Does the Combination of Platelet-rich Plasma and Supervised Exercise Yield Better Pain Relief and Enhanced Function in Knee Osteoarthritis? A Randomized Controlled Trial.

BACKGROUND: Knee osteoarthritis is a leading cause of disability with substantial healthcare costs, and efficient nonsurgical treatment methods are still needed. Platelet-rich plasma (PRP) injections and exercise therapy are used frequently in clinical practice. Whether PRP or PRP combined with exercise is more effective than exercise alone is unclear. QUESTIONS/PURPOSES: (1) Which treatment relieves knee osteoarthritis pain better: PRP alone, exercise, or PRP combined with exercise? (2) Does PRP alone, exercise, or PRP combined with exercise yield better results in terms of the WOMAC score, performance on the 40-m fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score? METHODS: In this randomized, controlled, three-arm clinical trial, we recruited patients with mild-to-moderate (Kellgren-Lawrence Grade II or III) knee osteoarthritis with a minimum of 3 points on the 11-point numeric rating scale for pain. During the study period, 157 patients with a diagnosis of knee osteoarthritis were screened and 84 eligible volunteers were enrolled in the study. Patients were randomly allocated (1:1:1) into either the exercise group (28), PRP group (28), or PRP + exercise group (28). Follow-up proportions were similar between the groups (exercise: 89% [25], PRP: 86% [24], PRP + exercise: 89% [25]; p = 0.79). All patients were analyzed in an intention-to-treat manner. There were no between-group differences in age, gender, arthritis severity, and baseline clinical scores (pain, WOMAC, functional performance tests, and health-related quality of life). The exercise group underwent a 6-week structured program consisting of 12 supervised individual sessions focused on strengthening and functional exercises. Meanwhile, the PRP group received three weekly injections of fresh, leukocyte-poor PRP. The PRP + exercise group received a combined treatment with both interventions. The primary outcome was knee pain over 24 weeks, measured on an 11-point numeric rating scale for pain (ranging from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2). The secondary outcome measures included the WOMAC index (ranging from 0 to 100, with lower scores indicating a lower level of disability and an MCID of 12), the durations of the 40-meter fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score. For the a priori sample size calculation, we used the numeric rating scale score for pain at 24 weeks as the primary outcome variable. The MCID for the numeric rating scale was deemed to be 2 points, with an estimated standard deviation of 2.4. Based on sample size calculations, a sample of 24 patients per group would provide 80% power to detect an effect of this size between the groups at the significance level of p = 0.05. RESULTS: We found no clinically important differences in improvements in pain-defined as ≥ 2 points of 10-at 24 weeks when comparing exercise alone to PRP alone to PRP + exercise (1.9 ± 0.7 versus 3.8 ± 1.8 versus 1.4 ± 0.6; mean difference between PRP + exercise group and exercise group -0.5 [95% confidence interval -1.2 to 0.4]; p = 0.69). Likewise, we found no differences in WOMAC scores at 24 weeks of follow-up when comparing exercise alone to PRP alone to PRP + exercise (10 ± 9 versus 26 ± 20 versus 7 ± 6; mean difference between PRP + exercise group and exercise group -3 [95% CI -12 to -5]; p = 0.97). There were no differences in any of the other secondary outcome metrics among the PRP + exercise and exercise groups. CONCLUSION: PRP did not improve pain at 24 weeks of follow-up in patients with mild-to-moderate knee osteoarthritis compared with exercise alone. Moreover, exercise alone was clinically superior to PRP alone, considering function and the physical component of health-related quality of life. Despite the additional costs and endeavors related to PRP products, the combination of PRP and exercise did not differ from exercise alone. The results of this randomized controlled trial do not support the use of PRP injections in the treatment of patients diagnosed with mild-to-moderate knee osteoarthritis. Consequently, exercise alone is the recommended treatment for reducing pain and enhancing function throughout this timeframe. LEVEL OF EVIDENCE: Level I, therapeutic study.

Effectiveness of telerehabilitation-based structured exercise program in individuals with unilateral transtibial amputation: a randomized controlled study.

PURPOSE: The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. MATERIALS AND METHODS: The telerehabilitation group (n = 24) received telerehabilitation combined with home exercise, while the control group (n = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA. RESULTS: The group-by-time interactions were significant for TUG (p = 0.002, F[1;41] = 10.74) and 30CST (p = 0.001, F[1;41] = 11.48). The mean difference (6th week-baseline) was -0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and -0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC (p = 0.0004, F[1;41] = 14.47), the TAPES-activity restriction (p = 0.0001, F[1;41] = 28.96), TAPES-prosthesis satisfaction (p = 0.004, F[1;41] = 9.19), and the NHP (p = 0.0002, F[1;41] = 16.07) favoring the telerehabilitation group. CONCLUSIONS: Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation.Implications for rehabilitationExercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively.Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy.Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization.In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life.

The effectiveness of telerehabilitation-based exercise combined with pain neuroscience education for patients with facet joint arthrosis: A randomized controlled study.

OBJECTIVES: This study aimed to investigate the short-term effectiveness of exercise combined with PNE and exercise alone via telerehabilitation for patients with low back pain (LBP) caused by facet joint arthrosis (FJA). METHODS: This is a prospective, single-blind, randomized-controlled clinical trial. Forty-five patients with LBP caused by FJA were randomly allocated into three groups. The exercise (n = 15) and the exercise with PNE (n = 15) groups were provided interventions twice a week for six weeks via telerehabilitation. The control group (n = 15) was placed on the waiting list. The primary outcome measures were the numeric pain-rating scale (NPRS) at rest and with activity, The Oswestry disability index (ODI), the pain beliefs questionnaire (PBQ), and secondary outcome measures were short form-12v2 (SF-12v2) and the global rating of change score (GROC). RESULTS: The groups (52.00 ± 4.86, 46.7% female) were similar at baseline except for gender (p = 0.029). There was a significant group-by-time interaction for NPRS-rest (F = 4.276, p = 0.021), NPRS-activity (F = 12.327, p = 0.0001), the ODI (F = 23.122, p = 0.0001) and organic pain belief (F = 39.708, p = 0.0001). Further comparison with ANOVA showed that the exercise with PNE group showed better improvement in only organic pain belief (p = 0.0001). All groups reported improvements according to GROC, but it was higher in the intervention groups (p = 0.001). CONCLUSION: The patients who received exercise combined with PNE and exercise alone significantly improved pain intensity, disability and organic pain beliefs via telerehabilitation for patients with LBP caused by FJA compared to the control group. The PNE in addition to exercise may exhibit greater benefit in improving organic pain beliefs in short term. SIGNIFICANCE: This study highlights that combining exercise with PNE can lead to greater improvements compared to exercise alone or no intervention for FJA patients. The implementation of PNE in physiotherapy sessions has the potential to offer significant benefits. Furthermore, our results highlight the promising role of telerehabilitation as an effective method for delivering interventions to individuals with FJA.

Factors affecting the features of platelet-rich plasma in patients with knee osteoarthritis.

OBJECTIVE: The aim of this study was to present an analysis of platelet-rich plasma obtained from patients with knee osteoarthritis and reveal the factors affecting its features. METHODS: A total of 62 patients (mean age: 56.68 ± 7.13 years) with symptomatic knee osteoarthritis were included in this study. Age (years), gender, height (m), weight (kg), body mass index (kg/m2), duration of symptoms, smoking status, smoking index, general health status, and physical activity scores were recorded. Whole blood and platelet-rich plasma cell counts were performed with a hematology analyzer. White blood cell, red blood cell, and platelet counts were recorded. According to the dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation classification, dose of platelets, efficiency of the procedure (platelet recovery rate, %), and purity of the obtained platelet-rich plasma product (relative composition in platelets, %) were calculated. Correlation analysis between the features of platelet-rich plasma and the patient-related variables, including age, gender, body mass index, smoking status, smoking index, presence of other health conditions, physical activity scores, duration of symptoms, and pain levels, was performed. RESULTS: Dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation analysis showed that the dose of injected platelets was 3.25 billion, the efficiency of the process was 77%, and the purity rate of the platelet-rich plasma was 98.4%. Platelet-rich plasma platelet count was correlated with whole blood platelet count (r = 0.81, P < .001), whole blood white blood cell count (r = 0.39, P = .002), smoking status (r = 0.56, P = .03), smoking index (r = -0.63, P = .002), and the presence of hypertension (r = -0.31, P=.04). Platelet-rich plasma white blood cell and purity of platelet-rich plasma were correlated with the smoking status of the patients (r = 0.52, P = .01; r = 0.64, P = .003, respectively). CONCLUSION: This study has demonstrated that high dose and very pure platelet-rich plasma with medium efficiency was yielded with this platelet-rich plasma preparation procedure; whole blood platelet count, the presence of hypertension, and the smoking status of patients affect the features of the obtained platelet-rich plasma. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Oral corticosteroids vs. exercises on treatment of frozen shoulder: a randomized, single-blinded study.

BACKGROUND: Many treatment strategies have been described for the management of frozen shoulder. However, to date no randomized controlled trial has directly compared the efficacy of exercise and oral corticosteroids. The aim of this study was to determine whether pain, range of motion (ROM), and function differ between patients with frozen shoulder randomized to treatment with exercise or oral corticosteroids. METHODS: This prospective, randomized, assessor-blinded trial was performed to compare the effectiveness of exercise and oral corticosteroids in patients with frozen shoulder. Overall, 33 patients with frozen shoulder were randomly assigned to receive either exercise (n = 17) or oral corticosteroids (n = 16). The exercise was applied 2 times per week for 6 weeks for 12 visits; patients in the oral corticosteroids group received prednisolone for 4 weeks. Participants were assessed at baseline, after 6 weeks and at the 12-week follow-up. The primary outcome was the Disabilities of the Arm, Shoulder and Hand and visual analog scale. Secondary outcomes were American Shoulder and Elbow Surgeons Standardized Shoulder Assessment, ROM, and Hospital Anxiety and Depression Scale. Repeated-measures analysis of covariance with baseline scores as the covariates was used to determine between-group differences. An intention-to-treat analysis was performed using the multiple imputation method to impute values for all missing data. RESULTS: Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups at the 6- and 12-week follow-ups compared to baseline. There were no significant time-by-group interactions between-group differences noted for the Disabilities of the Arm, Shoulder and Hand (F = 0.470, P = .93), visual analog scale (F = 0.006, P = .94), flexion ROM (F = 2.78, P = .1), internal rotation ROM (F = 3.440, P = .07) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (F = 0.470, P = .49). The overall group-by-time interaction for the 2 × 3 mixed-model analysis of covariance using baseline scores as a covariate was significant for the abduction range (F = 4.460, P = .04) and external rotation ROM (F = 12.100, P = .002) in favor of the exercise group. CONCLUSIONS: The study demonstrated that while both groups achieved significant improvements at the 6-, and 12-week follow-ups, the exercise group was superior in terms of abduction and external rotation ROM. Additionally, even though both groups were improved, the effect sizes were larger in the exercise group. Considering the systemic side effects of oral corticosteroids, even at low doses, a well-planned exercise program that considers pain may be a good option for frozen shoulder.

Effectiveness of Exercises With Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study.

OBJECTIVE: The aim of the study is to investigate the effectiveness of a rehabilitation program with electromyographic biofeedback compared with the control group on patients with massive rotator cuff tear. DESIGN: Forty-six adults with massive rotator cuff tears, randomly assigned to 2 groups (23 electromyographic biofeedback group vs. 23 control group). The electromyographic biofeedback group (experimental group) performed the exercises under the guidance of electromyographic biofeedback, unlike the control group. All patients underwent a 45-minute training session a day, 3 times a week over a 6-wk duration, and followed up until 1-year. The outcome measures were American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, Numeric Pain Rating Scale, and Global Rating of Change Scale. RESULTS: Compared with the control group, the electromyographic biofeedback group demonstrated a significant change in shoulder flexion strength and patient satisfaction from baseline to 6 wks (posttraining) and from baseline to 12-mo follow-up ( F = 4.671, P = 0.005). There were significant improvements in within groups statistics for American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, and Numeric Pain Rating Scale in both groups ( P < 0.05). CONCLUSIONS: The results demonstrate that deltoid-focused structured rehabilitation program combined with electromyographic biofeedback can be used to increase shoulder flexion strength and patient satisfaction in conservative treatment of massive rotator cuff tear.

The effect of a shaken baby syndrome prevention program on Turkish mothers' awareness and knowledge: A randomized controlled study.

PURPOSE: This study aimed to develop an evidence-based education program to increase mothers' awareness and knowledge of shaken baby syndrome (SBS) and evaluate program effectiveness. DESIGN AND METHODS: Mothers with babies between 2 and 4 months of age were completed the study (intervention group = 43 and control group = 44). This single-blind randomized controlled study was conducted between September 2020 and February 2021. The intervention group participated in an 8-week follow-up. Outcome variables were assessed at baseline and 8 weeks after commencement of the intervention, which included measures to evaluate the administration of the shaken baby syndrome prevention program (SBSPP). The study was approved by ClinicalTrials.gov NCT04568538. RESULTS: Scores for the SBS assessment survey were significantly higher in the intervention group than in the control group. PRACTICE IMPLICATIONS: Developing effective interventions for SBS is an important public health goal. This study is the first to prove the effectiveness of an SBSPP conducted by nurses in Turkey. We believe that the implementation of this program in a larger sample will make a significant contribution to SBS reduction. Pediatric nurses identify the needs of parents with babies younger than 6 months and support them to manage this process correctly.

Effectiveness of therapeutic electromyographic biofeedback after orthopedic knee surgeries: a systematic review.

PURPOSE: To present an evidence-based overview of the current utilization and the effectiveness of therapeutic Electromyographic Biofeedback (EMG-BF) in rehabilitation after orthopedic knee surgeries. MATERIALS AND METHODS: This systematic review was conducted according to the PRISMA statement. MEDLINE (PubMed), PEDro, The Cochrane Library, and Web of Science databases were searched from their inception to June 20, 2020. RESULTS: Eight RCTs investigating effectiveness of the EMG-BF in rehabilitation after orthopedic knee surgeries were identified. The quality scores for included studies ranged from 6 to 8 on PEDro Scale. Most of the included studies reported that EMG-BF was more effective compared to home exercises, standard rehabilitation program or electrical stimulation for improving quadriceps strength or activation. Besides, EMG-BF was revealed positive results in functional assessments except gait velocity and IKDC. Only two studies reported knee ROMs were significantly improved in favour of EMG-BF. CONCLUSIONS: This systematic review shows that EMG-BF seems to control pain and improve quadriceps femoris strength and functionality. However, the results are inconclusive regarding knee ROMs. Although available high-quality evidence is limited, EMG-BF might be a part of the rehabilitation after knee surgeries.Implications for rehabilitationThis paper reviews the effectiveness of the therapeutic EMG-BF as a potential option in rehabilitation after orthopedic knee surgeries.It is recommended EMG-BF can be used to control pain and to improve quadriceps strength and function.There is insufficient evidence to support EMG-BF to improve the range of motion.

Translation, cross-cultural adaptation, reliability, and validity of Turkish version of the university of California Los Angeles (UCLA) shoulder scale into Turkish.

PURPOSE: To translate and culturally adapt the University of California Los Angeles (UCLA) shoulder scale into Turkish (T-UCLA) and determine its psychometric properties. MATERIAL AND METHODS: The UCLA scale was translated into Turkish using Beaton guidelines. Ninety-one patients (46 male; mean age: 46.0 ± 13.7 years) with shoulder disorders completed T-UCLA and American Shoulder and Elbow Score (ASES), Simple Shoulder Test (SST) and 36-Item Short Form (SF-36). Test-retest reliability was tested in 50 patients at a mean of 5.2 ± 2.2 days after initial assessment. Validity was evaluated in 91 patients, and correlations between ASES, SST and SF-36 were analyzed. Responsiveness was assessed in 33 patients who underwent arthroscopic rotator cuff repair with a mean follow-up of 12.8 ± 0.5 months. RESULTS: Test-retest reliability of overall T-UCLA, pain and function subscales were 0.96, 0.94 and 0.86, respectively. The correlation coefficients between T-UCLA and SST and ASES were r = 0.752 and r = 0.783, respectively (p < 0.001). The highest correlations between T-UCLA and SF-36 were observed in physical functioning (r = 0.64) and bodily pain subscales (r = 0.66). No ceiling or floor effect observed. Overall and subscales of T-UCLA were highly responsive (ES = 3.22-4.31). CONCLUSION: T-UCLA has sufficient reliability and validity similar to original and translated versions. T-UCLA is responsive in patients who underwent rotator cuff repair.Implications for rehabilitationIn this study, Turkish version of the UCLA was found to be a reliable and valid outcome measure in patients with various shoulder pathologies.Turkish version of the UCLA is a very responsive tool in patients with who underwent arthroscopic repair of rotator cuff tears.

A comparison of the effectiveness of splinting, exercise and electrotherapy in women patients with hallux valgus: A randomized clinical trial.

BACKGROUND: Hallux valgus (HV) is a very common foot deformity involving lateral deviation of the hallux and medial deviation of the first metatarsal head. OBJECTIVES: To investigate the effects of HV night splinting, exercise and electrotherapy on the HV angle, and foot-specific health-related quality of life. METHODS: Sixty women (120 feet) with bilateral HV deformity were randomly assigned to one of three groups - an HV night splint (SP) group, an exercise (EX) group, and a high-voltage galvanic stimulation (HVPGS) (EL) group. The patients in SP group used the HV night splints while resting or sleeping for at least 8 h a day and the patients in the EX group performed exercises 3-4 times a day with 10 repetitions for the duration of the one-month treatment period. Twenty-minute HVPGS was applied in total over three weekly sessions for four weeks in EL group. Angular degrees (hallux interphalangeal angle (HIPA), HV angle (HVA), and intermetatarsal angle (IMA)) were determined before (t0) and three months after treatment (t2). Foot-specific quality of life was assessed using the Manchester-Oxford Foot Questionnaire (MOFQ) at t0, after one month (t1), and at t2. RESULTS: All groups exhibited significant changes in the HIPA, HVA, and IMA angles and outcome measures (p ≤ 0.001). Decreases in the HIPA and IMA angles, and MOFQ-Pain subscale scores, were higher in the SP group than in the other two groups (p < 0.05). IMA angle at t2, MOFQ-Walking score at t1 and t2 and MOFQ-Pain subscale score at t1 were lower in the SP group (p < 0.05). CONCLUSION: The SP group exhibited more positive effects in the parameters measured than the other two groups. A combination of these conservative treatment approaches may be more beneficial to improve HV symptoms with longer follow-up periods. CLINICALTRIALS. GOV IDENTIFIER: NCT04393545.

Effects of a Massage Protocol in Tensiomyographic and Myotonometric Proprieties.

BACKGROUND: Pre-competition massage is usually used to improve athletic performance and reduce risk of injury. Despite its usual use, the effects of pre-competition massage on neuromuscular function have barely been studied. The aim of this study is to evaluate the effects of the pre-competition massage over the gastrocnemius neuromuscular function. METHOD: The study is a quasi-experimental clinical trial thirty healthy athletes were enrolled in the study. Subjects received an intervention in one leg (experimental), consisting of a massage, and no intervention in the opposite leg (control). From all values of neuromuscular function, the following were analyzed: contraction time (Tc) and maximal displacement (Dm) by tensiomyography, and stiffness and tone by myotonometry. RESULTS: Main effects of pre-competition massage on neuromuscular function include a significant (p < 0.05) increase in Tc and Dm variables, as well as a reduction in stiffness and tone. CONCLUSION: Data shows an increase in Tc and maximal radial displacement (Dm) variables, as well as a reduction in stiffness and tone. More quality studies are needed to draw clear conclusions about the effects of pre-competition massage.

The Combination of Exercise and Manual Therapy Versus Exercise Alone in Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Clinical Trial.

BACKGROUND: Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic surgeries in the lower extremity. However, patient dissatisfaction and functional disability are mostly experienced because of pain and limited range of motion (ROM). Although manual therapy is commonly implemented to improve ROM and modulate pain in the management of musculoskeletal disorders, there is a lack of evidence about its clinical effectiveness on postoperative TKA rehabilitation. OBJECTIVE: To investigate the effectiveness of an exercise program combined with manual therapy compared with an exercise program only for pain, ROM, function, quality of life, and patient satisfaction outcomes. DESIGN: A randomized controlled clinical trial. SETTING: Rehabilitation unit of a university hospital. PARTICIPANTS: Forty-two patients (68.45 ± 6.3 years) scheduled for unilateral TKA as a treatment of severe osteoarthritis. INTERVENTIONS: Joint and soft tissue mobilizations in addition to exercise therapy were provided to the mobilization group (n = 21) while the control group received exercise therapy only (n = 21). MAIN OUTCOME MEASURES: The outcome measures were numeric pain-rating scale, knee ROMs, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, 10-meter walk test (10MWT), 5-times sit to stand test (5SST), and Short Form-12 (SF-12). RESULTS: Improvements in pain outcomes were significantly higher in the mobilization group than in the control group (P = .001, F [3, 33] = 7.06) and the between-group difference in change score was 1.3 points (P = .001). Although the between-group difference in change score was 12.8° for knee flexion at 2 months (P = .001), the overall group-by-time interactions were not significant for flexion and extension ROMs (P = .175, F [3, 33] = 1.75 and P = .57, F [2, 34] = 0.56, respectively). Additionally, there were statistically meaningful group-by-time interactions on total WOMAC score (P = .006, F [2, 34] = 5.29), 10MWT (P = .002, F [3, 33] = 5.98), and SF-12 mental component summary (P = .01, F [2, 34] = 4.92) favoring the mobilization group. Also, patient satisfaction was higher in the mobilization group (P = .02). CONCLUSIONS: A structured exercise program combined with manual therapy can be more beneficial in improving pain, function, and patient satisfaction compared to exercise program alone for postoperative TKA patients.

Estimating the Lumbar Puncture Needle Depth in Children.

Background: Lumbar puncture's (LP) success is dependent on the skill of the physician, anatomy, size, and posture of the patient. Aims: The purpose of this study was to describe a method that could be used to help estimate the correct depth of needle (Y) insertion in children based on age, weight (W), and height (H). Methods: The study consisted of 200 children American Society of Anesthesiologist class I-II aged 0-12 years who underwent spinal block for orthopedic, pediatric, and genitourinary surgery. The distance from the skin entry point to the tip of the spinal needle was measured after the LP was performed. The relationship between the Y and W, H and body mass index (BMI) was calculated. Predictive statistical models were used to determine the LP needle depth. A paired sample t-test was conducted to compare the findings of the developed model with those of earlier models. Results: The patients were aged 2-144 months, with H and W of 43-154 cm and 2.5-48 kg, respectively. The BMI was 10.75-37.72 kg/m2. Before the Y was estimated, the relationship between the independent variables and the depth variable, which was the dependent variable, was examined. According to the obtained results, the model consists of strong relationships with H, W, and H + W. The formula for predicting Y based on W plus H was as follows: for all patients: Y (cm) = 0.861 + 0.012 × H (cm) + 0.035 × W (kg). Based on H, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 0.393 + 0.023 × H (cm). Based on W, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 1.460 + [0.067 × W (kg)]. Conclusion: The formula may provide a more reliable estimate of the required LP depth in children than that obtained using current models. However, larger studies are needed to standardize the formula.

The clinical efficacy of kinesio taping in shoulder disorders: a systematic review and meta analysis.

OBJECTIVE: To evaluate the effects of kinesio taping on shoulder disorders, as a single treatment modality or as conjunction to other treatments. DATA SOURCES: MEDLINE, PEDro (Physiotherapy Evidence Database), The Cochrane Library, Web of Science, Embase and OpenGrey databases were searched for trials published before 5 February 2020. METHODS: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Randomized controlled trials published in English or Turkish were included. The methodological quality of the studies was assessed with the Physiotherapy Evidence Database scale. For analysis of continuous data, mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used. The I2 statistics was used to measure the heterogeneity. RESULTS: Fourteen studies were included with 680 participants. Kinesio taping did not produce better results on pain compared to sham (MD by -0.77 (95% CI = -1.77, 0.22), P = 0.13), exercises (MD by -0.51 (95% CI = -1.41, 0.39), P = 0.27), or passive treatments (MD by -0.29 (95% CI = -0.77, 0.19), P = 0.24). Similarly, kinesio taping did not found superior to sham kinesio taping (SMD by -0.01 (95% CI = -0.31, 0.29), P = 0.94), exercises (SMD by 0.41 (95% CI = -0.25, 1.07), P = 0.22), or passive treatments on function (SMD by -0.02 (95% CI = -0.19, 0.15), P = 0.82). There was no significant SMD on range of motion (ROM) by -0.07 (95% CI = -0.47, 0.33, P = 0.74) compared to sham kinesio taping and -0.06 (95% CI = -0.20, 0.09, P = 0.46) compared to passive treatment. Overall, effect size was found small to moderate. CONCLUSION: Despite reported positive effects in some studies, there is no firm evidence of any benefit of kinesio taping on shoulder disorders.

The effectiveness of superimposed neuromuscular electrical stimulation combined with strengthening exercises on patellofemoral pain: A randomized controlled pilot trial.

BACKGROUND: Patellofemoral pain (PFP) is one of the most common disorders of the knee. Neuromuscular electrical stimulation (NMES) is often assumed by clinicians to be an effective adjunctive therapy to quadriceps strengthening. OBJECTIVE: The aim of this study was to assess the efficacy of superimposed NMES combined with strengthening exercises to improve the recovery of quadriceps strength and function in patients with PFP. METHODS: This study was planned as a single blind randomized controlled pilot study. A total of twenty-seven patients diagnosed with PFP were randomly assigned into 2 groups. Patients received superimposed NMES in addition to the standardized program (Group I) or only the standardized program (Group II). The patients in both groups were treated 3 times a week for 6 weeks and followed at 12 weeks. Primary outcome measure was quadriceps isokinetic muscle strength. The changes in dependent variables before treatment, 6th, and 12th weeks were analyzed using a 2 × 3 mixed-model analysis of variance. RESULTS: There were significant improvements in the within groups statistics of all parameters for both groups (p< 0.05). No differences in quadriceps strength, Kujala and Lysholm scores between groups were found at the different time points [F (2, 21) = 0.86; p= 0.12, F (2, 21) = 0.001; p= 0.97, F (2, 21) = 0.12; p= 0.73, respectively]. CONCLUSIONS: The results indicate that superimposed NMES combined with the standardized rehabilitation program has no clinically significant superiority to standardized rehabilitation program alone.

Minimal clinically important difference of commonly used hip-, knee-, foot-, and ankle-specific questionnaires: a systematic review.

OBJECTIVE: Minimal clinically important difference (MCID) has become the most important psychometric factor for interpreting change in individual's responses over time from the patient's perspective, evaluating study results and planning sample sizes. The purpose was to synthesize and critically appraise MCID of the most frequently used hip-, knee-, foot-, and ankle-specific patient-reported outcomes (PROs). STUDY DESIGN AND SETTING: A search was conducted on PubMed, Cochrane Library, and Web of Science from each site's respective inception through January 2019 for MCID in 25 PROs. The studies reporting their results with anchor-based method were included. RESULTS: 228 full-text articles were assessed for eligibility, and 48 were included in the final evaluation. Our synthesis provides a comprehensive assessment of MCID for 16 disease or joint specific PROs. MCID of the Western Ontario and McMaster Universities Index (33.3%), International Knee Documentation Committee Subjective Knee Form (14.5%) and Knee Injury, and Osteoarthritis Outcome Score (14.5%) was found to be the most commonly presented PROs. The studies mainly (85%) used the receiver operating curve analysis to elicit MCID. CONCLUSION: MCID is increasingly used as a measure of patient's improvement. However, MCID varied based on the analytic methods, study population, type of disease, the baseline status, change in values and treatments, and patient demographics. Therefore, it should be interpreted with caution.

Photobiomodulation Therapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Lateral Epicondylitis.

Objective: To compare the effects of photobiomodulation therapy (PBMT) and extracorporeal shock wave therapy (ESWT) on lateral epicondylitis (LE). Background: Although several authors have investigated the effects of PBMT and ESWT on LE, only one study to date has compared ESWT with PBMT. Ours is also the first study assessing patient satisfaction levels and quality of life in addition to comparing the two methods. Methods: Forty-three patients were randomly divided into two groups: 23 (mean age: 48.2 ± 9.4; 17 female, 6 male) were included in the PBMT group and 20 (mean age: 48.0 ± 9.9; 15 female, 5 male) in the ESWT group. PBMT was applied three times a week for 4 weeks, and ESWT once a week for 4 weeks. Stretching and eccentric strengthening exercises were also given to both groups as a home program. The Mayo Elbow Performance Score and disabilities of the arm, shoulder, and hand (DASH) were used for evaluating upper extremity functions. Pain intensity was evaluated using a visual analog scale (VAS), and muscle strengths were also assessed using a hand-held dynamometer. The 12-Item Short Form (SF-12) Survey Physical and Mental Component Scales were used to evaluate quality of life, and the global rating of change scale to evaluate patient satisfaction. Patients were assessed before treatment and at 12-week follow-up. Results: Improvements for elbow extension and shoulder flexion strength and for VAS movement were observed only in the PBMT group, whereas improvement of handgrip strength was present in both groups (p < 0.05). However, handgrip strength was superior in the PBMT group than in the ESWT group (p = 0.02). Conclusions: Both PBMT and ESWT are useful and can be used in the treatment of LE.