Showing posts with label aquired brain injury. Show all posts
Showing posts with label aquired brain injury. Show all posts
Saturday, April 23, 2016
Friday, April 22, 2016
Residual Limb Hyperhidrosis and RimabotulinumtoxinB: A Randomized Placebo-Controlled Study
Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Paul F. Pasquina, Briana N. Perry, Aimee L. Alphonso, Sacha Finn, Kevin F. Fitzpatrick, Jack W. Tsao
ObjectiveTo investigate the use of rimabotulinumtoxinB (BoNT/B [Myobloc]) compared with placebo in treating hyperhidrosis in the residual limbs of individuals with amputation.DesignRandomized, double-blind, placebo-controlled pilot study.SettingMilitary medical center.ParticipantsMale participants (N=9) with 11 major amputations of the lower limbs and who complained of excessive sweating in their residual limbs were enrolled in the study between September 24, 2008 to October 28, 2011. Participants' lower limbs were randomly assigned to receive injections of either BoNT/B (n=7) or placebo (n=4).InterventionBoNT/B.Main Outcome MeasuresThe primary efficacy variable was a minimum of 50% reduction in sweat production 4 weeks after the injection as measured via gravimetric sweat analysis after 10 minutes of physical exertion. Secondary analyses were performed on prosthetic function and pain.ResultsAll volunteers (100%; 7) in the BoNT/B group achieved a minimum of 50% reduction in sweat production as compared with only 50% (2) in the placebo group. The percent reduction was significantly greater for the BoNT/B group than for the placebo group (−72.7%±15.7% vs −32.7%±39.2%; P<.05). Although both groups subjectively self-reported significant sweat reduction and improved prosthetic function (P<.05 for both), objective gravimetric sweat analyses significantly decreased only for the BoNT/B group (2.3±2.3g vs 0.7±1.1g; P<.05). Neither group reported a change in phantom limb pain or residual limb pain (P>.05 for both).ConclusionsBoNT/B successfully reduces sweat production in individuals with residual limb hyperhidrosis, but does not affect pain. No differences were found in perceived effect on prosthetic use between BoNT/B and placebo groups.
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Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Paul F. Pasquina, Briana N. Perry, Aimee L. Alphonso, Sacha Finn, Kevin F. Fitzpatrick, Jack W. Tsao
ObjectiveTo investigate the use of rimabotulinumtoxinB (BoNT/B [Myobloc]) compared with placebo in treating hyperhidrosis in the residual limbs of individuals with amputation.DesignRandomized, double-blind, placebo-controlled pilot study.SettingMilitary medical center.ParticipantsMale participants (N=9) with 11 major amputations of the lower limbs and who complained of excessive sweating in their residual limbs were enrolled in the study between September 24, 2008 to October 28, 2011. Participants' lower limbs were randomly assigned to receive injections of either BoNT/B (n=7) or placebo (n=4).InterventionBoNT/B.Main Outcome MeasuresThe primary efficacy variable was a minimum of 50% reduction in sweat production 4 weeks after the injection as measured via gravimetric sweat analysis after 10 minutes of physical exertion. Secondary analyses were performed on prosthetic function and pain.ResultsAll volunteers (100%; 7) in the BoNT/B group achieved a minimum of 50% reduction in sweat production as compared with only 50% (2) in the placebo group. The percent reduction was significantly greater for the BoNT/B group than for the placebo group (−72.7%±15.7% vs −32.7%±39.2%; P<.05). Although both groups subjectively self-reported significant sweat reduction and improved prosthetic function (P<.05 for both), objective gravimetric sweat analyses significantly decreased only for the BoNT/B group (2.3±2.3g vs 0.7±1.1g; P<.05). Neither group reported a change in phantom limb pain or residual limb pain (P>.05 for both).ConclusionsBoNT/B successfully reduces sweat production in individuals with residual limb hyperhidrosis, but does not affect pain. No differences were found in perceived effect on prosthetic use between BoNT/B and placebo groups.
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Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial
Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Claude Pichonnaz, Jean-Philippe Bassin, Estelle Lécureux, Guillaume Christe, Damien Currat, Kamiar Aminian, Brigitte M. Jolles
ObjectiveTo evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA).DesignRandomized controlled trial.SettingPrimary care hospital.ParticipantsTwo groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m2).InterventionsParticipants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery.Main Outcome MeasuresSwelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters.ResultsAt seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (−2.6°; 95% confidence interval, −5.0° to −0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%–52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments.ConclusionsMLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.
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Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Claude Pichonnaz, Jean-Philippe Bassin, Estelle Lécureux, Guillaume Christe, Damien Currat, Kamiar Aminian, Brigitte M. Jolles
ObjectiveTo evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA).DesignRandomized controlled trial.SettingPrimary care hospital.ParticipantsTwo groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m2).InterventionsParticipants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery.Main Outcome MeasuresSwelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters.ResultsAt seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (−2.6°; 95% confidence interval, −5.0° to −0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%–52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments.ConclusionsMLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.
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Resilience Pain Interference and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress
Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Michaela V. Walsh, Trey W. Armstrong, Julia Poritz, Timothy R. Elliott, Warren T. Jackson, Tiffany Ryan
ObjectiveTo test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference with distress reported by individuals with traumatic upper limb loss evaluated for prosthetics.DesignCross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and posttraumatic stress.SettingSix regional centers throughout the United States.ParticipantsA total of 263 prospective participants consented to be evaluated for eligibility and need for upper extremity prosthetics; participants (N=202; 57 women [28.2%] and 145 men [71.8%]; mean age, 41.81±14.83y; range, 18.01–72.95y) who sustained traumatic injuries were retained in this study. Most of them were identified as white (70.8%; n=143), followed by black (10.4%; n=21), Hispanic (9.9%; n=20), Asian (3.0%; n=6), other (1.5%; n=3), and missing (4.5%; n=9).InterventionsNot applicable.Main Outcome MeasuresPrimary Care Posttraumatic Stress Disorder Screen and depression screen.ResultsResilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction, and the 2 distress variables. A path model revealed that the associations of resilience and pain interference with both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference on either distress variable.ConclusionsResilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with the environment. These relations are independent of the significant and inverse associations of pain interference with these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment after traumatic limb loss. Individuals reporting depression and/or posttraumatic stress disorder symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.
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Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Michaela V. Walsh, Trey W. Armstrong, Julia Poritz, Timothy R. Elliott, Warren T. Jackson, Tiffany Ryan
ObjectiveTo test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference with distress reported by individuals with traumatic upper limb loss evaluated for prosthetics.DesignCross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and posttraumatic stress.SettingSix regional centers throughout the United States.ParticipantsA total of 263 prospective participants consented to be evaluated for eligibility and need for upper extremity prosthetics; participants (N=202; 57 women [28.2%] and 145 men [71.8%]; mean age, 41.81±14.83y; range, 18.01–72.95y) who sustained traumatic injuries were retained in this study. Most of them were identified as white (70.8%; n=143), followed by black (10.4%; n=21), Hispanic (9.9%; n=20), Asian (3.0%; n=6), other (1.5%; n=3), and missing (4.5%; n=9).InterventionsNot applicable.Main Outcome MeasuresPrimary Care Posttraumatic Stress Disorder Screen and depression screen.ResultsResilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction, and the 2 distress variables. A path model revealed that the associations of resilience and pain interference with both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference on either distress variable.ConclusionsResilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with the environment. These relations are independent of the significant and inverse associations of pain interference with these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment after traumatic limb loss. Individuals reporting depression and/or posttraumatic stress disorder symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.
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Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review
Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Suzie Noten, Mira Meeus, Gaetane Stassijns, Francis Van Glabbeek, Olivier Verborgt, Filip Struyf
ObjectiveTo systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder.Data SourcesPubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists.Study SelectionAll English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included.Data ExtractionTwo reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data SynthesisThe efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM.ConclusionsOverall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment.
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Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Suzie Noten, Mira Meeus, Gaetane Stassijns, Francis Van Glabbeek, Olivier Verborgt, Filip Struyf
ObjectiveTo systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder.Data SourcesPubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists.Study SelectionAll English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included.Data ExtractionTwo reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data SynthesisThe efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM.ConclusionsOverall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment.
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