Shoulder apprehension

ImportanceNew care models promoting early access to physical therapy by reducing or eliminating copays are emerging. Few studies have compared health care use in these programs to other care pathways across musculoskeletal conditions.ObjectiveThe objective of this study was to describe episode-level musculoskeletal health care use across different care pathway options, including a no-copay physical therapy program.DesignThis study was a descriptive retrospective analysis of claims data.Setting and ParticipantsThis study included health care beneficiaries of a self-insured employer with ~52,000 covered lives.Interventions or ExposuresThe study included musculoskeletal care episodes from October 2019 to September 2020 categorized as no copay physical therapy, traditional physical therapy, or other management.Main OutcomesRates of surgery/injection, imaging, inpatient services, physician services, emergency services, physical therapy, and other services by episode type, overall and stratified by body region: upper extremity, lower extremity, and spine.ResultsOf 9696 total episodes, 886 (9.1%) were no copay physical therapy, 1261 (13%) were traditional physical therapy, and 7549 (77.9%) were other management. No copay physical therapy episodes had lower imaging rates (38%) compared to traditional physical therapy (47%) and other management (45%) episodes. Inpatient services were similar for no copay (16%) and traditional (12%) physical therapy, both lower than other management episodes (23%). Physician services were higher in other management (100%) and traditional physical therapy (81%) episodes compared to no copay physical therapy episodes (43%). Surgery/injection rates were similar for no copay (11%) and traditional (8%) physical therapy, both lower than other management episodes (27%). Differences by pathway were more pronounced for extremity conditions than for spine conditions.ConclusionsRates of no copay program use were modest with those who used the program having lower rates of advanced imaging, injection, and surgery.RelevanceFindings may be most relevant for employers, health systems, and payors planning resource allocation and benefit design for similar programs.

Objectives: Knee arthroscopy results in significant improvements in functional outcomes, pain and quality of life for patients suffering from meniscal tears. Traditionally, patients have undergone formal physical therapy (PT) after knee arthroscopy to regain function. Prior studies have demonstrated that patients who undergo internet-based PT after total knee arthroplasty performed as well as patients receiving traditional PT, but this has not been studied in the knee arthroscopy population. The goal of this study is to compare traditional outpatient physical therapy to internet-based physical therapy in patients undergoing knee arthroscopy for partial meniscectomy. Methods: Patients undergoing knee arthroscopy from October 2017 to September 2018 for partial meniscectomy were enrolled. Patients were randomized to either an outpatient or internet-based physical therapy program. Participants in the outpatient physical therapy were prescribed PT for 2 sessions per week for 4-6 weeks while participants in the online physical therapy group were instructed to login daily to track progress and complete their exercises a minimum of 3 times per week. Additionally, participants completed 4 questionnaires: VR-12 mental and physical health, International Knee Documentation Committee (IKDC), Modified Cincinnati Rating System (MCRS) and Lysholm pre-operatively, 1 week, 6 weeks and 6 months after surgery. The primary outcome of knee function was measured via the IKDC. Results: Of the 97 patients who met the inclusion criteria, 51 (52.6%) were in the internet-based physical therapy group and 46 (47.4%) were in the outpatient PT group. There were 57 males (58.8%) and 40 females (41.2%). Participants in the online physical therapy group logged into the platform an average of 2.74 times pre-operatively and 14.99 times post-operatively. Additionally, patients viewed their PT exercise videos, on average, 5.58 times pre-operatively and 36.71 times post-operatively. At final follow-up, there was no significant difference in the primary outcome with an average IKDC score for the online physical therapy (71.83) compared to outpatient PT group (74.23) [p = 0.699]. Additionally, there was no significant difference noted in the three secondary outcome measures between the internet-based physical therapy group and the outpatient PT group at final follow-up (Table 1). Furthermore, no significant difference was noted between the two patient cohorts pre-operatively and 1 week and 6 weeks after surgery in all four outcome measures (Table 1). Conclusion: The results of our study indicate that patients using internet-based PT had similar functional outcomes as patients using traditional outpatient PT following knee arthroscopy for partial meniscectomy. [Table: see text]

This study was performed to evaluate the effects of Mirror therapy combined with EMG-triggered Functional Electrical Stimulation on upper extremity function in patient with Chronic Stroke. A total of 24 chronic stroke patients were divided into 3 groups. Group I (n=8) was given with traditional physical therapy (TPT), group II (n=7) was given with traditional physical therapy and mirror therapy (MT), and group III (n=9) was given with traditional physical therapy and mirror therapy in conjunction with EMG-triggered Functional Electrical Stimulation (EMGFES-MT). Each group performed one hour a day 5 times a week for 6 weeks.We obtained the following result between before and after treatments about changes of elbow flexion muscle strength (EFMS), elbow extension muscle strength (EEMS), wrist flexion muscle strength (WFMS), wrist extension muscle strength (WEMS), elbow flexion range of motion (EFROM), elbow extension range of motion (EEROM), wrist flexion range of motion (WFROM), wrist extension range of motion (WEROM), grip strength (GS) and upper extremity function.Each group showed a significant difference in EFMS, EEMS, WFMS, WEMS, EFROM, EEROM, WFROM, WEROM, GS and upper extremity function (p<0.05) EMFES-MT group revealed significant differences in EEMS, WEROM, grip strength and upper extremity function as compared to the other groups (p<0.05). No difference was found in the change of spasticity among the 3 groups.Our results showed that EMFES-MT was more effective on elbow, WFMS, WEMS, AROM, grip strength and upper extremity function in patients with chronic stroke. We suggest that this study will be able to be used as an intervention data for recovering upper extremity function in chronic stroke patients

To investigate the effect of mirror therapy (MT) together with taping compared to modified constraint-induced movement therapy (mCIMT) and MT alone on the quality of upper extremity (UE) function, dexterity, and grip strength in children with hemiplegic cerebral palsy (CP). Sixty children with hemiplegic CP ranging in age from 6 to 8 years were enrolled. The participants were randomly distributed into three groups. The three groups underwent the same suggested upper limb (UL) exercise programme for 1h/5 days/week for 12 successive weeks. Group A performed the programme with MT and taping. Group B performed the same programme using mCIMT alone, while group C performed this programme with MT alone. In addition, the three groups underwent a routine physical therapy programme for 1 h. The quality of UE function, dexterity, and grip strength was measured using the Quality of Upper Extremity Skills Test (QUEST), Box and Block Test (BBT), and hand-held dynamometer before and after 12 successive weeks of treatment. After treatment, the measurement of all variables in the three groups showed significant improvements with superior effects seen in group A. Based on the results obtained in this study, MT with taping, mCIMT alone, and MT alone are good supplements to traditional physical therapy programmes in improving the quality of UE function, dexterity, and grip strength in children with hemiplegic CP with more superior effects seen after using MT together with taping.

Objectives: Cerebral Palsy (CP) is a condition where non progressive disorders of posture caused by abnormal development of, or damage to, motor control centers of brain resulting in abnormal movements. Improving gross motor function in children with cerebral palsy has been a major aim of physical therapist. The purpose of this study is to find out the Effect of Cage Therapy using Advanced Spider Suit Compared to Traditional Physical Therapy on Gross Motor Function in Children with Cerebral Palsy. Materials and Methods: A comparative study was conducted to find out the effect of Cage Therapy using Advanced Spider Suit Compared to Traditional Physical Therapy on Gross Motor Function in Children with Cerebral Palsy. 10 children with cerebral palsy were selected for this intervention. Age group between 4-8 years With GMFCS level III-IV were selected for this study. In 10 children we have 2 Hypotonic, 2 hemiplegic and 6 Spastic diplegic kids. These subjects were equally distributed in each group. Intervention: Therapy lasted for 8 weeks (5 days a week and 2hrs/day). Group A - 5 subjects were subjected to Cage therapy using advanced spider suit. Group B – 5 subjects were subjected to traditional physical therapy. Gross Motor Function Measure was used to assess gross motor abilities of the subjects before and after intervention. Results: The result showed significant improvement with Cage therapy using advanced spider suit therapy than traditional physical therapy on Gross Motor Function Measure. Conclusions: The Cage Therapy using Advanced Spider Suit is more effective and beneficial therapy than Traditional Physical Therapy in improving Gross Motor Function in Children with Cerebral Palsy.

Cognitive behavioral treatment of men who batter their partners

Aim: To see the comparative effectiveness of Conventional physiotherapy with kinesio Taping and Conventional physiotherapy alone to reduce pain and increase Range of Motion (ROM) in patients with non-specific low back pain. Methodology: The study design was Randomized controlled trail. Non-probability Temporal method sampling technique was used. Sample size was 36. The data was collected from Department of Physiotherapy Mayo Hospital Lahore. Written informed contest was taken from each patients taking part in this prior to performing any examination. Patients with non-specific low back pain were divided randomly into two groups. In ‘group A’ Conventional physiotherapy with Kinesio Taping was applied while in ‘group B’ only conventional physiotherapy was applied. The patients were divided into two groups using a computer-generated list. Both groups will receive conventional therapy, which will remain same throughout the study. The conventional therapy will include back isometrics and hot pack for 15 minutes. Group A will receive conventional therapy and Kinesio Taping while group B will receive only conventional therapy. Treatment frequency will be thrice a week. The duration of treatment was be 2 weeks in both groups. Each patient's informed consent was obtained before Performa was filled out. The Roland Morris Disability Questionnaire and the Visual Analogue Scale (VAS) were both utilized for scoring. Results: Kinesio Taping with Traditional Physical Therapy technique is more effective in improving ROM and reducing disability as compared to only Traditional Physical Therapy technique. Patients in group A showed marked improvement as compared to group B. Conclusion: it was concluded that conventional physiotherapy with Kinesio Taping is more effective than Conventional physiotherapy alone for the treatment of low back pain. Conventional physiotherapy with Kinesio Taping not only decrease pain but also improves function and flexibility of spine. Key words: Non-specific low back pain, Kinesio-taping, Traditional physical therapy, RCT, Rehabilitation

INTRODUCTIONCerebral palsy (CP) is the predominant cause of children disability. It is characterized by motor, sensory, and postural deficits due to a non-progressive injury to the developing central nervous system. In recent years, new rehabilitation techniques targeting the central representations of motor patterns have been introduced: the most used are action observation therapy (AOT), motor imagery (MI), and mirror therapy (MT). Aim of this study is to assess the effectiveness of these cognitive strategies on the recovery of upper limb motor functions in children with CP.EVIDENCE ACQUISITIONThis study was designed as a systematic review and meta-analysis, registered in PROSPERO (CRD42023403794). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed. A total of 3 electronic databases (PubMed, Scopus, and Web of Science) were searched for relevant Randomized Control Trials (RCT) using the combinations of terms “cerebral palsy” AND “action observation” OR “motor imagery” OR “mirror therapy” OR “cognitive therapy.” A meta-analysis was carried out to compare cognitive and conventional approaches and combine direct and indirect effects. A random-effects meta-analysis model was used to derive pooled effect estimates.EVIDENCE SYNTHESISOut of 328 records, 12 RCTs were analyzed in this systematic review published from 2012 to 2022, and included 375 children, of whom 195 received cognitive therapies, and 180 underwent conventional rehabilitation. AOT was the most investigated (RCTs N.=7), and showed significant results in the recovery of upper limb motor functions, albeit the meta-analysis demonstrated a non-significant difference in Melbourne Unilateral Upper limb Scale (MUUL) (95% CI: -7.34, 12); in Assisting Hand Assessment (AHA) (95% CI: -4.84, 10.74), and in AbilHand-Kids Questionnaire (95% CI: -1.12, 1.45). Five RCTs investigated MT showing significant improvements in grip and dexterity; none used MI as intervention therapy.CONCLUSIONSCognitive therapies provided with encouraging results in the recovery of upper limb motor functions, although not a clinical effect in bimanual or unimanual performance; they could represent a valid therapeutic solution integrated to conventional rehabilitation in the treatment of upper limb motor impairment in children with CP.

This paper emerged from the author’s concern that mental health commissioners may interpret NICE recommendations as meaning that cognitive behavioural therapy (CBT) is a panacea. It documents the case of an individual for whom CBT may have been an appropriate but not necessarily optimal intervention. IThe case outline is followed by a critical analysis of cognitive behavioural and Kleinian approaches, concluding that the Kleinian approach offered long-term advantages to this client.

Background: Many patients can experience shoulder dysfunction and limited range of motion (ROM) following neck dissection that can have a detrimental impact on their quality of life (QOL). Purpose: To evaluate the therapeutic effect of muscle energy technique and mobilization on improving shoulder ROM following neck dissection surgeries and compare them.Subjects and methods: This Randomized, single blind controlled trial was carried out on thirty-patients with shoulder dysfunction after neck dissection surgeries, their ages ranged from 25-70. The participants were selected from National Cancer Institute and were assigned at random into two groups, with each group including 15 patients. Group A (Muscle Energy Technique group): were given Muscle Energy Technique along with traditional physical therapy, three times weekly, throughout a duration of four weeks. and Group B (Maitland`s Mobilization group): were given Maitland`s Mobilization along with traditional physical therapy, three times weekly, throughout a duration of four weeks. Shoulder range of motion (flexion, abduction, and external rotation) was measured pre and post four-weeks of intervention. Results: There was a substantial improvement in shoulder flexion, abduction, as well as external rotation in both groups and the comparison between both groups revealed that there was a statistical difference in shoulder ROM in favour of group A (p< 0.001). Conclusion: Both MET and Maitland's mobilization might be useful manual therapeutic techniques in improving shoulder ROM following neck dissection surgeries, but MET found to be superior to Maitland's mobilization in improving shoulder ROM.

Epilepsy surgery outcome and functional network alterations in longitudinal MEG: A minimum spanning tree analysis

ObjectivesTo estimate the cost-effectiveness of a cognitive behavioural approach (CBA) or a personalized exercise programme (PEP), alongside usual care (UC), in patients with inflammatory rheumatic diseases who report chronic, moderate to severe fatigue.MethodsA within-trial cost-utility analysis was conducted using individual patient data collected within a multicentre, three-arm randomized controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis.ResultsComplete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95% CI: £464, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (QALY) difference: PEP 0.043 (95% CI: 0.019, 0.068); CBA 0.001 (95% CI: −0.022, 0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs UC, and £793 777 for CBA vs UC. Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI: £324, £511) and a non-significant QALY gain of 0.016 (95% CI: −0.003, 0.035), leading to an ICER of £26 822 vs UC. The estimates from sensitivity analyses were consistent with these results.ConclusionThe addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.

As the Apolipoprotein E (APOE) ɛ4 allele is a major genetic risk factor for sporadic Alzheimer's disease (AD), which has been suggested as a disconnection syndrome manifested by the disruption of white matter (WM) integrity and functional connectivity (FC), elucidating the subtle brain structural and functional network changes in cognitively normal ɛ4 carriers is essential for identifying sensitive neuroimaging based biomarkers and understanding the preclinical AD-related abnormality development. We first constructed functional network on the basis of resting-state functional magnetic resonance imaging and a structural network on the basis of diffusion tensor image. Using global, local and nodal efficiencies of these two networks, we then examined (i) the differences of functional and WM structural network between cognitively normal ɛ4 carriers and non-carriers simultaneously, (ii) the sensitivity of these indices as biomarkers, and (iii) their relationship to behavior measurements, as well as to cholesterol level. For ɛ4 carriers, we found reduced global efficiency significantly in WM and marginally in FC, regional FC dysfunctions mainly in medial temporal areas, and more widespread for WM network. Importantly, the right parahippocampal gyrus (PHG.R) was the only region with simultaneous functional and structural damage, and the nodal efficiency of PHG.R in WM network mediates the APOE ɛ4 effect on memory function. Finally, the cholesterol level correlated with WM network differently than with the functional network in ɛ4 carriers. Our results demonstrated ɛ4-specific abnormal structural and functional patterns, which may potentially serve as biomarkers for early detection before the onset of the disease.

The robustness of dynamical properties of neuronal networks against structural damages is a central problem in computational and experimental neuroscience. Research has shown that the cortical network of a healthy brain works near a critical state and, moreover, that functional neuronal networks often have scale-free and small-world properties. In this work, we study how the robustness of simple functional networks at criticality is affected by structural defects. In particular, we consider a two-dimensional Ising model at the critical temperature and investigate how its functional network changes with the increasing degree of structural defects. We show that the scale-free and small-world properties of the functional network at criticality are robust against large degrees of structural lesions while the system remains below the percolation limit. Although the Ising model is only a conceptual description of a two-state neuron, our research reveals fundamental robustness properties of functional networks derived from classical statistical mechanics models.

The authors conducted a retrospective study involving description of a new surgical technique. The objective of this study was to describe and evaluate the efficacy of a new technique to stabilize the spine of young and small patients with congenital scoliosis after lumbosacral hemivertebra excision. Congenital scoliosis develops as the result of anomalous vertebral development and asymmetric growth. The vertebral anomalies include congenital fusions and congenital hemivertebrae. With lumbosacral hemivertebrae at the lumbosacral junction, surgical excision followed by instrumentation to close the resulting space is frequently the best way to correct the deformity and obtain spinal balance. Surgical stabilization is required for preventing recurrent deformity and restoration of spinal balance. A new surgical technique for spinal correction and stabilization in congenital scoliosis is described. The technique involves hemivertebra excision followed by fixation of the adjacent normal vertebra to the ilium with screws and cables. This technique allows efficient correction in both the coronal and sagittal planes. This construct was prospectively studied in 3 cases over a 3- to 5(1/2)-year period. All cases had solid fusion and well-balanced spine at latest follow up. This prospective study demonstrates a successful surgical technique for spinal stabilization after congenital hemivertebra excision in infants and young children with relatively small and soft bones when standard constructs like pedicle screws may not be optimal devices. Coronal and sagittal balance (restoration with improvement of lordosis) was successfully achieved in all cases.