Effect of multidirectional and unidirectional wobble board lateral step-upexercise in pain, symptom and ADLamong unilateral medial compartmental osteoarthrosis of knee

Introduction and Aim:Osteoarthrosis is defined as degenerative condition of the synovial joints. Weak thigh muscle will cause impaired walking and balance and leads to risk of fall during activities of daily living. Use of MD and UD wobble board is hypothesized to improve balance and proprioception. So, pain, muscle power and proprioception are clinically important for balance control. Hence there is a need to study weight bearing exercise to hip abductor in various balance strategies to achieve muscle strength, joint position sense, balance, and activity of daily living. Methodology: Knee osteoarthrosis subjects(n=219) were selected according to selection criteria andwere randomly allocated into 3 groups as multidirectional wobble board lateral step-up exercise group, unidirectional wobble board lateral step-up exercise group and control group. The pre-test KOOS pain, symptoms and ADL measurements were taken before the intervention and another measurement during the 2nd week of intervention and at the end of the intervention period during 4thweek post-test measurements were measured and statistically analysed. Results: At the end of 4th week control, UD and MD was found to be statistically significant with H=200.192 with p<0.001. KOOS symptoms between 3 groups was found to be statistically significant with H=200.288 and p <0.001. KOOS ADL values was found to be statistically significant between 3 groups with H=193.640 and p<0.001. Conclusion: This study concludes that both unidirectional and multidirectional wobble board lateral step-up exercise showed improvement with KOOS pain, symptom and ADL scores compared to control group.

Methadone and neuropathic cancer pain subcomponents: a prospective cohort pilot study

Forty per cent of cancer pain associate neuropathic and nociceptive pain simultaneously, and refractory pain affects 15% of cancer pain. Methadone is an effective opioid in treating nociceptive pain and could have an effect on neuropathic pain. Uncertainty remains on its effects on the different subcomponents of neuropathic pain.ObjectivesTo identify which subcomponents of neuropathic cancer pain are addressed using methadone.MethodsAn observational prospective cohort study of palliative care inpatients after rotation for refractory neuropathic cancer pain. Pain intensity was assessed weekly for 28 days, using a Visual Analogue Scale (VAS) and the Neuropathic Pain Symptom Inventory (NPSI).ResultsForty-eight patients were included and 17 completed the 28 days follow-up. VAS pain rating decreased by at least 20 mm in 47% of patients and the pain intensity was significantly lower at day 28 with 53% of patients with a VAS inferior to 4 (p<0.001). The pressure/squeezing component (NPSI score) decreased by more than 2 points in 50% of patients.A linear regression showed allodynia and pressure/squeezing were responsible for the largest part of the overall alleviation of pain (p=0.01).ConclusionsMethadone could significantly improve neuropathic pain through a targeted effect of allodynia and its pressure/squeezing component.

O-168 Chronic pelvic pain is the most troublesome endometriosis pain symptom for women’s quality of life

Study question Which pre-operative endometriosis pain symptom is most troublesome for the quality-of-life of women assessed at different meta-levels? Summary answer Of five pain symptoms chronic pelvic pain is most troublesome or has the strongest correlation to women’s overall quality-of-life and overall and endometriosis-specific health status. What is known already Endometriosis affects women’s quality of life negatively, and its impact seems to depend more on women’s symptoms than on their degree of endometriosis. Experts proposed to include ‘the most troublesome symptom’ and ‘overall pain’ as core outcomes but did not define how to assess these outcomes. It would be interesting to find out which pain symptom (i.e. assessed for presence and intensity) has most impact on women’s quality-of-life assessed at different meta-levels, including: overall quality-of-life (depending on amongst others one’s professional and relational life besides health), general health status and endometriosis-specific health status. Study design, size, duration A prospective survey addressed 277 adult women scheduled for diagnostic and/or therapeutic surgery in a University endometriosis clinic between October 2016 and November 2019. Women were reminded twice of our request to fill out the coded but anonymous questionnaire package assessing five pain symptoms (i.e. chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria and dyschezia) and assessing quality-of-life at three different meta-levels. Participants/materials, setting, methods Women scored five endometriosis symptoms between 0 (no pain) and 10 (worst imaginable pain), combined into ‘overall pain’ (0-50). ‘Overall quality-of-life’ was assessed with the Linear Analogue Scale (LAS; the higher, the better). General and endometriosis-specific health status were assessed with the overall scores of the EuroQol-5D and the Endometriosis-Health-Profile-30 (the higher, the better). Pearson correlation coefficients between the six pain scores and three measures of quality-of-life were computed (p = 0.003; 0.05/18 as Bonferroni correction). Main results and the role of chance A total of 227 women took part (participation rate=82%) and the data of 202 women (mean age 31±5 years old) with surgically confirmed endometriosis were analysed. In the previous six months, the majority of women reported chronic pelvic pain (56%), dyspareunia (55%), dysmenorrhea (56%) and/or dyschezia (58.4%), while only some reported dysuria (25%). Women’s mean overall pain score was 20 (±12). Women’s mean overall quality-of-life was 65 (±16). On average women rated their general health status to be 62 (±18) and their mean endometriosis-specific health status was 53 (±18). Only the pain symptom chronic pelvic pain was correlated (p &lt; 0.001) to assessments of quality-of-Life at all three meta-levels. The correlation for endometriosis-specific health status was large (r= -0.574), while the others were medium (r= -0.343 & r= -0.324). After taking account of the Bonferroni correction for multiple testing the remaining four pain symptoms only had a medium correlation (p &lt; 0.001) to endometriosis-specific health status (r= -0.356 – -0.265; p &lt; 0.001) and they were not correlated to overall quality-of-Life or general health status. Overall pain had a medium correlation (p &lt; 0.001) to Overall quality-of-Life (r= -0.270) and general health status (r= -0.259) and a strong correlation (p &lt; 0.001) to endometriosis-specific health status (r= -0.529). Limitations, reasons for caution The majority of patients (60%) of the recruiting University endometriosis clinic had severe endometriosis (AFS-IV) and this study could be repeated in another setting. Directly asking women which pain symptom is most troublesome to them would be interesting besides exploring correlations between pain symptoms and quality of life. Wider implications of the findings Nurses, midwives and other health care professionals should devote attention to chronic pelvic pain during the anamnesis and women-centred care as this pain symptom is most troublesome for women’s quality of life. Whether surgery decreases chronic pelvic pain and overall pain is currently followed-up in the studied prospective cohort. Trial registration number Not applicable

NURSING CARE FOR ACUTE PAIN RELATED TO GASTRITIS AT ANGGREK ROOM RSI NASHRUL UMMAH LAMONGAN

Introduction: Gastritis is a problem that many people experience and can occur at various ages. The most common symptom for gastritis sufferers is acute pain. However, acute pain nursing care in gastritis patients is different. This study is to explain Acute Pain Nursing Care for Gastritis Clients at Anggrek Room RSI Nashrul Ummah Lamongan. Methods: This study used case study design. Sampling of this study was one child suffering from gastritis with acute pain symptom. Data of this study were collected by interview, observation, physical examination and documentation. The data that obtained were analyzed with descriptive methods, diagnosis and evaluation. Results: The results showed that there were several gaps between case and theories for the assessment stage. A gap occurs in the assessment of the physical examination of the nasal passages which reveals the presence of nasal lobe breathing while holding pain. The priority of nursing diagnosis was acute pain and the focus of interventions was on pain management. Conclusion: Providing implementation of non-pharmacological techniques (distraction and relaxation techniques) and pharmacological (collaboration providing analgesics), environmental management, touch management, providing knowledge of the causes of pain and efforts to reduce pain, and observation of conditions that are effective in reducing pain in patients

Outcomes of Combined Unicondylar Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction

Young and more active patients with medial compartmental osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency are challenging for orthopaedic surgeons. The aim of the present study was to examine the early–mid clinical and radiological outcomes of combined Oxford unicondylar knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and concomitant medial compartment symptomatic OA. Twelve patients were included in the study. All patients were treated by combination of ACL reconstruction with medial UKA. The varus–valgus angles of the tibial and femoral components, and pathological radiolucent lines were measured on anteroposterior and lateral knee radiographs. Clinical evaluations include knee osteoarthritis outcome score (KOOS pain, symptom, daily life, sports, and quality of life), Oxford knee score (OKS), EQ-5D-3L, and EQ-visual analog scale (VAS). All the patients were followed up for an average of 45.6 months. The leg alignment showed 3.6 degrees ± 1 of varus deformity before surgery and 2.6 degrees ± 1 of valgus after surgery. With the exception of KOOS sports (p > 0.001), the KOOS pain, symptom, daily life, and quality of life, OKS, EQ-5D-3L, and EQ-VAS improved significantly after surgery (p < 0.001). Preoperative knee instability showed anterior translation of 5 to 10 mm in eight patients and >10 mm in four patients. There were no complications at follow-up. The early–mid clinical data have shown that UKA in conjunction with ACL reconstruction has revealed promising results. However, long-term follow-up studies are required to confirm the combined procedure in these patients.