Sina Esmaeilzadeh

The effects of strengthening and high-impact exercises on bone metabolism and quality of life in postmenopausal women: A randomized controlled trial

BACKGROUND AND OBJECTIVE The aim of this prospective, randomized controlled 6-month interventional trial was to investigate the effects of strengthening and high-impact exercise training on bone mineral density (BMD), bone turnover markers and health-related quality of life (HRQoL) in postmenopausal women. MATERIAL AND METHODS Forty-two eligible postmenopausal women with osteopenia who referred to our outpatient clinics were included in the study and allocated equally to three groups receiving strengthening exercise, high-impact exercise or no exercise (control). The supervised training program consisted of a one-hour exercise session three times a week for six months. BMD at the L1-L4 and femoral neck, serum bone turnover markers (osteocalcin, OC; N-telopeptides of type I collagen, NTx) and HRQoL were measured at the beginning and sixth months. RESULTS There was a significant increase in the BMD at the lumbar spine (p=0.017) and femoral neck (p=0.013) in the high-impact group compared to the strengthening and control groups. Serum OC (p=0.033) increased, and NTx (p=0.034) decreased significantly only in the high-impact group. HRQoL improved significantly in both training groups (p< 0.001). CONCLUSIONS Our data suggest that 6-month supervised high-impact exercise training can be effective in prevention of bone loss at lumbar spine and femoral neck. These data also indicate that both supervised training programs improve HRQoL in postmenopausal women.

Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis: A Double-Blind, Randomized, Placebo-Controlled Trial.

ObjectivesThe aim of this study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on pain, function, and grip strength in the treatment of patients with lateral epicondylitis unresponsive to previous treatments. DesignA double-blind, randomized, placebo-controlled trial was conducted in outpatient clinics in a medical faculty hospital. Fifty-six patients with lateral epicondylitis were randomized to rESWT (n = 28) or sham rESWT (n = 28) groups. Both the patients and the outcome assessing investigator were blinded to group assignment. The rESWT was administered to the painful epicondyle at the elbow with a total of 2000 pulses of 10 Hz frequency at a 1.8 bar of air pressure at each session at three once weekly sessions. Sham rESWT was applied without the contact of the applicator at the same area. Study patients were assessed at baseline and at 1 and 3 mos after treatment using a visual analog scale for pain and Roles and Maudsley scale and Patient-Rated Tennis Elbow Evaluation for pain and function. Grip strength of the affected extremity was also measured using a hand dynamometer. ResultsBoth rESWT and sham rESWT groups showed a significant improvement in all outcome measures at posttreatment follow-up points. Favorable absolute and percentage changes in assessments at 1- and 3-mo posttreatment did not show any significant difference between groups. ConclusionsThe rESWT does not seem to be more effective either in reducing pain or improving function or grip strength in patients with lateral epicondylitis at least at 3 mos after treatment when compared with sham rESWT.

The utility of the International Classification of Functioning, Disability and Health checklist for evaluating disability in a community-dwelling geriatric population sample.

The aim of this study was to investigate disability in community-dwelling individuals aged 65 years and over using the International Classification of Functioning, Disability and Health (ICF) checklist and the World Health Organization Disability Assessment Schedule II (WHODAS-II) and to compare how these two ICF-based instruments measured disability in an attempt to show the utility of the ICF checklist in a field setting to describe disability. In this population-based, cross-sectional and descriptive study, data on the ICF checklist and the WHODAS-II were collected from 200 selected participants who lived in a small town. Both the ICF checklist and the WHODAS-II identified a considerable proportion of the elderly with a disability in life areas relevant to cognition and domestic life in a similar manner, the proportions ranging from 52.5 to 68.5%. However, the proportions of those with a disability showed a statistically significant difference in the domains of the two instruments relevant to mobility, self-care, and participation in society. Although the absolute intrarater agreement for matching items of the instruments ranged from 40.5 to 87.5%, kappa statistics showed slight to moderate agreement for the original ICF qualifier and mostly moderate agreement with reduced response options. ICF qualifiers were found to discriminate between the WHODAS-II domain scores in those with no, mild-moderate and severe-complete difficulty. The disparity between the data obtained from the ICF checklist and the WHODAS-II in some domains may have resulted from differing interpretations of the items of the ICF checklist, lower reliability of some of the items, and the current feature of the qualifiers used without any adaptations. The ICF checklist has the potential to be used in a field setting, provided that some modifications are made.

Evaluation of the Sympathetic Skin Response to the Dry Needling Treatment in Female Myofascial Pain Syndrome Patients

Background The aim of this study was to evaluate sympathetic nervous system (SNS) activity following dry needling (DN) treatment, by using the sympathetic skin response (SSR) method in female patients diagnosed with myofascial pain syndrome (MPS). Methods Twenty-nine MPS patients with trapezius muscle pain and 31 healthy subjects were included in this study. During a single treatment session, DN treatment was applied into trigger points, for a duration of 10 minutes. Healthy patients were subjected to SSR in weeks 1 and 4; whereas the patient group was subjected to SSR 1 week prior to their treatment and in the first, second, third and fourth weeks following the completion of their treatment. Results We found diminished latency on both sides. A significantly high algometer measurement (P < 0.05) was observed in the control group. DN treatment was effective in diminishing the visual analog scale (VAS) (P < 0.001), pressure pain threshold (PPT) (P < 0.01), and SSR (P < 0.001). No SSR change was detected in the healthy group after the follow-up period (P > 0.05). Conclusion DN is an effective treatment in MPS and trigger point (TP). This original study is the first to deal with the SSR in MPS and weekly SSR trailing, requiring further investigation to solidy findings.

Effect of an early supervised rehabilitation programme compared with home-based exercise after temporomandibular joint condylar discopexy: a randomized controlled trial

The goal of rehabilitation after temporomandibular joint (TMJ) surgery is to achieve a normal range of motion. The aim of this study was to compare the impact of a comprehensive and early supervised rehabilitation programme with home-based exercise after TMJ condylar discopexy. Patients diagnosed with disc displacement without reduction were randomized to the study and control groups. After baseline assessments, the same surgical condylar discopexy procedure was applied to both groups. Following surgery, the study group patients underwent a supervised exercise programme conducted by a physiotherapist in the outpatient clinic. This comprised 30-min sessions 3 days per week for 8 weeks in the hospital. The control group patients performed the same exercise programme at home. Maximum mouth opening (MMO), protrusion, and right and left lateral movements were measured. Based on the results, the supervised rehabilitation programme yielded significantly better outcomes for pain at rest and with activity, MMO, and protrusion compared with the home-based exercise programme. Also certain parameters of quality of life improved significantly in the study group. In conclusion, exercise therapy is the cornerstone of rehabilitation of the TMJ, and a supervised rehabilitation programme after TMJ surgery is effective in improving functional parameters.

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study.

ABSTRACT Purpose: Dual-energy X-ray absorptiometry (DXA) is considered the “gold standard” in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case–control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX® (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. Materials and methods: This case–control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX® 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. Results: While all DXA BMD, and QUS variables and FRAX® fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX® major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. Conclusions: It can be concluded that QUS variables, particularly BUA, and FRAX® major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures.

Discriminative ability of calcaneal quantitative ultrasound compared with dual-energy X-ray absorptiometry in men with hip or distal forearm fractures

Objectives The aim of this case–control study was to compare the discriminatory ability of bone mineral density (BMD) measurements and calcaneal quantitative ultrasound (QUS) parameters for fractures and to determine fracture thresholds for each variable in men with hip or distal forearm fractures. Patients and methods A total of 20 men with hip and 18 men with distal forearm fractures and 38 age-matched controls were included in this study. Dual-energy X-ray absorptiometry (DXA) BMD (spine and hip) and calcaneal QUS measurements were made. Area under the curves (AUCs) were calculated to assess fracture discriminatory power of DXA and QUS variables. Results Quantitative Ultrasound Index (QUI) T-score and Speed of Sound (SOS) were found to be the best parameters for the identification of hip and distal forearm fractures, respectively, with AUCs greater than those of DXA BMD and other QUS parameters. While a QUI T-score of ≤−1.18 could identify and rule out hip fracture cases with approximately 80% sensitivity and specificity, a SOS value of ≤1529.75 reached to almost 90% for ruling in and out distal forearm fractures. Conclusion The discriminatory performance of calcaneal QUS variables between fractured and non-fractured men was as good as those of the DXA BMD and even better. Since men appear to sustain fractures at closer QUS variable levels than those of the DXA BMD regardless of the fracture type, it may be speculated that calcaneal QUS may be more helpful in predicting the risk of fractures when BMD alone does not demonstrate impaired bones. Level of Evidence: Level III, Study of Diagnostic Test

AB0667 The effectiveness of therapeutic ultrasound in non-specific mechanical cervical pain and comparison of different application methods for clinical practice

Objectives The aim of this study was to investigate the effectiveness of therapeutic ultrasound (US) in non-specific mechanical neck pain, and to compare the effects of intermittent and continuous US applications on pain severity and functional disability. Methods Seventy-one patients, aged between 18 and 65, with non-spesific mechanical neck pain suffering from less than three months were included the study. After the baseline measurements, patients were randomized to three physical treatment groups. US was applied at 1.5 Watt/cm2 power, 100 Hz, 1 MHz frequency with 50% duty cycle intermittently in the first group and 1.5 Watt/cm2 power, 100 Hz, 1 MHz frequency continuously in the second group while the third group received sham US application during 10 sessions. Three groups were also treated with transcutaneous electrical nerve stimulation. Patients were evaluated by visual analog scale and algometer for pain severity and sensitivity level of painful point on cervical region, also neck disability index was used for assessment of functional disability. Active cervical range of motion was measured by using goniometer. Control measurements were done after physical therapy and three months later after therapy. Results Fifty-three patients completed the study. Seventeen (32.1%) of them were in intermittent US group, 19 (35.8%) of them were in continuous US group and 17 (32.1%) of them were in placebo US group. The groups were homogeneous regarding to age, gender, body mass index and baseline measurements. Pain severity was improved statistically significant in three groups after the treatment and three months later after therapy (p<0.001). Pain pressure threshold (PPT) was increased statistically significant in the first and second group after the treatment (p<0.05), while PPT was decreased in control group. Three months later after therapy PPT was increased statistically significant in all of three groups (p<0.05). There were no statistically significant differences between three groups regarding to pain severity and PPT improvements (p>0.05). There were no statistically significant changes in cervical range of motion after intermittent US application (p>0.05). Cervical range of motion was statistically significant increased at three planes after continuous US application but, there were no significant differences between continuous and placebo applications (p>0.05). Continuous US was observed more effective than intermittent application in cervical rotation range when the groups were compared after the physical therapy sessions. Statistically significant improvement was observed in functional disability for all of three groups after physical therapy sessions and three months later after therapy (p>0.05). Continuous application was observed more effective when the group were compared in terms of functional recovery. Conclusions Therapeutic US applications are effective in reducing the severity of pain and sensitivity level of painful point on cervical region by increasing PPT, furthermore it affects the functional status positively by increasing cervical range of motion. Disclosure of Interest None Declared

Poster 404 The Impact of Ankylosing Spondylitis on Work Productivity in Patients with Paid Work

Disclosures: Juewon Khwarg: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 46-year-old man with history of chronic tophaceous gout presented with one week of acute, severe back pain radiating into the lower extremities. Pain was associated with numbness and weakness. He denied bowel/bladder changes or previous history of back pain. Patient reported twenty-year history of using 5-day courses of prednisone, obtained from local area EDs, monthly for persistent gouty pain. Lumbar spine MRI found epidural lipomatosis producing canal narrowing with effacement of the CSF containing spaces diffusely at L1-S1 levels. Inpatient EMG of the lower extremities was suggestive of spinal canal stenosis. Neurosurgery recommended monitoring but declined laminectomy. Patient was admitted to ARU where he participated in physical and occupational therapy, optimization of anti-gout regiment, and initiation of a neuropathic pain medication regiment. Setting: Emergency room, Acute rehabilitation unit. Results: Patient was discharged home with close follow-up by rheumatology and PM&R. At time of discharge, patient was able to ambulate independently and with reduced pain. Discussion: Epidural lipomatosis is a rare phenomenon of excessive adipose tissue deposition in the epidural space, with potential compression of the spinal cord. Presentation is consistent with progressive back pain, myelopathy or radicular signs. Most cases are associated with exogenous steroid use, though this pathology has also been associated with Cushing’s disease, hypothyroidism and pituitary prolactinomas. Diagnosis is made by clinical exam and MRI, with characteristic findings of adipose deposition in the epidural space. From a review of the literature, a conservative treatment approach with a focus on treating underlying pathologies, weaning off exogenous steroids, encouraging weight loss, optimizing pain medication and engaging the patient in physical modalities is helpful. Laminectomy for epidural lipomatosis have been associated with high mortality rates in the post-treatment phase, but may be required in the setting of neurological emergencies. Conclusions: Epidural lipomatosis is a rare cause of back pain usually associated with exogenous steroid use. Level of Evidence: Level V

Poster 383 Effects of Dextrose Prolotherapy in the Treatment of Patients with Knee Osteoarthritis: A Randomized Controlled Trial.

Disclosures: Alketa Toska Sert: I Have No Relevant Financial Relationships To Disclose Objective: The aim of our study was to determine the effects of dextrose prolotherapy in patients with knee osteoarthritis (KOA). Design: Prospective, randomized, controlled clinical trial. Setting: The outpatient clinics in our department. Participants: A total of 66 patients who had knee pain for more than three months and diagnosed as Grade II or III KOA according to the Kellgren-Lawrence Classification were included in the study and allocated to three groups: Dextrose Prolotherapy Group (DPG; n. 22), Saline Group (SG; n. 22), and Control Group (CG; n. 22). Interventions: The prolotherapy dextrose and saline plus local anesthetic injection were administered to the DPG and SG, respectively at the beginning, 3-, and 6-week of the study. The patients in the CG group did not receive any type of injection. The same home exercise program was prescribed for all patients in the three groups. Main Outcome Measures: The pain, function status, and quality of life was evaluated by Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form36 (SF-36), respectively. Results: The mean age of the patients was 54.1 6.8 years. The VASpain and all of the WOMAC scores decreased significantly in the DPG compared with the SG and CG at 18-week follow-up (P <.05). While a significant improvement in the physical functioning, physical role restriction, pain, emotional role restriction, and physical health total scores of the SF-36 was determined in the DPG compared with the SFG and the KG (P <.05) at 18-week assessment, there were no significant difference in the general health, vitality, social function, and mental health total scores (P >.05). Conclusions: These data suggested that dextrose prolotherapy was effective in reducing pain and improving the quality of life and the functional status in patients with KOA. We can conclude that dextrose prolotherapy is an effective and safe treatment method in patients with KOA. Level of Evidence: Level I