The study aimed to compare ultrasound-guided brachial plexus block (BPB) with local anesthesia (LA) on efficacy, safety and 12-month patency rate for percutaneous transluminal angioplasty (PTA) treatment of dysfunctional arteriovenous fistula (AVF).

Consecutive patients with dysfunctional AVF who underwent PTA from January 2021 to December 2022 were included. Overlap weighting was performed to adjust for significant differences between the two groups. The primary efficacy outcomes included visual analogue scale (VAS) score and 12-month target-lesion primary patency rate. The secondary efficacy outcomes included target-lesion primary-assisted patency rate, secondary patency rate, access-circuit thrombosis rate, access-circuit reintervention rate, and number of reinterventions within 12 months. Univariate analysis and multivariate analysis by log-binomial regression were used to identify the independent factors associated with intraoperative pain.

218 patients were included in the study: 82 patients underwent PTA under BPB and 136 patients underwent PTA under LA. After overlap weighting, the baseline, lesion characteristics and intraoperative details had no significant difference between the two groups. Patients under BPB had significantly lower VAS scores than those under LA (2.4 ± 1.4 vs 5.1 ± 1.9, p < 0.001). The 12-month target-lesion primary patency rate was significantly higher in the BPB group than that in the LA group (58.3% vs 40.0%, p = 0.037). The 12-month target-lesion primary-assisted patency rate and access-circuit secondary patency rate were significantly higher in the BPB group than those in the LA group (p = 0.023 and p = 0.028). The access-circuit thrombosis rate was significantly lower in the BPB group (10.0%) than that in the LA group (28.3%) (p = 0.011). BPB was the only independent factor associated with mild pain (p < 0.001, OR: 0.037, 95%CI: 0.011-0.119).

BPB could decrease the intraoperative pain and improve the 12-month primary patency rates compared with LA for patients underwent PTA treatment of dysfunctional AVF.

This study aimed to compare the prevalence of chronic pain using various definitions from previous studies and to determine the optimal definition for detecting chronic pain associated with physical and emotional dysfunction in a general Japanese population.

A total of 2700 community-dwelling Japanese residents aged ≥40 years were assessed for chronic pain and its components of duration, frequency, and intensity. The activities of daily living (ADL) disability and depressive symptoms of participants were also evaluated using the modified Lankin Scale and Patient Health Questionnaire-9. The odds ratios and the population attributable fractions (PAFs) for ADL disability and depressive symptoms were estimated using a logistic regression model.

The prevalence of chronic pain varied greatly by definition, ranging from 13% for pain defined as pain duration ≥3 months, pain frequency ≥ twice a week, and pain intensity of ≥50 mm by a visual analogue scale (VAS) to 48% for a simple definition of pain duration ≥3 months. The PAFs for ADL disability and depressive symptoms were relatively high at 33% in participants with pain duration of ≥6 months and 30% in those with pain frequency of ≥twice a week, while the VAS ≥50 mm group had a low PAF of 12%.

For screening people with chronic pain and ADL disability or depressive symptoms, the criteria of pain duration and pain frequency yielded essentially identical results, while the criterion of pain intensity risked overlooking individuals with chronic pain and these associated symptoms.

Pain is a common medical experience, and patient access to pain management could be improved with novel intervention formats. Emerging evidence indicates brief, asynchronous, single-session interventions delivered in the clinic waiting room can improve patient outcomes, but only a few treatment modalities have been investigated to date. Breathwork is a promising approach to managing acute clinical pain that could be delivered asynchronously in the clinic waiting room. However, the direct impact of a breathwork intervention (e.g., brief cyclic sighing) on patients' pain and psychological distress (e.g., anxiety and depression symptoms) while waiting in the clinic waiting room remains unexamined. This single-site, pilot, randomized controlled trial examined the impact of a 4-minute, asynchronous, cyclic sighing intervention on participants' acute clinical symptoms in the x-ray waiting room of a walk-in orthopedic clinic relative to a time- and attention-matched injury management control condition. Pain unpleasantness, pain intensity, anxiety symptoms, and depression symptoms were measured in the study. Participants receiving the cyclic sighing intervention reported significantly less pain unpleasantness and pain intensity while waiting for an x-ray relative to controls. Anxiety symptoms and depression symptoms were not found to differ by condition. Results from this RCT indicate a brief, asynchronous, cyclic sighing intervention may be capable of quickly decreasing pain in the waiting room. Continued investigation is now needed to determine if embedding brief, asynchronous, cyclic sighing interventions in clinic waiting rooms has the potential to help people experiencing acute pain feel better faster. CLINICAL TRIAL REGISTRATIONS: NCT06292793.

Somatic comorbidity is the main cause of reduced life expectancy in patients with substance use disorders (SUDs).

This study aims to investigate somatic health challenges in patients with SUDs using the USS. Patient self-management of somatic health and quality of life were also assessed.

In our study, a stratified random sample of 136 clients who received treatment at a specialist addiction facility was drawn to investigate their physical health and lifestyle behaviours using the Utrecht Somatic Screening 2.0 (USS 2.0). The sample included three subgroups, that is, patients receiving outpatient treatment through Flexible Assertive Community Treatment (FACT), Heroin-Assisted Treatment (HAT) and Opioid Replacement Therapy (ORT). Pain, self-management and quality of life were also measured. Descriptive statistics were used to analyse the data.

The findings indicate that many patients experience a large number of somatic health problems, including pain and exhaustion. The most prevalent conditions in this study are cardiovascular disease (25%) and COPD (20%), underweight and poor oral health. Tobacco smoking is prevalent among 88% of patients. Fifty percent of the patients expressed a need for support in managing their physical health.

Somatic health care and lifestyle promotion should be tailored to the specific characteristics of patients.

Patients with SUDs suffer from poor physical health and show unhealthy lifestyle behaviours, which demand the promotion of tailored somatic health.

This study determines video's effect on pregnant women's pain, anxiety, and perception of labor using virtual reality glasses during the active and transition phases of childbirth. This randomized controlled study was conducted with 60 pregnant women (30 in each group) admitted to the delivery room of a hospital. The data were collected by personal information form, visual comparison scale-pain, visual comparison scale-anxiety, and perception of birth scale. While there was no significant difference between the groups in terms of pre-intervention pain measurement in the active and transition phases, post-intervention pain measurement in the active and transition phases in the intervention group was found to be significantly lower than the control group. Anxiety measurement was also found to be significantly lower in the intervention group in the active and transition phases than in the control group after the intervention. It was determined that in the intervention group, anxiety measurements tended to decrease after the intervention compared to the pre-intervention period, while in the control group, anxiety measurements tended to increase continuously in the active and transition phases. Perceptions of birth in the postpartum period were similar. The use of virtual reality during childbirth reduces pain and anxiety at birth but does not affect the perception of birth. The use of virtual reality interventions as a nonpharmacological method can be included in childbirth preparation training. Trial Registration: NCT05495009.

Knee osteoarthritis (KOA) is associated with early muscular alterations and muscle weakness, which contribute to disease progression. However, limited knowledge exists regarding the potential exacerbation of lower extremity muscle architecture and its impact on functional performance. This study aimed to investigate the relationship between knee extensor and ankle plantar flexor muscle architecture, femoral cartilage thickness, age, body mass index (BMI), pain severity, and functional performance in middle-aged women with KOA.

A total of 87 patients diagnosed with KOA (mean age = 51.48 ± 4.89 years, mean BMI = 27.96 ± 4.66 kg/m2) were included in the study. Ultrasonography was used to assess muscle thickness, adipose tissue thickness, pennation angle, and the muscle/adipose tissue thickness ratio (MATR) of the Rectus Femoris (RF), Vastus Medialis (VM), Vastus Lateralis (VL), and Medial Gastrocnemius (MG) muscles. Physical performance was evaluated through the stair-climbing test and the 10-time sit to stand test. Pearson's correlation test and multiple linear regression analysis were used.

The pennation angle of the VL and pain level predicted sit to stand test results; the pennation angle of RF, age, BMI and pain level predicted stair-climbing test results (p < 0.001). Femoral cartilage thickness at the medial condyle, intercondylar area, and lateral condyle correlated with performance in both tests (p < 0.001). Additionally, age, BMI, pain intensity, muscle thickness, pennation angle and MATR of RF, VL, and VM correlated with both functional tests (p < 0.05).

Muscle architecture alterations correlated with functional test results in patients with KOA. Understanding the influence of muscle architecture on functional parameters can facilitate the development of effective rehabilitation strategies to preserve and optimize patient function before it becomes compromised.

Enrolled in clinical trials and awaiting approval.

Knee osteoarthritis (OA) is a common chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing OA pain and functional limitations, these strategies are often underused. To motivate and enhance patient engagement, personalized outcome prediction models can be used. However, the accuracy of existing models in predicting changes in knee pain outcomes remains insufficiently examined.

This study aims to validate existing models and introduce a concise personalized model predicting changes in knee pain from before to after participating in a supervised patient education and exercise therapy program (GLA:D) among patients with knee OA.

Our prediction models leverage self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those using average values. In supplementary analyses, we additionally considered recently added variables to the GLA:D registry.

We evaluated the performance of a full, continuous, and concise model including all 34 variables, all 11 continuous variables, and the 6 most predictive variables, respectively. All three models performed similarly and were comparable to the existing model, with R2 values of 0.31-0.32 and root-mean-squared errors of 18.65-18.85-despite our increased sample size. Allowing a deviation of 15 (visual analog scale) points from the true change in pain, our concise model correctly estimated the change in pain in 58% of cases, while using average values that resulted in 51% accuracy. Our supplementary analysis led to similar outcomes.

Our concise personalized prediction model provides more often accurate predictions for changes in knee pain after the GLA:D program than using average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. Based on current knowledge and available data, no better predictions are possible. Guidance is needed on when a model's performance is good enough for clinical practice use.

BackgroundPregnancy-related carpal tunnel syndrome (PRCTS) is the most common mononeuropathy during pregnancy.Objectiveto compare the efficacy of ultrasound (US)-guided steroid injection alone versus wiht splinting on symptom severity on PRCTS.MethodsThis retrospective cohort study included 37 pregnant women in their third trimester with PRCTS, treated with ultrasound-guided steroid injection of 4 mg dexamethasone into the median nerve (Group I, n = 15), volar splinting in a neutral position while sleeping and during the day whenever possible for at least ten weeks (Group S, n = 12), or both injection and splinting (Group I + S, n = 10). Patient data were collected from hospital records, and symptoms were assessed using the Boston Carpal Tunnel Symptom Questionnaire (BCTQ), the Douleur Neuropathique 4 (DN4) and the Numeric Rating Scale (NRS). Statistical analyses included Student's t-test, Mann-Whitney U test, Fisher's exact test, ANOVA, Kruskal-Wallis test, descriptive analyses, and power analyses.ResultsDuring the first month of intervention, group S had higher BCTQ scores than the other two groups (p < 0.001). In the postpartum period, the order of scores was Group S > Group I > Group I + S (p < 0.001). The effect size was significant with Partial eta squared = 0.369.ConclusionThe combination of splinting and injection seems to be more effective in the short term period. But still, to validate our findings, Additional randomized controlled trials are recommended.

Loss of upper extremity (UE) function impacts almost every aspect of daily life and upper limb recovery is reported to be a major priority of individuals living with tetraplegia. Surgical peripheral nerve transfer (PNT) offers the potential to restore volitional control of elbow, wrist and hand function of individuals with C5-C8 tetraplegia AIS A-C. Unfortunately, while there is growing evidence supporting the role of PNT in spinal cord injury (SCI) rehabilitation, there are currently no internationally-recognized consensus-derived best practices for provision of PNT following spinal cord injury (SCI) and few programs have focused on interdisciplinary collaboration during patient selection, surgical decision making, management of medical comorbidities and postoperative rehabilitation. This quality improvement initiative aimed to establish a novel, interdisciplinary PNT program with the goal of optimizing UE recovery and function in individuals with tetraplegia in Canada.

An interprofessional team assembled to complete a detailed exploration of care segments, organizing and sequencing care delivery.

As a result of this initiative, a care map of planned interprofessional services, their optimal timing across the continuum of care, and clinical functional and community integration outcomes were developed. Data collection and program evaluation are ongoing, and further work to mitigate barriers and develop educational materials around PNT surgery are intended to improve medical decision making and best practice implementation.

Genicular artery embolization (GAE) is an emerging minimally invasive procedure for managing knee osteoarthritis (OA), a condition affecting 365 million individuals globally. Initially developed to treat hemarthrosis, GAE selectively embolizes abnormal genicular vasculature, targeting synovial inflammation and reducing neoangiogenesis. This process alleviates pain and improves joint function, providing an alternative for patients with mild-to-moderate OA who are not candidates for surgical interventions due to comorbidities or other factors. Current evidence supports the use of GAE for patients with mild-to-moderate OA who experience persistent symptoms despite conservative treatments such as physical therapy, weight management, or intra-articular injections. The procedure effectively reduces pain, improves functionality, and provides sustained benefits. This review highlights the anatomical principles, procedural techniques, and patient selection criteria for GAE, as well as the clinical evidence supporting its safety and efficacy. It also explores potential future directions for research, including optimizing patient selection, evaluating long-term outcomes, and integrating GAE into routine OA management pathways.

ObjectiveTo analyze and synthesize the information available from five pivotal, large-scale, multicenter, observational studies (CHECK, OAI, FNIH Biomarkers Consortium, IMI-APPROACH, and MOST) focusing on knee osteoarthritis (OA), which can be used to elucidate disease progression, risk factors, and the effectiveness of potential interventions.DesignFor this narrative review, a comprehensive literature search and data extraction from official web pages and scientific databases were conducted to compare methodologies, in- and exclusion criteria, outcomes, and cohort characteristics across the studies. Thematic, comparative, and qualitative analyses were employed to identify trends, commonalities, and disparities among the findings.ResultsThe studies collectively enhanced understanding of the onset and progression of knee OA, and in several of the studies, hip OA, emphasizing the importance of both systemic and local risk factors. Advanced imaging and biomarkers are important components in all the cohorts, with the goal of aiding early diagnosis and tracking disease progression. All cohorts evaluated unique markers generally not available in the other cohorts, while other factors overlap, suggesting possibilities for combining or cross-validating between cohorts.ConclusionsThe collaborative efforts of major OA research significantly advance our understanding of knee OA. These studies highlight the importance of a multifaceted approach, integrating advanced imaging, biomarkers, and longitudinal data to tackle the complexities of OA. By synthesizing findings and addressing knowledge gaps such as heterogeneity of patients and used measurements, and use of novel pain measures, future research can develop more effective diagnostic tools and treatments, ultimately enhancing the quality of life for OA patients.

Background and Objectives: Musculoskeletal disorders (MD) affect over 1.7 billion people worldwide, with neck and low back pain being prevalent and debilitating conditions. Current treatments include various interventions, but novel approaches are needed to improve functionality and reduce disability. To evaluate the effects of a postural hammock on pain and functionality in people with chronic neck and low back pain. Materials and Methods: A randomized controlled trial was conducted with participants experiencing chronic neck and/or low back pain. They were assigned to either an experimental group using a postural hammock or a control group lying on a mat. Participants underwent five sessions of 10 min each over five consecutive days. Results: Forty-three subjects completed the study. While both groups showed improvements, the experimental group exhibited significant increases in hamstring flexibility and pain tolerance, measured through the Visual Analog Scale (VAS) and pressure pain thresholds (PPT). Postural hammock use demonstrated potential benefits in pain management and flexibility compared to conventional methods. Conclusions: Using a postural hammock may offer benefits for individuals with chronic back pain. Future research should explore combining hammock therapy with other interventions to enhance outcomes and improve the quality of life for patients with back pain.

Considering dissatisfaction rates of around 10% after total hip arthroplasty (THA), this study aimed to investigate the role of pain catastrophising (PC) on functional outcomes, pain, and quality of life following THA in a large prospective study. PC is the tendency to focus on and exaggerate painful stimuli combined with a decreased ability to deal with pain.

A prospective comparative study was performed with 531 patients undergoing primary unilateral THA between 2019 and 2020. Patients were considered PC with a preoperative score ⩾30 on the PC Scale, resulting in 57 (11%) PC-patients. Patient-reported outcome measures (PROMs) were collected preoperatively, at 3 months, 1 year, and 2 years postoperatively and consisted of Hip disability and Osteoarthritis Outcome Score-Physical Function (HOOS-PS), Oxford Hip Score (OHS), pain (NRS), and quality of life (EQ-5D), including minimal clinical important differences (MCIDs) and patient acceptable symptom state (PASS), as well as length of stay and aseptic revisions.

PC-patients reported inferior preoperative scores on all PROMs and had longer hospital stay (p = 0.02). Although PC-patients had more improvement in all scores and a higher proportion generally reached MCID, they still reported lower OHS, more pain, and lower EQ-5D at 2-year follow-up (all p < 0.03), and fewer PC-patients reached PASS for OHS and EQ-5D at final follow-up. No difference in aseptic revisions was seen (p = 0.95).

PC-patients had worse preoperative subjective function and more pain. Although they showed more improvement than non-PC patients at all outcomes, less patients reached PASS for OHS and EQ-5D at 2-year follow-up.

To determine the effect of virtual reality glasses accompanied by music during episiotomy repair on women's perceived pain, vital signs, and postnatal comfort.

This randomized controlled experimental study utilized the "VAS pain score" and "Postpartum Comfort Scale" to collect data. All participants received 5 mL of lidocaine during episiotomy repair. Women in the experimental group listened to the tune of Acemashiran and watched a natural landscape with virtual reality glasses (VRG) while undergoing episiotomy repair, whereas those in the control group did not undergo any intervention during the procedure. p < .05 was considered statistically significant.

The results showed that the episiotomy repair time was perceived as shorter in the experimental group than in the control group. VAS pain scores were significantly lower in the experimental group (during: 5, after: 2) than in the control group (during: 7, after: 4). There were no significant differences in vital sign measurements among participants before, during, and after episiotomy repair. The experimental group exhibited higher postpartum comfort scale scores (E: 4.20 ± 0.36/ C 3.99 ± 0.55).

The study concluded that combining VRG application with music resulted in a perceived reduction in episiotomy repair time. The visual and auditory stimuli contributed to pain management during and after episiotomy repair. Additionally, virtual glasses may reduce the need for pharmacological medication due to this reduction in pain during episiotomy repair.

This study provides evidence for the effectiveness of non-pharmacologic interventions for episiotomy repair, patients and facilitates support for future clinical trials and work.

NCT05134376.

Quality improvement in rehabilitation is needed due to unwarranted variations and suboptimal service coordination. Audit and feedback strategies are commonly used to improve healthcare quality, but evidence of their effectiveness in rehabilitation settings is limited.

To evaluate the impact of an audit and feedback strategy on rehabilitation quality, as measured by a set of quality indicators (QIs) specifically designed for rehabilitation.

Interrupted time series analysis was conducted across 16 Norwegian institutions delivering specialized rehabilitation for long-term diseases. Patient-reported rehabilitation quality data was collected continuously before and after a provider feedback intervention, while provider-reported quality was measured once before and after the intervention. We compared 11 pre- and 9 post-intervention observations, each spanning 3 weeks, over a 15-months study period.

The analyses included 2,415 patients, with 1,444 (59.8%) pre-intervention and 971 (40.2%) post-intervention. Mixed model analyses revealed that the mean differences in patient-reported QIs between the pre- and post-intervention phase were small and statistically non-significant. The expected impact model, including a gradually higher quality after the feedback to institution managers and clinical team members, was not confirmed. We observed variations in service quality among institutions, also post-intervention. The lowest pass rates were observed for indicators addressing the follow-up, involvement of external services and next of kin.

In this multicentre study, the audit and feedback intervention did not lead to improvements in the quality of rehabilitation services, as measured by changes in QI pass rates covering health service structures, processes and patient outcomes.

ClinicalTrials.gov [NCT03764982].

This study aims to investigate the relationship between interspinous ligament fluid (ISF) sign and low back pain, and the effect of ISF on the outcome of lumbar interbody fusion (LIF).

This retrospective analysis evaluated patients who underwent single-level LIF for lumbar degeneration from January 2012 to December 2019. Patients were divided into ISF (+) and ISF (-) groups based on preoperative lumbar MRI. Data collected included demographic information, surgical data, preoperative and postoperative VAS and ODI scores, and surgical satisfaction. Imaging data assessed intervertebral disc degeneration, lumbar spondylolisthesis, and stability of surgical segments. Differences in VAS, ODI, and satisfaction scores before and after surgery were compared, and regression analysis identified imaging factors linked to residual low back pain. Two-sided p < 0.05 was considered statistically significant.

A total of 328 patients participated in the study, with 108 in the ISF (+) group and 220 in the ISF (-) group. There were no significant differences in mean age, BMI, sex ratio, hypertension, or diabetes rates between the groups. However, the ISF (+) group had a significantly longer hospital stay (16.13 ± 6.83 days) compared to the ISF (-) group (14.51 ± 6.59 days) (p = 0.040). No significant differences were found in operative level, operation time, intraoperative blood loss, or complication rates. At 1 and 3 months postoperatively, VAS scores for low back pain were significantly higher in the ISF (+) group than in the ISF (-) group (p < 0.001 for both). ODI scores showed no significant differences at any postoperative time point (p > 0.05). A significant difference was observed in the proportion of patients with residual low back pain at both 1 and 3 months post-surgery, with more patients in the ISF (+) group reporting pain. Residual low back pain at 1 and 3 months post-surgery positively correlated with a positive ISF sign at the preoperative fusion level (R = 0.213, p < 0.001; R = 0.123, p = 0.025). Logistic regression analysis indicated that a positive ISF sign at the preoperative fusion level was an independent risk factor for residual low back pain at both 1 month and 3 months post-surgery [OR (95% CI) = 2.528 (1.552, 4.118), p < 0.001; OR (95% CI) = 2.146 (1.076, 4.277), p = 0.030].

A positive ISF sign observed at the fusion level may significantly influence the outcomes of lumbar fusion procedures. Specifically, the presence of a positive ISF sign is associated with an elevated risk of unfavorable early postoperative results following lumbar fusion. Furthermore, patients exhibiting a positive ISF sign are more likely to experience residual low back pain during the early postoperative phase compared to those with a negative ISF sign.

Fibromyalgia is characterized by widespread chronic pain and multiple additional symptoms which may result in significant disability. Recent studies have demonstrated disturbances in body image and body schema in people affected by this condition. Importantly, it affects a heterogenous population in which distinct profiles can be identified based on physiological and/or psychological characteristics. The objective of our study was to explore individual differences in experiencing one's own body in fibromyalgia. We applied a mixed methods design and included data from 28 women diagnosed with fibromyalgia. We measured symptom intensity (Fibromyalgia Impact Questionnaire, part 1), disturbances in body schema (adapted Fremantle Back Awareness Questionnaire) and body image (Body Esteem Scale, Multidimensional Assessment of Interoceptive Awareness). Additionally, participants drew their bodies and how they experienced them (Body Drawing task). Next, we asked five experts in chronic pain treatment to evaluate the drawings on a specially designed scale and indicate what kind of emotions these drawings expressed. We found evidence of disturbed body experiences and large individual differences in each of the measured variables which allowed for clustering participants into three groups, named 'Connected body', 'Conflicted body', and 'Disconnected body'. These preliminary results suggest patients with fibromyalgia may have both qualitatively and quantitatively distinct disrupted body experience.

Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have occurred after the amputation.

To assess the feasibility of a home-based Graded Motor Imagery intervention, the GraMI protocol, for amputee people with phantom limb pain.

Twenty individuals over 18 years of age with upper or lower limb amputation, experiencing phantom limb pain, who were pharmacologically stable, and had been discharged from the hospital were recruited. The experimental group followed the GraMI protocol. Primary outcomes included study processes, such as recruitment time and rate, adherence, compliance, and the acceptability of digital technologies as a treatment tool. Secondary outcomes assessed the impact on phantom limb pain, quality of life, functionality, and depressive symptoms.

On average, seven participants were recruited monthly over a three-month period. No losses were recorded throughout the nine weeks of intervention. Treatment adherence averaged 89.32%, and all participants demonstrated familiarity with the usability of digital technologies. No significant differences were observed between groups (p = .054). However, within the experimental group, intragroup analysis revealed a significant (p = .005) and clinically relevant reduction (>2 points) with a large effect size (0.89) in phantom limb pain.

Conducting a multicenter study with a home-based intervention using the GraMI protocol is feasible. Future clinical trials are needed to verify its effectiveness in managing phantom limb pain.

The objective of pulpotomy is to preserve the pulp vitality. However, the assessment of pulpal status following pulpotomy is often overlooked. This retrospective analysis aimed to compare the pulp responses to EPT (Electric pulp test) and cold test in mature permanent molars that have undergone either complete pulpotomy (CP) or partial pulpotomy (PP) for managing carious pulpal exposure and symptomatic irreversible pulpitis (SIP) and completed 12 months follow-up.

This retrospective analysis pooled data from three randomized clinical trials of pulpotomy (one using CP and two using PP) conducted in the Department of Conservative Dentistry and Endodontics of the Postgraduate Institute of Dental Sciences, Rohtak, from December 2020 to May 2024. The present study included a total of 220 cariously exposed mature permanent molars with SIP, that underwent either CP (n = 45) or PP (n = 175) using ProRoot Mineral Trioxide Aggregate, and were followed-up for 12 months. The teeth were evaluated for outcomes (clinical and radiographic), and pulp sensibility responses to EPT and the cold test, both individually and collectively as positive response to either test. Pulp sensibility responses were further analysed following teeth distribution considering variables like age, gender, number of tooth surfaces restored, preoperative pain intensity and hard tissue formation. Statistical analysis was performed using the Chi-squared test, Fisher's exact test and Mann-Whitney U-test, with significance at p < .05.

At 12 months follow-up, 209 of 220 teeth analysed had a successful pulpotomy outcome. Amongst these, PP-treated teeth responded more predictably to EPT and cold test as compared to CP-treated teeth. However, the difference was significant with EPT analysis only (p = .001). The proportion of teeth with a positive response was significantly higher in both the groups, when considering a combined positive response to either EPT or cold test, compared to the positive response to each test alone (p < .001). None of the included variables influenced the pulp sensibility responses in either group (p > .05).

PP-treated teeth responded more predictably to EPT and cold test than CP-treated teeth. Future studies must consider positive response to either EPT or the cold test collectively, whilst assessing the pulpal status following CP and PP.

Pain is a multidimensional and subjective experience, and its perception is influenced by sensory, emotional, and behavioral factors. This work aims to evaluate the influence of depression and anxiety in the quantitative and qualitative assessment of chronic pain.

This is a cross-sectional study carried out at the Multidisciplinary Pain Center of the Clinical Hospital of the Federal University of Minas Gerais. A total of 103 patients were interviewed and evaluated using the following instruments: McGill Questionnaire, visual numerical scale, Hospital Anxiety and Depression Scale and the Medical Outcomes Study SF-36.

The affective, sensory and miscellaneous categories of anxious patients were higher than the nonanxious population (p < 0.05). In the depressed population, the "affective" category was higher than the nondepressed population (p < 0.05). Regarding the anxious and depressed population, the affective, sensory and miscellaneous categories were superior to the nonanxious and nondepressed population (p < 0.05).

Depression and anxiety are the most common psychiatric disorders in the population with chronic pain, with a prevalence of 30-40%. In the presence of anxiety and depression, a worse qualitative evaluation was observed. The higher the scores obtained in the assessment of these two mental disorders, the higher the pain index found, and the higher pain index correlates with a lower quality of life.

The presence of anxiety and depression altered the qualitative assessment of pain, making it more unpleasant. The pain index correlated with quality of life without, however, being related to pain intensity.

This study aimed to assess the efficacy of a mobile phone application (app) to improve oral hygiene of patients undergoing fixed orthodontic treatment.

This randomized controlled clinical trial was conducted with a total of 60 patients undergoing fixed orthodontic treatment in two groups: intervention and control (n = 30 each). A previously designed mobile app (Labkhand) was used by patients in the intervention group. Orthodontic plaque index (OPI) and modified gingival index (MGI) were recorded in the two groups at baseline (first session or T0), and after 1 (T1) and 3 (T2) months. The number of debonded/broken brackets was also recorded, and pain score of the patients was assessed at nine time points. Data were analyzed using the χ2 test, paired t‑test, and repeated measures analysis of variance (ANOVA; α = 0.05).

The two groups demonstrated no significant difference in OPI and MGI at T0 (P > 0.05). OPI and MGI at T1 and T2 were significantly lower in the intervention group than in the control group (P < 0.05). The number of patients with broken brackets in the intervention group was significantly lower than that in the control group (P = 0.017). The two groups reported no significant difference in pain score (P > 0.05).

The Labkhand mobile app successfully improved oral hygiene indices of patients undergoing fixed orthodontic treatment, and decreased the frequency of broken brackets after 1 and 3 months of use.

Unethical attempts to misuse and overdose opioids have led to strict prescription limits, necessitating frequent hospital visits and prescriptions for long-term severe pain management. Therefore, this study aimed to develop a prototype wearable device that facilitates the extended delivery of opioid drugs while incorporating abuse-deterrent functionality, referred to as the abuse deterrent device (ADD).

The ADD was designed and fabricated using 3D-printed components, including reservoirs for the drug and contaminant, as well as an actuator. In vitro tests were conducted using a skin-mimicking layer and phosphate-buffered saline (PBS) to evaluate the drug release profile and the effectiveness of the ADD abuse-deterrent mechanism.

Under simulated skin attachment, ADD demonstrated sustained drug release with the potential to persist for up to 200 days. Upon detachment from the skin mimic, the mechanical components of the ADD facilitated immediate exposure of the contaminant to the drug and effectively halted further drug exposure throughout-diffusion.

Wearable ADD provides a secure and practical solution for the long-term treatment of high-risk medications such as opioids, enhances patient convenience, and addresses important public health concerns.

The online version contains supplementary material available at 10.1007/s13534-025-00459-7.

To determine whether readily available patient, ultrasound and treatment outcome data can be used to develop, validate and externally test two machine learning (ML) models for predicting the success of expectant and medical management of miscarriage respectively.

A retrospective, multi-site study of patients opting for expectant or medical management of miscarriage was undertaken. A total of 1075 patients across two hospital early pregnancy units were eligible for inclusion. Data pre-processing derived 14 features for predictive modelling. A combination of eight linear, Bayesian, neural-net and tree-based machine learning algorithms were applied to ten different feature sets. The area under the receiver operating characteristic curve (AUC) scores were the metrics used to demonstrate the performance of the best performing model and feature selection combination for the training, validation and external data set for expectant and medical management separately.

Parameters were in the majority well matched across training, validation and external test sets. The respective optimum training, validation and external test set AUC scores were as follows in the expectant management cohort: 0.72 (95% CI 0.67,0.77), 0.63 (95% CI 0.53,0.73) and 0.70 (95% CI 0.60,0.79) (Logistic Regression in combination with Least Absolute Shrinkage and Selection Operator (LASSO)). The AUC scores in the medical management cohort were 0.64 (95% CI 0.56,0.72), 0.62 (95% CI 0.45,0.77) and 0.71 (95% CI 0.58,0.83) (Logistic Regression in combination with Recursive Feature Elimination (RFE)).

Performance of our expectant and medical miscarriage management ML models demonstrate consistency across validation and external test sets. These ML methods, validated and externally tested, have the potential to offer personalised prediction outcome of expectant and medical management of miscarriage.

Background: The aim of this trial is to compare the effects of two types of exercises, Global Postural Re-education versus specific therapeutic exercises on pain perception, pain threshold to pressure, psychosocial factors associated with pain, and craniocervical posture in women with chronic nonspecific neck pain. Methods: This study is a randomized, parallel-group, single-blind clinical trial. Fifty-two women with chronic nonspecific neck pain (two excluded) were recruited and randomly assigned to (n = 25) Global Postural Re-education and (n = 25) specific therapeutic exercises. Interventions were carried out for 4 weeks, two sessions per week, and were combined with a daily home exercise program. Numerical Pain Rating Scale, mechanosensitivity to pressure, kinesiophobia, pain catastrophizing, and craniocervical angle were assessed in two pre-intervention assessments, one week apart, and at 2 and 4 weeks after the start of the intervention. Results: Global Postural Re-education was as effective as specific therapeutic exercises, showing improvements in all variables assessed with significant intra-group differences over time and high effect sizes (ŋp2 > 0.157 for all variables). Conclusions: Global Postural Re-education is as effective as a specific therapeutic exercise program in reducing subjective pain perception, local and remote mechanosensitivity, and short-term pain-related psychosocial factors in women with chronic nonspecific neck pain.

Female chronic pelvic pain disorders (CPPDs) affect 1 in 7 women worldwide and are characterized by psychosocial comorbidities, including a reduced quality of life and 2-10-fold increased risk of depression and anxiety. Despite its prevalence and morbidity, CPPDs are often inadequately managed with few patients experiencing relief from any medical intervention. Characterizing mental health symptom trajectories and lifestyle predictors of mental health is a starting point for enhancing patient self-efficacy in managing symptoms. Here, we investigate the association between mental health, pain, and physical activity (PA) in females with CPPD and demonstrate a method for handling multi-modal mobile health (mHealth) data.

The study sample included 4270 person-level days and 799 person-level weeks of data from CPPD participants (N=76). Participants recorded PROMIS global mental health (GMH) and physical functioning and pain weekly for 14 weeks using a research mHealth app, and moderate-to-vigorous PA (MVPA) was passively collected via activity trackers.

We used penalized functional regression (PFR) to regress weekly GMH-T (GMH-T) on MVPA and weekly pain outcomes while adjusting for baseline measures, time in study, and the random intercept of the individual. We converted 7-day MVPA data into a single smooth using spline basis functions to model the potential non-linear relationship.

MVPA was a significant, curvilinear predictor of GMH-T (F=18.989, p<0.001), independent of pain measures and prior psychiatric diagnosis. Physical functioning was positively associated with GMH-T, while pain was negatively associated with GMH-T (B=2.24, B=-1.16, respectively; p<0.05).

These findings suggest that engaging in MVPA is beneficial to the mental health of females with CPPD. Additionally, this study demonstrates the potential of ambulatory mHealth-based data combined with functional models for delineating inter-individual and temporal variability.

Objective: Chronic pain in knee osteoarthritis (OA) is a multidimensional phenomenon requiring thorough assessment and appropriate treatment. We assessed the impact of home-based, remotely supervised transcranial direct current stimulation (tDCS) on the overall pain experience of older adults with knee OA by simultaneously examining its effects on multiple pain domains-pain intensity, pain interference, and pain catastrophizing-using multigroup latent transition analysis (LTA). Methods: This secondary analysis of a randomized clinical trial involved 120 participants with knee OA pain, randomly assigned in a 1:1 ratio to receive 15 daily sessions of 2-mA tDCS or sham tDCS (20 min per session) over three weeks, with real-time remote supervision. Pain intensity was measured using the Numeric Rating Scale (NRS) and the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Pain interference was measured using the WOMAC functional scale. Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). All the measures were assessed at baseline and at the end of each week (weeks 1, 2, and 3), after the participants had completed five tDCS sessions per week. Multigroup LTA enabled the simultaneous measurement of multiple pain domains and analysis of their changes as a function of intervention exposure by modeling the transition probabilities of latent classes and comparing these changes between the groups. Results: Based on the NRS, WOMAC, and PCS scores, three latent categories were identified: "high pain (all scores high)," "moderate pain (all scores moderate)," and "low pain (all scores low)." Active group participants with "moderate pain" at baseline had a 24.2% probability of transitioning to "low pain" after Week 1, whereas sham group participants remained stagnant during this interval. Notably, 37.6% of active group participants with "high pain" at Week 1 transitioned to "moderate pain," while 35.8% of those with "moderate pain" at Week 1 transitioned to "low pain" by Week 2 (after an additional five sessions). Nevertheless, no noticeable changes were observed in the sham group during this period. No pronounced intervention effects were noted by Week 3. Conclusions: Simultaneously modeling pain-related measures enriches our understanding of the efficacy of tDCS in improving the overall pain experience among older adults with knee OA. Trial Registration: ClinicalTrials.gov identifier: NCT04016272.

Background and Objectives: In recent years, numerous studies have investigated and analyzed the levels of molecular biomarkers of temporomandibular disorders (TMD) from various tissue samples and body fluids. However, no study has investigated gingival crevicular fluid (GCF) in TMD patients. The purpose of this study was to determine the concentrations of pro-inflammatory cytokines in GCF before and after stabilization splint (SS) therapy in patients with painful TMD, to investigate whether SS administration causes changes in the concentrations of pro-inflammatory cytokines. An additional aim was to investigate the relationship of GCF cytokine levels with chronic pain intensity and clinical parameters. Materials and Methods: This prospective cohort study included 36 patients who were diagnosed with painful TMD using the Diagnostic Criteria for TMD (DC/TMD). GCF samples were collected at baseline before SS treatment (T0) and at one month (T1) and three months (T2) after the start of therapy. Customized ProcartaPlex Multiplex assays from eBioscience (Invitrogen™, Thermo Fisher Scientific, Viena, Austria) were used for the quantitative analysis of pro-inflammatory cytokines (IL-1β, IL-6, IL-7, IL-8, IL-13, and TNF-α). Patients filled out Croatian versions of questionnaires for self-assessment from Axis II DK/TMP: Graded Chronic Pain Scale (v2) (GCPSv2) and Jaw Function Limitation Scale-20 (JFLS-20). Results: The results showed that the GCF levels of IL-7 (Friedman's test, p = 0.008) and IL-13 (Friedman's test, p = 0.003) were significantly decreased at T2. The GCF level of IL-13 was in negative correlation with chronic pain grade score at T2 (Rho = -0.333), while the GCF level of IL-8 was in positive correlation with mobility limitation (Rho = 0.382) at T1. Conclusions: The results indicate that SS therapy might have a role in reducing inflammation and that the GCF could be a valuable medium for assessing molecular biomarkers.

This study aimed to investigate and compare the effecs of face-to-face and internet-based Basic Body Awareness Therapy (BBAT), in patients with fibromyalgia (FM).

FM-diagnosed patients were randomly allocated to one of three groups: face-to-face BBAT (F2F-BBAT), internet-based BBAT (I-BBAT), or a waiting list control group (CG). The F2F-BBAT group underwent individual 8-week BBAT sessions (2 sessions per week). The I-BBAT group received an equivalent dosage of BBAT via online video conferencing software. The primary outcome was the Fibromyalgia Impact Questionnaire Revised (FIQR). Secondary outcomes included the pressure pain threshold (PPT) via algometer, the PostureScreen Mobile® (PSM) application, the Short Form McGill Pain Questionnaire (SF-MPQ), the Short Form 36 Health Survey (SF-36), and plasma fibrinogen and haptoglobin levels.

A total of 41 patients completed the study. Both the F2F-BBAT (n = 14) and I-BBAT (n = 13) groups showed significant improvements in all outcome measures (p < 0.05) with no significant difference between them (p > 0.05). Conversely, the CG (n = 14) demonstrated no substantial improvements in the outcome measures (p > 0.05). Compared to the CG, both the F2F-BBAT and I-BBAT groups exhibited superior results in FIQR, PPT, PSM, SF-MPQ, and multiple SF-36 sub-parameters (p < 0.05).

This study showed that BBAT delivered via internet-based telerehabilitation can have comparable effective results on clinical parameters with conventional face-to face BBAT in patients with FM.

ClinicalTrials.gov: NCT04981132.

Background and Objectives: Chronic pelvic pain (CPP) is a common complication of pelvic inflammatory disease (PID). Although acupuncture has been increasingly used for the management of CPP, there is insufficient research to support the use of laser stimulation of sensitized acupoints. This study aimed to investigate the effects of laser on sensitized acupoints on pelvic pain perception and quality of life in women with pelvic inflammatory disease. Materials and Methods: Thirty-six women with CPP caused by chronic pelvic inflammatory disease were randomly divided into two equal groups. Both groups received non-steroidal anti-inflammatory drugs, while the study group also received a low-level laser at sensitized acupoints for 6 weeks. All the patients were evaluated before and after the intervention. The 12-item Short-Form Health Survey (SF-12) was used to measure the quality of life, while a pressure algometer and visual analog scale for pain (VAS-P) were used to measure pain sensitivity and intensity, respectively. A mixed MANOVA was used to investigate the effects of the treatment. Results: A mixed MANOVA on VAS, SF-12, and PPT scores revealed significant interaction effects of treatment and time (F = 38.34, p = 0.001, partial η2 = 0.96) and main effects of treatment (F = 9.74, p = 0.001) and time (F = 110.1, p = 0.001). Post-treatment, the study group showed greater reductions in VAS (MD = -1.00, p = 0.001), improvements in SF-12 (MD = 9.11, p = 0.001), and increased Pressure Pain Thresholds (PPT) at multiple anatomical points (p = 0.001-0.01). Conclusions: Laser biostimulation of neurogenic-sensitized acupoints significantly improves pain perception, intensity, and quality of life in women with CPP. suggested that the utilization of laser therapy at sensitized acupoints should be considered a potential component of a rehabilitation program for females suffering from chronic pelvic pain resulting from pelvic inflammatory disease. (Clinicaltrials.gov identifier: NCT05537207; Date of registration: 13 September 2022).

Post-operative pain following intra peritoneal onlay mesh (IPOM) repair of ventral hernia is commonly attributed to mechanical fixation devices. Fibrin sealant is a novel technique of mesh fixation purported to cause less pain. The aim of this study was to compare postoperative pain in these two methods of mesh fixation.

This was a double-blinded, randomized controlled trial. Eighty patients with primary ventral hernia underwent laparoscopic IPOM repair using PROCEED™ mesh, which was fixed with either mechanical fixation device, SECURESTRAP™ (MF group) or fibrin sealant, TISSEEL™ (FS group). Primary end point was postoperative pain at rest and movement on a Visual Analogue Scale (VAS) of 0-10. Operative time, recurrence, seroma and quality of life (QoL) were secondary outcomes. Patients were followed up for one year.

There was no significant difference in pain score at 12 h, 24 h, 7 days, 1, 3 and 12 months between the groups, except pain on movement, which was significantly less in the FS group on the seventh day (median VAS 3 vs. 2, p = 0.01). Mean operative time was 8 min longer in the FS group (p = 0.001). Two patients in the FS and none in the MF group had recurrence at one year (p = 0.18). Seroma formation, postoperative QoL and patient satisfaction scores were similar in both groups.

Use of fibrin sealant for mesh fixation does not provide significant advantage over mechanical fixation in laparoscopic IPOM repair.

To investigate the incidence patterns and risk factors of acute abdominal pain following hepatic arterial infusion chemotherapy (HAIC) in liver cancer patients and develop a preliminary prediction model for post-HAIC abdominal pain.

Four hundred hepatocellular carcinoma patients who underwent HAIC at the Affiliated Cancer Hospital of Shandong First Medical University from January 2021 to March 2023 were retrospectively analyzed. The patients were categorized into two groups (abdominal pain and no abdominal pain) based on the occurrence of acute moderate to severe abdominal pain within 24 h after HAIC. Univariate analysis was performed on data from the two groups. Statistically significant factors were subjected to logistic regression analysis to construct a preliminary prediction model, and the predictive performance was evaluated.

A total of 358 hAIC procedures were performed in 242 patients who met the inclusion criteria. Of the 242 eligible patients, 88 (36.4%) experienced moderate to severe abdominal pain, while 154 (63.6%) had no significant pain. Age, tumor diameter, distance between the tumor and liver capsule, presence of portal vein tumor thrombus, oxaliplatin preparation time, and oxaliplatin manufacturer were independent predictors of acute moderate to severe abdominal pain following HAIC. The final prediction model demonstrated good predictive ability with an area under the receiver operating characteristic curve of 0.795 (95% confidence interval: 0.740-0.853).

The model developed in this study effectively predicted the risk of acute moderate to severe abdominal pain following HAIC and may provide a basis for more precise prevention and intervention strategies in clinical practice.

Objectives: To detect differences between individualized homeopathic medicinal products (IHMPs) and placebo after 4 months of intervention in patients with chronic low-back pain (LBP). Design: Four-month, double-blind, randomized (1:1), placebo-controlled, two parallel arms trial. Setting: PG3 and research outpatient department of D. N. De Homoeopathic Medical College & Hospital. Subjects: Sixty participants with chronic LBP. Interventions: Verum (n = 30; IHMPs plus concomitant care) versus control (n = 30; placebos plus concomitant care). Outcome Measures: Primary-Oswestry LBP Disability Questionnaire (ODQ); Secondary-Roland Morris Pain and Disability Questionnaire (RMPDQ); McGill Pain Questionnaire-Short Form (SF-MPQ); measured at baseline, and every month, up to 4 months. Results: Group differences achieved significance or near significance in all the specified outcomes-ODQ score (F1, 58 = 4.331, p = 0.042), RMPDQ score (F1, 58 = 2.939, p = 0.092), and SF-MPQ total score (F1, 58 = 6.666, p = 0.012). Rhus toxicodendron (n = 13), Bryonia alba (n = 8), Hypericum perforatum, and Nux vomica (n = 5 each) were the most frequently prescribed medicines. Different repertories were used as per the need of the cases-Kent, Synthesis, Murphy, Pulford, Boericke, Boger Boenninghausen's Characteristics and Repertory, and Complete. Minor adverse events were reported from either group. Conclusions: Thus, homeopathic medicines worked significantly better than placebos in reducing chronic LBP. Independent replications are warranted to substantiate the findings. Clinical Trial Registration Number: CTRI/2022/04/041878.

Exergames are increasingly used in rehabilitation, yet their usability and user experience for patients and therapists, particularly for functional model systems, are underresearched. The diverse needs and preferences of users make conducting usability studies challenging, emphasizing the need for further investigation in real-world settings.

This study aimed to evaluate the usability, safety, and user experience of a novel exergame functional model, the ExerG, from the perspectives of patients and therapists in a rehabilitation setting.

In this mixed methods study, 15 patients undergoing rehabilitation (primary end users [PEUs]) and 20 therapists (secondary end users [SEUs]) from 2 rehabilitation centers in Switzerland and Austria participated in exercising and observation sessions with the ExerG. SEUs received training on system use and technical issue management, enabling them to fulfill their therapist roles while treating patients or mock patients. Rapid Iterative Testing and Evaluation was used and the training software adjusted based on participant feedback. Usability was assessed with questionnaires, semistructured interviews, and through observations during the ExerG testing. System acceptability was evaluated using specific quantitative thresholds based on PEU performance and feedback. An observation protocol tracked SEUs' correct use, errors, hesitations, task completion time, and needed assistance across scenarios.

Patients and therapists reported overall good usability and positive experiences with the exergame. PEUs rated 23/29 (79%) instructions as acceptable, showed good-to-very-good exercise performance in 19/29 (65%) tasks, and completed 28/29 (97%) tasks. Patients reported no adverse events, showing improved performance and enjoyment across ExerG exercising rounds, with 79/90 (88%) expressing positive emotions and reporting median scores of 9 (IQR 7.5-10) on a 1-10 user satisfaction scale. Patients were willing to continue using the device if the graphic design was improved (5/15), tracking systems and projector quality were enhanced (each 3/15), instructions clarified (12/15), and the game variety increased (2/15). PEUs felt secure in the safety harness (15/15) but recommended swivel arm movement enhancements (5/15). SEUs effectively executed scenarios, with hesitation and difficulties observed in only 14/41 tasks and 2/41 tasks, across all 20 therapists, accounting for 1.7% and 0.2% of the 820 total task cases, respectively. Therapists' quantitative usability ratings were high (median System Usability Scale score 82.5, IQR 65-95). All SEUs expressed their willingness to use the ExerG (20/20) and reported being able to operate the system using the user handbook (20/20). They emphasized the motivation-enhancing effect of video-game based training (12/20) and considered the activities supportive for physical and cognitive skills (20/20). They suggested incorporating daily living task simulations (13/20), more customizable options (6/20), more targeted motivational feedback (9/20), clearer performance ratings (9/20), and more concise activity instructions (6/20).

The interdisciplinary, iterative ExerG development approach shows promise. The findings will inform future optimizations. Future work will assess long-term impact.

Postoperative balance disorders in older adults after total knee arthroplasty (TKA) due to osteoarthritis are commonly attributed to proprioceptive joint deficits. Both Proprioceptive Neuromuscular Facilitation (PNF) and Focal Vibration (FV) can improve balance and proprioception.

To examine the combination of a PNF exercise program and quadriceps tendon FV in older adults after TKA due to osteoarthritis.

Ninety older adults who underwent TKA were randomly assigned to three groups of 30. The PNF Group followed a 6-week PNF exercise program starting four weeks post-surgery. The PNF + FV Group followed the same PNF program combined with FV applied to the rectus femoris and vastus medialis. The control group received instructions for a home-based exercise program. Pain (Numeric Pain Rating Scale; NPRS), knee range of motion (ROM), functional ability (Knee Injury and Osteoarthritis Outcome Score, KOOS), joint position sense (JPS), postural sway (force platform), and balance (Timed Up-and-Go; TUG test, Berg Balance Scale; BBS) were evaluated at baseline, six weeks, and six months post-intervention. A two-way repeated measures ANOVA analysis was applied with significance set at p < .05.

The PNF + FV group showed significant improvements compared to the control group in NPRS, KOOS, TUG, BBS, displacement parameters, and absolute error scores (p < .05). The PNF + FV group showed earlier improvements compared to the PNF group, indicating faster adjustments due to the combined effect of PNF and FV. Additionally, the PNF + FV group showed greater improvement in TUG, BBS, KOOS sport, anterior-posterior displacement distance, and absolute error scores at 25° compared to the PNF group (p < .05). PNF exercises improved knee ROM (p < .05) with no additional effect from FV.

A 6-week protocol combining PNF exercises and FV significantly improved balance, knee joint position sense, knee functional ability, and pain intensity in older adults after TKA due to osteoarthritis. These findings suggest faster and more effective rehabilitation, potentially reducing postoperative disorders and future injury risks. Further research is needed to investigate the combination of FV and PNF.

Background/Objectives: We aimed to compare non-pharmacological (non-PHM) and pharmacological (PHM) treatment for patients with non-acute lumbar disc herniation (LDH) and determine the feasibility of a large-scale study. Methods: This was a two-armed, parallel, multicenter, pragmatic controlled trial performed in South Korea. All patients underwent magnetic resonance imaging (MRI) scans both at the screening stage and the last follow-up. Patients with LDH findings on MRI were randomly assigned to non-PHM and PHM groups. Treatment was administered twice a week for a total of 8 weeks, and follow-up assessments were performed at weeks 9, 13, and 27 post-randomization. The primary outcome was the Oswestry Disability Index (ODI) score. A linear mixed model was used for primary analysis from intention-to-treat perspectives. The incremental cost-effectiveness ratio (ICER) was calculated for economic evaluation. Results: Thirty-six patients were enrolled, and thirty-five were included in the final analysis. At Week 9, the difference in ODI scores between the two groups was 5.17 (95% CI: -4.00 to 14.35, p = 0.262), and the numeric rating scale scores for lower back and leg pains were 1.89 (95% CI: 0.68 to 3.10, p = 0.003) and 1.52 (95% CI: 0.27 to 2.77, p = 0.018), respectively, confirming greater improvement in the non-PHM group than in the PHM group. The non-PHM group showed lower costs and higher quality-adjusted life years than the PHM group. The ICER calculated using the EuroQoL-5 Dimension (EQ-5D) was USD 20,926. Conclusions: We confirm the possibility that a non-PHM strategy could be a more effective and cost-effective treatment option than PHM for patients with non-acute lumbar disc herniation. Furthermore, this pilot study confirmed the feasibility of the main study in terms of design and patient compliance.

The current study aimed to investigate the dose-response efficacy and safety of MuvzTM (E-PR-01, a blend of V. negundo and Z. officinale) in 400 mg (High-dose [HD]) and 200 mg (Low-dose [LD]) of daily dose in physically active adults in 90 days.

The study included 157 adults aged 40-60 having knee/low back joint discomfort. The primary outcome was an enhancement in the overall musculoskeletal health in 90 days. Secondary outcomes included assessing the joint discomfort following physical activity, range of motion, quality of life, and the consumption of rescue medication.

E-PR-01 notably enhanced musculoskeletal health in a dose-dependent manner compared to placebo within 30 days (p<0.0001), with effects persisting through day 90 and demonstrated clinically significant difference by 13 and 10 units in the HD and LD groups, respectively. Joint discomfort reduced significantly in both the E-PR-01 groups by day 90 (p<0.0001). Furthermore, both doses of E-PR-01 improved the range of motion of the assessed joint (p<0.05) and enriched participants' overall quality of life (p<0.05) at the end of the study.

The study finds E-PR-01 effective for improving overall joint health, with the higher dose showing greater efficacy. These findings align with the earlier studies of E-PR-01 for knee and low back discomfort.

This RCT aimed to evaluate the effect of topical Rebamipide (regular and nanoparticulated) in comparison to topical Clobetasol propionate in the management of methotrexate-induced oral ulcers in rheumatoid arthritis patients.

Patients were divided randomly into three parallel arms: 1% Rebamipide; 1% nanoparticulated Rebamipide, Clobetasol propionate. The outcome measures included WHO oral mucositis grading, pain (NRS), ulcer size, and healing time. The data was analyzed for any statistical significance.

Intragroup comparisons of mucositis grade improvement and pain reduction revealed significant differences in all the groups. All intergroup comparisons demonstrated non-significant difference, yet nanoparticulated Rebamipide was leading, and all group participants achieved complete healing earlier than the other groups.

Rebamipide, regular and nanoparticulated forms, showed comparable results to potent Corticosteroid, Clobetasol propionate in management of the oral ulcers.

Rebamipide is an efficient promising alternative modality for management of methotrexate-induced oral ulcers in rheumatoid arthritis patients.

Background: Total knee arthroplasty (TKA) is commonly performed for severe osteoarthritis but often results in significant postoperative swelling and discomfort, impacting early rehabilitation. Photobiomodulation therapy (PBMT), utilizing low-level laser therapy (LLLT), has emerged as a potential adjunctive treatment to alleviate these symptoms. Methods: In this single-center, nonblinded prospective randomized clinical trial, conducted from May to July 2024, 30 patients undergoing primary TKA were enrolled and divided into two groups. Fifteen patients formed the control group receiving standard postoperative care, while the intervention group consisted of another 15 patients who received additional PBMT from the first to the fifth postoperative day (POD). The swelling was assessed using bioimpedance analysis, which offers a noninvasive, safe, and efficient method for assessing postoperative swelling by measuring tissue impedance, and functional outcomes were measured using the 2-min walk test (2MWT) and active range of motion (aROM). The study was registered with ClinicalTrials.gov (NCT06426251). Results: The PBMT group demonstrated significantly lower impedance, reactance, and phase angle ratios by POD6, suggesting reduced swelling compared to the control group. In the 2MWT, the PBMT group achieved a longer walking distance of 27 m, compared to 16 m in the control group. However, there were no significant differences in aROM or Visual Analogue Scale (VAS) pain scores between the groups. Conclusions: The findings indicate that PBMT effectively reduces postoperative swelling and enhances early mobility post-TKA. These benefits suggest that PBMT can be a valuable addition to conventional postoperative care, potentially accelerating functional recovery, and reducing rehabilitation time.

This study aimed to determine the efficacy of telerehabilitation for patients after hip fracture surgery through a systematic review and meta-analysis.

Eight electronic databases were searched in August 2022. The primary outcomes were mobility outcomes, activities of daily living (ADL) outcomes, and all adverse events, whereas the secondary outcomes were pain, health-related quality of life, and fall efficacy scale score.

Seven randomized controlled trials were eligible for this study. The evidence regarding the effect of telerehabilitation on mobility outcomes (standardized mean difference (SMD): 0.05, 95% confidence interval (CI): -0.39 to 0.48) and all adverse events (risk ratio: 1.14, 95% CI: 0.62 to 2.21) was very uncertain. A clinically irrelevant but significant mean difference (MD) in ADL outcomes was found (MD: 4.82, 95% CI: 2.63 to 7.01). Telerehabilitation may result in a slight increase in fall efficacy scale score (SMD: 0.26, 95% CI: -0.02 to 0.54) and little to no difference in pain (MD: -1.0, 95% CI: -18.31 to 16.31).

The efficacy of telerehabilitation for patients after hip fracture surgery was uncertain with respect to the mobility outcomes, all adverse events, and pain, with no clinically meaningful differences in ADL outcomes. Telerehabilitation may be necessary to be considered for patients after hip fracture surgery to improve their confidence in their ability to perform daily activities without falling. Therefore, medical staff may consider telerehabilitation for hip fractures.