American Journal of Physical Medicine & Rehabilitation最新文献

Abstract: The interest in dry needling as a treatment option for myofascial pain has flourished for the last decades and will probably continue to do so, because multiple clinical effects can be attributed to this technique. However, evidence about the underlying physiological mechanisms of its effects is still underrepresented in scientific research and caution must be taken in generalizing results from acupuncture or animal research. This review offers an overview of the possible mechanisms involved in the pathophysiology of myofascial trigger points, that is, the formation of the taut band, the presence of local pain and inflammation, and the occurrence of referred pain. Subsequently, the effect of dry needling on these same aspects will be discussed. The goal of this article is to provide clinicians with the most up to date insights in the underlying (neuro)physiological mechanisms of trigger point dry needling and to identify the opportunities for further research on this topic.

Objective: The aim of this study was to evaluate the effects of extracorporeal shock wave therapy and low-level laser therapy on pain, functional status, and quality of life in shoulder adhesive capsulitis.

Design: This single-center, prospective, single-blind randomized controlled trial included patients with shoulder adhesive capsulitis randomly assigned to extracorporeal shock wave therapy, low-level laser therapy, or control groups. The extracorporeal shock wave therapy group received three extracorporeal shock wave therapy sessions plus 15 sessions of hot pack and exercise; the low-level laser therapy group received 15 low-level laser therapy sessions with hot pack and exercise. Outcomes (Constant-Murley Score, visual analog scale, Short Form 36) were assessed at baseline, 3, and 12 wks.

Results: Sixty shoulder adhesive capsulitis patients were randomized equally into extracorporeal shock wave therapy ( n = 20), low-level laser therapy ( n = 20), and control ( n = 20) groups. By week 3, both extracorporeal shock wave therapy and low-level laser therapy showed significant improvements in visual analog scale-pain and Constant-Murley Score-pain versus control ( P < 0.05), while only low-level laser therapy improved Short Form 36 physical limitation scores ( P < 0.05). At week 12, the low-level laser therapy group showed greater improvements in Constant-Murley Score-range of motion, Constant-Murley Score-total, and Short Form 36 subdomains related to physical and emotional role limitations ( P < 0.05).

Conclusions: In patients with shoulder adhesive capsulitis, both extracorporeal shock wave therapy and low-level laser therapy added to exercises therapy positively affected pain and range of motion.

Objective: The aim of the study was to evaluate the efficacy of incorporating Wii Fit-based rehabilitation into a conventional physical therapy program on balance, functional ability, and fall risk in individuals with chronic ankle instability.

Design: This is a single-blinded randomized controlled trial.

Methods: Sixty participants with chronic ankle instability (aged 18-60 yrs) were randomly assigned to either an experimental group (Wii Fit-based rehabilitation plus conventional physical therapy) or a control group (conventional physical therapy only). Both groups received supervised therapy three times per week over 8 wks. Outcome measures included the anteroposterior, mediolateral, and overall stability indices assessed via the Biodex Balance System; functional ability via the Foot and Ankle Ability Measure-Activities of Daily Living; and fall risk via the Falls Efficacy Scale-International, measured before and after intervention.

Results: The Wii Fit-based rehabilitation combined with conventional physical therapy group demonstrated significantly greater improvements across all outcome measures compared with the conventional physical therapy-only group ( P < 0.001). At 8 wks, Foot and Ankle Ability Measure-Activities of Daily Living and Falls Efficacy Scale-International scores were 94.7 ± 3.22 and 17.77 ± 2.76 in the intervention group versus 83.43 ± 2.45 and 26.3 ± 3.51 in controls, respectively.

Conclusions: Combined Wii Fit-based rehabilitation and conventional physical therapy program significantly enhance postural stability, functional performance, and reduces fall risk in patients with chronic ankle instability. Wii Fit-based rehabilitation may serve as a valuable adjunct in rehabilitation protocols targeting balance deficits in this population.

Objective: To guide efforts in reducing discharge opioid prescribing, we aimed to investigate the rate of discharge with opioids for opioid-naïve older adults in inpatient orthopedic rehabilitation and to identify factors associated with this outcome.

Design: This is a single-center case-control study of opioid-naïve older adults participating in inpatient orthopedic rehabilitation, with patients grouped based on whether they received an opioid prescription upon discharge. Patient data were collected through the electronic health record. Logistic regression was used to assess for variables that were associated with discharge with an opioid prescription.

Results: Three hundred ninety-one patients were included, with 238 (60.9%) discharged with an opioid prescription. Factors predicting receiving an opioid prescription included longer acute care length of stay, admission for knee replacement, higher pain scores, higher opioid dose, a shorter rehab length of stay, and the absence of a dementia diagnosis. Rates were highest in patients aged 65-74 (77.17%) and lowest in patients aged 85+ (49.59%); however, age was not an independent predictor when all other factors were considered.

Conclusions: A large proportion of older patients were discharged from inpatient orthopedic rehabilitation with an opioid prescription, which may be linked to intrinsic and extrinsic patient factors that influence opioid prescribing.

Objective: The aim of the study was to evaluate the efficacy of laser therapy (high-intensity vs. low-level) in treating tennis elbow.

Design: PubMed, Scopus, Embase, and Web of Science were systematically searched for randomized controlled trials up to February 2025. Cochrane risk-of-bias tool was used for quality assessment. Data were analyzed via RevMan 5.4.

Result: Twelve randomized controlled trials were included. Laser therapy demonstrates significant improvements in pain, grip strength, and functional outcomes for tennis elbow patients. Subgroup analysis reveals that both high-intensity laser therapy ( P = 0.01) and low-level laser therapy ( P < 0.00001) effectively reduce pain versus baseline with comparable efficacy, although high-intensity laser therapy shows nonsignificant improvement versus placebo ( P = 0.07). Regarding functional improvement, high-intensity laser therapy is similar to low-level laser therapy (both significant, P < 0.05). For grip strength, both modalities show significant improvement ( P < 0.05), with high-intensity laser therapy exhibiting superior effects. Further analysis of combination therapies showed that laser combined with bandage demonstrates more significant pain relief and functional improvement.

Conclusions: High-intensity laser therapy and low-level laser therapy are both effective modalities for improving symptoms of tennis elbow (pain, function, and grip strength). Low-level laser therapy demonstrates more consistent significance in pain relief, while high-intensity laser therapy shows greater advantages in enhancing grip strength. More importantly, laser therapy combined with bandage produces synergistic effects, highlighting its value as a key complementary component within multimodal rehabilitation programs.

Objective: The aim of the study was to establish the physiologic baseline (person's physiologic state when their health is stable) for vital signs and urine lab measurements after spinal cord injury.

Design: This case-control study using outpatient data from the national Veteran's Health Administration Corporate Data Warehouse included 2000 veterans with spinal cord injury (cases) and 2000 Veterans without spinal cord injury (controls) between 2018-2019. Cases and controls were randomly selected, and frequency matched for age, sex, race, ethnicity, and Deyo Comorbidity Index.

Results: Spinal cord injury patients had lower temperature, heart rate, respiratory rate, and systolic and diastolic blood pressures than non-spinal cord injury ( P < 0.05). Pyuria and hematuria were higher in spinal cord injury patients, with approximately 73% of tetraplegic and paraplegic patients having urine white blood cells above 10 high power field. Tetraplegic patients had lower heart rate, systolic blood pressure, and diastolic blood pressure than both paraplegic patients and non-spinal cord injury patients ( P < 0.001).

Conclusions: Baseline vital signs were lower in spinal cord injury patients compared with non-spinal cord injury patients. Lower systolic blood pressure, diastolic blood pressure, and heart rate were associated with higher levels of spinal cord injury. Tetraplegic and paraplegic patients had baseline pyuria above 10 high power field suggesting the criteria for pyuria as a positive indicator of urinary tract infection should be different in patients with spinal cord injury than those without spinal cord injury.