Priya Kannan

Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review

QUESTION In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Women with primary dysmenorrhea. INTERVENTION Any form of physiotherapy treatment. OUTCOME MEASURES The primary outcome was menstrual pain intensity and the secondary outcome was quality of life. RESULTS The search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0-10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0-10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life. CONCLUSION Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects.

Management of Myofascial Pain of Upper Trapezius: A Three Group Comparison Study

It is important to identify the most effective therapeutic modality in the management of myofascial trigger points (MTPt). Thus we aimed to study the effect of therapeutic ultrasound, laser and ischemic compression in reducing pain and improving cervical range of motion among patients with MTPt. Experimental study comparing three groups was designed as a 5 days trial, a co-relational design was considered. Outcome measures: VAS for pain, provocative pain test using “soft tissue tenderness grading scheme” and active cervical lateral flexion using inch tape. Methods- Patients were divided into 3 groups, Gr 1 underwent treatment using therapeutic ultrasound, Gr 2 with therapeutic laserand Gr 3 with ischemic compression. Assessments were done on day 1 and day 5 of treatment respectively. Results: ANOVA revealed improvement among all 3 groups as statistically significant difference (p<0.05) between the start and end of trial. Analysis using Chi square test shows a statistically significant difference in the improvement between laser and the other 2 groups. Mean difference in the change of scores between the assessments showed laser therapy to have a tendency towards progressive improvement over the treatment period and a better improvement than the other 2 groups. Weconclude that laser can be used as an effective treatment regimen in the management of myofascial trigger points thereby reducing disability caused due to musculoskeletal pathology.

STRICTA: is it time to do more?

BackgroundIn order to facilitate the completeness and transparency of reporting on randomized controlled trials undertaken using acupuncture interventions, a consensus group of international experts developed the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) in 2002. This reporting guideline was updated in 2010, and was applicable to a broader range of acupuncture research, including uncontrolled trials and case reports. Subsequent evaluations have noted limitations on the impact of STRICTA in the reporting quality of acupuncture trials, and the description of acupuncture details remains poor. Thus improvement in the efficacy of the STRICTA guidelines is called for.DiscussionWe explored the STRICTA guidelines from four aspects, including the development procedure, validity assessment, endorsement and adherence, and citation situation. Based upon these findings, we provided five potential suggestions for further development of STRICTA.SummarySTRICTA are valid reporting guidelines based on robust methodology and scientific content. However specific implementation strategies including: updating the STRICTA checklist; improving the STRICTA reporting efficiency; consistency with implementing the “Instructions for authors” for journals; establishing global STRICTA research centers; and expanding the STRICTA website, are needed. Such strategies will improve their utilization and impact positively on the quality of reporting on acupuncture research outcomes.

Vigorous exercises in the management of primary dysmenorrhea: a feasibility study

Abstract Purpose: To examine the feasibility of using an exercise intervention for reducing menstrual pain associated with primary dysmenorrhea (PD) and to obtain preliminary results to estimate the sample size for a future randomized controlled trial (RCT). Methods: A quasi-experimental design was applied. Ten women 18–45 years with PD were included. The participants underwent vigorous aerobic training at the School of Physiotherapy on a treadmill three times a week for up to 4 weeks followed by aerobic training at home for up to 4 weeks. The feasibility measures were adherence to the intervention programme and intervention prescription, retention and safety. The short form McGill pain questionnaire was used to measure pain at first (T1), second (T2) and third (T3) menstrual cycles following trial entry. Results: Overall adherence was 98%, with 100% adherence to clinic-based intervention and intervention prescription and 96% for home exercise programme. Retention rate was 100%. With respect to pain a large effect size was identified at T2 and T3. No adverse events reported. Conclusions: Results demonstrated that the intervention is applicable and feasible. In addition, the preliminary results show evidence of positive changes after the intervention. The intervention programme’s effectiveness will be studied further, in a future RCT. Implications for Rehabilitation There is a lack of available evidence from randomized controlled trials regarding the use of exercise in alleviating the symptoms associated with primary dysmenorrhea (PD). The preliminary results of this study shows that exercises may be effective in reducing the pain associated with PD indicated by a large effect size. The preliminary findings from this study could also contribute significantly to PD management and introduce new practice opportunities for physiotherapists working in women’s health.

Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles : a systematic review and meta-analysis

Abstract Objectives: To evaluate the effect of ankle positions on pelvic floor muscles in women. Methods: Multiple databases were searched from inception-July 2017. Study quality was rated using the grading of recommendations, assessment, development, and evaluation system and the “threats to validity tool”. Results: Four studies were eligible for inclusion. Meta-analysis revealed significantly greater resting activity of pelvic floor muscles in neutral ankle position (−1.36 (95% CI −2.30, −0.42) p =  0.004) and induced 15° dorsiflexion (−1.65 (95% CI −2.49, −0.81) p =  0.0001) compared to induced 15° plantar flexion. Significantly greater maximal voluntary contraction of pelvic floor was found in dorsiflexion compared to plantar flexion (−2.28 (95% CI −3.96, −0.60) p =  0.008). Meta-analyses revealed no significant differences between the neutral ankle position and 15° dorsiflexion for either resting activity (0.30 (95% CI −0.75, 1.35) p =  0.57) or maximal voluntary contraction (0.97 (95% CI −0.77, 2.72) p =  0.27). Conclusion: Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position. Implications for rehabilitation Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion. As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion. Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position. Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.

Menstrual pain and quality of life in women with primary dysmenorrhea: Rationale, design, and interventions of a randomized controlled trial of effects of a treadmill-based exercise intervention☆

Dysmenorrhea in the absence of pelvic abnormality is termed primary dysmenorrhea (PD). The health burden and social and economic costs of PD are high as it is reported to be the leading cause of recurrent absenteeism from school or work in adolescent girls and young adults. The belief that exercise works for relieving symptoms in women with PD is based on anecdotal evidence and non-experimental studies. There is very limited evidence from randomized controlled trials (RCTs) to support the use of exercise to reduce the intensity of menstrual pain. The objective of this study is to evaluate the effectiveness of exercise to reduce intensity of pain and improve quality of life in women with PD. We describe the study design of a single-blind (assessor), prospective, two-arm RCT, and the participant characteristics of the 70 women recruited in the age-group 18 to 43 years. The primary outcome of the study is pain intensity. The secondary outcomes of the study are quality of life, functional limitation, sleep, global improvement with treatment, and protocol adherence. The outcomes assessments are done at first menstrual period (baseline, Week 0), 2nd menstrual period (Week 4) and at two additional time points (Week 16 and Week 28) during the trial. The results of the study will provide physiotherapists, medical practitioners, and researchers as well as the women who have PD with new insights, knowledge, and evidence about the use of exercise to manage pain in women with PD.

Effectiveness of Pelvic Floor Muscle Training Alone and in Combination With Biofeedback, Electrical Stimulation, or Both Compared to Control for Urinary Incontinence in Men Following Prostatectomy: Systematic Review and Meta-Analysis

Background The efficacy of pelvic floor muscle training (PFMT) alone and in combination with biofeedback (BFB), electrical stimulation (ES), or both for urinary incontinence in men following prostatectomy is inconclusive. Purpose The purpose of this study was to determine whether PFMT works well alone or in combination with BFB, ES, or both in comparison with a control. Data Sources The databases Ovid Medline, EMBASE, CENTRAL, Scopus, and Web of Science, and the specialized register of the Citroen Incontinence Review Group were searched from study inception to August 2017. Abstract proceedings from urological meetings, including the European Association of Urology and the American Urological Association, were also searched. Study Selection Randomized controlled trials that compared PFMT alone and PFMT with ES, BFB, or both and no treatment, placebo, or sham were included in the review. Data Extraction, Synthesis, and Quality Two independent reviewers completed data extraction and quality appraisal. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used for quality appraisal. Meta-analysis was done with software used for preparing and maintaining Cochrane reviews. Limitations Methodological flaws in the included studies limited internal validity. Conclusions PFMT alone, PFMT plus BFB and ES, and PFMT plus ES were more effective than the control for urinary incontinence following prostatectomy. The effect of PFMT plus BFB on postprostatectomy incontinence remains uncertain.

Can pre-screening vestibulocerebellar involvement followed by targeted training improve the outcomes of balance in cerebellar ataxia?

Balance problems and frequent falls are common among clients with Cerebellar Ataxia (CA). CA is not a disease by itself but a collection of symptoms due to the involvement of cerebellum or its pathways. Presently the treatment for balance problems for CA is not standardized. Interventions available to improve balance are not specific to symptoms presentation. Functionally the cerebellum is divided into the spinocerebellum, vestibulocerebellum and corticocerebellum. Each functional zone has a distinct role in maintaining balance. Therefore, the presentation of symptoms will vary according to the functional zone involved. Pre-screening clients with CA for identifying the part of cerebellum involved will facilitate clinicians to provide tailor-made interventions for targeting specific symptoms for better outcomes. Pre-screening clients with CA according to the part of cerebellum involved is not in practice and our study will introduce this concept. We hypothesize pre-screening participants with spinocerebellar ataxia (SCA) for the involvement vestibulocerebellum followed by prescribing vestibulocerebellum targeted exercises will have better outcomes when compared to conventional balance training. We plan to conduct two related studies. In study 1 we will screen participants with CA for the involvement of vestibulocerebellum. In study 2, the effects of vestibulocerebellum targeted balance exercises on balance will be studied. We will assess the Subjective Visual Vertical (SVV) deviation and postural sway pattern to screen participants into people with and without vestibulocerebellar involvement. SVV deviation will be estimated using a computerized Subjective Visual Vertical (cSVV) device and postural sway pattern will be assessed using the limits of stability program of the Bertec© Balance system. The obtained SVV deviation scores will be used to derive at cut-off scores to discriminate clients with and without vestibulocerebellar involvement. The second study will test the treatment effects of conventional exercises plus vestibulocerebellum targeted exercises to improve balance by correcting SVV deviation in SCA with vestibulocerebellar involvement. The intervention is planned as 12 one-to-one sessions over three months period. Participants will be reassessed after the intervention and 3 months post-intervention. The findings of this cutting-edge research are extremely important to the clinicians, researchers and clients with SCA.

Does Tai Chi improve balance and reduce falls incidence in neurological disorders? A systematic review and meta-analysis:

Objective: To evaluate the effect of Tai Chi on balance and reducing falls incidence in neurological disorders. Data sources: AMED, Embase, Web of Science, SCOPUS, EBSCO and Medline from inception until February 2018. Review method: Randomized controlled trials of Tai Chi compared with active or no treatment control, measuring balance with the Berg Balance Scale or the Timed Up and Go Test and number of falls in neurological disorders were included. Methodological quality was assessed using PEDro and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results: A total of 10 studies involving 720 participants were reviewed. Seven studies were in Parkinson’s disease and three in stroke. Seven studies were of high methodological quality and three were low. Meta-analyses of balance measured with the Timed Up and Go Test in Parkinson’s disease revealed a statistically significant effect of Tai Chi compared to no treatment (weighted mean difference (WMD), –2.13; 95% confidence interval (CI), −3.26 to −1.00; P < 0.001) and was insignificant (WMD, −0.19; 95% CI, −1.74 to 1.35; P = 0.81) when compared with active treatment. Tai Chi significantly reduced falls incidence in Parkinson’s disease (odds ratio (OR), 0.47; 95% CI, 0.29 to 0.77; P = 0.003) and stroke (OR, 0.21; 95% CI, 0.09 to 0.48; P < 0.001). Balance measured with the Timed Up and Go Test comparing Tai Chi and active treatment was insignificant (WMD, 0.45; 95% CI, –3.43 to 2.54; P = 0.77) in stroke. Conclusion: Tai Chi is effective in reducing falls incidence in Parkinson’s disease and stroke. This systematic review did not find high-quality studies among other neurological disorders.

Physiological rationales of physical therapy interventions in the management of primary dysmenorrhea: a critical review

Abstract Background: The mechanisms underlying the physical therapy interventions for obtaining relief from primary dysmenorrhea (PD) symptoms are not fully understood. Objective: To provide an overview of the physiological rationales from randomized controlled trials (RCTs) on how physical therapy interventions in the management of PD might work. Methods: Databases CINAHL, PEDro, Embase, Web of Science, Ovid Medline, and AMED were searched from database inception to October 2014 using related terms for dysmenorrhea and physical therapy interventions. Trials were independently selected and data extracted by two reviewers. Results: The search yielded 287 citations; 26 RCTs met the inclusion criteria and were included for review. Among the 26 included trials, eight trials on acupressure, seven on acupuncture, and five on TENS, two on spinal manipulation, one on low-level light therapy (LLLT), one on heat, one on far-infrared ray, and one on yoga were identified. The predominant physiological rationales identified in the RCTs are endogenous opioid mechanisms (n = 12), gate-control theory (n = 8), and traditional Chinese medicine (TCM) theory (n = 6). A few trials reported up to four different rationales. Conclusions: The analgesic effect of acupuncture is primarily through the release of endogenous opioids and hormones. In addition, practitioners of TCM believe that acupuncture alleviates pain of PD by regulating the prostaglandin levels. Acupressure, heat, high frequency transcutaneous electrical nerve stimulation (TENS), and yoga are proposed to work by segmental inhibition of pain pathway.