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
This document summarizes and discusses several research studies related to manual therapy and musculoskeletal conditions:
- One study found no additional benefit of adding neck manual therapy to treatment for shoulder impingement syndrome. Reasons may include a lack of sufficient dosage or benefits for patients without neck problems.
- Another study compared the effects of active craniocervical flexion exercise versus passive mobilization on cervical range of motion and pain in patients with chronic neck pain, finding greater short-term pain relief from exercise.
- A third study classified low back pain patients according to an existing system and found most classifications remained stable over 10 days, though differences between subgroups were small. Classification may need to consider psychological factors to be useful.
Effectiveness of Strain Counterstrain Technique on Quadratus Lumborum Trigger...IOSR Journals
Abstract: Quadratus lumborum (QL) myofascial trigger points (MTrP) are well documented in low back pain
(LBP) patients. There is a Growing body of evidence suggesting that Strain counterstrain technique (SCS) is an
effective treatment for the pain associated with MTrP. Literature is sparse regarding the effectiveness of SCS on
MTrP in QL in LBP subjects. We studied the immediate effects of SCS on pain intensity & functional outcome
in subjects having LBP with MTrP in QL. 40 subjects were randomly allocated into two groups. The Control
group (CG) received moist heat, & the Experimental group (EG) received moist heat & SCS technique.
Outcome measures were Visual Analogue Scale (VAS) & Patient Specific Functional Scale (PSFS).Pain
scores(VAS) Showed Statistically significant differences within the groups (P<0.0001), while clinically
significant improvement was seen only in EG with mean difference (3.75) , 95% confidence interval (4.17,3.04),
PSFS also showed significant improvement in EG.
Keywords: Quadratus lumborum, Myofascial Trigger Point, Pain, Low Back Pain, Strain Counterstrain
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.
This document summarizes evidence-based treatment approaches for shoulder pain, specifically shoulder impingement syndrome (SIS) and adhesive capsulitis. For SIS, manual therapy combined with exercise is more effective than exercise or usual care alone in reducing pain and improving function and strength. For adhesive capsulitis, corticosteroid injections and capsular distension provide short-term benefits but effects are not long-lasting. Manipulation is commonly used but risks injury, especially in osteoporotic patients. Physical therapy focused on stretching and strengthening is usually recommended first before more invasive treatments.
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.
This randomized controlled trial examined the effects of two modified posterior shoulder stretching exercises (PSSEs) on shoulder mobility, pain, and dysfunction in patients with subacromial impingement syndrome (SIS). 67 patients with SIS and internal rotation deficit were assigned to receive either a modified cross-body stretch, modified sleeper stretch, or a control treatment of modalities and exercises without PSSEs. Both stretching groups demonstrated greater improvements in pain with activity, internal rotation range of motion, function, and disability compared to the control group. However, there was no significant difference between the two stretching groups. All treatments led to improvements in pain, shoulder mobility, function, and disability.
Georgetown University Hospital Student InserviceKathleen Deaton
This document discusses the application of manual therapy techniques in the neurologic patient population. It provides examples of common manual therapy applications such as stretching, mobilization, and dry needling. It also discusses primary and secondary impairments associated with neurological dysfunction that manual therapy can address, such as changes in muscle tone, alignment, mobility and soft tissue length. The document then presents three case studies demonstrating the use of manual therapy for patients with cerebral palsy, multiple sclerosis, and traumatic brain injury. It concludes with a literature review showing a lack of research but some evidence that manual therapy may improve range of motion and decrease pain in neurological patients.
This document provides background information and literature review for a study comparing the effectiveness of kinesio taping and exercise for shoulder impingement syndrome. It introduces shoulder impingement as a common shoulder problem caused by inadequate space for rotator cuff tendons. The literature review summarizes previous studies that found scapular taping, therapeutic kinesio taping, and exercise programs can reduce pain and improve function in impingement. Outcome measures to be used in the proposed study include VAS (visual analog scale) for pain, DASH scale for function assessment, and goniometry for range of motion measurements.
This document summarizes and discusses several research studies related to manual therapy and musculoskeletal conditions:
- One study found no additional benefit of adding neck manual therapy to treatment for shoulder impingement syndrome. Reasons may include a lack of sufficient dosage or benefits for patients without neck problems.
- Another study compared the effects of active craniocervical flexion exercise versus passive mobilization on cervical range of motion and pain in patients with chronic neck pain, finding greater short-term pain relief from exercise.
- A third study classified low back pain patients according to an existing system and found most classifications remained stable over 10 days, though differences between subgroups were small. Classification may need to consider psychological factors to be useful.
Effectiveness of Strain Counterstrain Technique on Quadratus Lumborum Trigger...IOSR Journals
Abstract: Quadratus lumborum (QL) myofascial trigger points (MTrP) are well documented in low back pain
(LBP) patients. There is a Growing body of evidence suggesting that Strain counterstrain technique (SCS) is an
effective treatment for the pain associated with MTrP. Literature is sparse regarding the effectiveness of SCS on
MTrP in QL in LBP subjects. We studied the immediate effects of SCS on pain intensity & functional outcome
in subjects having LBP with MTrP in QL. 40 subjects were randomly allocated into two groups. The Control
group (CG) received moist heat, & the Experimental group (EG) received moist heat & SCS technique.
Outcome measures were Visual Analogue Scale (VAS) & Patient Specific Functional Scale (PSFS).Pain
scores(VAS) Showed Statistically significant differences within the groups (P<0.0001), while clinically
significant improvement was seen only in EG with mean difference (3.75) , 95% confidence interval (4.17,3.04),
PSFS also showed significant improvement in EG.
Keywords: Quadratus lumborum, Myofascial Trigger Point, Pain, Low Back Pain, Strain Counterstrain
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.
This document summarizes evidence-based treatment approaches for shoulder pain, specifically shoulder impingement syndrome (SIS) and adhesive capsulitis. For SIS, manual therapy combined with exercise is more effective than exercise or usual care alone in reducing pain and improving function and strength. For adhesive capsulitis, corticosteroid injections and capsular distension provide short-term benefits but effects are not long-lasting. Manipulation is commonly used but risks injury, especially in osteoporotic patients. Physical therapy focused on stretching and strengthening is usually recommended first before more invasive treatments.
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.
This randomized controlled trial examined the effects of two modified posterior shoulder stretching exercises (PSSEs) on shoulder mobility, pain, and dysfunction in patients with subacromial impingement syndrome (SIS). 67 patients with SIS and internal rotation deficit were assigned to receive either a modified cross-body stretch, modified sleeper stretch, or a control treatment of modalities and exercises without PSSEs. Both stretching groups demonstrated greater improvements in pain with activity, internal rotation range of motion, function, and disability compared to the control group. However, there was no significant difference between the two stretching groups. All treatments led to improvements in pain, shoulder mobility, function, and disability.
Georgetown University Hospital Student InserviceKathleen Deaton
This document discusses the application of manual therapy techniques in the neurologic patient population. It provides examples of common manual therapy applications such as stretching, mobilization, and dry needling. It also discusses primary and secondary impairments associated with neurological dysfunction that manual therapy can address, such as changes in muscle tone, alignment, mobility and soft tissue length. The document then presents three case studies demonstrating the use of manual therapy for patients with cerebral palsy, multiple sclerosis, and traumatic brain injury. It concludes with a literature review showing a lack of research but some evidence that manual therapy may improve range of motion and decrease pain in neurological patients.
This document provides background information and literature review for a study comparing the effectiveness of kinesio taping and exercise for shoulder impingement syndrome. It introduces shoulder impingement as a common shoulder problem caused by inadequate space for rotator cuff tendons. The literature review summarizes previous studies that found scapular taping, therapeutic kinesio taping, and exercise programs can reduce pain and improve function in impingement. Outcome measures to be used in the proposed study include VAS (visual analog scale) for pain, DASH scale for function assessment, and goniometry for range of motion measurements.
1) The study examined the effects of kinesio taping applied prior to proprioceptive neuromuscular facilitation (PNF) treatment on lower extremity proprioception in hemiplegic patients post-stroke.
2) 30 post-stroke patients were randomly assigned to an experimental group that received PNF and kinesio taping or a control group that received neurodevelopmental treatment.
3) The experimental group showed statistically significant improvements in balance, ankle dorsiflexion, and walking speed compared to the control group. The results suggest that applying kinesio taping before rehabilitation positively influences functional recovery in post-stroke patients.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck 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.
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
3. Levetiracetam appears to be a better-tolerated antiepileptic drug for
This document summarizes evidence on the use of manual therapy and manipulation in the treatment of shoulder impingement syndrome (SIS). Several randomized controlled trials have found that combining manual therapy/manipulation with exercise therapy leads to better outcomes in pain, strength, and function compared to exercise therapy alone. While more research is still needed, the existing evidence supports the use of manipulation as a component of comprehensive treatment for SIS. Manipulation appears to be a safe intervention when applied properly to appropriate patients by a skilled provider.
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
Effect of yogic asana on Adhesive capsulitis (frozen shoulder) to increasing ...Sports Journal
This document summarizes a study that examined the effects of sleeper stretch exercises and yogic asanas on pain level and range of motion (ROM) for internal rotation in patients with frozen shoulder. Forty patients were randomly assigned to two groups - Group A received sleeper stretches daily for a month, while Group B performed various yogic asanas daily for a month. Pain levels and ROM were measured before and after the interventions. The study found that Group B saw a statistically significant reduction in pain and improvement in ROM, while Group B saw no significant changes. The study concluded that yogic asanas were more effective than sleeper stretches for treating frozen shoulder by increasing flexibility and strengthening muscles.
This document contains an orthopedic physiotherapy quiz with 50 multiple choice questions covering various topics in orthopedics and physiotherapy. Some of the questions assess knowledge of common orthopedic conditions, treatments, tests, and complications. Other questions require identification of muscles, bones, diseases, and physiotherapy approaches. The quiz covers a wide range of topics to evaluate understanding of orthopedic and musculoskeletal physiotherapy.
This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
Management of frozen shoulder(adhesive capsulitis)Dhiwahar Kh
This document summarizes evidence from systematic reviews and clinical practice guidelines on the conservative management of adhesive capsulitis. It outlines the clinical question regarding interventions to reduce pain and improve range of motion and physical function for patients with this condition. A variety of interventions are examined, including corticosteroid injections, modalities, joint mobilization, translational manipulation, stretching exercises, and patient education. For each intervention, relevant studies are summarized, including study type and sample size, inclusion criteria, outcome measures assessed, and level of evidence. The document concludes that current evidence supports the use of corticosteroid injections, joint mobilization, stretching exercises, and patient education for improving outcomes in adhesive capsulitis.
This document summarizes several sources on the use of kinesiology taping. The sources discuss research that has found kinesiology taping can reduce pain from contractions and lymphedema in breast cancer patients. Additional research discussed found that kinesiology taping can improve joint position sense after muscle fatigue and help recovery from occupational wrist disorders in physical therapists. One source discussed a study that found kinesiology taping decreased upper back pain in female sedentary workers with rounded shoulder posture. Another source described a randomized controlled trial that found a mixed kinesiology taping-compression technique reduced venous symptoms, pain, and clinical severity in postmenopausal women with chronic venous insufficiency.
ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by me...painezeeman
1) Several studies examined the effects of transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) after shoulder and knee surgeries.
2) The studies found that TENS reduced pain levels and analgesic consumption after shoulder surgery compared to placebo. EMS improved quadriceps strength and gait more than voluntary exercise alone after ACL reconstruction.
3) Home interferential current therapy also reduced pain, edema, and improved range of motion more than placebo after ACL reconstruction, meniscectomy, or knee chondroplasty procedures.
1. This document provides summaries of 4 recent studies related to chiropractic care, beginning with a major study published in Annals of Internal Medicine that found spinal manipulative therapy and home exercises were superior to medication for neck pain.
2. The second study summarized was the first randomized controlled trial to examine chiropractic management for patients with chest pain, finding that chiropractic patients improved significantly more than those receiving self-management.
3. References and appendices are provided for each study summarized. The document concludes by commenting on how chiropractic addresses the mechanical cause of problems rather than just symptoms.
This document outlines a study to investigate the causes and treatment of shoulder pain in stroke patients. The study will examine clinical and functional factors related to shoulder pain occurrence, and how functional condition influences pain intensity. It will evaluate differences in muscle activity between affected and unaffected shoulders, and between patients with and without pain. The study will assess stroke patients for spasticity, functional ability, pain levels, impingement, joint stability, and muscle activity to clarify factors linked to shoulder pain. The goal is to develop effective prevention and physiotherapy protocols for shoulder pain in both inpatient and home-based settings.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
This study evaluated the results of 42 patients who underwent arthroscopic repair of full-thickness rotator cuff tears using a side-to-side suturing technique without fixation to bone. At an average follow-up of over 5 years, 98% of patients reported good or excellent results on the UCLA shoulder scale. The mean UCLA score was 33, and the majority of patients reported excellent strength, minimal pain, and full function following the procedure. The study concluded that for select rotator cuff tears, a purely arthroscopic side-to-side repair can provide excellent long-term outcomes without the need for anchoring the repair to bone.
Low frequency anteroposterior mobilization of the talus was found to be more effective at increasing ankle dorsiflexion range of motion than high frequency mobilization in healthy subjects. The low frequency technique allowed more time for plastic deformation of the connective tissues to occur, in line with their viscoelastic properties. Future studies should investigate these mobilization techniques in patients with acute, subacute, or chronic ankle conditions.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
1) The study examined the effects of kinesio taping applied prior to proprioceptive neuromuscular facilitation (PNF) treatment on lower extremity proprioception in hemiplegic patients post-stroke.
2) 30 post-stroke patients were randomly assigned to an experimental group that received PNF and kinesio taping or a control group that received neurodevelopmental treatment.
3) The experimental group showed statistically significant improvements in balance, ankle dorsiflexion, and walking speed compared to the control group. The results suggest that applying kinesio taping before rehabilitation positively influences functional recovery in post-stroke patients.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck 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.
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
3. Levetiracetam appears to be a better-tolerated antiepileptic drug for
This document summarizes evidence on the use of manual therapy and manipulation in the treatment of shoulder impingement syndrome (SIS). Several randomized controlled trials have found that combining manual therapy/manipulation with exercise therapy leads to better outcomes in pain, strength, and function compared to exercise therapy alone. While more research is still needed, the existing evidence supports the use of manipulation as a component of comprehensive treatment for SIS. Manipulation appears to be a safe intervention when applied properly to appropriate patients by a skilled provider.
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
Effect of yogic asana on Adhesive capsulitis (frozen shoulder) to increasing ...Sports Journal
This document summarizes a study that examined the effects of sleeper stretch exercises and yogic asanas on pain level and range of motion (ROM) for internal rotation in patients with frozen shoulder. Forty patients were randomly assigned to two groups - Group A received sleeper stretches daily for a month, while Group B performed various yogic asanas daily for a month. Pain levels and ROM were measured before and after the interventions. The study found that Group B saw a statistically significant reduction in pain and improvement in ROM, while Group B saw no significant changes. The study concluded that yogic asanas were more effective than sleeper stretches for treating frozen shoulder by increasing flexibility and strengthening muscles.
This document contains an orthopedic physiotherapy quiz with 50 multiple choice questions covering various topics in orthopedics and physiotherapy. Some of the questions assess knowledge of common orthopedic conditions, treatments, tests, and complications. Other questions require identification of muscles, bones, diseases, and physiotherapy approaches. The quiz covers a wide range of topics to evaluate understanding of orthopedic and musculoskeletal physiotherapy.
This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
Management of frozen shoulder(adhesive capsulitis)Dhiwahar Kh
This document summarizes evidence from systematic reviews and clinical practice guidelines on the conservative management of adhesive capsulitis. It outlines the clinical question regarding interventions to reduce pain and improve range of motion and physical function for patients with this condition. A variety of interventions are examined, including corticosteroid injections, modalities, joint mobilization, translational manipulation, stretching exercises, and patient education. For each intervention, relevant studies are summarized, including study type and sample size, inclusion criteria, outcome measures assessed, and level of evidence. The document concludes that current evidence supports the use of corticosteroid injections, joint mobilization, stretching exercises, and patient education for improving outcomes in adhesive capsulitis.
This document summarizes several sources on the use of kinesiology taping. The sources discuss research that has found kinesiology taping can reduce pain from contractions and lymphedema in breast cancer patients. Additional research discussed found that kinesiology taping can improve joint position sense after muscle fatigue and help recovery from occupational wrist disorders in physical therapists. One source discussed a study that found kinesiology taping decreased upper back pain in female sedentary workers with rounded shoulder posture. Another source described a randomized controlled trial that found a mixed kinesiology taping-compression technique reduced venous symptoms, pain, and clinical severity in postmenopausal women with chronic venous insufficiency.
ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by me...painezeeman
1) Several studies examined the effects of transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) after shoulder and knee surgeries.
2) The studies found that TENS reduced pain levels and analgesic consumption after shoulder surgery compared to placebo. EMS improved quadriceps strength and gait more than voluntary exercise alone after ACL reconstruction.
3) Home interferential current therapy also reduced pain, edema, and improved range of motion more than placebo after ACL reconstruction, meniscectomy, or knee chondroplasty procedures.
1. This document provides summaries of 4 recent studies related to chiropractic care, beginning with a major study published in Annals of Internal Medicine that found spinal manipulative therapy and home exercises were superior to medication for neck pain.
2. The second study summarized was the first randomized controlled trial to examine chiropractic management for patients with chest pain, finding that chiropractic patients improved significantly more than those receiving self-management.
3. References and appendices are provided for each study summarized. The document concludes by commenting on how chiropractic addresses the mechanical cause of problems rather than just symptoms.
This document outlines a study to investigate the causes and treatment of shoulder pain in stroke patients. The study will examine clinical and functional factors related to shoulder pain occurrence, and how functional condition influences pain intensity. It will evaluate differences in muscle activity between affected and unaffected shoulders, and between patients with and without pain. The study will assess stroke patients for spasticity, functional ability, pain levels, impingement, joint stability, and muscle activity to clarify factors linked to shoulder pain. The goal is to develop effective prevention and physiotherapy protocols for shoulder pain in both inpatient and home-based settings.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
This study evaluated the results of 42 patients who underwent arthroscopic repair of full-thickness rotator cuff tears using a side-to-side suturing technique without fixation to bone. At an average follow-up of over 5 years, 98% of patients reported good or excellent results on the UCLA shoulder scale. The mean UCLA score was 33, and the majority of patients reported excellent strength, minimal pain, and full function following the procedure. The study concluded that for select rotator cuff tears, a purely arthroscopic side-to-side repair can provide excellent long-term outcomes without the need for anchoring the repair to bone.
Low frequency anteroposterior mobilization of the talus was found to be more effective at increasing ankle dorsiflexion range of motion than high frequency mobilization in healthy subjects. The low frequency technique allowed more time for plastic deformation of the connective tissues to occur, in line with their viscoelastic properties. Future studies should investigate these mobilization techniques in patients with acute, subacute, or chronic ankle conditions.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
This study evaluated three splint designs for a patient with radial nerve palsy using a single-subject experimental design. The patient underwent assessments at baseline and after 3 weeks wearing each splint. Only the dynamic tenodesis suspension splint and dorsal wrist cock-up with dynamic finger extension splint resulted in statistically significant improvements compared to baseline based on standardized measures. Clinically, the patient completed all tasks while using these two splints but not the static volar wrist cock-up splint. The patient also preferred the dorsal wrist cock-up splint based on a questionnaire.
IM PNS vs UC for Motor Impairment 2014_04_10Henry Wu
This randomized controlled trial compared peripheral nerve stimulation (PNS) to usual care for reducing hemiplegic shoulder pain after stroke. The study assessed whether PNS improved glenohumeral stability through enhancing motor recovery. Both PNS and usual care groups showed significant improvements over time in isometric shoulder strength, pain-free range of motion, and motor impairment measures, but there were no significant differences between the groups, suggesting PNS did not enhance motor recovery more than usual care.
The document summarizes a randomized controlled trial that assessed the effectiveness of arm ergometer training for improving spasticity, range of motion, and motor control in patients with sub-acute and chronic stroke. 40 patients were divided into two groups - one that received conventional therapy alone and one that received conventional therapy plus arm ergometer training. The results showed that the group receiving arm ergometer training in addition to conventional therapy had significantly greater reductions in spasticity, as well as greater improvements in range of motion and gross motor function compared to the conventional therapy alone group. The study concluded that conventional therapy combined with arm ergometer treatment was effective for reducing spasticity and improving motor outcomes in sub-acute and chronic stroke
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.
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
This study aims to compare the effects of first carpometacarpal joint mobilization and transverse friction massage on pain, pinch strength, and hand function in subjects with De Quervain's tenosynovitis. Thirty subjects will be divided into two groups receiving either mobilization or massage treatments over 3 weeks. Outcome measures of pain, pinch strength, and hand function will be assessed before and after the intervention period using VAS, pinch gauge, and MAM-16 questionnaire. The results of this study could provide evidence on effective physiotherapy management of De Quervain's tenosynovitis.
Various causes of shoulder pain have been described. This lady presented with nonspecific right(Rt) severe shoulder pain radiating to the hand she could not sleep for 1 year with weakness at thenar eminence. The patient had history of 2 shoulder arthroscopic procedures within1 month interval. Postoperative Rt shoulder MRI evaluation revealed supraspinatous partial thickness tear, subscapularis tendinopathy and superior labrum tear from anterior to posterior(SLAP). The patient was treated successfully with a Multimodal Intereventional Pain management techniques and after6 months she was able to successfully move her shoulder without pain and regain muscle power. Introduction: Shoulder pain is one of the most frequent musculoskeletal complaints, which increases with age(1). Surgery is more successful in patients under age 40 SLAP tears(2). Common shoulder problems in old age include rotator cuff injury, secondary impingement &SLAP .Less common causes include nerve injuries(1)& long thoracic nerve in addition to vascular problems(2).One mechanism involves forceful traction on biceps tendon when someone falls onto an outstretched arm(3).The neurovascular causes can be difficult to diagnose& require special diagnostic tests such as EMG, dynamic ultrasound (US) and MRI(4). Consensus is lacking on the ideal treatment. Multimodal techniques includes Interventional-based therapy that has shown significant results in treating many conditions, including osteoarthritis (OA). Aim: The objective is to describe a multimodal interventional pain management approach in the treatment of persistent shoulder pain after failed surgery. Methods: The procedure was performed at Safwet Al-Golf Hospital, Cairo, Egypt, for a 60 years old female diabetic patient with a long-term history of untreated shoulder pain. She underwent 2 shoulder arthroscopic procedures on August & November 2021 respectively, progressed postoperatively with standard rehabilitation to increase the range of movement (ROM), however there had been no improvement. On examination, the patient had Rt dermatomal C5,6, 7 hypothesia. Bed side US examination showed Rt subscapularis tendinopathy& impingement,Rt supraspinatous partial thickness tear(Fig.1,2) & impingement,Subacromion sub-deltoid bursitis(SASD), effusion at gelnohumeral joint. MRI Rt shoulder revealed, previous surgery in the form of acromioplasty, biceps tenotomy and interosseous repair, Acromio-clavicular (AC) Joint OA, partial thickness tear of supraspinatus tendon, subscapularis tendinopathy, SLAP injury & Degenerated Anterior Glenoid labrum. She was unable to initiate abduction & limited ROM at medial and lateral rotation with severe pain. The patient completed numerical rating scale (NRS), verbally reported at the beginning of each visit, indicating her level of pain on a scale of 0 to 10, 0 = no pain and 10 = worst pain. At the initial visit she reported 10 on NRS. The patient scheduled for interventional pain management procedure.
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
1) This study compared the effects of limb exsanguination versus elevation on patient-reported pain levels when a tourniquet is used.
2) It found that exsanguinating the limb before inflating the tourniquet resulted in significantly less reported pain by patients compared to simply elevating the limb.
3) Exsanguination also resulted in faster recovery times for patients after the tourniquet was deflated.
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document summarizes a study that evaluated a 10-week multimodal treatment approach for lateral epicondylitis (tennis elbow) combining HVLA manipulation, exercise, physical therapy modalities, bracing, and activity modification. The treatment included HVLA manipulation, high-voltage pulse galvanic stimulation, bracing, icing, and progressive strengthening exercises. Outcomes were measured using the Patient Rated Tennis Elbow Questionnaire, which showed a 52% reduction in pain scores, 80% reduction in specific activity scores, and 77.5% reduction in usual activity scores. Some pain exacerbation occurred between weeks 4-8 with the addition of exercises and removal of bracing. The study demonstrated clinically meaningful improvements but had
2000 anti pronation tape_before_and_after_exercisepainfree888
1) The study evaluated the effects of antipronation tape and temporary orthotics on vertical navicular height before and after exercise compared to a control condition.
2) Both the tape and orthotic treatments significantly increased vertical navicular height after application compared to the control condition, but the effect diminished with exercise.
3) While diminished after exercise, the tape and orthotic conditions still performed better than the control at maintaining vertical navicular height, suggesting they provide some control of excessive foot pronation.
This randomized controlled trial investigated the effectiveness of pulsatile dry cupping therapy compared to no intervention for knee osteoarthritis. 40 patients were randomly assigned to receive either 8 cupping sessions over 4 weeks or no treatment. Outcome measures including pain, stiffness, physical function, and quality of life were assessed at 4 and 12 weeks. At 4 weeks, cupping resulted in significantly greater improvements in pain, physical function, and quality of life scores compared to the control group. Many benefits were still present at 12 weeks, though some scores were no longer significantly different. The study provides preliminary evidence that cupping may be an effective treatment for relieving symptoms of knee osteoarthritis.
Shoulder Impingement Diagnosis And Rehabilitatzagstdc
Rotator cuff impingement is a common cause of shoulder pain that occurs when the tendons of the rotator cuff are pinched between the acromion and humeral head, usually due to repetitive overhead motions. It has three stages ranging from inflammation to full tearing of the rotator cuff. Diagnosis involves physical exams like the Neer's impingement test and Hawkins-Kennedy test to identify painful arcs of motion. Treatment follows a progression from nonsurgical options like NSAIDs, physical therapy, and chiropractic adjustments to surgery if more conservative options fail. Chiropractic care uses a multimodal approach including manual therapy, exercise, and soft tissue work tailored to each patient.
Carpal Tunnel Syndrome is caused by compression of the median nerve in the wrist, often due to repetitive wrist motions. It causes numbness, tingling, and pain in the hand and fingers. Treatment options include splinting, medications, injections, and surgery. While most patients' symptoms improve with treatment, complete recovery can take up to a year, and carpal tunnel syndrome may occasionally recur, requiring additional surgery. Studies have found nonsurgical treatments including exercises can successfully treat around 67% of mild to moderate cases without surgery.
American Academy of Pain Management-September 2010MOHSEN RADPASAND
The 21st Annual Clinical Meeting of the American Academy entitled Exploring the Science, Practicing the Art: Integrative Pain Management for Optimal Patient Care, in Las Vegas, Nevada, from September 21-24, 2010. This poster was presented on Wednesday, September 22, and Thursday, September 23
This document provides information about frozen shoulder (adhesive capsulitis), including its causes, symptoms, diagnosis, treatment, and rehabilitation. It describes frozen shoulder as a condition causing stiffness and tightness in the shoulder joint capsule. There are typically three stages: freezing, frozen, and thawing. Risk factors include age over 40, female gender, diabetes, injury or trauma, and recent surgery. Symptoms are pain, stiffness, and difficulty moving the shoulder. Treatment involves hot/cold packs, TENS, gentle mobilization exercises, and physical therapy focused on maintaining range of motion. The pathology involves inflammation and fibrosis of the joint capsule and synovium. Diagnosis is made based on signs, symptoms, and imaging like x
Similar to Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study (20)
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumer Perspectives on Brand Preference: A Choice Based Model Approachiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
1. The document describes a study that designed a balanced scorecard for a nonprofit organization called Yayasan Pembinaan dan Kesembuhan Batin (YPKB) in Malang, Indonesia.
2. The balanced scorecard translated YPKB's vision and mission into strategic objectives across four perspectives: financial, customer, internal processes, and learning and growth.
3. Key strategic objectives included donation growth, budget effectiveness, customer satisfaction, reputation, service quality, innovation, and employee development. Customers perspective had the highest weighting, suggesting a focus on public service over financial growth.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
- The document examines customer experience in supermarkets and hypermarkets in India through a survey of 418 customers.
- It finds that in supermarkets, previous experience, atmosphere, price, social environment and experience in other channels most influence customer experience, while in hypermarkets, previous experience, product assortment, social environment and experience in other channels are most influential.
- The study provides insights for retailers on key determinants of customer experience in each format to help them improve strategies and competitive positioning.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
This document discusses the implementation of quality management principles at Zimbabwe Open University's Matabeleland North Regional Centre. It begins with background information on ZOU and the importance of quality management in open and distance learning institutions. The study aimed to determine if quality management and its principles were being implemented at the regional centre. Key findings included that the centre prioritized customer focus and staff involvement. Decisions were made based on data analysis. The regional centre implemented a quality system informed by its policy documents. The document recommends ensuring staffing levels match needs and providing sufficient resources to the regional centre.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
Unlocking the mysteries of reproduction: Exploring fecundity and gonadosomati...AbdullaAlAsif1
The pygmy halfbeak Dermogenys colletei, is known for its viviparous nature, this presents an intriguing case of relatively low fecundity, raising questions about potential compensatory reproductive strategies employed by this species. Our study delves into the examination of fecundity and the Gonadosomatic Index (GSI) in the Pygmy Halfbeak, D. colletei (Meisner, 2001), an intriguing viviparous fish indigenous to Sarawak, Borneo. We hypothesize that the Pygmy halfbeak, D. colletei, may exhibit unique reproductive adaptations to offset its low fecundity, thus enhancing its survival and fitness. To address this, we conducted a comprehensive study utilizing 28 mature female specimens of D. colletei, carefully measuring fecundity and GSI to shed light on the reproductive adaptations of this species. Our findings reveal that D. colletei indeed exhibits low fecundity, with a mean of 16.76 ± 2.01, and a mean GSI of 12.83 ± 1.27, providing crucial insights into the reproductive mechanisms at play in this species. These results underscore the existence of unique reproductive strategies in D. colletei, enabling its adaptation and persistence in Borneo's diverse aquatic ecosystems, and call for further ecological research to elucidate these mechanisms. This study lends to a better understanding of viviparous fish in Borneo and contributes to the broader field of aquatic ecology, enhancing our knowledge of species adaptations to unique ecological challenges.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
Or: Beyond linear.
Abstract: Equivariant neural networks are neural networks that incorporate symmetries. The nonlinear activation functions in these networks result in interesting nonlinear equivariant maps between simple representations, and motivate the key player of this talk: piecewise linear representation theory.
Disclaimer: No one is perfect, so please mind that there might be mistakes and typos.
dtubbenhauer@gmail.com
Corrected slides: dtubbenhauer.com/talks.html
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
The technology uses reclaimed CO₂ as the dyeing medium in a closed loop process. When pressurized, CO₂ becomes supercritical (SC-CO₂). In this state CO₂ has a very high solvent power, allowing the dye to dissolve easily.
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
1. IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 4, Issue 2 Ver. I (Mar.-Apr. 2015), PP 03-11
www.iosrjournals.org
DOI: 10.9790/1959-04210311 www.iosrjournals.org 3 | Page
Different Splinting Time for Carpal Tunnel Syndrome in Women:
Comparative Study
Mrs. Nourah Ali Al-Muhanna1
, Mr. Sharick Shamsi2
1
(Senior physiotherapist, Physiotherapy department,Prince Sultan Military Medical City, Riyadh, Kingdom of
Saudi Arabia)
2
(Physiotherapist, Physiotherapy department,Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi
Arabia)
Abstract:
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.
Keywords: Carpal Tunnel Syndrome, Splinting, Splint Wear Time, Algometer.
I. Introduction:
Carpal tunnel syndrome (CTS) is a neurological disorder involving compression of median nerve in
carpal tunnel of wrist1,2. It is considered the most common entrapment neuropathy3,4. Numbness,
tingling and pain in the hand, forearm, elbow or even shoulder, and weakness of the hand are common
symptoms of CTS5,6, the patient also may experience an electric-like shocking feeling. These impairments may
cause a disability in the performance of activities of daily living7,8. The syndrome shows improvement
with rest and worsen at night
6,7,9
, or with repetitive upper extremity activity
2,10
. It is more common in women
than men
9,11
and affects up to 10% of population
9
. Atroshi et al.(1999), reported that CTS estimated 3% of
adult population 12. According to Al-Rajeh (1994), the peripheral neuropathy in Saudi Arabia was 2.7% of
population
13
. In 2009-2010 data base of the Military hospital, Riyadh, CTS was estimated about 30% - 31% of
the Neurological disease. Although repetitive activity is an identified precipitating factor for the development of
CTS, the exact etiology remains unclear6,9. Other factors believed to be related to CTS onset include
ergonomic stressors, systemic/endocrine disorders (such as: diabetes mellitus, renal failure, thyroid disease, and
rheumatoid arthritis, obesity), acute trauma, pregnancy, and psychosocial factors1,11.
Idiopathic CTS c a n be relieved with surgical or conservative intervention4,. Current
conservative treatments include splints2,3,4,7,14, activity modification4,15, non-steroidal anti-inflammatory
drugs
4,16
and local injection of corticosteroids
1,7
. In addition, physical modalities like Ultrasound
17
, nerve
gliding exercises14,18,, acupuncture6,10,19 and laser treatment have also been used20. Splinting the wrist is
the most common conservative intervention10,9,12,15. The rationale for wrist splints was originally based on
observations that CTS symptoms improve with rest and worsen with activity2,21. The purpose of splint is to
decrease pain, slow disease progression and improve physical function
22
. Researchers have suggested that the
2. Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
DOI: 10.9790/1959-04210311 www.iosrjournals.org 4 | Page
therapeutic effect of wrist splinting arises from minimizing carpal tunnel pressure3,16 which is strongly
implicated in the pathophysiology of CTS, that pressure increases with wrist positions other than
neutral
2,10,7,14,21
The aim of this study was to define the best splinting wear times, night or day, in pain relief for female
patients with idiopathic chronic CTS in exacerbation phase.
II. Methods:
Subjects’: 42 female patients with idiopathic chronic CTS, during exacerbation phase participated in this study.
Their age ranged from 30 to 45 years (37.93 ± 5.24 years) and were recruited from Riyadh Military Hospital.
The inclusion criteria was: female patients aged between 30-45 years, patients with idiopathic chronic carpal
tunnel syndrome as diagnosed with nerve conduction study, patients who were in the exacerbation phase (acute)
but not under any anti-inflammatory medication, patients who didn't receive physiotherapy since 3 months, and
patients adherence to splint wear at least 70% for continuous 3 weeks. The exclusion criteria was: patient with
secondary entrapment neuropathies, trauma in the wrist area, muscle wasting or atrophy, patients with
inflammatory arthritis, hypothyroidism, congestive cardiac failure, diabetes mellitus, obesity (Body max Index
(BMI) > 30), patients who were pregnant and patients who received surgery. The research proposal was
approved by the Rehabilitation Health Science (RHS) department of King Saud University (KSU) and the
Physical and Occupational therapy departments in Military Hospital.
Design : Quasi experimental comparative design, of two groups, with day time and night time splinting and
pain threshold evaluation with pressure Algometer.
Equipments and measuring tools:
Algometer, Sheets, Diaries, Exercises ball,
Procedure:
a) Participants Recruitment: Patients were diagnosed by nerve conduction study in the
neurophysiology department. They were referred by physicians from Orthopedic, Neurologic and Plastic
Surgery clinics to the Physiotherapy or Occupational therapy departments. Aim and methods of the study were
explained to all participants before they sign the consent form. On basis of splint wear time patients were
divided into two equal groups of 21 wrists according to the patient preference. Group one wore splint
for day time and group two wore it for night time.
b) Therapeutic procedures:
Splint: Custom-made, thermoplastic, lightweight, neutral-positioned wrist splints (figure1) were given to
patients provided by the hospital, and made by the occupational therapist at the occupational therapy
department. The researcher instructed the patients to wear the splints daily depending on their groups, for
continuous successive 3 weeks. First group wore splint during day time and the second group wore it for
night time, the minimum hours of splint wear in both groups were from 6-8 hours.
Figure (1): Custom made, thermoplastic, light weight and neutral position wrist splint. A) Palmer view, B)
Dorsal view.
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DOI: 10.9790/1959-04210311 www.iosrjournals.org 5 | Page
Exercises: Patients were educated how to perform strengthening exercises to maintain their hands muscles
power and self stretching exercises to stretch the flexor retinaculum. Patient were trained at first session and
supplied by a researcher-designed brochure that describes the exercises, which were repeated during each visit
and used as home program exercises.
During the strengthening exercises, patients were asked to squeeze the ball (figure 2) and hold for 10
seconds while sitting on a chair with supported hand on padded table, keeping neck and shoulder in neutral
position, forearm in supination and elbow 90o of flexion.
During self stretching exercises patients were asked :1) to bring palms together with fingers pointed
up toward ceiling and slowly slide them down until she felt a stretch in the inner wrist area
23
, hold 20-30
second , then relax for 10 seconds and repeat the exercises. 2) to extend their a ffected arm straight so their
palm is faced away from them, then used the other hand to gently pull their fingers toward them, to stretch the
carpal tunnel area
23
, hold 20-30 seconds , then relax for 10 seconds and repeat the exercises. 3) to interlace
their fingers and stretched their arms out in front of them
23
, hold for 20-30 seconds , then relax for 10 seconds
and repeat the exercises. All these exercises were repeated 10 times, five sessions daily for 3 weeks.
Figure (2): Hand strengthening exercises using Egg squeeze ball.
Assessment procedures
Pain threshold was measured by pressure algometer using Bonci
24
protocol, while the patient is in
sitting position, the forearm was in supination and with elbow 90
o
of flexion, the painful wrist was placed on
a padded table with palm up. The researchers stood at the side of the painful wrist and hold the algometer with
her hand, then applied a perpendicular pressure on the palmer aspect of the patient’s wrist (figure 3), the patient
informed the researcher at the point when the sensation of "pressure" began to feel "painful". Average of 3 trails
was recorded as threshold value .
Figure (3): Patient and Researcher position during pain threshold assessment test.
Pain was assessed using algometer first session and at 3 sessions of follow up. Patient was instructed
to record whether she had been adherent to splint or not using daily diaries . At the final visit (3
rd
week), patients gave the diaries to the researcher.
Subjects were contacted by the researcher through phone calls to assure that they wore the splint and
they continued to perform prescribed exercises aiming to motivate and improve their adherence. After 3 months
follow-up phone calls to patients was performed to assess the splint effect on the pain.
4. Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
DOI: 10.9790/1959-04210311 www.iosrjournals.org 6 | Page
Data Analysis:
Statistical Package for the Social Sciences program (SPSS) (version 16) was used for statistical
analysis. Independent t-tests were used to compare the demographics of the two groups. Repeated measure
ANOVAs were used to evaluate the progression of pain threshold. The percentage of change of pain threshold
between the two groups was calculated and their means were compared by independent t-test. In addition the
Mixed Model ANOVA was used to evaluate the effect of patient's group on the progression of pain
threshold through the initial, 1
st
visit, 2
nd
visit and 3
rd
visit pain threshold measurements.
Chi-Square tests were used to compare between the two groups regarding the adherence to splint wear
and job statues of the participants.
III. Findings:
Table (1): Comparison of demographic data between Day and Night time groups.
Table (2): Progression of pain threshold in CTS patients' groups wearing day time and night time splint
(Mixed Model ANOVA test).
Splint wear time
Pain threshold values
Initial assessment
1
st
visit assessment 2
nd
visit assessment 3
rd
visit assessment
p
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Day time 88.4 (14.60) 94.4 (14.7) 98.8 (12.33) 102 (10.9)
0.0001
Night time 85.2 (14.57) 91.16 (14.33) 93.73 (14.83) 98.329 (15.27)
0.0001
Figure (4): The progressive increase in pain threshold through 4 assessments in day & night.
Table (2) and figure (4) shows significant progressive increase in pain threshold values from the initial
assessment, 1
st
, 2
nd
, to 3
rd
visit assessments. This progressive increase in pain threshold is applied for day time
group as well as night time group with p= 0.0001 for both groups.
Viable
Splint wear time
p
Day time Night time
Mean (SD) Mean (SD)
Age 36.7 (5.14) 39.0 (5.19) 0.152
BMI 27.1 (2.80) 26.1 (2.62) 0.223
Initial pain threshold 88.4 (14.60) 85.2 (14.57) 0.468
5. Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
DOI: 10.9790/1959-04210311 www.iosrjournals.org 7 | Page
Table (3): The percentage of change of pain threshold between day and night time groups.
Splints groups Mean(SD) p
Day time 17.25(12.68)
0.744
Night time 16.145(8.86)
Table (3) showed that there were no significance differences in the percentage of change of the
pain threshold between day and night time groups (p = 0.744).
Table (4): Different pain assessments for day & night time groups.
Initial pain assessment (N)
Group Mean (SD)
Day 88.4 (14.60)
Night 85.2 (14.57)
1
st
visit pain assessment
Day 94.4 (14.7)
Night 91.16 (14.33)
2
nd
visit pain assessment
Day 98.8 (12.33)
Night 93.73 (14.83)
3
rd
visit pain assessment
Day 102 (10.9)
Night 98.329 (15.27)
Pain assessments * groups P = 0.328
Table (4) shows that patient's grouping is not a significant factor (p= 0.328) affecting the pain threshold
progression from initial to1
st
, 2
nd
, and 3
rd
pain assessments.
Table (5): Comparisons of percentage of adherence to splint wear and exercises between day and
night time groups (Independent t-test).
Variables
Day time Night time
pMean (SD) Mean (SD)
% Adherence to splint
wear 80.63(10.17) 93.03 (9.35) 0.0001
% Adherence to
exercises 65.3(22.45) 75.07(17.84) 0.126
Figure (5): Comparisons of percentage of adherence to Splint wear and Exercises between day & night groups
Table (5) and figure (5) represented that night time group showed more adherence to splint wear as well as to
exercises but with only statistical significance for splint wear (p= 0.0001).
6. Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
DOI: 10.9790/1959-04210311 www.iosrjournals.org 8 | Page
Table (6): Job status of the day and night time groups (Chi-square tests).
Working (%) Housewives (%) Total P
Day time 7(33%) 14(66%) 21(100%)
0.0001
Night time 19(90.5%) 2(9.5%) 21(100%)
The association between splint wearing time and job status is significant (p= 0.000). The majority (90.5%) of
night time splint wear group are working, while, 2 thirds (66%) of day time splint wear group are housewives.
Figure (6): Phone call follow-up after 3 months
Figure (6) showed that splint effect persist after 3 months in 76.2% of patients, but pain returned in 14.3%
of the patients, while 9.5% of patients can’t be reached at that time.
IV. Discussion
The aim of this study was to define the best splinting wear time, day or night, for pain relief in female
patients with idiopathic chronic CTS in exacerbation phase. The results showed that splinting wear produced
significant improvement in form of increasing pain threshold of the patients in both groups. However, the
day time group showed more increase in pain threshold than night time group, there was no statistical significant
difference between the two groups.
In this study, fair inclusion and exclusion criteria were used to ensure validity of the results. Only
females were included to overcome the gender factor effect. It was approved that females have lower
thresholds of pain, greater abilities to discriminate pain, and higher pain ratings or less tolerance of
noxious stimuli than males25,26. Women generally have an increased sensitivity to experimental pain when
compared to men26.
Current study was concerned more with the short term effect of splint. Pain threshold was
measured through 3 consecutive weeks and result showed significant pain threshold improvement. This short
term pain threshold improvement was similar to many studies14,27. Furthermore, the results proved that
splint effect can persist for longer time. 3 months phone call-follow up showed that 76.2 % of the patients
reported that their pain is still controlled while 14.3% of them reported pain return and only one patient
approached surgical treatment. This was not surprising because a lot of studies have approved the long effect of
splint in CTS patients,21,28
In the current study, the researcher believes that the underlying mechanism of day time splint wear in
increasing the pain threshold in CTS patients could be due to prevention of repetitive movement during the
patients activity and this is seen usually at the day time more than the night time, and that was in agreement with
a lot of authors who found that splinting during repetitive movement which is usually at the day time was
effective in relieving symptoms12,14, Nobuta et al. (2008), reported that CTS improved with rest and
worsen with activity and the CT pressure elevated during repetitive hand activity
29
. Also Love (2003), reported
that CTS is an overuse injury and splint must be used when performing any task required wrist flexion11.
Carleson et al. (2010), stated that CTS has been associated with forceful, repetitive hand and wrist
activities and splint minimizes it during day time and limits prolonged periods of excessive wrist flexion
7. Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
DOI: 10.9790/1959-04210311 www.iosrjournals.org 9 | Page
or extension during sleep10. Kasdan et al. (2002), reported that CTS is repetitive motion disorder and symptoms
tend to exacerbated by activities that place loads on the tendons passing through the canal such as holding book,
driving car, and using hand held tools30. Moreover Goodyear and Arroll (2004), stated that splinting when in
bed is likely to be more accepted and tolerated by patients than splinting during the day31 and Walker et al.
(2000), reported that day time splint wear may lead to decrease upper extremity activities and contribute to the
therapeutic effect of splint2. The researcher also believed that the CTS is due to overload of the repetition
activity and wear splint would prevent and reduce the pain, so she hypothesized that wearing splint during night
time is giving the chance for recovery after day of a lot or repetitive movements, and patients adherent usually is
better during night splint wear. This researcher hypothesis is strengthened with the result, which showed that
night time group were significantly more adherent to splint wear than day time group.
This research work was developed to discover the best timing for splint wear and the researcher
found that wrist splint for CTS was effective, with no doubt, whether it is day time or night time.
It is difficult to get a specific treatment effect without appropriate use and restrict to its protocol.
Successful clinical outcome depends essentially on adherence to its management protocol
32,33
. Current study
results showed that day time patients were less adherent to the splint wear than night time patients and this
would affect the day time splint wear outcome and cause limitation in pain improvement. Although
patients of the day time splint wear was less adherent, result showed more pain threshold improvement in day
time patients more than the night time patients. However this improvement was with no statistical significance.
In addition the percentage of different between the initial assessment and 3
rd
visit pain assessment of the
two groups were very close to each other and no significant difference found between them. The
observed of increase in pain threshold of the day time group at the 3
rd
visit assessment is actually due to the
higher pain threshold in the initial assessment for day time group than night time group. Since splint wear as a
management of CTS considered as poor adherence procedure
31
and based on the results of this current study,
the researcher believes that patients with CTS should wear the splint at the time they prefer and they will be
more adherent to it no matter if it's night time or day time. And that is supported by Viera (2003), who
mentioned that optimal splinting regimen depends on the patient's preferences
9
. As for the splint wear, study
results showed that night time group were a little more adherent to exercises (75.07), than day time group
(65.3) although there was no statistical significant difference (p= 0.126). The researcher believes that the CTS
is due to overload of repetitive activity and working. Repetitive activities are job or house held activities. This
activity would decrease the pain improvement with splint wear and the researcher agrees with a lot of studies
which considered that CTS is work related syndrome
34,35,36
. In fact, the effect of women's job status was out
of the scope of the current study but the result showed the majority 90.5% of the night time splint wear were
working ladies while more than two thirds (66%) of the day time splint wear patients were housewives.
Moreover chi-square test showed significant association between job status and patients groups. Tang et al.
(1999) considered doing housewife activity as work37. On the other hand, a lot of authors don't consider
CTS as work related syndrome38,39,40, so it was difficult in this study to confirm whether or not the
work was associated factor with the pain improvement. It is recommended in future to control the job in
both groups and consider its effect in CTS. That’s why one limitation of this study is that random assignment of
women into the day and night time groups was not applied and this would affect the relation between splints
wear and job status. In addition, only the pain of the symptoms was studied and there is other symptoms which
can be considered in future researches such as the numbness and the hand strength. Follow up after 3
months was taken verbally and should be taken with the same outcome measure; pain threshold.
Due to limitation in published related articles, the result of this study cannot be compared. Because no
studies compared the difference between the day and night time splint wear effects in improving the pain
threshold in CTS patients. Majority of the studies compared only between splint and other modalities.
V. Conclusion:
Splinting is an effective conservative treatment to relief pain and increase pain threshold in female
patients with idiopathic CTS during exacerbation phase, and it has long term effect as well as short term relief of
pain in CTS patients. No significant difference was found in increasing pain threshold in both groups, day
or night time splint wear, in female patients with idiopathic chronic CTS during exacerbation phase. Splint
wear time is according to the patients preference.
8. Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Study
DOI: 10.9790/1959-04210311 www.iosrjournals.org 10 | Page
Acknowledgements:
First of all, thanks to ALLAH who enabled me to conduct this study. I am heartily thankful to Dr.Salwa El-
Sobkey, Assistant Professor, Health Rehabilitation Sciences, Collage of Applied Medical Sciences, King Saud
University, A deep thanks to my parent, my husband, and my kid’s for helping, supporting, understanding, and
encouraging me through my study and my whole life. Special thanks to Kholoud Al-Mubarak, Senior
Occupational therapist, in Military Hospital, who helped me in organizing and making splints for all the
patients.
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