The Effect of comprehensive rehabilitation on Lithuanian adolescent's nonspecific low back pain, depending on the duration: Nonrandomized single-arm trial.

OBJECTIVE: To determine pain and functional changes during comprehensive rehabilitation (CR) in adolescents with nonspecific low back pain (NLBP), and to determine the optimal CR duration. METHODS: The study included 106 adolescents (39 boys [36.8%], 67 girls [63.2%]), 14 to17 years old, with the following inclusion criteria: duration of NLBP for at least 12 weeks; conservative NLBP treatment was effectless; pain intensity using the visual analogue pain scale (VAS) ≤ 7 points; disrupted daily activities; ability to understand and answer the questions; written consent to participate voluntarily in the study. The pain was assessed using the VAS scale, functional changes were assessed using the Oswestry Disability Index (ODI), 12-Item Short Form Survey, Hospital Anxiety and Depression Scale (HAD), and physical functional capacity and proprioception (Proprio) were assessed using an isokinetic dynamometer. The participants performed a comprehensive pain rehabilitation program consisting of physiotherapy, TENS, magnetotherapy, lumbar massage, and relaxing vibroacoustic therapy. The active CR cycle lasted for 22 sessions (with intermediate measurements after 5 and 16 sessions), after which we performed passive observation for another half a year. Five measurements were performed. RESULTS: Pain, functional assessment, and physical capacity were improved with CR. Statistically significant improvement became apparent after 5 CR sessions, but statistical and clinical significance became apparent after 16 CR sessions. In the distant period, after the completion of CR, neither statistical nor clinical changes occurred. CONCLUSIONS: CR is effective in reducing pain, and improving functional state and physical capacity quickly and reliably in 16 CR sessions, which is sufficient to obtain clinically satisfactory CR results. Good results were achieved during CR and neither improved nor deteriorated spontaneously in the distant period. This study shows a possible mismatch between NLBP intensity and impaired functional state in adolescents.

Combination of a triple wavelength (650 nm, 810 nm, and 915 nm) class IV laser system and local mechanical abrasion in the treatment of chronic toenail onychomycosis: an uncontrolled prospective pilot study.

BACKGROUND: Toenail onychomycosis is a frequent fungal infection that is difficult to treat, especially in elderly patients. Diverse local and systemic antifungal treatments are available with variable results. Recently, different laser systems have been proposed for the treatment of onychomycosis, among them a class IV laser system adopting three different wavelengths, that is, 650, 810, and 915 nm (K-Laser Cube 3TM). OBJECTIVES: This prospective pilot study aims to clarify the clinical, histopathologic, and cultural mycological efficacy of the combination of a triple wavelength laser system and local mechanical abrasion in the treatment of toenail onychomycosis. METHODS: Eight treatment sessions were performed involving a mechanical drill of the friable nail material followed by the laser treatment with four 2-minute cycles per nail with a median power of 3 W providing 240 J each. Clinical exam, mycological culture, and histopathology with PAS staining of nail clips were performed at the beginning and the end of the treatment period. RESULTS: Nine patients with 16 clinically involved nails were included in this study (median age: 55.6). Clinical improvement was noted in eight patients (89%) at the end of the treatment cycles. Initial positive cultures could be reduced from six (67%) to two (22%), P = 0.07, while histopathologic examination by PAS staining remained invariable positive in all patients (100%). CONCLUSION: Despite clinical improvement, the combination of this laser treatment and mechanical abrasion could not reduce the fungal infection rate in affected toenails. Additional local or systemic antimycotic agents should be combined in order to avoid expected clinical recurrences.