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1.

Objectives

To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity.

Design

A 72-hour follow-up, single-blind randomized controlled trial.

Setting

University community.

Participants

Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle.

Intervention

All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention.

Main Outcome Measures

Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised.

Results

Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F3,204.8=3.19; P<.05; ηp2=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F2.6,175=1.9; P=.131; ηp2=.02).

Conclusions

The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.  相似文献   

2.

Background

Pain neuroscience education is effective in chronic pain management. Central sensitization (ie, generalized hypersensitivity) is often explained as the underlying mechanism for chronic pain, because of its clinical relevance and influence on pain severity, prognosis, and treatment outcome.

Objectives

To examine whether patients with more or fewer symptoms of central sensitization respond differently to pain neuroscience education.

Design

A secondary analysis of a multicenter, triple-blind randomized controlled trial.

Setting

University Hospital Ghent and University Hospital Brussels, Belgium.

Patients

120 persons with chronic spinal pain with high or low self-reported symptoms of central sensitization.

Interventions

Pain neuroscience education or neck/back school. Both interventions were delivered in 3 sessions: 1 group session, 1 online session, and 1 individual session.

Main Outcome Measures

disability (primary), pain catastrophizing, kinesiophobia, illness perceptions, and hypervigilance.

Results

Pain disability did not change in any group (P = .242). Regarding secondary outcomes: significant interaction effects were found for pain catastrophizing (P-values: P = .02 to P = .05), kinesiophobia (P = .02), and several aspects of illness perceptions (chronicity: P = .002; negative consequences: P = .02; personal control: P = .02; and cyclicity: P = .02). Bonferroni post hoc analysis showed that only the pain neuroscience education group (high and low self-reported symptoms of central sensitization) showed a significant improvement regarding kinesiophobia (P < .001, medium effect sizes), perceived negative consequence (P = .004 and P < .001, small to medium effect sizes), and perceived cyclicity of the illness (P = .01 and P = .01, small effect sizes). Pain catastrophizing only significantly reduced in people with high self-reported central sensitization symptoms (P < .05).

Conclusion

Pain neuroscience education is useful in all patients with chronic spinal pain as it improves kinesiophobia and the perceived negative consequences and cyclicity of the illness regardless the self-reported signs of central sensitization. Regarding pain catastrophizing, pain neuroscience education is more effective in patients with high self-reported symptoms of central sensitization.

Level of Evidence

I  相似文献   

3.

Background

There is controversy regarding the best technique for applying Kinesio Taping (KT), and the theory supporting that skin convolutions may explain its efficacy has recently been challenged.

Objective

To compare the immediate and short-term effectiveness of KT tightness on mechanosensitivity and spinal mobility in nonspecific low back pain (LBP), and to observe the influence of gender in the outcome measures.

Design

Double-blind, randomized, controlled trial.

Setting

University-based clinical research center.

Participants

A total of 75 individuals with a mean age of 33 years (±7.4 years), 60% female and 40% male, with nonspecific LBP were recruited and randomly assigned to 1 of the following study groups: standard KT tension (n = 26), increased KT tension (n = 25), and no KT tension (n = 24).

Interventions

All participants received a two I-strip taping over the paravertebral muscles for 24 hours. Paper-off tension (15%-25% of the available stretch) was used in the standard KT group, which was increased to 40% in the increased KT tension group. The rest of participants received a taping procedure with no KT tension. Measurements were taken at baseline, immediately after the taping, 24 hours after the taping, and after KT removal.

Main Outcome Measures

The primary outcome included pressure pain thresholds over the erector spinae and gluteus medius muscles. The secondary outcome was lumbar mobility (assessed with a digital inclinometer, and back-saver sit-and-reach, finger-to-floor, and sit-and-reach tests).

Results

In the between-groups analysis of the mean score changes after baseline assessment, no significant differences were found for any of the outcome measures (P > .05) except the left back-saver sit-and-reach test (P = .03). A statistically significant interaction group × gender × time was observed only for mechanosensitivity values (P = .02 for the gluteus and P = .01 for the erector spinae).

Conclusion

KT tightness does not seem to influence pain sensitivity and lumbar mobility in chronic LBP in either the immediate or short term.

Level of Evidence

II  相似文献   

4.

Objective

The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women.

Methods

In this randomized clinical trial, 42 female office workers with myofascial neck/shoulder pain were randomly allocated to either a DN or MP group and received 4 treatments. They were evaluated with the Neck Disability Index, general numeric rating scale, pressure pain threshold, and muscle characteristics before and after treatment. For each outcome parameter, a linear mixed-model analysis was applied to reveal group-by-time interaction effects or main effects for the factor “time.”

Results

No significant differences were found between DN and MP. In both groups, significant improvement in the Neck Disability Index was observed after 4 treatments and 3 months (P < .001); the general numerical rating scale also significantly decreased after 3 months. After the 4-week treatment program, there was a significant improvement in pain pressure threshold, muscle elasticity, and stiffness.

Conclusion

Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain.  相似文献   

5.
ObjectiveThe purpose of this study was to assess the effectiveness of the application of kinesio taping in reducing induced pain after dry needling of active trigger points (TrPs) to the upper trapezius muscle.MethodsConsecutive patients had mechanical neck pain (n = 34, 44% female) with active TrPs in the upper trapezius muscle. All participants received dry needling into upper trapezius active TrPs. Then, they were randomly divided into a kinesio taping group, which received an adhesive tape (Kinesio Tex), and a control group, which did not receive the taping. The numeric pain rating scale was assessed (0-10) at post-needling; immediately after; and 24 hours, 48 hours, and 72 hours after needling. Neck- and shoulder-related disability was assessed before and 72 hours after needling with the Neck Disability Index (NDI) and the Shoulder Pain and Disability Index, respectively. The pressure pain threshold (PPT) over the TrP was also assessed post-needling, immediately post-intervention, and 72 hours after needling.ResultsThe analysis of covariance did not find a significant group × time interaction (P = .26) for post-needling soreness: both groups exhibited similar changes in post-needling induced pain (P < .001). No significant group × time interactions were observed for changes in NDI (P = .62), SPADI (P = .41), or PPTs (P = .52): similar improvements were found after the needling procedure for the NDI (P < .001), Shoulder Pain and Disability Index (P < .001), and PPT (P < .001). The number of local twitch responses and sex (all, P > .30) did not influence the effect for any outcome.ConclusionThe application of kinesio taping after dry needling of active TrPs in the upper trapezius muscle was not effective for reducing post-needling induced pain in people with mechanical neck pain. Further, the application of kinesio taping as a post-needling intervention did not influence short-term changes in disability.  相似文献   

6.
The aim of this study was to analyze the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on muscle stiffness. A total of 51 recreational physically active subjects with LTrPs in the upper trapezius volunteered to participate and were randomly divided into a DN-group (n = 27) and a sham-DN group (n = 24). Volunteers received 1-session of DN or placebo treatment. Muscle stiffness, measured with strain and shear-wave elastography, pressure pain threshold (PPT), post-needling soreness, and muscle thickness were evaluated before treatment, and at 30-min, 24-hours, and 72-hours follow-up after treatment. The DN-group showed lower values from baseline for muscle stiffness measured with shear-wave elastrography at 24-hours (from 44.44 ± 15.97 to 35.78 ± 11.65 kpa; P < .01) and at 72-hours (35.04 ± 12.61 kpa; P < .01) and with strain elastography at 72-hours (from 1.75 ± 0.50 to 1.36 ± 0.40 AU; P < .01). The DN-group showed higher values of PPT than the sham-DN group at 72-hours (4.23 ± 0.75 vs. 5.19 ± 1.16 kg/cm2; P < .05). There was a progressive decrease in post-needling soreness compared to pain during needling of 33.13 ± 21.31% at 30-min, 80.92 ± 10.06% at 24-hours, and a total decrease in post-needling soreness in all participants at 72-hours. DN therapy is effective in reducing short-term muscle stiffness and increasing the PPT in volunteers with LTrPs in the upper trapezius after a treatment session.PerspectiveThis study found that one session of DN intervention in latent trigger points of the upper trapezius muscle reduced muscle stiffness and the pressure pain threshold for the dry needling group compared to the sham dry needling group.  相似文献   

7.

Background

Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion.

Objective

To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength.

Design

Secondary analyses from a randomized controlled trial (NCT01647243).

Setting

University Hospital and a Regional Hospital.

Patients

A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group.

Methods

Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally.

Main outcome measures

Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion.

Results

The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001).

Conclusion

PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded.

Level of Evidence

I  相似文献   

8.
ObjectiveThis study aimed to investigate the effects of myofascial release therapy vs a standard physical therapy program in patients with neck pain (NP).MethodsThis was a randomized controlled trial in which 54 participants with mechanical NP were randomly assigned into an experimental group (EG) or a comparison group (CG). The EG group (n = 27) received 5 therapy sessions of myofascial release therapy while the CG group (n = 27) received 10 sessions of massage, ultrasound therapy, and transcutaneous electric nerve stimulation over a 2-week period. Outcome measures were the numerical pain rating scale (NPRS), pressure pain thresholds (PPTs) and range of motion at the end of treatment and at 1-month follow-up.ResultsAt 1-month follow-up, between-group differences in change scores were found in the NPRS (mean = –1.56, 95% confidence interval [CI] [–2.30 to –0.81]; P < .001), in the right thoracic PPT (mean = 0.35, 95% CI [0.03-0.66]; P = .031), and in both left (mean = 0.34, 95% CI [0.08-0.61]; P = .012) and right (mean = 0.29, 95% CI [0.04-0.54]; P = .026) suboccipital PPTs. The success rate was 63.0% in the CG and 92.6% in the EG. The number needed to treat was 3.38 (95% CI = 1.99-11.23).ConclusionsMyofascial release therapy could be better than a standard physical therapy program for improving pain and suboccipital PPTs in patients with NP. However, the difference between both treatments is less than the minimum detectable change of the NPRS.  相似文献   

9.

Background

Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.

Objective

To examine adolescents’ use of mental health services after TBI.

Design

Secondary analysis from multicenter prospective randomized controlled trial.

Setting

Five level 1 U.S. trauma centers.

Participants

Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).

Methods

Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.

Main Outcome Measurements

Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.

Results

Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.

Conclusions

Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.

Level of Evidence

II  相似文献   

10.

Background

Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA.

Objective

To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings.

Design

Prospective cohort study with cross-sectional design.

Setting

Tertiary university.

Patients

A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test.

Methods

Hip radiographs were assessed by an independent examiner for hip OA and deformity.

Main Outcome Measurements

Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity.

Results

Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function.

Conclusion

Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP.

Level of Evidence

II  相似文献   

11.

Background

There are no guidelines on the ideal time to inject botulinum toxin type A (BT-A) for lower leg spasticity in stroke patients. An early injection may produce unwanted weakness, interfering with gait recovery.

Objective

To evaluate whether the outcomes after BT-A injection for plantarflexion spasticity can be different according to stroke chronicity.

Design

A secondary analysis study from a double-blinded, randomized trial with group reclassification according to stroke chronicity.

Setting

Two rehabilitation centers.

Participants

Stroke participants (n = 40) with plantar flexor spasticity, treated with BT-A (200 units) into the gastrocnemius muscle.

Methods

Outcome parameters were reanalyzed serially using 2-way repeated measures of analysis of variance (ANOVA), at baseline and 2, 4, and 8 weeks postinjection. Subjects were reclassified into 3 groups: early, within 6 months (n = 12); middle, between 6 months and 1 year (n = 14); and late, between 1 and 2 years from stroke onset (n = 12).

Main Outcome Measures

The Modified Ashworth Scale, clonus scale, 10-m walking test, ABILOCO, and the Functional Ambulation Category.

Results

The 2-way repeated measures of ANOVA showed improvement in gait and spasticity after injection in the 3 groups. Significant improvement in the Modified Ashworth Scale (P < .001) was observed, starting from the post–2 week injection period. Improvement of gait as assessed by the functional measurement ABILOCO and the Functional Ambulation Category (P < .001) were observed in all 3 groups, mostly at the post–8 week injection period.

Conclusions

Our serial measurements of the outcome parameters indicated that BT-A could be expected to lead to consistent improvement in both the muscle tone and gait quality in those with plantar flexor spasticity regardless of stroke chronicity, including those injected as early as within the first 6 months.

Level of Evidence

I  相似文献   

12.
ObjectiveThis study sought to compare the immediate effects of a single session of dry needling (DN), myofascial release (MR), and sham DN on pressure pain threshold (PPT) and neck pain intensity in individuals with chronic neck pain.MethodsThis was a randomized trial with a blinded outcome assessor. Forty-four individuals with chronic neck pain and unilateral myofascial trigger points in the upper trapezius muscle (UTM) were randomized to receive DN (n = 15), MR (n = 14), or sham DN (n = 15). The PPT over the UTM (ipsilateral and contralateral sides) and the proximal head of the radius (ipsilateral and contralateral to the treated side) and neck pain were assessed immediately and 10 minutes after the intervention.ResultsThere was no significant Group × Time interaction for PPT in the UTM on the treated side (F = 0.63, P = .641) or the contralateral side (F = 1.77, P = .144). However, there was a main effect of time on both the treated side (F = 4.917, P = .001) and the contralateral side (F = 4.70, P = .015), with DN and MR increasing PPT at the UTM. No significant Group × Time × Side interaction was found for PPT at the proximal head of the radius (F = 1.23, P = .276). Within-group analysis revealed a significant increase in PPT on the ipsilateral and contralateral sides in both DN and MR. Neck pain decreased after DN (P < .001), MR (P < .001), and sham DN (P = .008).ConclusionA single application of DN or MR generated local and distant hypalgesic responses superior to placebo. Future trials are needed to examine whether these findings occur in long-term follow-ups.  相似文献   

13.
ObjectiveThe purpose of the present study was to examine the effect of dry needling (DN) on the biomechanical properties of a latent medial myofascial trigger point (MTrP) of the soleus muscle compared with an adjacent point within the taut band (TB) measured by myotonometry.MethodsFifty asymptomatic volunteers were randomly assigned to an intervention group (n = 26) or control group (n = 24). One session of DN was performed in every group as follows: 10 needle insertions into the MTrP area (intervention group) or TB area (control group). Myotonometric measurements (frequency, decrement, and stiffness) were performed at baseline (pre-intervention) and after the intervention (post-intervention) in both locations (MTrP and TB areas).ResultsThe results showed that stiffness outcome significantly decreased with a large effect size after DN in the MTrP when measured in the MTrP location (P = .002; d = 0.928) but not when measured in the TB location. In contrast, no significant changes were observed in any location when the TB was needled (P > .05).ConclusionsThe findings suggest that only DN into the MTrP area was effective in decreasing stiffness outcome, therefore a specific puncture was needed to modify myofascial muscle stiffness.  相似文献   

14.
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15.

Background

Ankle sprains occur frequently among young and active people, accounting for almost 2 million injuries per year. Previous reports suggest that acupressure therapy for acute ankle sprains may shorten the recovery time.

Objective

To evaluate whether acupressure therapy can improve ankle sprain recovery compared with standard RICE (rest, ice, compression, and elevation) treatment.

Design

A randomized controlled trial was conducted. The study protocol was registered in the Chinese Clinical Trial Registry with the study registration number: ChiCTR-TRC-14004794.

Setting

Department of Traditional Chinese Medicine Orthopedics, PLA No.60 Center Hospital, Dali, China, and Department of Orthopedics, Xixi Hospital of Hangzhou, Hangzhou China, between June 2014 and January 2016.

Patients

A total of 68 patients with acute ankle sprains were assessed for study eligibility, and a total of 62 patients were included in the present study.

Methods

All patients with ankle sprains seen by the Orthopedics Department within 48 hours since the time of injury were identified. Consenting patients were randomized to either (1) standard treatment (ST group), (2) standard treatment + acupressure (AP group), or (3) standard treatment + mock acupressure (mock AP group).

Main Outcome Measurements

Outcomes of interest included a volumetric measurement of the foot, ankle, and lower leg), range of ankle movement, and visual analog pain scores. The American Orthopedic Foot and Ankle Score) and SF12v2 scores were used to assess quality of life.

Results

Among the 62 randomized patients, the mean (95% confidence interval [CI]) volumetric measurement of the foot, ankle, and lower leg in the AP group decreased from 185.24 (95% CI 142.80-227.67) to 62.14 (95% CI 44.03-80.25) after 3 sessions of acupressure treatment. This was a statistically significant difference (P < .01) compared with the means of ST group (119.00; 95% CI 89.14-148.86) and mock AP group (118.18; 95% CI 83.99-152.37). After the first treatment, the mean range of ankle movement, visual analog pain scores, and American Orthopedic Foot and Ankle Scores of the AP group were 31.67 (95% CI 27.78-35.55), 3.33 (95% CI 2.97-3.70), and 55.86 (95% CI 50.03-61.69), respectively. These scores were statistically better (P < .01) than the mean of the ST and mock AP group scores. In addition, the mean SF12v2 scores of AP group at 4 and 8 weeks were 109.95 (95% CI 107.29-112.62) and 119.67 (95% CI 119.27-120.05), respectively. These scores were also significantly greater than those of the ST group and mock AP groups (P < .01).

Conclusion

Acupressure therapy may improve recovery after acute ankle sprain injury, yielding shortened time of disability and improved quality of life.

Level of Evidence

I  相似文献   

16.
ObjectiveTo investigate the short-term effects of dry needling (DN) on physical function, pain, and hip muscle strength in patients with hip osteoarthritis (OA).DesignA double-blind, placebo-control, randomized controlled trial.SettingPrivate practice physiotherapy clinic.ParticipantsPatients with unilateral hip OA (N=45) were randomly allocated to a DN group, sham DN group, or control group.InterventionsPatients in the DN and sham groups received 3 treatment sessions. Three active myofascial trigger points (MTrPs) were treated in each session with DN or a sham needle procedure. The treatment was applied in active MTrPs of the iliopsoas, rectus femoris, tensor fasciae latae, and gluteus minimus muscles.Main Outcome MeasuresPhysical function was assessed with the Western Ontario and McMaster Universities (WOMAC) physical function subscale, the timed Up and Go test, and the 40-meter self-paced walk test. Intensity of hip pain related to physical function was evaluated using the visual analog scale and WOMAC pain subscale. The maximal isometric force of hip muscles was recorded with a handheld dynamometer.ResultsSignificant group by time interactions were shown for physical function, pain, and hip muscle force variables. Post hoc tests revealed a significant reduction in hip pain and significant improvements in physical function and hip muscle strength in the DN group compared with the sham and control groups. The DN group showed within- and between-groups large effect sizes (d>0.8).ConclusionsDN therapy in active MTrPs of the hip muscles reduced pain and improved hip muscle strength and physical function in patients with hip OA. DN in active MTrPs of the hip muscles should be considered for the management of hip OA.  相似文献   

17.

Background

A variety of tests have been proposed to measure the performance of neck flexor muscles, but head-to-head comparisons hardly have been documented.

Objective

To compare reliability indexes, construct validity, and ability to discriminate between individuals with and without neck pain of 4 muscle tests (deep neck flexors endurance test [DNFET]; 2 variations of the craniocervical flexion test [CCFT1 and CCFT2]; and dynamometry).

Design

Reliability and validity study.

Setting

General community.

Participants

A total of 66 participants, 33 with chronic idiopathic neck pain (mean ± standard deviation pain intensity: 3.2 ± 1.9) and 33 without neck pain, from the general population.

Methods/Main Outcome

Neck muscle functioning was assessed with the CCFT1, the CCFT2, the DNFET, and dynamometry on 2 separate sessions. Participants with neck pain also were assessed for pain intensity, disability, pain catastrophizing, and fear of movement.

Results

Relative reliability of all tests was at least moderate (intraclass correlation coefficient ≥ 0.62), whereas measurement error was high, particularly for the DNFET (95% minimum detectable change ≥ 23.00 seconds). All tests showed moderate correlation (r ≥ 0.3) with at least 2 pain-related measures and moderate-to-strong correlations with each other. Principal component analysis retained 2 factors explaining 68%-73% of the variance of the 4 muscle tests. Significant differences between groups were found for the DNFET and dynamometry (P < .05).

Conclusion

The reliability indexes suggest that the DNFET and the CCFT may be more appropriate for group comparisons than for individual comparisons. The 4 tests seem to have construct validity, but they also seem to measure slightly different constructs.

Level of Evidence

III  相似文献   

18.
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19.

Background

Poststroke distal lower limb spasticity impairs mobility, limiting activities of daily living and requiring additional caregiver time.

Objective

To evaluate the efficacy, safety, and sustained benefit of onabotulinumtoxinA in adults with poststroke lower limb spasticity (PSLLS).

Design

A multicenter, randomized, double-blind, phase 3, placebo-controlled trial (NCT01575054).

Setting

Sixty study centers across North America, Europe, Russia, the United Kingdom, and South Korea.

Patients

Adult patients (18-65 years of age) with PSLLS (Modified Ashworth Scale [MAS] ≥3) of the ankle plantar flexors and the most recent stroke ≥3 months before study enrollment.

Interventions

During the open-label phase, patients received ≤3 onabotulinumtoxinA treatments (≤400 U) or placebo at approximately 12-week intervals. Treatments were into the ankle plantar flexors (onabotulinumtoxinA 300 U into ankle plantar flexors; ≤100 U, optional lower limb muscles).

Main Outcome Measurements

The double-blind primary endpoint was MAS change from baseline (average score at weeks 4 and 6). Secondary measures included physician-assessed Clinical Global Impression of Change (CGI), MAS change from baseline in optional muscles, Goal Attainment Scale (GAS), and pain scale.

Results

Of 468 patients enrolled, 450 (96%) completed the double-blind phase and 413 (88%) completed the study. Small improvements in MAS observed with onabotulinumtoxinA during the double-blind phase (onabotulinumtoxinA, –0.8; placebo, –0.6, P = .01) were further enhanced with additional treatments through week 6 of the third open-label treatment cycle (onabotulinumtoxinA/onabotulinumtoxinA, –1.2; placebo/onabotulinumtoxinA, –1.4). Small improvements in CGI observed during the double-blind phase (onabotulinumtoxinA, 0.9; placebo, 0.7, P = .01) were also further enhanced through week 6 of the third open-label treatment cycle (onabotulinumtoxinA/onabotulinumtoxinA, 1.6; placebo/onabotulinumtoxinA, 1.6). Physician- and patient-assessed GAS scores improved with each subsequent treatment. No new safety signals emerged.

Conclusions

OnabotulinumtoxinA significantly improved ankle MAS, CGI, and GAS scores compared with placebo; improvements were consistent and increased with repeated treatments of onabotulinumtoxinA over 1 year in patients with PSLLS.

Level of Evidence

I  相似文献   

20.
Jaclyn Omura  Marisa Osorio 《PM & R》2018,10(3):317-319
We present a case of a 17-year-old girl who developed premenstrual dysphoric disorder (PMDD) after sustaining a severe traumatic brain injury (TBI), and we review the diagnosis of PMDD. The patient developed symptoms of severe depression surrounding her menses months after sustaining severe TBI and was diagnosed with PMDD by a psychiatrist. She ultimately required antipsychotics for optimal symptom resolution. PMDD is a severe form of premenstrual syndrome with symptoms including irritability, anxiety, and nonfatal suicidal behavior. We discuss other potential causes of mood disturbance that are important to screen for after TBI, including depression, anxiety, and hypothalamic-pituitary axis disorders. Rehabilitation medicine providers need to be aware of PMDD in postpubertal female patients with TBI because it can lead to nonfatal suicidal behaviors.

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