Sep
5
2023

Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis

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

David Butler on Pain

Sep
5
2023

Protein-added Sports Drinks Don’t Boost Performance During Exercise

Adding protein to a sports drink won’t make you race faster, suggests findings from researchers at McMaster University.

Martin Gibala, associate professor of kinesiology at McMaster University“Sports drinks improve performance during prolonged exercise because of two key ingredients: carbohydrate, which provides fuel for working muscles, and sodium, which helps to maintain fluid balance,” says Martin Gibala, an associate professor of kinesiology at McMaster. “Research also supports the practice of consuming protein after exercise to promote muscle recovery. However, the alleged benefit of consuming protein during exercise is controversial.”

The study, which is published in the August edition of Medicine & Science in Sports & Exercise, found that adding protein to a carbohydrate-electrolyte sports drink did not improve cycling time trial performance compared to the sports drink alone.

The research was conducted on 10 trained cyclists who performed a simulated 80 km bicycle race on three occasions. During exercise, the subjects were given a sports drink, a sports drink supplemented with protein, or a placebo drink that provided no energy. The drinks were similarly flavored and neither the subjects nor the researchers knew what drink was consumed during a given test. The study found that the sports drink improved performance compared to the placebo drink – confirming prior research – but there was no additional benefit of protein supplementation.

“Previous studies that suggested protein was beneficial used ‘ride to exhaustion’ tests that do not resemble normal athletic competition. In addition, the subjects in those studies received less than the optimal recommended amount of carbohydrate,” says Gibala. “Our study shows that protein confers no performance benefit during ‘real life’ exercise when athletes consume sufficient amounts of a sports drink.”

The study, which was funded by Gatorade, comes at a time when the sports drink industry is under pressure to create new products by adding ingredients that might further enhance performance. Some companies have heavily marketed protein-laced sports drinks as the next magic bullet, but Gibala’s research disputes such claims.

“Eating a little protein after exercise is important to help repair damaged muscles and promote training adaptations,” says Gibala, “but no compelling evidence suggests that endurance athletes need protein during exercise.”

McMaster University (2006, August 3). Protein-added Sports Drinks Don’t Boost Performance During Exercise, Study Finds. ScienceDaily.

Sep
5
2023

Height Loss & Mortality

People do become shorter as they get older. While a small amount of height loss is unlikely to cause problems, losing a significant amount of height might indicate other health problems, such as osteoporosis. Loss of height can affect the normal functioning of lungs and the gastrointestinal tract, which can lead to loss of appetite, poor nutritional status and weight loss. It also appears to be associated with loss of muscle mass and strength.

To study the problem, researchers from the Royal Free and University College Medical School and the University of London, involved in the British Regional Heart Study screened 7,735 men ages 40 to 59 years drawn from one general practice in 24 British towns between 1978 and 1980. After 20 years, all those who survived — now ages 60 to 79 — were asked to come in for a follow-up examination. Among other tests, the men’s height and weight were measured without shoes at the baseline examination and at 20 years later. A total of 4,252 men took part in the follow-up height and weight screening. Of these, valid measures of height change were available in 4,213 men.

Recordings were monitored during the entire period to identify deaths and heart disease in all those who took part in the initial part of the study. The men in the study also filled out surveys that detailed their habits and their medical histories. They were asked to describe their health status as excellent, good, fair or poor. They were also asked if their physicians had ever told them they had heart disease, as well as other chronic health conditions.

On average, the men lost 1.67 centimeters in height during the 20 years of the study. However, that height loss varied with individuals. Mean height loss increased with increasing age.

The researchers found that the risk of dying increased with the loss of height and was much higher in men who were three centimeters or more shorter than they had been when they were middle-aged. Losing three centimeters or more in height was also associated with an increase in risk for major heart disease problems.

The researchers noted that when the subjects became three centimeters or more shorter as they aged significantly increased the risk of death in the men, “largely owing to an excess in cardiovascular (heart and blood vessel), respiratory (lung) and other non-CVD (cardiovascular disease), non-cancer deaths.” They noted that while loss of height was associated with heart disease, it was not associated with stroke.

The researchers noted that the relationship between height loss and death is unclear. They hypothesized that osteoporosis or loss of bone mass is known to be associated with increased death rates and is also a reason for loss of height in men. However, the height loss associated with osteoporosis is usually much greater than that, and the researchers said osteoporosis is unlikely to be the only reason. Certain underlying features that may be a fault in heart disease may also contribute to loss of height, the researchers said.   However, they said the relationship remains unclear and warrants further study.

The bottom line: Losing significant amounts of height as you age may mean that you are at increased risk of developing heart disease. Talking with your doctor about these risks may enable you to reduce the threat.

Reference

S. Goya Wannamethee, PhD; A. Gerald Shaper, FRCP; Lucy Lennon, MSc; Peter H. Whincup, FRCP, PhD, “Height Loss in Older Men: Associations With Total Mortality and Incidence of Cardiovascular Disease,” Arch Intern Med. 2006;166:2546-2552

Sep
5
2023

Abstract from the Taks Force on neck pain paper

Here is the absctact from the article in Spine.

Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations.

Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12-member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians.

The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups:
Grade I neck pain with no signs of major pathology and no or little interference with daily activities;
Grade II neck pain with no signs of major pathology, but interference with daily activities;
Grade III neck pain with neurologic signs of nerve compression;
Grade IV neck pain with signs of major pathology.

In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy.

Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma.

Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.

CONCLUSION: The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.

http://www.ncbi.nlm.nih.gov/pubmed/18204393?dopt=Abstract