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1.
PM R ; 15(11): 1466-1477, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37041724

RESUMO

OBJECTIVE: The purpose of this systematic review with meta-analysis was to investigate the effect of early physical therapy (PT) for the management of acute low back pain (LBP) on patient-reported outcomes of pain and disability, compared to delayed PT or non-PT care. LITERATURE SURVEY: Randomized controlled trials in three electronic databases (MEDLINE, CINAHL, Embase) were searched from inception to June 12, 2020, and updated on September 23, 2021. METHODOLOGY: Eligible participants were individuals with acute low back pain. The intervention was early PT compared to delayed PT or non-PT care. Primary outcomes included the patient-reported outcomes of pain and disability. The following information was extracted from included articles: demographic data, sample size, selection criteria, PT interventions, and pain and disability outcomes. Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Random effects models were used for the meta-analysis. SYNTHESIS: Seven of 391 articles met the eligibility criteria and were included in the meta-analysis. Random effects meta-analysis comparing early PT to non-PT care for acute LBP indicated a significant reduction in pain (standard mean difference [SMD] = 0.43, 95% confidence interval [CI]: -0.69 to -0.17) and disability (SMD = 0.36, 95% CI: -0.57 to -0.16) in the short term. Early PT compared to delayed PT did not result in improvement in short-term pain (SMD = -0.24, 95% CI: -0.52 to 0.04) or disability (SMD = 0.28, 95% CI: -0.56 to 0.01), or long-term pain (SMD = 0.21, 95% CI: -0.15 to 0.57) or disability (SMD = 0.14, 95% CI: -0.15 to 0.42). CONCLUSIONS: This systematic review and meta-analysis suggest early PT versus non-PT care is associated with statistically significant reductions in short-term pain and disability (up to 6 weeks) with small effect sizes. The results indicate a nonsignificant trend favoring a small benefit of early PT over delayed PT for outcomes at short-term follow-up but no effect at long-term follow-up (6 months or greater).


Assuntos
Dor Aguda , Dor Crônica , Dor Lombar , Humanos , Dor Lombar/terapia , Dor Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Modalidades de Fisioterapia , Medidas de Resultados Relatados pelo Paciente
2.
Pain Physician ; 23(4): E335-E342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709179

RESUMO

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.


Assuntos
Dor nas Costas/cirurgia , Ablação por Cateter/normas , Desfibriladores Implantáveis/normas , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesiologia/métodos , Anestesiologia/normas , Ablação por Cateter/métodos , Dor Crônica/cirurgia , Humanos , Articulação Zigapofisária/cirurgia
3.
Spine J ; 19(9): 1455-1462, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31009770

RESUMO

BACKGROUND CONTEXT: The need for advanced imaging before spinal intervention is an area of ongoing debate. Many studies have demonstrated the accuracy of magnetic resonance imaging (MRI) results in evaluating structural pathology in the lumbar spine, but few have addressed how frequently MRI findings change clinical management. A randomized controlled trial showed that viewing MRI results did not impact outcomes in patients with radiculopathy undergoing epidural steroid injection (ESI). The results suggested ESIs that correlated with both imaging and clinical findings experienced slightly more benefit than the blinded cohort, although statistically insignificantly. PURPOSE: Three related studies were conducted to (1) increase understanding of the opinions of interventional spine physicians regarding the utility of viewing imaging before injection and (2) evaluate the impact of viewing MRI results on injection planning (retrospective and prospective analyses). STUDY DESIGN: Survey, prospective, and retrospective analysis. PATIENT SAMPLE: Patients presenting to a university-based spine center for initial evaluation of back or leg pain who were candidates for spinal intervention. OUTCOME MEASURES: Self-reported measures from a clinical practice questionnaire distributed to interventional spine physicians to determine rates and rationale for utilization of MRI before spine injection, physiologic measures including MRI results, functional measures including physician decision-making regarding type and location of injection performed. METHODS: This study was funded by the University of Colorado Health and Welfare Trust. A survey was sent to interventional spine physicians to assess their utilization of MRI results before spine procedures. A retrospective analysis of patients who were candidates for ESI was conducted to evaluate how initial injection plan compared with the postviewing of MRI results on injection performed. In a prospective analysis, injection plans pre- and post-MRI were compared among patients presenting for initial evaluation of low back or leg pain. RESULTS: Survey responses showed that specialists order MRI studies to correlate with physical exam (91%) and to detect the presence of synovial cysts (68%), whereas tumor/infection (93%) was most likely to cause a change in their approach. In the retrospective review, the physician's planned approach before viewing the MRI was concordant with the actual procedure 49% of the time. A different type of procedure was performed in 15% of planned injections. In such cases, the initial treatment plan was altered (ie, same procedure at a different or additional level or side) in 35% of planned injections. In the prospective data collection, 43% of injections were different from the initial physician decision. The most common reasons for altering the injection was different level affected (36%), facet pathology (22%), and different nerve root affected (16%). CONCLUSIONS: In clinical practice, MRI before injection frequently changes management decisions in the planning and delivery of lumbar spine injections.


Assuntos
Injeções Epidurais/métodos , Região Lombossacral/diagnóstico por imagem , Imageamento por Ressonância Magnética/normas , Radiculopatia/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Radiculopatia/tratamento farmacológico
4.
Clin J Sport Med ; 27(4): 409-414, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28653966

RESUMO

OBJECTIVE: Pilot study to determine the practicality and inter-rater reliability of the "Core Score," a composite measure of 4 clinical core stability tests. DESIGN: Repeated measures. SETTING: Academic hospital physician clinic. PARTICIPANTS: 23 healthy volunteers with mean age of 32 years (12 females, 11 males). ASSESSMENT OF VARIABLES: All subjects performed 4 core stability maneuvers under direct observation from 3 independent physicians in sequence. MAIN OUTCOME MEASURES: Inter-rater reliability and time necessary to perform examination. RESULTS: The Core Score scale is 0 to 12, with 12 reflecting the best core stability. The mean composite score of all 4 tests for all subjects was 9.54 (SD, 1.897; range, 4-12). The intraclass correlation coefficients (ICC 1,1) for inter-rater reliability for the composite Core Score and 4 individual tests were 0.68 (Core Score), 0.14 (single-leg squat), 0.40 (supine bridge), 0.69 (side bridge), and 0.46 (prone bridge). The time required for a single examiner to assess a given subject's core stability in all 4 maneuvers averaged 4 minutes (range, 2-6 minutes). CONCLUSIONS: Even without specialized equipment, a clinically practical and moderately reliable measure of core stability may be possible. Further research is necessary to optimize this measure for clinical application. CLINICAL RELEVANCE: Despite the known value of core stability to athletes and patients with low back pain, there is currently no reliable and practical means for rating core stability in a typical office-based practice. This pilot study provides a starting point for future reliability research on clinical core stability assessments.


Assuntos
Teste de Esforço/normas , Equilíbrio Postural , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consultórios Médicos , Projetos Piloto , Reprodutibilidade dos Testes , Adulto Jovem
6.
Muscle Nerve ; 43(4): 596-600, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21319168

RESUMO

INTRODUCTION: We examined the prognostic value of electrodiagnostic (EDX) studies for ulnar neuropathy at the elbow (UNE). METHODS: In this retrospective study, EDX results were compared with subjective recovery (resolution of symptoms) and surgery in patients diagnosed with UNE. RESULTS: Of the 193 patients, 59 with "definite" UNE were included in the analysis. The combination of conduction block across the elbow to the first dorsal interosseous (FDI) and normal distal compound muscle action potential (CMAP) amplitude from the abductor digiti minimi (ADM) was strongly associated with recovery: 86% of these subjects achieved full subjective recovery compared to only 7% without conduction block and with an abnormal CMAP. There were no EDX predictors of surgery. CONCLUSION: EDX results contain useful prognostic information in UNE.


Assuntos
Cotovelo/fisiopatologia , Eletrodiagnóstico/métodos , Neuropatias Ulnares/diagnóstico , Neuropatias Ulnares/fisiopatologia , Adolescente , Adulto , Idoso , Cotovelo/inervação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Prognóstico , Estudos Retrospectivos , Nervo Ulnar/fisiopatologia , Adulto Jovem
8.
Curr Sports Med Rep ; 9(1): 43-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20071921

RESUMO

The clinical use of lumbar epidural steroid injections has increased dramatically. Although there are certainly beneficial effects to using epidural steroid injections in a treatment regimen for lumbar radicular pain, there is a lack of well designed, placebo-controlled studies to define conclusively specific indications and techniques for different spinal diagnoses. This article reviews the pathophysiology of lumbar radiculopathy and the use of epidural steroid injections as one treatment option, as well as describes their risks and benefits. Based on current literature, we offer an evidence-based perspective regarding rational use of lumbar epidural steroid injections for certain indications and treatment goals.


Assuntos
Vértebras Lombares/efeitos dos fármacos , Vértebras Lombares/diagnóstico por imagem , Esteroides/administração & dosagem , Animais , Contraindicações , Hematoma Subdural Agudo/diagnóstico , Hematoma Subdural Agudo/etiologia , Humanos , Injeções Epidurais/efeitos adversos , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Radiculopatia/diagnóstico por imagem , Radiculopatia/tratamento farmacológico , Radiografia , Medição de Risco , Fatores de Risco , Esteroides/efeitos adversos , Resultado do Tratamento
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