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1.
J Fish Biol ; 87(2): 323-41, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26179676

RESUMO

This study used a network of acoustic receivers deployed around a no-take zone in Mangrove Bay, within the Ningaloo Reef Marine Park in Western Australia, to study residency and habitat preference of a small coastal shark, the nervous shark Carcharhinus cautus. Twelve C. cautus were tagged with acoustic tags and monitored for up to 579 days. Based on individuals detected within the receiver array for at least 2 months, C. cautus had small core (50% kernel utilization distribution, KUD) and home ranges (95% KUD) of 0.66 and 3.64 km2, respectively, and showed a strong habitat preference for mangroves, which are only found in the no-take zone. This resulted in C. cautus spending most of their detected time within the no-take zone boundaries (mean = 81.5%), showing that such a protected area could be beneficial to protect this species from extensive fishing pressure and local depletion, where required. Not all C. cautus remained within the acoustic array, however, suggesting that individual variations occur and that not all individuals would benefit from such protection. This study provides important information about the habitat, residency and movements of C. cautus that can be used for management and conservation. The strong affinity and residency of C. cautus within a mangrove-fringing coastline, emphasizes the importance of mangrove habitat to the species and suggests that such preferences can be used to design appropriate no-take zones for this species or others with similar habitat preferences.


Assuntos
Ecossistema , Tubarões/fisiologia , Acústica , Animais , Baías , Feminino , Masculino , Telemetria , Austrália Ocidental
2.
Br Dent J ; 217(10): E22, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25415040

RESUMO

OBJECTIVE: To identify reasons behind a lower than expected participant recruitment rate within the FiCTION trial, a multi-centre paediatric primary dental care randomised controlled trial (RCT). SUBJECTS (MATERIALS) AND METHODS: An online survey, based on a previously published tool, consisting of both quantitative and qualitative responses, completed by staff in dental practices recruiting to FiCTION. Ratings from quantitative responses were aggregated to give overall scores for factors related to participant recruitment. Qualitative responses were independently grouped into themes. RESULTS: Thirty-nine anonymous responses were received. Main facilitators related to the support received from the central research team and importance of the research question. The main barriers related to low child eligibility rates and the integration of trial processes within routine workloads. CONCLUSIONS: These findings have directed strategies for enhancing participant recruitment at existing practices and informed recruitment of further practices. The results help provide a profile of the features required of practices to successfully screen and recruit participants. Future trials in this setting should consider the level of interest in the research question within practices, and ensure trial processes are as streamlined as possible. Research teams should actively support practices with participant recruitment and maintain enthusiasm among the entire practice team.


Assuntos
Cárie Dentária/terapia , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Criança , Pré-Escolar , Assistência Odontológica para Crianças/métodos , Humanos , Estudos Multicêntricos como Assunto , Reino Unido
3.
Physiotherapy ; 100(2): 100-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24703523

RESUMO

OBJECTIVE: To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer (NSCLC). DESIGN: Randomised controlled trial. SETTING: Teaching hospital. PARTICIPANTS: One hundred and thirty-one subjects with NSCLC admitted for curative surgery. INTERVENTIONS: Participants were randomised to usual care or a hospital plus home exercise programme. OUTCOMES: The primary outcome was the between-group difference in physical activity 4 weeks after surgery. Secondary outcomes were the difference in quadriceps strength, exercise tolerance and quality of life [Short Form-36 (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-LC13] from pre-operatively (baseline) to 4 weeks after surgery. RESULTS: The participants (n=131) had a mean age of 68 [standard deviation (SD) 11] years and mean forced expiratory volume in 1 second of 2.4 (SD 1.1)l. There were no significant differences in physical activity between the groups 4 weeks after surgery [mean difference adjusted for baseline 12minutes/day, 95% confidence interval (CI) -20.2 to 44.1]. In addition, there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery. Both groups had recovered their pre-operative walking distance 4 weeks after surgery, and there were no differences between the groups (mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery (-26m, 95% CI -94.2 to 42.3). CONCLUSIONS: A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery. Regardless of group allocation, the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/reabilitação , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Terapia por Exercício/métodos , Neoplasias Pulmonares/reabilitação , Neoplasias Pulmonares/cirurgia , Idoso , Tolerância ao Exercício , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Qualidade de Vida
4.
Int J Clin Pract ; 67(10): 979-89, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23889885

RESUMO

BACKGROUND: Acute ankle sprains are common and activity limiting injuries, and topical diclofenac gel has proven efficacy in alleviating pain and restoring function. This trial aimed to compare a topical natural agent, Traumeel with topical diclofenac gel (1%) in the management of acute ankle sprain. METHODS: This prospective, multicentre, randomised, blinded, active-control and non-inferiority study involved 449 physically active adults sustaining unilateral grade 1 or 2 ankle sprain within the past 24 h. Participants were randomised to receive 2 g of Traumeel ointment (T-O) (n = 152) or Traumeel gel (T-G) (n = 150) or diclofenac gel (D-G) (n = 147), administered topically to the ankle three times a day for 14 days, with 6-weeks follow up. RESULTS: Day 7 median percentage reductions in Visual Analogue Scale pain score were 60.6%, 71.1% and 68.9% for the T-O, T-G and D-G groups, respectively. Total pain relief was reported by 12 (8.5%), 7 (5.0%) and 8 (5.9%) participants in each group, respectively. Median improvements in Foot and Ankle Ability Measure Activities of Daily Living subscale score were 26.2, 26.2 and 25.0 points for T-O, T-G and D-G groups, respectively. Mann-Whitney effect sizes and lower bound confidence intervals demonstrated non-inferiority of Traumeel vs. diclofenac for reducing pain and functional improvement. At 6 weeks, participants reported total pain relief and normal functioning. Adverse events (n = 43) were reported by 31/447 participants (6.9%). Treatments were equally well tolerated. CONCLUSIONS: T-O and T-G decreased pain and improved joint function to the same extent as D-G in acute ankle sprain, and were well tolerated.


Assuntos
Analgésicos/administração & dosagem , Traumatismos do Tornozelo/tratamento farmacológico , Anti-Inflamatórios não Esteroides/administração & dosagem , Artralgia/prevenção & controle , Diclofenaco/administração & dosagem , Minerais/administração & dosagem , Extratos Vegetais/administração & dosagem , Doença Aguda , Administração Cutânea , Adolescente , Adulto , Analgésicos/efeitos adversos , Traumatismos do Tornozelo/fisiopatologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco/efeitos adversos , Método Duplo-Cego , Feminino , Géis , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Minerais/efeitos adversos , Pomadas , Medição da Dor , Extratos Vegetais/efeitos adversos , Estudos Prospectivos , Amplitude de Movimento Articular/efeitos dos fármacos , Resultado do Tratamento , Adulto Jovem
5.
Rheumatol Int ; 32(1): 159-63, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20697896

RESUMO

In a progressive resistive strengthening programme, healthy individuals gain strength initially through neural adaptation followed by increases in muscle mass. Programmes are designed to maximise these responses. The physiological mechanisms of strength gain in RA are unknown, but their identification will help to develop more effective exercise programmes. The aim of this study was to investigate the responses to a 12-week isometric handgrip strengthening programme in female subjects with RA. Fourteen right-handed female subjects with RA and 14 age-matched female controls participated in a 12-week right handgrip strengthening programme. Maximum grip strength (MGS) and disease activity were measured serially over 12 weeks. Forearm muscle volume was measured using MRI at baseline and 12 weeks. Significant gains in right handgrip strength were noted in both groups, the gains being most marked in those with RA: mean (SD; range) MGS (mmHg) in RA group at baseline 105.1 (48.1; 34-108) and 174.8 (76.4; 50-340) at 12 weeks. Mean (SD; range) MGS in control group at baseline 311.7 (49.6; 220-370) and 357.0 (67.1; 250-540) at 12 weeks. Significant increases in forearm muscle volume occurred in the controls, correlating with gains in strength. No such changes were noted in the RA group, indicating that improvements were solely related to neural adaptation. Response to strength training in RA differs from those of healthy individuals. Significant gains in strength in individuals with RA can occur due to neural adaptation without gains in muscle mass during a strengthening programme. This has implications for the design of rehabilitation programmes for such subjects.


Assuntos
Artrite Reumatoide/terapia , Terapia por Exercício/métodos , Força da Mão/fisiologia , Força Muscular/fisiologia , Treinamento Resistido/métodos , Adaptação Fisiológica/fisiologia , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/reabilitação , Estudos de Casos e Controles , Exercício Físico/fisiologia , Feminino , Humanos , Contração Isométrica/fisiologia , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Health Technol Assess ; 14(52): 1-251, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21059322

RESUMO

OBJECTIVES: To investigate the clinical effectiveness and cost-effectiveness of laxatives versus dietary and lifestyle advice, and standardised versus personalised dietary and lifestyle advice. DESIGN: A prospective, pragmatic, three-armed cluster randomised trial with an economic evaluation. SETTING: General practices in England and Scotland, UK. PARTICIPANTS: People aged ≥ 55 years with chronic constipation, living in private households. Participants were identified as those who had been prescribed laxatives three or more times in the previous 12 months, or with a recorded diagnosis of chronic functional constipation. INTERVENTIONS: Prescription of laxatives, with class of laxative and dose at the discretion of the GP and patient (standard care control arm); standardised, non-personalised dietary and lifestyle advice; and, personalised dietary and lifestyle advice, with reinforcement. OUTCOME MEASURES: The primary outcome was the constipation-specific Patient Assessment of Constipation-Symptoms (PAC-SYM)/Patient Assessment of Constipation-Quality of Life (PAC-QOL). RESULTS: The trial planned to recruit and retain 1425 patients from 57 practices (19 per arm); however, only 154 patients were recruited from 19 practices. Due to these low recruitment rates it was not possible to report the conventional trial findings. Baseline characteristics of the sample from data gathered from both postal self-completion questionnaires and face-to-face interviews suggest that our sample experienced very few symptoms of constipation (PAC-SYM) and that the condition itself did not have a major impact upon their quality of life (PAC-QOL). The low level of symptoms of constipation is most likely explained by 90% of the sample using a laxative in the previous week. Most participants in our sample were satisfied with the performance of their laxatives, and levels of anxiety and depression were low. Their fibre consumption was classified as 'moderate' but their average water consumption fell below the recommended guidelines. Daily diaries, completed each day for a period of 6 months, were analysed primarily in terms of overall response rate and item response rates, and the participants accepted this method of data collection. For the economic evaluation, all of the trial arms experienced a reduction in utility, as measured by EQ-5D. There was no statistical evidence to suggest that either the personalised intervention arm or the standardised intervention arm was associated with significant changes in utility at 3 months compared with the control arm. Data on related health-care costs show a cost saving of £13.34 for those in the personalised arm, compared with the control arm, and a smaller cost saving for the standardised arm. These savings primarily occurred because of reduced hospital costs. There was no significant change measured in utility, so the personalised arm appeared to be the preferred course, producing the greatest cost savings. CONCLUSIONS: Due to the low number of participants in the trial, no firm conclusions could be drawn about the effectiveness of the interventions. However, a number of factors that contributed to the conduct and progress of the trial are highlighted, which may be relevant to others conducting research on a similar topic or population. TRIAL REGISTRATION: ISRCTN73881345. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 14, No. 52. See the HTA programme website for further project information.


Assuntos
Constipação Intestinal/dietoterapia , Constipação Intestinal/tratamento farmacológico , Comportamento de Redução do Risco , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Constipação Intestinal/diagnóstico , Análise Custo-Benefício , Aconselhamento , Dieta , Feminino , Medicina Geral , Humanos , Laxantes/administração & dosagem , Laxantes/uso terapêutico , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Reino Unido
9.
Rheumatology (Oxford) ; 45(5): 566-70, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16303817

RESUMO

OBJECTIVES: Pulsed low-intensity ultrasound therapy (LIUS) has been found to be beneficial in accelerating fracture healing and has produced positive results in animal tendon repair. In the light of this we undertook a randomized, double-blind, placebo controlled trial to assess the effectiveness of LIUS vs placebo therapy daily for 12 weeks in patients with chronic lateral epicondylitis (LE). METHODS: Patients with LE of at least 6 weeks' duration were recruited from general practice, physiotherapy and rheumatology clinics, and had to have failed at least one first-line treatment including non steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injection. Participants were assigned either active LIUS or placebo. Treatment was self-administered daily for 20 min over a 12-week period. The primary end-point was a 50% improvement from baseline in elbow pain measured at 12 weeks using a patient-completed visual analogue scale. RESULTS: Fifty-five subjects aged 18-80 were recruited over a 9-month period. In the active group 64% (16/25) achieved at least 50% improvement from baseline in elbow pain at 12 weeks compared with 57% (13/23) in the placebo group (difference of 7%; 95% confidence interval -20 to 35%). However, this was not statistically significant (chi(2) = 0.28, P = 0.60). CONCLUSION: In this study LIUS was no more effective for a large treatment effect than placebo for recalcitrant LE. This is in keeping with other interventional studies for the condition.


Assuntos
Cotovelo de Tenista/terapia , Terapia por Ultrassom/métodos , Adulto , Idoso , Doença Crônica , Método Duplo-Cego , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Autocuidado , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento
10.
Rheumatology (Oxford) ; 44(6): 800-5, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15769790

RESUMO

OBJECTIVES: To prospectively evaluate the incidence, spectrum of disease and relation to general health of shoulder disorders in primary care. METHODS: Patients presenting with shoulder pain to two large general practices in the Cambridge area over a 1-month period were invited to participate. After consulting their general practitioner, patients were administered a demographic information questionnaire, a shoulder pain and disability index (SPADI) and a short form 36 (SF-36) health survey. Subsequent review in a clinic held by a rheumatology registrar every 2 weeks was undertaken. RESULTS: The sex- and age-standardized incidence of shoulder pain was 9.5 per 1000 (95% confidence interval 7.9 to 11.2 per 1000). Rotator cuff tendinopathy was found in 85%, signs of impingement in 74%, acromioclavicular joint disease in 24%, adhesive capsulitis in 15% and referred pain in 7%. On the SPADI the mean disability subscale score was 45 (95% confidence interval 41 to 50) and the mean pain score was 58 (95% confidence interval 53 to 62) (range 0 to 100). Evaluation of general health status using the SF-36 showed the difference between population norms and those with shoulder pain was significant in six of the eight domains, being especially marked (greater than 20 point reduction) for emotional role, physical function and physical role. CONCLUSION: Shoulder pain, most commonly due to rotator cuff tendinopathy, is associated with significantly reduced health when measured by both specific and generic means. Effort towards prevention and early intervention in these complaints is warranted.


Assuntos
Nível de Saúde , Dor de Ombro/fisiopatologia , Articulação Acromioclavicular/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bursite/complicações , Bursite/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Artropatias/complicações , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Manguito Rotador/fisiopatologia , Síndrome de Colisão do Ombro/complicações , Síndrome de Colisão do Ombro/fisiopatologia , Dor de Ombro/etiologia
11.
Rheumatology (Oxford) ; 44(4): 469-71, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15716322

RESUMO

OBJECTIVES: While both community and hospital-based services strive to cope with the considerable burden posed by musculoskeletal disorders, multidisciplinary-led, integrated approaches are frequently lacking. It has been suggested that referrals to musculoskeletal services are frequently misdirected to an orthopaedic surgeon when non-surgical advice/intervention is warranted, reducing the efficiency of hospital-based services and potentially affecting quality of care. Triage of referrals may help to prevent this, but this system is dependent upon accurate and thorough information being provided in the referral letter. Our aim was to assess the feasibility of triage of musculoskeletal referrals to rheumatology and orthopaedic services at a large teaching hospital. METHODS: One thousand and eighty-seven consecutive referral letters to orthopaedic and rheumatology services were reviewed by a consultant rheumatologist. Letters were assessed for both basic content and the appropriate destination for that referral. In order to evaluate the accuracy of the assessor's prediction of the most appropriate destination of the referrals, the number of patients who were ultimately listed for surgical intervention was calculated in a random sample of orthopaedic referrals, 1 yr after the initial hospital appointment was requested. RESULTS: Six hundred and eighty-two referrals were to orthopaedics and 393 to rheumatology. Referrals relating to spinal pain were excluded. The content of letters was scant and no diagnosis was volunteered in 63.4% of referrals. Fifty-eight per cent of referrals to orthopaedics were considered appropriate; 27% of referrals to orthopaedics were defined as 'should definitely see a rheumatologist' (12%) or 'should probably see a rheumatologist' (15%). Fifteen per cent of referrals to orthopaedics were defined as 'could see either a surgeon or a rheumatologist'. Ninety-four per cent of referrals to rheumatology were defined as appropriate, 2% were not and 4% were defined as 'could see either a surgeon or a rheumatologist'. One year later, in a random sample of 373 of the orthopaedic referrals, 42.2% of those who were categorized as 'should see surgeon' and 9.7% of the 'should see a physician' group were listed for surgical intervention. CONCLUSIONS: Many referrals to hospital-based musculoskeletal services are likely to be misdirected. Integrated referral and care pathways are required for efficient and optimal care of patients with musculoskeletal diseases. The development of such pathways will require significant support, education and training for general practitioners.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Doenças Musculoesqueléticas/terapia , Ortopedia/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Encaminhamento e Consulta/normas , Reumatologia/estatística & dados numéricos , Triagem/normas , Correspondência como Assunto , Eficiência Organizacional , Inglaterra , Medicina de Família e Comunidade/normas , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Auditoria Médica , Doenças Musculoesqueléticas/diagnóstico , Ortopedia/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Reumatologia/organização & administração , Triagem/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde
13.
Eur J Cancer Prev ; 13(6): 529-34, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15548948

RESUMO

Studies are consistently declaring that the Mediterranean-type diet is transposable to non-Mediterranean regions. The nutritional end points of Med-type eating appear to be achievable through foods from a variety of traditions and appear to support predetermined expectations surrounding food preparation, choice, taste and sensory appeal. The broad emphasis on minimally processed plants and their products (vegetables, fruit, legumes, wholegrains, nuts, seeds and oils); low fat dairy, fish, less emphasis on animal products and removal of partially hydrogenated fats has piqued the attention of health professionals who are interested in arresting the incidence of chronic disease. The theoretical underpinnings of Med-type eating have driven new understandings in dietary guidelines, which is especially timely as well-marketed fad diets loom large on the current health horizon.


Assuntos
Dieta Mediterrânea , Equipe de Assistência ao Paciente , Gorduras na Dieta , Determinação de Ponto Final , Frutas , Humanos , Estilo de Vida , Fenômenos Fisiológicos da Nutrição , Necessidades Nutricionais , Relações Médico-Paciente , Verduras
14.
Ann Rheum Dis ; 63(10): 1288-92, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15361389

RESUMO

BACKGROUND: Rotator cuff lesions are common in the community but reproducibility of tests for shoulder assessment has not been adequately appraised and there is no uniform approach to their use. OBJECTIVE: To study interrater reproducibility of standard tests for shoulder evaluation among a rheumatology specialist, rheumatology trainee, and research nurse. METHODS: 136 patients were reviewed over 12 months at a major teaching hospital. The three assessors examined each patient in random order and were unaware of each other's evaluation. Each shoulder was examined in a standard manner by recognised tests for specific lesions and a diagnostic algorithm was used. Between-observer agreement was determined by calculating Cohen's kappa coefficients (measuring agreement beyond that expected by chance). RESULTS: Fair to substantial agreement was obtained for the observations of tenderness, painful arc, and external rotation. Tests for supraspinatus and subscapularis also showed at least fair agreement between observers. 40/55 (73%) kappa coefficient assessments were rated at >0.2, indicating at least fair concordance between observers; 21/55 (38%) were rated at >0.4, indicating at least moderate concordance between observers. CONCLUSION: The reproducibility of certain tests, employed by observers of varying experience, in the assessment of the rotator cuff and general shoulder disease was determined. This has implications for delegation of shoulder assessment to nurse specialists, the development of a simplified evaluation schedule for general practitioners, and uniformity in epidemiological research studies.


Assuntos
Lesões do Manguito Rotador , Síndrome de Colisão do Ombro/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Bursite/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Exame Físico/métodos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Dor de Ombro/etiologia
16.
J Orthop Res ; 21(5): 937-40, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12919884

RESUMO

BACKGROUND: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited. AIMS: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar fasciitis. METHODS: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJ/mm(2)) or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy. RESULTS: Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37% of the subjects in the ESWT group and 24% in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31% in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 37% and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period. CONCLUSIONS: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints.


Assuntos
Fasciíte Plantar/terapia , Ondas de Choque de Alta Energia/uso terapêutico , Adulto , Idoso , Ritmo Circadiano , Relação Dose-Resposta à Radiação , Método Duplo-Cego , Fasciíte Plantar/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Manejo da Dor , Cuidados Paliativos/métodos , Falha de Tratamento
18.
Rheumatology (Oxford) ; 42(8): 951-4, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12730505

RESUMO

OBJECTIVES: The aim of this study was to assess the extent of musculoskeletal assessment (history and examination) amongst medical in-patients and to determine the effects that GALS (gait, arms, legs, spine) teaching has had on this. METHODS: General medical in-patients were interviewed and examined. Case notes were reviewed to determine diagnoses and assess documentation of clinical signs and/or symptoms. Doctors were interviewed to determine whether they had been taught the GALS locomotor screen, assess their confidence in examining the musculoskeletal system and explore their attitudes to musculoskeletal problems. RESULTS: The presence or absence of locomotor symptoms was recorded in 50% of the 100 patients, whilst signs were recorded in 20%; 63% of all the patients had locomotor symptoms and/or signs. Relevant musculoskeletal history was missed in 49% of the patients, whilst signs were missed in 78%; 42% of those with musculoskeletal conditions would have benefited from additional treatment. Teaching of the GALS screen significantly increased doctors' confidence in examination of the locomotor system. CONCLUSIONS: Active musculoskeletal problems are seen frequently amongst medical in-patients. There is a significant discrepancy between the number of patients with clinical symptoms and signs and the frequency with which they are detected and treated.


Assuntos
Pacientes Internados , Doenças Musculoesqueléticas/diagnóstico , Exame Físico/métodos , Educação de Pós-Graduação em Medicina , Humanos , Reumatologia/educação
19.
Best Pract Res Clin Rheumatol ; 17(1): 167-81, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12659827

RESUMO

Local injection therapies are used in the management of a variety of musculoskeletal pain syndromes and include the local infiltration of substances such as corticosteroid and/or anaesthetic, dry needling and neural blockade. Although commonly used, the rationale for their use in many conditions is arguable and evidence of efficacy is often lacking. In this chapter, a number of common injection therapies for soft-tissue-mediated pain are described. The reasoning for their use, potential mechanisms of action and unwanted effects are discussed. The literature relating to their documented effects is critically reviewed. Practical suggestions for their utilization in the management of soft-tissue conditions are given and proposals are made for future research in this important area.


Assuntos
Anti-Inflamatórios/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Doenças Musculoesqueléticas/tratamento farmacológico , Bloqueio Nervoso/métodos , Dor/tratamento farmacológico , Humanos , Injeções , Doenças Musculoesqueléticas/complicações , Dor/etiologia , Esteroides
20.
J Orthop Res ; 20(5): 895-8, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12382950

RESUMO

UNLABELLED: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach to the treatment of a number of soft tissue complaints. Whilst benefit has been demonstrated in calcific tendinitis, evidence is lacking for benefit in the management of non-calcific rotator cuff disorders. AIMS: To perform a double-blind placebo controlled trial of moderate dose ESWT in chronic lateral epicondylitis. METHODS: Adults with lateral epicondylitis were randomised to receive either active treatment (1500 pulses ESWT at 0.12 mJ/ mm2) or sham therapy, monthly for three months. All were assessed before each treatment and one month after completion of therapy. Outcome measures consisted of visual analogue scores for pain in the day and at night. RESULTS: Seventy-five subjects participated and there were no significant differences between the two groups at baseline. The mean duration of symptoms was 15.9 and 12 months in the ESWT and sham groups, respectively. Both groups showed significant improvements from two months. No significant difference existed between the groups with respect to the degrees of change in pain scores over the study period. In the ESWT group the mean (SD, range) pain score was 73.4 (14.5, 38-99) at baseline and 47.9 (31.4, 3-100) at three months. In the sham group the mean (SD, range) pain score was 67.2 (21.7, 12-100) at baseline and 51.5 (32.5, 3-100) at three months. At three months, 50% improvement from baseline was noted in 35% of the ESWT group and 34% of the sham group with respect to pain. CONCLUSIONS: There appears to be a significant placebo effect of moderate dose ESWT in subjects with lateral epicondylitis but there is no evidence of added benefit of treatment when compared to sham therapy.


Assuntos
Ondas de Choque de Alta Energia/uso terapêutico , Litotripsia/métodos , Cotovelo de Tenista/terapia , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Manejo da Dor , Medição da Dor , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento
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