The analgesic effectiveness of radial shock wave therapy in extra-articular rheumatism

CILJ: Istraživanje učinka terapije radijalnim udarnim valom (SWT = Shock Wave Therapy), provedeno je tijekom 10-mjesečnog praćenja bolesnika u KBC Split, a praćen je učinak na smanjenje boli, vodećeg simptoma bolesti, u bolesnika s izvanzglobnim reumatskim bolestima (IZRB). MATERIJALI I METODE: Praćen je terapijski učinak SWT-a (model BTL-6000, 4Bar, 15Hz), kao monoterapijskog oblika liječenja, na bol u skupini od 49 bolesnika s IZRB-om podijeljenih u 5 podskupina, s obzirom na zahvaćenost regije: rame (n=21), lakat (n=3), kuk i natkoljenica (n=5), koljeno (n=1) i stopalo (n=19). Od ukupnog broja bolesnika 15 ih nije zadovoljilo kriterije uključenja u analizu podataka po završenom liječenju. Bolesnici su bili prosječne životne dobi od 46,5 godina (raspon 16-76) te su prije i poslije terapije subjektivno procijenili osjećaj boli prema tzv. vizualno-analognoj skali (VAS). REZULTATI: Istraživanje je pokazalo da postoji statistički značajna učinkovitost SWT-a na bol u ispitivanih bolesnika s IZRB-om. Razina statističke značajnosti određena je paired samples T-testom. Prosječno smanjenje boli na VAS-u po regijama je bilo kako slijedi: rame (n=16): smanjenje sa 6,8 (±1,5) na 4,5 (±2,7) uz prosječnu razliku -2,3 (±2,8) i P<0,01, stopalo (n=8): smanjenje sa 6,0 (±2,1) na 2,6 (±2,3) uz prosječnu razliku -3,4 (±2,4) i P<0,01, petni trn (n=10): smanjenje sa 6,7 (±1,8) na 2,4 (±1,8) uz prosječnu razliku -4,3 (±1,2) i P<0,0001. Zbog malog broja bolesnika, učinak nije analiziran za regiju lakta, kuka i natkoljenice te koljena. Nije zabilježena ni jedna neželjena nuspojava liječenja. ZAKLJUČAK: Monoterapija SWT pokazala je statistički značajnu učinkovitost na liječenje boli kod svih praćenih IZRB-ova, te se zbog svoje učinkovitosti može preporučiti kao metoda izbora liječenja boli za sva ispitivana područja.Objective: The aim of this study was to evaluate the effect of radial shock wave therapy (SWT = Shock Wave Therapy) on reduction of pain, the leading symptom of the disease, in patients with extra-articular rheumatism. Patients and methods: The study followed the therapeutic effect of SWT (model BTL-6000, 4bar, 15Hz) as a monotherapeutic form of treatment in a group of 49 patients with extra-articular rheumatism divided into five regional sub-groups: shoulder (n = 24), elbow (n = 3), hip and thigh (n = 5), knee (n = 1) and feet (n = 19). Of the total number of patients, 15 did not meet the criteria for inclusion in the analysis of the data after completion of the monitoring. Patients had an average age of 46.5 years (range 16-76). Before and after therapy patients subjectively assessed the feeling of pain on the visual analogue scale (VAS). Results: The study showed statistically significant efficiency of SWT on pain reduction in extra-articular rheumatism. Statistical significance was determined by T-test. The average reduction of pain on the VAS scale was, by clinical entities: painful shoulder syndrome (n = 16) reduction in VAS pain from 6.8 (±1.5) to 4.5 (± 2.7) with an average difference -2.3 (±2.8) and P < 0.01. Feet (n = 8): VAS pain reduction from 6.0 (±2.1) to 2.6 (±2.3) with an average difference -3.4 (±2.4) and P < 0.01. Heel spur (n = 10): VAS pain reduction from 6.7 (±1.8) to 2.4 (±1.8) with average difference -4.3 (±1.2) and P < 0.0001. Due to the small number of patients, the effect is not analyzed for the region of the elbow, hip and upper leg and knee. There was no side effect of this treatment. Conclusion: SW monotherapy showed statistically significant efficacy in the treatment of pain in all monitored extra-articular diseases, and because of its effectiveness can be recommended as a method of choice for the treatment for all investigated areas

Prikaz slučaja kronične Bellove pareze: koje su mogućnosti rehabilitacije?

Bell’s palsy, or idiopathic peripheral facial nerve palsy is a neurologic condition characterized by unilateral weakness of facial muscles. The evidence-based guidelines mostly consider the acute treatment of Bell’s palsy. However, chronic cases of Bell’s palsy are not supported by strong evidence regarding treatment options, except for a weak recommendation to utilize physical therapy. This case report has presented an application of a combination of physical therapy modalities (Mirror Book Therapy, High Intensity Laser Therapy, and Acupuncture) within 10 weeks, to treat a patient with long-term sequelae. This combination of therapies has resulted in a significant improvement in the level of recovery measured by facial grading scales. However, further research is necessary to provide stronger evidence regarding the benefits of this treatment option.Bellova pareza ili periferna idiopatska pareza facijalisa, neurološko je stanje koju karakterizira jednostrana slabost mišića lica. Smjernice za liječenje su uglavnom utemeljene na dokazima o preporukama za liječenje akutnih stadija Bellove pareze. Međutim, kronični slučajevi Bellove pareze nisu potkrijepljeni dovoljno snažnim dokazima o mogućnostima liječenja, osim slabe preporuke u smjeru primjene terapijskih vježbi. Ovaj prikaz slučaja predstavlja primjenu kombinacije modaliteta fizikalne terapije (akupunktura, laser visokog intenziteta i terapija zrcalom) unutar 10 tjedana, za liječenje bolesnika s dugotrajnim posljedicama Bellove pareze. Ova kombinacija terapija rezultirala je značajnim poboljšanjem razine oporavka mjerenog kliničkim ljestvicama. Međutim, potrebna su daljnja istraživanja kako bi se pružili snažniji dokazi o prednostima ove kombinacije terapija

The effectiveness of high intensity laser related to the pain in extra-articular rheumatism

CILJ: Istraživanje učinka terapije laserom visokog intenziteta (HIL= HighIntensity Laser), provedeno je tijekom desetomjesečnog praćenja bolesnika u KBC Split, a praćen je učinak na smanjenje boli, vodećeg simptoma bolesti, u bolesnika s izvanzglobnim reumatskim bolestima (IZRB). METODE: Praćen je terapijski učinak terapije HIL-om (model BTL-6000, 12W, 1064nm), kao monoterapijskog oblika liječenja, na skupini od 152 bolesnika s IZRB, podijeljenih u 7 podskupina, s obzirom na zahvaćenost regije: rame (n=24), lakat (n=17), ručni zglob i šaka (n=18), kuk i natkoljenica (n=20), koljeno (n=21), nožni zglob (n=32) i stopalo (n=20). Od ukupnog broja bolesnika 45 ih nije zadovoljilo kriterije uključenja u analizu podataka po završenom praćenju. Bolesnici su bili prosječne životne dobi od 43 godine (raspon 14–78) te su prije i poslije terapije subjektivno procijenili osjećaj boli vizualno-analognom skalom (VAS). REZULTATI: Istraživanje je pokazalo statistički značajnu učinkovitost HIL-a na bol u IZRB. Razina statističke značajnosti određena je t-testom. Prosječno smanjenje boli na VAS je bilo, prema regijama: rame (n=20) smanjenje VAS boli sa 6,7(±1,4) na 3,8(±2,2) uz prosječnu razliku -2,9(±1,7), P<0,0001;lakat (n=17): smanjenje VAS boli sa 6,5(±1,3) na 3,4(±2,4) uz rosječnu razliku -3,1(±2),P<0,0001;ručni zglob i šaka (n=11): smanjenje sa 6,0(±1,8) na 3,2(±1,5) uz prosječnu razliku -2,8(±1,8), P<0,001;kuk i natkoljenica(n=10): smanjenje sa 7,2(±1,6) na 3,4(±2,2) uz prosječnu razliku -3,8(±2,6),P<0,01;koljeno (n=18): smanjenje sa 5,8(±2,1) na 3,6(±2,4) uz prosječnu razliku -2,2(±2,2),P<0,001;nožni zglob(n=12): smanjenje sa 5,6(±2,0) na 3,6(±1,8) uz prosječnu razliku -2,1(±1,6), P<0,001;stopalo(n=8): smanjenje sa 6,5(±1,6) na 4,4(±2,4) uz prosječnu razliku -2,1(±1,3),P<0,01. Metatarzofalangealna etaža(n=9): smanjenje sa 8,1(±1,6) na 5,0(±1,4) uz prosječnu razliku -3,1(±2,3), P<0,01. ZAKLJUČAK: MonoterapijaHIL-om pokazala je statistički značajnu učinkovitost liječenja boli, kod svih praćenih IZRB, te se zbog svoje učinkovitosti može preporučiti kao metoda izbora liječenja boli za sva ispitivana područja.OBJECTIVES: The aim of this study was to evaluate the effect of high intensity laser (HIL) on reduction of pain, the leading symptom of the disease, in patients with extra-articular rheumatism. PATIENTS AND METHODS: The study followed the therapeutic effect of HIL therapy (model BTL-6000, 12W, 1064nm) as a monotherapeutic form of treatment in a group of 152 patients with extra-articular rheumatism divided into 7 regional sub-groups: shoulder (n = 24), elbow (n= 17), wrist and hand(n= 18), hip and thigh (n= 20), knee (n= 21), ankle (n= 32) and feet (n= 20). Of the total number of patients 45 did not meet the criteria for inclusion in the analysis of the data after completion of monitoring. The average age of patients was 45 years (range 14–78). The patients subjectively assessed the feeling of pain on the visual analogue scale (VAS) before and after therapy. RESULTS: The study showed statistically significant efficiency of HIL on pain reduction in extra-articular rheumatism. Statistical significance was determined by t-test. The average reduction of pain on the VAS scale by clinical entities was as follows: shoulder(n = 20) reduction in VAS pain from 6.7 (±1.4) to 3.8 (±2.2) with an average difference -2.9 (±1.7), P <0.0001;elbow (n = 17): VAS pain reduction from 6.5 (±1.3) to 3.4 (±2.4) with an average difference -3.1 (±2),P <0.0001;wrist and hand (n = 11): decrease from 6.0 (±1.8) to 3.2 (±1.5) with an average difference -2.8 (±1.8),P <0.001;hipand thigh (n = 10): decrease from 7.2 (±1.6) to 3.4 (±2.2) with an average difference -3.8 (±2.6),P <0.01; knee (n = 18): decrease from 5.8 (±2.1) to 3.6 (±2.4) with an average difference -2.2 (±2.2),P <0.001;ankle (n = 12): decrease from 5.6 (±2.0) to 3.6 (±1.8) with an average difference -2.1 (±1.6),P <0.001; feet (n = 8): decrease from 6.5 (±1.6) to 4.4 (±2.4) with an average difference -2.1 (±1.3), P <0.01; metatarsalgia (n = 9): decrease from 8.1 (±1.6) to 5.0 (±1.4) with an average difference -3.1 (±2.3), P <0.01. CONCLUSION: HILmonotherapyshowed statistically significant efficacy in the treatment of pain in all monitored extra-articular diseases, and because of its effectiveness can be recommended as themethod of choice for the treatment of all monitored extra-articular diseases

THE EFFECTIVENESS OF HIGH INTENSITY LASER RELATED TO THE PAIN IN EXTRA-ARTICULAR RHEUMATISM

CILJ: Istraživanje učinka terapije laserom visokog intenziteta (HIL= HighIntensity Laser), provedeno je tijekom desetomjesečnog praćenja bolesnika u KBC Split, a praćen je učinak na smanjenje boli, vodećeg simptoma bolesti, u bolesnika s izvanzglobnim reumatskim bolestima (IZRB). METODE: Praćen je terapijski učinak terapije HIL-om (model BTL-6000, 12W, 1064nm), kao monoterapijskog oblika liječenja, na skupini od 152 bolesnika s IZRB, podijeljenih u 7 podskupina, s obzirom na zahvaćenost regije: rame (n=24), lakat (n=17), ručni zglob i šaka (n=18), kuk i natkoljenica (n=20), koljeno (n=21), nožni zglob (n=32) i stopalo (n=20). Od ukupnog broja bolesnika 45 ih nije zadovoljilo kriterije uključenja u analizu podataka po završenom praćenju. Bolesnici su bili prosječne životne dobi od 43 godine (raspon 14–78) te su prije i poslije terapije subjektivno procijenili osjećaj boli vizualno-analognom skalom (VAS). REZULTATI: Istraživanje je pokazalo statistički značajnu učinkovitost HIL-a na bol u IZRB. Razina statističke značajnosti određena je t-testom. Prosječno smanjenje boli na VAS je bilo, prema regijama: rame (n=20) smanjenje VAS boli sa 6,7(±1,4) na 3,8(±2,2) uz prosječnu razliku -2,9(±1,7), P<0,0001;lakat (n=17): smanjenje VAS boli sa 6,5(±1,3) na 3,4(±2,4) uz rosječnu razliku -3,1(±2),P<0,0001;ručni zglob i šaka (n=11): smanjenje sa 6,0(±1,8) na 3,2(±1,5) uz prosječnu razliku -2,8(±1,8), P<0,001;kuk i natkoljenica(n=10): smanjenje sa 7,2(±1,6) na 3,4(±2,2) uz prosječnu razliku -3,8(±2,6),P<0,01;koljeno (n=18): smanjenje sa 5,8(±2,1) na 3,6(±2,4) uz prosječnu razliku -2,2(±2,2),P<0,001;nožni zglob(n=12): smanjenje sa 5,6(±2,0) na 3,6(±1,8) uz prosječnu razliku -2,1(±1,6), P<0,001;stopalo(n=8): smanjenje sa 6,5(±1,6) na 4,4(±2,4) uz prosječnu razliku -2,1(±1,3),P<0,01. Metatarzofalangealna etaža(n=9): smanjenje sa 8,1(±1,6) na 5,0(±1,4) uz prosječnu razliku -3,1(±2,3), P<0,01. ZAKLJUČAK: MonoterapijaHIL-om pokazala je statistički značajnu učinkovitost liječenja boli, kod svih praćenih IZRB, te se zbog svoje učinkovitosti može preporučiti kao metoda izbora liječenja boli za sva ispitivana područja.OBJECTIVES: The aim of this study was to evaluate the effect of high intensity laser (HIL) on reduction of pain, the leading symptom of the disease, in patients with extra-articular rheumatism. PATIENTS AND METHODS: The study followed the therapeutic effect of HIL therapy (model BTL-6000, 12W, 1064nm) as a monotherapeutic form of treatment in a group of 152 patients with extra-articular rheumatism divided into 7 regional sub-groups: shoulder (n = 24), elbow (n= 17), wrist and hand(n= 18), hip and thigh (n= 20), knee (n= 21), ankle (n= 32) and feet (n= 20). Of the total number of patients 45 did not meet the criteria for inclusion in the analysis of the data after completion of monitoring. The average age of patients was 45 years (range 14–78). The patients subjectively assessed the feeling of pain on the visual analogue scale (VAS) before and after therapy. RESULTS: The study showed statistically significant efficiency of HIL on pain reduction in extra-articular rheumatism. Statistical significance was determined by t-test. The average reduction of pain on the VAS scale by clinical entities was as follows: shoulder(n = 20) reduction in VAS pain from 6.7 (±1.4) to 3.8 (±2.2) with an average difference -2.9 (±1.7), P <0.0001;elbow (n = 17): VAS pain reduction from 6.5 (±1.3) to 3.4 (±2.4) with an average difference -3.1 (±2),P <0.0001;wrist and hand (n = 11): decrease from 6.0 (±1.8) to 3.2 (±1.5) with an average difference -2.8 (±1.8),P <0.001;hipand thigh (n = 10): decrease from 7.2 (±1.6) to 3.4 (±2.2) with an average difference -3.8 (±2.6),P <0.01; knee (n = 18): decrease from 5.8 (±2.1) to 3.6 (±2.4) with an average difference -2.2 (±2.2),P <0.001;ankle (n = 12): decrease from 5.6 (±2.0) to 3.6 (±1.8) with an average difference -2.1 (±1.6),P <0.001; feet (n = 8): decrease from 6.5 (±1.6) to 4.4 (±2.4) with an average difference -2.1 (±1.3), P <0.01; metatarsalgia (n = 9): decrease from 8.1 (±1.6) to 5.0 (±1.4) with an average difference -3.1 (±2.3), P <0.01. CONCLUSION: HILmonotherapyshowed statistically significant efficacy in the treatment of pain in all monitored extra-articular diseases, and because of its effectiveness can be recommended as themethod of choice for the treatment of all monitored extra-articular diseases