Effects of the right carotid sinus compression technique on blood pressure and heart rate in medicated patients with hypertension

Objectives: To identify the immediate and middle-term effects of the right carotid sinus compression technique on blood pressure and heart rate in hypertensive patients. Design: Randomized blinded experimental study. Settings: Primary health centers of Cáceres (Spain). Subjects: Sixty-four medicated patients with hypertension were randomly assigned to an intervention group (n = 33) or to a control group (n = 31). Intervention: In the intervention group a compression of the right carotid sinus was applied for 20 sec. In the control group, a placebo technique of placing hands on the radial styloid processes was performed. Outcome measures: Blood pressure and heart rate were measured in both groups before the intervention (preintervention), immediately after the intervention, 5 min after the intervention, and 60 min after the intervention. Results: The intervention group significantly decreased systolic and diastolic blood pressure and heart rate immediately after the intervention, with a large clinical effect; systolic blood pressure remained reduced 5 min after the intervention, and heart rate remained reduced 60 min after the intervention. No significant changes were observed in the control group. Conclusions: Right carotid sinus compression could be clinically useful for regulating acute hypertension

Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial

This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a "sham" manipulation. A high-speed, low-amplitude technique was applied to the T9-T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 +/- 0.95 days) than the CG (2.39 +/- 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 +/- 1.88 episodes/year in total) than the CG (2 +/- 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (chi(2) (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9-T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients

Visceral origin: an underestimated source of neck pain

The diagnosis of neck pain is challenging. Many visceral disorders are known tocause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis.However, the absence of suspicion of any cause impedes one from establishing that specific aetiology asthe final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematicsearch of trials about neck pain was carried out to evaluate their selection criteria. The search yielded309 eligible articles, which were screened by two independent reviewers. The PEDro scale score wasused to assess the methodological quality of the studies. The following information was retrieved:number of authors affiliated to a clinical or non-clinical institution, number of citations in the Webof Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most citedtrials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartilejournals of the Journal Citation Reports, were selected. Females represented 67.5% of participants.A single study was of poor methodological quality (4/10). Based on the eligibility criteria of thearticles that were systematically reviewed, it would appear that visceral aetiology was not consideredin eighty percent of the trials on neck pain, showing a low level of suspicion both in research andclinical settings

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial

Objective: To evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). Design: Randomized, double-blind, placebo-controlled before and after trial. Setting: Rehabilitation area of the local hospital and a private physiotherapy center. Participants: Patients (NZ97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. Interventions: (A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. Main Outcomes Measures: The pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. Results: Groups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention. Conclusions: The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions

Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

Current evidence for widespread hyperalgesia in non-specific neck pain (NSNP) is unclear. It is currently recommended to group NSNP patients according to pain-provoking movements. The aim of this study was to investigate local and widespread pain sensitivity in females with unilateral NSNP that is reproducible during passive neck rotation compared with matched controls, and to compare the side specific effect of pain location on pressure pain sensitivity among females with unilateral NSNP. Thirty-six females with unilateral NSNP evoked during passive ipsilateral (n = 20) or contralateral (n = 16) rotation toward the painful side were compared with 20 controls. Participants reported their pain intensity at rest and during passive neck rotation and completed the Neck Disability Index. Pressure pain thresholds (PPTs) were assessed bilaterally over the anterior scalene; the sternocleidomastoid; the levator scapulae; lateral to the spinous process of C6; the median, ulnar, and radial nerves; and the tibialis anterior. The ANOVA revealed lower PPTs in females with unilateral NSNP compared with the controls (all at p < 0.001), but no differences were found between the sides, nor was there any Groupside interaction. Among females with NSNP, those with higher pain intensity during ipsilateral rotation toward the painful side showed lower PPTs over the anterior scalene, median nerve, ulnar nerve, and tibialis anterior (all, p < 0.05) than females with higher pain intensity during contralateral rotation toward the painful side. These findings demonstrated bilateral local and widespread pressure pain hyperalgesia in females with unilateral NSNP that was reproducible during passive neck rotation compared with controls. There was no side specific effect of pain location on PPTs among females with unilateral NSNP.Ministerio de Educación, Cultura y Deporte (CAS 16/00046

Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement

Background. Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients. Objectives. Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed "reinforced feedback virtual environment" (RFVE). Methods. The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total). Results. The MAS and FAC reached statistical significance (P<0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=-0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke. Conclusions. The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools

Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach

Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP

Changes in body balance and functional performance following whole-body vibration training in patients withfibromyalgia syndrome: a randomized controlled trial.

Objective: To determine whether an 8-week exercise pro-gramme supplemented with whole-body vibration improves body balance and dynamic strength in women with fibro-myalgia. Design: Randomized controlled trial. Patients: Forty-six participants diagnosed with fibromyal-gia. Methods: Participants were randomly assigned to: (i) an exercise training group with whole-body vibration (n=15), which performed twice-weekly exercise sessions (aerobic ex-ercise, strengthening and flexibility) combined with 3 whole-body vibration training sessions a week (bilateral squats: 6–9 sets of 30 s with 45-s recovery between sets; and uni-lateral squat: 4–7 sets of 30 s, 30 Hz–4 mm); (ii) an exercise group (n=15) with the same combined exercise therapy; and (iii) a usual-care control group (n=16). Results: Statistically significant improvements in the Medio–Lateral Stability Index and Medio–Lateral Mean Deflection with open eyes were found in the whole-body vibration exer-cise group compared with the control group. Non-significant effects were found for lower-limb physical function. Conclusion: The results show that a traditional exercise pro-gramme, supplemented with whole-body vibration training, improved balance in women with fibromyalgia. This may represent a key factor for falls prevention in this patient grou

Effect of Whole-Body Vibration Exercise on Balance in Women with Fibromyalgia Syndrome: A Randomized Controlled Trial

Objectives: This study evaluated the effectiveness of a 6-week ‘‘usual care’’ exercise program supplemented with whole-body vibration (WBV) to improve balance and strength in women with fibromyalgia (FM). Design: This was a randomized controlled study. Settings: The setting was a physical therapy department in an academic setting. Subjects: The subjects were 30 postmenopausal women with FM (age: 59 – 7.90 years). Interventions: Subjects were randomized into one of two groups: an experimental group (EG: n = 15), which combined exercise training (2 days a week) with 3 days of WBV, and a control group (CG: n = 15), who performed the same exercise training program (2 days a week) but without WBV. Outcome measures: Balance and muscle strength were measured at baseline and after the 6-week intervention. Results: Significant differences were found ( p < 0.05) between the study groups for the Medio–Lateral Stability Index (MLSI), when patients were assessed with their eyes open and closed. The effect size of the improvement was large with eyes closed (R2 = 0.260) and moderate when the eyes were open (R2 = 0.047). However, no significant differences were found ( p > 0.05) between the study groups for other outcomes. Conclusions: Women with FM may increase their MLSI by engaging in a 6-week traditional exercise program with supplementary WBV. This may have implications for falls prevention in this patient group