Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke

Introduction: Dry needling (DN) has been shown to be effective for the treatment of upper extremity hypertonia in patients with stroke. Purpose: To evaluate the cost-effectiveness of DN in patients with stroke. Methods: A cost-effectiveness analysis was performed in a research study conducted at a Spanish public hospital where patients were classified into two groups with or without DN. Hypertonia was measured using the Modified Modified Ashworth Scale (MMAS), and quality of life (QOL) was assessed using the EuroQoL 5-dimension questionnaire. Data regarding the effects and costs of physiotherapy were presented by calculating the mean and 95% confidence interval. The health outcomes were evaluated considering the rate of responders to the treatment based on the MMAS. Spanish preference weights were used to estimate quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated to determine the economic value of DN. Results: Eighty patients with stroke in the subacute stage of recovery were selected to participate in this study. Based on the rate of responders, the ICER of the DN group was very low. Despite the sensitivity analysis performed, the results of the ICUR were not encouraging. Discussion: Cost-effectiveness with responder rate results were favourable for the DN group and were confirmed by the sensitivity analysis according to levels of care. In addition, our findings revealed that 4 weeks of treatment could be more cost-effective than 8 weeks. DN treatment of the upper extremity appears to be cost-effective based on the rate of responders measured using the MMAS scale. © The Author(s) 2021

Cost-effectiveness of two dry needling interventions for plantar heel pain: A secondary analysis of an rct

Plantar heel pain is a common cause of foot pain that affects patients’ quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN

Microscopic and NanoSIMS characterization of black shale-hosted pre-kinematic pyrites: Possible gold source of the orogenic gold deposits in the Truchas Syncline (Variscan Iberian Massif)

[EN] The Truchas Syncline contains orogenic gold deposits (OGDs), hosted mainly by the Armorican Quartzite Fm. In order to look for the source of gold in these deposits, pre-kinematic sulphides from black shales from the overlying Luarca Fm. were studied using both optical and scanning electron (SEM) microscopy, as well as nanoscale secondary ion mass spectrometry (NanoSIMS). NanoSIMS images allowed the observation of relevant structures (pyrite with high As content nodules) hidden to SEM. Microscopy and 36S, 75As32S, 75As, 75As34S, and 197Au mappings, as well as δ34S analysis (‰ Vienna-Canyon Diablo Troilite) allowed 4 types of pyrite to be characterized. According to their sequence of deposition, the pyrite types identified are the following: (1) framboid nuclei (FmPy), with δ34S between +4.1‰ and +57.5‰; (2) overgrowths (OgPy), with presence of Au, As and δ34S of approximately +20.5‰; (3) pyrite with high As content (AsPy), replacing previous pyrites, with δ34S of approximately +23‰, nodular shapes and non-detected Au; (4) subhedral pyrite (ShPy), with δ34S of approximately +19.7‰ and Au and As distribution showing (a) nuclei, (b) rims with Au and As and (c) structures interpreted as replacements of previous pyrite. Luarca Fm. pyrite framboids reach 75 μm in size, larger than framboids described in most previous NanoSIMS work, with microcrystals sufficiently large to be analyzed without contamination from edge effects. The FmPy formed in early diagenetic conditions by dissimilatory reduction of marine sulphate plus Rayleigh distillation or anaerobic oxidation of methane processes. The first FmPy nuclei formed in the periphery of framboids, and then started to form in the central region until completion of the framboidal structure. Growth of OgPy, AsPy and ShPy corresponded to more advanced diagenetic conditions, although the last stage of ShPy growth followed an aggregation model, in which ShPy metamorphic pyrites grew over ShPy diagenetic pyrites. The sulphur isotopic signature of the four types of pyrite is in good agreement with a source from Ordovician marine sulphate. A hypothesis stating that the source of Au in OGDs in the district could be in Luarca Fm. is supported by the results of the present research. Firstly, a source of Au in the district could have been the replacement of previous pyrites by AsPy and the release of Au to the system, instead of the framboidal to euhedral pyrite recrystallization process observed in other gold deposits. Secondly, by the correspondence between δ34S isotopic signature of the pyrites from Luarca Fm. and those from sulphides in OGDs. However, these results do not rule out other possible sources.SIThis project was funded by Project 0284_ESMIMET_3_E (INTERREG V-A Spain-Portugal Cooperation Programme, 2014-20) and by Project LE167G18 (Junta de Castilla y Le´on, Spain)

Comparing two dry needling interventions for plantar heel pain: a randomised controlled trial

OBJECTIVES: To compare the effectiveness of dry needling (DN) versus percutaneous needle electrolysis (PNE) for improving the level of pain, function and quality of life (QoL) of patients suffering from plantar heel pain (PHP) provoked by myofascial trigger points. DESIGN: A prospective, parallel-group, randomised controlled trial with blinded outcome assessment. SETTING: A single treatment facility in the State of Kuwait. PARTICIPANTS: 118 participants were screened for eligibility. Of these, 102 participants were enrolled (30 men (49.5±8.9 years) and 72 women (48.1±8.8 years)) and 68 of them completed the trial. INTERVENTIONS: Two parallel groups, one study arm received DN and a stretching protocol whereas the other arm received percutaneous needling electrolysis with a stretching protocol. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the Foot Pain domain of the Foot Health Status Questionnaire, with 13 questions related to foot health-related domains. Secondary outcome measures included the 0-10 numerical rating scale pain visual analogue scale (VAS) scores, performed before and after each treatment session. In addition, QoL was measured using the EuroQoL-5 dimensions. All measurements were taken at baseline, at 4, 8, 12, 26 and 52 weeks. RESULTS: Foot Pain domain improved at all time points for DN group (p<0.001; 29.7 (17.8 to 41.5)) and percutaneous needling electrolysis group (p<0.001; 32.7 (18.3 to 47.0)), without significant differences between groups. Pain VAS scores decreased at all time points for both DN (p<0.001; -2.6 (-4.0 to -1.2)) and percutaneous needling electrolysis group (p<0.001; -3.0 (-4.5 to -1.6)). QoL improved at 4 weeks for both DN (p<0.01; 0.15 (0.5 to 0.25)) and percutaneous needling electrolysis group (p<0.01; 0.09 (0.01 to 0.17)) and at 8 and 52 weeks for the PNE group (p<0.01; 0.10 (0.02 to 0.18)), with significant differences between groups for the QoL at 52 weeks (p<0.05; 0.10 (0.01 to 0.18)). There were two small haematomas in the PNE group and one in the DN group. No serious adverse events were reported. CONCLUSIONS: Both PNE and DN were effective for PHP management, reducing mean and maximum pain since the first treatment session, with long lasting effects (52 weeks) and significant differences between groups in the case of QoL at 52 weeks in favour of the PNE group

Lesiones en el manguito rotador tras luxación anterior de hombro en pacientes mayores de 40 años.

Se ha realizado un estudio prospectivo de la evolución de 32 luxaciones anteriores de hombro en pacientes de más de 40 años con el objetivo de establecer la incidencia, localización y tipo de rotura del manguito rotador a causa de la luxación, conocer evolución clínica y establecer los criterios clínicos que nos permitan sospechar una rotura del manguito rotador, sin necesidad de recurrir a resonancia magnética (RM) de entrada. Los pacientes fueron sometidos a estudio mediante RM, clasificando las lesiones observadas en cinco grados en función de la extensión de la rotura, siendo el grupo 1 la integridad del manguito. El 90% de los casos presentó una rotura del manguito rotador asociada a la luxación. Tras un periodo de rehabilitación se demostró una diferencia significativa en la recuperación de la abducción en los pacientes con manguito íntegro, siendo un signo clínico de importancia para valorar el estado del manguito rotador.A prospective study of the evolution of 32 anterior dislocations of the shoulder in patients older than forty years has been done with the objective of establishing the incidence, location and kind of tear caused by the dislocation, to know the evolution and to establish the clinical parameters that allow us to suspect an injury of the rotator cuff without the help of magnetic resonance (MR) in the beginning. All the patients were studied with MR, doing a classification of the tears in five degrees, depending on the extension of the tears, being the group 1 the integrity of the rotator cuff. In 90% of the cases a rotator cuff tear has been found to be associated with the dislocation. After the rehabilitation, a significative difference in the recovery of the abduction has been demonstrated in the patients with integrity of the rotator cuff, being an important clinical sign to know the state of the rotator cuff

Reliability of the resonance frequency analysis values in new prototype transepithelial abutments: A prospective clinical study

Resonance frequency analysis (RFA) requires abutment disconnection to monitor implant stability. To overcome this limitation, an experimental transepithelial abutment was designed to allow a SmartPeg to be screwed onto it, in order to determine the prototype abutments repeatability and reproducibility using Osstell ISQ and to assess whether implant length and diameter have an influence on the reliability of these measurements. RFA was conducted with a SmartPeg screwed directly into the implant and onto experimental abutments of different heights of 2, 3.5 and 5 mm. A total of 32 patients (116 implants) were tested. RFA measurements were taken twice for each group from mesial, distal, buccal and palatal/lingual surfaces. Mean values and SD were calculated and Intraclass Correlation Coefficients (ICC) (p < 0.05, IC 95%). The implant stability quotient (ISQ) mean values were 72.581 measured directly to implant and 72.899 (2 mm), 72.391 (3.5 mm) and 71.458 (5 mm) measured from the prototypes. ICC between measurements made directly to implant and through 2-, 3.5-and 5-mm abutments were 0.908, 0.919 and 0.939, respectively. RFA values registered through the experimental transepithelial abutments achieved a high reliability. Neither the implant length nor the diameter had any influence on the measurements’ reliability