颈椎脊神经后支射频热凝术有效性的随机对照研究

目的:通过随机对照研究,评价射频热凝术治疗颈椎脊神经后支诱发慢性颈肩痛的有效性.方法:自2005年12月至2008年12月共127名患者纳入研究,所有病人均经诊断性颈椎脊神经后支阻滞有效,明确为颈椎脊神经后支诱发慢性颈肩痛.随后随机分为两组,A组采用DSA影像引导下脊神经后支射频热凝术治疗,B组采用口服药物保守治疗,随访期2年.利用视觉模拟评分法(Visual Analog Scores,VAS)进行治疗前后疗效评定.以VAS评分小于治疗前的50％视为优良疗效,反之视为疗效不佳.利用Kaplan-Meier生存曲线与Log-Rank检验进行两组疗效对比.记录手术并发症与用药副作用.结果:A组VAS评分回到术前50％的平均时间是217天,B组为27夭(P＜0.0l).在第27周(治疗后200天),A组36名患者完全无痛,B组为1名.A组术后疗效优良率显著高于B组(P＜0.01).B组3例病人出现胃部不适,纳差,经对症治疗后消失.A组9例病人术后出现神经支配区域的皮肤麻木,无感染及脊神经前支、椎动脉损伤等并发症.结论:对于颈椎脊神经后支诱发慢性颈肩痛,颈椎脊神经后支射频热凝术相比保守治疗,能够更有效的长期缓解疼痛,且操作安全,副作用很少.     

OPTIMAL DURATION OF STRETCHING EXERCISE IN PATIENTS WITH CHRONIC MYOFASCIAL PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo explore the effect of variable durations of stretching on neural function, pain, and algometric pressure in patients with chronic myofascial pain syndrome.DesignRandomized controlled trial.PatientsA total of 100 participants diagnosed with chronic myofascial pain syndrome were randomly assigned to a control group or 1 of 3 intervention groups.MethodsThe 3 experimental groups received different durations of cervical spine stretching: 15, 30 or 60 s. The control group did not stretch. Primary outcome measures included peak-to-peak somatosensory-evoked potential for dermatomes C6, C7 and C8. Secondary outcome measures included central somatosensory conduction time (N13–N20), pain intensity, and pressure-pain threshold algometric measurements. All outcome measures were assessed immediately after and 2 h after the treatment session.ResultsPost hoc analysis indicated that stretching for 60 s significantly decreased the dermatomal amplitude for C6, C7 and C8 (p < 0.001) and significantly increased the central conduction time, indicating negative effect (p < 0.001). Stretching for 30 and 60 s resulted in greater improvement in pain intensity and algometric pressure than stretching for 15 s or no stretch (control) p < 0.001.ConclusionStretching cervical muscles involved in chronic myofascial pain syndrome for 30 s was optimal in achieving stretching benefits and minimizing the negative effects on the neural function of the involved nerve roots and central nervous system.LAY ABSTRACTThis study measured the effect of different durations of stretching (15 s, 30 s, 60 s and no stretching) of the muscles around the neck and shoulders in 100 participants with chronic myofascial pain syndrome. The outcome measures assessed the effect on neural function. The results show that stretching for 30 s was the optimal time, for achieving stretching benefits and minimizing the negative effects on the neural function of the involved nerve roots and central nervous system. Stretching for a longer time negatively affected the neural function, but decreased the pain level, while stretching for a shorter time did not achieve the optimal muscle length after stretching.Key words: stretching, randomized controlled trial, cervical, neural function, optimal stretching duration

Chronic myofascial pain syndrome (CMPS) is a syndrome of musculoskeletal pain that is typically linked to myofascial trigger points (MTrP) (1, 2). CMPS is mostly prevalent in muscles that are consistently active against gravity or muscles that are essential in repetitive activities, such as the head, neck, shoulders, hips and low back muscles (3). The postural muscles that most commonly tend to be shortened are the upper trapezius and levator scapulae, resulting in limited neck mobility (4) and, due to the continuous demand on these muscles to maintain an upright posture, there appears to be a strong justification for stretching them.Current approaches to the management of CMPS include pharmacological and non-pharmacological interventions (5–7). Among the non-pharmacological approaches, many studies have supported stretching exercises as a beneficial intervention to treat CMPS (8–11). Overall, while the results of these studies are not specific to stretching alone, stretching exercises appear to be an important component of CMPS management. While the benefits of stretching are known, controversy remains about the stretching parameters needed to achieve a particular goal or treatment outcome. In clinical practice, multiple stretching techniques are used; nevertheless, there is no evidence-based agreement on the most effective parameters. One of the parameters that might affect treatment outcome the most is stretching duration; however, to date, there is a little agreement about the optimal duration of stretching (12–15).Of interest, comparison and subsequent conclusions about appropriate stretching times are based mainly on mechanical factors, such as range of motion and flexibility, while ignoring the neural adverse mechanical tension that may be created during sustained stretching exercises. According to the literature (16–18), stretching induces neural tension that may adversely affect the central nervous system and nerve root function, due to the absence of the perineurium, which is the primary load-carrying structure. Thus, safe or unsafe limits of nerve elongation are not well established, despite several basic scientific and clinical studies (19). It is thought that the same phenomenon of tissue loading is applicable to the nervous system. The literature indicates that the most offensive: the most structure damaging postural loading of the central nervous system and related structures occurs in any procedure or position requiring spinal flexion (20).Consequently, the current study aimed to determine whether increased longitudinal strain and stress on the spinal cord and nerve roots from continuous stretching exercises could subtly impair neural function. The study hypothesis is that there is a duration threshold, beyond which adverse neural function will be apparent, resulting in a reduction in either or both latency and amplitudes of evoked potentials.     

EFFECTS OF VIRTUAL REALITY-BASED NECK-SPECIFIC SENSORIMOTORTRAINING IN PATIENTS WITH CHRONIC NECK PAIN: A RANDOMIZED CONTROLLED PILOT TRIAL

ObjectiveTo evaluate the effects of neck-specific sensorimotor training using a virtual reality device compared with 2 standard rehabilitation programmes: with, and without general sensorimotor training, in patients with non-traumatic chronic neck pain.DesignPilot randomized control study.Patients and methodsA total of 51 participants were randomly assigned to 1 of 3 groups: 1: control group; 2: sensorimotor group; 3: virtual reality group. All 3 groups received the clinic’s standard rehabilitation programme. Group 2 also received “general sensorimotor training” in the form of group therapy, for a total of 120 min. Group 3 received additional virtual reality-based “neck-specific sensorimotor training” for a total of 120 min. Participants’ neck pain, headaches, active cervical range of motion, and Neck Disability Index were determined before and after 3 weeks of intervention.ResultsCompared with the control group, the virtual reality group showed significant (p < 0.05) advantages in relief of headaches, and active cervical range of motion in flexion and extension. Compared with the sensorimotor group, the virtual reality group showed significant improvements in cervical extension.ConclusionVirtual reality-based sensorimotor training may increase the effects of a standard rehabilitation programme for patients with non-traumatic chronic neck pain, especially active cervical range of motion in extension.LAY ABSTRACTThe aim of this study was to evaluate the effectiveness of neck-specific coordination training using a virtual reality device, in comparison with general coordination training and a standard exercise programme as part of inpatient rehabilitation for patients with chronic neck pain. Pain, disability and mobility of the neck were determined before and after 3 weeks of training intervention in 51 patients. The virtual reality training group exhibited greater effects in relief of headaches, and bending the neck forwards and backwards compared with the standard exercise group, and an increased ability to bend the neck backwards compared with the coordination training group. The results suggest that neck-specific coordination training using a virtual reality device increases the benefits of standard inpatient rehabilitation in patients with chronic neck pain, particularly in bending the neck backwards.Key words: neck pain, rehabilitation, virtual reality, kinematics

Neck pain is a widespread problem; 60–80% of individuals develop neck pain during their life-time, with 30–50% of the general population reporting neck pain annually (1–3). Many patients experience neck pain as a complex biopsychosocial disorder, with problematic physical and psychological symptoms (3), such as reduced cervical range of motion, headaches, lack of concentration, emotional and cognitive disorders (4, 5). Aside from the decreased quality of life, these complaints are a major cause of inability to work (6, 7) and lead to considerable economic damage (8). Hence, the demand for an effective treatment is indisputable.According to a recently published review (9), the strongest treatment effects for neck pain are those associated with exercise. However, the evidence for this claim is only of moderate quality. Since there is no data available at present to show that any one form of exercise is evidentially more effective than another, multimodal care is concordantly recommended by leading experts (3, 9).Sensorimotor training methods are a current trend in exercise therapy, and for the first time they take into account the special function of the neck, by including connections between the perceptions of sensory organs located in the head and neck muscles (10–14). Alterations of sensorimotor control have been identified in many patients with neck pain, and are thought to play an important role in the aetiology and maintenance of associated disorders (14, 15).To date, there are only a few sensorimotor training concepts that have been specially developed for the neck region. Initial studies found that patients undergoing these training methods experienced reduced neck pain, as well as improvements in cervical range of motion, self-reported disability, and general health (11, 13, 14, 16). However, a systematic review from 2014 (17) revealed very little evidence for eye-neck coordination and proprioceptive exercises. Furthermore, a randomized controlled trial (RCT) found that neck coordination exercises did not produce a larger effect than strength training and massages (18).Application of a virtual reality (VR) device is a novel and promising option for training cervical kinematics (10, 12, 19). In theory, this technique provides several advantages: distracting attention and therefore reducing pain and kinesiophobia (20, 21), engaging and motivating physical activities, and improving the effectiveness of exercise (22, 23).To date, only one RCT has compared the effects of VR-based training with conventional kinematic training using laser beams in patients with chronic neck pain (12). The VR group exhibited significant improvements in motion velocity, pain intensity, health status, and accuracy of neck motion.Due to the conflicting evidence and lack of research, there is a need for more studies that consider the effectiveness of VR-based sensorimotor training concepts, especially in combination with other effective therapeutic exercises or as part of individually tailored programmes (12).The aim of this study was therefore to evaluate the effects of neck-specific sensorimotor training using a VR device, in comparison with standard rehabilitation programmes, both with and without general sensorimotor training, in patients with non-traumatic chronic neck pain.     

EFFECTS OF KINESIO TAPING ON HIP ABDUCTOR MUSCLE STRENGTH AND ELECTROMYOGRAPHY ACTIVITY IN ATHLETES WITH CHRONIC ANKLE INSTABILITY: A RANDOMIZED CONTROLLED TRIAL

ObjectiveAthletes with chronic ankle instability tend to develop hip abductor muscle weakness. Kinesio taping may help this muscle perform its functions, thus preventing injury. The aim of this study was to assess the effects of Kinesio taping on hip abductor muscle strength and electromyography (EMG) activity.SubjectsA total of 34 athletes, mean age 22.08 years (standard deviation 2.71 years) participated in the study.MethodsA pre-test–post-test experimental design was used. For the experimental group, Kinesio tape, and for the control group, Micropore tape, was applied over the gluteus medius muscle. Gluteus medius muscle strength and EMG activity were noted in supine and during the single-leg squat test (SLST), respectively, before and after the intervention. Strength was measured through maximum voluntary isometric contraction (MVIC) force with a handheld dynamometer, and muscle activation measured through EMG.ResultsIn the experimental group, there was a significant increase in gluteus medius strength, by 10.27% (p = 0.00), and a significant decrease in EMG activity (p = 0.00), by 8.38%. In the control group, there was a significant increase in gluteus medius strength, by 2.89% (p = 0.01) and a not statistically significant decrease in EMG activity, by 0.80% (p = 0.15).ConclusionKinesio taping is effective in increasing hip abductor muscle strength in athletes with chronic ankle instability.LAY ABSTRACTAthletes with chronic ankle instability tend to develop hip abductor weakness, which further predisposes them to injuries in the lower limb and hinders their athletic performance. Kinesio taping may help this muscle perform its functions. The aim of this study was to determine the effects of Kinesio taping, applied over the hip abductors, on muscle strength and activation. A total of 34 athletes with chronic ankle instability were recruited to the study. Kinesio taping was found to be effective in increasing the strength of the hip abductor muscle and reducing its activation. Kinesio taping can be used by athletes with chronic ankle instability to prevent injury to the lower limb, for rehabilitation, and to enhance their athletic performance.Key words: ankle injury, hip abductors, Kinesio taping, muscle strength, electromyography

One of the most common injuries, occurring not only in sports, but also in everyday activities, is ankle sprain (1, 2). Incomplete recovery of ankle sprain is very common, and the majority of individuals after initial ankle sprains experience residual symptoms, such as repeated sprains, pain, and a sensation of “giving way” (3). This condition is called chronic ankle instability (CAI) (4). CAI is highly prevalent in high-school/ collegiate athletes, and occurs in up to 70% of athletes with initial ankle sprains (5–8). CAI is associated with reduced health-related quality of life, reduced physical activity levels, and suboptimal functional levels (9). In individuals with chronic ankle sprains the ipsilateral hip abductor muscles are weak in comparison with the uninjured side (10, 11). Beckman & Buchanan observed a significant delay in muscle activation of the gluteus medius (GM) in individuals with CAI (12).Weak hip musculature and comparatively stronger hip adductors further predispose the ankle joint to sprains, because hip joint stability and hip musculature strength are crucial for foot positioning during the heel strike phase of the gait cycle and overall proper gait mechanics (11, 13). This becomes a vicious cycle, in which CAI causes hip abductor muscle weakness and weak hip abductor muscles cause ankle injuries. Therefore, to prevent future problems in the foot and ankle complex in such individuals, this vicious cycle should be broken, either through strengthening the weak hip abductors or by reinforcing the actions of these muscles. Application of Kinesio tape (KT) (3B Scientific®tape, Burnham-on-Sea, UK) is also a method for improving muscle functions, and thus can be used to reinforce the actions of hip abductors. KT is a thin elastic tape that has stretchability up to 120–140% of its original length, and hence provides less mechanical constraint during movement. KT is considered to prevent injuries during sports and to reduce muscle spasms, swelling, and pain (14).A recent study has examined the effects of KT on hip abductor muscle strength in athletes with and without functional ankle instability (FAI) and reported an increase in muscle strength after application of KT (15). However, in that study, KT was applied over both the peroneus longus and the GM, not over the GM only. To the best of our knowledge, no study has examined the effects of KT on muscle strength and electromyography (EMG) activity of GM when KT is applied over the GM only.The aim of this study was to examine the effects of KT on muscle strength and EMG activity of GM in athletes with CAI. If KT is found to have significant effects on muscle strength and EMG activity then it can be used to improve lower limb kinematics, improve athletic performance, prevent and treat lower limb injuries. It has been hypothesized that muscle strength would increase and EMG activity of GM decrease after the application of KT over GM in athletes with CAI.     

A REHABILITATION PROGRAMME FOCUSSING ON PELVIC FLOOR MUSCLE TRAINING FOR PERSISTENT LUMBOPELVIC PAIN AFTER CHILDBIRTH: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo evaluate the effects of a rehabilitation programme for lumbopelvic pain after childbirth.MethodsWomen with lumbopelvic pain 3 months postpartum were included in a randomized controlled trial. Patients in the intervention group (n = 48) received pelvic floor muscle training combined with neuromuscular electrical stimulation of the paraspinal muscles for 12 weeks, while patients in the control group (n = 48) received neuromuscular electrical stimulation for 12 weeks. Outcomes were measured with the Triple Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ) and Short-Form Health Survey-36 (SF-36).ResultsThe NPRS score was significantly better in the intervention group at 12 weeks compared with the control group (p = 0.000). The MODQ score was significantly better at 6 and 12 weeks compared with the control group (p = 0.009 and p = 0.015, respectively). The mean value of the Physical Components Summary of the SF-36, was significantly better in the intervention group at 6 weeks (p = 0.000) and 12 weeks (p = 0.000) compared with the control group, but there was no significant improvement in Mental Components Summary of the SF-36.ConclusionA postpartum programme for women with lumbopelvic pain is feasible and improves the physical domain of quality of life.LAY ABSTRACTPostpartum lumbopelvic pain is common, and there are a range of treatments available. The aim of this study was to establish a programme for use in clinical practice, comprising pelvic floor muscle training combined with other traditional treatments. The programme was shown to reduce pain and improve patients’ quality of life. No adverse events occurred.Key words: lumbopelvic pain, biofeedback, myoelectric stimulation, pelvic floor, postpartum women

Lumbopelvic pain refers to self-reported pain in the lower back, sacroiliac joints, or a combination of these locations, among pregnant and postnatal women (1). The pain may radiate into the posterior thigh and is also experienced in conjunction with, or separately from, symphysis pubis pain. Approximately 50% of pregnant women report lumbopelvic pain to some degree (1). Although the majority of women recover within 3 months of delivery, in a substantial number of women the pain persists, with prevalence ranging from 26.5% to 91.0% 2–3 years after delivery (2). Risk factors for such pain include maternal age, parity, body mass index, education, and uncomfortable working conditions (3). Recent studies indicate the importance of hip extensors, pelvic floor muscle (PFM) and transverse abdominal muscle (TrAM) in the development of lumbopelvic pain (4). Moreover, pelvic instability, asymmetry and insufficient compression of the sacroiliac joints contribute to continuous lumbopelvic pain after delivery (5). Studies have demonstrated the importance of choosing an optimal treatment strategy in clinical practice, and 5 subgroups of self-rated pain locations have been identified in the pelvic area (6). This study focused on pelvic girdle pain (PGP), or PGP in combination with lumbar pain, since these groups have been shown to have the highest impact on activity levels and health-related quality of life (6).Stabilization exercises that include dynamically controlling the lumbar segments and pelvic joints have been shown to result in functional improvement in patients with lumbopelvic pain (7). Different treatments have been used, including drugs, specific exercises, shortwave therapy, ultrasound, neuromuscular electrical stimulation, corsets, acupuncture and massage (2). The most frequently used interventions are strengthening exercises for the TrAM, PFM training, and a technique involving manipulation of the lumbar multifidus. Although several studies have shown that correct PFM contractions cause co-contractions of the abdominal muscles (8, 9), to date, studies of exercise programmes for treatment of lumbopelvic pain have shown mixed findings and there is insufficient evidence to guide clinical practice in this area. There was also variability across existing randomized controlled trials (RCTs) in the components of programmes, modes of delivery, follow-up times and outcome measures (3, 4, 7). It is therefore not known whether PFM training works well alone, or in combination with other therapies. There is a strong need for the development of a validated postpartum programme.A common concept in PFM training is the use of standardized exercises or electromyographic activity of the PFM (10). Physical therapists are frequently needed to give instructions on how to contract the PFM correctly at hospital or at home. A new validated myoelectric activation method, using biofeedback registration, was used in the current study (11). This technique can be regarded as an adjuvant electromyography, allowing both patients and physical therapists to observe PFM functioning and assess muscle integrity. This technique has been shown to improve self-reported subjective success and satisfaction in patients with pelvic floor dysfunction (11).The aim of the current study was to investigate whether a rehabilitation programme focusing on biofeedback-assisted PFM training is sufficient as treatment for women with PGP or combined pain postnatally.     

阿片耐受的癌痛患者HANS辅助镇痛的随机对照研究

目的:观察并评价韩氏穴位神经刺激仪(Han's acupoint nerve stimulator,HANS)对阿片耐受癌痛患者的辅助镇痛效果。方法:将阿片耐受的癌痛患者随机分两组,分别予HANS和MockHANS(假韩氏)治疗。用患者自评问卷评估基线和第8、15日的疼痛、生活质量和焦虑抑郁,并比较两组治疗后的均值。结果:64例患者完成2周治疗和评估(HANS组33例,Mock-HANS组31例),两组基线资料无显著差异。与Mock-HANS组相比,HANS组第8、15日的最轻和平均疼痛强度均值、第8日的最重疼痛强度均值都显著降低;第8及第15日的日常生活及睡眠的受干扰程度也明显改善。HANS组第8、15日时的便秘、乏力、失眠以及抑郁的得分均值、第15日的焦虑得分均值都显著低于对照组。结论:HANS可有效缓解阿片耐受患者的癌痛,减轻便秘、乏力和失眠等症状,并能显著缓解焦虑抑郁,是一种简便安全的非药物镇痛方法,值得进一步研究和应用。     

IMPACT OF AEROBIC EXERCISE ON CLINICAL AND MAGNETIC RESONANCE IMAGING BIOMARKERS IN PERSONS WITH MULTIPLE SCLEROSIS: AN EXPLORATORY RANDOMIZED CONTROLLED TRIAL

BackgroundThere is insufficient knowledge about how aerobic exercise impacts the disease process of multiple sclerosis, which is characterized by accumulation of white matter lesions and accelerated brain atrophy.ObjectiveTo examine the effect of aerobic exercise on neuroinflammation and neurodegeneration by magnetic resonance imaging and clinical measures of disease activity and progression in persons with multiple sclerosis.Patients and methodsAn exploratory 12-week randomized control trial including an intervention group (n = 14, 12 weeks of aerobic exercise twice weekly) and a control group (n = 14, continuation of usual lifestyle). Primary outcomes were magnetic resonance imaging measures (lesion load, brain structure volume change), while secondary outcomes included disability measures, blood cytokine levels, cognitive tests and patient-reported outcomes.ResultsThe effects of aerobic exercise on whole brain and grey matter atrophy were minor. Surprisingly, the observed effect on volume (atrophy) in selected brain substructures was heterogeneous. Putaminal and posterior cingulate volumes decreased, parahippocampal gyrus volume increased, thalamus and amygdala volume remained the same, and active lesion load and count decreased. However, apart from weak improvements in walking speed and brain-derived neurotrophic factor levels, there was no effect of aerobic exercise on other clinical, cognitive or patient-reported outcomes.ConclusionThese results suggest that aerobic exercise in persons with multiple sclerosis has a positive effect on the volume of some of the substructures of the brain, possibly indicating a slowing of the neurodegenerative process in these regions, but a negative impact on the volume of some other substructures, with unclear implications. Further research is needed to determine whether the slight decrease in active lesion volume and count implies an anti- inflammatory effect of aerobic exercise, and the exact significance of the heterogeneous results of volumetric assessments.LAY ABSTRACTThe aim of this study was to evaluate the effects of aerobic exercise (physical exercise in the form of aerobics) on people with multiple sclerosis who were being treated with fingolimod. Two groups of patients with multiple sclerosis were studied: an intervention group (n = 14) who undertook 12 weeks of exercise training, and a control group (n = 14) who continued with their usual lifestyle. Magnetic resonance imaging, bloodwork analysis and some other clinical assessments were performed before and after the 12-week period, and the patients completed several questionnaires about their wellbeing and accompanying symptoms of multiple sclerosis. The results suggest that aerobic exercise (combined with appropriate pharmacological treatment) can positively affect some of the brain regions in people with MS by reducing the rate of their degeneration and might decrease the inflammatory activity. However, longer and larger studies should be performed to evaluate whether such rehabilitation is effective and could, in the long-term, possibly slow down the rate of disability accrual.Key words: multiple sclerosis, aerobic exercise, neuroinflammation, neurodegeneration, magnetic resonance imaging, brain atrophy, cognition, cytokines

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS) that is incurable despite the availability of potent disease-modifying drugs (DMDs). Most of the currently available DMDs aim to limit the disease by controlling the inflammatory process in the CNS. However, less is known about how to directly target neurodegeneration, which is dominant in the progressive phase of MS, but can also be present early, in the context of clinically isolated syndrome, and is reflected by whole brain and regional atrophy (1). The aim of this study was to investigate the effect of physical activity in the form of aerobic exercise (AE) on neuroinflammation and neurodegeneration, by quantifying magnetic resonance imaging (MRI) biomarkers, along with clinical, cognitive and patient-reported outcome measures of disease activity and progression in persons with MS (pwMS).Gerontology literature suggests that AE may decelerate age-related neurodegeneration in certain brain structures, which therefore remain responsive to such an intervention (2). Besides improvements in cardiac and immune function, mechanisms include alterations in trophic factor signalling, modifying the neuronal structure and function (3). However, a systematic review of research in pwMS concluded that there is no strong evidence that confirms a positive or negative effect of exercise on cytokine or adipokine profiles (4). Furthermore, studies on ageing in healthy subjects mostly demonstrate an inverse relationship between physical activity and inflammatory biomarkers (5), while a recent study in young adults found an exercise-induced pro-inflammatory response (6). Exercise in pwMS could thus exhibit disease-modifying effects (7), although there is a lack of data on this subject (8).PwMS are less physically active than the general population (9), possibly due to disease-related physical disability; however, exercise is considered safe, well tolerated and effective in controlling various disease symptoms (9). For instance, exercise has been shown to reduce fatigue and improve mobility and health-related quality of life (HRQoL) of pwMS and has been found to be effective in improving aerobic capacity and muscular strength (7). Exercise training studies have typically included only pwMS with mild-to-moderate disability, although there is promising evidence for the benefits of exercise training in pwMS with severe mobility disability (10). Most exercise training programmes employed endurance and resistance training, while AE programmes mostly consisted of (treadmill) walking and bicycle training, all performed in a supervised environment (4, 7).Research on the effects of physical exercise in pwMS has focused predominantly on outcomes such as physical fitness, walking mobility, balance, cognition, fatigue, depressive symptoms, and QoL (8). There are less data on the effects of exercise on MRI biomarkers, such as brain structures and lesions, apart from a few cross-sectional (11, 12) and case studies (13, 14) and a recent randomized control trial (RCT) of progressive resistance training (PRT) (15). The last suggests that PRT can counteract brain atrophy in pwMS, adding to the evidence that exercise might slow the progression of MS (9). Cross-sectional studies on pwMS show that objectively measured levels of physical activity and cardiorespiratory fitness are significantly correlated with volumes of whole brain grey matter (GM), white matter (WM) and deep GM structures, the last being involved in motor and cognitive functions in MS (11, 12). Some case studies (13, 14) have indicated that AE might increase hippocampal volume and integrity in pwMS. Emerging evidence thus indicates that exercise might promote neuroplasticity in pwMS.The available DMDs each have a different effect on the immune system (16) and MRI parameters (17). Previous studies focusing on the effects of exercise on outcomes, such as cytokines, cognition, mobility, and MRI biomarkers in pwMS (15, 18, 19), have included participants irrespective of the type of DMD treatment they are undergoing, which could be an important confounding factor. To our knowledge, no study has yet investigated whether physical activity, combined with pharmaceutical treatment with a single DMD, might have a role in the management of MS.The aim of this exploratory randomized controlled trial was to investigate whether AE, performed concurrently with fingolimod treatment, can beneficially modify the disease course in pwMS, by focusing primarily on MRI biomarkers of disease activity and progression, such as lesion load and change in brain structure volume. Secondarily, the impact of AE was evaluated through a comprehensive set of clinical, serological, cognitive and patient-reported outcomes (PROs).     

针刺肌筋膜疼痛激痛点治疗髌股疼痛综合征的疗效：随机对照试验

目的:观察针刺股四头肌激痛点结合静态拉伸股四头肌治疗髌股疼痛综合征的临床疗效。方法:50例髌股疼痛综合征(patellofemoral pain syndrome, PFPS)病人,随机分为两组(n=25):实验组采用针刺股四头肌激痛点结合股四头肌拉伸。对照组采用安慰剂针法,拉伸和实验组相同,两组均每周针刺1次,拉伸每日3次,每次1 min,持续6周。于治疗前、治疗3周和6周后和治疗结束后3个月,分别采用疼痛数字评价量表(numberical rating scale, NRS)、膝关节主动屈膝活动度(active range of motion, AROM)和膝关节Lysholm评分进行疗效观察。结果:两组病人一般资料无显著性差异,两组NRS在治疗3周、6周后,较治疗前均有显著性下降,但3个月随访时,对照组较治疗前无显著性差异;两组治疗后的膝关节AROM较治疗前均有显著性提高,但是在治疗6周后,实验组显著高于对照组;两组膝关节Lysholm评分治疗后较治疗前均有显著性提高,但是在治疗6周后和3个月随访,实验组显著高于对照组。结论:针刺激痛点与安慰针疗法结合静态拉伸均可在短期内有效缓解疼痛及改善膝关节活动度,但前者长期效果更佳。     

DOSE-RELATED EFFECTS OF RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY FOR KNEE OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo assess the dose-related effects of radial extracorporeal shock wave therapy on pain alleviation in knee osteoarthritis.MethodsWith the use of a 2 × 2 factorial randomized controlled design, 89 patients diagnosed with knee osteoarthritis were assigned to 1 of 4 treatment groups, which varied in terms of shock intensity (0.12 mJ/mm², lower density, or 0.24 mJ/mm², higher density) and shock number (2,000 impulses or 4,000 impulses), or to a placebo control. Each group received 4 sessions of radial extracorporeal shock wave therapy, one week apart. The primary outcome was pain intensity measured on a visual analogue scale, and the secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Assessments were performed at baseline, after each session, and at 4-week follow-up.ResultsTwo-way repeated-measures analysis of variance revealed a significant effect on the Pain score for intensity (p < 0.001), with no effect for number (p = 0.467) or the intensity–number interaction (p = 0.536). Similar results were obtained for the WOMAC scores, except for an association between number and WOMAC score (p = 0.036). At the 4-week follow-up, all treatment groups showed greater reductions in the Pain and WOMAC scores than the control group. In addition, scores decreased more at higher densities of shock intensity than at lower densities, while there was no significant difference between the 2,000- and 4,000-shock conditions.ConclusionModerate-intensity radial extracorporeal shock wave therapy was effective, and a higher density might be more efficacious in alleviating pain in knee osteoarthritis.LAY ABSTRACTExtracorporeal shock wave therapy may be a viable treatment for knee osteoarthritis with local pain and dysfunction; however, there are no standards on how to choose the treatment parameters to obtain the best outcome. This study compared 5 different levels of amount of treatment in 89 patients with knee osteoarthritis, and found that a medium intensity of therapy was effective. In addition, a higher intensity of extracorporeal shock wave therapy, rather than higher shock numbers, might result in a higher level of alleviation of symptoms in these patients.Key words: dose-response relationship, radial extracorporeal shock wave therapy, knee osteoarthritis

Knee osteoarthritis (KOA) is the most common degenerative joint lesion; it has a high prevalence and a negative impact on the quality of life of affected individuals (1). It has been reported in a case–control study carried out in North Staffordshire that 9.6% of men and 18% of women have symptomatic KOA at the age of 60 years and over (2). In addition, approximately 25% of the population older than 55 years reports at least one episode of knee pain each year in the United Kingdom.(3). The management of early- medium stage KOA is crucial; the main aims during this stage of conservative therapy for KOA are to relieve pain and enhance joint mobility (4, 5). Treatments for KOA include oral medication, exercise therapy, intra-articular drug injection, and physiotherapy. Among these treatments, radial extracorporeal shock wave therapy (rESWT) has recently attracted increasing attention (6). rESWT is widely used for pain relief and the treatment of musculoskeletal disorders, and has proven beneficial at specific stages of KOA (7).An extracorporeal shock wave is a transient sequence of acoustic pulses with a high peak pressure of 100 MPa, followed by a negative pressure of approximately 5–10 MPa, with an energy density between 0.003 and 0.89 mJ/mm² (8). Radial shock wave devices generate the maximum energy at the probe tip and then distribute it radially into the tissue, providing effective treatment (9). rESWT may be a more acceptable treatment for some patients because of its non-invasiveness, low complication rate, lack of required hospitalization and low cost compared with other approaches. However, rESWT has not met established efficacy standards, and the optimal dose is unknown. A meta-analysis indicated that the effects of rESWT are superior to those of a placebo and physical therapy for pain relief in KOA (10). Nevertheless, an RCT that applied a relatively small dose of radial extracorporeal shock waves did not demonstrate any statistically significant difference from a placebo treatment in terms of pain control in patients with severe KOA (11). Another systematic review identified that the positive energy flux density (EFD) should be as high as possible; however, the dose was based on the subjective feeling of the individual patient (12).It is important to quantify the amount of rESWT needed to reduce symptoms of KOA and establish the efficacy of rESWT. Thus, the primary aim of this prospective randomized placebo-controlled study was to test whether there was a dose-response relationship between the treatment doses and reduction in pain and dysfunction. The secondary aim was to examine whether the mean change in pain and function scores was greater for the active rESWT conditions than for the placebo control 4 weeks after the final treatment.     

SPECIFIC AND CROSS OVER EFFECTS OF MASSAGE FOR MUSCLE SORENESS: RANDOMIZED CONTROLLED TRIAL

Purpose/Background:

Muscle soreness can negatively interfere with the activities of daily living as well as sports performance. In the working environment, a common problem is muscle tenderness, soreness and pain, especially for workers frequently exposed to unilateral high repetitive movements tasks. The aim of the study is therefore to investigate the acute effect of massage applied using a simple device Thera‐band roller Massager on laboratory induced hamstring muscle soreness, and the potential cross over effect to the non‐massaged limb.

Methods:

22 healthy untrained men (Mean age 34 +/− 7 years; mean height 181.7 +/− 6.9 cm; mean weight 80.6 +/− 6.4 kg; BMI: 24.5 +/− 1.3) with no prior history of knee, low back or neck injury or other adverse health issues were recruited. Participants visited the researchers on two separate occasions, separated by 48 hours, each time providing a soreness rating (modified visual analog scale 0‐10), and being tested for pressure pain threshold (PPT) and active range of motion (ROM) of the hamstring muscles. During the first visit, delayed onset muscular soreness of the hamstring muscles was induced by 10 x 10 repetitions of the stiff‐legged dead‐lift. On the second visit participants received either 1) 10 minutes of roller massage on one leg, while the contralateral leg served as a cross over control, or 2) Resting for 10 minutes with no massage at all. Measurement of soreness, PPT and ROM were taken immediately before and at 0, 10, 30 and 60 min. after treatment.

Results:

There was a significant group by time interaction for soreness (p < 0.0001) and PPT (p = 0.0007), with the massage group experiencing reduced soreness and increasing PPT compared with the control group. There was no group by time interaction for ROM (p = 0.18). At 10 min. post massage there was a significant reduction in soreness of the non‐massaged limb in the cross over control group compared to controls but this effect was lost 30 minutes post massage.

Conclusion:

Massage with a roller device reduces muscle soreness and is accompanied by a higher PPT of the affected muscle.

Level of Evidence:

2c; outcomes research     

OUTCOMES FROM A RANDOMIZED CONTROLLED TRIAL OF A GROUP INTERVENTION FOR HIV POSITIVE MEN AND WOMEN COPING WITH AIDS-RELATED LOSS AND BEREAVEMENT

The purpose of this study was to examine the impact of a group coping intervention for HIV-positive men and women who have lost a loved one(s) to AIDS in the past 2 years. Two hundred thirty-five participants, diverse with respect to race/ethnicity and sexual orientation, were randomly assigned to a 12-week cognitive-behavioral group intervention or to an individual therapy on request comparison condition. Measures assessing grief and psychiatric distress were administered at baseline and 2 weeks post-intervention period. Although a strong gender effect was observed in outcome, both men and women participating in the group intervention demonstrated significantly more reduction in psychiatric distress than controls. Further, women in the group intervention demonstrated significant reductions in grief and depressive symptoms over men in both conditions and women in the comparison condition. Brief cognitive-behavioral group interventions for coping with grief have a positive impact on the psychiatric functioning of HIV-positive participants. This appears to be especially true for HIV-positive women; a group not previously focused on in clinical research related to AIDS bereavement.     

PRERECORDED HYPNOTIC PERI-SURGICAL INTERVENTION TO ALLEVIATE RISK OF CHRONIC POSTSURGICAL PAIN IN TOTAL KNEE REPLACEMENT: A RANDOMIZED CONTROLLED PILOT STUDY

This pilot study evaluated the effect sizes associated with prerecorded hypnotic interventions provided during the perisurgical period for reducing risk factors associated with chronic postsurgical pain, including acute postsurgical pain, anxiety, depression, and pain catastrophizing. A total of 25 participants (N = –25) were randomly assigned to receive a hypnotic intervention (n = 8), minimal-effect treatment (n = 8), or treatment as usual (n = 9) during their hospital stay for total knee replacement (TKR). Participants were followed for 6 months after hospital discharge. Results indicate that prerecorded hypnotic intervention exerted medium effects for reducing acute postsurgical pain and large effects for reducing perisurgical anxiety and pain catastrophizing. The findings indicate that a fully powered clinical trial to evaluate the beneficial effects of prerecorded hypnosis to manage pain and psychological distress in patients undergoing TKR is warranted.