The HAR-index: a reliable method for evaluating the risk of total hip arthroplasty conversion after hip arthroscopy for femoroacetabular impingement.

PURPOSE: Hip arthroscopy is a growing technique in the treatment of femoroacetabular impingement (FAI), but can sometimes lead to unsatisfactory results such as the early conversion to total hip arthroplasty (THA). The purpose of this study is to describe a new tool for assessing the preoperative risk of THA conversion after hip arthroscopy in patients with FAI. METHODS: This study is a retrospective analysis of a prospective cohort of 584 patients with FAI who underwent hip arthroscopy at a single centre with a minimum 2 years follow-up. The preoperative variables of these patients were analysed to calculate the risk of each variable for THA. By selecting variables with an area under the receiver operating characteristic (ROC) curve greater than 0.7, a calculator was created to provide a risk index for each patient. RESULTS: Four variables (age, body mass index, Tönnis score and ALAD) were associated with an increased risk of THA conversion. The optimal cut-off points for each variable were determined, and a risk index was created. The Hip-Arthroplasty-Risk Index (HAR-Index) is a 0-4 points scale obtained from four binary scores of 0 or 1 depending on whether the cut-off point for each variable was reached or not. The increased risk of THA for each HAR-Index value was 1.1%, 6.2%, 17.9%, 55.1% and 79.3% respectively. The HAR-Index showed a very good predictive capacity with an area under the ROC curve of 0.89. CONCLUSION: The HAR-Index is a simple and practical tool for practitioners to make more informed decisions about performing hip arthroscopy in patients with FAI. With a very good predictive capacity, the HAR-Index can help to reduce the rate of conversion to THA. LEVEL OF EVIDENCE: Level III.

"Short- and mid-term effects of adding upper cervical manual therapy to a conventional physical therapy program in patients with chronic mechanical neck pain. Randomized controlled clinical trial."

OBJECTIVE: To evaluate the effect of adding an Upper Cervical Translatoric Mobilization (UCTM) or an Inhibitory Suboccipital Technique (IST) to a physiotherapy treatment in the symptomatology and function of mechanical chronic neck pain patients. DESIGN: Randomized controlled trial. SETTING: Primary Care Center in Cornellà, Spain. SUBJECTS: 78 patients (64 women), with mean age (SD) of 59.96 (13.30) years with mechanical chronic neck pain were divided in three groups: control, IST and UCTM groups. INTERVENTIONS: All groups received 15 physiotherapy sessions for three weeks. The UCTM and IST groups added 5 minutes of the assigned technique during six sessions. MAIN MEASURES: Neck disability index (NDI) and numeric pain rating scale (NPRS) for neck pain were measured baseline, three-weeks and 15-weeks follow-up. RESULTS: NDI (SD) at baseline, three-weeks and 15-weeks were 11.62 (7.08), 9.65 (6.25), 7.58 (5.64) for the control group, 14.38 (6.92), 8.50 (6.11), 7.12 (4.98) for the IST group and 13.19(7.23), 5.35(6.10), 4.35(2.76) for the UCTM group. NPRS (SD) at baseline, three-weeks and 15-weeks were 58.69 (19.46), 45.19 (23.43), 44.58 (24.08) for the control group; 64.08 (19.26), 42.19 (19.69), 34 (21.14) for the IST group; and 67.65 (20.65), 36.23 (20.10), 39.85 (25.44) for the UCTM group. CONCLUSIONS: Compared with no treatment, both forms of mobilization were associated with reduced disability at three weeks, and UCTM remained better than control at 15 weeks; there were no significant differences between the two mobilization groups. TRIAL REGISTRATION: This study was registered in Clinicaltrials.gov (NCT02832232).

Comparative study of the effects of two inhibitory suboccipital techniques in non-symptomatic subjects with limited cervical mobility.

BACKGROUND: Hypomobility on a cervical segment is a frequent finding which is sometimes asymptomatic. The effects of inhibitory suboccipital techniques on cervical mobility have not been evaluated. OBJECTIVE: To compare the effect on cervical mobility, of pressure maintained suboccipital inhibition manual technique versus a self-treatment using an Occipivot cushion, in asymptomatic subjects with limited mobility assessed by the flexion-rotation test. METHODS: Before-after randomized uncontrolled trial. Thirty-two subjects were recruited and randomized into two groups: Manual Group and Instrumental Group, receiving a single session of the assigned technique. Upper and overall cervical spine mobility was measured. Subjective sensation during technique application and post-treatment, and number and intensity of headache episodes during the following 15 days after treatment were also registered. RESULTS: Comparing with the Instrumental Group, the Manual Group showed statistically significant improvements on flexion-rotation test (p< 0.01 to p< 0.03), upper cervical extension (p< 0.01), overall right rotation (p< 0.05) and overall right (p< 0.01) and left (p< 0.01) side-bending. CONCLUSION: In asymptomatic subjects with limited cervical mobility, pressure maintained suboccipital inhibition manual technique achieves further improvement on cervical range of motion than the technique using the Occipivot cushion.

Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial.

OBJECTIVE: To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia. DESIGN: Double-blind (patient and evaluator) randomized controlled trial. SETTING: Primary Care Center of the Spanish NHS. SUBJECTS: A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years. INTERVENTIONS: All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis. MAIN MEASURES: Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment. RESULTS: Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm2; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm2; SD, 7.86) and to the Control Group (mean, 2.09 km/cm2; SD, 4.45) ( P values <0.01 and <0.03, respectively) and also in function (mean, 20.87; SD, 14.25) compared to the Control Group (mean, 4.17; SD, 18.02) ( P < 0.01). Subjective assessment was statistically better in the Intervention Group both at the end of treatment ( P < 0.01) and three months after treatment ( P < 0.03). CONCLUSION: Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients.

Effectiveness of a specific manual approach to the suboccipital region in patients with chronic mechanical neck pain and rotation deficit in the upper cervical spine: study protocol for a randomized controlled trial.

BACKGROUND: Mechanical neck pain is a highly prevalent problem in primary healthcare settings. Many of these patients have restricted mobility of the cervical spine. Several manual techniques have been recommended for restoring cervical mobility, but their effectiveness in these patients is unknown. The aim of the present study is to compare the effectiveness of two types of specific techniques of the upper neck region: the pressure maintained suboccipital inhibition technique (PMSIT) and the translatory dorsal glide mobilization (TDGM) C0-C1 technique, as adjuncts to a protocolized physiotherapy treatment of the neck region in subjects with chronic mechanical neck pain and rotation deficit in the upper cervical spine. METHODS: A randomized, prospective, double-blind (patient and evaluator) clinical trial. The participants (n = 78) will be randomly distributed into three groups. The Control Group will receive a protocolized treatment for 3 weeks, the Mobilization Group will receive the same protocolized treatment and 6 sessions (2 per week) of the TDGM C0-C1 technique, and the Pressure Group will receive the same protocolized treatment and 6 sessions (2 per week) of the PMSIT technique. The intensity of pain (VAS), neck disability (NDI), the cervical range of motion (CROM), headache intensity (HIT-6) and the rating of clinical change (GROC scale) will be measured. The measurements will be performed at baseline, post-treatment and 3 months after the end of treatment, by the same physiotherapist blinded to the group assigned to the subject. DISCUSSION: We believe that an approach including manual treatment to upper cervical dysfunction will be more effective in these patients. Furthermore, the PMSIT technique acts mostly on the musculature, while the TDGM technique acts on the joint. We expect to clarify which component is more effective in improving the upper cervical mobility. TRIAL REGISTRATION: ClinicalTrials.gov NCT02832232 . Registered on July 13th, 2016.

Effectiveness of Diacutaneous Fibrolysis for the treatment of subacromial impingement syndrome: a randomised controlled trial.

Our objective was to assess the effectiveness of Diacutaneous Fibrolysis on pain intensity, range of motion and functional status in patients suffering from Subacromial Impingement Syndrome. A randomised controlled trial was conducted in two Spanish National Health Service Primary Health Care Centres. Participants (n = 120) were randomly assigned to one of three groups (intervention, placebo or control groups). All three groups received a protocolised treatment based on therapeutic exercises, analgesic electrotherapy and cryotherapy. Additionally, the intervention group received six sessions of Diacutaneous Fibrolysis treatment; the placebo group received six sessions of sham Diacutaneous Fibrolysis treatment, while the control group received only the protocolised treatment. Pain intensity, available active range of motion and function were measured pre-treatment, post-treatment, and at a three-month follow-up. At the post-treatment assessment, differences between intervention and control groups were statistically significant or clinically relevant in function, flexion, extension and external rotation movements. Differences between placebo and control groups were significant only in extension movement. No significant differences were found in pain intensity. At the 3 month follow-up assessment, between-groups differences were not statistically significant and clinical relevance was achieved only for external rotation movement between intervention and control groups. At the post-treatment assessment 89% of the participants in the intervention group, 76% of the participants in the placebo group and 67% of the participants in the control group reported subjective improvement (p < 0.01). In conclusion, adding Diacutaneous Fibrolysis to the conservative treatment of Subacromial Impingement Syndrome improves function and external rotation movements and also gives significantly higher patient satisfaction.