Effects of Transcutaneous Electrical Nerve Stimulation on Chronic Pelvic Pain in Women: A Systematic Review and Meta-Analysis.

INTRODUCTION: The study aimed to identify the effects of transcutaneous electrical nerve stimulation (TENS) in women with chronic pelvic pain (CPP) by conducting a systematic review and meta-analysis of randomized controlled trials. METHODS: We used five international databases from 2000 to 2020 and selected the clinical trials that reported the effects of TENS on CPP. We excluded the case reports, acute pelvic pain reports, men-related, animal-related, and intravaginal and intrarectal electrical stimulation articles. The level of pain (based on the visual analog scale) was considered for pooling data through the meta-analysis. RESULTS: Ten studies met the inclusion criteria, and three articles were included in the meta-analysis. The results showed that TENS application mildly reduced pain in women with primary dysmenorrhea (mean difference = -1.29; 95% CI: -2.57 to -0.01; Z = 1.98, p = 0.05). Also, to reduce pain in patients with CPP, the TENS must be applied at least for 20 min, with a pulse duration of 50-400 µs, at a frequency of 2-120 Hz. The meta-analysis was followed by assessing the risk of bias, including publication bias. Based on the Cochrane risk of bias evaluation, the majority of the included trials were assessed with moderate methodological quality. CONCLUSION: TENS application can mildly improve the level of pain in patients with CPP caused by primary dysmenorrhea. Although no distinct agreement was observed among the effective parameters, the high-frequency mode with maximum tolerated intensity was more effective compared to the low-frequency mode.

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences.

OBJECTIVE: Imaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups. DESIGN: Sonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA). RESULTS: ICCs (3, 3) for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls. CONCLUSION: The results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.

Efficacy of low-level laser therapy on management of Bell's palsy: a systematic review.

The aim of this study is to evaluate the efficacy of low-level laser therapy (LLLT) in patients with Bell's palsy (BP) through a systematic review method. We systematically searched international databases including PubMed, Scopus, and Web of Science to find eligible articles without language limitation. All relevant randomized controlled trials (RCTs) that compared the efficacy of the LLLT with placebo laser, exercise, massage, or no intervention on BP patients were included. Four studies (out of 259) had met our inclusion criteria involving 171 patients and were entered to the systematic review. Full texts of the selected studies were retrieved and critically appraised using Physiotherapy Evidence Database (PEDro) scale. The patients of all trials were in sub-acute (less than 1 week) stage. Both of LLLT and control groups showed significant improvement after trials. Two authors reported significant differences between the groups after 6 weeks of laser application (830 nm, 100 mW). In converse, two other authors did not identify any effectiveness following 4 weeks and 15 days of LLLT application with 670 and 830 nm wavelength, sequentially. There is clear lack of information lead to get and evidence-based suggestion for the LLLT application on Bells' palsy; however, the LLLT irradiation with 830 nm and 100 mW power for a period of 6 weeks might be beneficial on recovery for the patients with sub-acute Bell's palsy. There were no reported adverse effects during treatment and/or follow-up sessions.

The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach.

This study aimed to identify the role of the scapula in shoulder musculoskeletal disorders (SMDs) and provided a systematic review of available studies in the field of scapular three-dimensional kinematics. We systematically searched 5 international databases, including Scopus, EMBASE, PubMed, CINAHL, PEDro, and Cochrane Library from June to September 2015. Twenty studies met the inclusion criteria and were retrieved in full paper. The selected studies were critically appraised independently by two researchers. The patients with shoulder impingement syndrome (SIS) and shoulder instability had an increased protraction, lesser upward rotation (UR), and increased internal rotation (IR) during scapular plane elevation, whereas the patients with frozen shoulders had lesser protraction. Moreover, the patients with SIS had a greater scapular posterior tilt (PT) and external rotation during shoulder abduction. Increased scapular UR and PT with decreased scapular IR was seen in patients with stiffness of Latissimus Dorsi and fibromyalgia without any changes in the scapular IR. The results of this systematic review help the clinicians to have an insight about scapular kinematics as a predictive index for SMDs.

Reliability and Validity of Electro-Goniometric Range of Motion Measurements in Patients with Hand and Wrist Limitations.

STUDY DESIGN: Cross-sectional reliability and validity study. PURPOSE: 1. To determine intrarater, interrater and inter instrument reliabilities and validity of two digital electro goniometry to measure active wrist/finger range of motions (ROMs) in patients with limited motion. 2. To determine intrarater and interrater reliabilities of digital goniometry to measure torques of PIP passive flexion of the index finger in patients with limited motion. METHODS: The study was designed in a randomized block plan on 44 patients (24 women, 20 men) with limited wrist or hand motions. Two experienced raters measured active wrist ROMs, and active and passive index PIP flexion using two digital goniometers. All measures were repeated by one rater 2-5 days after the initial measurements. The reliability measures were analyzed using Intraclass Correlation Coefficients (ICCs) and the construct validity was determined by correlation coefficients analysis between sub measures of scores; patient rated pain and function (PRWE) and quick Disabilities of the Arm, Shoulder and Hand (quick DASH) scores. RESULTS: The intrarater, interrater and inter instrument reliabilities were high in most ROM measures (range 0.64-0.97) for both types of electro-goniometers. The 95% limit of agreements and Bland and Altman plots did not show progressive changes. There was a significant difference in force application between the raters when performing passive ROM measures for PIP index, but the same rater produced consistent force. Most of the NK and J-Tech ROM measures were moderately correlated with the patient rated pain and function scores (range 0.32-0.63).

Effects of low-intensity pulsed ultrasound therapy on fracture healing: a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis was performed to identify the clinical trials relevant to the effects of low-intensity pulsed ultrasound (LIPUS) on bone regeneration. DESIGN: We searched five international electronic databases including MEDLINE (1966-June 2010), and PubMed, EMBase, Cumulative Index to Nursing and Allied Health, and Cochrane (1980-June 2010) to identify the relevant studies on the effects of LIPUS on bone healing. The inclusion criteria were human clinical trial, all types of bones, fractures, and outcome measurements, LIPUS application, and English language. Overall, 260 potentially eligible abstracts were identified, and 65 articles were retrieved in full text. Of the 65 studies, 23 met the inclusion criteria and were critically appraised by two raters independently using the PEDro quality measurement method. The results of all eligible studies were categorized in three groups: fresh fractures, delayed or nonunions, and distraction osteogenesis. Seven trials among fresh fracture trials were identified eligible for meta-analysis because of the varieties of outcome measurements and clinical situations. The time of the third cortical bridging (increase in density or size of initial periosteal reaction) in radiographic healing was our common criteria for the meta-analysis. RESULTS: The time of third cortical bridging was statistically earlier following LIPUS therapy in fresh fractures (mean random effect, 2.263; 95% CI, 0.183-4.343, P = 0.033). CONCLUSIONS: LIPUS can stimulate radiographic bone healing in fresh fractures. Although there is weak evidence that LIPUS also supports radiographic healing in delayed unions and nonunions, it was not possible to pool the data because of a paucity of sufficient studies with similar outcome measures.

Effects of low power laser irradiation on bone healing in animals: a meta-analysis.

PURPOSE: The meta-analysis was performed to identify animal research defining the effects of low power laser irradiation on biomechanical indicators of bone regeneration and the impact of dosage. METHODS: We searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment). Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis. RESULTS: Studies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08-1.37, p 0.028). While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.