The Short-term Effectiveness of Full-Contact Custom-made Foot Orthoses and Prefabricated Shoe Inserts on Lower-Extremity Musculoskeletal Pain

2008 ◽  
Vol 98 (5) ◽  
pp. 357-363 ◽  
Author(s):  
Leslie C. Trotter ◽  
Michael Raymond Pierrynowski
Keyword(s):  
Lower Extremity ◽  
Musculoskeletal Pain ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Symptomatic Relief ◽  
Clinical Effectiveness ◽  
Foot Orthoses ◽  
Full Contact ◽  
Custom Made ◽  
Lower Pain

Background: Foot orthoses are commonly dispensed for musculoskeletal complaints of the foot and lower limb. Few randomized clinical trials evaluate the clinical effectiveness of foot orthoses. Methods: In this randomized clinical trial with a crossover design, 42 participants wore custom orthoses and prefabricated inserts in their regular footwear for 4 weeks each, consecutively. Twenty-seven participants received prefabricated inserts first and 13 received custom orthoses first. A numeric pain rating scale (possible score, 0–10) was used to measure participant pain. Results: Statistically and clinically important decreases in pain were reported after 3 weeks by participants wearing custom orthoses first (−1.39 pain units, t12 = 2.70, P = .02). Participants who wore prefabricated inserts first reported no statistically significant change in pain. When the alternative intervention was introduced, participants now wearing prefabricated inserts had greater pain after 1 and 2 weeks (1.1 pain units, t12 = 3.09, P = .01 and 0.9 pain units, t12 = 2.65, P = .02, respectively). Participants now wearing custom orthoses did not demonstrate significantly lower pain at any week compared with the second baseline but did have significantly lower pain scores compared with their initial baseline scores (−0.81 pain units, t12 = 2.31, P = .03). Conclusion: Full-contact custom-made foot orthoses provide symptomatic relief after 3 weeks of use for patients with lower-extremity musculoskeletal pain if they are prescribed as the initial treatment. (J Am Podiatr Med Assoc 98(5): 357–363, 2008)

Changes in Gait Economy Between Full-Contact Custom-made Foot Orthoses and Prefabricated Inserts in Patients with Musculoskeletal Pain

2008 ◽  
Vol 98 (6) ◽  
pp. 429-435 ◽  
Author(s):  
Leslie C. Trotter ◽  
Michael Raymond Pierrynowski
Keyword(s):  
Musculoskeletal Pain ◽  
Path Length ◽  
Controlled Trial ◽  
Length Ratio ◽  
Foot Orthoses ◽  
Randomized Controlled ◽  
Full Contact ◽  
Custom Made ◽  
Gait Economy ◽  
Walking Economy

Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts. Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides. Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01). Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. (J Am Podiatr Med Assoc 98(6): 429–435, 2008)

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

scholarly journals Effectiveness of custom-made foot orthoses in patients with systemic lupus erythaematosus: protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042627
Author(s):  
María Reina-Bueno ◽  
María del Carmen Vázquez-Bautista ◽  
Inmaculada C Palomo-Toucedo ◽  
Gabriel Domínguez-Maldonado ◽  
José Manuel Castillo-López ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomised Controlled Trial ◽  
Outcome Measures ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Foot Orthoses ◽  
Systemic Lupus ◽  
Custom Made ◽  
Randomised Controlled

IntroductionSystemic lupus erythaematosus (SLE) is a chronic autoimmune disease of heterogeneous involvement. The disease may affect feet with a high prevalence of symptoms such as, for example, pain, forefoot and rearfoot deformities, and biomechanics dysfunctions. Custom-made foot orthoses (CMFO) have been previously reported to be effective in patients with other rheumatic diseases. However, as far as the authors know, there exist no studies about their effectiveness in SLE. This study aims at determining the effect of CMFO versus placebo flat cushioning insoles on pain, foot functionality, fatigue and quality of life in patients with SLE.Methods and analysisA randomised controlled trial would compare the effects of (1) CMFO and group B, which received a placebo, flat cushioning insoles, for 3 months. The main outcome measures are foot pain, foot functionality and foot-related disability. The secondary outcome measures are fatigue and quality of life.Ethics and disseminationThe study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía ethical committee 1494-N-19. The results will be disseminated regardless of the magnitude or direction of effect.Trial registartion numberClinicaltrials.gov identifier NCT04098055.

scholarly journals Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment

2021 ◽  
Vol 18 (13) ◽  
pp. 6816
Author(s):  
Aurora Castro-Méndez ◽  
Inmaculada Concepción Palomo-Toucedo ◽  
Manuel Pabón-Carrasco ◽  
Javier Ramos-Ortega ◽  
Juan Antonio Díaz-Mancha ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Control Group ◽  
Foot Orthoses ◽  
Low Back ◽  
Custom Made ◽  
Foot Posture ◽  
Foot Pronation ◽  
Pain Symptoms

Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.

scholarly journals Clinical effectiveness and potential long-term benefits of high-intensity focused ultrasound therapy for patients with adenomyosis

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097649
Author(s):  
Wei Li ◽  
Jiayu Mao ◽  
Yang Liu ◽  
Ying Zhu ◽  
Xiaojing Li ◽  
...  
Keyword(s):  
High Intensity ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Clinical Effectiveness ◽  
Treatment Method ◽  
Mean Difference ◽  
High Intensity Focused Ultrasound ◽  
Noninvasive Treatment ◽  
Numerical Rating

Objectives Adenomyosis is a common and refractory disease in gynecology. Preserving the uterus during treatment for adenomyosis remains a problem. High-intensity focused ultrasound (HIFU) is widely used in treatment of solid tumors. This study aimed to analyze patients with adenomyosis who were treated by HIFU and to preliminarily examine the characteristics of patients who are more suitable for HIFU to treat adenomyosis with reliable efficacy. Methods Over 2 years, 67 women who were diagnosed with adenomyosis and treated with HIFU at our gynecology department were included in this study. We investigated outcomes of their symptoms (dysmenorrhea and hypermenorrhea) and the volume of their uterine lesions. We also compared the patients’ clinical profiles. Results The women had a mean follow-up duration of 11.6 ± 0.46 months. In the numerical rating scale, used to assess the degree of dysmenorrhea, the score was significantly lower (mean difference: −1.94, 95% confidence interval: −2.704 to −1.176) 3 months after HIFU treatment compared with before treatment, then it remained stable for 3 to 12 months. Hypermenorrhea was reduced to a certain degree, with a mean difference of −0.54 (−1.01–0.02). Conclusions HIFU is a new noninvasive treatment method for adenomyosis that may help relieve dysmenorrhea.

Abstract P467: Clinical Effectiveness of Endovascular Stroke Treatment in the Early and Extended Time Windows

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Diogo C Haussen ◽  
David S Liebeskind ◽  
Tudor G Jovin ◽  
Rishi Gupta ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Time Windows ◽  
Clinical Effectiveness ◽  
Inclusion Criteria ◽  
Open Label ◽  
Time To Treatment ◽  
Stroke Treatment ◽  
Real World Setting ◽  
Lower Baseline ◽  
Iv Tpa

Background and Purpose: The clinical efficacy of mechanical thrombectomy (MT) has been unequivocally demonstrated in multiple randomized clinical trials (RCTs). However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. We aim to assess the clinical effectiveness of MT by comparing the specific RCT populations with corresponding patient cohorts derived from a prospective registry. Methods: A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label MT registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials based on the age, baseline NIHSS, occlusion site, IV tPA use, pre-morbid mRS and time to treatment criteria used in the RCTs without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. Results: As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of IV tPA and general anesthesia were higher in DAWN- and DEFUSE 3-registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS 0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding RCTs (SWIFT-Prime, 64.5% vs 60.2%; DAWN, 50.4% vs 48.6%; Beyond-DAWN: 52.4% vs 48.6%; DEFUSE 3, 52% vs 44.6%, respectively; all P>0.05). Registry-derived patients had significant less disability than the corresponding RCT controls (ordinal mRS shift OR, P <0.05 for all). Conclusion: Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the “real-world” setting and supports that patients may be safely treated outside the constraints of RCTs and strict guidelines.

scholarly journals Multimodal Analgesia in Perioperative Settings: Improvement Perspectives / Multimodāla Analgēzija Perioperatīvajā Periodā: Uzlabošanas Iespējas

2014 ◽  
Vol 68 (5-6) ◽  
pp. 222-227
Author(s):  
Iveta Golubovska ◽  
Aleksejs Miščuks ◽  
Ēriks Rudzītis
Keyword(s):  
Pain Management ◽  
Lower Extremity ◽  
Pain Intensity ◽  
Severe Pain ◽  
Rating Scale ◽  
Multimodal Analgesia ◽  
Numeric Rating Scale ◽  
Plexus Brachialis ◽  
Single Shot ◽  
Maximum Pain

Abstract The aim of this study was to evaluate the intensity of pain in orthopaedic hospital patients and to identify unsatisfactory pain management and possibilities for improvements in the future. Data collection included Numeric Rating Scale (NRS) scores, which characterised the intensity of pain. Maximum pain on the day of surgery, mean pain on the day of surgery (D0), and mean pain on first (D1) and second (D2) postoperative days were documented. The pain of an intensity from 0 to 3 was defined as mild pain, 4 to 6 as moderate pain, and 6 to 10 as severe pain. Maximum severe pain intensity on the day of surgery was experienced by 20.5% of patients, moderate by 45.8%, and mild by 33.6%. The reported mean pain intensity according to type of surgery was as follows: hip replacement- 2.79 ± 1.6 (D0), 2.09 ± 1.4 (D1), and 1.35 ± 1.2 (D2); knee replacement - 3.39 ± 1.7 (D0), 2.98 ± (D1), 1.82 ± 1.36, and (D2); upper extremity surgery - 3.59 ± 1.9 (D0), 3.4 ± 1.7 (D1), and 2.1 ± 1.5 (D2); lower extremity surgery - 4.1 ± 2.1 (D0), 3.49 ± 1.42 (D1), and 2.58 ± 1.4 (D2); spine surgery - 3.31 ± 1.58 (D0), 2.88 ± 1.96 (D1), and 1.83 ± 1.74 (D2). Patients in the lower extremity group experienced unacceptable mean pain. The maximum pain intensity on day of surgery was experienced by patients after single-shot plexus brachialis block anaesthesia (5.24 ± 2.4). Well-designed multimodal analgesia with special attention to single shot techniques may improve pain management and functional outcomes after orthopaedic surgery.

scholarly journals Effectiveness of Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses on Balance, Fear of Falling, and Physical Activity in Older Adults: A Randomized Controlled Trial

Gerontology ◽  
2018 ◽  
Vol 65 (3) ◽  
pp. 299-307 ◽  
Author(s):  
Changhong Wang ◽  
Rahul Goel ◽  
Hadi Rahemi ◽  
Qianzi Zhang ◽  
Brian Lepow ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Fear Of Falling ◽  
Controlled Trial ◽  
Foot Orthoses ◽  
Female Age ◽  
Randomized Controlled ◽  
Custom Made ◽  
Ankle Foot Orthoses

Background: Foot problems are prevalent in older adults, which may increase the risk and concern for falls. Ankle-foot orthoses (AFO) have been shown to be effective in the stabilization of lower extremities, but their long-term effectiveness in improving balance and their potential to encourage older adults to become more physically active are still debated. Objective: This randomized controlled trial investigated the effectiveness of daily use of a custom-made AFO on balance, fear of falling, and physical activity in older adults. Study Design: Forty-four older adults with concern about or at risk for falling were randomly allocated to either the control group (CG; 77.3% female, age 75.6 ± 6.5 years, BMI 29.3 ± 6.4) or the intervention group (IG; 63.6% female, age 73.7 ± 6.3 years, BMI = 27.8 ± 4.8). The IG received walking shoes and bilateral custom-made AFO. The CG received only walking shoes. At the baseline and 6-month follow-ups, balance and physical activity were assessed using validated wearable instrumentation and fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Adherence and acceptability toward wearing the AFO were assessed using self-reported questionnaires at the 6-month follow-up. Results: No significant between-group difference was observed at baseline (p = 0.144–0.882). Compared to baseline and the CG, hip, ankle, and center-of-mass (COM) sways were significantly reduced at the 6-month follow-up in the IG while standing with the feet together during the eyes-open condition (p = 0.005–0.040). Within the IG, the FES-I was reduced significantly (p = 0.036) and there was an increasing trend in the number of walking bouts with a medium effect size (d = 0.52, p = 0.440) compared to baseline. However, there were no significant changes in FES-I and physical activity measures in the CG (p = 0.122–0.894). The reduction in COM sway in the IG was moderately correlated with adherence (r = –0.484, p = 0.047) and strongly correlated with baseline COM sway (r = –0.903, p < 0.001). Conclusion: Results suggest that bilateral custom-made AFO plus walking shoes is effective in improving balance compared to walking shoes alone, and it significantly reduces the fear of falling, with a nonsignificant but noticeable positive trend in physical activity, compared to baseline. The results also suggest that older adults with poor balance at baseline and higher daily adherence to using the AFO will gain more benefit from the AFO intervention.

scholarly journals Electroanalgesia for the postoperative control pain in dogs

2012 ◽  
Vol 27 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Renata Navarro Cassu ◽  
Daniele Alves da Silva ◽  
Túlio Genari Filho ◽  
Helaine Stevanin
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Serum Cortisol ◽  
Acupuncture Points ◽  
Rescue Analgesia ◽  
Postoperative Control ◽  
Lower Pain ◽  
Numerical Rating ◽  
Control Pain ◽  
Electrical Stimuli

PURPOSE: To evaluate the analgesic and neuroendocrine effects of electroanalgesia in dogs undergoing ovariohysterectomy. METHODS: Eighteen dogs were randomly distributed to three groups of six animals each and received either electrical stimuli at acupuncture points (EA), at peri-incisional dermatomes (DER) and at both acupuncture points and peri-incisional dermatomes (EAD). Pre-anesthetic medication was acepromazine (0.05mg kg-1, IV). Anesthesia was induced with propofol (4 to 5mg kg-1, IV) and maintained with isoflurane. Postoperatively pain degree was measured using a numerical rating scale. Dogs were scored at 1, 3, 6, 12 and 24 hours postoperative. If the pain score was ≥6, supplemental morphine (0.5mg kg-1, IM) was administered. Serum cortisol concentration was measured before pre-anesthetic medication (basal), and at 1, 12 and 24 hours postoperative. RESULTS: EA and EAD- treated dogs had lower pain scores than DER treated dogs one hour postoperatively. Fewer EA and EAD-treated dogs required rescue analgesia. Serum cortisol did not differ among treatments. CONCLUSION: Preoperative application of electrical stimuli to acupuncture points isolated or in combination with peri-incisional dermatomes provides a reduced postoperative opioid requirement and promotes an effective analgesia in dogs undergoing ovariohyterectomy.

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