Assessment of Follow-Up Sonography and Clinical Improvement Among Infants With Congenital Muscular Torticollis.
Assessment of Follow-Up Sonography and Clinical Improvement among Infants with Congenital Muscular Torticollis.
Filed under: Rehab Centers
AJNR Am J Neuroradiol. 2012 Oct 4;
Park HJ, Kim SS, Lee SY, Lee YT, Yoon K, Chung EC, Rho MH, Kwag HJ
BACKGROUND AND PURPOSE:Infants grow rapidly, which causes the SCM to thicken physiologically. Therefore some cases of physiologically- thickened SCM can be confused with a poor response to physical therapy. There have been only a few quantitative ultrasonographic studies on the clinical outcome of rehabilitation for CMT. Our aim was to evaluate whether a new sonographic assessment method that uses the muscular thickness ratio of the SCM can help quantify the outcome of rehabilitation therapy for patients with CMT.MATERIALS AND METHODS:We evaluated 48 patients (male/female, 17:31; mean age, 3.9 months) who were diagnosed with CMT and who underwent initial and follow-up sonography. The ratio of the thickness of the involved SCM to the thickness of the intact SCM (SCM thickness ratio) was calculated. A scoring system based on the range of motion of the neck was used to assess clinical improvement. The correlations between clinical improvement and the thickness of the involved muscle, the difference in involved muscle thickness, the SCM thickness ratio, and the difference in the SCM thickness ratio were evaluated with Spearman rank correlations.RESULTS:Follow-up Cheng scores were higher than initial scores; this difference indicates clinical resolution (follow-up, 4.90; initial, 3.38). The SCM thickness ratio at follow-up was lower than that at the initial evaluation (follow-up, 1.29 -1.34; initial, 1.65-1.77). Intra- and interobserver agreements were excellent. Most variables were moderately correlated with clinical improvement (correlation coefficients, 0.36-0.509). R1 showed the highest correlation with clinical improvement (0.481 and 0.509), followed by the initial maximal thickness of the SCM (0.434 and 0.488). ?P (P1-P2) and ?R showed similar correlation coefficients with clinical improvement.CONCLUSIONS:Measurement of the SCM thickness ratio appears to overcome the problem of a false-positive diagnosis of clinical aggravation of CMT resulting from physiologic growth. R1 and ?R are accurate objective measurements, which can be used in the management of CMT.
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Filed under: Rehab Centers
Muscle Nerve. 2012 May 24;
Korstanje JW, Scheltens-de Boer M, Blok JH, Amadio PC, Hovius SE, Stam HJ, Selles RW
Phonophoresis of Dexamethasone Sodium Phosphate May Manage Pain and Symptoms of Patients With Carpal Tunnel Syndrome.
Filed under: Rehab Centers
Clin J Pain. 2012 Oct 5;
Bakhtiary AH, Fatemi E, Emami M, Malek M
OBJECTIVES:: This study was designed to compare the efficacy of iontophoresis and phonophoresis of dexamethasone sodium phosphate (Dex-P) treatment for mild to moderate carpal tunnel syndrome (CTS). METHODS:: Fifty-two hands in 34 consecutive patients with mild to moderate CTS confirmed by electromyography were allocated randomly into 2 groups. One group received iontophoresis of 0.4% Dex-P and the other group received phonophoresis of 0.4% Dex-P. Phonophoresis (using ultrasound 1 MHz, 5-cm probe, 1.0 W/cm, pulse 1:4, 5 min/session) and iontophoresis (using galvanic current, negative electrode, 2 mA/min, total dose 40 mA for 20 min) was applied over the wrist chin for 10 daily treatment sessions (5 sessions/wk). Measurements were performed before and after treatment and at follow-up 4 weeks later, and included pain assessment by visual analogue scale, electroneurographic measurement (motor and sensory latency, motor and sensory action potential amplitude), and pinch and grip strength. RESULTS:: Improvement was significantly more pronounced in the phonophoresis group than in the iontophoresis group for motor latency [mean difference 0.8 m/s; 95% confidence interval (CI), 0.5-1.1], motor action potential amplitude (4.1 mV; 95% CI, 3.0-5.2), finger pinch strength (31.6 N; 95% CI, 15.9-47.3), hand grip strength (27.1 N; 95% CI, 13.5-40.5), and pain relief (2.1 points on a 10-point scale; 95% CI, 1.3-2.9). Effects were sustained in the follow-up period. DISCUSSION:: Phonophoresis of Dex-P treatment was more effective than iontophoresis of Dex-P for treatment of CTS. Further study is needed to investigate the combination therapy effects of these treatments with other conservative treatments in CTS patients.
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The Meaning of Global Outcome Measures in Pain Clinical Trials: More Than Just Change in Pain Intensity.
Filed under: Rehab Centers
Clin J Pain. 2012 Oct 5;
Jensen MP, Wang W, Potts SL, Gould EM
OBJECTIVES:: To understand the factors that contribute to patient and physician global outcome ratings and the extent to which receiving different doses of opioids or placebo might influence the importance of these factors better. METHODS:: A secondary analysis was performed using data from a prospective, multicenter, double-blind placebo-controlled, and active-controlled parallel group dose-ranging study comparing the efficacy of oxymorphone extended release (ER) 20 mg (ER20, N=121); oxymorphone ER 40 mg (ER40, N=121); oxycodone controlled release 20 mg (Oxy20, N=125); and placebo (N=124) in a sample of patients with osteoarthritis. We performed 2 regression analyses to identify the predictors of pretreatment to posttreatment improvement in patient and physician global ratings of arthritis status. RESULTS:: Improvement in global ratings of arthritis status was strongly associated with a decrease in pain intensity. Pretreatment to posttreatment improvement in physical and psychological functioning made independent contributions to the prediction of both criterion variables. DISCUSSION:: The findings underscore the importance of change in pain intensity as a key correlate of ratings of global improvement. However, pain intensity is not the only important factor. In the current sample, improvement in both physical and psychological functioning made independent contributions to improvements in ratings of osteoarthritis status, supporting global ratings as assessing multicomponent domains. Overall, the findings suggest that when a patient or physician reports that the patient is “doing better,” the patient is likely reporting less pain intensity and engaging in more physical activity and feeling better emotionally.
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