Search Results (138)

Objective: This study aimed to improve the understanding of the lives of patients with chronic neuropathic pain planned for invasive motor cortex stimulation (iMCS) and assess their expectations towards this intervention and its impact. Methods: Semi-structured face-to-face interviews were conducted until saturation of data was reached. Patients were recruited from one university medical center in the Netherlands. All interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using iterative and inductive coding by two researchers independently. Results: Fifteen patients were included (11 females; mean age 63 ± 9.4 yrs). Analysis of the coded interviews revealed seven themes: (1) the consequences of living with chronic neuropathic pain; (2) loss of autonomy and performing usual activities; (3) balancing energy and mood; (4) intimacy; (5) feeling understood and accepted; (6) meaning of life; and (7) the expectations of iMCS treatment. Conclusions: This is the first qualitative study that describes the suffering of patients with chronic neuropathic pain, and their expectations prior to invasive brain stimulation. Significant themes in the lives of patients with chronic pain have been brought to light. The findings strengthen communication between physicians, caregivers, and patients. Practice Implications: The insights gathered from the interviews create a structured framework for comprehending the values and expectations of patients living with central pain and reveal the impact of symptoms due to the central pain. This knowledge improves the communication between physicians and caregivers on one side and the patient on the other side. Furthermore, the framework enhances the capacity for shared decision-making, particularly in managing expectations related to iMCS. Full article

Spontaneous quadriceps tendon rupture is a very rare occurrence, notably for bilateral simultaneous ruptures. Its occurrence is commonly linked to an underlying condition that may weaken the tendons leading to rupture. We report the case of a 68-year-old Caucasian male afflicted with long-term gout who presented a bilateral simultaneous quadriceps tendon rupture (BSQTR). We showcase the clinical presentation, the surgical intervention, rehabilitation program, dynamic sonographic monitoring, and home-based rehabilitation techniques of this injury, which aimed to improve activities of daily living (ADL) and quality of life (QoL). The patient was included in a 9-week post-surgical rehabilitation program and a home-based rehabilitation program with subsequent pain management and gait reacquisition. The outcome measures included right and left knee active range of motion (AROM), pain intensity measured on Visual Analogue Scale (VAS), functioning measured through ADL score, and gait assessment on Functional Ambulation Categories (FAC). All endpoints were measured at different time points, scoring significant improvement at discharge compared to baseline (e.g., AROM increased from 0 degrees to 95 degrees, while VAS decreased from 7 to 1, ADL score increased from 6 to 10, and FAC increased from 1 to 5). Moreover, some of these outcomes continued to improve after discharge, and the effects of home-based rehabilitation program and a single hip joint manipulation were assessed at 6-month follow-up. Musculoskeletal ultrasound findings showed mature tendon structure, consistent dynamic glide, and no scarring. Full article

Background/Objectives: Manual therapy techniques, including mobilization and manipulation, are commonly used for chronic low back pain (CLBP), with clinical guidelines recommending their use. This study aimed to compare the immediate hypoalgesic effects of mobilization and manipulation in patients with non-specific CLBP, evaluating their impact on pain sensitivity and range of motion. Methods: A cross-over randomized controlled trial was conducted with 27 participants with non-specific CLBP. Participants received either mobilization or manipulation on two different intervention days. Outcome measures included pressure pain thresholds (PPTs) assessed with a digital algometer, pain intensity using a numeric rating scale, and lumbar range of motion (ROM) measured with a digital inclinometer. Results: The results indicated no statistically significant differences between mobilization and manipulation for any outcome measures (all p > 0.05). However, significant within-intervention improvements were observed, including pain reduction, increased PPTs, and enhanced ROM of the lower back. Conclusions: Our findings suggest that both mobilization and manipulation provide similar immediate benefits for patients with CLBP. The choice between these techniques should be based on therapists’ clinical reasoning and individualized risk stratification, considering the potential benefits and risks of each approach for a specific patient. Full article

Objective: Although Global Postural Re-education (GPR) is widely used for musculoskeletal conditions, its specific benefits for this population remain unclear due to inconsistent findings across studies. This systematic review aims to analyze the effects of GPR on pain intensity, functionality, and range of motion (ROM) in individuals with chronic non-specific neck pain. Methods: Computerized search was performed in the Cochrane CENTRAL, Lilacs, EBSCO, PEDro, Pubmed, RCAAP and Scielo databases using the keyword combination (“Global Postural Rehabilitation” OR “Global Postural Reeducation” OR “Global Posture Reeducation” OR “Global Postural Re-education” OR “GPR”) AND (“Neck Pain” OR “Cervicalgia”). Methodological quality was assessed using the Physiotherapy Evidence Database Scale. Results: Six studies with a total of 393 participants (322 women, aged 18–80) were included. The methodological quality was moderate (average PEDro score: 6.7/10), with frequent limitations related to lack of blinding and allocation concealment. Risk of bias was rated as “some concerns” in four studies and “high” in two. GPR was associated with improvements in pain intensity, functionality, and cervical ROM (flexion/extension). While three studies found no significant differences between GPR and static stretching or specific cervical exercises, the remaining three studies reported greater improvements with GPR compared to manual therapy or traditional neck education and exercise therapy. No adverse effects were reported in any of the included trials. Conclusions: GPR appears to be a safe and potentially effective intervention for individuals with chronic non-specific neck pain, particularly in improving pain, function, and cervical ROM. Nonetheless, further high-quality randomized controlled trials are needed to confirm its superiority over other physiotherapeutic interventions and to determine the optimal treatment parameters. PROSPERO registration: CRD420251068974. Full article

Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular facilitation in patients with systemic lupus erythematosus. Methods: A randomized, single-blind, crossover clinical trial. Seventeen patients with systemic lupus erythematosus were randomly assigned to two sequences: Sequence A–B (intervention phase first, then control phase) and Sequence B–A (control phase first, then intervention phase). The intervention lasted for four weeks, with two weekly sessions lasting 50 min each. The intervention consisted of myofascial and proprioceptive neuromuscular facilitation techniques. The variables were: pain intensity (Visual Analog Scale), functional capacity of lower limbs (2-Minute Walk Test), physical function (Timed Up and Go Test), and fatigue (Fatigue Assessment Scale). After a 2-week follow-up and a 2-week washout period, the patients switched groups, and the methodology was replicated. Results: None of the patients developed injury or adverse effects as a direct consequence of the intervention. There were statistically significant differences between groups (p < 0.001) in the intensity of ankle (η²_p = 0.38) and knee (η² = 0.37) pain, functional capacity (η² = 0.33), and physical function (η² = 0.56). There were also intergroup changes in fatigue (η² = 0.52), and the relevant mental (η² = 0.26) and physical (η² = 0.45) components. Conclusions: Proprioceptive myofascial and neuromuscular facilitation techniques are safe in patients with systemic lupus erythematosus. This physical therapy protocol can improve the intensity of knee and ankle joint pain in these patients. This intervention can improve functional capacity, physical function, and fatigue in people with systemic lupus erythematosus. Full article

Background: Chronic postsurgical pain (CPSP) occurs in approximately one in five children who undergo surgery. Youth with anxiety and depressive symptoms are at greater risk of developing CPSP. Psychological interventions hold promise to prevent CPSP; however, existing psychological interventions are often brief and offered exclusively pre-surgically. Objective: The Perioperative Pain Program (PPP) was designed to address psychological risk factors for CPSP. This study aimed to explore acceptability and satisfaction with the PPP, from the perspective of youth and caregivers. Method: In this mixed-methods study, 24 youth and caregivers completed a satisfaction questionnaire, and six dyads participated in semi-structured interviews. Quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed using inductive content analysis. Results: The qualitative analysis generated four categories: (1) developing support and a sense of preparedness for surgery; (2) connection matters between families and the team; (3) personal characteristics may impact intervention use; (4) the need for adaptable content and delivery. Quantitative data indicated overall satisfaction and acceptability of the intervention. Conclusions: Psychological interventions that facilitate interpersonal connections in a timely manner may be key to facilitating more meaningful engagement and help prevent CPSP in youth. Full article

Objectives: The objective of this overview of systematic reviews with meta-analysis was to summarize the evidence on the possible effectiveness of interventions focused on physical activity in improving and preventing postpartum depression symptoms. Methods: CINAHL (via EBSCOhost), Embase, Epistemonikos, PsycINFO, PubMed, Scopus, SPORTDiscus (via EBSCOhost), and the Cochrane library were searched from inception to 19 February 2025. The methodological quality of the included reviews was assessed with AMSTAR 2. The degree of overlap between meta-analyses was calculated. Results: A total of eight systematic reviews were included. Overall, the included meta-analyses showed favorable results regarding the effects of physical activity on postpartum depression symptoms. Considering specific physical activity modalities, the largest number of meta-analyses focused on aerobic exercise, yoga, or multimodal exercise. In all three cases, most meta-analyses found that aerobic exercise, yoga, and multimodal exercise could be beneficial in reducing postpartum depression symptoms. Furthermore, several meta-analyses explored the effectiveness of walking, finding positive results in favor of this intervention in reducing postpartum depression symptoms. Finally, movement in water was only explored in one meta-analysis, and no differences were found between these interventions and control groups. Conclusions: Aerobic exercise, walking, yoga, and multimodal exercise programs may improve postpartum depression symptoms. Movement in water was not more effective than control groups for reducing this outcome. However, the results of our overview should be considered with caution, since important methodological and clinical implications have been discussed (e.g., lack of subgroups by prevention and treatment) and should guide the development of future systematic reviews on this topic. Full article

Background/Objectives: Non-specific low back pain represents a high number of primary care consultations, generating a great social and economic cost. There is a higher prevalence in women, and it may be associated with multiple factors. One of the most innovative tools in rehabilitation is virtual reality-based therapy. Virtual reality positively affects the motivation of participants and generates greater adherence to treatment, so this factor could lead to long-term functional improvement. The objective of this review is to update the effectiveness of virtual reality programs on pain, disability, kinesiophobia, and changes in the thoracoabdominal musculature in patients with chronic nonspecific low back pain. Methodology: PubMed, PEDro, SCOPUS, Web of Science, and the Cochrane Library were used in this systematic review. The research question was formulated using PICOS. The Physiotherapy Evidence Database (PEDro) scale was used. Inclusion criteria were randomized clinical trials, participants were men and/or women over 18 years of age who were diagnosed with chronic non-specific low back pain, and articles that included virtual reality as a treatment. Articles with a level of evidence lower than 5/10 on the PEDro scale were excluded. Results: A total of 14 studies were included with sample sizes between 34 and 188 participants. Studies showed significant improvements in pain reduction, kinesiophobia, and disability (inflammation and motor control). Some studies showed long-term benefits, with effects maintained up to 18 months post-intervention, especially in the reduction in pain and its interference with daily activities. Conclusions: The findings of this systematic review support the efficacy of virtual reality as an effective and safe therapeutic option for the treatment of chronic non-specific low back pain. Full article

Background: Low back pain (LBP) in older mothers is a prevalent and multifaceted condition influenced by a range of biopsychosocial factors. As the trend of late motherhood increases globally, it is essential to understand how LBP affects this population from a biopsychosocial perspective. Objective: This systematic review aims to examine the biopsychosocial determinants of LBP in older mothers by synthesizing findings from quantitative studies published between January 2010 and May 2024. Specifically, it explores the biological, psychological, and social factors contributing to LBP in this population and how it affects their daily lives and well-being. Methods: A comprehensive literature search was conducted across PubMed, PsychInfo, Web of Science, EMBASE, DARE, and the Cochrane Library. Studies were screened for eligibility based on predefined criteria. Five quantitative studies with a combined sample of 118,964 participants were included. The methodological quality was assessed, and data were extracted for analysis. Results: All five studies addressed biological aspects of LBP, including pelvic girdle pain, hemorrhoids, and varicose veins. Three studies also explored psychological factors such as depression and stress. Two studies incorporated social dimensions, including inadequate support systems, occupational burdens, and healthcare access barriers. Age and parity were consistently reported as exacerbating physical and psychological symptoms. Conclusions: This review highlights the importance of considering biopsychosocial factors when managing LBP in older mothers. Tailored interventions, such as exercise programs, family support, and workplace accommodations, are essential for improving outcomes. Further research using longitudinal studies is needed to explore these factors in greater depth. Full article

Alterations in static plantar pressure distribution serve as important indicators of gait and balance impairments in individuals with Multiple Sclerosis (MS). In addition, the identification of altered patterns of plantar load distribution, along with restricted ankle dorsiflexion, may serve as early markers of postural instability and gait dysfunction in women with MS. Objectives: To assess differences in static plantar pressure, load distribution, and ankle dorsiflexion range of motion between women diagnosed with MS and women without the condition. Methods: A cross-sectional observational study was conducted between April and December 2024. Women with MS were recruited from patient associations in the provinces of Alicante and Murcia, as well as from the neurology outpatient clinic at the Doctor Balmis University Hospital (Alicante, Spain). Static postural assessment was performed using the Neo-Plate^® pressure platform, which measured maximum and mean plantar pressure (kPa), load distribution (%), contact surface area (cm²), and anterior–posterior weight distribution between the forefoot and rearfoot. The ankle dorsiflexion range of motion was assessed with a universal two-arm goniometer. All parameters were compared with those of a group of women without a diagnosis of MS. Results: Compared to women without MS, participants with MS showed a significantly greater load on the right forefoot (25.75% vs. 23.41%, p = 0.021), and reduced load on the right (23.09% vs. 26.01%, p = 0.004) and left rearfoot (26.60% vs. 30.85%, p = 0.033). Total forefoot loading was significantly higher (52.33% vs. 46.40%, p < 0.001), and rearfoot loading was lower (47.64% vs. 52.42%, p = 0.006) in the MS group. Ankle dorsiflexion range of motion was also significantly reduced in women with MS, both with the knee flexed (5.95° ± 4.50 and 6.76° ± 4.69 vs. 15.45° ± 5.04 and 14.90° ± 5.43) and extended (2.69° ± 3.69 and 3.12° ± 3.83 vs. 8.17° ± 3.41 and 8.60° ± 3.31), with all differences reaching statistical significance (p < 0.001). Conclusions: Women with MS present significant alterations in static plantar load distribution, with increased forefoot and decreased rearfoot loading, as well as markedly reduced ankle dorsiflexion, in comparison to women without the disease. These findings suggest the presence of postural imbalances associated with MS, potentially affecting functional stability and mobility. Full article

Background/Objectives: Sedentary office workers (SOWs) often adopt prolonged sitting postures, which potentially disrupt the lumbar–pelvic rhythm (LPR) and contribute to lower back pain (LBP). This study aimed to clarify the group differences in LPR and related physical factors between SOWs with and without LBP. Methods: Sixty-three SOWs were divided into LBP (n = 30) and non-LBP (n = 33) groups. The lumbar flexion angle (LF) and lumbar–hip angle difference (LHD), which are indicators of LPR, were measured using inertial sensors during trunk flexion. Hip flexion muscle strength (HFMS) and hip-extension muscle strength (HEMS) were assessed using handheld dynamometry. Hip joint range of motion (ROM) was measured using a goniometer. Lumbar proprioception was evaluated via active joint repositioning, and pain and perception were assessed using the Visual Analog Scale, Oswestry Disability Index, and Fremantle Back Awareness Questionnaire. Results: Multiple regression analysis showed significantly greater LF (estimated regression coefficient [ERC]: −2.9, p < 0.05) and LHD (ERC: −5.5, p < 0.05) during early trunk flexion (ETF) in the LBP group. In the LBP group, LHD during ETF and late trunk flexion were positively correlated with HFMS, and HFMS was correlated with HEMS. Conclusions: HFMS may contribute to an altered LPR in SOWs with LBP. Full article

Background: In 2022, more than 107,000 people died in the US from an opioid overdose. The Opioid Rapid Response and Pain (ORRP) ECHO was developed to educate primary care clinicians on best practices in pain and substance use management consistent with the 2016 Guideline for Prescribing Opioids for Chronic Pain. Methods: Six 1 h virtual sessions consisting of didactics and case discussions focusing on pain and substance use were delivered by a multidisciplinary hub team to four diverse US regions. The authors utilized qualitative analyses, including a modified Delphi Technique and thematic analysis, to assess participant questions during the sessions, focus groups with participants, and post-session survey responses for ORRP ECHO training between 14 October 2021 and 15 November 2022. Results: One hundred and eighteen primary care clinicians performed 627 chat responses and were eligible to receive 648 continuing education unit credits. The majority of chat questions were related to Patient-Centered Care (28%, 170 total responses) and Knowledge (27%, 178 total responses). The focus groups revealed five core themes: (1) there was a clear need for the ECHO trainings, (2) the program fostered a unique and supportive community, (3) the content was applicable, (4) the administration of the program was effective, and (5) it had a meaningful impact on practice. The participants who completed the post-session surveys reported that they would apply their knowledge (range across cohorts: 85.7% to 100.0% of survey respondents agreed or strongly agreed) and communication skills gained (range: 71.4% to 98.6%). Conclusions: Through didactics and interactive case discussions, the ECHO model holds promise as a useful training model to support the appropriate use of clinical practice guidelines by informing individualized, patient-centered care and clinical judgment. Full article

Background: Soccer is a high-intensity sport characterized by a considerable incidence of injuries, particularly among professional male players, with injury rates ranging from 5.9 to 9.6 per 1000 player-hours. Lower limb injuries, including those affecting the knee, ankle, hip/groin, and hamstring muscles, are particularly prevalent. Additionally, a history of prior injuries may exacerbate the risk of recurrence. In response to these concerns, various injury prevention programs have been developed and implemented, targeting different genders and age groups. Methods: This systematic review and meta-analysis, conducted with the PRISMA guidelines, critically evaluated randomized RCTs across diverse genders and age groups to assess the efficacy of multi-component exercise-based injury prevention programs in reducing musculoskeletal injuries among soccer players. Comprehensive searches were conducted in ClinicalTrials.gov, CENTRAL, EMBASE, PubMed, Scopus, and Web of Science, with no language restrictions applied. Results: A total of 15 RCTs met the predefined inclusion criteria. The intervention programs were found to be significantly effective in reducing lower limb injuries, with a pooled RR of 0.73 (95% CI: 0.63 to 0.84, p = 0.035). Subgroup analyses further revealed a significant reduction in the incidence of hamstring, knee, and ankle injuries following the implementation of these programs. Conclusions: Multi-component exercise-based injury prevention programs demonstrate considerable efficacy in reducing musculoskeletal injuries in soccer players, spanning various age groups and genders. These findings underscore the potential of such programs in professional soccer injury management and highlight their importance in the development of comprehensive injury prevention strategies. Full article

Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To evaluate the effect of the cervical Specific Adjustment Technique (SAT) in adults affected by whiplash on pain, functionality, cervical mobility, and radiological changes in cervical curvature through a prospective, single-blind, randomized clinical trial. Methods: One hundred and nineteen patients with grade II acute WL were randomly assigned to either the manipulation group (MAN group = 59) or the rehabilitation group (RHB group = 60) to receive 3 or 20 sessions of treatment, respectively. Both groups were measured at baseline and 15, 30, and 120 days after starting treatment. Results: Statistically significant differences were found in the MAN group in flexion (p = 0.041) and left-side bending (p = 0.022); similar statistical values were found in the other measures. According to the interaction treatment-time effect, statistical significance for the Cobb angle was obtained in the MAN group (p = 0.047). Conclusions: the effects of SAT were comparable in terms of pain, functionality, and mobility of the cervical spine. Although further research is needed on its effects in the acute phase, due to its effectiveness and lower associated cost, SAT could be considered a useful technique, at least during the first 3 months after a traffic collision. Full article

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), and thiocolchicoside, a muscle relaxant, are commonly combined to target inflammation and muscle spasm. However, the efficacy and safety of their combination remain under discussion. This systematic review evaluates the efficacy and safety of diclofenac-thiocolchicoside therapy for LBP and other musculoskeletal conditions. Methods: A systematic review was conducted following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing diclofenac-thiocolchicoside combination with placebo, monotherapy, or alternative treatments. A search was performed in PubMed, Scopus, and relevant websites, identifying articles published up to 30 September 2024. Studies from trial registries were excluded. Risk of bias was assessed using Revised Cochrane Risk of Bias for randomized trials (RoB 2) for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Evidence certainty was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Results were visualized using Robvis, tables, and graphs. Results: Of 393 identified records, 9 studies (1097 patients) met the inclusion criteria. Seven RCTs reported significant pain reduction and functional improvement with combination therapy compared to placebo or active controls. However, study heterogeneity, dosage variations, and risk of bias limited comparability. Adverse events (AEs) included gastrointestinal (GI) discomfort and drowsiness, though no severe complications were consistently reported. Conclusions: Despite methodological limitations, the diclofenac-thiocolchicoside combination demonstrates promising efficacy for acute LBP and musculoskeletal pain management. However, there is no clear evidence of its clinical superiority over other available treatments, due to study heterogeneity and potential biases. Rigorous, standardized research with larger sample sizes and consistent methodologies is essential to definitively establish the efficacy and safety of diclofenac-thiocolchicoside, providing clearer guidance for clinical decision-making. Full article