A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

2021 ◽  
pp. 1357633X2110098
Author(s):  
Aya Sedky Adly ◽  
Afnan Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Mohammad F Ali
Keyword(s):  
Rheumatoid Arthritis ◽  
Virtual Reality ◽  
Elderly Patients ◽  
Aerobic Exercise ◽  
Health Professionals ◽  
Post Treatment ◽  
Laser Acupuncture ◽  
Virtual Reality Training ◽  
Significant Difference ◽  
Elderly Onset

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this study was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group ( p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments ( p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups ( p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group. Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

Similarity of response to biologics between elderly-onset rheumatoid arthritis (EORA) and non-EORA elderly patients: from the FIRST registry

2021 ◽  
pp. jrheum.201135
Author(s):  
Sae Ochi ◽  
Fumitaka Mizoguchi ◽  
Kazuhisa Nakano ◽  
Yoshiya Tanaka
Keyword(s):  
Rheumatoid Arthritis ◽  
Elderly Patients ◽  
Disease Activity ◽  
Trajectory Analysis ◽  
Response Patterns ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Elderly Onset ◽  
Disease Modifying ◽  
Elderly Onset Rheumatoid Arthritis

Objective Increasing numbers of patients are developing rheumatoid arthritis (RA) at an older age, and optimal treatment of elderly-onset RA (EORA) patients is attracting greater attention. This study aimed to analyze the efficacy and safety of biological/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in EORA and non-EORA elderly patients. Methods A cohort of RA patients treated with b/tsDMARDs were retrospectively analyzed. Among patients who were ≥60 years old, those who developed RA after age 60 years were categorized as EORA, while others were categorized as non-EORA elderly. Disease activity were compared between the EORA and non-EORA elderly groups. Results In total, 1,040 patients were categorized as EORA and 710 as non-EORA elderly. There were not significant differences in characteristics at baseline between the two groups. The proportion of patients with low and high disease activity was comparable at week 2, 22 and 54 between in the EORA and the non-EORA elderly group. There was not significant difference in reasons of the discontinuation of b/tsDMARDs between the two groups. Elderly onset did not affect changes in CDAI and HAQ-DI as well as reasons of the discontinuation between the two groups. The trajectory analysis on CDAI-responses to b/tsDMARDs for 54 weeks identified three response patterns. The proportions of patients categorized into each group and CDAI-response trajectories to b/tsDMARDs were very similar between EORA and non-EORA elderly patients. Conclusion CDAI response patterns to b/tsDMARDs and hazard ratio of adverse events were similar between EORA and non-EORA elderly patients.

scholarly journals Effects of laser therapy versus laser acupuncture on rheumatoid arthritis elderly patients

2021 ◽  
pp. 2717-2725
Keyword(s):  
Rheumatoid Arthritis ◽  
Elderly Patients ◽  
Laser Therapy ◽  
Inflammatory Marker ◽  
Low Level Laser Therapy ◽  
Laser Acupuncture ◽  
Therapeutic Effects ◽  
Oxidation Stress ◽  
Therapeutic Benefits ◽  
Significant Difference

Objective Rheumatoid arthritis (RA) is regarded as the commonest and one of most known inflammatory arthritis. Our study was to determine the effects of laser therapy and laser acupuncture therapy on RA elderly patients. Subjects and Methods Forty patients with age of 65 to 75 years were being randomly allocated to 2 groups. Group(A) included twenty participants having RA treated via low level laser therapy. Group(B) included twenty participants having RA treated via laser acupuncture. All the patients underwent treatment by methotrexate. Treatments were provided three times each week to the two groups for twelve weeks.Independent laboratory technician and statistician were blinded to the study groups. Results There was significant reduction in scores of RAQoL questionnaire pre as well as post treatments for both the groups, with p<0.05. For HAQ questionnaire, significant difference was in the group treated with laser acupuncture. The IL-6 inflammatory marker had a significant reduction in pre as well as post treatments in only the group treated with laser acupuncture, with p < 0.05. In the MDA marker, it had a significant reduction in both groups for pre as well as post treatments. There was also a significant increase to the ATP antioxidant marker in pre as well as post treatments for both the groups, p<0.05. Conclusions This study suggested that the laser acupuncture can offer promising therapeutic benefits to assess in rheumatoid arthritis treatments; those therapeutic effects might be from inflammation reduction and oxidation stress alleviation, in addition to improvements in the antioxidants and energy status for RA patients.

scholarly journals Sleep Impairment at the Time of First Diagnosis in Patients with Seronegative Elderly-Onset Rheumatoid Arthritis and in Patients with Polymyalgia Rheumatica    

2019 ◽  
Author(s):  
Ciro Manzo ◽  
Alberto Castagna
Keyword(s):  
Rheumatoid Arthritis ◽  
Differential Diagnosis ◽  
Polymyalgia Rheumatica ◽  
Rating Scale ◽  
Depression And Anxiety ◽  
Sleep Impairment ◽  
Significant Difference ◽  
Elderly Onset ◽  
Total Point ◽  
Elderly Onset Rheumatoid Arthritis

Background: Differential diagnosis between polymyalgia rheumatica (PMR) and seronegative elderly-onset rheumatoid arthritis (SEORA) is not easy, to the point that in the past they were considered the same entity. In these patients, sleep disorders have been scarcely assessed, and considered as expression of mood disorders such as depression and anxiety. Methods: In 38 Caucasian elderly patients (median age: 73.9 &plusmn; 8.06 years) consecutively referred to two outpatient clinics from January to May 2018 with diagnosis of PMR and SEORA, sleep impairment was assessed using the Medical Outcomes Study-Sleep scale (MOS-SS). Depression and anxiety were assessed using the Neuropsychiatric Inventory (NPI) score, with point 0 for absent and point 3 for severe. Comorbidities were assessed using the Cumulative Illness Rating Scale (CIRS).&nbsp; Patients taking medications used to treat sleep disturbance or that could favor sleep disturbances were excluded.&nbsp; The study was approved by the local ethics committee and carried out in accordance with the Helsinki Declaration, revised 2013. Every patient signed an informed consent form at the time of the first visit. Results: MOS-SS total point in PMR patients was significantly higher than in SEORA patients (47.60 &plusmn; 8.4 vs 28.26 &plusmn; 12.4; P = 0.000). After six-month therapy with prednisone (12.5&ndash;15 mg/day, followed after 4 weeks by gradual tapering), MOS-SS total point improved in the two groups of patients, with no significant difference (17.0 &plusmn; 6.2 vs 17.8 &plusmn; 4.2; P = 0.644). No correlation was found between MOS-SS and comorbidities, and between MOS-SS, anxiety or depression. Conclusions: Our data suggest that the assessment of sleep impairment could be very useful in the differential diagnosis between PMR and SEORA. Up today, the reasons why patients with PMR have&mdash;at the time of diagnosis&mdash;a sleep impairment higher than SEORA are speculative. Further ad hoc complementary studies in multicenter cohorts are needed.

scholarly journals Efficacy, safety, and adherence of tocilizumab therapy in elderly patients with rheumatoid arthritis: A real-world observational study

2021 ◽  
Vol 19 ◽  
pp. 205873922110457
Author(s):  
Yoshinobu Nakao ◽  
Yu Funakubo Asanuma ◽  
Takuma Tsuzuki Wada ◽  
Mayumi Matsuda ◽  
Hiroaki Yazawa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Elderly Patients ◽  
Disease Activity ◽  
Activity Index ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Drug Survival ◽  
Significant Difference

Objective: We evaluated the efficacy, safety, and drug survival rate of tocilizumab in the elderly patients with rheumatoid arthritis (RA). Methods: This study was conducted in 108 RA patients who started tocilizumab between 2008 and 2018. The patients were divided into a young group (<65 years) and an elderly group (≥65 years). The efficacy, safety, and drug survival rate of tocilizumab were compared between the two groups. Results: At baseline, there were no significant differences between the elderly ( n = 45) and the young group ( n = 63) in RA duration, percentage of biologic-naïve, and RA disease activity. Health Assessment Questionnaire-Disability Index (HAQ-DI) was higher, renal function was worse, and frequency of using methotrexate was lower in the elderly group. Tocilizumab demonstrated similar efficacy in the elderly and the young group with Clinical Disease Activity Index and HAQ-DI. Compared with baseline, the frequency of steroid use was lower at one year after initiation of tocilizumab in both groups. There was no significant difference between the groups in the drug survival rate of tocilizumab for three years. Discontinuation rates of TCZ due to toxic adverse events were similar between the two groups. Conclusions: The efficacy, steroid-sparing effect, and safety of tocilizumab therapy, as well as the drug survival rate for three years, were not inferior in elderly RA compared to young RA patients.

124 Virtual Reality for Reducing Pain and Perioperative Anxiety in Pediatric Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S83-S84 ◽  
Author(s):  
Heather J Schwartz ◽  
Shawn Fagan ◽  
Beretta Craft-Coffman ◽  
Christopher A Truelove ◽  
Robert F Mullins
Keyword(s):  
Virtual Reality ◽  
Burn Injury ◽  
Post Treatment ◽  
Improvement Project ◽  
Burn Care ◽  
Anxiety Control ◽  
Significant Difference ◽  
Scale Scores ◽  
Before And After ◽  
Pre Treatment

Abstract Introduction One of the most traumatizing and frightening experiences a child can experience is to sustain a burn injury. As a result, the child may experience excruciating pain and anxiety. The objective of this quality improvement project is use virtual reality as a nonpharmacologic intervention for pain and anxiety control and compare to traditional distractions methods. Methods There were 46 subjects ages 4 to 20 enrolled in a sample of convenience. Participants were given either virtual reality or distraction for dressing changes or minor surgical procedures. Before and after the surgical procedure or dressing change, the participants, their parent and nursing staff completed a Modified Yale Perioperative Anxiety Scale (mYPAS, Faces, Legs, Activity, Cry, and Consolability (FLACC) scale or Numeric Rating System (NRS). Results There was no significant difference in FLACC, NRS, and mYPAS scale scores pre-treatment. The post treatment NRS scores were significantly different between distraction and virtual reality (p= 0.031). FLACC scores for the distraction group increased 3.5-fold, while the virtual reality group scores decreased (p.0.0008). Mean mYPAS scores decreased again showing a significant difference between distraction and virtual reality with p= 0.004. The score increased with distraction and decreased with virtual reality with a difference of 12. In all cases virtual reality was better than distraction, when measuring pain and anxiety. Conclusions This QI project demonstrates that VR was more effective in reducing both pain and anxiety in burned pediatric patients as opposed to traditional distraction post treatment. Traditional distraction unfortunately was shown to increase both pain and anxiety post treatment. These conclusions suggest that VR may be utilized as a non-pharmacologic treatment option in conjunction with standard treatment to help decrease pain and anxiety in acutely burned children. Applicability of Research to Practice This study increases the knowledge base and advances the evidence-based practice of advanced practice registered nurses in the specialty of burn care. It suggests that a non-pharmacologic intervention such as virtual reality can be used to effectively reduce pain and anxiety in children who are undergoing treatment for their burn injury.

scholarly journals Effects of laser acupuncture tele-therapy for rheumatoid arthritis elderly patients

2021 ◽  
Author(s):  
Afnan Sedky Adly ◽  
Aya Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Heba Ahmed Ali Abdeen
Keyword(s):  
Rheumatoid Arthritis ◽  
Elderly Patients ◽  
Laser Acupuncture

scholarly journals A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Naveed Anwar ◽  
Hossein Karimi ◽  
Ashfaq Ahmad ◽  
Nazia Mumtaz ◽  
Ghulam Saqulain ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Virtual Reality ◽  
Physical Therapy ◽  
Lower Extremity ◽  
Randomized Clinical Trial ◽  
Virtual Reality Training ◽  
Lower Extremity Function ◽  
Stroke Patients ◽  
Extremity Function ◽  
Significant Difference

Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score ( p < 0.001 ), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function ( p < 0.001 ), FMA-joint pain, and joint range ( p < 0.001 ); however, there is no significant difference p = 0.202 for time vs. group interaction and significant ( p < 0.001 ) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country’s perspective.

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