A randomized clinical trial on the changing of median nerve cross-sectional area and pain after extracorporeal shock wave and low-level laser therapy added to conventional physical therapy in patients with mild-to-moderate carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common mononeuropathy in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients. PURPOSE: This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the median nerve and pain in mild-to-moderate CTS patients. STUDY DESIGN: This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1. METHODS: Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample t-tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's d effect size was used to assess the intervention's magnitude. RESULTS: Both ESWT and LLLT groups showed significant improvements in CSA (p = 0.002) and pain (p < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy. CONCLUSION: The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction.

Diaphragmatic Ultrasound Advantages in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Systematic Review and Metaanalysis.

Background: Diaphragmatic ultrasound is increasingly used to assess patients with Chronic Obstructive Pulmonary Disease (COPD). The present study aims to investigate diaphragmatic dysfunction in COPD patients through a systematic review and meta-analysis. Methods: In December 2022,The researchers studied four international databases such as Medline/PubMed, ProQuest, ISI/WOS, and Scopus. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. Results: Finally, 6 articles were included in the analysis. Based on the meta-analysis results, forced expiratory volume (FEV1) was significantly lower in COPD patients compared to the control group (Hedges's g= -2.99, 95 % CI -4.78, -1.19; P =0.001). Forced vital capacity (FVC) was significantly lower in COPD patients compared to the control group (Hedges's g= -1.12, 95 % CI -1.91, - 0.33; P =0.005). COPD patients had significantly lower FEV1/FVC than the control group (Hedges's g= -1.57, 95 % CI -2.33, -0.81; P <0.001). Conclusion: The present study showed that the diaphragm ultrasound (DUS) method could identify the difference in FEV1, FVC, and FEV1/FVC indices in two groups of COPD patients and healthy people.

Effectiveness of ultrasound and median nerve gliding with and without shock-wave therapy in patients with moderate carpal tunnel syndrome.

[Purpose] The aim of this research was to see how ultrasound and nerve gliding with and without shock wave therapy effects on clinical and sonographic data of patients with carpal tunnel syndrome (CTS). [Participants and Methods] Forty four patients with moderate carpal tunnel syndrome participated in this research. One group got shock-wave therapy in addition to median nerve glide exercises and ultrasound, whereas the other group received median nerve glide exercises and ultrasound alone. Hand grip strength (HGS), pinch grip strength (PGS), Visual Analogue Scale (VAS)-pain, Boston Questionnaire (BQ), and Cross-sectional area (CSA) of median nerve were examined before and after 10 sessions of treatment. [Results] HGS, PGS, VAS, BQ and CSA of median nerve improved considerably after therapy. [Conclusion] Patients with moderate CTS who received ultrasound and median nerve glide exercises with and without shock-wave therapy improved considerably without preference of adding shock-wave therapy to other treatment.

Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial.

BACKGROUND: It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. METHODS: The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. RESULTS: Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher's exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005). CONCLUSIONS: Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP. TRIAL REGISTRATION: The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on September 10, 2020 as IRCT20090228001719N8 .

Combining Patient Education With Dry Needling and Ischemic Compression for Treating Myofascial Trigger Points in Office Workers With Neck Pain: A Single-Blinded, Randomized Trial.

OBJECTIVE: The purpose of this study was to compare immediate and short-term effects of combining dray needling (DN) + patient education vs ischemic compression (IC) + patient education for treating myofascial trigger points (MTP) in office workers with neck pain. METHODS: This was a single-blinded, randomized trial. Thirty-two participants were randomly assigned to either DN + patient education or IC + patient education group. Both groups received 2 treatment sessions with a 48-hour time interval. Pain intensity, cervical range of motion, Neck Disability Index, and satisfaction were measured. RESULTS: Pain intensity and neck disability level decreased, whereas the cervical range of motion (side-bending and rotation) increased in both groups. Analysis of variance revealed a significant interaction of group × treatment only for pain intensity, indicating a greater reduction in the IC group. Satisfaction generally increased in the follow-up assessment in both groups. CONCLUSION: Both intervention groups had some positive immediate and short-term effects after 2 treatment sessions. However, IC + patient education was more effective than DN + patient education in the treatment of MTPs in office workers with neck pain.

Comparison of the Effect of Massage and Music on Fatigue in Mothers With Premature Newborns Admitted to the Neonatal Intensive Care Unit: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the effect of massage and music on fatigue in mothers with preterm newborns in neonatal intensive care units (NICUs). METHODS: This study was a clinical trial with a crossover design which was conducted in Valiye Asr Hospital, Tehran, Iran. A convenience sample of 41 mothers with hospitalized premature neonates in the NICU were randomly assigned to massage-first or music-first groups. Both groups received music and massage, but in different orders. Fatigue was measured using the Multidimensional Fatigue Inventory before and after interventions. Data were analyzed using SPSS version 16 and repeated-measures analysis of variance. RESULTS: The mean ± SD Multidimensional Fatigue Inventory scores after music, massage, and control measurements were, respectively, 66.90 ± 6.23, 55.78 ± 6.65, and 54.71 ± 6.81. Results of the analysis of variance indicated that there was a significant difference in mean fatigue score between the control group and after both music and massage (P < .001). However, there was no significant difference between the music and massage groups (P = .780). CONCLUSION: In this sample of participants, massage and music reduced fatigue in mothers who had preterm newborns in the NICU.

A prophylactic effect of local vibration on quadriceps muscle fatigue in non-athletic males: a randomized controlled trial study.

[Purpose] This study was conducted to investigate the immediate prophylactic effects of local vibration on quadriceps muscle fatigue in young non-athletic males. [Participants and Methods] Thirty healthy young males were randomly assigned to vibration and sham control groups. Participants in the local vibration group received a single session vibration (2 minutes, 30 Hz). They also in the control group received a 2-minute vibration, while the vibration system was off. MVC, RMS and median frequency of EMG findings and time to reach fatigue were measured. [Results] Time to reach fatigue and MVC in the local vibration group was significantly high than those in the sham control group. [Conclusion] It seems that the prior local muscle vibration may be useful to attenuate some signs and symptoms of muscle fatigue.

The effect of myofascial neck pain on postural control: visual deprivation.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the standing balance (with open and closed eyes) on rigid surface in women with myofascial neck pain syndromes. MATERIAL AND METHOD: This study was carried out in single and double limbs stances, open versus closed eyes, and the results were compared with control group. Forty subjects (20 in each group) were tested on a force-platform, during 30 seconds. The mean velocity (cm/s), surface area (cm2), antero-posterior and medio-lateral displacements (cm) of center of foot pressure (COP) were determined. RESULTS: There were significant differences between two groups regarding the mean velocity and area of COP displacements. In addition, significant differences were observed in respect to eye and limb conditions (open versus closed; single versus double limbs stances; respectively) on mean velocity, area, antero-posterior (AP) and medio-lateral (ML) displacements of COP. CONCLUSION: Our results showed that myofascial neck pain syndrome might be one of the disturbing factors on standing balance.

The beneficial effects of adding low level laser to ultrasound and exercise in Iranian women with shoulder tendonitis: a randomized clinical trial.

OBJECTIVES: A randomized, double-blind, clinical trial study was conducted with the aim of determining the efficacy of adding laser (830 nm) to ultrasound (US) and exercise for the management of shoulder tendonitis. METHODS: 42 subjects (n=21, in adding laser group and n=21, in US and exercise group) received a course of 10 sessions treatment over one month in the shoulder region. Outcome measures such as Visual Analogue Scale (VAS), Tenderness Severity Scale (TSS), Constant Murley Score (CMS) and Manual Muscle Testing (MMT) were performed before treatment and at the end of 4 weeks treatment. In addition, follow up were performed 2 months after the end of treatment based on the degree of pain improvement. RESULTS: VAS, TSS and CMS improved significantly (P=0.001) in both groups, however the muscle strengths only improved significantly in adding laser group (P< 0.01). CONCLUSION: It seems that both protocols of physical therapy interventions were effective in relieving the signs and symptoms of shoulder tendonitis. Furthermore, adding low level laser therapy (LLLT) to the US and exercise was more efficient in improving the muscle strength in patients with shoulder tendonitis over a period of three months. However, it should be emphasized that, the current results might be due to the effects of laser and exercise instead of laser, us and exercise (as we had no independent group for US).