Extracorporeal Shock Wave Therapy Combined With Oral Medication and Exercise for Chronic Low Back Pain: A Randomized Controlled Trial.

OBJECTIVE: To compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic at a university hospital. PARTICIPANTS: Eligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration. INTERVENTION: The intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program. MAIN OUTCOME MEASURES: Visual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months. RESULTS: The pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P<.0001) and 1.8 after 3 months (P<.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P<.0001), and 1.1 after 3 months (P<.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P<.001, third month: P<.05). The mean ODI score did not differ significantly between the groups (P=.942). CONCLUSION: Extracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain.

Extracorporeal Shockwave Therapy in Pillar Pain after Carpal Tunnel Release: A Prospective Randomized Controlled Trial.

BACKGROUND: The aim of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pillar pain after carpal tunnel release. MATERIALS AND METHODS: In this prospective randomized controlled trial, forty patients with pillar pain for at least 1 month after carpal tunnel release surgery were randomly assigned in two groups. ESWT group received four sessions of ESWT at weekly intervals, and patients in the control group received sham ESWT treatment at the same intervals, involved sound but no energy. At baseline, 1st month, and 3rd month, hand function (using Brief-Michigan Hand Outcome Questionnaire) and pain score were assessed and compared between groups. RESULTS: At baseline, pain score and hand function score were similar in both groups. After 1st month, pain score in ESWT and control groups was 3.7 versus 4.7, respectively (P = 0.066), and hand function score was 60.7 versus 52.2, respectively (P = 0.032). After 3 months, pain score in ESWT group was significantly lower than the control group (1.6 versus 3.6, respectively, P < 0.0001), hand function score in ESWT group was significantly better than the control group (75.4 vs. 63.7, respectively, P < 0.0001). Trend of decrease in pain score between groups was significantly different, but trend of increase in hand function score was not significantly different. CONCLUSION: After ESWT, hand function and pain score in patients with pillar pain improved faster compared to control patients. Hence, ESWT can be used as a safe and effective noninvasive technique in patients with pillar pain after carpal tunnel release.

Survey of medical students' attitude and knowledge toward physical medicine and rehabilitation in Isfahan University of Medical Sciences.

CONTEXT: Physical medicine and rehabilitation (PMR) is a specialized clinical field of musculoskeletal diseases and physical impairment that is unknown for most of the medical students. AIMS: This study aimed to assess medical students' attitude and knowledge toward PMR and its role in the diagnosis and treatment of musculoskeletal diseases. SETTING AND DESIGN: This cross-sectional study was done on 175 medical students of Isfahan University of Medical Sciences from 2015 to 2016. Sample population was selected by random sampling among 350 students. MATERIALS AND METHODS: Participants were evaluated by a research-made questionnaire with confirmed validity and reliability. This questionnaire included 36 questions divided in four parts including demographic data, knowledge, attitude, and performance ranking. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS 20. Statistical test for quantitative and qualitative variables was carried out by mean ± standard deviation and percentage or number, respectively. For analyzing variables, Student's t-test and Chi-square test were used. RESULTS: In this study, 150 medical students with a mean age of 24.48 ± 1.48 years participated of which 40% of them were male. The mean score of Student's knowledge about PMR and its role in diagnosis and treatment of disorders was 5.16 ± 1.90, and 91.3% had low level of knowledge. The mean score of student's attitude toward PMR and its role in the diagnosis and treatment of musculoskeletal problems was 3.33 ± 0.46, and 69.3% had attitude level above the average. Evaluation of student's performance showed that when they manage patients with musculoskeletal problems as general physician, they refer the patients to physiatrists at the first step if it is necessary. CONCLUSION: Understanding the factors influencing the attitudes and knowledge of medical students is prime to help establishing the roles, providing proper facilities, carrying out successful planning to train expert physicians and create a motivated environment in medical schools.