Abin Abraham Mammen.
Background: Trigger point is a extremely irritable local spot of exquisite tenderness in the nodule
within the tangible taut muscle band. The prevalence studies have shown that the occurrence of myofascial trigger point in the general population.
Objective: The aim of the study was compare the effects of low level laser therapy( LLLT) Vs
ultrasound therapy in the management of active trapezius trigger point.
Methodology: The participants will be allocated into two groups using simple random sampling.
One group has to be given Low level laser therapy (LLLT) and Moist Heat and other group treated
with US and Moist Heat. Both group receive treatment for 3 times a week. Total number of 9
session has to be given in 21 days. The outcome measure has to be taken at the first day and end
of the day.
Conclusion: Based on the above results we conclude that Low Level Laser Therapy can be used as a therapeutic device in the management of Active Trapezius Trigger points.
Low-level laser therapy (LLLT) involves applying red or near-infrared light to injuries or lesions to improve wound and soft tissue healing and provide pain relief. LLLT works by stimulating cellular activity through absorption by chromophores like cytochrome c oxidase in the mitochondria. Clinical studies show LLLT can speed wound healing, reduce pain, and treat conditions like tendonitis. While LLLT dosage is challenging to define precisely due to variable beam shapes and densities, clinical results generally improve with higher total energy delivery.
This randomized controlled trial evaluated the effectiveness of low-level laser therapy (LLT) for treating chronic knee pain. 126 patients with knee osteoarthritis were randomly assigned to receive either active laser treatment or sham laser treatment over 12 sessions within 4 weeks. The primary outcome was pain level measured using a visual analog scale (VAS) from 0-10. Results showed that the active laser treatment provided significant pain relief and osteoarthritic improvements compared to the sham laser, with statistical significance of p<0.01 in reduced VAS scores from baseline to 30-day follow-up. The laser treatment was thus found to be an effective adjunctive therapy for chronic knee pain.
Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) an...MusaDanazumi
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
Management of Non Disco-genic low back pain: Our Experience of 40 Cases of RF...Apollo Hospitals
RF) rhizotomy or neurotomy is a therapeutic procedure
designed to decrease and/or eliminate pain symptoms arising from degenerative facet joints within the spine. The procedure involves denaturation of proteins in the nerves with highly localized heat generated with radiofrequency thus functionally destroying the nerves that innervate the facet joints. By destroying these nerves, the communication link that signals pain from the facet joint to the brain can be broken. The onset of lumbar facet joint pain is usually insidious, with predispos- ing factors including degenerative disc pathology and old age.
Abin Abraham Mammen.
Background: Trigger point is a extremely irritable local spot of exquisite tenderness in the nodule
within the tangible taut muscle band. The prevalence studies have shown that the occurrence of myofascial trigger point in the general population.
Objective: The aim of the study was compare the effects of low level laser therapy( LLLT) Vs
ultrasound therapy in the management of active trapezius trigger point.
Methodology: The participants will be allocated into two groups using simple random sampling.
One group has to be given Low level laser therapy (LLLT) and Moist Heat and other group treated
with US and Moist Heat. Both group receive treatment for 3 times a week. Total number of 9
session has to be given in 21 days. The outcome measure has to be taken at the first day and end
of the day.
Conclusion: Based on the above results we conclude that Low Level Laser Therapy can be used as a therapeutic device in the management of Active Trapezius Trigger points.
Low-level laser therapy (LLLT) involves applying red or near-infrared light to injuries or lesions to improve wound and soft tissue healing and provide pain relief. LLLT works by stimulating cellular activity through absorption by chromophores like cytochrome c oxidase in the mitochondria. Clinical studies show LLLT can speed wound healing, reduce pain, and treat conditions like tendonitis. While LLLT dosage is challenging to define precisely due to variable beam shapes and densities, clinical results generally improve with higher total energy delivery.
This randomized controlled trial evaluated the effectiveness of low-level laser therapy (LLT) for treating chronic knee pain. 126 patients with knee osteoarthritis were randomly assigned to receive either active laser treatment or sham laser treatment over 12 sessions within 4 weeks. The primary outcome was pain level measured using a visual analog scale (VAS) from 0-10. Results showed that the active laser treatment provided significant pain relief and osteoarthritic improvements compared to the sham laser, with statistical significance of p<0.01 in reduced VAS scores from baseline to 30-day follow-up. The laser treatment was thus found to be an effective adjunctive therapy for chronic knee pain.
Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) an...MusaDanazumi
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
Management of Non Disco-genic low back pain: Our Experience of 40 Cases of RF...Apollo Hospitals
RF) rhizotomy or neurotomy is a therapeutic procedure
designed to decrease and/or eliminate pain symptoms arising from degenerative facet joints within the spine. The procedure involves denaturation of proteins in the nerves with highly localized heat generated with radiofrequency thus functionally destroying the nerves that innervate the facet joints. By destroying these nerves, the communication link that signals pain from the facet joint to the brain can be broken. The onset of lumbar facet joint pain is usually insidious, with predispos- ing factors including degenerative disc pathology and old age.
Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromia...ijtsrd
Introduction Subacromial impingement syndrome SIS is commonest among various joint pains. Study is done in order to compose the efficacy of PEMF treatment of various duration for patients with SIS. Subject and Methods One hundred and eight patients who had been diagnosed with subacromial impingement syndrome by clinical examination. Patients were sequentially enrolled following informed consent were administered PEMF therapy for 15 minutes combined with exercise therapy. The second group received the same treatment except that each of the patients has received 30 minutes therapy the patients were evaluated before and after the treatment. Parameters examined were pain score, disability score and range of motion at shoulder joint. Result Second group was significantly improved in pain score, disability score and range of motion. Conclusion 30 minutes of PEMF therapy was shown to be more effective than 15 minutes of PEMF therapy. Anuja Pasari | Bismay Das | C. Monanty | Saurabh Singh | Sujoy Roy | T. B. Singh "Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromial Impingement Syndrome" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38177.pdf Paper URL : https://www.ijtsrd.com/medicine/other/38177/comparison-of-pemf-therapy-of-various-duration-in-the-treatment-of-subacromial-impingement-syndrome/anuja-pasari
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
paper regarding implementation of shakers exercise for impaired swallowing patients and compare pre , immediate and post implementation of the exercises
1) The document describes a study on the effects of low level laser therapy (LLLT) on human appendicular bone fracture healing.
2) A total of 40 patients with fractures were divided into a laser group (20 patients) who received LLLT, and a control group (20 patients) who did not.
3) Results showed the laser group had better clinical outcomes like less pain and earlier movement, and radiological outcomes like faster/greater callus formation and bone density increases.
4) The study concluded LLLT can accelerate bone union and enhance healing when used as an adjunct to standard fracture treatment.
Background:
Osteoarthritis (OA) is one of the most common joint disorders in the elderly
Webermedical intra-articular laser ( WEL) therapy makes it possible to irradiate directly in the tissue.Infrared laser(IR) has dose-dependent anti-inflammatory effect on OA . Thermal radiofrequency (RF) of the knee joint articular nerve branches were targeted to address the entire nociception and stiffness in OA3.This study aimed to investigate the effects of WEL and TRF on nonspecific knee joint pain.
Case report:
50 patients suffering from non-specific knee pain for more than 3 months with no response to conservative treatments ,were enrolled in the study with Knee pain rated 44 mm or greater on the pain visual analogue scale (VAS) and 4 or greater on the Numeric rating scale ( NRS).Procedures performed from Feb. to Oct. 2014 Cairo, Egypt. Assessment of pain was done at baseline then weekly post procedure for 1 month then at 1-month follow-up visits for 6 months.
Patients of the 1st group received WEL Blue and IR, using Ultrasound guided imaging, 2 WEL needles were advanced successively in the retro-patellar recess. The procedure includes 3 sessions with 1 week interval. Patients of the 2nd group received RF with temperature 80°C for 90 sec.,2 cycles, using fluoroscopy guided imaging ,3 of the 5 genicular nerves were targeted.
Impact of exercise program on functional status among post lumbar laminectom...Alexander Decker
This document summarizes a study that evaluated the impact of an exercise program on functional status in post-lumbar laminectomy patients. The study involved 30 patients who underwent a 6-week exercise program after lumbar laminectomy surgery. Outcome measures assessed pre-and post-operatively included pain, functional status, range of motion, and disability levels. The results showed that after participating in the exercise program, patients demonstrated significantly reduced pain levels and functional disabilities compared to pre-operative levels. The study concluded that exercise programs can effectively improve outcomes for post-lumbar laminectomy patients.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
This study examined the effects of using the upper limb tension test (ULTT) as a neural mobilization technique in addition to conservative treatment for patients with cervical radiculopathy. 40 patients were divided into a control group receiving conservative treatment only and an experimental group receiving conservative treatment plus ULTT. Outcome measures of cervical range of motion and pain were assessed before and after treatment. The results showed significantly greater improvements in cervical flexion, extension, and side flexion ranges of motion as well as pain levels for the experimental group compared to the control group, indicating that ULTT provides additional benefits for managing symptoms of cervical radiculopathy.
- Cold laser therapy is an effective treatment for lymphedema that reduces swelling, fibrosis, and symptoms like heaviness and tightness. It was pioneered in Australia where research has shown both immediate and long-term benefits.
- The advantages of cold laser over other therapies are that it has no negative impact on lifestyle, carries no risk of carcinogenesis, and may be as effective as manual lymph drainage while posing fewer costs and time commitments for patients.
- Case studies demonstrate significant volume reductions, improved range of motion, and resumed activities from using cold laser to treat lymphedema.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of...dbpublications
OBJECTIVE: To compare the effectiveness of passive stretching versus massage on preventing the symptoms of delayed onset muscle soreness in normal adults. STUDY DESIGN: Quasi- Experimental study design. SUBJECTS: 50subjects, with the age group of 18-21 years of both the genders were selected. INTERVENTION: Subjects were randomly divided into 2 groups (Group A& Group B), 25 subjects in Group A received passive stretching and 25 subjects in Group B received Massage after 3 hours of inducing DOMS. OUTCOME MEASURE: Pain, Elbow Range of Motion and swelling were assessed by Visual analogue scale, goniometer, Inch tape. RESULTS: Statistical analysis was done by using independent ‘t’ test and paired ‘t’ test which showed there is no statistical significant difference between Group A(Passive stretching) and Group B(Massage). CONCLUSION: The result of this study concludes that massage decreased the pain immediately after intervention and regained the Elbow Range of Motion at immediately at 24 hours, at 48 hours and 72 hours than passive stretching. But massage and passive stretching has equal effect on pain reduction at 24hours, 48 hours and 72 hours after intervention. Similarly they both have equal effect on Arm Circumference.
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
This meta-analysis reviewed 22 randomized controlled trials involving 1014 patients to determine the effectiveness of low-level laser therapy (LLLT) for pain relief in various joint areas. The average methodological quality score of the trials was 7.96 out of 10. The analysis found that 11 trials reported positive effects of LLLT for pain relief while 11 reported negative effects. However, when pooling the results, the mean weighted difference in pain reduction on a visual analogue scale was 13.96 mm in favor of the active LLLT groups, indicating LLLT provides statistically significant pain relief for joints. Restricting the analysis to trials using energy doses within previously suggested therapeutic windows produced even greater mean pain relief of 19.88-21
This study analyzed the effectiveness of the Kinetrac KNX-7000 multifunctional bed in treating degenerative diseases of the lumbar spine. 24 patients were divided into two groups - one receiving conventional physiotherapy treatment and the other receiving conventional treatment plus the multifunctional bed. Results showed that the group using the bed had statistically significant improvements in functional abilities, quality of life, and lumbar spine flexion compared to the conventional treatment group. However, there was no statistically significant difference in pain perception between the groups. The study had limitations due to its small sample size.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Out comes of lower level laser vs ultrasonicDR.SUNIL KUMAR
De Quervain's tenosynovitis is a painful condition of the wrist caused by overuse of the thumb. This study compared the effectiveness of low-level laser therapy (LLLT) and ultrasound therapy (UST) in treating De Quervain's tenosynovitis. 30 patients were randomly assigned to receive either LLLT or UST daily for 7 sessions. Outcome measures including pain, tenderness, grip strength and tendon thickness were assessed before and after treatment. The study found that grip strength and pain improved more in the UST group compared to the LLT group. However, differences in tendon thickness changes between the groups were not statistically significant. In conclusion, UST seemed to
Artigo - Acupuncture and physiotherapy for painful shoulderRenato Almeida
This randomized controlled trial evaluated the efficacy of single-point acupuncture combined with physiotherapy compared to physiotherapy alone for the treatment of painful shoulder. 425 patients with subacromial syndrome received 15 sessions of physiotherapy over 3 weeks along with either weekly acupuncture at point ST38 or sham TENS. Patients receiving acupuncture showed significantly greater improvement in shoulder function scores and reported less analgesic use compared to the control group receiving only physiotherapy. The study demonstrates that adding acupuncture to physiotherapy can more effectively treat painful shoulder conditions.
Senior Seminar in Business Administration BUS 499Coope.docxWilheminaRossi174
Senior Seminar in Business Administration
BUS 499
Cooperative Strategy
Hitt, M.A., Ireland, R.D., & Hoskisson, R.E. (2009). BUS499: Strategic management: Competitiveness and globalization, concepts and cases: 2009 custom edition (8th ed.). Mason, OH: South-Western Cengage Learning.
Welcome to Senior Seminar in Business Administration.
In this lesson we will discuss Cooperative Strategy.
Please go to the next slide.
ObjectivesUpon completion of this lesson, you will be able to:Identify various levels and types of strategy in a firm
Upon completion of this lesson, you will be able to:
Identify various levels and types of strategy in a firm.
Please go to the next slide.
Supporting TopicsStrategic alliancesCooperative strategiesCompetitive risks
In order to achieve this objective, the following supporting topics will be covered:
Strategic alliances;
Cooperative strategies; and
Competitive risks.
Please go to the next slide.
Strategic AlliancesCooperative strategyStrategic allianceCombination of resources and capabilitiesExchange and sharing of resourcesFirms leverage existing resourcesCornerstone of many firms’ competitive strategy
Recognized as a viable engine of firm growth, cooperative strategy is a strategy in which firms work together to achieve a shared objective. Thus, cooperating with other firms is another strategy firms use to create value for a customer that exceeds the cost of providing that value and to establish a favorable position relative to competition.
A strategic alliance is a cooperative strategy in which firms combine some of their resources and capabilities to create a competitive advantage. Thus, strategic alliances involve firms with some degree of exchange and sharing of resources and capabilities to co-develop, sell, and service goods or services. Strategic alliances allow firms to leverage their existing resources and capabilities while working with partners to develop additional resources and capabilities as the foundation for new competitive advantages. To be certain, the reality today is that strategic alliances have become a cornerstone of many firms’ competitive strategy.
Please go to the next slide.
Strategic Alliances, continuedJoint ventureEquity strategic allianceNonequity strategic alliance
The three major types of strategic alliances include joint venture, equity strategic alliance, and nonequity strategic alliance.
A joint venture is a strategic alliance in which two or more firms create a legally independent company to share some of their resources and capabilities to develop a competitive advantage. Joint ventures, which are often formed to improve firms’ abilities to compete in uncertain competitive environments, are effective in establishing long-term relationships and in transferring tacit knowledge. Because it can’t be codified, tacit, or implied, knowledge is learned through experiences such as those taking place when people from partner firms work together in a join.
Select two countries that have been or currently are in confli.docxWilheminaRossi174
Select two countries that have been or currently are in conflict.
Compare the two countries using the cultural dimensions interactive index.
Briefly describe the two countries that you selected and the conflict in which they are engaged. Explain why you selected them.
Compare the two countries on the following dimensions: collectivism-individualism, masculinity-femininity, power distance, long-term orientation, and uncertainty avoidance.
Explain what insights you had or conclusions that you might now draw about the countries and/or the conflict between them based on your comparison.
Explain the role that culture plays in this conflict and how dimensions of culture might influence the resolution of the conflict.
"Hofstede's Cultural Dimensions: Understanding Workplace Values Around the World." Notice the differences between each dimension of culture.
.
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Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromia...ijtsrd
Introduction Subacromial impingement syndrome SIS is commonest among various joint pains. Study is done in order to compose the efficacy of PEMF treatment of various duration for patients with SIS. Subject and Methods One hundred and eight patients who had been diagnosed with subacromial impingement syndrome by clinical examination. Patients were sequentially enrolled following informed consent were administered PEMF therapy for 15 minutes combined with exercise therapy. The second group received the same treatment except that each of the patients has received 30 minutes therapy the patients were evaluated before and after the treatment. Parameters examined were pain score, disability score and range of motion at shoulder joint. Result Second group was significantly improved in pain score, disability score and range of motion. Conclusion 30 minutes of PEMF therapy was shown to be more effective than 15 minutes of PEMF therapy. Anuja Pasari | Bismay Das | C. Monanty | Saurabh Singh | Sujoy Roy | T. B. Singh "Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromial Impingement Syndrome" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38177.pdf Paper URL : https://www.ijtsrd.com/medicine/other/38177/comparison-of-pemf-therapy-of-various-duration-in-the-treatment-of-subacromial-impingement-syndrome/anuja-pasari
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
paper regarding implementation of shakers exercise for impaired swallowing patients and compare pre , immediate and post implementation of the exercises
1) The document describes a study on the effects of low level laser therapy (LLLT) on human appendicular bone fracture healing.
2) A total of 40 patients with fractures were divided into a laser group (20 patients) who received LLLT, and a control group (20 patients) who did not.
3) Results showed the laser group had better clinical outcomes like less pain and earlier movement, and radiological outcomes like faster/greater callus formation and bone density increases.
4) The study concluded LLLT can accelerate bone union and enhance healing when used as an adjunct to standard fracture treatment.
Background:
Osteoarthritis (OA) is one of the most common joint disorders in the elderly
Webermedical intra-articular laser ( WEL) therapy makes it possible to irradiate directly in the tissue.Infrared laser(IR) has dose-dependent anti-inflammatory effect on OA . Thermal radiofrequency (RF) of the knee joint articular nerve branches were targeted to address the entire nociception and stiffness in OA3.This study aimed to investigate the effects of WEL and TRF on nonspecific knee joint pain.
Case report:
50 patients suffering from non-specific knee pain for more than 3 months with no response to conservative treatments ,were enrolled in the study with Knee pain rated 44 mm or greater on the pain visual analogue scale (VAS) and 4 or greater on the Numeric rating scale ( NRS).Procedures performed from Feb. to Oct. 2014 Cairo, Egypt. Assessment of pain was done at baseline then weekly post procedure for 1 month then at 1-month follow-up visits for 6 months.
Patients of the 1st group received WEL Blue and IR, using Ultrasound guided imaging, 2 WEL needles were advanced successively in the retro-patellar recess. The procedure includes 3 sessions with 1 week interval. Patients of the 2nd group received RF with temperature 80°C for 90 sec.,2 cycles, using fluoroscopy guided imaging ,3 of the 5 genicular nerves were targeted.
Impact of exercise program on functional status among post lumbar laminectom...Alexander Decker
This document summarizes a study that evaluated the impact of an exercise program on functional status in post-lumbar laminectomy patients. The study involved 30 patients who underwent a 6-week exercise program after lumbar laminectomy surgery. Outcome measures assessed pre-and post-operatively included pain, functional status, range of motion, and disability levels. The results showed that after participating in the exercise program, patients demonstrated significantly reduced pain levels and functional disabilities compared to pre-operative levels. The study concluded that exercise programs can effectively improve outcomes for post-lumbar laminectomy patients.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
This study examined the effects of using the upper limb tension test (ULTT) as a neural mobilization technique in addition to conservative treatment for patients with cervical radiculopathy. 40 patients were divided into a control group receiving conservative treatment only and an experimental group receiving conservative treatment plus ULTT. Outcome measures of cervical range of motion and pain were assessed before and after treatment. The results showed significantly greater improvements in cervical flexion, extension, and side flexion ranges of motion as well as pain levels for the experimental group compared to the control group, indicating that ULTT provides additional benefits for managing symptoms of cervical radiculopathy.
- Cold laser therapy is an effective treatment for lymphedema that reduces swelling, fibrosis, and symptoms like heaviness and tightness. It was pioneered in Australia where research has shown both immediate and long-term benefits.
- The advantages of cold laser over other therapies are that it has no negative impact on lifestyle, carries no risk of carcinogenesis, and may be as effective as manual lymph drainage while posing fewer costs and time commitments for patients.
- Case studies demonstrate significant volume reductions, improved range of motion, and resumed activities from using cold laser to treat lymphedema.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of...dbpublications
OBJECTIVE: To compare the effectiveness of passive stretching versus massage on preventing the symptoms of delayed onset muscle soreness in normal adults. STUDY DESIGN: Quasi- Experimental study design. SUBJECTS: 50subjects, with the age group of 18-21 years of both the genders were selected. INTERVENTION: Subjects were randomly divided into 2 groups (Group A& Group B), 25 subjects in Group A received passive stretching and 25 subjects in Group B received Massage after 3 hours of inducing DOMS. OUTCOME MEASURE: Pain, Elbow Range of Motion and swelling were assessed by Visual analogue scale, goniometer, Inch tape. RESULTS: Statistical analysis was done by using independent ‘t’ test and paired ‘t’ test which showed there is no statistical significant difference between Group A(Passive stretching) and Group B(Massage). CONCLUSION: The result of this study concludes that massage decreased the pain immediately after intervention and regained the Elbow Range of Motion at immediately at 24 hours, at 48 hours and 72 hours than passive stretching. But massage and passive stretching has equal effect on pain reduction at 24hours, 48 hours and 72 hours after intervention. Similarly they both have equal effect on Arm Circumference.
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
This meta-analysis reviewed 22 randomized controlled trials involving 1014 patients to determine the effectiveness of low-level laser therapy (LLLT) for pain relief in various joint areas. The average methodological quality score of the trials was 7.96 out of 10. The analysis found that 11 trials reported positive effects of LLLT for pain relief while 11 reported negative effects. However, when pooling the results, the mean weighted difference in pain reduction on a visual analogue scale was 13.96 mm in favor of the active LLLT groups, indicating LLLT provides statistically significant pain relief for joints. Restricting the analysis to trials using energy doses within previously suggested therapeutic windows produced even greater mean pain relief of 19.88-21
This study analyzed the effectiveness of the Kinetrac KNX-7000 multifunctional bed in treating degenerative diseases of the lumbar spine. 24 patients were divided into two groups - one receiving conventional physiotherapy treatment and the other receiving conventional treatment plus the multifunctional bed. Results showed that the group using the bed had statistically significant improvements in functional abilities, quality of life, and lumbar spine flexion compared to the conventional treatment group. However, there was no statistically significant difference in pain perception between the groups. The study had limitations due to its small sample size.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Out comes of lower level laser vs ultrasonicDR.SUNIL KUMAR
De Quervain's tenosynovitis is a painful condition of the wrist caused by overuse of the thumb. This study compared the effectiveness of low-level laser therapy (LLLT) and ultrasound therapy (UST) in treating De Quervain's tenosynovitis. 30 patients were randomly assigned to receive either LLLT or UST daily for 7 sessions. Outcome measures including pain, tenderness, grip strength and tendon thickness were assessed before and after treatment. The study found that grip strength and pain improved more in the UST group compared to the LLT group. However, differences in tendon thickness changes between the groups were not statistically significant. In conclusion, UST seemed to
Artigo - Acupuncture and physiotherapy for painful shoulderRenato Almeida
This randomized controlled trial evaluated the efficacy of single-point acupuncture combined with physiotherapy compared to physiotherapy alone for the treatment of painful shoulder. 425 patients with subacromial syndrome received 15 sessions of physiotherapy over 3 weeks along with either weekly acupuncture at point ST38 or sham TENS. Patients receiving acupuncture showed significantly greater improvement in shoulder function scores and reported less analgesic use compared to the control group receiving only physiotherapy. The study demonstrates that adding acupuncture to physiotherapy can more effectively treat painful shoulder conditions.
Similar to Clinical StudyComparison of High-Intensity Laser Therapy and (20)
Senior Seminar in Business Administration BUS 499Coope.docxWilheminaRossi174
Senior Seminar in Business Administration
BUS 499
Cooperative Strategy
Hitt, M.A., Ireland, R.D., & Hoskisson, R.E. (2009). BUS499: Strategic management: Competitiveness and globalization, concepts and cases: 2009 custom edition (8th ed.). Mason, OH: South-Western Cengage Learning.
Welcome to Senior Seminar in Business Administration.
In this lesson we will discuss Cooperative Strategy.
Please go to the next slide.
ObjectivesUpon completion of this lesson, you will be able to:Identify various levels and types of strategy in a firm
Upon completion of this lesson, you will be able to:
Identify various levels and types of strategy in a firm.
Please go to the next slide.
Supporting TopicsStrategic alliancesCooperative strategiesCompetitive risks
In order to achieve this objective, the following supporting topics will be covered:
Strategic alliances;
Cooperative strategies; and
Competitive risks.
Please go to the next slide.
Strategic AlliancesCooperative strategyStrategic allianceCombination of resources and capabilitiesExchange and sharing of resourcesFirms leverage existing resourcesCornerstone of many firms’ competitive strategy
Recognized as a viable engine of firm growth, cooperative strategy is a strategy in which firms work together to achieve a shared objective. Thus, cooperating with other firms is another strategy firms use to create value for a customer that exceeds the cost of providing that value and to establish a favorable position relative to competition.
A strategic alliance is a cooperative strategy in which firms combine some of their resources and capabilities to create a competitive advantage. Thus, strategic alliances involve firms with some degree of exchange and sharing of resources and capabilities to co-develop, sell, and service goods or services. Strategic alliances allow firms to leverage their existing resources and capabilities while working with partners to develop additional resources and capabilities as the foundation for new competitive advantages. To be certain, the reality today is that strategic alliances have become a cornerstone of many firms’ competitive strategy.
Please go to the next slide.
Strategic Alliances, continuedJoint ventureEquity strategic allianceNonequity strategic alliance
The three major types of strategic alliances include joint venture, equity strategic alliance, and nonequity strategic alliance.
A joint venture is a strategic alliance in which two or more firms create a legally independent company to share some of their resources and capabilities to develop a competitive advantage. Joint ventures, which are often formed to improve firms’ abilities to compete in uncertain competitive environments, are effective in establishing long-term relationships and in transferring tacit knowledge. Because it can’t be codified, tacit, or implied, knowledge is learned through experiences such as those taking place when people from partner firms work together in a join.
Select two countries that have been or currently are in confli.docxWilheminaRossi174
Select two countries that have been or currently are in conflict.
Compare the two countries using the cultural dimensions interactive index.
Briefly describe the two countries that you selected and the conflict in which they are engaged. Explain why you selected them.
Compare the two countries on the following dimensions: collectivism-individualism, masculinity-femininity, power distance, long-term orientation, and uncertainty avoidance.
Explain what insights you had or conclusions that you might now draw about the countries and/or the conflict between them based on your comparison.
Explain the role that culture plays in this conflict and how dimensions of culture might influence the resolution of the conflict.
"Hofstede's Cultural Dimensions: Understanding Workplace Values Around the World." Notice the differences between each dimension of culture.
.
Serial KillersFor this assignment you will review a serial kille.docxWilheminaRossi174
Serial Killers
For this assignment you will review a serial killer's case in depth. The killer you choose to review will also be the subject of your Week 5 final assignment, so keep your research material handy.
First, choose
one
of the following serial killers:
David Berkowitz ("Son of Sam") taunted police over a year and shot 15 people (6 died) in New York City. The movie "Summer of Sam" was about this time.
Gary Ridgway (the "Green River Killer") holds the American record for most victims. He confessed to killing 48 over a 16-year period but is suspected of having killed many more!
Wayne B. Williams is believed to be the killer of 24 children and young men in Atlanta, though there is still some doubt.
John Allen Muhammad and Lee Boyd Malvo were the "DC snipers" who shot 13 people (ten died) over three weeks in the Washington DC area in 2002.
Ted Bundy: Confessed to almost 30 murders (there may have been more). He was known for being smart and good-looking, and acted as his own lawyer.
Jeffrey Dahmer: His case captured worldwide attention after his capture, mostly due to his habit of keeping parts of his victims long after their deaths, as well as cannibalism and necrophilia.
Kristen Gilbert: An example of a female serial killer, she was a nurse who killed hospital patients in her care.
For this assignment, create a report in Microsoft Word that covers the following points:
Summarize the case: time period, location, number of victims, etc.
Describe the killer's background, methods, and area of operation.
How did the killer select his or her victims? Was there anything that the victims did to provoke the killer?
By analyzing all of the above information, you should now be able to propose a
three-part typology
and explain your analysis. Your typology should describe the killer's
motivation, location, and organized or disorganized factors. For instance, John Wayne Gacy might be described as a
Power/Control, local, organized killer.
.
SESSION 1Michael Delarosa, Department ManagerWhat sugg.docxWilheminaRossi174
SESSION 1
Michael Delarosa, Department Manager
What suggestions do you have for improvement in regards to training new supervisors?
Make sure there are opportunities for hands on problem solving. Too much of our training is theory
and supervisors need to be focused on the real-world problems that come up.
What challenges do supervisors in our plants encounter that training would help them resolve?
I'd say that a lot of the challenges we see relate to the diversity on the line. There are a lot of different
types of people working at CapraTek and they don't always play well together.
What are the most important abilities for supervisors in our plants?
Well… the first thing that comes to mind is the ability to find information. Whether it's technical
information or answers for the people who report to you. Another key ability though is the ability to
acquire technical expertise. No one comes in knowing it all, but the ability to gain necessary
knowledge is very important.
What knowledge does a new supervisor need?
A solid understanding of the job itself. Supervisors provide a lot of training to new employees, so they
need to know our systems and processes inside and out.
Should training be conducted face to face, online, or a combination of both?
I'd say a combination. There are some topics that don't really need a classroom experience, but
others where the face-to-face interaction provides as much as the actual training materials. If it had to
be one or the other, I'd definitely say face to face.
Leland Butler, Shift Supervisor
What suggestions do you have for improvement in regards to training new supervisors?
Don't think you can cover this stuff once and be done with it. I went through supervisor training when I
was promoted, but I've gotta admit, I don't remember much of it. That kind of stuff doesn't always
stick unless you're doing it. Having an opportunity to be in the job and then get training on what you're
actually dealing with is better than sitting in a training room listening to someone talk about theories
and policies.
What challenges do supervisors in our plants encounter that training would help them resolve?
Well… like I said, being able to apply the leadership and supervisory ideas in realistic situations. I'm a
hands-on kind of person and it's always better if I can do something, so maybe like getting training on
performance reviews or some of the paperwork we're all dealing with. That would be helpful.
What are the most important abilities for supervisors in our plants?
Communication and flexibility. Hands down. You need to be able to shift gears decisively and
communicate with your team.
What knowledge does a new supervisor need?
He or she needs to know what the role of their team is to the division. How it all fits together. A good
supervisor needs to be able to communicate to the people who report to him what's going on and why
things are the way they are. So, he's got to be in .
Selecting & Implementing Interventions – Assignment #4
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Behavioral Interventions
Behav. Intervent. 19: 205–228 (2004)
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/bin.161
MODIFICATIONS TOBASIC FUNCTIONAL
ANALYSIS PROCEDURES IN SCHOOL
SETTINGS: A SELECTIVE REVIEW
Janet Ellis* and Sandy Magee
University of North Texas, Denton, TX, USA
This review describes applied behavioral research involving functional analyses conducted in public
school settings. Functional analyses in public school settings often require added conditions. The
modified conditions described herein include changes to experimental designs, antecedent changes that
include task variation, tasks included, idiosyncratic variables, physiological conditions, and modified
escape conditions. Finally, consequent modifications cover peer attention, tangibles, varied attention,
and altered escape. Copyright # 2004 John Wiley & Sons, Ltd.
INTRODUCTION
The primary body of functional analysis (FA) literature has historically focused on
persons with developmental disabilities in institutional/residential settings who
engaged in severe self-injurious behavior (SIB). Mace and Lalli (1991) noted that
interventions based on FAs conducted in experimental settings under highly
controlled analog conditions may be effective only to the extent that those analog
conditions match the subject’s natural environment. Johnston (1993) recommended
that, once a procedure has been experimentally developed, its value and applicability
should be assessed under practical/natural conditions. Further, passage of Public Law
105-17, Individuals with Disabilities Education Act (IDEA), in 1997 mandated that a
‘functional behavioral assessment’ be conducted on students who exhibit significant
behavior and adjustment problems. For at least these reasons, FA research has moved
beyond the tightly controlled laboratory setting and into more natural environments
involving more diverse populations. Development of behavioral assessments of
problem behavior in school settings had empirical roots—for example, 36 years ago
Thomas, Becker, and Armstrong (1968) noted that classroom teacher’s disapproval
increased rates of student’s disruptive behavior. These assessments allowed effective
Copyright # 2004 John Wiley & Sons, Ltd.
*Correspondence to: Janet Ellis, Department of Behavior Analysis, University of North Texas, P.O. Box 310919,
Denton, TX 76203-0919, USA. E-mail: [email protected]
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behavior change procedures to be implemented in t.
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/299831446
A Case Study of Global Leadership Development
Best Practice
Article · April 2016
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A Case Study of Global
Leadership Development
Best Practice
“GLD is a challenging task that has become more imp.
Shared Reading FrameworkFollow this framework when viewing the v.docxWilheminaRossi174
Shared Reading Framework
Follow this framework when viewing the video lessons for Days 1,2, & 3 from Ms. Chan’s class. Compare and contrast Ms. Chan’s teaching to what is listed on this page.
(Whole)
Read aloud a shared or big book to the students. Label each step and clearly state how you will accomplish this.
·
Introduce the book: Explain what you will say to the students to introduce the book to them, if you choose to point out concepts of book, concepts of print, predicting, etc.
·
Picture Walk: Explain what you will do to provide a Picture Walk for the students, telling all that you will say to the students.
·
Read the book aloud: Explain how you will read the book aloud to the students, will you stop, on what pages, what will you say.
·
Students’ Responses: Develop a set of both literal and higher-order thinking questions to elicit student responses, use Bloom’s or Webb’s as a guide to questions.
(PART)
Direct Instruction (Name the reading skill and explain what it means)
· Explain:
(I do) Explain to the students what they will be learning and why they should learn it. Explain the skill they will be learning and explain “how it works” Summarize the skill in your own words. Teacher tells students everything you want them to learn
(objectives).
· Demonstrate
: (I do) Show the students what you would like them to do. Demonstrate to them what they will be doing to help them learn the skill. You must explain what you will do to demonstrate the skill you will be teaching. PROVIDE EXAMPLES and link to your explain step.
· Guide:
(We do, more teacher responsibility, some student responsibility) Guide the students to discuss and/or attempt the skill you just demonstrated. Explain how you will guide the students to allow them opportunities to try to apply the skill. Give support and feedback. Teacher brings students into discussion about objective and gives guidance and feedback
. (Feedback must be accurate, positive and encouraging, but also firm.)
· Practice:
(We do, more student responsibility) Explain specifically how you will guide the students to practice applying the skill by allowing them to work together with less teacher support but still feedback.
(WHOLE)
· Application:
(You do) (Read the book again and this time ask the students to apply what they learned about the reading skill to the book you are rereading.) Explain what you will have the students do to apply the skill to the text. The students should demonstrate that they can meet objective in this step.
· Students Reflect:
(You do) Develop a set of 6 – 8 questions you would ask the students to reflect on what they learned about the reading skill and what they learned from the book you read to them. This is a good time to ask questions that would meet.
Self-disclosureDepth of reflectionResponse demonstrates an in.docxWilheminaRossi174
Self-disclosure/Depth of reflection
Response demonstrates an in-depth reflection on, and personalization of, the theories, concepts, and/or strategies presented in the course materials to date. Viewpoints and interpretations are insightful and well supported. Clear, detailed examples are provided, as applicable. Demonstrates an open, non-defensive ability to self-appraise, discussing both growth and frustrations as they related to learning in class, as well as implications for future learning.
Analysis/Connection to reading and outside experiences
In-depth synthesis of thoughtfully selected aspects of experiences related to the course topics. Makes clear connections between what is learned from readings, outside experiences and the topics. The reflection is an in-depth analysis of the learning experience, the value of the derived learning to self or others, and the enhancement of the student’s appreciation for the discipline. Demonstrate further analysis and insight resulting from what you have learned from readings, includes reference to at least two readings other than those assigned for class.
Connection to course objectives and BSN outcomes
Synthesize, analyze and evaluate thoughtfully selected aspects of ideas or issues from the class discussion as they relate to the course learning outcomes and the BSN program outcome. (Review your syllabus and students handbook to help make connections)
Structure, organization and grammar
Writing is clear, concise, and well organized with excellent sentence/paragraph construction. Thoughts are expressed in a coherent and logical manner. There are no more than three spelling, grammar, or syntax errors per page of writing.
APA format, page limitations and spelling
Follows APA professional writing style of using 12 point Times New Roman
font, 1inch margins all around, correct
APA headings, and correct format of title page.
.
Seemingly riding on the coattails of SARS-CoV-2, the alarming sp.docxWilheminaRossi174
Seemingly riding on the coattails of SARS-CoV-2, the alarming spread of monkeypox across western Europe and the United States has filled the news cycle through the summer of 2022. Monkeypox is an orthopoxvirus, similar in presentation to smallpox and chickenpox (Varicella zoster). In contrast to the related poxviruses, monkeypox has been reported to spread by sexual contact and direct skin-to-skin contact, as well as through the traditional respiratory droplet route. While there is currently no effective treatment for infected individuals, two vaccines with good efficacy are available to help stem the spread of the disease. Likewise, individuals that have been vaccinated against smallpox with vaccinia virus have some protection against contracting monkeypox. While changes in sexual behavior among vulnerable populations has so far limited the outbreak, the disease is still spreading throughout the country and has caused a handful of deaths.
What is the life cycle of monkeypox, and how exactly is it spread? What does the fact that vaccination against smallpox provides some protection against monkeypox indicate about this virus? Also, what does the spread of monkeypox reveal about the susceptibility of the population to smallpox, a disease that has been considered eradicated worldwide since the late 1980s?
In addition to your original response, you will need to respond to at least two other students’ original posts. Responses should be substantive in nature instead of just reiterating what the original poster stated, or a “good job explaining” or “me too” type of post.
Please note that in your response, plagiarism is not allowed. Please do NOT simply cut and paste information from books, journals, websites, or other sources. In addition, direct quotation of sources, regardless of whether or not the source is cited, is not allowed. Please summarize the material and what you have learned in your own words.
.
See the attachment of 1 Article belowPlease answer all the que.docxWilheminaRossi174
See the attachment of 1 Article below
Please answer all the questions below in 1-2 pages (in MLA)
1) the important concepts and terms of the readings
2) the most important arguments of the readings
3) the parts of the readings they found confusing or unclear
4) how this reading relates to previous class readings, lectures, and discussions
You do not need to have a work cited page unless you have outside materials. Please let me know if you have questions.
.
SHAPING SCHOOL CULTURE BY LIVING THE VISION AND MISSIONNameI.docxWilheminaRossi174
SHAPING SCHOOL CULTURE BY LIVING THE VISION AND MISSION
Name
Institution
Date
School
Hello everyone and welcome to today’s presentation. The school in focus is Highland High School which has 9 to 12th grade.
2
Name
Highland High School
Grade levels
9 to 12
Mission
The mssion of the school is to “Empower students to use knowledge, skills, and strategies to become productive members of society who use higher level thinking”. The vision of the school is Students will “Own Their learning”
3
Mission statement
“Empower students to use knowledge, skills, and strategies to become productive members of society who use higher level thinking”
Vision statement
Students will “Own Their learning”
Strategies that embed the mission and vision
It is possible for a school to convey its ethos, mission, goals, and values to its students, staff, and parents in a variety of different methods. A school's prospectus or handbook should present information in a way that is clear and easy to comprehend, taking into account the diverse ethnic group in the area and maybe translating the text into many languages. The website of the school is the spot that makes the most sense to transmit any sort of information regarding the institution as a whole, including its ethos and so on. The internet is the first place that people search for information in this day and age since it can be accessed from anywhere in the world and every school now has its own personal website. Again, in order to experience the true environment of the school, it is necessary to combine this mode of communication with a trip to the location itself.
4
Strategy 1
Communication
Repetitive communication of the mission and vision ensures it is embedded (Jensen et al., 2018)
Communications will target all stakeholders
Technology tools will be used to facilitate communication to all stakeholders
Strategies that embed the mission and vision cont…
A well-defined statement that provides an explanation of the line of work that an individual plans to pursue over the entirety of his career is an example of a career objective. It is essential for each and every student to articulate their aspirations for their future careers. They are able to devise more efficient action plans as a result of this.
5
Strategy 2
Helping students establish career goals
Students will be encouraged to work hard to actualize the goals
Successful careers enable students to become productive members of the society (Şenol & Lesinger, 2018)
Strategies that embed the mission and vision cont…
Finding and employing the appropriate faculty members is possibly the single most significant factor that will determine the institution's long-term success. Even though conducting interviews and making hires is seen by many as an art form, there are tried-and-true strategies that the school may employ to boost its chances of finding the proper people to work there. These approaches are suppo.
Select a healthcare legislature of interest. Discuss the historica.docxWilheminaRossi174
Select a healthcare legislature of interest. Discuss the historical background of the legislation. For example, the person(s) who presented the bill. The committees the bill went through, and revision of the bill until it was passed into law. For example, health insurance is a problem within the USA. The ACA bill was created and pass into law.
.
See discussions, stats, and author profiles for this publicati.docxWilheminaRossi174
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/13998136
Self-management within a token economy for students with
learning disabilities
Article in Research in Developmental Disabilities · May 1997
DOI: 10.1016/S0891-4222(96)00045-5 · Source: PubMed
CITATIONS
17
READS
1,084
3 authors, including:
Some of the authors of this publication are also working on these related projects:
Self-regulation View project
Animal Assisted Physical Activity View project
Al Cavalier
University of Delaware
29 PUBLICATIONS 491 CITATIONS
SEE PROFILE
Ralph P Ferretti
University of Delaware
46 PUBLICATIONS 1,276 CITATIONS
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All content following this page was uploaded by Al Cavalier on 30 June 2018.
The user has requested enhancement of the downloaded file.
https://www.researchgate.net/publication/13998136_Self-management_within_a_token_economy_for_students_with_learning_disabilities?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_2&_esc=publicationCoverPdf
https://www.researchgate.net/publication/13998136_Self-management_within_a_token_economy_for_students_with_learning_disabilities?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_3&_esc=publicationCoverPdf
https://www.researchgate.net/project/Self-regulation-5?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_9&_esc=publicationCoverPdf
https://www.researchgate.net/project/Animal-Assisted-Physical-Activity?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_9&_esc=publicationCoverPdf
https://www.researchgate.net/?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_1&_esc=publicationCoverPdf
https://www.researchgate.net/profile/Al_Cavalier?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_4&_esc=publicationCoverPdf
https://www.researchgate.net/profile/Al_Cavalier?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_5&_esc=publicationCoverPdf
https://www.researchgate.net/institution/University_of_Delaware?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_6&_esc=publicationCoverPdf
https://www.researchgate.net/profile/Al_Cavalier?enrichId=rgreq-db53aece611d16c3ef6017901d8bec29-XXX&enrichSource=Y292ZXJQYWdlOzEzOTk4MTM2O0FTOjY0MzI5NDUxNDEyNjg0OEAxNTMwMzg0NzcyNTky&el=1_x_7&_esc=publicationCoverPdf
https://ww.
Segmented Assimilation Theory and theLife Model An Integrat.docxWilheminaRossi174
Segmented Assimilation Theory and the
Life Model: An Integrated Approach to
Understanding Immigrants and Their Children
Lissette M. Piedra and David W Engstrom
The life model offers social workers a promising framework to use in assisting immigrant
families. However, the complexities of adaptation to a new country may make it difficult
for social workers to operate from a purely ecological approach. The authors use segmented
assimilation theory to better account for the specificities of the immigrant experience. They
argue that by adding concepts from segmented assimilation theory to the life model, social
workers can better understand the environmental Stressors that increase the vulnerabilities
of immigrants to the potentially harsh experience of adapting to a new country. With these
concepts, social workers who work with immigrant families will be better positioned to
achieve their central goal: enhancing person and environment fit.
KEY WORDS: acculturation; assimilation; immigrants; life model; second generation
Nearly a century ago,Jane Addams (1910)
observed that immigrants needed help
integrating their European and American
experiences to give them meaning and a sense of
relation:
Power to see life as a whole is more needed in
the immigrant quarter of the city than anywhere
else Why should the chasm between fathers
and sons, yawning at the feet of each generation,
be made so unnecessarily cruel and impassable
to these bewildered immigrants? (p. 172)
The inability of some immigrant families to
integrate the cultural capital from the world left
behind with the demands of the new society creates
a gulf of experience between immigrants and their
children that can undermine the parental relation-
ship. Today, the issue of family cohesion in the face
of acculturative Stressors remains central to the im-
migrant experience and creates a sense of urgency
because it is so linked with the success of the second
generation. The size of the immigrant population
and the role their children \vill play in future labor
markets (Morales & Bonilla, 1993; Sullivan, 2006)
moves the problem from the realm of the person
to the status of a larger public concern.
Immigrant families are rapidly becoming the
"typical" American family. More than one in seven
families in the United States is headed by a foreign-
born adult. Children of immigrant parents are the
fastest growing segment of the nation's child popula-
tion (Capps, Fix, Ost, Reardon-Anderson, & Passel,
2004).The U.S. Census Bureau (2003) reported that
slightly more than 14 million children (approxi-
mately one in five) live in immigrant families; the
percentage is even higher (22 percent) for children
under the age of six (U.S. Census Bureau, 2001).
At a structural level, these changing demographics
create large-scale and long-range effects that bear
on many social services and many issues of social
pohcy (Sullivan, 2006). Specifically, the population
growth of native-born children in nonwhite.
Select a local, state, or national public policy that is relev.docxWilheminaRossi174
Select a local, state, or national public policy that is relevant today in the local, regional, or national news
Examples:
Local: community or urban growth (examples: results of rezoning, reuse of public structures, closed down school/public buildings that will convert to private business enterprise).
State: Private land converted to public spaces (examples: airports, road, or highway usage).
Federal: Gun policy, drug policy, immigration (examples: effects on jobs, background checks, cultural changes in communities).
Identify how the policy was formulated from a historical standpoint and identify which stakeholders were involved in the process.
Appraise the position whether the policy creates a benefit for one group (or stakeholder) while other groups experience disadvantages or negative challenges because of public policy implementation.
.
School of Community and Environmental HealthMPH Program .docxWilheminaRossi174
School of Community and Environmental Health
MPH Program
Epidemiology: MPH 746
(
Second
Assignment
)
(
Type in you name here as
First Name , Last Name
)
Read the Paper below and answer the following questions. Your answer should be typed in below; and the submitted document should be in Microsoft Word document. The answer for any question should not exceed one paragraph (5-6 lines). The deadline for submission is 11:59 pm EST Nov. 9th, 2022.
(
Ellison LF, Morrison HI:
Low serum cholesterol concentration and risk of suicide
.
Epidemiology
2001,
12
(2):168-172.
)
Question1 (Max. 0.5 point)
What is the purpose of the study?
Question2 (Max. 0.5 point)
What is the study design? What is the exposure? What is the outcome?
Question3 (Max. 2 points)
How the exposure was measured? How the outcome was measured?
Question4 (Max. 1.5 points)
From Table II, calculate the Crude Rate Ratio for serum total cholesterol <4.27 mmol/l compared to >5.77 mmol/l. (must show the details of calculation)
Question5 (Max. 1.5 points)
What is the meaning of this crude Rate Ratio?
Question6 (Max. 1.5 points)
In Table 3, what is the meaning of age and sex adjusted RR of serum total cholesterol <4.27 mmol/l compared to serum total cholesterol >5.77 mmol/l. Was there confounding by age and sex, why or why not? Is the RR statistically significant? What is the meaning of the 95%CI for the RR?
Question7 (Max. 0.5 points)
Was the ascertainment of the outcome as complete as possible? Was there a follow chart?
Question8 (Max. 0.5 points)
The authors stated in the discussion “The possibility of under-ascertainment of suicide deaths is always a concern, although it is probably unlikely that ascertainment varied by serum total cholesterol level”
Explain what the authors meant by their statement.
Question9 (Max. 0.5 points)
Were those who measured the outcome blinded from the exposure status?
Question10 (Max. 0.5 points)
Have the exposures been well measured, or is there any random or systematic misclassification?
Question11 (Max. 5 points)
Do the “exposed” differ from the “unexposed” with respect to other factors? Have these differences taken into account in the design or analysis? i.e. How the authors dealt with confounding?
1
image1.png
Students will synthesize the information they have gathered during the course to formulate a presentation advocating for a practice change in relation to an area of interest to NP practice.
Creating a Professional PowerPoint PresentationDownload Creating a Professional PowerPoint Presentation
In a PowerPoint Presentation, address the following.
1.
Title Slide
2.
Introduction (1 slide): Slide should identify concepts to be addressed and sections of the presentation. Include speaker’s notes that explain, in more detail, what will be covered.
.
School Effects on Psychological Outcomes During Adolescence.docxWilheminaRossi174
School Effects on Psychological Outcomes During Adolescence
Eric M. Anderman
University of Kentucky
Data from the National Longitudinal Study of Adolescent Health were used to examine school-level
differences in the relations between school belonging and various outcomes. In Study 1, predictors of
belonging were examined. Results indicated that belonging was lower in urban schools than in suburban
schools, and lower in schools that used busing practices than those that did not. In Study 2, the relations
between belonging and psychological outcomes were examined. The relations varied depending on the
unit of analysis (individual vs. aggregated measures of belonging). Whereas individual students’
perceptions of belonging were inversely related to depression, social rejection, and school problems,
aggregated belonging was related to greater reports of social rejection and school problems and to higher
grade point average.
Research on school-level differences during adolescence often
has focused on nonpsychological outcomes, such as academic
achievement and behavioral issues, instead of on psychological
outcomes (Roeser, 1998). Indeed, research on school-level differ-
ences in nonacademic variables is quite rare. The purpose of the
present research was to examine school-level differences in a
variety of psychological outcomes, using a large nationally repre-
sentative sample of adolescents.
School Effects on Student Outcomes
Although there is an abundant literature on effective schools,
most of the research in this literature has focused on academic
variables, such as achievement, dropping out, and grade point
average (GPA; e.g., Edmonds, 1979; Miller, 1985; Murphy, Weil,
Hallinger, & Mitman, 1985). This literature generally indicates
that schools that are academically effective have certain recogniz-
able characteristics.
Some of these studies have examined differences between pub-
lic schools and other types of schools. For example, some research
indicates that students who attend public schools achieve more
academically than do students who attend other types of schools
(e.g., Coleman & Hoffer, 1987). Other research suggests that there
may be a benefit in terms of academic achievement for students
who attend Catholic schools compared with non-Catholic schools
(Bryk, Lee, & Holland, 1993). Lee and her colleagues (Lee,
Chow-Hoy, Burkam, Geverdt, & Smerdon, 1998) found that stu-
dents who attended private schools took more advanced math
courses than did students who attended public schools. However,
they also found specific benefits for Catholic schools: Specifically,
in Catholic schools, there was greater school influence on the
courses that students took, and the social distribution of course
enrollment was found to be particularly equitable.
In recent years, psychologists have started to become interested
in the effects of schooling on mental health outcomes (e.g., Boe-
kaerts, 1993; Cowen, 1991; Roeser, Eccles, & Strobel, 1998;
Rutter,.
Search the gene belonging to the accession id you selected in week 2.docxWilheminaRossi174
Search the gene belonging to the accession id you selected in week 2. Use both Ensembl
https://useast.ensembl.org/index.html
and UCSC
https://genome.ucsc.edu/cgi-bin/hgGateway
genomic browsers to get these genomic/sequence features.
For transcript information including UTRs. provide:
Chromosome
Gene location
Coordinates (exons and introns) these are positions in the sequence
Total exon count -> state if this was the same as what you retrieved from NCBI. Note it could be different because it is a different organism.
ORF Strand: some tools present with signs such as -/+, others will state positive/negative or forward/reverse
promoter region
Coding Region
Coordinates (start and end sequence positions)
coding exon count (this may differ from the total count).
positions for coding exons
Compare and contrast the level of information provided by the two genomic browsers against each other and against the information you were able to get from NCBI resources
.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
How Barcodes Can Be Leveraged Within Odoo 17Celine George
In this presentation, we will explore how barcodes can be leveraged within Odoo 17 to streamline our manufacturing processes. We will cover the configuration steps, how to utilize barcodes in different manufacturing scenarios, and the overall benefits of implementing this technology.
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
Bro. Oh Teik Bin 🙏🤓🤔🥰
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
Slides from a Capitol Technology University webinar held June 20, 2024. The webinar featured Dr. Donovan Wright, presenting on the Department of Defense Digital Transformation.
This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
2. intensity
laser to the lumbar region, Group 2 received 10 sessions of
ultrasound, and Group 3 received medical therapy for 10 days
and
isometric lumbar exercises. The efficacy of the treatment
modalities was compared with the assessment of the patients
before the
therapy at the end of the therapy, and in third month after the
therapy. Comparing the changes between groups, statically
significant
difference was observed in MH (mental health) parameter
before treatment between Groups 1 and 2 and in MH parameter
and VAS
score in third month of the therapy between Groups 2 and 3.
However, the evaluation of the patients after ten days of
treatment did
not show significant differences between the groups compared
to baseline values. We found that HILT, ultrasound, and
exercise
were efficient therapies for lumbar discopathy but HILT and
ultrasound had longer effect on some parameters.
1. Introduction
The lumbar region is the most common site involved in
musculoskeletal pain. In developed countries, low-back pain
ranks second after headaches among the other causes of pain.
Of people living in industrialized countries, approximately
80% suffer from low-back pain at a certain time in their lives
[1]. Approximately 10% of people who experience low -back
pain develop chronic low-back pain. Approximately 1% of the
population is completely disabled due to low-back pain. Low-
back pain often starts at a young age, and the prevalence is
the highest in middle-aged population [1]. Intervertebral disc
diseases, which are an important etiological cause of low -back
pain, often occur in the lumbar region (61.94%). The majority
3. of people presenting with low-back pain have problems with
intervertebral discs. There are many different approaches
in the management of low-back pain. There is a wide
spectrum of treatment options including patient education,
behavioral therapies, lumbar support, and physical therapy
modalities such as massage, traction, superficial heaters, deep
heaters, transcutaneous electrical nerve stimulation (TENS),
and laser. The treatment of disc herniation is important to
control pain, to prevent the recurrence, and development of
chronic pain and disability, and to accelerate the return to
work process. Exercises and education on lumbar protective
measures have become prominent in recent years [2].
The term laser originated as an acronym for “light
amplification by stimulated emission of radiation.” The basic
principle of laser devices is the amplification of electron spin
rates by passing photon energy through a particular medium
to produce a single directional laser beam having a different
wavelength than the original light beam [3]. The action
mechanism of lasers is based on tissue stimulation. This
stimulation occurs at the level of the cell, vascular structure,
interstitial tissue, and immune system. Furthermore, laser has
direct effects when applied to the tissues locally and systemic
effects when applied to acupuncture points [4]. The analgesic
and anti-inflammatory effects of laser can be explained by
many mechanisms. Laser produces reactive vasodilation by
decreasing the pain sensation in the sensory nerve endings
Hindawi Publishing Corporation
BioMed Research International
Volume 2015, Article ID 304328, 6 pages
http://dx.doi.org/10.1155/2015/304328
http://dx.doi.org/10.1155/2015/304328
4. 2 BioMed Research International
and the spasm in the muscle arterioles. It exerts analgesic
and anti-inflammatory effects by promoting regeneration
and increasing the release of beta-endorphins through the
induction of protein synthesis in the rheumatoid synovial
fluid. Laser is also suggested to stimulate hematopoiesis in the
bone marrow and exert antibacterial effects by stimulating
the immune system [4]. Lasers do not cause a significant
change in the tissue temperature. This finding indicates that
the potential physiological effects of laser are independent
from heat. Recent studies implicated laser in the regenerative
process of the tissue, bone formation, synthesis of new carti -
lage tissue, and synthesis of the cartilage matrix [5, 6]. It was
found that Nd: YAG lasers contribute to the healing process
in the tendons and ligaments and prevent the formation of
fibrosis [7]. Some studies showed that low level laser therapy
combined with exercise had more beneficial than exercise
alone in chronic low-back pain for the long term [8–10].
Superficial and deep heaters used in the treatment of
lumbar disc herniations have an important place in physical
therapy applications. Superficial and deep heaters have mul -
tiple effects such as vasodilation, increased pain threshold,
and increased collagen production in connective tissues. It
was found that ultrasound (US) exerts many effects mediated
by its thermal effects such as increase in nerve transmission
speed and enzymatic activity, increase in the contractility of
skeletal muscles, increase in the elongation of collagen tissue,
increase in blood flow rate, decline in pain threshold, and
relief of muscle spasms [11]. US is important physical therapy
agent used in the treatment of musculoskeletal disorders [12].
The aim of the present study is to evaluate the efficiency
of high intensity laser and ultrasound therapy in patients
5. who are diagnosed with lumbar disc herniation and who are
capable of performing physical exercises.
2. Materials and Methods
The present study included patients who were admitted
to the outpatient or inpatient clinic of Physical Therapy
and Rehabilitation at our hospital to undergo a physical
therapy program and who met the study inclusion criteria.
The diagnoses of the patients were established by medical
history, physical examination, and results of imaging studies.
The diagnose of 65 patients confirmed with lumbar MRI as
lumbar disc herniation. The patients were randomly divided
into three groups: Group 1 received 10 sessions of high
intensity laser to the lumbar region five sessions per week,
Group 2 received 10 sessions of US to the lumbar region five
sessions per week, and Group 3 received medical therapy
(NSAII) for 10 days and all of the patients in three groups
performed isometric lumbar exercises. The efficacy of the
treatment modalities was compared with the assessment of
the patients before the therapy, at the end of the therapy, and
in third month after the therapy.
The patients, who were diagnosed with lumbar disc her-
niation on lumbar MRI performed, who were not working on
occupations requiring intensive effort and in whom physical
therapy was not contraindicated, who did not have congenital
abnormalities or history of trauma, and who had sufficient
mental capacity to understand and answer the questions
asked in the assessment scales, were included in the study. The
patients who had a history of injection to the lumbar region
in the last four weeks or who had severe osteoporosis, history
of lumbar surgery, acute trauma, inflammatory pain, neuro-
logical disorder, or lumbar instability, patients who received
physical therapy in the last three months, and patients with
6. uncontrolled or severe cardiovascular or metabolic disorder
were excluded from the study.
A detailed medical history was obtained from the patients
and all underwent physical examination of the locomotor
system. The patients were randomly divided into three
groups: Group 1 included 20 patients, Group 2 included
25 patients, and Group 3 included 20 patients. VAS (visual
analog scale) was used to assess the pain level of the patients.
The Oswestry disability index, SF-36 (short form 36), was
used to evaluate the functional and psychologic status of the
patients. A locomotor system examination was repeated after
the therapy.
The patients in Group 1 received laser therapy 3.8 watts
for 14 minutes at a wavelength of 1064 nm. The total energy
received was 1800 joules. A cosmogamma Cyborg laser
device was used as the high intensity laser in this study.
This device produces laser beams with a wavelength of
1064 nm. This device is also known as a gallium aluminum
arsenide laser (GaAlAs laser) and designed to provide a fiber
output of at least 10 w (±10%). The device has continuous,
pulsed, and high pulsed modes. Different treatment programs
are recorded on the device memory according to different
diagnoses. The treatments were applied to the lumbar region
using beam expanders for the treatment of large areas up to
120 cm2.
The patients in Group 2 received a US therapy. A Chat-
tanooga intelect mobile US device was used in the treatments.
The intelect mobile US device allows the application of 1
or 3 MHz, and 20% or 50% or continuous modes without
any need to change the applicators. In the present study,
US was applied at 1.5 watt/cm for six minutes to the lumbar
paravertebral area. In addition, an isometric lumbar exercise
program was initiated to be performed with five repetitions in
7. each set (modified straightening and pelvic tilt exercises) in
Groups 1 and 2. The repetitions of both sets were increased up
to ten, provided that this did not increase the patient’s pain.
The patients in Group 3 received a medical therapy agent
for ten days in addition to two sets of lumbar isometric
exercises (pelvic tilt and modified straightening), which were
repeated five times in the morning and at night. All patients in
the study were trained on lumbar exercises. The patients were
administered pelvic tilt and modified straightening exercises,
to be performed in two sets, each containing at least five
repetitions during periods with intensive pain. The patients
were instructed to increase the number of repetitions to ten
in each set when the treatment provided some relief. The
patients were informed that the key to prevent recurrences
and provide functional recovery was making the exercises
part of their lives.
The demographic features of the patients were ques-
tioned. The patient’s age, place of residence, comorbid con-
ditions, and medications were questioned. The patients were
BioMed Research International 3
assessed before and after the therapy. The lumbar MR images
of the patients were evaluated.
Statistical Analysis. All statistical analyses were performed
using SPSS 17.0 for Windows (SPSS, Chicago, IL, USA). The
Kolmogorov-Smirnov test was used to test the normality of
the data distribution, and the data were expressed as the
mean and standard deviation. The chi-square test was used
to compare the categorical variables between the groups.
The one-way ANOVA test was used for comparisons of the
8. parametric continuous data. The Kruskal-Wallis test was used
for the nonparametric continuous data. Pearson’s correlation
analysis was used to examine the associations between the
variables, and a linear regression analysis was performed
to identify independent predictors of the pain domains of
the SF-36. A two-sided � value < 0.05 was considered to
be statistically significant. A repeated measures ANOVA
was used to analyze the changes in variables. Significant
differences were determined by Bonferroni post hoc tests.
3. Results
Of 20 patients in Group 1, 5 were males and 15 were females.
Of 25 patients in Group 2, 8 were males and 17 were females.
Of 20 patients in Group 3, 9 were males and 11 were females.
There was no statistically significant difference in terms of
gender distribution. The mean age was 58.4 ± 10.76 years in
Group 1, 61±10.47 years in Group 2, and 54.6±14.89 years
in Group 3. There was no significant difference between the
groups in terms of age (�> 0.05).
The lumbar MRI reports of 65 patients with lumbar disc
herniations were examined. Of these patients, 53 had disc
protrusion at one or more levels and 12 had disc extrusion.
Of 65 patients, 32 had compression of the nerve roots at one
or more levels. There was no significant difference in terms of
compression of the nerve root and level of disc herniation.
The comparison of parameters in Group 1 before the
treatment and at the end of the therapy revealed significant
changes in VAS (visual analog scale), Oswestry scale score,
BP (body pain), GH (general health), VT (vitality), and SF
(social functioning) (� < 0.05). There was no significant
change in PF (Physical Function), RP (Restricted Physical
Roles), RE (Restricted Emotional roles), and MH (Mental
Health) parameters (� > 0.05). Changes of Oswestry scale
9. score and PF, BP, GH, and VT parameters in third month after
the therapy compared to values at the end of the treatment
were statically significant (Table 1).
The comparison of parameters in Group 2 before the
therapy and at the end of the therapy revealed significant
changes in VAS score, Oswestry scale score, and PF, RF, BP,
GH, VT, SF, RE, and MH parameters (�< 0.05). Comparing
results in third month of the treatment and at the end of the
treatment, statically significant changes were determined in
Oswestry scale score and PF, BP, GH, and MH parameters
(Table 1).
The comparison of parameters in Group 3 before the
therapy and at the end of the therapy revealed significant
changes is VAS, Oswestry scale score, and PF, RP, BP, GH, and
RE parameters (� < 0.05). VT, SF, and MH parameters did
not significantly change in Group 3 (� > 0.05). Comparing
results at the end of the treatment and in third month of
the treatment, statically significant change was continuing in
Oswestry scale score and BP and GH parameters (Table 1).
Comparing the changes between groups, statically sig-
nificant difference was observed in MH parameter before
treatment between Groups 1 and 2 and in MH parameter and
VAS score in third month of the therapy between Groups 2
and 3. However, the evaluation of the patients after ten days
of treatment did not show significant differences between the
groups compared to baseline values (Table 1).
4. Discussion
In the present study, a total of 65 patients with lumbar disc
herniation in the high intensity laser treatment (HILT), US,
and control groups were compared in terms of their scores
10. in VAS, SF-36, and Oswestry scale. In all treatment groups,
most parameters measured showed significant changes. The
differences in the three treatment groups did not achieve
statistical significance in terms of some parameters (� >
0.05). The comparison of parameters in Group 1 before
and at the end of the therapy revealed significant changes
in VAS score, Oswestry scale score, BP, GH, VT, and SF.
The comparison of parameters in Group 2 before and at
the end of the therapy revealed significant changes in VAS,
Oswestry scale score, and PF, RF, BP, GH, VT, SF, RE, and
MH parameters. The comparison of parameters in Group
3 before therapy and at the end of the therapy revealed
significant changes in terms of VAS, Oswestry scale score,
and PF, RP, BP, GH, and RE parameters. Improvement of
Oswestry scale score and PF, BP, GH, and VT parameters in
Group 1, improvement of Oswestry scale score and PF, BP,
GH, and MH parameters in Group 2, and improvement of
Oswestry scale score and BP and GH parameters in Group
3 were going on increasingly for three months. VAS scores
were better than compared to value before the therapy and at
the end of the therapy but there was no significant difference
between VAS scores in third month after the therapy and at
the end of the therapy.
Fiore et al. demonstrated the short term effects of a high
intensity laser on lumbar pain in a study that included 30
patients, 15 of which received US therapy and 15 who received
laser therapy. They reported more prominent pain relief and
recovery disability in the HILT group compared to US group
after three weeks of treatment. The rate of decline in the
VAS score in the two patient groups was 10% in favor of
the HILT group and 20% in Oswestry scale in favor of the
HILT group. They did not have control group as an important
lack of the study [13]. Alayat et al. conducted a randomized,
single-blind, placebo-controlled study to evaluate the long
term effects of HILT in patients with lumbar pain. The study
11. included 72 patients, and 28 patients in Group 1 received
HILT + exercise therapy, 24 patients in Group 2 received
placebo laser + exercise, and 20 patients in Group 3 received
HILT. They performed a total of 12 sessions of therapy for
four weeks. The patients were evaluated at baseline, fourth
week, and twelfth week. This study showed higher efficacy of
4 BioMed Research International
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42. the HILT + exercise program compared to placebo HILT +
exercise program and only exercise group [14]. Conte et al.
evaluated the HILT + lumbar school versus lumbar school
alone and studied 28 patients using VAS and Oswestry scale.
They emphasized that the HILT + lumbar school provided
higher improvement in Oswestry and VAS scores compared
to the lumbar school alone. Furthermore, they concluded that
the laser possessed low biological activity and produced little
side effects, if any, compared to pharmacological therapies
[15]. A meta-analysis of studies on low intensity laser therapy
reported positive effects on tissue repair and pain control
at various levels. However, these studies did not specifically
evaluate lumbar pain [16]. Monochromatic laser beams can
inherently modulate cellular and tissue functions. There
are controversial data regarding the effects of low intensity
laser on lumbar pain. Despite this controversy, low intensity
laser therapy has demonstrated efficacy in the short term
compared to the placebo when the patients were assessed
using VAS and Oswestry scales [17]. Considering last surveys,
HILT therapy can be good alternative physical therapy agent
for the patients with lumbar disc herniation. It does not
have distinct adverse effect and we did not encounter any
complication in our study.
Therapeutic US is an important treatment agent in mus-
culoskeletal disorders [12]. Ebadi et al. evaluated a total of 50
patients divided into two groups in order to investigate the
efficacy of continuous US in chronic lumbar pain. The first
group received continuous US and exercise, and the second
group received placebo US + exercise. They performed a total
of ten sessions of therapy for four weeks. They evaluated the
patients before and after the therapy using FRI (functional
rating index), VAS score, ROM, and endurance time. They
found significant improvement in the FRI index in the
continuous US group. The decrease in VAS scores, increase
in lumbar ROM, and endurance time were more prominent
43. in the continuous US group compared to the placebo US
group. The limitation of this study was that the effectiveness
of placebo US was not evaluated with the addition of a third
group that received exercise only [18]. Durmus et al. also
evaluated three patients groups that received either US +
exercise therapy, electrical stimulation, and exercise therapy
or exercise therapy alone for lumbar pain. They found that
US + exercise provided better pain relief compared to the
other two treatment modalities [19]. Doğan et al. divided 60
patients into three groups in order to evaluate three different
approaches in the treatment of chronic lumbar pain. In their
study, Group 1 received home exercises + aerobic exercise,
Group 2 received physical therapy (hot-pack, TENS, and US)
and home exercises, and Group 3 received home exercises
alone. They found a significant reduction in the pain level and
an increase in aerobic capacity, but there was no significant
difference between the groups. They stated that the rate
of functional disability and physiological disturbances were
lower in the physical therapy and home exercise group [20].
In the study by Grubisić et al. that evaluated the therapeutic
efficiency of US in the treatment of chronic lumbar pain,
16 out of 31 patients received US therapy. Ongoing medical
therapies of the study participants were not changed and
the patients were only allowed to take paracetamol during
painful periods. In the control group, a US device was
switched off while performing physical therapy. At the end
of the treatment period, US was found to be more effective
in providing pain relief; however, US was not found to
be superior to the control group in providing functional
improvement [21]. Basford et al. reported that US therapy has
gained a wide acceptance in routine practice in the treatment
of chronic lumbar pain; however, the evidence is not strong
enough to support the efficiency of this therapy [17]. US is
used for a long time in physical therapy and it is so safe and
effective treatment agent in several locomotor diseases. In our
44. study, we obtained improvement in terms of some parameters
in US group. We did not encounter any complication.
Limitation of this study may be the number of the
patients. If we received a larger numbers of patients, the effect
of HILT would be displayed obviously. We permitted the
patients to take medicine only during treatment period. It
may be seen disadvantage for the short term effect of the
treatment. Further studies with a larger number of patients
and controls are required to evaluate the long term effects of
the therapies.
There were no studies in the literature that compared the
effectiveness of HILT, US, and medical therapies in patients
with lumbar disc problems, which have an important place
in the etiology of acute and chronic lumbar pain. The current
literature search did not show a sufficient number of similar
studies. There are a very limited number of studies that
evaluated the efficiency of HILT in lumbar pain. The number
of patients included in the present study was similar to that
reported in other studies in the literature. The inclusion of a
control group allowed for the comparison of HILT and US
therapies with exercise therapies in the short term. However,
the evaluation of the patients aftermath ten-day treatment
did not show significant differences between the groups
compared to baseline values. This may have been caused
by the fact that the patients in our study were allowed to
take medical therapies during the most painful periods. The
patients in the HILT and US groups were not allowed to take
medical therapies unless they had extreme pain. We found
that HILT, US, and exercise were efficient therapies for lumbar
discopathy but HILT and US had longer effect in terms of
some parameters. Exercise therapy should never be ignored
to treat and prevent lumbar back pain.
Disclosure
45. All authors have no financial disclosures. They do not accept
any grants.
Conflict of Interests
The authors declare that there is no conflict of interests
regarding the publication of this paper.
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Ebadi et al. BMC Musculoskeletal Disorders 2012, 13:192
http://www.biomedcentral.com/1471-2474/13/192
RESEARCH ARTICLE Open Access
The effect of continuous ultrasound on chronic
non-specific low back pain: a single blind
placebo-controlled randomized trial
Safoora Ebadi1*, Noureddin Nakhostin Ansari1, Soofia
Naghdi1, Shohre Jalaei1, Mirmostafa Sadat2, Hosein Bagheri1,
Maurits W vanTulder3, Nicholas Henschke4 and Ehsan Fallah5
Abstract
Background: Non-specific chronic low back pain (NSCLBP) is
one of the most common musculoskeletal disorders
around the world including Iran. One of the most widely used
modalities in the field of physiotherapy is
therapeutic ultrasound (US). Despite its common use, there is
still inconclusive evidence to support its effectiveness
in patients with NSCLBP. The objective of this study was to
evaluate the effect of continuous US compared with
placebo US additional to exercise therapy for patients with
NSCLBP.
50. Methods: In this single blind placebo controlled study, 50
patients with NSCLBP were randomized into two
treatment groups: 1) continuous US (1 MHz &1.5 W/cm2) plus
exercise 2) placebo US plus exercise. Patients received
treatments for 4 weeks, 10 treatment sessions, 3 times per week,
every other day. Treatment effects were assessed
in terms of primary outcome measures: 1) functional disability,
measured by Functional Rating Index, and 2) global
pain, measured by a visual analog scale. Secondary outcome
measures were lumbar flexion and extension range of
motion (ROM), endurance time and rate of decline in median
frequency of electromyography spectrum during a
Biering Sorensen test. All outcome variables were measured
before, after treatment, and after one-month follow-up.
An intention to treat analysis was performed. Main effects of
Time and Group as well as their interaction effect on
outcome measures were investigated using repeated measure
ANOVA.
Results: Analysis showed that both groups had improved
regarding function (FRI) and global pain (VAS) (P < .001).
Lumbar ROM as well as holding time during the Sorensen test
and median frequency slope of all measured
paravertebral muscles did not change significantly in either
group (P > .05). Improvement in function and lumbar
ROM as well as endurance time were significantly greater in the
group receiving continuous US (P < .05).
Conclusions: The study showed that adding continuous US to a
semi supervised exercise program significantly
improved function, lumbar ROM and endurance time. Further
studies including a third group of only exercise and
no US can establish the possible effects of placebo US.
Trial registration: NTR2251
52. population under survey in Tehran (urban area) [3] and
in 23.4% of the population in rural areas in Iran [4].
Specific back pain occurs in approximately 2% of all
patients with back complaints [5]. For the majority of
patients with LBP a specific diagnosis cannot be defined
on the basis of anatomical or physiological abnormal-
ities. Non-specific LBP (NSLBP) is assumed to be in-
flammatory or mechanical in nature [6]. Chronic NSLBP
refers to an episode of activity-limiting LBP (with no
pain referred into either lower limb) that lasts for 3
months or more [7].
Non-pharmacological methods including a variety of
physical agents are the cornerstone of the management
of chronic LBP. Therapeutic ultrasound (US) is among
the commonly used physical modalities for treating soft
tissue injuries [8]. There is a dearth of evidence for the
clinical use of therapeutic US in patients with LBP [9].
Therapeutic US is delivered in two modes: 1) Continu-
ous mode in which the delivery of US is non-stop
throughout the treatment period; 2) Pulsed mode in which
the delivery of US is intermittently interrupted [10].
Therapeutic effects of US are classified as thermal and
non-thermal. Ultrasonic energy causes soft tissue mole-
cules to vibrate from exposure to the acoustic wave. This
increased molecular motion generates frictional heat and
consequently increases tissue temperature. This increased
temperature, named thermal effects, is thought to cause
changes in nerve conduction velocity, increase in enzym-
atic activity, changes in contractile activity of skeletal mus-
cles, increase in collagen tissue extensibility, increase in
local blood flow, increase in pain threshold, and reducing
muscle spasm [11].
53. Acoustic waves cause normally present minute gas
pockets in the tissue to develop into microscopic bubbles
or cavities. With therapeutic US, stable acoustic cavita-
tion results, whereby the microbubbles pulsate without
imploding. This pulsation leads to microstreaming of
fluid around the pulsating bubbles. When occurring
around cells, this process, referred to as non-thermal
effects, is reported to alter cell membrane activity, vascu-
lar wall permeability, and facilitate soft tissue healing
[12]. Traditionally, continuous US is used for its thermal
effects. Pulsing the US is thought to minimize its thermal
effects [10]. In fact, it is not possible to truly isolate the
thermal and non-thermal effects as both effects occur
with US application [13].
Studies on the efficacy of continuous US in chronic
LBP are lacking [8] and there is little evidence of its ef-
fectiveness in physiotherapy practice [14,15]. However,
lack of evidence is not evidence of lack of effect. There-
fore, the main objective of the current study was to
compare the effect of continuous US to placebo US
combined with exercise therapy on the primary out-
comes, functional status and pain of a group of patients
with NSCLBP, as well as on the secondary outcomes, en-
durance of paravertebral and hip muscles, and lumbar
range of motion.
Methods
Study design
The protocol of this study was approved by the Research
Council of Rehabilitation Faculty and the Ethical com-
mittee of Tehran University of Medical Sciences
(TUMS). The trial was registered with the Netherlands
Trial Registry (NTR2251). A more detailed description
of the study protocol has been published before [16].
54. Inclusion criteria in this study were as follows: 1) hav-
ing NSCLBP, 2) age between 18 and 60. Exclusion criteria
were: 1) having nerve root symptoms, 2) having systemic
disease and specific conditions such as neoplasm, frac-
tures, spondylolysthesis, spondylolysis, spinal stenosis,
ankylosing spondylitis, previous low back surgery, 3) tak-
ing medication for specific psychological problems, and
4) being pregnant. Patients were recruited from three
university hospitals of TUMS in Tehran, Iran. Patients
were provided with oral and written information about
the study and were asked to sign a consent form.
Sample size
The primary outcome measure of this study was changes
in functional status using Functional Rating Index (FRI).
Assuming the effect size of .8 for FRI with alpha set
at .05 and a power of .8, and accounting for 10% drop-
outs, the sample size needed was calculated as being 23
patients in each group.
Randomization
Randomization was performed using opaque sealed
envelopes, which were prepared by a statistician using a
computer generated randomization schedule. Half of the
envelopes were allocated to each group ensuring equal
number of subjects in each group.
Interventions
The intervention group received continuous US plus
semi-supervised exercise; the control group received pla-
cebo US plus semi-supervised exercise. Patients were
Ebadi et al. BMC Musculoskeletal Disorders 2012, 13:192 Page
55. 3 of 10
http://www.biomedcentral.com/1471-2474/13/192
requested not to take pain medications during the inter-
vention period and not to participate in any other exer-
cise or treatment program. All patients in both groups
received 10 sessions of treatment, three times a week,
every other day.
US therapy
Recent reviews of therapeutic US have failed to identify
a dose–response relationship [17-19]; though intensities
from 0.5 W/cm2 to 3 W/cm2 have been advocated [18].
Recently published randomized controlled trials, which
have reported significant benefits of therapeutic US over
placebo US, have used intensities of 1 W/cm2 to 1.5
W/cm2 [20,21].
Mild heating in the chronic phase of injury is known
to reduce pain and muscle spasm and to promote heal-
ing process. More chronic lesions are treated with con-
tinuous US. US frequency of 1 MHz is preferable when
treating large and deep soft tissue volumes. Intensities
between .8 to 3 W/cm2 are suggested for chronic lesions
[10,22,23]. Therefore, we chose continuous mode with a
frequency of 1 MHz and an intensity of 1.5 W/cm2 due
to the chronocity of the condition and the deep position
of lower back musculature.
US was applied using Enraf Nonius Sonoplus 434,
ENRAF,Netherland (coupling gel: Sono Gel, Germany).
Slow circular movements were applied using the trans-
ducer head over the painful paravertebral low back re-
gion. The duration of US was estimated for each patient
using Grey’s formula [24]. The average local exposure
time was planned to be one minute and the effective ra-
diating area of the transducer head was 5 cm2. For a pa-
56. tient with an area of low back pain of 40 cm2, for
example, the required total treatment time was: 1 min ×
(40 cm2/5 cm2) = 8 minutes.
Patients in the intervention group received continuous
US. Placebo US was delivered according to Hashish
et al. [25]. The therapist moved the applicator at the
same rate and pressure as for the continuous US group.
The machine and the light-emitting diode which sig-
naled that its power was connected were in view of the
subject, but the dials which indicated the US were out of
sight. Commonly, the patient is not aware of what she/
he should expect at the beginning of treatment with US
and since even with real US subjects are unaware of any
sensation at most therapeutic intensities [22], patients
were told in both groups that they may feel some heat
and should this cause discomfort, to notify the therapist
in order to safeguard patients in the continuous US
group from overheating.
Exercise therapy
There is strong evidence that exercise is as effective as
other conservative treatments in chronic LBP, and
functional and pain outcomes significantly improves in
groups receiving exercises relative to other interventions
[26]. Studies indicate that stretching and strengthening
exercises can improve pain and function. Home exer-
cises combined with therapist supervision have been
identified as the most effective strategy for patients with
CLBP [27].
It is recognized that the abdominal muscles, back
extensors, and gluteals are weak in patients with CLBP,
which can cause significant spinal loading. Patients with
LBP also exhibit tightness of hamstring and hip exten-
sors, which may impair spinal mechanics. Therefore,
57. strengthening and flexibility exercises are important for
a healthy lower back [28].
A semi-supervised exercise program was developed.
The program included posterior pelvic tilts, sit-ups,
bridging, quadruped exercises, and posterior hip and
knee muscles stretching [29,30]. Patients were instructed
to perform 2 to 3 stretches (of all muscles) per day and
hold the stretch for 20 seconds unless it hurts. Strength-
ening exercises started with 5 repetitions and progressed
according to each patient’s improvement, to 3 sets of 10
repetitions. Patients received a pamphlet describing
exercises with figures. To emphasize correct perform-
ance of the exercises at home, all exercises were checked
by the therapist on each treatment session.
Patients were asked to perform the exercises daily; the
stretching exercises before the strengthening exercises.
They were advised to stay active during the day, and
walk for at least 15 minutes before exercising, which
could also act as a warm-up. After completion of all
treatment sessions, patients were asked to maintain the
daily home exercises for one further month. During
the period from the completion of the treatment to the
follow-up measuring session (1 month), patients visited
the clinic once a week to control their exercises for cor -
rect performance.
Outcome measures
Primary and secondary outcome measures were docu-
mented at baseline, after the final treatment session
(after 4 weeks), and at one-month follow-up.
Pain and function are the two most fundamental clin-
ical outcomes for low back pain [31], while accurate as-
sessment of lumbar range of motion has been
58. recommended as a core domain in the evaluation of
patients with lumbar dysfunction and monitoring treat-
ment progress [32,33]. Since the endurance of trunk
muscles has been shown to be related to the incidence
of low back pain, surface electromyography, specifically
power spectral analysis of EMG signals has become an
increasingly common method for the assessment of lum-
bar muscle activity and localized muscle fatigue and has
been suggested as an objective, safe, easy and non
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invasive measure for the evaluation of patients with low
back pain [34].
Readers are referred to the design article of this study
for further details on assessment methods related to out-
come measurements [16].
The Primary outcomes were functional disability mea-
sured by the Persian version of the Functional Rating
Index (FRI) [35-37] and pain intensity measured during
last week on a 100 mm visual analogue scale (VAS) [38].
Secondary outcome measures were paravertebral
muscle fatigue during a Biering-Sorensen test using sur-
face electromyography [39], and lumbar flexion and ex-
tension range of motion using the Modified-Modified
Schober Test (MMST) [40].
Briefly, electromyographic data acquisition was per-
formed using an 8-channel surface EMG recorder
(DATA Log Biometrics Ltd) and analyzed by the built in
59. software, DATA LOG PC software version 7.5 (Biomet-
rics Ltd, UK). The software applied Fast Fourier trans-
formation to calculate median frequency and gave the
rate of decline in median frequency (MF slope) by trend
lines which were calculated using Linear Regression
Analysis based upon the least squares method to pro-
duce a slope m and an intercept of the Y-axis. Preampli-
fied bipolar Ag-AgCl electrodes (Type NO.SX230,
Biometrics Ltd, UK, 10 mm in diameter) with fix center
to center inter electrode distance of 20 mm were used.
The signal was gathered at a sample rate of 1000 Hertz
and a gain of 1000 Decibel.
Data analysis
All data were analyzed using SPSS V19, SPSS Inc.,
Chicago, IL, USA. Kolmogorov-smirnov test revealed
normal distribution of data. Repeated measure ANOVA
was used to determine the main and interaction effects
of Time and Group on the outcome measures. Bonfer-
roni test was used for pos -hoc analysis when necessary.
An intention-to-treat analysis of the data was per-
formed to retain data for all patients. In the case of
dropouts, the last recorded values for the outcome mea-
sures were used in the analysis (Last Observation Car-
ried Forward (LOCF)). p-values ≤ .05 were considered as
statistically significant.
Results
Figure 1 shows a flow chart of participants. A total of 50
patients were randomized, 25 to each group. One patient
in each group dropped out after the 9th session, because
of personal reasons. Nine more patients (3 patients in
the experimental group and 6 patients in the placebo
group) did not complete the follow-up measurement,
because of travelling, complete improvement or other
personal reasons.
Mean age of all participants was 34.7 (SD 12.6) years
60. with a mean pain history of 7.0 (SD 4.6) years. There
was no statistically significant difference in baseline
characteristics as well as baseline outcome measures be-
tween groups except for endurance time (Table 1). Pos-
sible effect of endurance time at baseline was measured
by evaluating the effect of adding this variable to the
model using analysis of covariance (ANCOVA). It
resulted in no change in the statistical significance of the
Time or Group effects.
Mean values for baseline, after 10 session treatment
and 1-month follow up measurements as well as
P values for baseline differences are shown in Table 2.
As can be seen, FRI has shown improvement (decreased)
in both groups. Also, VAS scores have dropped in both
groups. Details of secondary outcome measures can be
found in Table 2.
Table 3 details the results of the mixed model ANOVA
[Group (US and placebo US) × Time (Pre, Post, and fol-
low-up)] showing the effect of continuous US versus
sham US on outcome measures.
Primary outcome measures
There was a significant effect of Time (p < .001) on FRI.
Bonferroni post-hoc test revealed that FRI scores had
improved significantly after 10 treatment sessions
(p < .001) and over time after one month follow-up in
both groups (p < .001). The improvement of FRI scores
was maintained one month after the end of the 10th
treatment session (p = .24). Main effect of Group on FRI
was significant (p = .004) while the Time × Group inter-
action was not significant (p = .31).
There was a significant effect of Time on VAS
61. (p < .001). The mixed model ANOVA on VAS did not
reveal a statistically significant Group effect (p = .48).
Post-hoc analysis showed that VAS scores improved sig-
nificantly from baseline to after the 10th session (p < .001)
and continued to improve until the one-month follow-up
measurement (p = .004). The Time × Group interaction
was not significant (p = .48).
Secondary outcome measures
Main effect of Time was not significant on both flexion
(p = .09) and extension lumbar ROM (p = .11). However,
a significant Group effect was identified for flexion
(p = .02) and extension (p = .01). The interaction effect
of Time × Group on lumbar range of motion was not
significant (flexion: p = .23, extension: p = .21).
The values for median frequency slope did not show a
statistically significant Time effect (p > .05); Group effect
(p > .05) or Group × Time interaction (p > .05).
Although main effect of Time on holding time during
Sorensen test was not significant (p = .09), the effect of
Group showed statistical significance (p = .01). There
Assessed for eligibility (n = 56)
Excluded (n = 6)
• Not meeting inclusion criteria (n = 4)
• Declined to participate (n = 0)
• Other reasons (n = 2)
Analysed (n = 25)
• Excluded from analysis (n = 0)
62. Lost to follow-up (didn’t attend the follow up
measurement session because of personal reasons
other than not being satisfied with the treatment)
(n = 3)
Allocated to continuous US group (n = 25)
• Received allocated intervention (n = 24)
• Did not receive allocated intervention (n = 1)
(Discontinued intervention after session 9th
(travelling))
Lost to follow-up (didn’t attend the follow up
measurement session because of personal reasons
other than not being satisfied with the treatment)
(n = 6)
Allocated to placebo US group (n = 25)
• Received allocated intervention (n = 24)
• Did not receive allocated intervention (n = 1)
(Discontinued intervention after session 9th
(travelling))
Analysed (n = 25)
• Excluded from analysis (n = 0)
Allocation
Analysis
Follow-Up
Randomized (n=50)
Enrollment
63. Figure 1 Flow diagram of participation and withdrawals for
patients in continuous ultrasound and placebo ultrasound
groups.
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was no interaction effect of Time × Group on this
parameter.
Discussion
In everyday clinical practice the application of US is
often combined with other physiotherapeutical interven-
tions, usually with exercise therapy [41]. The aim of this
study was to investigate whether continuous US can add
to the effects of exercise therapy in patients suffering
from NSCLBP compared to placebo US.
The results showed that both FRI and VAS have
improved after 10 sessions of treatment and over time
Table 1 Characteristics of patients with non specific chronic l
and placebo ultrasound groups
Parameter Continuous US*
(n=25)
Mean S
Age(years) 31.4 12
Onset since first episode(years) 5.8 4
BMI** 24.4 4
64. Sex 25%female _ 75%male
* Ultrasound.
** Body Mass Index.
***p values are for baseline differences between the two
groups. Significance level
after 1 month in both groups. FRI improvement was sig-
nificantly greater in the group receiving continuous US.
This finding is consistent with Ansari et al. [20] who
demonstrated a better functional outcome in a continu-
ous US group in comparison with a placebo US group.
In their study patients did not receive any treatment in
addition to continuous and placebo US. Other rando-
mized trials in which the effect of US is directly com-
pared with placebo US in NSCLBP are lacking. US is
usually studied in comparison with other modalities
[42,43] or is presented in a package of physiotherapy
[44] and is also investigated in other subgroups of
ow back pain before treatment in continuous ultrasound
Placebo US P value***
(n=25)
D Mean SD
.3 37.4 11.9 .09
.1 8.1 4.7 .08
.1 25.3 3.5 .39
50%female _ 50%male
≤ .05.
65. Table 2 Mean and SD of primary and secondary outcome
measures for continuous ultrasound and placebo ultrasound
groups at baseline, after 10 treatment sessions, and after 1
month follow up
Parameter Continuous US* Placebo US P value***
Before
treatment
After 10
sessions
After 1
month
Before
treatment
After 10
sessions
After 1
month
N=24 N=24 N=21 N=24 N=24 N=18
FRI** 40.8 (14.6) 23.4 (6.9) 22.8 (7.8) 43.9 (16.9) 31.1 (13.4)
30.5 (11.9) .49
VAS** 46.6 (17.7) 26.6 (13.8) 27.7 (14.4) 49 (16) 30.7 (13.1)
25.5 (9.9) .62
Flexion ROM (millimeters) 48.8 (19.4) 52.4 (18.6) 52.4 (19.60)
66. 57.4 (18.9) 59.8 (17.9) 57.5 (18.3) .13
Extension ROM (millimeters) 19.4 (8.2) 20.12 (8.5) 21.7 (8.5)
23.6 (9.6) 24.1 (9.3) 24.7 (9.6) .11
Endurance time(in seconds) 111.5 (33.5) 128.9 (30.2) 128.3
(26.2) 134.2 (27.1) 140.3 (43.5) 139.3 (45.8) .01
Median frequency slope of right muscles
Illiocostalis lumborum -.24 (.17) -.21 (.09) -.19 (.07) -.21 (.13)
-.20 (.06) -.19 (.06) .56
Multifidus -.26 (.15) -.26 (.16) -.24 (.13) -.30 (.17) -.25 (.05) -
.24 (.05) .82
Gluteus maximus -.11 (.13) -.09 (.10) -.09 (.10) -.13 (.13) -.09
(.09) -.09 (.1) .65
Biceps femoris -.12 (.09) -.12 (.08) -.09 (.06) -.11 (.07) -.12
(.07) -.09 (.05) .83
Median frequency slope of left muscles
Illiocostalis lumborum -.18 (.11) -.18 (.11) -.16 (.09) -.21 (.12)
-.19 (.07) -.18 (.08) .29
Multifidus -.24 (.14) -.25 (.15) -.25 (.15) -.29 (.21) -.24 (.10) -
.25 (.11) .31
Gluteus Maximus -.06 (.04) -.06 (.06) -.08 (.05) -.09 (.07) -.08
(.05) -.09 (.08) .11
*US: Ultrasound.
**FRI: Functional Rating Index, VAS: Visual Analog Scale.
***p values are for baseline differences between the two groups
67. at significance level ≤ .05.
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patients with LBP other than non-specific LBP, such as
lumbar disk herniation [45-47].
Durmus et al. [42] in comparing 3 groups of NSCLBP
patients who received US + exercise, Electrical Stimula-
tion (ES) + exercise and exercise only, showed signifi -
cantly greater improvement in pain and function of the
ES and US groups in comparison with the control group.
The study found no difference in function between
groups receiving either ES, or US but the US group had
significantly better scores regarding pain improvement.
Mohseni et al. [43] compared manipulation and exer-
cise treatment with US and exercise treatment in a ran-
domized clinical trial. One hundred and twenty patients
with chronic LBP were given a program of exercises. In
addition, one group received spinal manipulation ther-
apy and the other group received therapeutic US. Pain
intensity, functional disability, lumbar movements mea-
sured by Modified Modified Schober Test and muscle
endurance were measured shortly before treatment, at
the end of the treatment program and 6 months after
randomization using surface electromyography. Al-
though improvements were recorded in both groups,
patients receiving manipulation/exercise showed a
greater improvement compared with those receiving US/
exercise at both the end of the treatment period and at
6-month follow-up. The authors did not report on the
details of the exercise program, and US delivery was in-
consistent (continuous 1MHz, 1.5-2.5W/cm2 for 5 to 10
minutes, average 6 sessions, one or two times a week)
68. which could both be possible sources of difference with
our study.
Since the current study lacks a third group with no
US, it is impossible to explore the effects of exercise and
US separately except in parts where the continuous US
group has shown significant differences in comparison
to the placebo group. As both groups in our study
improved significantly regarding pain, we can conclude
that the treatment common to both groups (exercise
and mechanical application of US head) have attributed
to the outcome. There is strong evidence that exercise is
an effective treatment in chronic low-back pain [48]. Ex-
ercise programs for CLBP may be designed to reverse
deconditioning or the fear of movement associated with
pain. Such exercises typically include aerobic exercises
like walking as well as strengthening and stretching regi-
mens [27]. The specific exercises administered to
patients in this study may have been of benefit in im-
proving pain. Since many items of the FRI questionnaire
are indirectly related to the pain experienced by patients
during that specific task, the decreased pain achieved
with treatment could have caused the patients in both
groups to perform better during those tasks as well.
However, the individual role of the placebo effects of
US in the placebo group as well as the individual effect
of mechanical movement of US head and exercising in
both groups cannot be specified although each one may
Table 3 Main effects of Time and Group and their
interaction effect on primary and secondary outcome
measures (CI=95%,) *
69. Outcome measure Effects df F P value
FRI** Time 2 75.92 <.001*
Group 1 3.90 .004*
Time*Group 2 1.03 .31
VAS** Time 2 80.11 <0.001*
Group 1 .00 .48
Time*Group 2 .514 .98
Lumbar flexion Time 2 3.47 .09
Group 1 3.16 .02*
Time*Group 2 1.48 .23
Lumbar extension Time 2 1.53 .11
Group 1 4.12 .03*
Time*Group 2 1.61 .21
Endurance time Time 2 0.63 .43
Group 1 3.05 .05*
Time*Group 2 1.99 .17
Right Illiocostalis Lumborum Time 2 .39 .53
Group 1 .01 .93
70. Time*Group 2 .52 .41
Right Multifidus Time 2 .06 .16
Group 1 .16 .69
Time*Group 2 .52 .48
Right Gluteus Maximus Time 2 3.41 .73
Group 1 .02 .89
Time*Group 2 .52 .47
Right Biceps Femoris Time 2 5.38 .86
Group 1 .02 .79
Time*Group 2 .05 .82
Left IliocostalisLumborum Time 2 3.65 .06
Group 1 .87 .35
Time*Group 2 .38 .54
Left Multifidus Time 2 1.49 .23
Group 1 .14 .71
Time*Group 2 1.22 .27
Left Gluteus Maximus Time 2 .98 .33
Group 1 .95 .33
71. Time*Group 2 .86 .36
*The effect of the US versus placebo US on outcome measures
was analyzed
using a Group (US and placebo US) × Time (Pre, Post, and
follow-up) mixed
model ANOVA at significance level ≤ .05.
**FRI: Functional Rating Index, VAS: Visual Analog Scale.
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have played a part in the outcome. A placebo effect of
US can be the result of moving the applicator head thus
benefitting from the effects of massaging [20,25]. Con-
tinuous movement of the applicator may increase the
temperature of the area under treatment and may stimu-
late the skin receptors causing the pain gate control
mechanism to become active [20]. It has been shown
that moving the applicator of US on the affected area
can change the level of serum cortisol, which in turn can
affect inflammation and swelling [25]. Patients in both
groups could have benefitted from the Placebo effects of
the treatment [49].
A significant difference in the improvement of FRI
scores in favor of the continuous US group can be
related to the thermal and mechanical effects of continu-
ous US.
Morrisette et al. [50] showed that continuous 1 MHz
US given at either 1.5 W/cm2 or 2.0 W/cm2 intensity has
the capability of heating lumbar periarticular tissue while
the intervening muscle may heat as well. Morrisette sta-
ted that the temperature elevation was at a level thought
to be sufficient to produce the theoretical therapeutic
72. effects proposed with an elevation in temperature.
Regarding secondary outcome measures, although
lumbar flexion and extension ROM increased in both
groups after treatment, the increase did not reach statis-
tical significance within groups. Nevertheless, the
amount of improvement in ROM was significantly
greater in the continuous US group. Durmus et al. [42]
reported significant improvement in Modified Schober
scores in the group receiving US + exercise. However,
this improvement was not significantly different from
the two other treatment groups receiving ES + exercise
and exercise only. In the study carried out by Mohseni
et al. [43], lumbar flexion and extension ROM as mea-
sured by MMST (Modified Modified Schober Test)
improved significantly in US + exercise group but this
improvement was significantly lower in comparison with
the manipulation + exercise group. Though none of the
studies above, had reported the exact exercises pre-
scribed, their difference with our study can be possibly
explained by the differences in exercise type and inten-
sity and patient population as well as the difference in
the dosage of US.
Clinical assessment of movement impairment in low
back pain is predominantly done by measuring changes
in lumbar ROM in order to investigate patient’s response
to treatment [51]. The reduction in pain alongside
stretching and strengthening exercises prescribed could
have contributed to the increase of ROM in both groups.
The significant additional increase of ROM in the con-
tinuous US group may be due to the thermal and mech-
anical effects of continuous US. It has been shown that
temporary increases in range of movement can be pro-
duced by US treatment [52]. There is considerable evi -
dence that the extensibility of collagen based tissues will
73. change with ultrasound thermal applications as long as
sufficient temperature change is achieved [53]. Since the
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therapeutic window for stretching following US applica-
tion is limited to some 3 minutes immediately after
treatment [54], our participants that performed exercises
after the treatment sessions, at home, barely could have
benefited from such thermal effect. Given that patients
suffering from chronic low back pain usually have spasm
[7], using continuous US could have been effective in
decreasing spasm [10] and consequently resulting in
greater ROM increase in comparison with placebo US.
Considering surface EMG parameters, no significant
effect of Time or Group was found on median frequency
slope of all measured muscles.
The assessment of fatigue based on SEMG techniques
during a fatiguing contraction can be demonstrated by a
trend of the power spectrum to lower frequencies usu-
ally measured by the decrease in median frequency. It
has been proposed that better endurance would exhibit
a less precipitous decay rate of the median frequency
[55], though conflicting opinions exist [56]. It has been
indicated that trunk muscle endurance can be increased
by using specific exercises [57].
Sung [58] investigated changes in multifidi muscle en-
durance and functional status after a 4-week supervised
spinal stabilization exercise program in 16 patients pre-
senting with chronic low back dysfunction (LBD).
74. Results showed that Oswestry scores improved signifi-
cantly from pre to post treatment. Significant pre- to
post treatment increase in multifidi muscle fatigue for
men coupled with a nonsignificant improvement in mul-
tifidi muscle endurance for women was also seen. Sung
[58] concluded that a 4-week spinal stabilization exercise
program significantly improved functional status in
patients presenting with LBD but the program was in-
sufficient to effect muscle fatigue. In another study,
Mohseni et al. [43] did not find any significant change in
median frequency slope or endurance time in the group
of patients with low back pain who received continuous
US plus exercise for an average of 6 sessions. We also
witnessed a nonsignificant change in MF slope of mea-
sured paravertebral muscles, which may imply that the
usefulness and sensitivity of this parameter was limited
in our study.
Regarding endurance time, the group receiving con-
tinuous US showed a significantly greater increase than
the placebo group. Traditionally, endurance is thought
of as the time for sustaining a nonstationary activity,
which ceases with fatigue [59]. One of the main reasons
for muscle fatigue is the accumulation of metabolite
wastes in the region and the inability of the system to
provide adequate blood circulation to supply oxygen to
the tissue and deplete it from wastes [60]. Additionally,
ischemia due to inflammation and spasm is a common
finding in chronic low back pain [7,28,61]. It is possible
that continuous US has improved low back muscle
fatigue by increasing blood circulation in the region and
helping improve blood supply [17,23,61] which in turn
have caused more sufficient and longer muscle contrac-
tion during the test.
Limitations
75. The main limitation of this study could be that the treat-
ing physiotherapist who collected the data was not
blinded to the group allocation. The number of dropouts
in our study was higher than what we had predicted at 1
month (22%). The self-reported compliance rate seemed
high, but it was not checked. The study lacks a third
group without US which makes it impossible to com-
ment on individual interventions separately.
Conclusions
This single blind, placebo -controlled, randomized clin-
ical trial showed that adding 1 MHz, 1.5 W/cm2 US to a
semi-supervised regimen of exercise had significantly
beneficial effects on function, lumbar flexion and exten-
sion ROM, and endurance time in patients with
NSCLBP.
Further studies including a third group of no US are
needed to explore the differential effects of each inter-
vention on patients with NSCLBP. In addition, it would
be helpful to measure other surface electromyography
parameters other than median frequency slope, such as
mean frequency, initial median frequency and normal-
ized median frequency slope to explore the possible
effects of the method used in this study on these
parameters.
Studies, in which the methodological shortcomings of
this study and similar studies are addressed, are needed
to verify a dose response relation in patients with
chronic low back pain.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
76. SE and NNA came up with the original concept for the study.
SN, NH, and
MvT helped to design the study and contributed to the
development of the
manuscript. EF and MS coordinated and referred the patients,
HB
participated in the executive steps of the study and SHJ
performed the
statistical analysis. SE wrote the first draft of the manuscript
with help from
the other authors. All authors read and approved the final
manuscript.
Acknowledgements
The authors would like to thank all patients included in this
study. We would
also like to thank the Research Deputy, Tehran University of
Medical Sciences
for their financial support.
Author details
1Department of physiotherapy, School of Rehabilitation, Tehran
University of
Medical Sciences, Shahnazari St, Tehran, Iran. 2Sina Hospital,
Medical Faculty,
Tehran University of Medical Sciences, Hasanabad St, Tehran,
Iran.
3Department of Health Sciences, VU University, De Boelelaan,
Amsterdam,
The Netherlands. 4Musculoskeletal Division NHMRC
Postdoctoral Fellow, The
George Institute for Global Health, Kent St, Sydney, Australia.
5Emam Reza
77. Ebadi et al. BMC Musculoskeletal Disorders 2012, 13:192 Page
9 of 10
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hospital, Medical Faculty, Army University of Medical sciences
of the I.R.Iran,
Etemadzade St., Tehran, Iran.
Received: 15 December 2011 Accepted: 26 September 2012
Published: 2 October 2012
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doi:10.1186/1471-2474-13-192
Cite this article as: Ebadi et al.: The effect of continuous
ultrasound on
chronic non-specific low back pain: a single blind placebo-
controlled
randomized trial. BMC Musculoskeletal Disorders 2012 13:192.
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AbstractBackgroundMethodsResultsConclusionsTrial
registrationBackgroundMethodsStudy designSample
sizeRandomizationInterventionsUS therapyExercise
therapyOutcome measuresData analysisResultsPrimary outcome
measuresSecondary outcome
measuresDiscussionLimitationsConclusionsCompeting
interestsAuthors´ contributionsAcknowledgementsAuthor
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