 minutes after the treatment as follows: second finger on the 20th minute, fifth finger on the 25th minute (ulnar nerve innervated control finger), and third finger on the 30th min.Interventions
Not applicable.Main Outcome Measure
Differences in fMRI activation between the 2 groups were evaluated.Results
Our results demonstrated that 20 to 25 minutes after TENS treatment—but not in the sham TENS group—a significant fMRI signal decrease for digit 2 (post-TENS vs baseline) was observed in the secondary somatosensory regions, ipsilateral primary motor cortex (M1), contralateral supplementary motor cortex (SMA), contralateral parahippocampal gyrus, contralateral lingual gyrus, and bilateral superior temporal gyrus. Measurements on the 25th to 30th minutes for digit 5 were similar between the groups, with presence of activities in areas other than generally activated regions because of painful stimuli. Thirty to 35 minutes after TENS treatment, a significant fMRI signal decrease for digit 3 was detected in the contralateral M1 and contralateral SMA only in the TENS group.Conclusions
Our findings showed that TENS treatment significantly decreased the pain-related cortical activations caused by stimulation of the median nerve-innervated fingers up to 35 minutes after treatment. 相似文献3.
Jeffrey J. Hebert Shane L. Koppenhaver John S. Magel Julie M. Fritz 《Archives of physical medicine and rehabilitation》2010,91(1):78-85
Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study.
Objective
To examine the relationship between prognostic factors for clinical success with a stabilization exercise program and lumbar multifidus (LM) and transversus abdominis (TrA) muscle activation assessed using rehabilitative ultrasound imaging (RUSI).Design
Cross-sectional study.Setting
Outpatient physical therapy clinic.Participants
Volunteers with current low back pain (N=40).Intervention
Not applicable.Main Outcome Measures
We examined the relationship between prognostic factors associated with clinical success with a stabilization exercise program (positive prone instability test, age <40y, aberrant movements, straight leg raise >91°, presence of lumbar hypermobility) and degree of TrA and LM muscle activation assessed by RUSI.Results
Significant univariate relationships were identified between LM muscle activation and the number of prognostic factors present (Pearson correlation coefficient [r] =−.558, P=.001), as well as the individual factors of a positive prone instability test (point biserial correlation coefficient [rpbis]=.376, P=.018) and segmental hypermobility (rpbis=.358, P=.025). The multivariate analyses indicated that after controlling for other variables, the addition of the variable “number of prognostic factors present” resulted in a significant increase in R2 (P=.006). No significant univariate or multivariate relationships were observed between the prognostic factors and TrA muscle activation.Conclusions
Decreased LM muscle activation, but not TrA muscle activation, is associated with the presence of factors predictive of clinical success with a stabilization exercise program. Our findings provide researchers and clinicians with evidence regarding the construct validity of the prognostic factors examined in this study, as well as the potential clinical importance of the LM muscle as a target for stabilization exercises. 相似文献4.
Ailin Shadani Mohammad Ali Mohseni Bandpei Nahid Rahmani Seyed Alireza Bassampour 《Journal of manipulative and physiological therapeutics》2018,41(8):691-697
Objective
Using ultrasonography, this study investigated the abdominal and lumbar multifidus muscle size in patients with lumbar spondylolisthesis compared with healthy patients at rest and during contraction.Methods
This research was a nonexperimental, analytic case-control study. Ultrasound imaging was used to assess the thickness of the abdominal and lumbar multifidus muscles in 25 healthy patients and 25 patients with spondylolisthesis. For the purpose of this study, both men and women, aged 30 to 70 years, were recruited from physiotherapy clinics affiliated with the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Measurements were taken at rest and during contraction.Results
There was a significant difference in abdominal and lumbar multifidus muscle size between the healthy and spondylolisthesic groups, both at rest and contraction (P < .05 in all instances). No significant difference was found between the right and left for all measurements (P > .05).Conclusion
Patients with spondylolisthesis had smaller stabilizer muscle thickness at rest and during contraction compared with the healthy group. 相似文献5.
Objective
To study the immediate and short-term efficacy of adding transcutaneous electrical nerve stimulation (TENS) to standardized physical therapy on subacute spasticity within 6 months of spinal cord injury.Design
Randomized controlled trial for 3 weeks.Setting
A university hospital.Participants
Subjects (N=16) with clinically determined spasticity were randomly assigned to either the experimental group (n=8) or the control group (n=8).Intervention
Sixty-minute sessions of TENS over the bilateral common peroneal nerves before 30 minutes of physical therapy for the experimental group and 30 minutes of physical therapy alone for the control group. All patients in both groups had access to standardized rehabilitation care.Main Outcome Measures
The composite spasticity score, which included 3 subscores (ankle jerk, muscle tone, and ankle clonus scores), was used as the primary end point to assess plantar flexor spasticity. These subscores were designated as secondary end points. Serial evaluations were made at baseline before study entry and immediately after the first and last sessions in both groups.Results
On analysis for immediate effects, there was a significant reduction only in the composite spasticity score (mean difference, 1.75; 99% confidence interval [CI], 0.47–3.03; P=.002) in the experimental group, but no significant reduction was observed in all outcome variables in the control group. A significant difference in the composite spasticity score (1.63; 99% CI, 0.14–3.11; P=.006) was observed between the 2 groups. After 15 sessions of treatment, a significant reduction was determined in the composite spasticity score (2.75; 99% CI, 1.31–4.19; P<.001), the muscle tone score (1.75; 99% CI, 0.16–3.34; P=.006), and the ankle clonus score (0.75; 99% CI, 0.18–1.32; P=.003) in the experimental group, whereas none of the outcome variables revealed a significant reduction in the control group. The between-group difference was significant only for the composite spasticity score (2.13; 99% CI, 0.59–3.66; P=.001) and the muscle tone score (1.50; 99% CI, 0.15–2.85; P=.005) after 15 intervention sessions.Conclusion
Addition of TENS to standardized physical therapy had synergistically antispastic action, providing more effective reduction of clinical spasticity. 相似文献6.
Zhuomao Mo Renwen Zhang Jinfeng Chen Xinnong Shu Tang Shujie 《Journal of manipulative and physiological therapeutics》2018,41(9):771-779
Objective
The purpose of this review was to compare oblique pulling spinal manipulation with other treatments for lumbar disc herniation.Methods
Randomized controlled trials of oblique pulling manipulation versus other treatment for lumbar disc herniation were identified using the following databases: China National Knowledge Infrastructure, Wanfang Data, Chinese Science and Technology Periodical Database, PubMed, the Cochrane Library, Embase, Chinese Biological Medicine, and Web of Science. Data extraction was carried out based on inclusion and exclusion criteria, and meta-analysis were performed using RevMan 5.3 software.Results
Nine relevant randomized controlled trials with a total of 887 patients were included. Meta-analysis revealed that oblique pulling manipulation was superior in effective rate to lumbar traction (risk ratio = 1.12; 95% confidence interval [CI]: 1.06-1.19; P < .01) and acupuncture (risk ratio = 1.22; 95% CI: 1.06-1.39; P < .01) and more effective in Visual Analog Scale score (mean difference = - 1.03, 95% CI: -1.32 to -0.74; P < .01) when compared to lumbar traction. It also demonstrated a favorable effect of modified oblique pulling manipulation in Japanese Orthopedic Association scores when compared with lumbar traction (mean difference = 1.66, 95% CI: 0.89 to 2.43; P < .01).Conclusion
In the treatment of lumbar disc herniation, oblique pulling spinal manipulation presented with a higher effective rate than acupuncture and lumbar traction. Manipulation had a favorable effect in alleviating pain, and modified oblique pulling manipulation had significant superiority in improving lumbar function when compared with lumbar traction. However, considering the low methodological quality of included studies, more rigorously designed trials should be performed in the future. 相似文献7.
Wen-Ling Chen Wei-Chun Hsu Yi-Jia Lin Lin-Fen Hsieh 《Archives of physical medicine and rehabilitation》2013
Objective
To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis.Design
A prospective, randomized controlled trial.Setting
Rehabilitation clinic of a teaching hospital.Participants
Patients with knee osteoarthritis (N=50; aged 51–80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23).Interventions
The HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks.Main Outcome Measures
The primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed.Results
The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17±1.98 vs 5.31±1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78±2.08 vs 9.85±3.54, respectively; P=.01) and at 3 months' follow-up (7.07±2.85 vs 9.24±4.04, respectively; P=.03).Conclusions
TENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up. 相似文献8.
Amreen Mahmood Sundar Kumar Veluswamy Aditi Hombali Aditi Mullick Manikandan N John M. Solomon 《Archives of physical medicine and rehabilitation》2019,100(4):751-768
Objectives
(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.Data Sources
PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.Study Selection
Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.Data Extraction
Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.Data Synthesis
Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD ?0.64; 95% confidence interval [95% CI], ?0.98 to ?0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD ?0.83; 95% CI, ?1.51 to ?0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.Conclusion
There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151). 相似文献9.
Meimei Zhou Fang Li Weibo Lu Junfa Wu Song Pei 《Archives of physical medicine and rehabilitation》2018,99(9):1730-1739
Objective
To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).Design
This is a prospective randomized controlled trial.Setting
A rehabilitation hospital.Participants
Participants (N=90) were randomized into NMES (n=36), TENS (n=36), or control groups (n=18).Interventions
NMES (15Hz, pulse width 200μs) was applied to supraspinatus and deltoids (medial and posterior parts), whereas TENS (100Hz, pulse width 100μs) was used on the same areas. The surface electrodes were placed near the motor points of the supraspinatus and medial or posterior bundle of deltoids. The 4-week treatment consisted of 20 sessions, each session composed of 1 hour of stimulation per day. Routine rehabilitation program without any stimulation was administered to the control and the NMES/TENS groups. Numerical rating scale (NRS), active/passive range of motion (AROM/PROM) of shoulder, upper extremity Fugl-Meyer Assessment (FMA), modified Ashworth scale (MAS), Barthel Index (BI), and stroke-specific quality of life scale (SSQOLS) were assessed in a blinded manner at baseline, 2, 4, and 8 weeks after treatment, respectively.Main Outcome Measures
The primary endpoint was the improvement from baseline in NRS for HSP at 4 weeks.Results
NRS scores in NMES, TENS, and control groups had decreased by 2.03, 1.44, and 0.61 points, respectively after 4 weeks of treatment, with statistically significant differences among the 3 groups (P<.001). The efficacy of the NMES group was significantly better than that of the TENS group (P=.043). Moreover, the efficacy of NMES and TENS groups was superior to that of the control group (P<.001, P=.044, respectively). The differences in the therapeutic efficacy on shoulder AROM/PROM, FMA, MAS, BI, and SSQOLS scores were not significant among the 3 groups.Conclusions
TENS and NMES can effectively improve HSP, the efficacy of NMES being distinctly superior to that of TENS in maintaining long-term analgesia. However, NMES was not more efficacious than the TENS or control group in improving the shoulder joint mobility, upper limb function, spasticity, the ability of daily life activity, and stroke-specific quality of life in HSP patients. 相似文献10.
《Journal of manipulative and physiological therapeutics》2020,43(5):418-428
ObjectiveNonspecific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms, such as fear-avoidance behaviors. This study aimed to evaluate the effect of cognitive behavioral therapy (CBT) associated with stabilization exercise (SE) on thickness of transverse abdominis (TrA) muscle in patients with NCLBP.MethodsForty patients with NCLBP were randomly assigned into experimental CBT associated with SE (n = 20) and control groups without SE (n = 20). Transverse abdominis muscle thickness was assessed during abdominal drawing in maneuver (ADIM) and active straight leg raise (ASLR) of the right lower limb using ultrasound imaging. Fear-avoidance belief and disability were evaluated using a fear-avoidance belief questionnaire (FABQ) and a Roland-Morris disability questionnaire (RMDQ) before and after intervention.ResultsMixed-model analysis of variance indicated that the effect of time was significant for the right and left TrA contraction thickness during ADIM and left TrA contraction thickness during ASLR (P < .05). However, the experimental group exhibited higher right and left TrA muscle thickness compared with the control group during ADIM (P = .001). Moreover, there were no significant differences between groups in the thickness of TrA muscle during ASLR (P > .05). The effect of time was significant for FABQ (P = .02) and RMDQ (P = .01); however, the effect of group was significant for the FABQ after intervention (P = .04).ConclusionsStabilization exercise associated with CBT is more effective than SE alone in improving fear avoidance belief and in increasing the thickness of the TrA muscle during ADIM task. 相似文献
11.
Kanako Shimoura Hirotaka Iijima Yusuke Suzuki Tomoki Aoyama 《Archives of physical medicine and rehabilitation》2019,100(2):300-306.e1
Objective
To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and comprehensive physical function in preradiographic knee osteoarthritis.Design
A single, participant-blinded, randomized controlled trial (RCT) with pre-post design.Setting
University research laboratory.Participants
Patients with knee pain belonging to Kellgren–Lawrence grade 0 or 1 (N=50; aged 50-69y) were randomly assigned to the TENS (n=25) and sham-TENS groups (n=25).Interventions
All participants wore the TENS device under the patella of the symptomatic knee. After measurement, the TENS devices in the TENS group were turned on, and those in the sham-TENS group were not connected.Main Outcome Measures
The primary outcome measures included the stair climb test, timed Up and Go (TUG) test, 6-minute walk test (6MWT), and knee pain evaluated using the visual analog scale (VAS) for stair climb test, TUG test, and 6MWT. Secondary outcomes included knee extensor strengths and the 2-step test and stand-up test from the locomotive syndrome risk test.Results
Multiple regression analysis revealed that TENS intervention significantly improved the walk distance and VAS score of the 6MWT, after adjusting for premeasurement data (distance; P=.015, VAS; P=.030).Conclusions
Use of TENS improved the VAS score for pain and the distance walked in the 6MWT for individuals with Kellgren–Lawrence grade 0 or 1 of the knee. Thus, TENS may be effective for long-distance walking in patients with preradiographic knee osteoarthritis. 相似文献12.
Alison Schinkel-Ivy Janessa D.M. Drake 《Journal of manipulative and physiological therapeutics》2019,42(6):461-469
ObjectiveThe purpose of this study was to investigate the interaction between thoracic movement and lumbar muscle co-contraction when the lumbar spine was held in a relatively neutral posture.MethodsThirty young adults, asymptomatic for back pain, performed 10 trials of upright standing, maximum trunk range of motion, and thoracic movement tasks while lumbar muscle activation was measured. Lumbar co-contraction was calculated, compared between tasks, and correlated to thoracic angles.ResultsMovement tasks typically exhibited greater co-contraction than upright standing. Co-contraction in the lumbar musculature was 67%, 45%, and 55% greater than upright standing for thoracic flex, thoracic bend, and thoracic twist, respectively. Generally, the thoracic movement task demonstrated greater co-contraction than the maximum task in the same direction. Co-contraction was also correlated to thoracic angles in each movement direction.ConclusionTasks with thoracic movement and a neutral lumbar spine posture resulted in increases in co-contraction within the lumbar musculature compared with quiet standing and maximum trunk range-of-motion tasks. Findings indicated an interaction between the 2 spine regions, suggesting that thoracic posture should be accounted for during the investigation of lumbar spine mechanics. 相似文献
13.
Stephanie Hyeyoung Lee Ji-Yeong Lee Mi-Young Kim Yu-Jin Jeon Suyoung Kim Joon-Ho Shin 《Archives of physical medicine and rehabilitation》2018,99(8):1447-1453.e1
Objective
To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.Design
A pilot, randomized, single-blind, controlled trial.Setting
Stroke rehabilitation inpatient unit.Participants
Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.Interventions
FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity–based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.Main Outcome Measures
Primary outcome measures were changes in Fugl-Meyer Assessment–Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance.Results
Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment–distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test–gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale–activities of daily living/instrumental activities of daily living score.Conclusions
FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke. 相似文献14.
Jan Oosterhof PT Oliver H. Wilder‐Smith MD PhD Theo de Boo Ir Rob A. B. Oostendorp MPT PT PhD Ben J. P. Crul MD PhD 《Pain practice》2012,12(7):513-522
Background: Transcutaneous electrical nerve stimulation (TENS) is an easy to use analgesic intervention. However, long‐term randomized placebo‐controlled studies with treatment periods of more than 3 months have not been executed to date. The aim of our study is to explore the long‐term (1 year) time course of the treatment effects of TENS compared to placebo (sham TENS). Method: We performed a randomized placebo‐controlled trial in patients with chronic pain (165), referred to a multidisciplinary pain center of a university hospital. Main outcome measures are the proportion of patients satisfied with treatment result and willing to continue treatment, pain intensity, pain disability, and perceived health status. Results: Survival analysis of time courses of proportions of satisfied patients revealed no significant differences (P = 0.79; log‐rank test) for TENS treatment compared to sham TENS. After 1 year, 30% (24/81) of the patients of the TENS group and 23% (19/82) of the sham TENS group were satisfied with treatment result. These patients experienced a mean overall improvement of 62.7% (n = 43). This effect was not significantly different between both groups. For satisfied patients, there were no differences in pain intensity or disability and perceived health status between the TENS and sham TENS group. Conclusions: Transcutaneous electrical nerve stimulation and sham TENS show similar effects in patients with chronic pain over a period of 1 year. We found support for a long sustained placebo effect. 相似文献
15.
Mira Meeus Jo Nijs Jessica Van Oosterwijck Veerle Van Alsenoy Steven Truijen 《Archives of physical medicine and rehabilitation》2010,91(8):1153-1159
Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial.
Objective
To examine whether pain physiology education was capable of changing pain cognitions and pain thresholds in patients with chronic fatigue syndrome (CFS) and chronic widespread pain.Design
Double-blind randomized controlled trial.Setting
Specialized chronic fatigue clinic in university hospital.Participants
A random sample of patients (N=48) with CFS patients (8 men, 40 women) experiencing chronic pain, randomly allocated to the control group (n=24) or experimental group (n=24). Two women in the experimental group did not complete the study because of practical issues (lack of time and restricted mobility).Interventions
One individual pain physiology education session (experimental) or 1 pacing and self-management education session (control).Main Outcome Measures
Algometry, the Neurophysiology of Pain Test, and questionnaires evaluating pain cognitions—the Pain Coping Inventory, the Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia-version CFS—were completed immediately before and immediately after the intervention.Results
After the intervention, the experimental group demonstrated a significantly better understanding of the neurophysiology of pain (P<.001) and a reduction of the Pain Catastrophizing Scale subscale “ruminating” (P=.009) compared with controls. For these variables, moderate to large Cohen d effect sizes were revealed (.79-2.53).Conclusions
A 30-minute educational session on pain physiology imparts a better understanding of pain and brings about less rumination in the short term. Pain physiology education can be an important therapeutic modality in the approach of patients with CFS and chronic pain, given the clinical relevance of inappropriate pain cognitions. 相似文献16.
Silvana Carla Barros GalvãoRebeka Borba Costa dos Santos MSc Priscila Borba dos SantosMaria Eduarda Cabral PT Kátia Monte-Silva 《Archives of physical medicine and rehabilitation》2014
Objective
To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) for decreasing upper-limb muscle tone after chronic stroke.Design
A randomized sham-controlled trial with a 4-week follow-up.Setting
Research hospital.Participants
Patients with stroke (N=20) with poststroke upper limb spasticity.Interventions
The experimental group received rTMS to the primary motor cortex of the unaffected side (1500 pulses; 1Hz; 90% of resting motor threshold for the first dorsal interosseous muscle) in 10 sessions, 3d/wk, and physical therapy (PT). The control group received sham stimulation and PT.Main Outcome Measures
Modified Ashworth scale (MAS), upper-extremity Fugl-Meyer assessment, FIM, range of motion, and stroke-specific quality-of-life scale. All outcomes were measured at baseline, after treatment (postintervention), and at a 4-week follow-up. A clinically important difference was defined as a reduction of ≥1 in the MAS score.Results
Friedman test revealed that PT is efficient for significantly reducing the upper limb spasticity of patients only when it is associated with rTMS. In the experimental group, 90% of the patients at postintervention and 55.5% at follow-up showed a decrease of ≥1 in the MAS score, representing clinically important differences. In the control group, 30% of the patients at postintervention and 22.2% at follow-up experienced clinically meaningful changes. There were no differences between the groups at any time for any of the other outcome measures, indicating that both groups demonstrated similar behaviors over time for all variables.Conclusions
rTMS associated with PT can be beneficial in reducing poststroke spasticity. However, more studies are needed to clarify the clinical changes underlying the reduction in spasticity induced by noninvasive brain stimulations. 相似文献17.
Tristan Bonnevie Francis-Edouard Gravier David Debeaumont Catherine Viacroze Jean-François Muir Antoine Cuvelier Marie Netchitaïlo Anne-Laure Roy Jean Quieffin Marie-Hélène Marques Clément Médrinal Johan Dupuis Catherine Tardif 《Archives of physical medicine and rehabilitation》2018,99(8):1462-1470
Objective
To assess the additional effect of a home-based neuromuscular electrical stimulation (NMES) program as an add-on to pulmonary rehabilitation (PR), on functional capacity in subjects with chronic obstructive pulmonary disease (COPD).Design
Single-blind, multicenter randomized trial.Setting
Three PR centers.Participants
Subjects with severe to very severe COPD (N=73; median forced expiratory volume in 1 second, 1L (25th–75th percentile, 0.8–1.4L) referred for PR. Twenty-two subjects discontinued the study, but only 1 dropout was related to the intervention (leg discomfort).Intervention
Subjects were randomly assigned to either PR plus quadricipital home-based NMES (35Hz, 30min, 5 time per week) or PR without NMES for 8 weeks.Main Outcome Measure
The 6-minute walk test (6MWT) was used to assess functional capacity.Results
Eighty-two percent of the scheduled NMES sessions were performed. In the whole sample, there were significant increases in the distance walked during the 6MWT (P<.01), peak oxygen consumption (P=.02), maximal workload (P<.01), modified Medical Research Council dyspnea scale (P<.01), and Saint George’s Respiratory Questionnaire total score (P=.01). There was no significant difference in the magnitude of change for any outcome between groups.Conclusions
Home-based NMES as an add-on to PR did not result in further improvements in subjects with severe to very severe COPD; moreover, it may have been a burden for some patients. 相似文献18.
Florian Strasser MD Iris Müller-Kser MD Daniel Dietrich PhD 《Journal of pain and symptom management》2009,38(4):505-514
To assess cancer-related fatigue (CRF), multidimensional questionnaires are required. The aim of this study was to evaluate single-item fatigue (SIF) screening questions—one for global fatigue and three for the fatigue domains (cognitive, emotional, and physical)—for their immediate use in daily oncology practice. Sixty-one fatigued patients with advanced cancer completed SIF assessments (visual analog scales for global fatigue and for fatigue in the cognitive, emotional, and physical domains, respectively), and the Brief Fatigue Inventory (BFI), the Fatigue Assessment Questionnaire (FAQ), the Hospital Anxiety and Depression Scale (HADS), and the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life-C30 (QLQ-C30). SIF-global correlated with BFI (r = 0.51), and the domain-SIFs correlated with their respective FAQ domains (cognitive r = 0.59; affective r = 0.45; physical r = 0.33) and functional EORTC QLQ-C30 subscales (r = 0.62; r = 0.42; r = 0.34). The SIF-emotional also correlated with HADS-Anxiety (r = 0.43) and HADS-Depression (r = 0.62). Principal component analysis (domain-SIF; respective FAQ and functional EORTC QLQ-C30 subscales) revealed three clusters and a two-factor model (cognitive/emotional, physical), explaining 74% of variability. Patients with one predominant SIF domain had more domain-tailored fatigue interventions than had patients with mixed SIFs. These data suggest that three simple SIF questions permit rapid assessment of the physical and cognitive and probably the emotional domains of CRF in patients with advanced cancer. 相似文献
19.
Douglas J. Weber Elizabeth R. Skidmore Christian Niyonkuru Chia-Lin Chang Lynne M. Huber Michael C. Munin 《Archives of physical medicine and rehabilitation》2010,91(5):679-686
Weber DJ, Skidmore ER, Niyonkuru C, Chang C-L, Huber LM, Munin MC. Cyclic functional electrical stimulation does not enhance gains in hand grasp function when used as an adjunct to onabotulinumtoxinA and task practice therapy: a single-blind, randomized controlled pilot study.
Objective
To determine whether onabotulinumtoxinA injections and task practice training with or without functional electrical stimulation (FES) improve upper limb motor function in chronic spastic hemiparesis.Design
Randomized controlled trial.Setting
Outpatient spasticity clinic.Participants
Participants (N=23) had chronic spastic hemiparesis with moderate-severe hand impairment based on Chedoke-McMaster Assessment greater than or equal to 2.Interventions
OnabotulinumtoxinA injections followed by 12 weeks of postinjection task practice. Participants randomly assigned to FES group were also fitted with an orthosis that provided FES.Main Outcome Measures
Motor Activity Log (MAL)-Observation was the primary outcome. Secondary outcomes were Action Research Arm Test (ARAT) and MAL-Self-Report.Results
For the entire cohort, MAL-Observation mean item scores improved significantly from baseline to week 6 (P=.005) but did not remain significant at week 12. MAL-Self-Report mean item scores improved significantly (P=.009) from baseline to week 6 and remained significantly higher (P=.014) at week 12. ARAT total scores also improved significantly from baseline to week 6 (P=.018) and were sustained at week 12 (P=.032). However, there were no significant differences between the FES and no-FES groups for any outcome variable over time.Conclusions
Rehabilitation strategies that combine onabotulinumtoxinA injections and task practice therapy are feasible and effective in improving upper-limb motor function and reducing spasticity in patients with chronic spastic hemiparesis. However, the cyclic FES protocol used in this study did not increase gains achieved with the combination of onabotulinumtoxinA and task practice alone. 相似文献20.
Carmen Krewer Sandra HartlFriedemann Müller MD MSc Eberhard Koenig MD 《Archives of physical medicine and rehabilitation》2014