Autor: Sebastan Rutkowski, Pawel Kiper, Luisa Cacciante, Błażej Cieślik, Justyna Mazurek, Andrea Turolla, Joanna Szczepańska-Gieracha
Use of virtual reality-based training in different fields of rehabilitation: A systematic review and meta-analysis
Journal: J Rehabil Med . 2020 Oct 19. doi: 10.2340/16501977-2755
Objectives: To analyse the effectiveness of virtual reality-based interventions within several fields of rehabilitation, and to investigate whether the outcomes of virtual reality-based interventions, in terms of upper or lower limb function, gait and balance, differ with respect to the virtual reality system used.
Methods: A search of MEDLINE database resulted in an initial total of 481 records. Of these, 27 articles were included in the study. A final total of 20 articles, published between 2012 and 2019, were included in the study. Two independent reviewers selected potentially relevant articles based on the inclusion criteria for full-text reading. They extracted data, and evaluated the methodological quality of each study.
Results: Seventeen studies were included in the meta-analysis. Eight studies analysed upper limb function, with no significant effect on pooled all measures. Regarding Fugl-Meyer scale results, the effect of specialized virtual reality therapy was found to be significantly better than conventional treatment. No significant differences were observed in effects on hand dexterity and gait. There was a significant difference in effects on balance between specialized virtual reality and conventional treatment. Gaming virtual reality was significantly better than conventional treatment for upper limb function, but not for hand dexterity, gait and balance.
Conclusion: Use of specialized virtual reality and gaming virtual reality can be advantageous for treatment of the upper extremity, but not for hand dexterity and gait. Specialized virtual reality can improve balance.
Keywords: gait, balance; hand dexterity; lower limb; rehabilitation; upper limb; virtual reality.
Autor: Selaiman A Noori, Abdullah Rasheed, Rohit Aiyer, Boyoun Jung, Nitin Bansal, Ke-Vin Chang, Einar Ottestad, Amitabh Gulati
Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review
Journal: Pain Med . 2020 Nov 7;21(7):1482-1493. doi: 10.1093/pm/pny287
Background: Low back pain (LBP) and neck pain are major causes of pain and disability that are experienced across all ages. The primary goals of treatment are to improve patient function and facilitate a return to the patient’s desired level of daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders, but there continues to be controversy regarding its use due to insufficient evidence of effectiveness. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with chronic LBP and neck pain.
Methods: Using PRISMA guidelines, a search of the PubMed and CENTRAL (The Cochrane Library) databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound in patients with chronic LBP or neck pain.
Results: The search strategy identified 10 trials that met the criteria for inclusion. Three studies in LBP reported that both therapeutic and sham (placebo) ultrasound provided significant improvement in pain intensity. In each of these studies, ultrasound was found to be more effective than placebo when using only one of several validated instruments to measure pain. Three of the four studies on neck pain demonstrated significant pain relief with ultrasound in combination with other treatment modalities. However, only one of these studies demonstrated that the use of ultrasound was the cause of the statistically significant improvement in pain intensity.
Conclusions: Therapeutic ultrasound is frequently used in the treatment of LBP and neck pain and is often combined with other physiotherapeutic modalities. However, given the paucity of trials and conflicting results, we cannot recommend the use of monotherapeutic ultrasound for chronic LBP or neck pain. It does seem that ultrasound may be considered as part of a physical modality treatment plan that may be potentially helpful for short-term pain relief; however, it is undetermined which modality may be superior. In both pain syndromes, further trials are needed to define the true effect of low-intensity ultrasound therapy for axial back pain. No conclusive recommendations may be made for optimal settings or session duration.
Keywords: Axial Pain; Low Back Pain; Neck Pain; Therapeutic Ultrasound.
Autor: Alison H McGregor, Katrin Probyn, Suzie Cro, Caroline J Doré, A Kim Burton, Federico Balagué, Tamar Pincus, Jeremy Fairbank
Journal: Spine (Phila Pa 1976) . 2014 Jun 1;39(13):1044-54. doi: 10.1097/BRS.0000000000000355
Study design: A systematic review of randomized controlled trials.
Objective: To determine the effects of active rehabilitation on functional outcome after lumbar spinal stenosis surgery when compared with “usual postoperative care.”
Summary of background data: Surgery rates for lumbar spinal stenosis have risen, yet outcomes remain suboptimal. Postoperative rehabilitation has been suggested as a tool to improve postoperative function but, to date, there is limited evidence to support its use.
Methods: CENTRAL (The Cochrane Library), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL, and PEDro electronic databases were searched. Randomized controlled trials comparing the effectiveness of active rehabilitation with usual care in adults with lumbar spinal stenosis who had undergone primary spinal decompression surgery were included. Two authors independently selected studies, assessed the risk of bias, and extracted the data in line with the recommendations of the Cochrane Back Review Group. Study results were pooled in a meta-analysis when appropriate using functional status as the primary outcome, with secondary outcomes including measures of leg pain, low back pain, and global improvement/general health. The GRADE approach was used to assess the quality of the evidence.
Results: Our searches yielded 1726 articles, of which 3 studies (N = 373 participants) were suitable for inclusion in meta-analysis. All included studies were deemed to have low risk of bias; no study had unacceptably high dropout rates. There was moderate evidence suggesting that active rehabilitation was more effective than usual care in improving both short- and long-term functional status after surgery. Similar findings were noted for secondary outcomes, including short-term improvement in low back pain and long-term improvement in both low back pain and leg pain.
Conclusion: We obtained moderate-quality evidence indicating that postoperative active rehabilitation after decompression surgery for lumbar spinal stenosis is more effective than usual care. Further work is required particularly with respect to the cost-effectiveness of such interventions.
Level of evidence: 1.
Autor: Yu-Hsuan Cheng, Chih-Yang Hsu, Yen-Nung Lin
The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis
Journal: Clin Rehabil . 2020 Jan;34(1):13-22. doi: 10.1177/0269215519872528. Epub 2019 Aug 28
Objective: To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.
Data source: PubMed, Scopus, Embase, and the Cochrane Library were searched from the earliest record to July 2019.
Review methods: We included randomized control trials which (1) involved adult patients with low back pain associated with herniated disk confirmed by magnetic resonance imaging or computed tomography, (2) compared lumbar traction to sham or no traction, and (3) provided quantitative measurements of pain and function before and after intervention. Methodological quality was assessed using the physiotherapy evidence database (PEDro) scale and Cochrane risk of bias assessment.
Results: Initial searches for literature yielded 3015 non-duplicated records. After exclusion based on the title, abstract, and full-text review, 7 articles involving 403 participants were included for quantitative analysis. Compared with the control group, the participants in the traction group showed significantly greater improvements in pain and function in the short term, with standard mean differences of 0.44 (95% confidence interval (CI): 0.11-0.77) and 0.42 (95% CI: 0.08-0.76), respectively. The standard mean differences were not significant to support the long-term effects on pain and function, nor the effects on herniated disk size.
Conclusion: Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.
Keywords: Lumbar traction; herniated disks; intervertebral disk displacement; nerve root compressions; physical therapy modality.