JPMRE

Long-term Efficacy of Dextrose Prolotherapy versus Hyaluronic Acid in Knee Osteoarthritis

Zahra Rezasoltani — 2020-06-05

Background: Osteoarthritis (OA) is the most common form of arthritis. Management of OA includes lifestyle modification, exercise, supportive care, weight control, pharmacological treatment, intra-articular injection, and surgery. Due to little knowledge about knee prolotherapy, in this study, we investigated the efficacy of prolotherapy for knee OA compared with hyaluronic acid (HA).

Methods: In this prospective randomized blinded clinical trial, after the diagnosis of OA, the range of motion (ROM), joint line tenderness, pain intensity [visual analog scale (VAS) score], and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire were evaluated. Randomization was performed by concealed allocation using computer software. The participants, outcome assessor, physical examiner, and radiologist were blinded to injection group status. Three intra-articular injections (every month in prolotherapy
group and every week in the HA group) were performed. Patients at one week, one month, three months, eight months, and nine months after the end of treatment were re-evaluated.

Results: A total of 130 patients were screened and finally 61 patients in the HA group and 53 in the dextrose prolotherapy group completed the study. In the dextrose prolotherapy group, changes in joint ROM had an upward trend, but pain intensity and the total WOMAC score constituted a downward pattern and in the HA group, maximum improvement was achieved between 4 to 6 months after the last injection, followed by a slightly progressive worsening after 6 to 12 months. The final clinical scores remained higher compared with baseline in both groups (P < 0.001). The mean scores for all patients significantly improved (P < 0.001 for VAS and P < 0.030 for ROM) from baseline to months 6 and 12. However, dextrose prolotherapy group had a significantly greater improvement (P < 0.001) than HA group.

Conclusion: Dextrose prolotherapy showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Therefore, it can be a good choice for the treatment of knee OA.

Comparison of Manual Treatment and Co-administration of Methylprednisolone Injection with Manipulation in Coccydynia

Mohammadjavad Hadianfard — 2020-06-05

Background: This study was conducted to evaluate the usefulness of manipulation along with local methylprednisolone acetate injection on the improvement of chronic coccydynia.

Methods: A randomized trial was designed. Thirty patients were recruited and divided randomly into two groups. The first group received three sessions of manual therapy based on Maigne and Thiele methods. The other group received manipulation with injection of methylprednisolone acetate around the coccyx and sacrococcygeal and intercoccygeal joints. Then, the patients were followed up for one day, a week, a month, and three months after the intervention. Severity of pain was assessed by Visual Analog Scale (VAS) and the Paris (functional coccydynia impact) Questionnaire during the follow-ups. Finally, the data were analyzed using a repeated measures analysis of variance (ANOVA) model.

Results: The mean duration of coccygeal pain was 23.3 ± 38.3 months. There were not any significant differences between the two groups regarding the age and duration of coccydynia. The results of repeated ANOVA indicated that the pain decreased during three months of the follow-up in both groups significantly (P < 0.0001). However, there was no statistically significant difference between the two groups regarding the pain reduction (P = 0.691).

Conclusion: One episode of injection of methylprednisolone acetate can limit the treatment sessions of manipulation to just one session without additive effect on pain reduction.

Transcranial Direct Current Stimulation Efficacy on Pain and Quality of Life of Patients with Fibromyalgia Syndrome

Afsaneh Dadarkhah — 2020-06-05

Background: Fibromyalgia (FM) is a chronic pain disorder which is determined by pain and accompanying symptoms such as emotional distress, fatigue, and sleep inconvenience. One opinion is that it may be associated with changes in pain and sensory processing in the central nervous system (CNS), especially nociceptive pathways. The purpose of this study is to assess the efficacy of transcranial direct current stimulation (tDCS) on pain and quality of life (QOL) of patients with FM syndrome (FMS) by affecting the level of neurotransmitters and changing the functional connectivity of the stimulated region.

Methods: This study was a randomized double-blinded sham-control clinical trial. The groups were matched in terms of gender, age, education, pain duration, and premenstrual syndrome. In the case group, patients received M1 anodal stimulation with 2 mA constant current for 20 minutes for ten sessions (3 times a week). QOL and pain improvement were measured with Fibromyalgia Impact Questionnaire (FIQ) and Visual Analog Scale (VAS) forms before and 2 weeks (short-term) and 10 weeks (long-term) after the 10-session treatments.

Results: 80 patients with inclusion criteria were enrolled, out of which 12 were excluded due to lack of cooperation. The remaining 68 patients [46 (68%) women] had an average age of 46 years. Pain intensity was significantly lower in the case group compared to the sham group 2 weeks and 10 weeks after the treatment (P < 0.001). The QOL in patients 2 weeks after the treatment showed no significant improvement compared to the baseline, but 10 weeks after the treatment, QOL was higher than the sham group (P < 0.001).

Conclusion: Our results imply that tDCS is a safe and effective method in treating patients with FMS by reducing the pain and QOL improvement.

Comparison of the Effect of Hip, Knee, and Ankle Fatigue on Dynamic Balance of Armed Forces

Zahra Rezasoltani — 2020-06-05

Background: Muscles of the lower limbs play a very important role in the control of balance and performance in military activities. Fatigue in these muscles results in a decrease in balance and increase in risk of damage. Thus, it is important to determine the group of muscles in which fatigue has more effect on dynamic balance in the armed forces. Therefore, this study was aimed at the investigation of the effects of fatigue in each group of lower limb muscles on dynamic balance of the armed forces and risk assessment of damage to the military.

Methods: The participants of the current study included 15 military personnel with a mean age of 27.00 ± 2.12 years and mean height of 178.1 ± 3.1 cm. This study used star excursion balance test (SEBT) to measure balance and used the ankle plantar flexion system, knee extension system, knee flexion system, thigh abduction system, and thigh adduction system to assess fatigue. First, all the participants were asked to warm up for about 5 minutes. Then, using a annual dynamometer, the maximal voluntary contraction ‎(MVC) for the muscles was measured. A 50% reduction in MVC is associated with fatigue. Nevertheless, if the individual was able to continue exercise after 50 extensions, he was given a 4-minute rest and the measurement was performed again using the dynamometer. If MVC was reduced by 50%, the SEBT was immediately performed. To analyze data, descriptive statistics, paired t-test, and repeated measures analysis of variance (ANOVA) test were used at a significance level of P ≤ 0.05.

Results: Comparison of the total mean of balance in the SEBT before and after fatigue showed that there was a significant decrease in balance after fatigue in all 5 groups of muscles (knee extensor, knee flexor, thigh abductor, thigh adductor, and ankle plantar flexor) (P ≤ 0.05). The results of ANOVA for the total mean score of muscles did not show a significant statistical difference (P ≥ 0.05). However, there was a significant difference between the thigh abductor muscles, ankle plantar flexor, and knee extensors in terms of the anterior and anterolateral direction scores (P ≤ 0.05).

Conclusion: The findings of the current study showed an inverse relationship between lower limb fatigue and an individual’s balance; an increase in fatigue in the muscles resulted in a decrease in balance.

Undergraduate Medical Students’ Curriculum of Physical Medicine and Rehabilitation

Seyed Mansoor Rayegani — 2020-06-05

Education in medical specialties is one of the most important ways to expand and grow these fields. Physical medicine and rehabilitation is one of the specialties that is less present in the curriculum of medical students than other specialties. The main focus of physical medicine and rehabilitation training programs is mainly on training assistants and subspecialty residents and fellows. One of the necessities in the medical community is to complete the health chain by strengthening or adding a rehabilitation ring. The main and major factor in the development and recognition of the field of rehabilitation medicine is to acquaint medical students with the concepts and applications of this field. In some countries, rehabilitation rotation is mandatory during hospital training, such as internships, and in some countries, such as Iran, it is optional. But in most countries, there is no physical medicine and rehabilitation course. Due to the increasing population of patients in need of rehabilitation services and the high share of disabilities in the burden of disease and the effective role of rehabilitation in reducing the complications of debilitating diseases, it is necessary to include physical education and rehabilitation training program in general medicine. The International Society of Physical Medicine and Rehabilitation (ISPRM) is currently completing and modifying this training program. It is hoped that with the publication of this program, we will be able to seriously provide training in the basic concepts of rehabilitation in general medicine.