The Effect of Depression on Pain Perception and Function in the Foot and Ankle Patient

Category: Other Introduction/Purpose: Foot and ankle (FA) pain can be found in up to 20% of the adult population.1 Etiologies are multifactorial and include neurologic injury, trauma, deformity, tendinopathies and psychological factors. The purpose of this investigation is to assess psychological factors contributing to FA pain in surgical and nonsurgical patients. By identifying how psychological factors influence patient reported pain and disability, clinicians may be able to develop interventions to decrease catastrophic thinking and improve psychological well-being prior to considering surgical intervention Methods: All patients seen in a FA clinic by a single fellowship trained orthopaedic surgeon from August 2016 to October 2016 were included. All patients completed 5 functional assessments prior to their visit (PHQ-2, VAS Pain Scale, FAAM, PSEQ, PCS). We divided the patients into two groups based on their performance on the PHQ (PHQ < 3, or PHQ = 3), which measures depression. Scores = 3 are indicative of clinical depression. Nonparametric Wilcoxon testing was used to determine whether the distributions of the other scores (VAS Pain Scale, FAAM, PSEQ and PCS) were significantly different between these two groups. Results: Of the 225 patients included in our analysis, there were 175 (88%) had PHQ-2 depression scores of < 3 (Group 1) and 50 (22%) had scores = 3 (Group 2). Group 2 demonstrated a statistically significant increase in VAS Pain Scale and PCS. In addition, patients in Group 2 showed statistically significant decreases in FAAM and PSEQ. Patients in Group 2 were statistically more likely to be obese, use tobacco, and be unemployed. Conclusion: In patients with common FA complaints, those with clinical depression, as assessed by the PHQ-2, demonstrated increased pain scores, decreased ability to cope with pain, and lower functional outcome scores compared to patients without depression. Tobacco use, obesity and employment status were found to independently affect pain, coping, and function of patients. These data suggest that depression can significantly affect a patient’s ability to cope with pain and to achieve a higher functional outcome. This data suggests patients with depression may have increased difficulty coping with their FA ailment leading to the need for increased counseling regarding expected outcomes.

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Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis

Journal of Foot and Ankle Research ◽

10.1186/s13047-020-00426-8 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Jade M. Tan ◽

Kay M. Crossley ◽

Shannon E. Munteanu ◽

Natalie J. Collins ◽

Harvi F. Hart ◽

...

Keyword(s):

Range Of Motion ◽

Knee Pain ◽

Single Step ◽

Ankle Dorsiflexion ◽

Trial Registration ◽

Patellofemoral Osteoarthritis ◽

Foot And Ankle ◽

Patient Reported ◽

Foot Posture ◽

And Function

Abstract Background Foot and ankle characteristics are associated with patellofemoral pain (PFP) and may also relate to patellofemoral osteoarthritis (PFOA). A greater understanding of these characteristics and PFOA, could help to identify effective targeted treatments. Objectives To determine whether foot and ankle characteristics are associated with knee symptoms and function in individuals with PFOA. Methods For this cross-sectional study we measured weightbearing ankle dorsiflexion range of motion, foot posture (via the Foot Posture Index [FPI]), and midfoot mobility (via the Foot Measurement Platform), and obtained patient-reported outcomes for knee symptoms and function (100 mm visual analogue scales, Anterior Knee Pain Scale [AKPS], Knee injury and Osteoarthritis Outcome Score, repeated single step-ups and double-leg sit-to-stand to knee pain onset). Pearson’s r with significance set at p < 0.05 was used to determine the association between foot and ankle charateristics, with knee symptoms and function, adjusting for age. Results 188 participants (126 [67%] women, mean [SD] age of 59.9 [7.1] years, BMI 29.3 [5.6] kg/m2) with symptomatic PFOA were included in this study. Lower weightbearing ankle dorsiflexion range of motion had a small significant association with higher average knee pain (partial r = − 0.272, p < 0.001) and maximum knee pain during stair ambulation (partial r = − 0.164, p = 0.028), and lower scores on the AKPS (indicative of greater disability; partial r = 0.151, p = 0.042). Higher FPI scores (indicating a more pronated foot posture) and greater midfoot mobility (foot mobility magnitude) were significantly associated with fewer repeated single step-ups (partial r = − 0.181, p = 0.023 and partial r = − 0.197, p = 0.009, respectively) and double-leg sit-to-stands (partial r = − 0.202, p = 0.022 and partial r = − 0.169, p = 0.045, respectively) to knee pain onset, although the magnitude of these relationships was small. The amount of variance in knee pain and disability explained by the foot and ankle characteristics was small (R2-squared 2 to 8%). Conclusions Lower weightbearing ankle dorsiflexion range of motion, a more pronated foot posture, and greater midfoot mobility demonstrated small associations with worse knee pain and greater disability in individuals with PFOA. Given the small magnitude of these relationships, it is unlikely that interventions aimed solely at addressing foot and ankle mobility will have substantial effects on knee symptoms and function in this population. Trial registration The RCT was prospectively registered on 15 March 2017 with the Australia and New Zealand Clinical Trials Registry (ANZCTRN12617000385347).

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Pain Perception in Cataract Surgery: Topical versus Peribulbar Anaesthesia

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v13i1.30574 ◽

2021 ◽

Vol 13 (1) ◽

pp. 50-58

Author(s):

Indraman Maharjan ◽

Eliya Shrestha ◽

Babita Gurung ◽

Hara Maya Gurung ◽

Hari Bikram Adhikari ◽

...

Keyword(s):

Cataract Surgery ◽

Pain Score ◽

Pain Perception ◽

Pain Scale ◽

Topical Anaesthesia ◽

Injection Group ◽

Peribulbar Anaesthesia ◽

Patient Reported ◽

The Mean ◽

Phacoemulsification Cataract Surgery

Introduction: The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection. Materials and methods: The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain. Results: In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p <0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p<0.001 for both genders). Conclusion: Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.

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Pain Assessment in Foot and Ankle Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00067 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0006

Author(s):

Meghan Kelly ◽

David Bernstein ◽

Ashlee MacDonald ◽

John Ketz ◽

Adolph Flemister ◽

...

Keyword(s):

Pain Management ◽

Physical Function ◽

Patient Reported Outcomes ◽

Pearson Correlation ◽

Pain Level ◽

Foot And Ankle ◽

Moderate Correlation ◽

Patient Reported ◽

And Function

Category: Other Introduction/Purpose: The ability to accurately quantify a patient’s pain pre-operatively is advantageous in the preparation of post-operative expectations and pain management. The Numeric Pain Rating Scale (NPRS) is a popular method to identify patient pain level. Other patient reported outcomes are being collected, such as the Patient Reported Outcomes Measurement Information System (PROMIS) and has been suggested to be more accurate in measuring pain as well as physical function. The aim of this study was to 1) determine whether NPRS or PROMIS Pain Interference (PI) demonstrates a stronger association with physical function as determined by PROMIS Physical Function (PF) and 2) to determine which method better predicts post-surgical pain in a population of elective surgical foot and ankle patients. Methods: Prospective PROMIS PF, PI and NPRS (0-10) data was obtained for common foot and ankle elective surgical procedures (CPT codes 27698, 27870, 28285, 28289, 28300, 28705, 28730, 28750) from a multi-surgeon foot and ankle clinic between February 2015 until November 2017. Pearson correlation coefficients were used to determine the relationship between NPRS (0-10) and PROMIS domains (PI, PF) pre and post-operatively. Correlations were considered high (> 0.7), high moderate (0.6-0.69), moderate (0.4-0.6) or weak (<0.4). Results: A total of 502 patients found to have complete data sets and > 6 month follow up were evaluated (74% women, mean age 54+/- SD, mean follow-up 14.4 months, range 6-34 months). Pearson correlation evaluation of NPRS and PI revealed a moderate correlation in the pre- and postoperative setting. There was a high moderate negative correlation between PI and PF t-scores pre and postoperatively suggesting more pain and less function. However, the negative correlation between NPRS and PF pre- and postoperatively was weak indicating a poor relationship between NPRS pain assessment and function. There was a moderate correlation between pre- and postoperative scores in all domains of PROMIS while the correlation between pre- and postoperative NPRS scores was weak. Conclusion: In a population of elective surgical foot and ankle patients, the use of both NPRS and PROMIS can be utilized to assess pain level, however the PROMIS PI domain demonstrated a stronger relationship with PROMIS PF than NPRS. Furthermore, only the PROMIS domains demonstrated at least a moderate correlation between pre- and post-operative scores. PROMIS PI provides superior assessment of pre- and post-operative physical function and prediction of post-operative pain. PROMIS PI can be used to gauge a patient’s pre-operative level of pain and function and aid the surgeon in guiding post-operative patient expectations and pain management.

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Long-Term Results of Surgically Treated Radial Polydactyly – An Outcome Correlation Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500322 ◽

2019 ◽

Vol 24 (03) ◽

pp. 264-269

Author(s):

Ching Man Yeung ◽

Alexander Kai Yiu Choi ◽

Jennifer Wing Sze Tong ◽

Winnie Fok ◽

Yat Fai Chan ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Well Being ◽

Structure And Function ◽

Long Term Results ◽

Activity Restriction ◽

Patient Reported ◽

And Function

Background: Thumb polydactyly is one of the commonest congenital hand differences. Traditional surgeon-based outcome scores capture outcomes mainly on bodily structure and function. Outcomes on the long-term well-being of the patients in the domains of activity and participation are not fully studied. Methods: Forty-eight thumbs in forty-five Chinese patients with radial polydactyly underwent surgical treatment at or before 3 years old were recruited. Mean follow-up was 11.6 years. Surgical outcomes were collected and compared to the normal opposite thumb. The results were compiled into the Japanese Society for Surgery of the Hand (JSSH) score, Cheng score and Tada score. Patients’ activity involving hands were assessed by both objective tools and patient-reported outcome measure while their health-related quality of life (HRQoL) was assessed by Patient- and Parent-reported Pediatric Quality of Life Inventory (PedsQL). Correlations between outcomes were analysed. Results: Overall, both parents and patients themselves reported good quality of life with mean score of 86.6% and 92.1% respectively in PedsQL. The combined surgical scores ranged from 52% good or excellent results using JSSH score to 100% good result using Cheng score. None of the outcomes on bodily structure and function showed positive correlation with patient’s well-being. Negative correlation was noted in total passive range of movement, active movement and Cheng score. All patients reported no activity restriction. Writing test did not show significant slowing. The operated hands had significantly poorer fine motor dexterity than normal. No significant correlation is noted between activity outcomes and PedsQL. Conclusions: Outcomes on bodily structure, function and activity showed little correlation with patients’ well-being after thumb polydactyly correction. It should be careful in using or analysing patient/parent-reported outcome measures on HRQoL as outcome assessment of surgical treatment of radial polydactyly.

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Patient reported outcome of 33 operatively treated talar fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04572-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Patrick Pflüger ◽

Michael Zyskowski ◽

Anne Weber ◽

Katharina Gleisenberg ◽

Chlodwig Kirchhoff ◽

...

Keyword(s):

Lower Extremity ◽

Functional Outcome ◽

Avascular Necrosis ◽

Patient Reported Outcome ◽

Timing Of Surgery ◽

Foot And Ankle ◽

Concomitant Injuries ◽

Concomitant Injury ◽

Patient Reported ◽

Talar Fractures

Abstract Background Management of talar fractures remains to be one of the most challenging aspects in trauma surgery. Unfortunately, the evidence regarding the correct treatment of these fractures is mainly based on retrospective case series, while studies assessing the patient-reported outcome are rare. Therefore, the aim of this trial was to analyze the patient reported outcome in context of trauma mechanism and concomitant injuries following operative treatment of talar fractures. Methods A retrospective outcome study of patients with operatively treated talar fractures between 2003 and 2015 was conducted. The fractures were classified according to AO-/Hawkins classification system and to the Marti-Weber classification. Data was collected via patient registry, radiographs and a validated patient-reported outcome measure (PROM) for foot and ankle pathologies (Foot and Ankle Outcome Score = FOAS). An analysis regarding the functional outcome, concomitant injury and timing of surgery using the nonparametric Mann-Whitney U test and Spearman`s rank correlation was performed. Results In total the functional outcome of 32 patients suffering from fractures to the talus were analyzed. The median age of the study cohort was 35±12.2 years, including 9 female (28 %) and 23 male (72 %) patients. The median FAOS score was 72±22.7 (range 13–94). Patients with an isolated talar fracture had an FAOS of 87±20 and with concomitant injury a score of 60±23.4 (p = 0.016). Patients with a closed talar fracture without emergency operation due to dislocation or polytrauma, showed no correlation between timing of surgery and FAOS (r= -0.17, p = 0.43). 10 % of the patients developed an avascular necrosis and 25 % showed signs of a posttraumatic arthritis. The follow-up time was 41 months (range: 16–145). Conclusions Talar fractures were typically caused by high-energy trauma often associated with additional injuries of the lower extremity. The majority of the patients showed a fair to poor functional long-term outcome. Concomitant injuries of the lower extremity led to a lower FAOS. In closed talar fractures without the necessity of an emergency surgical intervention, time to surgery did not influence the patient reported outcome. Relating to the presented data, delayed surgery after soft tissue consolidation was not associated with a higher risk of developing an avascular necrosis.

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Functional improvement in hip pathology improves anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being

10.21203/rs.3.rs-67751/v1 ◽

2020 ◽

Author(s):

Paul Gudmundsson ◽

Paul Nakonezny ◽

Jason Lin ◽

Rebisi Owhonda ◽

Heather Richard ◽

...

Keyword(s):

Psychological Factors ◽

Pain Catastrophizing ◽

Negative Relationship ◽

Depression Scale ◽

Well Being ◽

Functional Improvement ◽

Anxiety And Depression ◽

Patient Reported ◽

Anxiety Depression ◽

The Impact

Abstract BackgroundPain catastrophizing, anxiety, and depression represent risk factors that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment.MethodsPatients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes.ResultsA total of 201 patients (78 male, 123 female) were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = -0.373, p < 0.0001), depression (rs = -0.363, p < 0.0001), and anxiety (rs = -0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes.ConclusionsPatients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Establishing this connection demonstrates the impact that musculoskeletal impairment has on psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care.

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Effectiveness of Global Postural Re-Education in Chronic Non-Specific Low Back Pain: Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10225327 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5327

Author(s):

Gloria Gonzalez-Medina ◽

Veronica Perez-Cabezas ◽

Carmen Ruiz-Molinero ◽

Gema Chamorro-Moriana ◽

Jose Jesus Jimenez-Rejano ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Pain Scale ◽

Low Back ◽

Scientific Databases ◽

Patient Reported ◽

Meta Analyses ◽

And Function

Background: The aim of this systematic review and meta-analysis was to evaluate the global postural re-education (GPR) program’s effectiveness compared to other exercise programs in subjects with persistent chronic low back pain. Methods: A systematic review and meta-analysis were carried out using PRISMA2020. An electronic search of scientific databases was performed from their inception to January 2021. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. Four meta-analyses were performed. The outcomes analyzed were disability due to back pain and pain. The risk of bias and quality of evidence were evaluated. The final search was conducted in March. Results: Seven trials were included, totaling 334 patients. The results showed improvement in pain measured by Visual Analogue Scale (VAS) (Standardised Mean Difference (SMD) = −0.69; 95% Confidence Interval (CI), −1.01 to −0.37; p < 0.0001), Numerical Pain Scale (NRS) (SMD = −0.40; 95% CI, −0.87 to 0.06); p = 0.022), VAS + NRS (SMD = −1.32; 95% CI, −1.87 to −0.77; p < 0.0001) and function (Roland Morris Disability Questionnaire (RMDQ)) (SMD = −0.55; 95% CI, −0.83 to −0.27; p < 0.0001) after GPR treatment. Conclusion: This meta-analysis provides reliable evidence that GPR may be an effective method for treating LBP by decreasing pain and improving function, with strong evidence.

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Patient-Reported Outcomes after Laparoscopic Ventral Hernia Repair

The American Surgeon ◽

10.1177/000313481608200618 ◽

2016 ◽

Vol 82 (6) ◽

pp. 550-556 ◽

Cited By ~ 3

Author(s):

Johnathon M. Aho ◽

Ahmad Nourallah ◽

Mario J. Samaha ◽

Ryan M. Antiel ◽

Sean C. Dupont ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Patient Reported Outcomes ◽

Ventral Hernia Repair ◽

Well Being ◽

Pain Scale ◽

Analog Scale ◽

Self Assessment ◽

Patient Reported ◽

Over Time

Approximately 350,000 ventral hernia repairs are performed in the United States each year. Patients expect fast recovery after laparoscopic ventral hernia repair (LVHR) and undisturbed postoperative quality of life (QOL). We examined the utility of a brief, validated 10-point Linear Analog Self-Assessment coupled with the Visual Analog Scale pain scale to discern risk factors for decreased postoperative QOL. Between January 2011 and May 2013, we prospectively assessed patient-reported outcomes for patients who underwent LVHR. Visual Analog Scale pain scale and Linear Analog Self-Assessment items were recorded preoperatively and postoperatively at four hours, one day, and seven days. Eighteen patients were included, 11 were female (61%) and 8 > 60 years old (44%). Patient-reported fatigue increased clinically and statistically from baseline over time ( P = 0.007) as did pain ( P < 0.001). There was a statistically significant difference in QOL scores over time by gender with women reporting worse scores than men ( P = 0.001). In conclusion, our study detected significant changes from baseline in both fatigue and pain over the seven days after LVHR. Age is associated with postoperative differences in physical well-being. Gender is associated with differences in postoperative course in QOL and physical well-being.

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Patients' perceptions and patient-reported outcomes in progressive-fibrosing interstitial lung diseases

European Respiratory Review ◽

10.1183/16000617.0075-2018 ◽

2018 ◽

Vol 27 (150) ◽

pp. 180075 ◽

Cited By ~ 12

Author(s):

Jeffrey J. Swigris ◽

Kevin K. Brown ◽

Rayid Abdulqawi ◽

Ketan Buch ◽

Daniel F. Dilling ◽

...

Keyword(s):

Treatment Options ◽

Well Being ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Interstitial Lung Diseases ◽

Therapeutic Interventions ◽

Patient Reported ◽

Significant Burden ◽

And Function ◽

The Impact

The effects of interstitial lung disease (ILD) create a significant burden on patients, unsettling almost every domain of their lives, disrupting their physical and emotional well-being and impairing their quality of life (QoL). Because many ILDs are incurable, and there are limited reliably-effective, life-prolonging treatment options available, the focus of many therapeutic interventions has been on improving or maintaining how patients with ILD feel and function, and by extension, their QoL. Such patient-centred outcomes are best assessed by patients themselves through tools that capture their perceptions, which inherently incorporate their values and judgements. These patient-reported outcome measures (PROs) can be used to assess an array of constructs affected by a disease or the interventions implemented to treat it. Here, we review the impact of ILD that may present with a progressive-fibrosing phenotype on patients' lives and examine how PROs have been used to measure that impact and the effectiveness of therapeutic interventions.

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Functional Outcomes of 24-Hour Thumb Immobilization in Healthy Volunteers: Prospective Comparative Study

Journal of Wrist Surgery ◽

10.1055/s-0037-1598025 ◽

2017 ◽

Vol 06 (03) ◽

pp. 201-205

Author(s):

Raghuveer Muppavarapu ◽

Lyubov Tsytsikova ◽

Poonam Dalwadi ◽

Charles Cassidy ◽

Michael Gottschalk

Keyword(s):

Comparative Study ◽

Healthy Volunteers ◽

Functional Outcome ◽

Measurement Information ◽

Dominant Hand ◽

Significant Difference ◽

Patient Reported ◽

Prospective Comparative Study ◽

Group 2 ◽

Group 1

Background Immobilization is often needed for the treatment of wrist and hand injuries. The current best method of immobilization for several types of injuries has yet to be elucidated with little being reported on the functional differences of each type of immobilization. Purpose The purpose of this study is to compare the functional outcome between healthy young volunteers with a 24-hour short arm cast (SAC) versus thumb spica cast (TSC) immobilization. Methods A total of 50 healthy volunteers completed a baseline typing assessment and a Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity functional scoring assessment. Participants in group 1 were randomly initially assigned to a TSC of their dominant hand followed by an SAC, whereas participants in group 2 were randomly initially assigned to a TSC of their nondominant hand followed by an SAC. The volunteers completed the typing assessment and PROMIS assessment at the end of the 24-hour casting period. Results A total of 50 participants were enrolled in the study with 25 in group 1 and 25 in group 2. There was a 24.3-point difference between the average PROMIS score for participants with SAC compared with participants with TSC (93 vs. 68.7; p = 0.0001). There was a significant difference between the typing speed and accuracy of participants with SAC compared with participants with TSC (p = 0.0001). Conclusion There is a significant difference in functionality of a TSC immobilization versus an SAC immobilization according to the PROMIS functional outcome score and typing speed in a 24-hour casting period. SAC immobilization should be considered to have a possible similar effect in pathologic conditions instead of TSC immobilization given these findings even though a 24-hour period is not enough to provide adequate long-term conclusions. Level of Evidence I, prospective comparative study.

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