Photobiomodulation in Sciatic Nerve Crush Injuries in Rodents: A Systematic Review of the Literature and Perspectives for Clinical Treatment

Introduction: The aim of the study was to perform a literature review to analyze the effect of photobiomodulation in experimental studies on peripheral nerve regeneration after sciatic nerve crush injury in rodents.Methods: A bibliographic search was performed in the electronic databases, including MEDLINE (PubMed), SCOPUS, and SciELO, from 2008 to 2018.Results: A total of 1912 articles were identified in the search, and only 19 fulfilled all the inclusion criteria. Along with the parameters most found in the manuscripts, the most used wavelengths were 660 nm and 830 nm, power of 30 and 40 mW, and energy density of 4 and 10 J/cm2. For total energy throughout the intervention period, the lowest energy found with positive effects was 0.70 J, and the highest 1.141 J. Seventeen studies reported positive effects on nerve regeneration. The variables selected to analyze the effect were: Sciatic Functional Index (SFI), Static Sciatic Index (SSI), morphometric, morphological, histological, zymographic, electrophysiological, resistance mechanics and range of motion (ROM). The variety of parameters used in the studies demonstrated that there is yet no pre-determined protocol for treating peripheral nerve regeneration. Only two studies by different authors used the same power, energy density, beam area, and power density.Conclusion: It was concluded that the therapeutic window of the photobiomodulation presents a high variability of parameters with the wavelength (632.8 to 940 nm), power (5 to 170 mW) and energy density (3 to 280 J /cm2), promoting nerve regeneration through the expression of cytokines and growth factors that aid in modulating the inflammatory process, improving morphological aspects, restoring the functionality to the animals in a brief period.Keywords: Phototherapy; Nerve regeneration; Sciatic nerve; Experimental studies; Injury; Lasers and light sources

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: Systematic review of psychometric properties

© 2018 The Author(s). Background: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. Methods: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. Results: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. Conclusions: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective

Capacidad para el trabajo y síntomas osteomusculares en trabajadores de un hospital público

El objetivo de este estudio fue conocer el perfil sociodemográfico, identificar las quejas osteomusculares y evaluar la capacidad para el trabajo de los trabajadores de un hospital público. Es un estudio cuantitativo, analítico y transversal. 31 servidores del Hospital das Clínicas de la Facultad de Medicina de Ribeirão Preto de la Universidad de São Paulo y de la Unidad de Emergencia de Ribeirão Preto fueron evaluados y encaminados al servicio de Fisioterapia en el Centro de Rehabilitación en el período de mayo a diciembre de 2012. Dos cuestionarios fueron aplicados: el Cuestionario Nórdico de Síntomas Osteomusculares, de carácter sociodemográfico y desarrollado por los pesquisidores deste estudio, para la tipificación y mensuración de relatos de los síntomas osteomusculares, y el Cuestionario Índice de Capacidad para el Trabajo, que posibilita la evaluación y detección precoz de alteraciones en la calidad de vida de los trabajadores. Los 31 evaluados tienen, en media, 46,5±11,8 años, siendo 27 mujeres y 4 hombres. Las ocupaciones con mayor prevalencia fueron: auxiliar de enfermería (19,3%), auxiliar de servicios (19,3%) y tesoreros (16,13%). 74,2% no practican actividades físicas, 38,7% tienen más de 20 años en el servicio y 64,5% pasan mucho tiempo de pie. La mayoría de las quejas osteomusculares tenía relación con las rodillas, después con los hombros y lumbar. La media del Índice de Capacidad para el Trabajo fue de 33,84±8,35, revelando una capacidad para el trabajo moderada. Los resultados presentados muestran la necesidad de la evaluación de las condiciones laborales, basada en una evaluación ergonómica con base en los aspectos físicos, cognitivos y organizacionales, cómo estrategia correctiva y/o preventiva de las lesiones osteomusculares y de la mejoría de la capacidad de realización del trabajo.O objetivo do estudo foi conhecer o perfil sociodemográfico, identificar as queixas osteomusculares e avaliar a capacidade para o trabalho de trabalhadores de um hospital público. Trata-se de um estudo quantitativo, analítico e transversal. Constituiu-se de 31 servidores do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e da Unidade de Emergência de Ribeirão Preto, que foram encaminhados ao serviço de Fisioterapia no Centro de Reabilitação no período de maio a dezembro de 2012. Três questionários foram aplicados: o Questionário Sociodemográfico, que foi desenvolvido pelos pesquisadores deste estudo, o Questionário Nórdico de Sintomas Osteomusculares, que visa a padronizar a mensuração de relatos de sintomas osteomusculares, e o questionário Índice de Capacidade para o Trabalho, que possibilita a avaliação e detecção precoce de alterações na qualidade de vida dos trabalhadores. Os 31 avaliados possuem, em média, 46,5±11,8 anos, sendo 27 mulheres e 4 homens. As ocupações mais prevalentes foram: auxiliar de enfermagem (19,3%), auxiliar de serviços (19,3%) e escriturário (16,13%). Um total de 74,2% deles não praticam atividade física, 38,7% possuem mais de 20 anos no serviço e 64,5% ficam a maior parte do tempo em pé. A prevalência das queixas osteomusculares tinha relação com os joelhos, seguida das relacionadas aos ombros e lombar. A média do Índice de Capacidade para o trabalho foi de 33,84±8,35, revelando uma capacidade para o trabalho moderada. Os resultados apresentados apontam a necessidade de avaliação das condições laborais, com base em uma avaliação ergonômica fundada nos aspectos físicos, cognitivos e organizacionais do trabalho, como estratégia corretiva e/ou preventiva das lesões osteomusculares e da melhoria da capacidade de realização do trabalho.This paper aimed to characterize the sociodemographic profile, identify musculoskeletal complaints and evaluate the work ability of a public hospital workers. This study is quantitative, analytical and cross-sectional, consisted of 31 Hospital das Clinicas' workers, from the School of Medicine, at the University of São Paulo, and the Emergency Unit of Ribeirão Preto, Brazil, which were referred to the physiotherapy service at the Centre for Rehabilitation in the period from May to December 2012. Three questionnaires were administered: the Sociographic Questionnaire, developed by the researchers of this study, the Nordic Musculoskeletal Questionnaire, with socio-demographic intent, which aims to standardize the measurement of reported musculoskeletal symptoms, and the questionnaire Index Capacity for Work, that enables the assessment and early detection of changes in the quality of life of these workers. A total of 31 workers reviews have, on average, 46.5±11.8 years, being 27 women and 4 men. The prevalent occupations were: nursing assistant (19.3 %), auxiliary services (19.3 %) and clerks (16.13%). A number of 74.2 % did not engage in physical activity, 38.7 % have more than 20 years in service and 64.5 % are most of the time standing. The higher prevalence of musculoskeletal complaints was related to the knees, followed by shoulders and lower back. The average Index Capacity for Work was 33.84±8.35, revealing a moderate capacity to work. The presented results indicate the need to evaluate working conditions, based on an ergonomic evaluation consisted of physical, cognitive and organizational aspects of work, as well as corrective and/or preventive strategy of musculoskeletal injuries and improvements of the capacity to work

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

Abstract\ud \ud Background\ud Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome.\ud \ud \ud Methods/Design\ud Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test.\ud \ud \ud Discussion\ud This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome.\ud \ud \ud Trial registration\ud Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184FAPESPFAEP

Ascorbic acid iontophoresis for chondral gain in rats with arthritis

OBJECTIVES: To examine the cellularity and thickness of the articular cartilage of the femur in rats with arthritis after treatment with iontophoresis. METHODS: To evaluate these objectives, a histological analysis was performed on hematoxylin and eosin, where cellularity and cartilage thickness were observed and evaluated qualitatively and quantitatively by manual counting by 700.09µm² area. RESULTS: The group treated with IAA had normal cellularity (40.1 cells/μm2) and maintenance of non-calcified cartilage (75.5μm), suggesting normal thickness. The non-treated group C+, on the other hand, had a lower mean number of chondrocytes (13.0μm2) (P <0.05) and, when the cartilage thickness was compared, it showed higher average thickness of calcified cartilage (104.8 mm) and lower mean of non-calcified cartilage (53.3μm) CONCLUSION: The use of iontophoresis with L-ascorbic acid by continuous electric current contributed to a quantitative gain of chondrocytes and improved the thickness distribution of calcified and non-calcified cartilage. Level of Evidence III, Case Control Study.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Capacidade para o trabalho e sintomas osteomusculares em trabalhadores de um hospital público

O objetivo do estudo foi conhecer o perfil sociodemográfico, identificar as queixas osteomusculares e avaliar a capacidade para o trabalho de trabalhadores de um hospital público. Trata-se de um estudo quantitativo, analítico e transversal. Constituiu-se de 31 servidores do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e da Unidade de Emergência de Ribeirão Preto, que foram encaminhados ao serviço de Fisioterapia no Centro de Reabilitação no período de maio a dezembro de 2012. Três questionários foram aplicados: o Questionário Sociodemográfico, que foi desenvolvido pelos pesquisadores deste estudo, o Questionário Nórdico de Sintomas Osteomusculares, que visa a padronizar a mensuração de relatos de sintomas osteomusculares, e o questionário Índice de Capacidade para o Trabalho, que possibilita a avaliação e detecção precoce de alterações na qualidade de vida dos trabalhadores. Os 31 avaliados possuem, em média, 46,5±11,8 anos, sendo 27 mulheres e 4 homens. As ocupações mais prevalentes foram: auxiliar de enfermagem (19,3%), auxiliar de serviços (19,3%) e escriturário (16,13%). Um total de 74,2% deles não praticam atividade física, 38,7% possuem mais de 20 anos no serviço e 64,5% ficam a maior parte do tempo em pé. A prevalência das queixas osteomusculares tinha relação com os joelhos, seguida das relacionadas aos ombros e lombar. A média do Índice de Capacidade para o trabalho foi de 33,84±8,35, revelando uma capacidade para o trabalho moderada. Os resultados apresentados apontam a necessidade de avaliação das condições laborais, com base em uma avaliação ergonômica fundada nos aspectos físicos, cognitivos e organizacionais do trabalho, como estratégia corretiva e/ou preventiva das lesões osteomusculares e da melhoria da capacidade de realização do trabalho

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

Abstract Background Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184</p