A sequential cognitive and physical approach (SCOPA) for patellofemoral pain: a randomized controlled trial in adolescent patients

Objective: To compare a sequential treatment algorithm considering psychosocial and physical impairments, with a conventional rehabilitation approach considering only physical impairments in adolescents with patellofemoral pain. Design: A randomized, single-blind, controlled study. Participants: Fifty-five adolescents (36 females; mean age 14.3 ± 1.8 years). Interventions: The sequential cognitive and physical approach (SCOPA) group ( n = 28) was treated based on sequential testing and treatment of activity-related fear, flexibility, kinematics, and strength. The comparator group ( n = 27) was treated with a non-sequential physical impairment–based approach. Both groups received treatment two times a week for up to six weeks. Measurements: Function (Anterior Knee Pain Scale), pain (Numeric Pain Rating Scale), and Global Rating of Change were assessed at baseline, three weeks, and six weeks, with a six-month follow-up. Results: Both groups had similar function (73.7 ± 9.6) and pain (6.0 ± 2.3) at baseline. A third of individuals with patellofemoral pain demonstrated elevated activity-related fear at baseline. Patients randomized to the SCOPA group had clinically significant greater improvements at six weeks in function (SCOPA, 95.0 ± 7.4 and comparator, 84.8 ± 10.4; mean difference: 10.2, 95% CI: 5.3, 15.1) and pain (SCOPA, 0.9 ± 1.9 and comparator, 2.7 ± 2.1; mean difference: 1.7, 95% CI: 0.5, 2.9). No differences were noted in Global Rating of Change. No between-group differences were noted in any outcome at six-month follow-up. Conclusion: The sequential cognitive and physical approach resulted in greater improvements in short-term function and pain. By six months, both groups demonstrated similar clinically significant improvements in all outcomes.

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Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽

10.1136/rmdopen-2020-001372 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001372

Author(s):

Sella Aarrestad Provan ◽

Brigitte Michelsen ◽

Joseph Sexton ◽

Tillmann Uhlig ◽

Hilde Berner Hammer

Keyword(s):

Rheumatoid Arthritis ◽

Rating Scale ◽

Numeric Rating Scale ◽

Tender Joint Count ◽

Tender Joint ◽

Logistic Regression Models ◽

Patient Reported ◽

Biologic Dmard ◽

Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

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Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication

The British Journal of Psychiatry ◽

10.1192/bjp.186.4.324 ◽

2005 ◽

Vol 186 (4) ◽

pp. 324-330 ◽

Cited By ~ 99

Author(s):

Lucia R. Valmaggia ◽

Mark van der Gaag ◽

Nicholas Tarrier ◽

Marieke Pijnenborg ◽

Cees J. Slooff

Keyword(s):

Cognitive Behavioural Therapy ◽

Rating Scale ◽

Behavioural Therapy ◽

Controlled Study ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

Cognitive Behavioural ◽

Supportive Counselling ◽

Treatment Refractory

BackgroundThere is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.AimsTo investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.MethodManualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.ResultsParticipants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.ConclusionsCognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

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A Treatment-Based Classification Algorithm to Treat Achilles Tendinopathy: An Exploratory Case Series

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0033 ◽

2017 ◽

Vol 26 (3) ◽

pp. 260-268

Author(s):

Patti Syvertson ◽

Emily Dietz ◽

Monica Matocha ◽

Janet McMurray ◽

Russell Baker ◽

...

Keyword(s):

Outcome Measures ◽

Repeated Measures ◽

Rating Scale ◽

Case Series ◽

Numeric Rating Scale ◽

Achilles Tendinopathy ◽

Global Rating ◽

Physically Active ◽

Indirect Treatment

Context:Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.Objective:To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.Participants:11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.Design:Case series.Setting:Participants were evaluated, diagnosed, and treated at multiple clinics.Main Outcome Measures:Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.Results:A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.Conclusion:The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

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Long-term Effects of Cognitive-Behavioural Therapy and Lithium Therapy on Depression in the Elderly

The British Journal of Psychiatry ◽

10.1192/bjp.167.5.653 ◽

1995 ◽

Vol 167 (5) ◽

pp. 653-658 ◽

Cited By ~ 17

Author(s):

K. C. M. Wilson ◽

M. Scott ◽

M. Abou-Saleh ◽

R. Burns ◽

J. R. M. Copeland

Keyword(s):

Maintenance Therapy ◽

Cognitive Behavioural Therapy ◽

Rating Scale ◽

Behavioural Therapy ◽

Lithium Therapy ◽

Controlled Study ◽

Depression Severity ◽

Cognitive Behavioural

BackgroundWe examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients.MethodThe study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy.ResultsReceiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy.ConclusionsCBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.

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0794 Reduction in Restless Legs Syndrome Symptoms with Non-Invasive Peripheral Nerve Stimulation

SLEEP ◽

10.1093/sleep/zsaa056.790 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A302-A302

Author(s):

J D Charlesworth ◽

F C Baker ◽

V Kolotovska ◽

B Adlou ◽

M de Zambotti ◽

...

Keyword(s):

Medical Device ◽

Restless Legs Syndrome ◽

Therapeutic Efficacy ◽

Rating Scale ◽

Pharmacological Intervention ◽

Controlled Study ◽

Promising Alternative ◽

Restless Legs ◽

Non Invasive ◽

Clinically Significant

Abstract Introduction Restless Legs Syndrome (RLS) is a sensorimotor neurological condition characterized by an uncontrollable urge to move the legs that interferes with falling and staying asleep. For the over 5 million Americans with clinically significant RLS, these symptoms occur multiple nights per week, significantly impair quality of life, increase the prevalence of depression and anxiety, and increase suicide risk. FDA-approved medications for RLS are associated with progressively worsening RLS symptoms and numerous adverse events, whereas existing medical device treatments have limited efficacy. Methods We evaluated a novel neurostimulation intervention for RLS developed by Noctrix Health; electrical stimulation was applied non-invasively and bilaterally to the peroneal nerve of patients with moderate-to-severe primary RLS. Stimulation parameters were engineered to maximize therapeutic efficacy while minimizing interference with sleep. To assess the therapeutic efficacy of this technique, we conducted a multi-site randomized patient-blinded crossover trial comparing active neurostimulation treatment to a sham device. Following a lab visit for calibration, optimization, and training, each patient was instructed to self-administer each treatment - active and sham - for 14 consecutive nights at home. Results Active neurostimulation treatment resulted in a clinically significant reduction in RLS severity of 4.2 points on the International RLS Rating Scale (IRLS) relative to sham (P<0.01), comparable to FDA-approved medications. Moreover, 79% of patients demonstrated a clinically significant improvement on the Clinical Global Impressions-Improvement scale (CGI-I) compared to 7% for sham (P<0.01). Conclusion To our knowledge, this is the first sham-controlled study demonstrating a clinically significant reduction in RLS severity resulting from a non-pharmacological intervention. This therapeutic effect was sustained over 2-weeks of in-home patient-administered usage, indicating consistent efficacy. A medical device based on this technology could be a promising alternative or complement to medications. Support Funding was provided by Noctrix Health, Inc.

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Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial

Acupuncture in Medicine ◽

10.1177/0964528420912253 ◽

2020 ◽

Vol 38 (6) ◽

pp. 371-379

Author(s):

Shabnam Behrangrad ◽

Maryam Abbaszadeh-Amirdehi ◽

Amin Kordi Yoosefinejad ◽

Seyed Mokhtar Esmaeilnejadganji

Keyword(s):

Functional Status ◽

Mechanical Stimulation ◽

Rating Scale ◽

Pressure Pain Threshold ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Dry Needling ◽

Myofascial Trigger Points

Background: To compare the effectiveness of ischaemic compression (IC) applied directly to the knee versus dry needling (DN) with respect to pain, functional status and sensitivity to mechanical stimulation of vastus medialis obliquus (VMO) myofascial trigger points (MTrPs) in patients with patellofemoral pain syndrome (PFPS). Methods: A total of 54 patients with unilateral PFPS aged 20–30 years were selected randomly from patients referred to physical therapy clinics of Babol University of Medical Sciences in Iran. Twenty-seven patients were allocated to either IC or DN groups. Three sessions of treatment were applied over 1 week with follow-up at 1 week, 1 month and 3 months. Primary outcome measures comprised the Kujala questionnaire score for functional status, numerical pain rating scale (NPRS) for pain intensity and pressure pain threshold (PPT) for sensitivity to mechanical stimulation; these were measured and recorded before treatment and 1 week, 1 month and 3 months after the last treatment session. Results: There were no statistically significant differences in the between-group comparisons of any variables at the various follow-up points. Both groups (n = 27 participants each) had significant improvements (p < 0.05) in pain, functional status and PPT values at follow-up. Conclusions: There were no differences in markers of pain, function or pressure sensitivity over a 3-month follow-up period between patients with PFPS treated with DN and IC. Temporal improvements in both groups suggested that the two techniques may be similarly effective for the treatment of PFPS.

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The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period

International Psychogeriatrics ◽

10.1017/s1041610213001609 ◽

2013 ◽

Vol 26 (1) ◽

pp. 81-91 ◽

Cited By ~ 76

Author(s):

Geir Selbæk ◽

Knut Engedal ◽

Jūratė Šaltytė Benth ◽

Sverre Bergh

Keyword(s):

Nursing Home ◽

Rating Scale ◽

Neuropsychiatric Symptoms ◽

Clinical Dementia Rating ◽

Severe Dementia ◽

Persistent Symptoms ◽

Nursing Home Patients ◽

Affective Symptoms ◽

Clinically Significant

ABSTRACTBackground:Neuropsychiatric symptoms (NPS) are prevalent in nursing-home (NH) patients with dementia, but little is known about the long-term course of these symptoms.Methods:In this study, 931 NH patients with dementia took part in a prospective cohort study with four assessments over a 53-month follow-up period. NPS and level of dementia were assessed with the Neuropsychiatric Inventory scale and the Clinical Dementia Rating scale, respectively.Results:Mild, moderate, and severe dementia was present in 25%, 33%, and 42%, respectively. There was an increase in the severity of the dementia from the first to the fourth assessment. Agitation, irritability, disinhibition, and apathy were the most prevalent and persistent symptoms during the study period. The affective subsyndrome (depression and anxiety) became less severe, whereas the agitation subsyndrome (agitation/aggression, disinhibition, and irritability) and apathy increased in severity during the follow-up period. More severe dementia was associated with more severe agitation, psychosis, and apathy, but not more severe affective symptoms. Mild dementia was associated with an increase in the severity of psychosis, whereas moderate or severe dementia was associated with decreasing severity of psychosis over the follow-up period.Conclusion:Nearly all the patients experienced clinically significant NPS, but individual symptoms fluctuated. Affective symptoms became less severe, while agitation and apathy increased in severity. An increase in dementia severity was associated with an increase in the severity of agitation, psychosis, and apathy, but not affective symptoms. The results may have implications when planning evaluation, treatment, and the prevention of NPS in NH patients.

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Botulinum toxin injections as salvage therapy is beneficial for management of patellofemoral pain syndrome

Knee Surgery and Related Research ◽

10.1186/s43019-021-00121-3 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Yuval Kesary ◽

Vivek Singh ◽

Tal Frenkel-Rutenberg ◽

Arie Greenberg ◽

Shmuel Dekel ◽

...

Keyword(s):

Botulinum Toxin ◽

Physical Therapy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Post Treatment ◽

Functional Scores

Abstract Purpose Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection. Materials and methods A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected. Results The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up. Conclusions A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS. Level III evidence Retrospective cohort study.

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Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.264.isq ◽

2017 ◽

Vol 26 (4) ◽

pp. 339-344 ◽

Cited By ~ 2

Author(s):

Keith Siau ◽

Jessie Li ◽

Neil C. Fisher ◽

Chris J.J. Mulder ◽

Sauid Ishaq

Keyword(s):

Gastrointestinal Endoscopy ◽

Rating Scale ◽

Global Rating Scale ◽

Zenker’S Diverticulum ◽

Advisory Group ◽

Global Rating ◽

Zenker's Diverticulum ◽

Underlying Pathology ◽

Failure To Progress

Background: Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus. Aim: To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF.Methods: All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into ‘failure to tolerate’ and ‘failure to progress’ based on endoscopy reports.Results: The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker’s diverticulum in 73.2%. ‘Failure to progress’ predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age ≥65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001).Conclusion: Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age ≥65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy. .Abbreviations: ASGE: Association for Gastrointestinal Endoscopy; CI: Confidence interval; CP: Cricopharyngeus; CPH: Cricopharyngeal hypertrophy; FESD: Flexible endoscopic septum division; GRS: Global rating scale; IF: Intubation failure; JAG: Joint Advisory Group for gastrointestinal endoscopy; NME: Non-medical endoscopist; OR: Odds ratio; SI: Successful intubation; ZD: Zenker’s diverticulum.

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Repetitive transcranial magnetic stimulation for the treatment of depression

The British Journal of Psychiatry ◽

10.1192/bjp.182.6.480 ◽

2003 ◽

Vol 182 (6) ◽

pp. 480-491 ◽

Cited By ~ 194

Author(s):

José Luis R. Martin ◽

Manuel J. Barbanoj ◽

Thomas E. Schlaepfer ◽

Elinor Thompson ◽

Víctor Pérez ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Rating Scale ◽

Repetitive Transcranial Magnetic Stimulation ◽

Pooled Analysis ◽

Mean Difference ◽

Treatment Of Depression ◽

Randomised Controlled

BackgroundRepetitive transcranial magnetic stimulation (rTMS) may be useful in the treatment of depression but results from trials have been inconclusive to date.AimsTo assess the efficacy of rTMS in treating depression.MethodWe conducted a systematic review of randomised controlled trials that compared rTMS with sham in patients with depression. We assessed the quality of design of all studies and conducted a metaanalysis of data from trials with similar rTMS delivery.ResultsWe included a total of 14 trials. The quality of the included studies was low. Pooled analysis using the Hamilton Rating Scale for Depression showed an effect in favour of rTMS compared with sham after 2 weeks of treatment (standardised mean difference=–0.35; 95% CI –0.66 to –0.04), but this was not significant at the 2-week follow-up (standardised mean difference= — 0.33; 95% CI —0.84 to 0.17).ConclusionsCurrent trials are of low quality and provide insufficient evidence to support the use of rTMS in the treatment of depression.

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