A Meta-analysis to Assess the Effectiveness of a Procedural Scale to Measure Pain in a Child Aged 0-1 Year

Background: The burden of pain in newborns has been investigated in several studies, but little is known about the appropriateness and effectiveness of using pain scales according to the specific type of pain or the condition of the infant. Our purpose was to conduct a meta-analysis to assess and report on the effectiveness of the used procedural pain scale to measure pain in a child over 0-1years reflecting that by using the non-pharmacological interventions in pain reduction in randomized trials. Methods: A systematic search was performed up to October 2021 in PubMed and Cochrane Library The current review enrolled randomized clinical trials (RCTs). It was also conducted according to PRISMA guidelines. Cochrane's risk of bias assessment was used to assess the studies' quality and risk of bias. Meta-analyses were performed by calculating the standardized mean difference (SMD) at a 95% confidence interval (CI) using Review Manager Software Results: 50 trials were found 8 trials were included in this meta-analysis. Most of the studies related to procedural pain (heel lance and vaccination), Three validated pain scales were used in all trials (neonatal infant pain scale NIPS, premature infant pain profile PIPP, AND neonatal pain, agitation, and sedation scale NPASS. The Meta-analysis showed significant effect of non- pharmacological interventions (swaddling, mother holding, sucrose) in pain reduction compared with control group (SMD 1.2, 95% CI -1.88 to -.52, P =0.0005), I` = 95%, P> 0.00001. The 8 studies with 918 infant’s participants entered into analysis used effective pain scales (NIPS, PIPP, and NPASS) to measure procedural pain effectively Conclusions: overall the non-pharmacological interventions show positively effect in pain reduction, these mean the pain scales that are used in studies appropriate to assess pain when measure procedural pain (heel lice, vaccination), however, there is no consistency about the best tool to use in children related to several factors

Melatonin serum level, sleep functions, and depression level after bilateral anodal transcranial direct current stimulation in patients with Parkinson’s disease: a feasibility study

Objective: Parkinson’s disease (PD) is associated with non-motor complications such as sleep disturbance and depression. Transcranial direct current stimulation (tDCS) showed therapeutic effects on the motor dysfunctions. However, the potential effects of tDCS therapy on melatonin hormone, sleep dysfunctions, and depression in patients with PD still unclear. This feasibility study aimed to identify any potential changes in melatonin serum level, sleep functions and depression after the bilateral anodal tDCS in patients with PD. Material and Methods: Tensessions of bilateral anodal tDCS stimulation applied over left and right prefrontal and motor areas were given to twenty-five patients with PD. Melatonin serum level, Pittsburgh sleep quality index, and geriatric depression scale examined before and after tDCS stimulation. Results: After bilateral anodal tDCS, there was a significant reduction in melatonin serum level, improvement in depression, improvements in overall sleep quality, and sleep latency. Correlations test showed significant associations between melatonin serum level reduction and changes in subjective sleep quality, and sleep duration, as well as between improvements in depression and overall sleep quality, sleep latency, and sleep disturbance.Conclusion: Bilateral anodal tDCS therapy was a feasible and safe tool that showed potential therapeutic effects on melatonin serum level, sleep quality, and depression level in patients with PD. Although the further large scale and randomized-control trial studies are crucially needed, there is still a need for such a feasibility study to be established before such trials can be implemented as is recommended in the new medical research council guidelines

ASYMMETRY OF SOMATOSENSORY CORTICAL PLASTICITY IN PATIENT WITH BILATERAL CARPAL TUNNEL SYNDROME

Background: Following peripheral nerve lesion, the adult somatosensory system showedcortical reorganizational abilities.Previous studies identified the digits' somatotopy map changes and somatosensory cortical plasticity in response to the Carpal Tunnel Syndrome (CTS) that affected the dominant hand only. Objective: Answering the remained question is that what the extent of the cortical plasticity would be in left and right somatosensory cortices in response to CTS affecting the right and left hands simultaneously. Methods: Cortical representations activated by tactile stimulation of median nerve (index) and ulnar nerve (little) of both dominant and non-dominant hands were evaluated by Magnetoencephalography (MEG) systemfor healthy participants and patient with bilateral moderate CTS. index – little fingers'somatotopy map and inter-digit cortical distance was then mapped and calculated for each participant on the real MRI data and the 3D brain surface image. Results: in healthy participants, index – little inter-digit somatosensory cortical distance of right hand (dominant) was significantly larger than the index – little inter-digitsomatosensory cortical distance of left hand (11.2±2.1mm vs.7.0±2.9mm, P = 0.006). However, in patient with bilateral CTS, the index – little inter-digit somatosensory cortical distance of righthand (dominant) was significantly smaller than the index – little inter-digit somatosensory cortical distance of left hand (5.8mm vs. 7.4mm). Conclusion: our data could be interpreted as the hand use – dependency served more median nerve – cortical territory from the ulnar nerve invasion in the right somatotopy map (left hand) than the left somatotopy map of the right hand

Ipsilateral primary sensorimotor cortical response to mechanical tactile stimuli

We studied somatosensory-evoked fields elicited by mechanical versus electrical stimuli to index finger of healthy participants. Mechanical stimulation was index pulp compression and decompression by using nonmagnetic mechanical stimulator. Electrical stimulation was three times of sensory threshold and delivered to index pulp by using ball-shaped electrodes. Mechanical/electrical stimuli evoked contralateral primary somatosensory cortical responses in all respective participants. Compressive stimuli evoked ipsilateral primary sensorimotor cortical responses in all respective participants, with dipole strengths less than contralateral primary somatosensory cortical responses of compressive stimuli. Mechanical/electrical stimuli evoked secondary somatosensory (SII) cortical responses bilaterally; electrical-stimuli SII dipole strengths were relatively stronger than compressive-stimuli SII responses. It is concluded that the use of mechanical stimulation may improve our understanding of functional sensory cortical responses compared with electrical stimulation

Physiotherapists' job satisfaction in the workplace: A cross-sectional study in Jordan, Lebanon, West Bank, and Gaza

Background: Job satisfaction among physiotherapists has been studied in many developing and developed countries, but not yet in areas recently affected by wars and refugee crises in the Middle East, including Jordan, Lebanon, West Bank, and Gaza regions. Objectives: To explore physiotherapists' job satisfaction in Jordan, Lebanon, West Bank, and Gaza and examine differences in job satisfaction according to regions, gender, academic qualifications, and years of clinical experience. Methods: A cross-sectional study using a self-administered online questionnaire. The questionnaire consisted of participants' characteristics and a 17-items Likert scale of job satisfaction. Results: A total of 413 participants completed the online questionnaire. Most of the respondents were older than 27 years (55%), males (53.8%), and holding a bachelor's degree (70.2%), and had 5-10 years of experience (70.4%). The overall job satisfaction was 66.1%. There was no significant difference in job satisfaction according to the region in all questionnaire items. Female physiotherapists reported higher satisfaction in receiving career advice (p = .013). In many items, physiotherapists with higher qualifications and longer years of experience reported higher satisfaction (p < 0.05). Salaries and remunerations, lack of continuing education support, and lack of evidence-based practice in the workplace were the main reasons for job dissatisfaction. Conclusion: To improve physiotherapy job satisfaction, healthcare administrators should increase physiotherapists' financial rewards, support continuing education, and set evidence-based practice policies.This work was supported by a USAID grant

Impact of the COVID-19 Pandemic and Governmental Policies on Rehabilitation Services and Physical Medicine in Jordan: A Retrospective Study

Background: Although the COVID-19 pandemic led to a series of governmental policies and regulations around the world, the effect of these policies on access to and provision of rehabilitation services has not been examined, especially in low and middle- income countries. Aims: The aim of this study was to investigate the impact of governmental policies and procedures on the number of patients who accessed rehabilitation services in the public sector in Jordan during the pandemic and to examine the combined effect of sociodemographic factors (age and gender) and the governmental procedures on this number of patients. Methods: A retrospective cohort study was conducted based on records of 32,503 patients who visited the rehabilitation center between January 2020 and February 2021. Interrupted time-series analysis was conducted with three periods and by age and gender. Results: The number of patients who visited the rehabilitation clinics decreased significantly between January 2020 and May 2020 due to government-imposed policies, then increased significantly until peaking in September 2020 (p = 0.0002). Thereafter, the number of patients decreased between October 2020 and February 2021 as a result of the second wave of the COVID-19 pandemic (p = 0.02). The numbers of male and female patients did not differ (p &gt; 0.05). There were more patients aged 20 years and older attending rehabilitation clinics than younger patients during the first strict lock down and the following reduction of restriction procedures periods (p &lt; 0.05). Conclusions: The COVID-19 public measures in Jordan reduced access to rehabilitation services. New approaches to building resilience and access to rehabilitation during public health emergencies are needed. A further examination of strategies and new approaches to building resilience and increasing access to rehabilitation during public health emergencies is warranted

Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington&rsquo;s Disease: A Systematic Review and Meta-Analysis

Exercise in different settings has become a fundamental part of Huntington&rsquo;s disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form&minus;36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future

Needs assessment of national rehabilitation priorities in Jordan

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