Sep
5
2023
Arthritis Res Ther. 2011 Feb 18;13(1):R28. [Epub ahead of print]
Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review.
Ye L, Kalichman L, Spittle A, Dobson F, Bennell K.
Abstract
INTRODUCTION: Hand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion and joint stiffness leading to impaired hand function and difficulty with daily activities. The effectiveness of different rehabilitation interventions on specific treatment goals has not yet been fully explored. The objective of this systematic review is to provide evidence based knowledge on the treatment effects of different rehabilitation interventions for specific treatment goals for hand OA.
METHODS: A computerized literature search of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, the Physiotherapy Evidence Database (PEDro) and SCOPUS was performed. Evidence level 2b or higher studies that compared a rehabilitation intervention with a control group and assessed at least one of the following outcome measures: pain, physical hand function or other measures of hand impairment, were included. The eligibility and methodological quality of trials were systematically assessed by two independent reviewers using the PEDro scale. Treatment effects were calculated using standardized mean difference and 95% confidence intervals.
RESULTS: Ten studies were included, of which six were of higher-quality (PEDro score>6). The rehabilitation techniques reviewed included three studies on exercise, two studies each on laser and heat, and one study each on splints, massage and acupuncture. One higher quality trial showed a large positive effect of 12-months use of a night splint on hand pain, function, strength and range of motion. Exercise had no effect on hand pain or function although it may be able to improve hand strength. Low level laser therapy may be useful to improving range of motion. No rehabilitation interventions were found to improve stiffness.
CONCLUSIONS: There is emerging high quality evidence to support that rehabilitation interventions can offer significant benefits to individuals with hand OA. A summary of the higher quality evidence is provided to assist with clinical decision making based on current evidence. Further high-quality research is needed concerning the effects of rehabilitation interventions on specific treatment goals for hand OA.
Sep
5
2023
Size counts – more evidence about multifidus in back pain
Brett Vaughan, Lecturer, School of Biomedical & Health Sciences, Victoria University, Australia
A growing number of studies have identified that lumbar multifidus undergoes atrophy with low back pain with a predictable pattern of atrophy in an acute low back pain population. The location and the extent of atrophy of multifidus in a chronic low back pain population are still debated. Hides et al.1 investigated the size and symmetry of the multifidus bilaterally, comparing a chronic low back pain population (mean age 47 years) with a sample of convenience of people with no back pain (mean age 28 years). A secondary aim of this study was to compare the pattern of atrophy in different chronic low back pain presentations. Clinical records of 42 patients presenting to a hospital low back pain clinic were assessed with the clinical presentation data coded to indicate a bilateral or unilateral low back pain presentation. Cross-sectional area of the multifidus muscle was measured at levels L2–L5 using ultrasound imaging apparatus. Results of this study demonstrated a difference in multifidus cross-sectional area, with the chronic low back pain population demonstrating a decrease in diameter, particularly evident at the L4 and L5 vertebral levels. This result was not dependent upon the age of the patient. Unilateral low back pain patients demonstrated an asymmetry in the cross-sectional area at L4 and L5; however, this was not demonstrated in the bilateral low back pain or asymptomatic populations. The results of this study suggest that multifidus does atrophy in a chronic low back pain population and this is most evident at L4 and L5 levels indicating localized rather than generalised muscle change. Single sided pain is associated with asymmetry in patients with chronic low back pain. The authors suggest that their findings re-inforce the need for clinicians to provide exercise therapy that is designed for individual patients tailored to their impairments and that assessment should address comparisons between segmental levels and between sides.
Further research is required to contextualise the growing body of knowledge about specific muscle changes in patients with low back pain with current guidelines for treatment which suggest non-specific exercise interventions.
Reference
1. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008;13:14–19.
International Journal of Osteopathic Medicine
Volume 11, Issue 3, September 2008, Pages 114-119
Sep
5
2023
Psychooncology. 2008 Feb 26 doi.wiley.com/10.1002/pon.1331
Objective: The objective is to identify whether single 20 min massage sessions were safe and effective in reducing stress levels of isolated haematological oncology patients.Design: Based on a randomised controlled trial, 39 patients were randomised to aromatherapy, massage or rest (control) arm.Measures: The measures were serum cortisol and prolactin levels, quality of life (EORTC QLQ-C30) and semi-structured interviews. Primary outcome measure was the fall in serum cortisol levels.Results: A significant difference was seen between arms in cortisol (P=0.002) and prolactin (p=0.031) levels from baseline to 30 min post-session. Aromatherapy and massage arms showed a significantly greater drop in cortisol than the rest arm. Only the massage arm had a significantly greater reduction in prolactin then the rest arm. The EORTC QLQ-C30 showed a significant reduction in ‘need for rest’ for patients in both experimental arms compared with the control arm, whereas the semi-structured interviews identified a universal feeling of relaxation in patients in the experimental arms.Conclusion: This pilot study demonstrated that in isolated haematological oncology patients, a significant reduction in cortisol could be safely achieved through massage, with associated improvement in psychological well-being. The implications are discussed.
