Features of walking in patients with knee arthrosis before and after arthroplasty according to the GAITRite system

Background. Hardware examinations are the key to standardizing the assessment of the patient’s condition, they reduce the doctor’s error, make it possible to obtain digital material, which can be used to determine the functional ability of the patient. One of such studies is the GAITRite system, the purpose of which is to assess the parameters of a person’s walking. The study was aimed to determine the basic parameters of walking in patients with gonarthrosis before and after the endoprosthesis. Materials and methods. There were examined 23 patients with gonarthrosis after unilateral endoprosthesis. The studies carried out concern the analysis of temporal, geometric parameters of walking, as well as the assessment of the functional ability of patients with degenerative diseases of the hip joint before treatment and one year after arthroplasty. Results. Before treatment for knee arthrosis, patients experience a violation of walking in the form of asymmetry of steps. There is a decrease in the time of support on the foot of the impaired limb and, therefore, an increase in the time of transfer of the foot of this limb. Changes in the impaired limb are reflected in the opposite one. After surgery, the changes in the parameters of walking in patients were as follows: an increase in the time of support on the prosthetic limb, and, therefore, a decrease in the time of support on the foot of the opposite limb that manifested in an increase in the symmetry of the parameters of steps. Reduction of pain syndrome and restoration of limb support ability increase the indicator of gait functionality. Osteoarthritis is a systemic disease and develops more often in both knee joints, and other structures of the skeleton are often involved in the degenerative process. Therefore, in elderly patients, FAP after arthroplasty reaches only satisfactory values. We examined patients after endoprosthesis on one knee joint, and this does not always give the expected good result immediately. Conclusions. Instrumental methods of studying patients’ gait make it possible to determine the degree of impairment of dynamics. Knee arthroplasty eliminates pain and restores limb resistance, which improves gait. This method of assessing walking allows determining the degree of recovery of patients and to adjust the need for further methods of correcting walking or a plan for further treatment.

Single-centre study on the use of virtual reality in the reduction of pain after the administration of vaccines in children aged 3 to 6 years in primary care centres in Central Catalonia: randomized clinical trial (Preprint)

BACKGROUND Pain and anxiety caused by vaccination and other medical procedures in childhood can cause discomfort for both the patient and their parents. Virtual reality (VR) is a technology capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions. OBJECTIVE Reduction of pain and anxiety after the administration of two vaccines in children aged 3 to 6 years. METHODS Randomized, parallel, controlled clinical trial with two assigned groups. The intervention group will wear virtual reality goggles during the administration of two vaccines, while the control group will receive standard primary care centre care for the procedure. Randomization will be carried out using the "RandomizedR" computer system, a randomization tool of the R Studio program. This is an open or unblinded trial, both the subject and the investigator will know the assigned treatment group. Due to the nature of the VR intervention, it is impossible to blind patients, caregivers or observers. However, a blind third party assessment will be carried out. The study population focuses on children aged 3 to 6 years, included in the patient registry and cared for in the primary care centre of the region of Central Catalonia, who will receive the following vaccines during the well child check-up: triple viral + varicella at 3 years of age and hepatitis A + Diphtheria-Tetanus-Pertussis at 6 years of age. RESULTS The study is scheduled to begin in January 2022 and is scheduled to end in January 2023 when the statistical analysis will begin. CONCLUSIONS Virtual reality can be a useful tool in paediatric procedures that generate pain and anxiety. CLINICALTRIAL The clinical trial has been approved by the IDIAP Jordi Gol i Guirna ethics committee with code 4R21/061.

Is Homeopathic Arnica Effective for Postoperative Recovery? A Meta-analysis of Placebo-Controlled and Active Comparator Trials

Background: Homeopathic Arnica montana is used in surgery as prevention or treatment for the reduction of pain and other sequelae of surgery. Our aim was to perform a metaanalysis of clinical trials to assess efficacy of Arnica montana to reduce the inflammatory response after surgery.Method: We conducted a systematic review and metaanalysis, following a predefined protocol, of all studies on the use of homeopathic Arnica montana in surgery. We included all randomized and nonrandomized studies comparing homeopathic Arnica to a placebo or to another active comparator and calculated two quantitative metaanalyses and appropriate sensitivity analyses. We used “Hegde's g,” an effect size estimator which is equivalent to a standardized mean difference corrected for small sample bias. The PROSPERO registration number is CRD42020131300.Results: Twenty-three publications reported on 29 different comparisons. One study had to be excluded because no data could be extracted, leaving 28 comparisons. Eighteen comparisons used placebo, nine comparisons an active control, and in one case Arnica was compared to no treatment. The metaanalysis of the placebo-controlled trials yielded an overall effect size of Hedge's g = 0.18 (95% confidence interval −0.007/0.373; p = 0.059). Active comparator trials yielded a highly heterogeneous significant effect size of g = 0.26. This is mainly due to the large effect size of nonrandomized studies, which converges against zero in the randomized trials.Conclusion: Homeopathic Arnica has a small effect size over and against placebo in preventing excessive hematoma and other sequelae of surgeries. The effect is comparable to that of anti-inflammatory substances.

A Study to Compare the Efficacy of Back Strengthening Therapy in Patients with Lower Back Pain on Analgesics to that of those on Placebo in a Tertiary Care Hospital in Chennai

Aim: Isometric and Core strengthening exercises for lower back pain provides relief to patients, whereas combing it with analgesics also provides relief of pain, thereby in this study the efficacy of isometric and core strengthening exercises alone is evaluated. Method: A cross-sectional study involving 200 subjects was conducted in the OPD of department of Orthopaedics, Saveetha Medical college and hospital. Assessment of lower back pain was done using ODI (Oswestry Disability Index) among patients receiving Isometric and Core strengthening exercises with and without analgesics for a period of 3 months. Results: There is no significance difference in the reduction of pain among group A who received analgesics along with isometric and core strengthening exercises and group B who received only isometric and core strengthening exercises. Conclusion: Isometric and core strengthening exercises alone is as effective as its combination with analgesics.

EFFECTIVENESS OF KINESIOLOGICAL TAPE IN MYOFASCIAL PAIN SYNDROME OF GASTROCNEMIUS MUSCLE

Objective: To see the effectiveness of kinesiological tape in myofascial pain syndrome of gastrocnemius muscle for the early recovery after injury and thus increase functional outcome. Study Design: Quasi-experimental study. Place and Duration of Study: National cricket academy Lahore and Sports and Spine Professional’s Clinic, Defense Phase-IV Lahore Pakistan, from Aug 2017 to Oct 2017. Methodology: Consecutive sampling technique was used to enrol the patients of myofascial pain syndrome based on the predefined inclusion and exclusion criteria. Patients were selected and the kinesiological tape was applied thrice a week for two consecutive weeks. the patient was then re-evaluated after every two days of previous kinesiological tape application in terms of the visual Analogue Scale. Results: It was observed that kinesiological tape had a significant effect on pain reduction of the myofascial pain syndrome of the gastrocnemius muscle (p<0.001). There was a significant reduction of pain level after application of Kinesio tape till 4th application with pre-treatment means 6.70 ± 1.45 that was reduced to 2.98 ± 2.24 in post-treatment (p<0.05). In addition, there was no significant reduction of pain between the 5th and 6th application with mean for the 6th session as 2.96 ± 2.27 (p>0.05). Conclusion: The Kinesiological tape has a significant effect on pain reduction of gastrocnemius muscle suffering from myofascial pain syndrome. The application of kinesiological tape has maximum effect up to its 4th application. After 5th session of taping, the effect was almost constant. Keywords: , , , .

Comparison of NSAIDS Versus NSAIDS Plus Duloxetine in Knee Osteoarthritis Patients

Objective: To compare the efficacy of Duloxetine with NSAIDS versus NSAIDS alone for the treatment of knee pain secondary to osteoarthritis. Study Design: Randomized clinical trial study. Setting and Duration: Department of Rheumatology, PIMS Hospital, Islamabad, from April to August 2021. Methodology: One hundred and twenty eight patients with knee osteoarthritis were included in the study and were divided in two equal groups; one group was subjected to Duloxetine plus NSAIDs and other to just NSAIDs. The response was assessed at end of 3 months. Reduction in pain more than or equal to 50% from the baseline was considered as efficacy. Results: The mean VAS score was 3.56±1.15 in group A (Duloexetine plus NSAIDS) A while in group B (NSAID alone), 4.45±1.22 and significantly (p-value > 0.05). Similarly, the comparison of WOMAC score for pain showed that the mean WOMAC score was significantly (P-value > 0.05) less 5.68±1.56 in group A in contrast to 6.39 ± 1.69 in group B. Comparison of efficacy between two groups showed that the rate of efficacy was significantly (P-value >0.05) higher in group A 48.4% as compared to 31.3% in group B. Conclusion: Addition of Duloxetine to NSAIDs resulted in more reduction of pain in terms of VAS and WOMAC score with acceptable adverse effects. Keywords: Chronic pain, Duloxetine, Knee pain, NSAIDs, Osteoarthritis

The importance of professional based questionnaire in the dog’s acute and chronic pain evaluation

The measurement of pain levels is made differently depending if acute or chronic pain is diagnosed, objective (e.g. cortisol, prolactin, serotonin, catecholamines, or the cardiac frequency and arterial pressure evaluation) or subjective methods being imagined. All subjective methods are including questionnaires and specific additional methods. The aim was the verifying the effectiveness of drug and physiotherapy combinations by using an owner based questionnaire for the chronic patients and a veterinary professional based questionnaire for the acute pain patient group. In this study a total of 20 dogs with observable pain were selected and two groups (n = 10 / group), constituted: G1 - chronic pain, and G2 - acute pain. The treatment of dogs with acute signs of pain was made oral or injectable with NSAIDs administration and for dogs with signs of chronic pain, physiotherapy treatment and drug therapy was administered. The owners of the dogs with chronic pain received the HCPI questionnaire in order to evaluate their dog’s pain level subjectively. For the dogs with acute pain the veterinarian filled out the short form of Glasgow Composite Measure Pain Scale (CMPS-SF). After initiating a Paired t-test in Excel 2010 with the scores obtained with HCPI and CMPS-SF, there was observed a significant reduction of pain after associated drug administration and physiotherapy and no significant evidence of acute pain after drug therapy. The used physiotherapy and drug combinations delivered a significant reduction of chronic pain, both clinically and visually mirrored in score reduction after treatments. The HCPI questionnaire could be considered a valuable tool for evaluating chronic pain in patients in the clinic environment. The CMPS-SF has also proven to be a very useful questionnaire in diagnose of acute pain and evaluation of the effectiveness of drug therapy used.

EFFECTS OF A DEEP LEARNING-BASED SMARTPHONE APPLICATION ON SHOULDER ABDUCTION KINEMATICS AND BRAIN ACTIVATION IN ADHESIVE CAPSULITIS: A RANDOMIZED CONTROLLED TRIAL

Patients with adhesive capsulitis (AC) demonstrate limited shoulder movement, often accompanied by pain. Common treatment methods include pain medication, and continuous passive movement (CPM). However, it is sometimes difficult to improve the reduction of pain and movement using a CPM intervention because the patient’s interest is diminished. In this study, we developed an innovative deep learning-based smartphone application (Funrehab exercise game (FEG)) to provide accurate kinematics movement and motivation as well as high-intensity and repetitive movements using deep learning. We compared the effects of CPM and FEG on brain activity and shoulder range of motion in patients with AC. Sixteen patients (males, [Formula: see text]; females, [Formula: see text]; mean age, [Formula: see text] years) with acute AC were randomized into either CPM group or FEG group 4 days/week for 2 weeks. The outcome measures were shoulder abduction kinematics movement and electroencephalography (EEG) brain activity (bilateral prefrontal, bilateral sensorimotor cortex, and somatosensory association cortex) during the intervention. The analysis of variance (ANOVA) test was performed at [Formula: see text], and the analysis demonstrated that FEG showed superior effects on shoulder abduction kinematics and brain [Formula: see text] and [Formula: see text]-wave activations compared to CPM. Our results provide a novel and promising clinical evidence that FEG can more effectively improve neurophysiological EEG data and shoulder abduction movements than CPM in patients with AC.

Personalized behavior management as a replacement for medications for pain control and mood regulation

A lack of personalized approaches in non-medication pain management has prevented these alternative forms of treatment from achieving the desired efficacy. One hundred and ten female patients with fibromyalgia syndrome (FMS) and 60 healthy women without chronic pain were assessed for severity of chronic or retrospective occasional pain, respectively, along with alexithymia, depression, anxiety, coping strategies, and personality traits. All analyses were conducted following a ‘resource matching’ hypothesis predicting that to be effective, a behavioral coping mechanism diverting or producing cognitive resources should correspond to particular mechanisms regulating pain severity in the patient. Moderated mediation analysis found that extraverts could effectively cope with chronic pain and avoid the use of medications for pain and mood management by lowering depressive symptoms through the use of distraction mechanism as a habitual (‘out-of-touch-with-reality’) behavior. However, introverts could effectively cope with chronic pain and avoid the use of medications by lowering catastrophizing through the use of distraction mechanism as a situational (‘in-touch-with-reality’) behavior. Thus, personalized behavior management techniques applied according to a mechanism of capturing or diverting the main individual ‘resource’ of the pain experience from its ‘feeding’ to supporting another activity may increase efficacy in the reduction of pain severity along with decreasing the need for pain relief and mood-stabilizing medications.