The association between cognitive impairment, gait speed, and Walk ratio

Background: Gait speed has been found to be associated with cognitive function. However, gait speed is an unspecific measure that may not be informative about gait patterns. The Walk ratio (step length divided by step frequency) can be measured without specialized equipment, and has been suggested as an indicator of central gait control. However, the association with cognitive function is unknown. Research question: Is there a relationship between Walk ratio and cognitive function, and gait speed and cognitive function? Methods: This was a systematic literature review of studies where spatiotemporal gait parameters was reported in populations with cognitive impairment. The search was performed through PubMed, PEDro, AMED, Cochrane, Embase, MEDLINE, and PsycINFO. The studies had to contain either the Walk ratio, or report average step length and average step frequency. In the latter case, the average step length was divided by the average step frequency. The studies also had to report gait speed and the minimal mental state examination (MMSE). Studies testing patients on treadmills or that did not state the exclusion of patients with neurologic or orthopedic diseases, possible affecting gait ability, were excluded. Results: A total of 24 studies were included, consisting of 909 patients with cognitive impairment and 4,108 healthy controls. The patient group had a lower Walk ratio (mean difference 0.07, p ≤ 0.001) and gait speed (mean difference 0.26, p ≤ 0.001) than the healthy controls. Using linear regression models, we found an association between the MMSE and the Walk ratio (R2 = 0.29, p < 0.001) and gait speed (R2 = 0.41, p < 0.001) in separate, unadjusted models. In a final model with Walk ratio, gait speed and age, Walk ratio was not significantly associated with MMSE, while gait speed was. Significance: Our results suggest that preferred gait speed may be preferable to the Walk ratio when assessing older adults with cognitive impairment.publishedVersio

Pain pressure threshold algometry in knee osteoarthritis: intra- and inter-rater reliability

Introduction: Synovitis and effusion can cause pain sensitization in persons with knee osteoarthritis (KOA). Pain Pressure Threshold (PPT) algometry is a means to quantify somatosensory abnormalities, including inflammatory-mediated pressure hyperalgesia. We investigated the reliability of PPT algometry with three raters. Methods: Twenty-seven persons (50 knees) with KOA, according to the American College of Rheumatology criteria, were included. The PPT of the most tender spot in the joint line of each knee, identified by palpation, was assessed using a digital pressure algometer with a round 1 cm2 rubber tip. The algometer was applied three times with at least twenty-second intervals by three physiotherapists each in a single session. Two of the physiotherapists had no experience with the procedure prior to the study. We estimated the Intraclass Correlation Coefficient (ICC) model 2.1, 95% within-subject standard deviation (sw), and Minimal Detectable Difference (MDD). Results: The mean PPTs ranged from 39.94 to 41.81 Newton (N), the intra-rater ICC ranged from 0.909 to 0.956, the sw ranged from 6.44 to 10.77 N, and the related MDD ranged from 9.11 to 15.23 N. The three raters achieved an inter-rater ICC of 0.707, an sw of 17.68 N, and an MDD of 25.01 N. The results were homoscedastic. Conclusions: Our results indicate that PPT algometry is a suitable method for assessment of pain in osteoarthritic knees. After a short session of PPT procedure training, good intra-rater and acceptable inter-rater ICCs were achieved.publishedVersio

Measuring pressure pain threshold in the cervical region of dizzy patients-The reliability of a pressure algometer

Objectives: A tool for measuring neck pain in patients with dizziness is needed to further investigate the relationship between the two symptoms. The objective of this study was to examine the reliability and validity of a hand‐held pressure algometer in measuring pressure pain threshold (PPT) in different cervical regions of dizzy patients. Methods: PPT was measured at two bilateral standardized sites of the neck by a trained physiotherapist in 50 patients with dizziness. Intraclass correlation coefficients (ICC) were calculated for intrarater and test–retest reliability. Concurrent validity was assessed by measuring the association between PPT and the American College of Rheumatology (ACR) tender points at each site and with the numeric pain rating scale (NPRS). Results: Almost perfect intrarater (ICC = 0.815–0.940) and within‐session test–retest (ICC = 0.854–0.906) reliability was found between the measures. On each site, a low PPT predicted a positive ACR tender point at each site (OR = 0.864–0.922). Last, we found a statistical inverse relationship between the PPT and the NPRS (R = −0.52 to −0.66). Conclusion: The study shows that a pressure algometer is a reliable tool for measuring PPT in the neck of dizzy patients. Further, the PPT correlates significantly with other subjective measures of pain indicating that it may be a useful tool for further research.publishedVersio

Effectiveness of Low-Level Laser Therapy Associated with Strength Training in Knee Osteoarthritis: Protocol for a Randomized Placebo-Controlled Trial

Physical activity and low-level laser therapy (LLLT) can reduce knee osteoarthritis (KOA) inflammation. We are conducting a randomized placebo-controlled trial to investigate the long-term effectiveness of LLLT combined with strength training (ST) in persons with KOA, since it, to our knowledge, has not been investigated before. Fifty participants were enrolled. LLLT and ST was performed 3 times per week over 3 and 8 weeks, respectively. In the LLLT group, 3 Joules of 904 nm wavelength laser was applied to 15 spots per knee (45 Joules/knee/session). The primary outcomes are pain during movement, at night and at rest (Visual Analogue Scale) and global pain (Knee injury and Osteoarthritis Outcome Score, KOOS) pain subscale. The secondary outcomes are KOOS disability and quality-of-life, analgesic usage, global health change, knee active range of motion, 30 s chair stand, maximum painless isometric knee extension strength, knee pain pressure threshold and real-time ultrasonography-assessed suprapatellar effusion, meniscal neovascularization and femur cartilage thickness. All the outcomes are assessed 0, 3, 8, 26 and 52 weeks post-randomization, except for global health change, which is only evaluated at completed ST. This study features the blinding of participants, assessors and therapists, and will improve our understanding of what occurs with the local pathophysiology, tissue morphology and clinical status of persons with KOA up to a year after the initiation of ST and a higher 904 nm LLLT dose than in any published trial on this topic.publishedVersio

Photobiomodulation Therapy is Able to Modulate PGE2 Levels in Patients With Chronic Non‐Specific Low Back Pain: A Randomized Placebo‐Controlled Trial

Background and Objectives Non-specific low back pain (LBP) is responsible for triggering increased biomarkers levels. In this way, photobiomodulation therapy (PBMT) may be an interesting alternative to treat these patients. One of the possible biological mechanisms of PBMT involved to decrease pain intensity in patients with musculoskeletal disorders is modulation of the inflammatory mediators’ levels. The aim of this study was to evaluate the effects of PBMT compared with placebo on inflammatory mediators’ levels and pain intensity in patients with chronic non-specific LBP. Study Design/Materials and Methods A prospectively registered, randomized triple-blinded (volunteers, therapists, and assessors), placebo-controlled trial was performed. Eighteen patients with chronic non-specific LBP were recruited and treated with a single session of active PBMT or placebo PBMT. The primary outcome of the study was serum prostaglandin E2 levels and the secondary outcomes were tumor necrosis factor-α, interleukin-6 levels, and pain intensity. All outcomes were measured before and after 15 minutes of treatment session. Results PBMT was able to decrease prostaglandin E2 levels at post-treatment compared with placebo, with a mean difference of −1470 pg/ml, 95% confidence interval −2906 to −33.67 in patients with LBP. There was no difference between groups in the other measured outcomes. Patients did not report any adverse events. Conclusion Our results suggest that PBMT was able to modulate prostaglandin E2 levels, indicating that this may be one of the mechanisms involved in the analgesic effects of PBMT in patients with LBP.publishedVersio

Short-and Long-Term Effectiveness of Low-Level Laser Therapy Combined with Strength Training in Knee Osteoarthritis: A Randomized Placebo-Controlled Trial

Background: Both physical activity and low-level laser therapy (LLLT) can reduce knee osteoarthritis (KOA) inflammation. We conducted a randomized clinical trial to investigate the short- and long-term effectiveness of LLLT combined with strength training in persons with KOA. Methods: Fifty participants were randomly divided in two groups, one with LLLT plus strength training (n = 26) and one with placebo LLLT plus strength training (n = 24). LLLT and strength training were performed triweekly for 3 and 8 weeks, respectively. In the laser group, 3 joules 904 nm wavelength laser was applied to fifteen points (45 joules) per knee per session. Patient-reported outcomes, physical tests, and ultrasonography assessments were performed at baseline and 3, 8, 26, and 52 weeks after initial LLLT or placebo therapy. The primary outcomes were pain on movement, at rest, at night (Visual Analogue Scale), and globally (Knee injury and Osteoarthritis Outcome Score (KOOS) subscale). Parametric data were assessed with analysis of variance using Šidák’s correction. Results: There were no significant between-group differences in the primary outcomes. However, in the laser group there was a significantly reduced number of participants using analgesic and non-steroidal anti-inflammatory drugs and increased performance in the sit-to-stand test versus placebo-control at week 52. The joint line pain pressure threshold (PPT) improved more in the placebo group than in the laser group, but only significantly at week 8. No other significant treatment effects were present. However, pain on movement and joint line PPT were worse in the placebo group at baseline, and therefore, it had more room for improvement. The short-term percentage of improvement in the placebo group was much higher than in similar trials. Conclusions: Pain was reduced substantially in both groups. LLLT seemed to provide a positive add-on effect in the follow-up period in terms of reduced pain medication usage and increased performance in the sit-to-stand test.publishedVersio

A reimbursement-based historical analysis of primary care physiotherapists practice in an evidence-based and financial perspective during 1984-2008

Research question: Has primary care physiotherapists changed their pattern of reimbursement , and are these changes correlated to financial or scientific changes in reimbursement rates and frequencies ? Design: Longitudinal study with descriptive statistics analysis Method: Historical development of reimbursement rates and their correlation with their respective reimbursement frequencies. Material: Historical data for reimbursement rates from 1988 to 2008, and reimbursement frequencies from 1998 to 2008. Results: This analysis shows that physical therapists examine less and deliver less individual treatment than before. Nearly one in four patients is now treated in groups. Major changes (>20%) in reimbursement rates were significantly associated with changes in clinical physiotherapy practice. Regulatory intervention stopping overlap between patient treatments, resulted in fewer treatments delivered per physiotherapist. Conclusion: Primary care physiotherapists changed their practice to less individual examinations, less individual and physical modality treatments towards increased use of group exercise treatments. Major changes in reimbursement rates seemed to initiate shifts in treatment preferences. Our data suggest an evolution of two distinctly different physiotherapist roles in primary care; the autonomous examiner/therapist working on an individual patient/therapist basis, and the exercise therapy group instructor. The physiotherapy profession may need to clarify what role future primary care physiotherapists should possess

Pain pressure threshold algometry in knee osteoarthritis: intra- and inter-rater reliability

Introduction: Synovitis and effusion can cause pain sensitization in persons with knee osteoarthritis (KOA). Pain Pressure Threshold (PPT) algometry is a means to quantify somatosensory abnormalities, including inflammatory-mediated pressure hyperalgesia. We investigated the reliability of PPT algometry with three raters. Methods: Twenty-seven persons (50 knees) with KOA, according to the American College of Rheumatology criteria, were included. The PPT of the most tender spot in the joint line of each knee, identified by palpation, was assessed using a digital pressure algometer with a round 1 cm2 rubber tip. The algometer was applied three times with at least twenty-second intervals by three physiotherapists each in a single session. Two of the physiotherapists had no experience with the procedure prior to the study. We estimated the Intraclass Correlation Coefficient (ICC) model 2.1, 95% within-subject standard deviation (sw), and Minimal Detectable Difference (MDD). Results: The mean PPTs ranged from 39.94 to 41.81 Newton (N), the intra-rater ICC ranged from 0.909 to 0.956, the sw ranged from 6.44 to 10.77 N, and the related MDD ranged from 9.11 to 15.23 N. The three raters achieved an inter-rater ICC of 0.707, an sw of 17.68 N, and an MDD of 25.01 N. The results were homoscedastic. Conclusions: Our results indicate that PPT algometry is a suitable method for assessment of pain in osteoarthritic knees. After a short session of PPT procedure training, good intra-rater and acceptable inter-rater ICCs were achieved

Measuring pressure pain threshold in the cervical region of dizzy patients-The reliability of a pressure algometer

Objectives: A tool for measuring neck pain in patients with dizziness is needed to further investigate the relationship between the two symptoms. The objective of this study was to examine the reliability and validity of a hand‐held pressure algometer in measuring pressure pain threshold (PPT) in different cervical regions of dizzy patients. Methods: PPT was measured at two bilateral standardized sites of the neck by a trained physiotherapist in 50 patients with dizziness. Intraclass correlation coefficients (ICC) were calculated for intrarater and test–retest reliability. Concurrent validity was assessed by measuring the association between PPT and the American College of Rheumatology (ACR) tender points at each site and with the numeric pain rating scale (NPRS). Results: Almost perfect intrarater (ICC = 0.815–0.940) and within‐session test–retest (ICC = 0.854–0.906) reliability was found between the measures. On each site, a low PPT predicted a positive ACR tender point at each site (OR = 0.864–0.922). Last, we found a statistical inverse relationship between the PPT and the NPRS (R = −0.52 to −0.66). Conclusion: The study shows that a pressure algometer is a reliable tool for measuring PPT in the neck of dizzy patients. Further, the PPT correlates significantly with other subjective measures of pain indicating that it may be a useful tool for further research

Efficacy of low-level laser therapy in patients with lower extremity tendinopathy or plantar fasciitis: systematic review and meta-analysis of randomised controlled trials

Objectives We investigated the effectiveness of low-level laser therapy (LLLT) in lower extremity tendinopathy and plantar fasciitis on patient-reported pain and disability. Design Systematic review and meta-analysis. Data sources Eligible articles in any language were identified through PubMed, Embase and Physiotherapy Evidence Database (PEDro) on the 20 August 2020, references, citations and experts. Eligibility criteria for selection of studies Only randomised controlled trials involving participants with lower extremity tendinopathy or plantar fasciitis treated with LLLT were included. Data extraction and synthesis Random effects meta-analyses with dose subgroups based on the World Association for Laser Therapy treatment recommendations were conducted. Risk of bias was assessed with the PEDro scale. Results LLLT was compared with placebo (10 trials), other interventions (5 trials) and as an add-on intervention (3 trials). The study quality was moderate to high. Overall, pain was significantly reduced by LLLT at completed therapy (13.15 mm Visual Analogue Scale (VAS; 95% CI 7.82 to 18.48)) and 4–12 weeks later (12.56 mm VAS (95% CI 5.69 to 19.42)). Overall, disability was significantly reduced by LLLT at completed therapy (Standardised Mean Difference (SMD)=0.39 (95% CI 0.09 to 0.7) and 4–9 weeks later (SMD=0.32 (95% CI 0.05 to 0.59)). Compared with placebo control, the recommended doses significantly reduced pain at completed therapy (14.98 mm VAS (95% CI 3.74 to 26.22)) and 4–8 weeks later (14.00 mm VAS (95% CI 2.81 to 25.19)). The recommended doses significantly reduced pain as an add-on to exercise therapy versus exercise therapy alone at completed therapy (18.15 mm VAS (95% CI 10.55 to 25.76)) and 4–9 weeks later (15.90 mm VAS (95% CI 2.3 to 29.51)). No adverse events were reported. Conclusion LLLT significantly reduces pain and disability in lower extremity tendinopathy and plantar fasciitis in the short and medium term. Long-term data were not available. Some uncertainty about the effect size remains due to wide CIs and lack of large trials.publishedVersio