scholarly journals Predictors of Short-Term Outcome to Exercise and Manual Therapy for People With Hip Osteoarthritis

2014 ◽  
Vol 94 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Helen P. French ◽  
Rose Galvin ◽  
Tara Cusack ◽  
Geraldine M. McCarthy
Keyword(s):  
Physical Therapy ◽  
Treatment Response ◽  
Manual Therapy ◽  
Hip Osteoarthritis ◽  
Predictor Variables ◽  
Likelihood Ratios ◽  
Short Term ◽  
Discriminative Ability ◽  
Predictors Of Response

Background Physical therapy for hip osteoarthritis (OA) has shown short-term effects but limited long-term benefit. There has been limited research, with inconsistent results, in identifying prognostic factors associated with a positive response to physical therapy. Objectives The purpose of this study was to identify potential predictors of response to physical therapy (exercise therapy [ET] with or without adjunctive manual therapy [MT]) for hip OA based on baseline patient-specific and clinical characteristics. Design A prognostic study was conducted. Methods Secondary analysis of data from a multicenter randomized controlled trial (RCT) (N=131) that evaluated the effectiveness of ET and ET+MT for hip OA was undertaken. Treatment response was defined using OMERACT/OARSI responder criteria. Ten baseline measures were used as predictor variables. Regression analyses were undertaken to identify predictors of outcome. Discriminative ability (sensitivity, specificity, and likelihood ratios) of significant variables was calculated. Results The RCT results showed no significant difference in most outcomes between ET and ET+MT at 9 and 18 weeks posttreatment. Forty-six patients were classified as responders at 9 weeks, and 36 patients were classified as responders at 18 weeks. Four baseline variables were predictive of a positive outcome at 9 weeks: male sex, pain with activity (<6/10), Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale score (<34/68), and psychological health (Hospital Anxiety and Depression Scale score <9/42). No predictor variables were identified at the 18-week follow-up. Prognostic accuracy was fair for all 4 variables (sensitivity=0.5–0.58, specificity=0.57–0.72, likelihood ratios=1.25–1.77), indicating fair discriminative ability at predicting treatment response. Limitations The short-term follow-up limits the interpretation of results, and the low number of identified responders may have resulted in possible overfitting of the predictor model. Conclusions The authors were unable to identify baseline variables in patients with hip OA that indicate those most likely to respond to treatment due to low discriminative ability. Further validation studies are needed to definitively define the best predictors of response to physical therapy in people with hip OA.

scholarly journals The Necessity of Chest Physical Therapy for Thoracoscopic Oesophagectomy

2005 ◽  
Vol 33 (4) ◽  
pp. 434-442 ◽  
Author(s):  
T Nakatsuchi ◽  
M Otani ◽  
H Osugi ◽  
Y Ito ◽  
T Koike
Keyword(s):  
Physical Therapy ◽  
Respiratory Function ◽  
Radical Surgery ◽  
Thoracoscopic Surgery ◽  
Respiratory Complications ◽  
Short Term ◽  
Less Invasive ◽  
Before And After ◽  
Chest Physical Therapy

Radical surgery for thoracic oesophageal cancer is highly invasive and often leads to respiratory complications; thoracoscopic surgery is a less-invasive alternative. We examined the need for chest physical therapy (CPT) after thoracoscopic oesophagectomy. Thirty-six consecutive patients, randomly selected for either thoracotomy or thoracoscopic surgery, were included in a randomized clinical trial and received CPT under the same protocol. During short-term post-operative follow-up, both groups showed a marked reduction in respiratory function and responded to CPT to the same extent, although 2 weeks after surgery some parameters of respiratory function were significantly higher in the thoracoscopy group. Thoracoscopic surgery has been reported to be less invasive than standard thoracotomy, but our results suggest that the procedure is also invasive with respect to respiratory function and that CPT should be performed before and after thoracoscopic surgery.

scholarly journals Timing of Supervised Physical Therapy after Hindfoot Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Stephanie Albin ◽  
Drew Van Boerum ◽  
James Morgan ◽  
Shane Koppenhaver
Keyword(s):  
Physical Therapy ◽  
Clinical Outcomes ◽  
Manual Therapy ◽  
Foot And Ankle ◽  
Therapeutic Exercise ◽  
Therapy Program ◽  
Surgical Fixation ◽  
Physical Therapy Program

Category: Ankle, Hindfoot Introduction/Purpose: Fractures to the hindfoot, including the talus and calcaneus, have devastating long-term functional outcomes. To date, no randomized trials have been done assessing the best time to initiate physical therapy after surgical fixation of these fractures. The purpose of this study is to assess whether initiating a supervised physical therapy program including therapeutic exercise and manual therapy two weeks post-operatively (EARLY) versus seven weeks post-operatively (LATE) in patients following surgical fixation for these fractures results in differences in clinical outcomes. The secondary purpose of this study is to assess what factors predict outcomes after these hindfoot fractures. Methods: Fifty patients between the ages of 18-70 years having undergone an open reduction internal fixation (ORIF) of the calcaneus or talus were recruited to participate from two foot and ankle fellowship-trained orthopedic surgeons. Subjects were randomly assigned to initiate formal physical therapy starting within 2 weeks post-operatively (EARLY) (n=26) or 8 weeks post-operatively (LATE) (n=24). Treatment for both groups consisted of impairment based manual therapy and therapeutic exercise. The lower extremity functional scale (LEFS), the American Orthopeadic Foot and Ankle Society (AOFAS) hindfoot scale, range of motion (ROM), pain and girth measurements to assess swelling were the outcome measures for this study. Subjects in both groups were seen for a total of 10 visits. All subjects underwent follow-up assessments at 3 months, 6 months, and 12 months post-operatively. Between-group differences were analyzed using ANCOVAs with baseline scores as covariates. Regression was used to assess factors predicting patients’ self-reported outcomes. Results: Results demonstrated no significant differences between the groups at any time point (3, 6 or 12 months) for the LEFS (p=0.637) or the AOFAS (p=0.634). No significant differences existed between the two groups for active ROM (p=0.106) or swelling (p=0.389). Subjects in both groups demonstrated improved AOFAS scores from baseline to one year follow-up by 26 points (p=0.00); however, most of the change occurred within the first 6 months post-operatively with only a 1.722 (95% CI -3.63 to 7.08) change between 6 to 12 month follow-up visits. Baseline anxiety (as measured by the Beck Anxiety Questionnaire) significantly predicted LEFS scores at both the 6 month and 12 month follow-up periods (r= -0.55, p=0.0015 and r= -0.53, p=0.007). Conclusion: This study did not demonstrate that initiating early supervised physical therapy (within 2 weeks after surgical fixation) improves self-reported outcomes for patients after surgical fixation of a hindfoot fracture as assessed by the LEFS, the AOFAS hindfoot scores, or clinical outcomes such as ROM or swelling compared to patients initiating a formal physical therapy program seven weeks after surgery. Although, many these patients typically have less than ideal clinical outcomes, it is possible that addressing other factors such as anxiety may help improve long-term outcomes.

The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis

2016 ◽  
Vol 30 (12) ◽  
pp. 1141-1155 ◽  
Author(s):  
Kesava Kovanur Sampath ◽  
Ramakrishnan Mani ◽  
Takayuki Miyamori ◽  
Steve Tumilty
Keyword(s):  
Quality Of Life ◽  
Physical Function ◽  
Manual Therapy ◽  
Exercise Therapy ◽  
Meta Analysis ◽  
Hip Osteoarthritis ◽  
Post Treatment ◽  
Quality Evidence

Objective: To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life. Methods: Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest. Results: Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life. Conclusion: An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate.

scholarly journals Short-Term Outcomes of Treatment of Hip Osteoarthritis With 4 Bone Marrow Concentrate Injections: A Case Series

2018 ◽  
Vol 11 ◽  
pp. 117954761879157 ◽  
Author(s):  
Marc Darrow ◽  
Brent Shaw ◽  
Brittany Darrow ◽  
Stevie Wisz
Keyword(s):  
Bone Marrow ◽  
Total Joint Replacement ◽  
Case Series ◽  
Hip Osteoarthritis ◽  
Daily Activities ◽  
Limited Evidence ◽  
Short Term ◽  
Bone Marrow Concentrate

The use of mesenchymal stem cells from bone marrow concentrate (BMC) has become an increasingly popular option as an alternative to total joint replacement. Although there is evidence to support the use of BMC injections to improve quality of life for patients with knee osteoarthritis (OA), there is limited evidence to support its use in patients with hip OA. This case series provides the short-term outcomes of 4 hip OA patients who each underwent 4 BMC injections. On average, the last follow-up was administered 3.5 months after the first injection. The results show that patients experienced decreased resting and active pain compared with baseline and mean 72.4% total overall improvement. Patients also reported less difficulty in performing daily activities following the procedure. These encouraging results warrant further research to better understand the effects of BMC injections on hip OA.

scholarly journals Physical Therapy for the Horizontal Semicircular Cupulolithiasis: A Prospective Interventional Case Series from an Otoneurology Center in South Rajasthan, India

2021 ◽  
Author(s):  
Ajay Kumar Vats ◽  
Jugal Kishor Sharma ◽  
G. D. Ramchandani
Keyword(s):  
Physical Therapy ◽  
Treatment Options ◽  
Case Series ◽  
Positional Nystagmus ◽  
Interventional Study ◽  
Short Term ◽  
Physical Therapies ◽  
Established Treatment

Abstract Objective This article aims to study the effect of physical therapy in patients of horizontal semicircular cupulolithiasis with results audited in the short term. Design Nonrandomized prospective interventional study. Study Sample Four patients with horizontal semicircular cupulolithiasis. Results All four patients in whom diagnostic supine roll test (carried at least thrice to look for the sustainability as well as the polarity of the nystagmus) elicited apogeotropic horizontal positional nystagmus lasting more than 1 minute were subjected to therapeutic head-shaking maneuver (HSM). The results were audited immediately after the physical therapy, and at 1 hour. Follow-up by telephonic interviews for 4 weeks was done in all patients. Three out of four patients responded to HSM alone. One patient who did not respond to HSM was successfully treated with four other sequent physical therapies. Conclusion The response of physical therapy for horizontal semicircular cupulolithiasis occasionally indicates the side of the cupula to which otoconial debris is adherent (Cup-U or Cup-C). Occasionally, Cup-C variant of horizontal semicircular cupulolithiasis can be transformed by physical therapy to long posterior arm horizontal semicircular canalolithiasis—a disorder with better established treatment options.

Predictor Variables for Identifying Patients with Chronic Tension-Type Headache Who are Likely to Achieve Short-Term Success with Muscle Trigger Point Therapy

Cephalalgia ◽  
2008 ◽  
Vol 28 (3) ◽  
pp. 264-275 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
JA Cleland ◽  
ML Cuadrado ◽  
JA Pareja
Keyword(s):  
Trigger Point ◽  
Bodily Pain ◽  
Tension Type Headache ◽  
Predictor Variables ◽  
Successful Outcome ◽  
Headache Frequency ◽  
Short Term ◽  
Probability Of Success ◽  
Type Headache

To date, no studies have investigated the predictive validity of variables from the initial examination to identify patients with tension-type headache pain who are likely to benefit from muscle trigger point (TrP) therapy. The purpose of this study was to develop a preliminary clinical prediction rule (CPR) to identify chronic tension-type headache (CTTH) patients who are likely to experience a successful response from TrP therapy. Consecutive patients with CTTH underwent a standardized examination and then received six sessions of TrP therapy over 3 weeks (two sessions per week). They were classified as having experienced a successful outcome at short-term (1 week after discharge) and 1-month follow-up based on a 50% reduction on at least one headache parameter (intensity, frequency or duration) and self-report perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for identifying treatment success. Data from 35 patients were included, of which 19 (55%) experienced a successful outcome. A CPR with four variables for short-term (headache duration < 8.5 h/ day, headache frequency < 5.5 days/week, bodily pain < 47 and vitality < 47.5) and a CPR with two variables for 1-month (headache frequency < 5.5 days/week and bodily pain < 47) follow-up were identified. At short-term follow-up, if three of four variables [positive likelihood ratio (LR) 3.4] were present, the chance of experiencing a successful outcome improved from 54% to 80%, and if all the variables (positive LR 5.9) were present, the probability of success was 87.4%. At 1-month follow-up, if one of two variables (positive LR 2.2) was present, the probability of success increased from 54% to 72%, and if both variables (positive LR 4.6) were present, the probability of success was 84.4%. The present CPR provides the potential to identify CTTH patients who are likely to experience short-term and 1-month follow-up success with a muscle TrP therapy approach. Future studies are necessary to validate the CPR.

scholarly journals Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110375
Author(s):  
Opeyemi O. Babatunde ◽  
Joie Ensor ◽  
Chris Littlewood ◽  
Linda Chesterton ◽  
Joanne L. Jordan ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Manual Therapy ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Treatment Options ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Short Term ◽  
And Function

Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others.

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