The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study.

BACKGROUND: Most patients with lumbar spinal stenosis improve significantly within 6 months of lumbar decompression surgery, however, unfavorable long-term disability may persist in some patients. It was unclear which potential influencing factors were more likely to be associated with disability. This study aimed to assess the association between disability and physical performance, pain, and pain-related anxiety in patients after lumbar decompression surgery. METHODS: Patients who underwent decompression for lumbar spinal stenosis were included. Participants completed the visual analog scale, Oswestry Disability Index, and Pain Anxiety Symptoms Scale-20 to collect pain intensity, disability, and pain-related anxiety information. For physical performance assessment, participants performed timed up and go (TUG), functional reach test (FRT), 6-min walking test, and modified Sorensen test, 6-12 months after lumbar decompression surgery. The associations were examined with bivariate and multivariable linear regression analyses. RESULTS: A total of 80 patients were included. A significant association between disability and pain-related anxiety, the FRT, and the modified Sorensen test scores was confirmed in multivariable analyses. Both bivariate (r = - 0.75) and multivariable (ß = 0.60, 95% CI, 0.24, 0.54; P = 0.00) analyses confirmed that pain-related anxiety was the strongest indicator of disability. The association between disability and pain intensity, TUG, and 6-min walking test scores was not confirmed. CONCLUSION: Pain-related anxiety should be considered in the rehabilitation programs after lumbar decompression surgery. The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended.

Comparing the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability: Randomized controlled trial.

OBJECTIVE: To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI). DESIGN: Two-arm, parallel-group, randomized, double-blind, controlled trial. PARTICIPANTS: 60 patients with unilateral CAI. INTERVENTION: integral physiotherapy (n = 30) or conventional physiotherapy (n = 30). OUTCOMES: Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention. RESULTS: The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (meanintegral = 20.14 (14.95-25.37), meanConventional = 29.46 (24.09-34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05). CONCLUSION: Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients' functional ability.

Relationship of Impaired Lumbar Spine-Hip Coordination During Sit To Stand and Stand To Sit with Functional Disability in Chronic Nonspecific Low Back Pain Patients.

Background: This study aimed to investigate the relationships of lumbar spine-hip discoordination during sit-to-stand (STD) and stand-to-sit (SIT) with pain and functional disability in chronic nonspecific low back pain (CNLBP) patients. Methods: A cross-sectional observational study was conducted in a biomechanics laboratory of the physical therapy department located at the School of Rehabilitation Sciences, Iran University of Medical Sciences (Tehran-Iran). A total of 16 CNLBP patients (men 9, female 7) aged 18-40 years (mean 31.48) were selected according to our eligibility criteria. Furthermore, ten reflective markers were placed on the spinous processes of T12 and S2, posterior and anterior superior iliac spines, greater trochanters, and lateral epicondyles. The patients were instructed to perform STD and SIT tasks at a preferred speed without using their hands. Relative phase angle was used as an indicator of coordination and was identified as the inverse tangent of angular displacement/angular velocity. Moreover, the relative phase angle between the lumbar spine and right and left hip joints was measured by subtracting the phase angle of the hip joint from the lumbar spine joint. The ratios of the total movements of the lumbar spine to the total movements of the right and left hip joints were also calculated in the sagittal plane. Finally, Pearson correlation coefficients (r) were utilized to assess the association between variables. Results: The results of this study indicated that kinematic parameters of the pain had statistically significant direct relationships with functional disability in CNLBP participants during STD and SIT with r values ranging from 0.57 (Pvalue = 0.021) to 0.85 (Pvalue<0.001) and 0.54 (Pvalue=0.053) to 0.82 (Pvalue<0.001), respectively. Conclusion: Out of the results of this study, it could be stated that pain and functional disability play a major role in lumber spine-hip discoordination, and it altered the movement ratio in CNLBP patients during STD and SIT. In clinical practice, clinicians should improve lumber spine-hip discoordination in patients with CNLBP since there is a linear relationship between kinematic parameters of the pain and functional disability in patients with CNLBP.

Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials.

Low-level laser therapy (LLLT) is one of recent modalities for treatment of myofascial neck pain (MNP). Several RCTs have been conducted on its effectiveness. The aim of this comprehensive meta-analysis was to evaluate the effectiveness of LLLT on MNP. Electronic databases were searched for identifying eligible studies comparing the effectiveness of LLLT using any wavelength with placebo or active control in myofascial neck pain up to June 2022. Data related to pain intensity, pain pressure threshold (PPT), range of motion (ROM), and disability was analyzed as a pooled estimate of mean difference or standard mean difference (SMD) with 95% confidence intervals (CIs) using random/fixed-effect model. Funnel plot and Egger's linear regression test were also conducted to examine the risk of publication bias. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The data assessing laser effectiveness on different outcomes of 556 patients were considered for meta-analysis. Pooled results revealed that LLLT was significantly effective in pain reduction (MD = - 1.29, 95% CI = - 2.36; - 0.23, P < 0.001). Also, secondary outcomes including PPT (SMD of 2.63, 95% CI = 0.96; 4.30, P < 0.01) and right bending ROM (SMD of 3.44, 95% CI = 0.64; 6.24, P < 0.01) were improved, while disability (MD of - 7.83, 95% CI = - 17.1; 0.08, P = 1.34) did not improve significantly after LLLT. Our meta-data revealed that LLLT may reduce myofascial neck pain and its related outcomes. LLLT is suggested to be used by clinicians along with other therapies such as manual and exercise therapy.

Do carpal Tunnel Hands Have Different Shape Compare to Normal Hands?

BACKGROUND: Given the fact that the carpal tunnel syndrome (CTS) happens as a consequence of the median nerve entrapment, besides other known factors, the shape and anthropometric characteristics of the carpal tunnel, wrist, and hand could be considered as a predisposing risk factor for idiopathic CTS. The aim of this study was to evaluate the morphology and radiologic scales in CTS hands. METHODS: In this prospective study, patients who underwent upper extremity electrodiagnostic studies were enrolled for hand morphologic and radiographic indexes. Patients were divided into CTS suffering and CTS symptom-free groups according to nerve conduction velocity (NCV) findings. A true posteroanterior radiograph of the hands was pas performed for each participant. Metacarpal length to wrist length index (carpal ratio), metacarpal length to metacarpal width index, third to first metacarpal length, hand length index, and hand volume index were measured in both groups. RESULTS: Significant differences were seen between the two groups regarding the body mass index (P< 0.001), metacarpal length divided by metacarpal width index (P=0.08), first metacarpal length divided by third metacarpal length (P=0.002), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P< 0.001), distal flexor wrist crease to the tip of the third finger divided by hand volume (P=0.05), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P< 0.001). Multivariable analysis of hand indices were statically significant for the first metacarpal length divided by third metacarpal length (P=0.00), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P=0.138), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P=0.117). However, first metacarpal length divided by third metacarpal length and third metacarpal length divided by palm height were associated with higher CTS occurrences. Receiver operating characteristic curve analysis demonstrated cutoff points which were possible to estimate only for first metacarpal length divided by third metacarpal length and wrist circumference divided by distal flexor wrist crease to the tip of the third finger. CONCLUSION: Based on our findings, CTS hand is characterized by shorter fingers compared to thumb and wrist (metacarpal length to wrist length and hand length indexes), wider (metacarpal length to metacarpal width index), and bulkier (hand volume index) compared to non-CTS hands. The severity of CTS was correlated with a higher carpal ratio. In conclusion, CTS hands are bulkier with wider palms and shorter fingers compared to thumb. In this study, the thumb to the third metacarpal length was proved to be the best index for diagnosis of "CTS hand".