Pulsed Electromagnetic Field and Exercises in Patients With Shoulder Impingement Syndrome: A Randomized,Double-Blind,Placebo-Controlled Clinical Trial

Objective

To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS).

Design

Double-blind, randomized controlled trial with a 3-month posttreatment follow-up.

Setting

Outpatient rehabilitation of a public hospital.

Participants

Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y).

Interventions

After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening.

Main Outcome Measures

A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment.

Results

Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)—that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures.

Conclusions

The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups.     

Symptoms of Depression Over Time in Adults With Pediatric-Onset Spinal Cord Injury

Objective

To investigate the prevalence of depressive symptoms in adults with pediatric-onset spinal cord injury (SCI) and explore potential risk factors that may be associated with elevated symptoms.

Design

Longitudinal, cohort survey over a period of 2 to 9 years. Follow-up occurred approximately every year, a total of 868 interviews were conducted, and most participants contributed to at least 3 waves of data (72%; range, 2–8; mean, 4.34±2.16).

Setting

Community.

Participants

Adults (N=214; 133 men; mean age at first interview, 29.52±5.21y; range, 24–42y) who sustained an SCI prior to age 19 (mean age at injury, 13.93±4.37y; range, 0–18y). Participants tended to have complete injuries (71%) and tetraplegia (58%).

Interventions

Not applicable.

Main Outcome Measures

Participants completed measures assessing psychosocial functioning, physical independence, participation, and depression at each time point. Multilevel growth modeling analyses were used to explore depression symptoms across time.

Results

Depression symptoms at initial status were typically minimal (3.07±.24; 95% confidence interval, 2.6–3.54) but fluctuated significantly over time (P<.01). Several factors emerged as significant predictors of depressive symptoms in the final model, including less community participation (P<.01), incomplete injury (P=.02), hazardous drinking (P=.02), bladder incontinence (P=.01), and pain (P=.03). Within individuals, as bowel accidents (P<.01) and pain increased (P<.01), depression scores increased; however, marriage resulted in decreases in depression scores for individuals (P=.02).

Conclusions

These findings suggest that most patients with pediatric-onset SCI are psychologically resilient, but strategies to minimize secondary health complications and foster community participation and engagement should be considered.     

Relationship Between Ultrasonographic,Electromyographic, and Clinical Parameters in Adult Stroke Patients With Spastic Equinus: An Observational Study

Objective

To find more accurate indices that could affect decisions in spasticity treatment by investigating the relation between ultrasonographic, electromyographic, and clinical parameters of the gastrocnemius muscle in adults with spastic equinus after stroke.

Design

Observational study.

Setting

University hospitals.

Participants

Chronic patients with stroke with spastic equinus (N=43).

Interventions

Not applicable.

Main Outcome Measures

Ultrasonographic features were spastic gastrocnemius muscle echo intensity, muscle thickness, and posterior pennation angle of the gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) in both legs. Electromyographic evaluation included compound muscle action potentials (CMAPs) recorded from the GM and GL of both legs. Clinical assessment of the spastic gastrocnemius muscle was performed with the Modified Ashworth Scale (MAS) and by measuring ankle dorsiflexion passive range of motion (PROM).

Results

Spastic muscle echo intensity was inversely associated with proximal (GM and GL: P=.002) and distal (GM and GL: P=.001) muscle thickness, pennation angle (GM: P< .001; GL: P=.01), CMAP (GM: P=.014; GL: P=.026), and ankle PROM (GM: P=.038; GL: P=.024). The pennation angle was directly associated with the proximal (GM and GL: P< .001) and distal (GM: P=.001; GL: P< .001) muscle thickness of the spastic gastrocnemius muscle. The MAS score was directly associated with muscle echo intensity (GM: P=.039; GL: P=.027) and inversely related to the pennation angle (GM and GL: P=.001) and proximal (GM: P=.016; GL: P=.009) and distal (GL: P=.006) muscle thickness of the spastic gastrocnemius.

Conclusions

Increased spastic muscle echo intensity was associated with reduced muscle thickness, posterior pennation angle, and CMAP amplitude in the gastrocnemius muscle. Building on previous evidence that these instrumental features are related to botulinum toxin response, these new findings may usefully inform spasticity treatment decisions.     

Sensory and Sensorimotor Features in Violinists and Violists With Neck Pain

Objective

To investigate sensory and sensorimotor function in violin and viola players with and without neck pain.

Design

Prospective, cross-sectional study.

Setting

University laboratory.

Participants

Convenience sample of violin players with playing-related neck pain (n=22), violinists without neck pain (n=21), and healthy nonmusician comparison subjects (n=21).

Interventions

Not applicable.

Main Outcome Measures

Measures include thermal pain thresholds (cold and heat) and pressure pain thresholds (PPTs) over the cervical spine and over a remote region (tibialis anterior muscle). Motor performance tests including reaction times, speed of movement, accuracy, coordination, and tapping speed assessed with a special upper-limb test battery.

Results

Musicians with neck pain had significantly lower heat and elevated cold pain thresholds as well as lower PPTs over C5-6 (P<.01) and over the tibialis anterior (P<.05). Motor performance tests revealed no differences between the symptomatic and asymptomatic musicians and nonmusician comparison groups (P>.05).

Conclusions

Violin players with neck pain demonstrated signs of sensory impairment, suggesting that playing-related neck pain may be associated with augmented central pain processing consistent with findings in other neck pain groups. No differences were evident in the motor performance tests. Fine motor skills of violin players may be better assessed in the context of playing their musical instruments before definitive conclusions can be drawn about the presence or not of sensorimotor impairments in this group of musicians with playing-related neck pain.     

Gabapentinoids Are Effective in Decreasing Neuropathic Pain and Other Secondary Outcomes After Spinal Cord Injury: A Meta-Analysis

Objective

To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI).

Data Sources

A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013.

Study Selection

Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with ≥3 subjects and ≥50% of study population with SCI, were included.

Data Extraction

Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted.

Data Synthesis

Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at <3 months (SMD=.96±.11; 95% CI, .74–1.19; P<.001) and between 3 and 6 months (SMD=2.80±.18; 95% CI, 2.44–3.16; P<.001). A subanalysis found a significant decrease in pain with gabapentin (SMD=1.20±.16; 95% CI, .88–1.52; P<.001) and with pregabalin (SMD=1.71±.13; 95% CI, 1.458–1.965; P<.001). A significant reduction in other SCI secondary conditions, including sleep interference (SMD=1.46±.12; 95% CI, 1.22–1.71; P<.001), anxiety (SMD=1.05±.12; 95% CI, .81–1.29; P<.001), and depression (SMD=1.22±.13; 95% CI, .967–1.481; P<.001) symptoms, was shown. A significantly higher risk of dizziness (risk ratio [RR]=2.02, P=.02), edema (RR=6.140, P=.04), and somnolence (RR=1.75, P=.01) was observed.

Conclusions

Gabapentin and pregabalin appear useful for treating pain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects.     

Immediate Effect of Scapular Repositioning With Active Cervical Rotation in Acute Spasmodic Torticollis

Objectives

The aim of this preliminary study was to investigate the immediate effects on pain and pressure pain threshold (PPT) of a scapular repositioning technique in patients with acute spasmodic torticollis.

Methods

A randomized, single blind pilot study was conducted. The subjects were 23 individuals (age 20-40 years) with a clinical diagnosis of spasmodic torticollis. Visual analog scale pain score, cervical active ranges of motion, and PPT were assessed before and after the intervention. The comparison group was treated with only conventional physiotherapy (microwave diathermy, submaximal isometrics, and ergonomic advice). The intervention group was given scapular repositioning with active cervical rotation technique, in addition to conventional physiotherapy treatment.

Results

There were significant improvements in intensity of pain (P < .01), cervical rotation to the ipsilateral side (P < .01), cervical side flexion to the contralateral side (P < .01), and PPT (P < .01) immediately after the treatment of the scapular repositioning and conventional therapy compared with the conventional therapy alone.

Conclusion

The present pilot study demonstrated that scapular repositioning may have an immediate hypoalgesic effect on individuals with spasmodic torticollis in terms of pain severity, PPT, and cervical range of motion. Therefore, further controlled trials are warranted.     

Relationship Between Sleep,Pain, and Disability in Patients With Spinal Pathology

Objective

To characterize sleep and its relationship with disability and pain in patients with spine pathology.

Design

A survey study.

Setting

A university-based hospital spine clinic.

Participants

Subjects (N=121) with mixed-etiology spine pathology.

Interventions

Not applicable.

Main Outcome Measures

Self-reported disability (Oswestry Disability Index [ODI]), back and leg pain intensity, the effect of back or leg pain on function, and sleep (Pittsburgh Sleep Quality Index [PSQI]) assessments were completed.

Results

Severe disability was evident with a mean ODI ± SD of 54.9±14, with mean pain intensities ± SD of 50±30mm and 54±27mm of 100mm for the leg and back, respectively. The mean PSQI ± SD was 10.4±5.3, with 87% of participants scoring greater than the sleep-disordered threshold of 5. PSQI was correlated to ODI (r=.53, P<.001), and ODI without the sleep component (r=.47, P<.001). Six of the subscales of PSQI were all also significantly correlated to ODI (.25<r<.42, P<.05). Stepwise regression (ODI dependent variables; PSQI, pain intensity and function, age, body mass index as independent variables) was performed. PSQI was retained in the model along with 2 pain measures (r²=.50, P<.001). Substitution of the 7 subscales for the overall PSQI score revealed 2 subscales (sleep quality, use of sleep medications) as predictors of ODI (r²=.490, P<.001).

Conclusions

Despite its being intuitive that sleep disorders will be present in patients with spinal disorders, it was surprising that sleep quality was an independent predictor of disability along with pain. Furthermore, sleep quality is more closely correlated to disability than leg pain, which is the current focus of medical interventions.     

Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Objective

To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).

Negative Affect and Sleep Disturbance May Be Associated With Response to Epidural Steroid Injections for Spine-Related Pain

Objective

To describe whether negative affect and sleep impairment are associated with the clinical effect of epidural steroid injections (ESIs) for low back pain.

Design

Observational study; patients were evaluated before ESI and 1 and 3 months after ESI.

Setting

Spine center and related treatment sites.

Participants

Participants (N=158) seeking treatment for low back pain with or without radiculopathy.

Intervention

ESI for low back pain with or without radiculopathy.

Main Outcome Measures

We assessed the dependent (global pain severity for back and leg pain, pain behavior, pain interference) and independent variables (depression, sleep disturbance, and covariates of back pain response) with the Patient-Reported Outcome Measurement Information System (PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple regression and longitudinally with path analysis.

Results

After 1 month, sleep disturbance was the only predictor for the global ratings of improvement in back pain (R²=16.8%) and leg pain (R²=11.4%). The proportions of variance explained by sleep disturbance and negative affect for all dependent variables were greater at 3 months than 1 month. Mediation analysis was significant for negative affect for the 3-month outcomes on PROMIS pain behavior (β=.87, P<.01) and pain interference (β=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome.

Conclusions

Negative affect and sleep disturbance are associated with worse outcomes after ESI. Further research is needed to determine if treatment of negative affect and sleep disturbance prior to or concurrently with ESI will improve outcomes.     

Cost Analysis Related to Dose-Response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes From a Randomized Controlled Trial

Objective

The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

Methods

We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

Results

Lost productivity accounts for most societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P = .03), greater disability (P = .01), lower quality-adjusted life year scores (P = .01), and higher costs in the period preceding enrollment (P < .01). Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P = .03) and19.8 disability-free days (P = .04). No statistically significant group differences in quality-adjusted life years were noted.

Conclusions

A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.     

Improvement of Upper Extremity Motor Control and Function After Home-Based Constraint Induced Therapy in Children With Unilateral Cerebral Palsy: Immediate and Long-Term Effects

Objective

To investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP).

Design

Randomized controlled trial.

Setting

Home based.

Participants

Children with unilateral CP (N=45; aged 6–12y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22).

Interventions

Both groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training.

Main Outcome Measures

All children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM).

Results

The home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group.

Conclusions

The home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.     

Outcome of Percutaneous Osseointegrated Prostheses for Patients With Unilateral Transfemoral Amputation at Two-Year Follow-Up

Objective

To report outcomes regarding general and specific physical health-related quality of life of treatment with percutaneous osseointegrated prostheses.

Design

Prospective 2-year case-control study.

Setting

University hospital.

Participants

Individuals (N=39; mean age, 44±12.4y) with unilateral transfemoral amputation as a result of trauma (n=23), tumor (n=11), or other cause (n=5). At baseline, 33 of the 39 participants used socket-suspended prostheses.

Intervention

Osseointegrated prosthesis.

Main Outcome Measures

Questionnaire for Persons with Transfemoral Amputation (Q-TFA), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical functioning (PF) and physical component summary (PCS), SF-6D, and Physiological Cost Index (PCI).

Results

At 2 years postimplantation, 6 of 7 Q-TFA scores improved (P<.0001) compared with baseline (prosthetic use, mobility, problem, global, capability, walking habits). The walking aid subscore did not improve (P=.327). Of the 39 participants, increased prosthesis use was reported by 26, same amount of use by 11, and less use by 2. Improvement was reported in 16 of the 30 separate problem items (P<.05). Unchanged items included problems regarding phantom limb pain and pain from the back, shoulders, and contralateral limb. The PF, PCS, and SF-6D improved a mean of 24.1±21.4 (P<.0001), 8.5±9.7 (P<.0001), and .039±.11 (P=.007) points, respectively. Walking energy cost decreased (mean PCI at baseline, .749; mean PCI at follow-up, .61; P<.0001).

Conclusions

Two years after intervention, patients with a unilateral TFA treated with an OPRA implant showed important improvements in prosthetic function and physical quality of life. However, walking aids used and the presence of phantom limb pain and pain in other extremities were unchanged. This information is valuable when considering whether percutaneous osseointegrated prostheses are a relevant treatment option.     

High-Level Mobility in Chronic Traumatic Brain Injury and Its Relationship With Clinical Variables and Magnetic Resonance Imaging Findings in the Acute Phase

Objectives

To compare high-level mobility in individuals with chronic moderate-to-severe traumatic brain injury (TBI) with matched healthy controls, and to investigate whether clinical variables and magnetic resonance imaging (MRI) findings in the acute phase can predict high-level motor performance in the chronic phase.

Design

A longitudinal follow-up study.

Setting

A level 1 trauma center.

Participants

Individuals (N=136) with chronic TBI (n=65) and healthy matched peers (n=71).

Interventions

Not applicable.

Main Outcome Measures

High-Level Mobility Assessment Tool (HiMAT) and the revised version of the HiMAT performed at a mean of 2.8 years (range, 1.5–5.4y) after injury.

Results

Participants with chronic TBI had a mean HiMAT score of 42.7 (95% confidence interval [CI], 40.2–45.2) compared with 47.7 (95% CI, 46.1–49.2) in the control group (P<.01). Group differences were also evident using the revised HiMAT (P<.01). Acute-phase clinical variables and MRI findings explained 58.8% of the variance in the HiMAT score (P<.001) and 59.9% in the revised HiMAT score (P<.001). Lower HiMAT scores were associated with female sex (P=.031), higher age at injury (P<.001), motor vehicle collisions (P=.030), and posttraumatic amnesia >7 days (P=.048). There was a tendency toward an association between lower scores and diffuse axonal injury in the brainstem (P=.075).

Conclusions

High-level mobility was reduced in participants with chronic, either moderate or severe TBI compared with matched peers. Clinical variables in the acute phase were significantly associated with high-level mobility performance in participants with TBI, but the role of early MRI findings needs to be further investigated. The findings of this study suggest that the clinical variables in the acute phase may be useful in predicting high-level mobility outcome in the chronic phase.     

Factors contributing to lumbar region passive tissue characteristics in people with and people without low back pain

Background

Previously, we demonstrated that people in the Rotation with Extension low back pain subgroup display greater asymmetry of passive tissue characteristics during trunk lateral bending than people without low back pain. The purpose of this secondary analysis is to examine factors that explain the group differences.

Methods

Twenty-two people in the Rotation with Extension subgroup, and 19 people without low back pain were examined. Torque, lumbar region kinematics, and trunk muscle activity were measured during passive and isometric resisted trunk lateral bending. The dependent variables were lumbar region passive elastic energy to each side; the independent variables included group, gender, anthropometrics, trunk muscle characteristics, and an interaction factor of group and trunk muscle characteristics. Multiple linear regression was used for the analysis.

Findings

Anthropometrics explained passive measures to the left (P = .03). Anthropometrics (P < .01), trunk muscle characteristics (P < .01), and the interaction of group and trunk muscle characteristics (P = .01) explained passive measures to the right. After accounting for gender and anthropometrics, 43.7% of the variance in passive measures to the right was uniquely accounted for by trunk muscle characteristics for the Rotation with Extension subgroup, compared to 0.5% for the group without low back pain.

Interpretation

Anthropometrics explained passive measures with trunk lateral bending to both sides, in both groups. For people in the Rotation with Extension subgroup, there was a direct relationship between trunk muscle performance and passive measures to the right. Muscle is an important contributing factor to asymmetry in this subgroup and should be considered in treatment.     

Waist Circumference Provides an Indication of Numerous Cardiometabolic Risk Factors in Adults With Cerebral Palsy

Objective

To report the prevalence of cardiometabolic risk factors in a cohort of adults with cerebral palsy (CP) and to investigate the ability of anthropometric measures to predict these factors.

Design

Cross-sectional study.

Setting

Testing took place in a laboratory setting.

Participants

Adults with CP (N=55; mean age, 37.5±13.3y; Gross Motor Function Classification System levels, I–V) participated in this study.

Interventions

Not applicable.

Main Outcome Measures

Total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, and C-reactive protein levels were measured from a fasting venous blood sample. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA-IR) index. Blood pressure, body mass index (BMI), waist circumference (WC), waist-hip ratio, and waist-height ratio were also measured. The metabolic syndrome (MetS) was defined according to the 2009 Joint Interim Statement.

Results

The prevalence of the MetS was 20.5% in ambulatory adults and 28.6% in nonambulatory adults. BMI was associated with HOMA-IR only (β=.451; P<.01). WC was associated with HOMA-IR (β=.480; P<.01), triglycerides (β=.450; P<.01), and systolic blood pressure (β=.352; P<.05). Receiver operating characteristic curve analysis revealed that WC provided the best indication of hypertensive blood pressure, dyslipidemia, HOMA-IR, and the presence of multiple risk factors (area under the curve, .713–.763).

Conclusions

A high prevalence of the MetS was observed in this relatively young sample of adults with CP. WC was a better indicator of a number of risk factors than was BMI and presents as a clinically useful method of screening for cardiometabolic risk among adults with CP.     

Biomechanical properties of the glenohumeral joint capsule in hemiplegic shoulder pain

Background

Although many hemiplegic shoulder patients have been suffering from limited range of motion, it is not fully established whether the pathologic biomechanics are same in hemiplegic shoulder pain and adhesive capsulitis. Therefore we aimed to investigate biomechanical properties of glenohumeral joint capsules of hemiplegic shoulder pain with limited range of motions.

Methods

Participants were 14 patients with hemiplegic shoulder pain, 10 controls, and 42 adhesive capsulitis patients matched with the hemiplegic shoulder pain group for sex, age, and range of motion. Demographic data, clinical variables, and sonographic findings were comparable between hemiplegic shoulder pain and adhesive capsulitis groups. We compared capsular capacity, maximal pressure, and capsular stiffness of glenohumeral joint capsule among the 3 groups.

Findings

Hemiplegic shoulder pain and adhesive capsulitis groups had smaller capsular capacity and higher maximal pressure than controls. The capsular stiffness of hemiplegic shoulder pain group was higher than that of controls (P = 0.001) but lower than that of adhesive capsulitis group (P < 0.001).

Interpretation

The stiffness of glenohumeral joint capsules in hemiplegic shoulder pain and adhesive capsulitis patients was substantially higher than that in controls, suggesting that hemiplegic shoulder pain patients had stiffer capsules as adhesive capsulitis patients did although the severities were different. This finding implicates that hemiplegic shoulder pain may share common pathologic properties of tighter capsules with adhesive capsulitis. However, there may be additional mechanisms contributing to range of motion limitation in hemiplegic shoulder pain because capsular stiffness in those patients was not as severe as that in adhesive capsulitis patients with similar range of motion limitation.     

Comparative Impacts of Tai Chi,Balance Training,and a Specially-Designed Yoga Program on Balance in Older Fallers

Objective

To compare the effect of a custom-designed yoga program with 2 other balance training programs.

Design

Randomized controlled trial.

Setting

Research laboratory.

Participants

A group of older adults (N=39; mean age, 74.15±6.99y) with a history of falling.

Interventions

Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks.

Main Outcome Measures

Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively.

Results

Training produced significant improvements in all field tests (P<.005), but group difference and time × group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P=.001) and eyes closed (P=.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P=.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<.01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<.001) directions were seen for the sample.

Conclusions

Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs.     

Smoking among Individuals with Schizophrenia in Korea: Gender Differences

Objective

This study examined gender differences in smoking and quitting among individuals diagnosed with schizophrenia in Korea. In addition, the study investigated differences in caffeine use by gender and smoking status.

Method

An anonymous self-report survey was conducted with psychiatric inpatients.

Results

Compared to males, females were less likely to be current smokers (P < .001) and more likely to be former smokers (P < .01). Females were also less likely to be daily caffeine users (P < .001). Having more years of education (P < .05) and higher nicotine dependence scores (P < .05) were associated with decreased odds of intending to quit smoking, whereas having more previous quit attempts (P < .01) was associated with increased odds. These findings were significant even after adjusting for gender. Smokers were more likely to be daily caffeine users (P < .001) than their non-smoking counterparts.

Conclusion

Nurses in Korea should play an active role in tobacco control for patients with schizophrenia by providing cessation counseling and educating the effect of caffeine use on cigarette consumption, while tailoring the service to gender differences found in this study.     

Effect of Ischemic Compression on Trigger Points in the Neck and Shoulder Muscles in Office Workers: A Cohort Study

Objective

The purpose of this study was to determine the short-term effect of ischemic compression (IC) for trigger points (TPs) on muscle strength, mobility, pain sensitivity, and disability in office workers and the effect on disability and general pain at 6-month follow-up.

Methods

Nineteen office workers with mild neck and shoulder complaints received 8 sessions of IC in which deep pressure was given on the 4 most painful TPs identified during examination. Outcome measures were general neck and shoulder complaints on a Numeric Rating Scale, Neck Disability Index (NDI), neck mobility (inclinometer), muscle strength (dynamometer), and pain sensitivity (Numeric Rating Scale and algometry). Subjects were tested at baseline (precontrol), after a control period of no treatment of 4 weeks (postcontrol), and after a 4-week intervention training (posttreatment). At 6-month follow-up, pain and disability were inquired.

Results

The results showed a statistically significant decrease in general neck/shoulder pain at posttreatment (P = .001) and at 6-month follow-up (P = .003) compared with precontrol and postcontrol. There was no significant main effect for NDI scores. Pressure pain threshold increased at posttreatment in all 4 treated TPs (P < .001). There was a significant increase in mobility and strength from precontrol/postcontrol to posttreatment (P < .05).

Conclusion

This study has demonstrated that a 4-week treatment of TPs for IC resulted in a significant improvement in general neck and shoulder complaints, pressure pain sensitivity, mobility, and muscle strength in the short term in a small sample of office workers with mildly severe chronic pain. At 6-month follow-up, there was a further decrease in general pain, but no change in NDI scores.     

Balance Confidence and Falls in Nondemented Essential Tremor Patients: The Role of Cognition

Objectives

To examine (1) the effect of cognitive ability on balance confidence and falls, (2) the relationship of balance confidence and falls with quantitative measures of gait, and (3) measures that predict falls, in people with essential tremor (ET).

Design

Cross-sectional study.

Setting

General community.

Participants

People with ET (n=132) and control subjects (n=48). People with ET were divided into 2 groups based on the median score on the Modified Mini-Mental State Examination: those with lower cognitive test scores (ET-LCS) and those with higher cognitive test scores (ET-HCS).

Interventions

Not applicable.

Main Outcome Measures

Six-item Activities of Balance Confidence (ABC-6) Scale and falls in the previous year.

Results

Participants with ET-LCS had lower ABC-6 scores and a greater number of falls than those with ET-HCS (P<.05 for all measures) or control subjects (P<.01 for all measures). Quantitative gait measures were significantly correlated with ABC-6 score and falls. Gait speed (P<.007) and ABC-6 score (P<.02) were significant predictors of falls. Receiver operating characteristic curve analysis revealed that gait speed <0.9m/s and ABC-6 score <51% were associated with moderate sensitivity and specificity in identifying fallers.

Conclusions

People with ET-LCS have impaired gait and report lower balance confidence and a higher number of falls than their counterparts (ET-HCS) and than control subjects. We have identified assessments that are easily administered (gait speed, ABC-6 Scale) and are associated with falls in ET.