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  • Additional manual mobilization reduced pain due to knee OA when compared to exercise alone

    21 randomized control studies examining the use of strength training, exercise therapy, and exercise therapy with passive, manual mobilization in adult patients with knee osteoarthritis were examined in this meta-analysis. This study was undertaken to determine the comparative efficacy of these three treatment methods. The results form this analysis suggest that pain outcomes can be reduced with the addition of manual mobilization to exercise therapy. However, there were no differences in physical function measures between the three groups. Further research is required to determine the long term effects of physiotherapy with manual mobilization.

    POSTED: TODAY

    Additional manual mobilization reduced pain due to knee OA when compared to exercise alone

  • Phonophoresis of piroxicam significnatly reduces pain in severe knee OA

    46 patients with severe to mild knee osteoarthritis were randomized to 2 weeks treatment of either phonophoresis (PhP), using ultrasound and 0.5% piroxicam gel, or to ultrasound treatment alone (UT). The study investigated the effects of phonophoresis in improving knee function and pain, by promoting the absorption of non-steroidal anti-inflammatory drug (NSAID) using an ultra-sound. Post-treatment Visual Analog Scale (VAS) pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores significantly reduced in PhP group compared to ultrasound only. Total WOMAC, representing functional improvement, also improved over time, but did not differ between the two groups.

    POSTED: TODAY

    Phonophoresis of piroxicam significnatly reduces pain in severe knee OA

  • Physiotherapy functional restoration in the treatment of post-acute LBP

    16 trials were selected to study the effects of physiotherapy functional restoration (PFR), consisting of exercise and cognitive-behavioural interventions, compared to other treatments or placebo in patients with post-acute low back pain. Outcomes of interest included pain, function, and sick leave. There was moderate to high quality evidence for small but statistically signficant effects favouring PFR to advice for pain and fuction. Low to moderate evidence suggested no difference between PFR and other single treatments.

    POSTED: TODAY

    Physiotherapy functional restoration in the treatment of post-acute LBP

  • Manual therapy effective in treating subacromial impingement syndrome

    77 patients with shoulder pain due to supraspinatus tendinopathy participated in therapy programs to determine the optimal treatment for tendinopathy due to subacromial impingement. The three therapies included manual therapy along with glenohumeral and scapulothoracic exercises, supervised exercises and home-based exercises. The results show minimal benefits when examining individual outcomes such as function, pain, range of motion and muscle strength; however, the overall effect of combined manual therapy is significantly better than the exercise therapies.

    POSTED: TODAY

    Manual therapy effective in treating subacromial impingement syndrome

  • Operative vs. nonoperative treatment of complex proximal humeral fractures

    Six randomized control trials were included in the meta-analysis investigating the efficacy between operative and nonoperative treatment for complex 3- and 4-part humeral fractures. Overall, outcomes were similar between operative and nonoperative treatment, with few differences noted in functional outcome up to 24 months. Operative management required more additional surgery than did nonoperative treatment, and implants demonstrated a significant rate of penetration into joint spaces. Upon sub-group analyses for these findings, differences were in large part due to open reduction and internal fixation; hemiarthroplasty in the subgroup analyses was found to be statistically similar to nonoperative treatment.

    POSTED: TODAY

    Operative vs. nonoperative treatment of complex proximal humeral fractures

  • Efficacy of cervical corpectomy with preserved posterior vertebral wall

    178 cases of cervical spondylotic myelopathy (CSM) underwent either cervical corpectomy with preserved posterior vertebral wall (CPW) or conventional corpectomy (CC). Results indicated that the CPW procedure resulted in significant decreases in blood loss and surgery time compared to the CC group at the 6-month follow-up and is an effective method in treating CSM in patients indicative of this study.

    POSTED: TODAY

    Efficacy of cervical corpectomy with preserved posterior vertebral wall

  • Interlaminar or transforaminal MI versus open MD for lumbar disc herniation sciatica

    Evidence from 29 studies (n=4472), including 16 RCTs and 13 non-RCTs, was reviewed and, where possible, pooled to evaluate outcomes associated with 2 minimally invasive techniques (MI) and a conventional open microdiscectomy (MD) in the treatment of sciatica due to lumbar disc herniation. 21 studies compared interlaminar minimally invasive discectomy (ILMI) against MD, and estimates suggested that ILMI reduced blood loss and hospital stay, although no difference in clinical outcome. Clinical outcome was similar between transforaminal MI (TFMI) discectomy and MD. Additional high-quality evidence is needed in the comparisons of these three surgical techniques for the treatment of sciatica from disc herniation.

    POSTED: TODAY

    Interlaminar or transforaminal MI versus open MD for lumbar disc herniation sciatica

  • Allograft for pes planus lateral column lengthening viable alternative to autograft

    31 patients (33 feet) with acquired pes planus were randomized to undergo operative treatment for stage II posterior tibial tendon insufficiency (PTTI). Lateral column lengthening was performed with a bone graft from the iliac crest obtained either through allograft or autograft procedures. Results showed that at the 12-week follow-up, union was achieved in both groups. Allograft of the iliac crest appeared to be a viable alternative to autograft procedures, leading to decreased risk of morbidity and costs, as seen in autograft surgeries.

    POSTED: TODAY

    Allograft for pes planus lateral column lengthening viable alternative to autograft

  • Hematoma block: effective alternative for fracture reduction in distal radius fractures

    96 patients with displaced distal radius fractures were placed into 1 of 2 treatment groups to test the efficacy of hematoma block when compared to intravenous general anesthesia in the reduction of displaced distal radius fractures. Results showed that hematoma block is just as effective in the reduction of distal radius fractures as general intravenous anesthesia, but that overall treatment time is shorter when using hematoma block.

    POSTED: TODAY

    Hematoma block: effective alternative for fracture reduction in distal radius fractures

  • Imageless computer-assisted TKA superior in mechanical alignment & short-term function

    21 randomized controlled trials analyzing a total of 1713 knees were included in this meta-analysis comparing radiographic alignment and functional outcome between imageless computer-assisted (CAS) TKA to conventional TKA. Results indicated significantly better mechanical alignment and significantly higher Knee Society Scores in favour of CAS over control groups. Femoral component alignment was significantly better with CAS, but tibial component alignment was comparable with conventional TKA. Operative time was significantly longer with CAS compared to conventional methods.

    POSTED: TODAY

    Imageless computer-assisted TKA superior in mechanical alignment & short-term function

  • Denosumab and teriparatide significantly improves BMD in patients with osteoporosis

    94 postmenopausal women, >45 years of age, who had been diagnosed with osteoporosis and who were at high risk for fracture, were randomly assigned into 1 of 3 treatment groups to determine the long term effect (24 months) a combination of denosumab and teriparatide had on hip and spine BMD. Patients either received a combined drug treatment of denosumab and teriparatide, or intervention with denosumab or teriparatide alone. At 24 months, lumbar spine, femoral neck, and total hip BMD was significantly higher in the combination group when compared to the single dose groups. Spine and hip BMD continued to increase in the second year in all groups, but no difference in the rate at which BMD increased was noted during the second year follow up (12 to 24 months). Serum C-telopeptide and N-terminal propeptide of type 1 procollagen were suppressed in similar amounts in the denosumab and combination groups. Serum osteocalcin decreased by a significantly greater amount in the denosumab group than in the combination group.

    POSTED: YESTERDAY

    Denosumab and teriparatide significantly improves BMD in patients with osteoporosis

  • Delayed LMWH lowers bleeding while maintaining DVT prophylaxis in TKA

    210 patients undergoing primary total knee arthroplasty were randomized to administration of low-molecular-weight heparin (enoxaparin) started at either 12 hours or 24 hours after wound closure. The purpose of this study was to determine the effect of delayed LMWH administration (24h) on bleeding and the incidence of deep vein thrombosis after TKA compared to standard administration (12h). Over the first 72 postoperative hours, total blood loss was significantly lower in the delayed administration group, leading to a significantly lower incidence of transfusion and major bleeding events. There was no significant difference in the incidence of deep vein thrombosis observed between groups.

    POSTED: YESTERDAY

    Delayed LMWH lowers bleeding while maintaining DVT prophylaxis in TKA

  • Unilateral vs. bilateral screw fixation in degenerative lumbar diseases

    12 studies (n=865; 9 RCTs, 1 prospective, 2 retrospective) were included in this meta-analysis comparing the clinical outcomes between unilateral pedicle screw fixation to bilateral pedicle screw fixation in the treatment of degenerative lumbar diseases. Pooled results demonstrated bilateral fixation led to a significantly higher rate of successful fusion with, but was also associated with significantly higher intraoperative blood loss and operative time. The latter two results, were however, heterogeneous. Pooled results for clinical outcome measures (JOA, VAS, ODI, SF-36), total complications, and hospital stay were comparable between groups.

    POSTED: YESTERDAY

    Unilateral vs. bilateral screw fixation in degenerative lumbar diseases

  • TLIF suggested to be not cost-effective compared to intrumented PLF in cLBP

    100 patients with chronic low back pain were randomized to undergo either transforaminal lumbar interbody fusion (TLIF) or posterolateral fusion (PLF). The purpose of the current study was to evaluate the cost-utility and cost-efficacy of TLIF relative to PLF. Data on primary health care costs, secondary health care costs, and production loss costs over the first 2 postoperative years were used for the analysis. Overall, no significant differences in costs were noted between groups, although total cost was higher with TLIF (59863€ vs. 55200€). As clinical outcome was found to not differ, cost-effective acceptability curves using QALYs and the Oswetry Disability Index did not demonstrate cost-effectiveness of TLIF compared to PLF.

    POSTED: YESTERDAY

    TLIF suggested to be not cost-effective compared to intrumented PLF in cLBP

  • FIFA11+ programme reduced incidence of overall injury in male youth soccer players

    416 male youth football (soccer) players in Africa were randomized to evaluate the injury-prevention efficacy of the FIFA11+ programme, when compared against routine training over 6 months. Players were evaluated primarily based on time-loss injury to players, injuries by type of exposure (match or training) and all injuries to lower extremities (LE), along with further injury analysis. The evidence presented in this trial demonstrated that FIFA11+ players sustained an overall reduction rate of injury of 41%, and a reduction in lower extremity injury of 48%. Injury incidence was significantly lowered in FIFA11+ players compared to those in the control group with the exception of injury sustained during training- which was similar between groups. Other evaluated outcomes such as injury by body location, mechanism, and severity indicated no significant differences between groups but FIFA11+ players exhibited better results.

    POSTED: YESTERDAY

    FIFA11+ programme reduced incidence of overall injury in male youth soccer players

  • Arthroscopic simulators distinguish between novice and expert orthopaedic trainees

    13 studies, consisting of randomized control trials and validation studies, were selected to investigate the role of arthroscopic simulators in improving the surgical skills of users. Systematic review revealed that the simulators discriminated between novice and expert trainees, but not between novice and intermediate trainees on completion time of a simulated task. This analysis did not conclusively determine whether simulator training improves the surgical skills of orthopaedic residents.

    POSTED: THIS WEEK

    Arthroscopic simulators distinguish between novice and expert orthopaedic trainees

  • Knee OA: Superior scores for pain and Lequesne Index for TENS compared to Hyaluronic acid

    54 patients with moderate to severe knee osteoarthritis (OA) were randomized to receive transcutaneous electric nerve stimulation (TENS) with silver spike electrodes (SSP) or intra-articular hyaluronic acid injections, in order to compare the success of each treatment over 3 months post-treatment. Patients were assessed for pain using the visual analog scale (VAS) and for functional disability using the Lequesne index. The study found that TENS treatment for knee OA achieved superior scores for pain at the 2 week follow-up, and for functional disability at the 2 week and final 3 month follow-ups. The TENS groups also displayed superiority for the secondary assessments of range of knee motion (ROM), walking, patient-global assessment, and disability.

    POSTED: THIS WEEK

    Knee OA: Superior scores for pain and Lequesne Index for TENS compared to Hyaluronic acid

  • Cross-education training improves strength and ROM after unilateral distal radius fracture

    Fifty-one women, older than 50 years of age, with a unilateral distal radius fracture were randomized to standard rehabilitation or standard rehabilitation plus cross education strength training to compare training effects on strength and mobility of the fractured limb. Cross-education is a term for neural adaptation defined by increased strength or functional performance of the affected limb after unilateral training of the contralateral unaffected limb. The fractured hand demonstrated significantly better hand grip peak force strength and range of motion at wrist flexion/extension than the control at 12 weeks. No differences were seen by 26 weeks in peak force strength, ROM (flexion/extension; supination/pronation) or in Patient Rated Wrist Evaluation questionnaires.

    POSTED: THIS WEEK

    Cross-education training improves strength and ROM after unilateral distal radius fracture

  • Combined sciatic nerve/lumbar plexus block: effective but tedious preoperative anesthetic

    50 patients, between 50-90 years old, with an ASA score of 2-3 who were scheduled to receive surgery due to various lower extremity pathologies, were placed in 1 of 2 treatment groups to test the effectiveness of various forms of anesthesia before surgery: The first group, named the spinal anesthesia group, received a common spinal anesthesia before treatment, while the second group, named the Combined sciatic nerve/lumbar plexus block (CSLPB) group, was given a combined sciatic nerve/lumbar plexus block before surgery began. Results showed that while both preoperative methods are effective in terms of lower extremity orthopedic surgery, CSLPB preparation takes a significantly longer than the standard SA treatment. Surgeons and patients showed no preference to either surgery.

    POSTED: THIS WEEK

    Combined sciatic nerve/lumbar plexus block: effective but tedious preoperative anesthetic

  • Chemonucleolysis: An effective treatment of sciatica

    100 patients aged 18 to 64 years, with typical signs of sciatica, and that had undergone at least 4 months of conservative treatment were randomly assigned into 1 of 2 treatment groups to compare the effectiveness of surgery and chemonucleolysis. The Chemonucleolysis group, which treated patients with an injection that dissolved the soft center and protruding portion of the disc which was causing the sciatica, or the surgery group, which had the soft disc herniation removed in patients through conventional surgical methods. The results showed no difference between the groups in terms of efficacy of treatment, or complications (at 1 year, 23-13 year, and 24-27 year follow up).It should be noted that the manufacturing of Chemonucleolysis was ceased in 2001. Based on the results of this trial the authors advocate for restoration of its availability, as it may be beneficial to patients and provide an alternative treatment option.

    POSTED: THIS WEEK

    Chemonucleolysis: An effective treatment of sciatica

  • No evidence of superiority using custom-made vs. pre-fabricated splints in TMC arthrosis

    119 patients with clinically diagnosed trapeziometacarpal (TMC) joint arthrosis (62 of which completed the study) were randomized to wear either a customized 3.2 mm-thick thermoplast hand-based thumb spica splint, or a pre-fabricated neoprene splint to determine if superiority exists between the two types. Results indicated that, although both splint types improved pain, grip strength and pinch strength, they did not improve DASH scores at a mean follow-up of 9 +/- 9 weeks. In addition, one splint type was not superior over the other in terms of physical function.

    POSTED: THIS WEEK

    No evidence of superiority using custom-made vs. pre-fabricated splints in TMC arthrosis

  • General anesthesia for TKA presents better postoperative results than spinal anesthesia

    One hundred and twenty patients, between the ages of 45 and 85 years, scheduled to undergo total knee arthroplasty were randomly assigned into one of two groups to compare the postoperative effect of modern general anaesthetic to spinal anaesthetic. Results demonstrated that participants who received modern general anaesthetic treatment experienced significantly less pain postoperatively, less nausea and dizziness, and required less morphine following treatment than patients who received a spinal anaesthetic. Subjects who received spinal anesthesia were found to be more likely to request a different method of anesthesia for a subsequent treatment

    POSTED: THIS WEEK

    General anesthesia for TKA presents better postoperative results than spinal anesthesia

  • Videoinsight method improves subjective outcomes in ACL rehabilitation

    106 patients were selected in this preliminary trial to study the psychological influence of the Videoinsight method on short term subjective and functional recovery after single bundle ACL reconstruction. Patients were randomized to view either positive "insight" images or negative images during their 3 month rehabilitation period. The positive images greatly improved subjective outcomes such as International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia (TSK) scores, and time to crutches discharge, compared to negative ones. A positive correlation between TSK scores and time to crutches was also discovered.

    POSTED: THIS WEEK

    Videoinsight method improves subjective outcomes in ACL rehabilitation

  • CPANC: Nintendo Wii-based exercise therapy for balance rehabilitation after stroke

    30 stroke patients were randomized to evaluate the feasibility and the efficacy of Nintendo-Wii based therapy on balance rehabilitation. Patients were allocated to undergo Wii-therapy whilst standing (Balance group) or while sitting (Upper Limb Group) and were monitored over 2 to 4 weeks. The evidence presented in this conference report suggested that Wii-based therapy was feasible, safe, and produced a trend towards improved balance after stroke.

    POSTED: THIS WEEK

    CPANC: Nintendo Wii-based exercise therapy for balance rehabilitation after stroke

  • CPANC: Pilates exercise therapy for chronic low back pain

    9 RCTs were systematically reviewed to determine if Pilates exercise is an effective therapy for patients with chronic low back pain (cLBP). The evidence presented in this conference reported indicated that Pilates produced benefits of reduced pain and disability when compared against usual care and static levels of physical activity. The comparative efficacy of Pilates against general exercise remained inconclusive. Further high-quality evidence is needed to investigate the role of Pilates in patients with cLBP.

    POSTED: THIS WEEK

    CPANC: Pilates exercise therapy for chronic low back pain

  • CPANC: Superiority of post-acute physiotherapy for THA remains uncertain

    14 studies (n=1148) were included in this systematic review of literature comparing post-acute physiotherapy to control interventions following total hip arthroplasty (THA) with respect to pain, function, and health-related quality of life (HRQOL). The result indicated physiotherapy was favoured over control interventions with respect to short-term pain, physical function, and health-related quality of life in moderate- to high-quality evidence. Additionally, none of the physiotherapy interventions met the American College of Sports Medicine exercise prescription guidelines.

    POSTED: THIS WEEK

    CPANC: Superiority of post-acute physiotherapy for THA remains uncertain

  • Role of high flexion implant design for cruciate-retaining TKA

    132 patients undergoing cruciate-retaining total knee arthroplasty (TKA) were randomized to evaluate the efficacy of high flexion implants against a standard prosthetic. 122 patients were included in the analysis with 51 patients receiving standard prosthetic and 71 receiving the High Flex implant. Patients' preoperative, intraoperative, and 1 year postoperative range of motion were assessed, along with other measures of knee function, and patient status. The evidence presented in this trial indicated superior intraoperative range of motion, associated with the high flexion implant. However, range of motion was comparable at all other time points, along with the similar clinical outcomes of Knee Society Score, and Short-Form 36. Knee flexion during the preoperative period was the only significant factor influencing knee flexion at follow-up.

    POSTED: THIS WEEK

    Role of high flexion implant design for cruciate-retaining TKA

  • APTA: Tai Chi may improve balance and reduce falls in elderly

    13 studies were included (10 randomized controlled trials, 2 systematic reviews, 1 meta-analysis) in this systematic review examining the efficacy of Tai Chi in improving balance and reducing number of falls in elderly populations. Results indicated that Tai Chi may improve balance and reduce falls. Effects were maintained regardless of type or form of Tai Chi.

    POSTED: THIS WEEK

    APTA: Tai Chi may improve balance and reduce falls in elderly

  • APTA: Manual therapy in the treatment of patients with cervicogenic cephalic syndrome

    7 studies (6 randomized controlled trials, 1 repeated measures design) investigating the clinical efficacy of manual therapy in the treatment of cervicogenic cephalic syndrome were included in this systematic review. The purpose of this study was to determine whether manual therapy can significantly reduce the intensity, severity and duration of dizziness and headaches experienced in this patient population. The results of this systematic review indicated that, among the 7 included high-quality studies, manual therapy was found to be clinically efficacious in 85% of them.

    POSTED: THIS WEEK

    APTA: Manual therapy in the treatment of patients with cervicogenic cephalic syndrome

  • APTA: Ultrasound and diathermy equally effective for treatment of Knee OA

    10 high quality RCTs, were analyzed via systematic review to determine the effect ultrasound and diathermy have on pain and function in patients with knee osteoarthritis (OA). Analysis indicated that ultrasound and diathermy were both effective treatments for reducing pain and improving function; however, no difference was demonstrated between the two treatments regarding these outcomes.

    POSTED: THIS WEEK

    APTA: Ultrasound and diathermy equally effective for treatment of Knee OA

  • APTA: Low-Level Laser Therapy for Musculoskeletal Impairments of the Shoulder

    Data from 9 Randomized Controlled Trials (RCTs) was pooled and reviewed to investigate the efficacy of Low-Level Laser Therapy (LLLT) in the management of symptoms of musculoskeletal pathologies of the shoulder. The evidence presented in this conference report indicated that LLLT was associated with effective pain relief and range of motion recovery- particularly overhead elevation. The benefits of LLLT on internal and external rotation range of motion remain unclear.

    POSTED: THIS WEEK

    APTA: Low-Level Laser Therapy for Musculoskeletal Impairments of the Shoulder

  • The effect of lumbopelvic belts on trunk muscles in patients suffering from low back pain

    60 healthy male volunteers, between the ages of 18 and 55 years, with no history of low back pain, were randomly assigned into 1 of 2 groups to determine the effect lumbopelvic belts had on the thickness of lateral abdominal and lumbar multifidus (LM) muscles- two muscle groups that are closely related to spine stability. Patients received 8 weeks of intervention with a lumbopelvic belt, or no intervention at all. The results of the study demonstrated that thickness of the lateral abdominal muscles and the cross-sectional area (CSA) of the lumbar multifidus (LM) muscles (both sides) decreased significantly among patients in the belt group at 8 week follow up.

    POSTED: THIS WEEK

    The effect of lumbopelvic belts on trunk muscles in patients suffering from low back pain

  • THA: Computer-navigated technique more favorable compared to conventional techniques

    Data from 7 randomized controlled trials were pooled to compare the effects of computer-navigated and conventional free-hand techniques in THA. Primary outcomes included abduction angle, anteversion angle, operation time, decrease in haemoglobin after 24 hours and the number of acetabular outliers. Results indicated a significant increase in accuracy and longer operation time in the computer-navigated technique compared to the free-hand technique. There was no difference in the reduction in haemoglobin after 24 hours between the two groups.

    POSTED: 07/16/2014

    THA: Computer-navigated technique more favorable compared to conventional techniques

  • US guidance is beneficial in arthroscopic debridement for calcific rotator cuff tendinitis

    20 patients undergoing arthroscopic debridement for calcific rotator cuff tendinitis were randomized to have the deposit located either with ultrasound guidance or using conventional methods. The purpose of this study was to compare these two techniques with respect to the number of needle punctures and time required to locate the calcific deposit, as well as shoulder pain and function, over a period of 9 months. Results indicated that, although both groups yielded excellent results, the use of US guidance significantly reduced the number of needle punctures and the amount of time required to detect the calcific deposit. Shoulder pain and function were statistically similar between groups at all time points.

    POSTED: 07/16/2014

    US guidance is beneficial in arthroscopic debridement for calcific rotator cuff tendinitis

  • Shoelace technique for leg fasciotomy is both time and cost effective

    50 patients with acute compartment syndrome stemming from leg fracture and/or blunt injury undergoing leg fasciotomy were randomized to wound closure through either vacuum-assisted closure (VAC) or the shoelace technique. This study aimed to compare wound outcome, time to closure, and complications between these treatments. Results indicated significantly shorter time to wound closure, and significantly lower daily costs with the shoelace technique compared to VAC. Fasciotomy wound length and incidence of wound infection were similar, and there was a non-significant trend indicating a reduction in the need for additional split thickness skin grafting in the shoelace technique group.

    POSTED: 07/16/2014

    Shoelace technique for leg fasciotomy is both time and cost effective

  • The effect of topical tranexamic acid on blood loss following TKA or THA

    100 patients (50 TKA and 50 THA) who were over the age of 18 and scheduled to receive either TKA or THA, were randomly assigned into 1 of 2 groups (an intervention and a placebo) to determine the effect that topical tranexamic acid, applied at the joint space immediately prior to joint closure for TKA and THA, had on blood loss in patients following surgery. The results of the study demonstrated that tranexamic acid lead to significantly higher postoperative hemoglobin level when compared to placebo treatment. A numerical improvement in the amount of blood transfused was indicated in patients who received treatment with topical tranexamic acid, but the amount did not differ significantly from those in the comparison group. No significant increase in complications was noted in patients who received tranexamic intervention.

    POSTED: 07/16/2014

    The effect of topical tranexamic acid on blood loss following TKA or THA

  • TKA: Gap Balancing versus Measured Resection Techniques

    103 patients undergoing primary total knee arthroplasty (TKA) were randomized to evaluate the efficacy of the gap balancing approach (GB) against the measured resection technique (MR) for TKA. Patients were monitored for 24 months, and were primarily evaluated on femoral component rotation (Hollywood Perth-Protocol CT-scan) and joint-line (defined as the difference between resected bone and prosthesis thickness from femoral and tibial sides). The evidence presented in this trial indicated significantly raised joint-line associated with gap balancing when compared to the measured resection technique (MR) - and ultimately better gap symmetry. Functional outcomes, along with quality-of-life evaluations were similar throughout the trial.

    POSTED: 07/16/2014

    TKA: Gap Balancing versus Measured Resection Techniques

  • Uncemented stems: Higher function but increased risk of late periprosthetic fracture

    223 patients (with 230 fractures) were randomized to either an uncemented femoral stem or cemented femoral stem in hemiarthroplasty for a displaced femoral neck fracture. While outcomes at 3 months and 1 year were demonstrated to be similar, this study reported on functional outcome, health-related quality of life, and complications at a median of 5 year follow-up. Harris Hip Scores were significantly higher in the uncemented group at 5 years, while the incidence of periprosthetic fracture was also significantly higher in this treatment group. Health-related quality of life outcomes were comparable between cemented and uncemented stems.

    POSTED: 07/16/2014

    Uncemented stems: Higher function but increased risk of late periprosthetic fracture

  • Frozen shoulder: Comparison of exercise class, individual physiotherapy, and home exercise

    75 patients diagnosed with frozen shoulder were randomized to one of three common physiotherapy interventions - physiotherapist-supervised exercise class (EC) with home exercise, individual multimodal physiotherapy (IMP) and home exercise, or home exercise (HE) alone - to compare patient-reported outcomes. Results indicated more significant improvements in Constant and Oxford scores in the EC group compared to both the IMP and HE groups. Additionally, Constant and Oxford scores were significantly better with IMP versus HE. Range of movement and HADS scores were similarly better in both the EC and IMP groups compared to the HE group. SF-36 scores were not significantly different overall between groups.

    POSTED: 07/16/2014

    Frozen shoulder: Comparison of exercise class, individual physiotherapy, and home exercise

  • The effect of trigger point dry needling on acute mechanical neck pain

    17 patients with acute mechanical, idiopathic, unilateral neck pain were randomly assigned into 1 of 2 groups to determine if trigger point dry needling had any effect on neck pain, pressure pain sensitivity, and cervical range of motion 1 week after intervention. Patients received either trigger point dry needling intervention or no intervention at all. The results of the study indicated that patients treated with 1 session of TrPDN experienced significantly greater decreases in neck pain, increases in pressure pain threshold, and increases in cervical range of motion when compared to those who received no intervention at all (1 week after intervention).

    POSTED: 07/16/2014

    The effect of trigger point dry needling on acute mechanical neck pain

  • Nondisplaced scaphoid fracture union with and without thumb immobilization

    62 patients with a fracture of the scaphoid waist were randomized to below-elbow casting with or without immobilization of the thumb. Cast were worn for 10 weeks. The purpose was to assess the extent of union after 10 weeks with both treatment options. Computed tomography (CT) scans at 10 weeks revealed a significantly greater extent of union across the fracture line in the group without thumb immobilization (85%) in comparison to those who had their thumb cast (70%). Clinical evaluation at 6 months demonstrated no significant differences between groups.

    POSTED: 07/16/2014

    Nondisplaced scaphoid fracture union with and without thumb immobilization

  • Analgesics have no effect on functional outcome in CLBP patients

    50 patients suffering from chronic low back pain were randomized to investigate the effect of acetaminophen and tramadol in achieving favorable outcomes of function, self-reported disability, and pain relief in patients, when compared to a placebo administered over 2 weeks. The evidence presented in this study suggested that the use of acetaminophen and tramadol did not produce significant improvements in functional capacity or self-reported disability when compared to placebo in chronic low back pain patients. Further analysis pertaining to responders observed improved functioning as a result of treatment with analgesics, and responders reported lower catastrophizing scores.

    POSTED: 07/16/2014

    Analgesics have no effect on functional outcome in CLBP patients

  • Decision support system reduces time to detect critical events in orthopaedic surgery

    150 patients undergoing elective orthopaedic lower-limb surgery requiring spinal analgesia with propofol sedation were randomized to undergo the procedure with or without the use of a decision support system (DSS) by the attending anaesthesiologist. The purpose of this study was to determine whether using a DSS decreased the time to detect a critical event. Results indicated that the DSS group had a significantly shorter time to detect a critical event, reduced incidence of undetected alarms, reduced frequency of low peripheral oxygen saturation cases, increased mean propofol dose, and increased number of propofol dose changes per hour. The proportion of false positive alarms was similar between groups.

    POSTED: 07/16/2014

    Decision support system reduces time to detect critical events in orthopaedic surgery

  • LBP: Pelvic stabilization during lumbar exercises improves strength, pain and disability

    42 patients with chronic low back pain participated in a study to determine whether pelvic stabilization during lumbar exercises increases the improvement in pain, disability, range of motion and muscle strength. Patients were separated into three groups; the control group participated in a standard physiotherapy program, the other two groups participated in lumbar strengthening exercises, one group with pelvic stabilization and one without. The results suggest that pelvic stabilization is effective in isolating lumbar muscles to strengthen muscles while simultaneously decreasing pain and disability.

    POSTED: 07/16/2014

    LBP: Pelvic stabilization during lumbar exercises improves strength, pain and disability

  • Active neck exercise program feasible and safe treatment method for cervical dystonia

    20 patients with idiopathic cervical dystonia were randomized to undergo a 12 week program of active neck exercises and relaxation or relaxation alone, to determine the efficacy of physiotherapy in treating condition. Following evaluations over 16 weeks, the results indicated that there were no significant differences in any of the outcome measures between the two groups. However, it should be noted that the improvement in the Toronto Western Spasmodic Torticollis Rating Scale and quality of life scores was greater in the exercise group. There were also no adverse events reported by any patients.

    POSTED: 07/16/2014

    Active neck exercise program feasible and safe treatment method for cervical dystonia

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