An ICON overview on physical modalities for neck pain and associated disorders

Introduction: Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited. Purpose: To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain. Methods: A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus. Results: Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. Conclusions: The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research

Physiological Demands and Muscle Activity of Jockeys in Trial and Race Riding.

Copyright: © 2022 by the authorsPhysiological parameters and muscle activity of jockeys may affect their fall and injury risk, performance, and career longevity, as well as the performance and welfare of the horses they ride. Therefore, this study aimed to quantify the physiological demands, body displacement, and electromyographic (EMG) activity of twelve jockeys riding 52 trials and 16 professional races. The jockeys were instrumented with heart rate (HR) monitors, accelerometers, and integrated EMG clothing (recording eight muscle groups: quadriceps, hamstrings, gluteal, erector spinae/lower back, abdominal external obliques, abdominal, trapezial and pectoral) which recorded continuously whilst riding. During race day, jockeys rode an average of 5 ± 4 trials and 4 ± 2 races over 2–2.5 h. The trials represented lower intensity cardiovascular demand (~81% HRmax) and Training Impulse (TRIMP) scores (4.4 ± 1.8) than races at maximal intensity effort (~94% HRmax, 7.2 ± 1.8 TRIMP, p 0.05), with more vertical (6.7 ± 2.7 cm) and less medio/lateral (2.3 ± 0.7 cm) and fore/aft (3.7 ± 1.6 cm) displacement for jockeys riding in trials than races (5.5 ± 2.3, 2.8 ± 1.0, 5.6 ± 2.5 cm, p < 0.05). Jockeys in races adopted a lower crouched posture, with their centre of mass (COM) shifted anteriorly, using greater hamstring activation and less upper arm muscle activation than in trials. The differences in riding posture and physiological demands on jockeys riding in a race rather than a trial, highlight the requirement for an off-horse race-specific training programme to improve jockey fitness and performance. Greater jockey stability and coordination will have mutual benefits for both horse welfare and performance

Do Multidisciplinary Team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience

BACKGROUND: MDT (multidisciplinary team) meetings are considered an essential component of care for patients with cancer. However there is remarkably little direct evidence that such meetings improve outcomes. We assessed whether or not MDT (multidisciplinary team) processes influenced survival in a cohort of patients with colorectal cancer. METHODS: Observational study of a population-based cohort of 586 consecutive patients with colorectal cancer diagnosed in Tayside (Scotland) during 2006 and 2007. RESULTS: Recommendations from MDT meetings were implemented in 411/586 (70.1 %) of patients, the MDT+ group. The remaining175/586 (29.9 %) were either never discussed at an MDT, or recommendations were not implemented, MDT- group. The 5-year cause-specific survival (CSS) rates were 63.1 % (MDT+) and 48.2 % (MDT-), p < 0.0001. In analysis confined to patients who survived >6 weeks after diagnosis, the rates were 63.2 % (MDT+) and 57.7 % (MDT-), p = 0.064. The adjusted hazard rate (HR) for death from colorectal cancer was 0.73 (0.53 to 1.00, p = 0.047) in the MDT+ group compared to the MDT- group, in patients surviving >6 weeks the adjusted HR was 1.00 (0.70 to 1.42, p = 0.987). Any benefit from the MDT process was largely confined to patients with advanced disease: adjusted HR ((early)) 1.32 (0.69 to 2.49, p = 0.401); adjusted HR((advanced)) 0.65 (0.45 to 0.96, p = 0.031). CONCLUSIONS: Adequate MDT processes are associated with improved survival for patients with colorectal cancer. However, some of this effect may be more apparent than real – simply reflecting selection bias. The MDT process predominantly benefits the 40 % of patients who present with advanced disease and conveys little demonstrable advantage to patients with early tumours. These results call into question the current belief that all new patients with colorectal cancer should be discussed at an MDT meeting

Blessing or Burden? The Impact of PTSD Service Dogs on Military Families

While PTSD service dogs are specifically trained to interact with their veterans, emerging evidence suggests that service dogs may also have an impact on other members of veteran households. To our knowledge, only one study quantifies these effects focused on veteran spouses (McCall et al., 2020). Our study aimed to quantitatively measure the impact of PTSD service dogs on military family wellbeing. Data was collected from survey responses of 88 veteran spouses who rated their experiences on standardized outcome measures. Each spouse answered the surveys at two time points: (1) baseline, and (2) three months post-baseline (follow-up). Spouses in the control group (n=40) were on the waitlist for a service dog for both baseline and follow-up, while the service dog group (n=48) received a service dog after baseline. Multiple regression analysis yielded statistically significant differences between the waitlist and service dog groups which suggested that service dogs may increase caregiver burden and decrease caregiver satisfaction, but potentially encourage increased participation in activities for veteran spouses. Small effect sizes suggested service dogs may also foster increased companionship and positive affect in veteran spouses. Analyses indicated no notable impact on veteran children. These findings suggest that the impact of PTSD service dogs may extend to veteran spouses, potentially encouraging interest and investment in this complementary intervention option. Two statistically significant negative effects emphasize the need to inform the military family of practical strategies to minimize possible detrimental effects, which would likely lead to an improved family experience with the service dog

Psychometric properties of the Zephyr bioharness device: A systematic review

© 2018 The Author(s). Background: Technological development and improvements in Wearable Physiological Monitoring devices, have facilitated the wireless and continuous field-based monitoring/capturing of physiologic measures in healthy, clinical or athletic populations. These devices have many applications for prevention and rehabilitation of musculoskeletal disorders, assuming reliable and valid data is collected. The purpose of this study was to appraise the quality and synthesize findings from published studies on psychometric properties of heart rate measurements taken with the Zephyr Bioharness device. Methods: We searched the Embase, Medline, PsycInfo, PuMed and Google Scholar databases to identify articles. Articles were appraised for quality using a structured clinical measurement specific appraisal tool. Two raters evaluated the quality and conducted data extraction. We extracted data on the reliability (intra-class correlation coefficients and standard error of measurement) and validity measures (Pearson/Spearman’s correlation coefficients) along with mean differences. Agreement parameters were summarised by the average biases and 95% limits of agreement. Results: A total of ten studies were included: quality ratings ranged from 54 to 92%. The intra-class correlation coefficients reported ranged from 0.85–0.98. The construct validity coefficients compared against gold standard calibrations or other commercially used devices, ranged from 0.74–0.99 and 0.67–0.98 respectively. Zephyr Bioharness agreement error ranged from − 4.81 (under-estimation) to 3.00 (over-estimation) beats per minute, with varying 95% limits of agreement, when compared with gold standard measures. Conclusion: Good to excellent quality evidence from ten studies suggested that the Zephyr Bioharness device can provide reliable and valid measurements of heart rate across multiple contexts, and that it displayed good agreements vs. gold standard comparators – supporting criterion validity

Ice and pulsed electromagnetic field to reduce pain and swelling after distal radius fractures

Objective: To examine the relative effectiveness of ice therapy and/or pulsed electromagnetic field in reducing pain and swelling after the immobilization period following a distal radius fracture.Methods: A total of 83 subjects were randomly allocated to receive 30 minutes of either ice plus pulsed electromagnetic field (group A); ice plus sham pulsed electromagnetic field (group B); pulsed electromagnetic field alone (group C), or sham pulsed electromagnetic field treatment for 5 consecutive days (group D). All subjects received a standard home exercise programme. A visual analogue scale was used for recording pain; volumetric displacement for measuring the swelling of the forearm; and a hand-held goniometer for measuring the range of wrist motions before treatment on days 1, 3 and 5.Results: At day 5, a significantly greater cumulative reduction in the visual analogue scores as well as ulnar deviation range of motion was found in group A than the other 3 groups. For volumetric measurement and pronation, participants in group A performed better than subjects in group D but not those in group B.Conclusion: The addition of pulsed electromagnetic field to ice therapy produces better overall treatment outcomes than ice alone, or pulsed electromagnetic field alone in pain reduction and range of joint motion in ulnar deviation and flexion for a distal radius fracture after an immobilization period of 6 weeks.<br /

Associations of military divorce with mental, behavioral, and physical health outcomes

Background Divorce has been linked with poor physical and mental health outcomes among civilians. Given the unique stressors experienced by U.S. service members, including lengthy and/or multiple deployments, this study aimed to examine the associations of recent divorce on health and military outcomes among a cohort of U.S. service members. Methods Millennium Cohort participants from the first enrollment panel, married at baseline (2001–2003), and married or divorced at follow-up (2004–2006), (N = 29,314). Those divorced were compared to those who remained married for mental, behavioral, physical health, and military outcomes using logistic regression models. Results Compared to those who remained married, recently divorced participants were significantly more likely to screen positive for new-onset posttraumatic stress disorder, depression, smoking initiation, binge drinking, alcohol-related problems, and experience moderate weight gain. However, they were also more likely be in the highest 15thpercentile of physical functioning, and be able to deploy within the subsequent 3-year period after divorce. Conclusions Recent divorce among military members was associated with adverse mental health outcomes and risky behaviors, but was also associated with higher odds of subsequent deployment. Attention should be given to those recently divorced regarding mental health and substance abuse treatment and prevention strategies

The prevalence of pain and disability one year post fracture of the distal radius in a UK population: A cross sectional survey

<p>Abstract</p> <p>Background</p> <p>A fracture of the distal radius is a commonly occurring fracture and accounts for a third of all fractures in the elderly. Thus far, one year estimates of pain and disability following a fracture of the distal radius have been reported on Canadian populations. The primary aim of this study is to investigate the prevalence of pain and disability in a UK population one year post fracture of the distal radius.</p> <p>Methods</p> <p>A cross-sectional survey was undertaken, of all subjects suffering a fracture of the distal radius between October 2005 and February 2006 in Nottingham, UK. Primary outcomes used were the VAS for pain and the DASH for disability. Prevalence of pain and disability were calculated and odds ratios presented for associations between demographics, pain and disability.</p> <p>Results</p> <p>93/264 (35%) subjects responded to the questionnaire. 6 subjects did not fulfill the inclusion criteria and were excluded from further analysis. 11% of subjects reported moderate to very severe pain. 16% of subjects reported moderate to very severe disability. Statistically significant associations were found between pain medication usage for the wrist fracture and moderate to very severe pain (OR 11.20, 95% CI 2.05 – 61.23). Moderate to very severe disability was associated with older age (OR 6.53, 95%CI 1.65 – 25.90) and pain medication usage for the wrist fracture (OR 4.75, 95% CI 1.38 – 16.37). Working was associated with a reduction in risk of moderate to very severe disability (OR 0.14, 95% CI 0.03 – 0.67).</p> <p>Conclusion</p> <p>This study demonstrates that there are a small proportion of patients who are still suffering moderate to very severe pain and disability one year post fracture of the distal radius. The study also demonstrates that there are significant associations between characteristics of the patients and the level of pain and disability. This highlights the need for further research into the most appropriate management of these patients in order to reduce this burden of pain and disability, particularly as this is a predominantly elderly patient group.</p

Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis

© 2017 Foundation of Rehabilitation Information. Objective: To perform a systematic review and meta- analysis of randomized controlled trials on the efficacy of workplace-based interventions to prevent or treat shoulder pain. Data sources: A systematic review of 4 databases was performed up to January 2016. Study selection: Randomized controlled trials were included if the intervention under study was a workplace- based intervention performed to prevent or reduce shoulder pain and disability in workers. Data extraction: The methodological quality of the studies was evaluated and meta-analyses were conducted. Pooled mean differences and risk ratios were calculated. Data synthesis: Data from 4 studies on strengthening exercises performed in the workplace for workers with shoulder pain (n = 368) were pooled. A statistically significant reduction in pain intensity was observed compared with different control interventions (mean differences (scale out of 10) 1.31 (95% confidence interval (95% CI) 0.86-1.76)). Pooled data from 5 studies on the efficacy of workstation modifications (n = 2,148) showed a statistically significant reduction in the prevalence of shoulder pain with a risk ratio of 1.88 (95% CI 1.20-2.96) compared with different control interventions. Conclusion: Low-grade evidence exists that a workplace exercise programme may reduce the intensity of shoulder pain, and that workstation modifications may reduce the prevalence of shoulder pain