Background:
Alfredson isolated eccentric loading and Silbernagel concentric–eccentric loading have both shown beneficial effects on clinical symptoms in midportion Achilles tendinopathy (AT), but ...they have never been compared directly.
Purpose:
To test for differences in clinical effects at 1-year follow-up between Alfredson and Silbernagel loading in midportion AT.
Study Design:
Randomized controlled trial; Level of evidence, 2.
Methods:
A total of 40 recreational athletes were allocated to the Alfredson group (AG) or the Silbernagel group (SG). The primary outcome was the difference in the Victorian Institute of Sports Assessment–Achilles (VISA-A) at 1-year follow-up. Secondary outcomes were the visual analog scale for pain during activities of daily living (VAS-ADL) and sports activities (VAS–sports), the EuroQol 5 Dimensions instrument (EQ-5D), and global perceived effect score. Measurements were performed at baseline and 12-week, 26-week, and 1-year follow-up. Analysis was performed using a linear mixed-regression model with intervention (AG vs SG), time (12 weeks, 26 weeks, and 1 year postoperatively), and intervention-by-time interaction.
Results:
The VISA-A score improved for both AG and SG, from 60.7 ± 17.1 at baseline to 89.4 ± 13.0 at 1-year follow-up and from 59.8 ± 22.2 to 83.2 ± 22.4, respectively (P < .001 for both). Because the interaction term did not significantly improve the model, we reported a treatment effect without interaction term, indicating a constant difference at each follow-up. The linear mixed model with correction for baseline VISA-A and confounders revealed a nonsignificant treatment effect (2.4 95% CI, –8.5 to 13.3; P = .656). In addition, after adjustment for the respective baseline values and confounders, nonsignificant treatment effects were found for the VAS-ADL (–2.0 95% CI, –11.3 to 7.3; P = .665) and VAS-sports (1.3 95% CI, –12.8 to 15.3, P = .858). The EQ-5D subscales improved in both groups. After 1 year, significantly more SG participants considered themselves improved (77.3% SG vs 50.0% AG; P = .04).
Conclusion:
No differences in clinical effects were found between Alfredson and Silbernagel loading at up to 1-year follow-up. Both programs significantly improved clinical symptoms, and given their high adherence rates, offering either of them as a home-based program with limited supervision appears to be an effective treatment strategy for midportion AT.
Registration:
NTR5638 (Netherlands Trial Register number).
BACKGROUND:Multidisciplinary treatment guidelines for Dupuytren disease can aid in optimizing the quality of care for patients with this disorder. Therefore, this study aimed to achieve consensus on ...a multidisciplinary treatment guideline for Dupuytren disease.
METHODS:A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of interventions was conducted and used as an evidence-based starting point for this study. In total, 39 experts (hand surgeons, hand therapists, and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report.
RESULTS:After four Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of Dupuytren disease. No nonsurgical interventions were included in the guideline. Needle and open fasciotomy, and a limited fasciectomy and dermofasciectomy, were seen as suitable surgical techniques for Dupuytren disease. Factors relevant for choosing one of these surgical techniques were identified and divided into patient-related (age, comorbidity), disease-related (palpable cord, previous surgery in the same area, skin involvement, time of recovery, recurrences), and surgeon-related (years of experience) factors. Associations of these factors with the choice of a specific surgical technique were reported in the guideline. Postsurgical rehabilitation should always include instructions and exercise therapy; postsurgical splinting should be performed on indication. Relevant details for the use of surgical and postsurgical interventions were described.
CONCLUSION:This treatment guideline is likely to promote further discussion on related clinical and scientific issues and may therefore contribute to better treatment of patients with Dupuytren disease.
To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS).
The Cochrane Library, PubMed, Embase, CINAHL, and ...Physiotherapy Evidence Database.
Two reviewers independently applied the inclusion criteria to select potential eligible studies.
Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool.
A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials RCTs). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified.
Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS.
Abstract Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments–a systematic review. Objective To review ...literature systematically concerning effectiveness of nonsurgical interventions for treating carpal tunnel syndrome (CTS). Data Sources The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Study Selection Two reviewers independently applied the inclusion criteria to select potential studies. Data Extraction Two reviewers independently extracted the data and assessed the methodologic quality. Data Synthesis A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 20 RCTs were included. Strong and moderate evidence was found for the effectiveness of oral steroids, steroid injections, ultrasound, electromagnetic field therapy, nocturnal splinting, and the use of ergonomic keyboards compared with a standard keyboard, and traditional cupping versus heat pads in the short term. Also, moderate evidence was found for ultrasound in the midterm. With the exception of oral and steroid injections, no long-term results were reported for any of these treatments. No evidence was found for the effectiveness of oral steroids in long term. Moreover, although higher doses of steroid injections seem to be more effective in the midterm, the benefits of steroids injections were not maintained in the long term. For all other nonsurgical interventions studied, only limited or no evidence was found. Conclusions The reviewed evidence supports that a number of nonsurgical interventions benefit CTS in the short term, but there is sparse evidence on the midterm and long-term effectiveness of these interventions. Therefore, future studies should concentrate not only on short-term but also on midterm and long-term results.
To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.
Cochrane Library, ...Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).
Two reviewers independently applied the inclusion criteria to select potential studies.
Two reviewers independently extracted the data and assessed the methodologic quality.
A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.
In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.
The objective of this study was to systematically review the literature on the effect of CGs versus non-CGs (such as regular socks) or versus placebo garments on 1) the incidence of lower extremity ...sports injuries and 2) subjective ratings of fatigue and biomechanical variables in athletes at participating in any sport that required any level of running performance, given that fatigue-related biomechanical alterations may increase the risk of sports injuries. This study was a systematic review with meta-analyses. PubMed, Embase, CINAHL, Cochrane, PEDro, and Scopus were searched for eligible studies until 7 July 2021. Two reviewers independently assessed the risk of bias using the Cochrane Collaboration's tool for risk of bias. Meta-analyses were performed using a random-effects model. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence for all outcome measures. Twenty-three studies, all with a high risk of bias, were included. Nineteen studies were used in the meta-analyses. No studies focused on the effect of CGs on the incidence of lower extremity sports injuries in athletes. Seventeen studies investigated the effect of CGs on subjective ratings of fatigue, but meta-analysis showed no difference in effectiveness between CGs versus non-CGs (such as regular socks) and versus placebo CGs (low certainty evidence). Because of heterogeneity, pooling of the results was not possible for the biomechanical variables. Nonetheless, low certainty evidence showed no effect of CGs. We identified no evidence for a beneficial or detrimental effect of lower leg CGs on the occurrence of lower extremity sports injuries, subjective ratings of fatigue, or biomechanical variables in athletes at any level of running performance. Based on the variable use of running tests, definitions used for biomechanical variables, and reporting of CG characteristics and more standardized reporting is recommended for future studies evaluating CGs.
Abstract Objectives To systematically review the effects of energy conservation management (ECM) treatment for fatigue in multiple sclerosis (MS), and to study the effect of ECM treatment on ...restrictions in participation and quality of life (QoL). Data Sources PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials. Study Selection To select potential studies, 2 reviewers independently applied the inclusion criteria. Data Extraction Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results. Data Synthesis The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference MD=−2.91; 95% confidence interval CI, −4.32 to −1.50), physical (MD=−2.99; 95% CI, −4.47 to −1.52), and psychosocial (MD=−6.05; 95% CI, −8.72 to −3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69–24.84), social function (MD=6.91; 95% CI, 1.32–12.49), and mental health (MD=5.55; 95% CI, 2.27–8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results. Conclusions The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales—role physical, social function, and mental health—in fatigued patients with MS. More RCTs that also study long-term results are needed.
Summary Background An intact digital nerve is obligatory for hand function. When transected, the hand surgeon has several options. However, there is no hard evidence which technique to choose. ...Objective The aim of this study was to provide an evidence-based overview of the effectiveness of interventions used in reconstruction and post-surgical management of digital nerve injuries. Methods The Cochrane Library, PubMed, EMBASE, CINAHL and PEDro databases were searched. Two reviewers independently applied the inclusion criteria to select potential relevant randomised controlled trials (RCTs) and controlled clinical trials (CCTs), extracted data and performed a methodological quality assessment of the included studies. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method was used to summarise the results. Results Eight RCTs were included, five on surgical and three on post-surgical interventions. Low-quality evidence was found for effectiveness in favour of a polyglycolic acid conduit compared to primary neurrorhaphy or autologous graft, in digital nerve gaps of ≤4 mm and ≥8 mm at long-term follow-up. Very low quality of evidence was found for effectiveness in favour of EMLA crème, compared to placebo, in enhancing sensory relearning for the short-term, but not for the long-term outcomes. Low quality of evidence was found for effectiveness in favour of sensory re-education compared with control at long-term follow-up. For other interventions, no evidence for effectiveness was found. Conclusions Indications for effectiveness of some treatment strategies in digital nerve repair were found, but due to a minimal number of RCTs in this field no firm conclusions could be drawn for the different techniques. More high-quality RCTs are needed for a more confident estimate of effect. Level of evidence Therapeutic II.
OBJECTIVE: In addition to known risk factors for musculoskeletal complaints in the general population, playing a musical instrument is an additional risk factor. In this pilot study, the prevalence ...of musculoskeletal complaints in student amateur musicians and their relation with playing
posture and playing time were evaluated. METHODS: A cross-sectional web-based survey among amateur musicians studying at a Dutch university. RESULTS: 162 amateur musicians were included in this pilot study (response rate 17.6%). 46.9% of these amateur musicians played with an elevated arm
position. Presence of complaints of the arm, neck and/or shoulder (CANS) was not statistically significantly related to arm position, except for complaints in the left shoulder with an elevated left arm position compared to neutral left arm position (OR 6.7, CI 95% 2.2-20.8) The number
of hours playing per week did not significantly contribute to CANS (OR 1.0, CI 95% 0.95-1.17). CONCLUSIONS: In this pilot study among student amateur musicians, the occurrence of CANS was not significantly related to arm position, except for musicians playing with an elevated left arm
position, which was associated with complaints of the left shoulder (OR 6.7). The number of hours playing per week did not significantly contribute to CANS in this group of musicians.
Objectives
Although muscle flexibility is considered to be a risk factor for hamstring‐and‐lower back injuries (HLB‐injuries) in male soccer players, it is unclear whether this is true for elite ...female soccer players.
Design
Prospective observational cohort study.
Method
One hundred fourteen elite female soccer players were monitored during the 2014‐2015 soccer season. Hamstring‐and‐lower‐back flexibility (HLB‐flexibility) was assessed using the sit‐and‐reach test (SRT) and soccer exposure and soccer‐related injuries were registered. Poisson regression was used to study the association between HLB‐flexibility and HLB‐injuries with adjustment for possible confounders.
Results
Of the 114 players, 46 (40%) reported an HLB‐injury (60 hamstring injuries and 20 lower back injuries) during the season, accounting for 22% of all injuries reported. No significant association was found between HLB‐flexibility and HLB‐injuries (P = .534). Also, after correction for potential confounders (age, weight, height, match exposure, and training exposure), HLB‐flexibility was not found to be associated with HLB‐injuries ((1.027 (0.989‐1.066) (RR 95% CI)), P = .164 unadjusted, and 1.022 (0.987‐1.059), P = .217 adjusted). Match exposure was significantly associated with HLB‐injuries. When the number of match hours increased by 1, the number of HLB‐injuries increased by a factor 1.051.
Conclusion
HLB‐flexibility does not influence the occurrence of HLB‐injuries in elite female soccer players.
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