scholarly journals The Effects of Visuomotor Training on the Functional Recovery of Post-Surgery Musculoskeletal Conditions: A Randomized Controlled Trial

2021 ◽  
Vol 11 (9) ◽  
pp. 4053
Author(s):  
Elisa Andrenelli ◽  
Luciano Sabbatini ◽  
Maurizio Ricci ◽  
Maria Gabriella Ceravolo ◽  
Marianna Capecci
Keyword(s):  
Motor Function ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Controlled Trial ◽  
Musculoskeletal Conditions ◽  
Post Surgery ◽  
Pain Scores ◽  
To Receive ◽  
Human Burden ◽  
Minimally Clinical Important Difference

(1) Background: Musculoskeletal conditions show increasing prevalence and high economic/human burden. Recovery for hip or knee surgery may require more than 26 weeks, while universally accepted rehabilitation guidelines are missing. Provided that multisensory-based training enhances motor learning, the study aims to verify if visuomotor training accelerates the recovery of lower limb motor function after orthopedic surgery. (2) Methods: Post-surgery subjects were randomly assigned to receive visuomotor training as an add-on to the conventional physical therapy (VTG), or receive the conventional therapy alone (CG). Subjects performed 40 one-hour training sessions in 8 weeks. The primary endpoint was the improvement in the Lower Extremity Functional Scale (LEFS) over the minimally clinical important difference (MCID) at 4 weeks post-randomization. The secondary endpoint included pain reduction. (3) Results: Eighteen patients were equally distributed into the VTG and CG groups. While LEFS and pain scores significantly improved in both groups, the VTG exceeded the LEFS MCID by 12 points and halved the pain value after the first 4 weeks of treatment, while the CG reached the endpoints only after treatment end (p = 0.0001). (4) Conclusions: Visuomotor training offers an innovative rehabilitation approach that accelerates the recovery of lower limb motor function in patients undergoing orthopedic surgery.

scholarly journals The Quality of Recovery after Dexamethasone, Ondansetron, or Placebo Administration in Patients Undergoing Lower Limbs Orthopedic Surgery under Spinal Anesthesia Using Intrathecal Morphine. A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Eduardo Toshiyuki Moro ◽  
Miguel Antônio Teixeira Ferreira ◽  
Renyer dos Santos Gonçalves ◽  
Roberta Costa Vargas ◽  
Samira Joverno Calil ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Intrathecal Morphine ◽  
Controlled Trial ◽  
Lower Limbs ◽  
Postanesthesia Care Unit ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
To Receive

Intrathecal morphine is widely and successfully used to prevent postoperative pain after orthopedic surgery, but it is frequently associated with side effects. The aim of this study was to evaluate the effect of dexamethasone or ondansetron when compared to placebo to reduce the occurrence of these undesirable effects and, consequently, to improve the quality of recovery based on patient’s perspective. Methods. One hundred and thirty-five patients undergoing lower extremity orthopedic surgery under spinal anesthesia using bupivacaine and morphine were randomly assigned to receive IV dexamethasone, ondansetron, or saline. On the morning following surgery, a quality of recovery questionnaire (QoR-40) was completed. Results. No differences were detected in the global and dimensional QoR-40 scores following surgery; however, following postanesthesia care unit (PACU) discharge, pain scores were higher in patients receiving ondansetron compared with patients who received dexamethasone. Conclusion. Neither ondansetron nor dexamethasone improves the quality of recovery after lower limbs orthopedic surgery under spinal anesthesia using intrathecal morphine.

Impact of Temperature on Injection-Related Pain Caused by Subcutaneous Administration of Ustekinumab: A Three-arm Crossover Open-label Randomized Controlled Trial

2017 ◽  
Vol 1 (3) ◽  
pp. 117-127
Author(s):  
Yasaman Mansouri ◽  
Yasmin Amir ◽  
Michelle Min ◽  
Raveena Khanna ◽  
Ruiqi Huang ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Subcutaneous Administration ◽  
Open Label ◽  
Post Dose ◽  
Subcutaneous Injections ◽  
Pain Scores ◽  
Observational Cohort ◽  
Vas Scores ◽  
Pre Treatment ◽  
To Receive

Background: Adherence to subcutaneous biologic agents for the treatment of psoriasis can be negatively influenced by injection pain.Objective: To explore the differences in injection site pain when patients are pre-treated with heat or cold, versus no pre-treatment prior to administration of a subcutaneous biologic agent.Methods: In an observational cohort study, patients receiving subcutaneous injections of ustekinumab were randomly assigned to receive pretreatment with ice, heat, or no intervention over three visits. Post-dose, patients rated pain on a 100 mm visual analogue scale (VAS).Results: There was an increase in the VAS score for both heat (2.51, P=0.30) and ice (3.33, P=0.16), compared to no intervention. No differences were found between the two intervention groups (-0.83, P=0.73). On average, females had the same VAS scores with ice compared to that of no intervention (-0.12, P=0.97) and a non–significant decrease of 3.29 points (P=0.38) with heat. Males had increased pain scores by 5.65 points (P=0.07) with ice and by 6.39 points (P=0.04) with heat.Limitations: Pain is a subjective measurement and objective quantification is difficult.Conclusions: On average, neither heat nor cold application reliably reduced pain. Our results do not support the application of heat or cold prior to ustekinumab injection.

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial

Hand ◽  
2019 ◽  
pp. 155894471988466
Author(s):  
J. Randall Patrinely ◽  
Shepard P. Johnson ◽  
Brian C. Drolet
Keyword(s):  
Local Anesthetic ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Treatment Method ◽  
Trigger Finger ◽  
Injection Pain ◽  
Double Blind ◽  
Pain Scores ◽  
Injection Methods ◽  
To Receive

Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.

“Prospective, Randomized, Controlled Trial of Ultra-modified Internal Sphincterotomy vs Closed Lateral Internal Sphincterotomy for Chronic Fissure-in-Ano”

2021 ◽  
pp. 000313482110111
Author(s):  
Ugur Sungurtekin ◽  
Utku Ozgen ◽  
Hulya Sungurtekin
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Internal Sphincter ◽  
Cleveland Clinic ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Randomized Controlled ◽  
Post Surgery ◽  
Pain Scores ◽  
Prospective Randomized Controlled Trial

Background Currently, the lateral internal sphincterotomy is the treatment of choice for a chronic anal fissure (CAF). However, the length of the internal sphincter incision varies, due to lack of standardization. Insufficient length increases the risk of recurrence. To compare a new ultra-modified internal sphincterotomy (UMIS) to the closed lateral internal sphincterotomy (CLIS) for treating CAF, based on internal anal sphincter function and postoperative complications. The primary endpoint was continence after UMIS. The secondary outcomes were CAF healing complications, visual analog scale pain scores, and sphincter pressures. Methods This was a prospective, randomized, controlled trial (block randomization method). 200 patients with CAFs were randomly assigned to receive either UMIS (n = 100) or the closed lateral internal sphincterotomy (CLIS) (n = 100). Follow-up was 2 years. RESULTS: All (100%) patients in both groups showed clinical improvement at 1 month post-surgery. Recurrences were accompanied by deteriorations in Cleveland Clinic Florida Fecal Incontinence scores at 12 months and 2 years ( P < .05). The groups showed significant differences in fissure healing rates and pain scores. After 1 and 2 years, incontinence rates were significantly higher, and patient satisfaction scores were significantly lower in the CLIS group than the UMIS group ( P < .05). Conclusion UMIS provided a faster healing rate and fewer side effects than the CLIS for treating CAFs. These results might lead to a standardized treatment among surgeons.

scholarly journals Effectiveness of combined modified constraint-induced movement therapy for upper and lower limb in stroke rehabilitation: a study protocol for randomized controlled trial (Preprint)

2018 ◽  
Author(s):  
Lawan Umar
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Gait Speed ◽  
Stride Length ◽  
Controlled Trial ◽  
Stroke Survivors ◽  
Hrqol Score ◽  
Randomized Controlled ◽  
Post Hoc

BACKGROUND Background: The translation of neuroscientific research into care has led to new approaches and renewed promise. Stroke survivors with hemiparesis often exhibit impaired balance, ambulation dysfunction and asymmetrical weight distribution leading to physical dysfunction and decreased Health-Related Quality of Life (HRQoL).Constraint-induced movement therapy (CIMT) approach could be translated into a clinical protocol for gait rehabilitation. Modified CIMT for upper limb and lower limb when applied singly improve lower limb motor function, balance, gait and HRQoL of stroke survivors OBJECTIVE However, effects of combined modified CIMT for upper and lower limbs (CoMCIMTULL) have not been investigated. Therefore, the effects of four-week CoMCIMTULL was compared with Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) among hemiparetic stroke survivors in this study. METHODS This single-blind randomized controlled trial involved random assignment of 56 consecutive stroke survivors to three groups: CoMCIMTULL (n=19), MCIMTLL (n=20), and MCIMTUL (n=17). The CoMCIMTULL group received both upper and lower limb CIMT for the reduced use of the upper limb and maladaptive use of the lower limb. The MCIMTLL group used the affected lower limb to lead weight bearing activities and exercises while the MCIMTUL group used the affected upper limbs for motor task practice following the unaffected hand’s restraining in a special splint. These treatments were administared in the clinic for two hours daily, five times per week for four consecutive weeks. Lower Limb Motor Function (LLMF) and balance were assessed using Fugyl Meyer Motor Assessement Scale, Lower Limb Use (LLU) with Lower Extremity Motor Activity Log, balance confidence using Activities-specific Balance Confidence Scale, Weight Asymmetry Ratio (WAR) using two weighing scales, spatiotemporal gait parameters [gait speed (m/s) and stride length (m)] using foot print method and HRQoL using the Stroke Impact Scale. These assessments were done at baseline, ends of weeks two and four. Data were analysed using descriptive statistics, ANOVA with post-hoc, Kruskal-Wallis with post-hoc and Wilcoxon Signed Rank at ᾳ0.05. RESULTS MBetween-group comparisons showed that the differences were significant in CoMCIMTULL (HRQoL score=70.00(10.00) ; LLMF = 29.00(5.00); gait speed=0.650(0.70)m/s ; Stride length=0.60(0.30)m ; and WAR=0.90(0.80) ) compared to MCIMTLL (HRQoL score=80.00(17.50); LLMF =29.50(2.50) ; gait speed=0.80(0.28)m/s; Stride length=0.65(0.40)m; and WAR=0.85(0.40) and MCIMTUL (HRQoL score= 60.00(10.00; LLMF =26.00(4.00) ; gait speed= 0.60(0.20)m/s;Stride length= 0.40(0.40)m; and WAR= 0.80(0.40) CONCLUSIONS It is expected, the outcome of this study will clarify whether the effect of combined modified CIMT upper and lower limb (CoMCIMTULL), Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) will leads to better recovery of motor function in stroke survivors. CLINICALTRIAL This study has been approved by both Health Research Ethics Committee of Universty of Ibadan/University College Hospital (UI/EC/14/0101) and the Murtala Muhammad Specialist Hospital, Kano (HMB/GEN/488/VOL.I)(Nigeria). Additionaly, the study employed a randomized controlled clinical trial design, registered with Pan Africa Clinical Trial Registry PACTR 201611001646207, available on www.pactr.org.

Effects of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on motor function and cortex excitability in subacute stroke patients: A randomized controlled trial

2020 ◽  
pp. 026921552097294
Author(s):  
Yan Gong ◽  
Xian-Ming Long ◽  
Ying Xu ◽  
Xiu-Ying Cai ◽  
Ming Ye
Keyword(s):  
Evoked Potentials ◽  
Motor Function ◽  
Lower Limb ◽  
Motor Evoked Potentials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Change Score ◽  
Stroke Patients ◽  
Subacute Stroke ◽  
Motion Threshold

Objective: To explore effects of repetitive transcranial magnetic stimulation (rTMS) combined with transcranial direct current stimulation (tDCS) on motor function and cortex excitability in subacute stroke patients. Design: Randomized controlled trial. Setting: Inpatient hospitals. Subjects: Sixty-five participants were randomly assigned to four groups: sham, 1Hz rTMS, cathodic tDCS combined with 1Hz rTMS (tDCS-/rTMS-) and anodic tDCS combined with 1Hz rTMS (tDCS+/rTMS-). Interventions: Four interventions were used, including sham, 1Hz rTMS, and cathodal or anodal tDCS, followed by 1Hz rTMS over contralesional motor cortex, which continued for four weeks. Main measures: Outcome measures were motor function and cortical excitability, evaluated by Fugl-Meyer Assessment, National Institutes of Health Stroke Scale and Barthel Index, resting Motion Threshold, Motor Evoked Potentials and Central Motor Conduction Time, assessed at baseline, four weeks and eight weeks. Results: At four weeks after interventions, Fugl-Meyer Assessment lower limb change score in tDCS+/rTMS- group was significantly larger than other three groups ( P < 0.001). There were significant differences in bilateral Motor Evoked Potentials changes between tDCS+/rTMS- group and sham group ( P < 0.05). At eight weeks, compared to other groups, National Institutes of Health Stroke Scale ( P = 0.003), Barthel Index ( P = 0.002), FMA lower limb score ( P < 0.001), and bilateral resting Motion Threshold, Motor Evoked Potentials ( P < 0.05) showed significant changes in tDCS+/rTMS- group. Furthermore, Fugl-Meyer Assessment lower limb change score was associated with increased ipsilesional Motor Evoked Potentials ( r = 0.703 P < 0.001) in tDCS+/rTMS- group. Conclusion: 1Hz rTMS combined with anode tDCS stimulation protocol could be a preferable rehabilitative strategy for motor recovery in subacute stroke patients.

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