理学療法と理学リハビリテーションのジャーナル

Background and objectives: Osteoarthritis (OA) is a common cause of physical and psychosocial disabilities in people characterised by pain and joint dysfunctions which hinder their daily and social activities as well as quality of sleep. Iontophoresis, involving the transference of drugs transdermally, is one of the novel therapeutic modalities for managing OA .The objective of this study was to determine the effect of diclofenac sodium iontophoresis on pain, functional ability and quality of sleep in people with knee osteoarthritis.

Method: Twenty (20) participants (5 males, 15 females; mean age 55 years) with knee OA were recruited for this study. The participants were randomly assigned into two groups. Group A was treated with diclofenac sodium iontophoresis in addition to exercises. Group B, the control group, received only exercises. Each group was treated for duration of 4 weeks, comprising 2 treatment sessions per week. The visual analogue scale (VAS), Ibadan Knee/Hip Osteoarthritis Outcome Assessment Measure (IKHOAM) and the Medical Outcome Study (MOS) Sleep Scale were used to assess pain, functional ability and quality of sleep, respectively.

Result: Significant improvement occurred in both groups post-treatment (experimental group p=0.029, 0.001 and 0.004 respectively. Control group: p=0.04, 0.001). However, Group A had more improvement (p=0.023, 0.04, 0.02) in pain, functional ability and quality of sleep when compared to Group B.

Conclusion: This study revealed that there is a significant pain reduction, improved functional ability and quality of sleep in people with osteoarthritis when treated with diclofenac sodium iontophoresis.

Objectives: The prevalence of back and neck complaints resulting from poor posture is high, and the rate of posture related back pain and healthcare costs have been increasing rapidly with the widespread use of smartphones, computers, and work-related risks. Compliance with traditional back braces and other solutions for treating this pain is low, which affects patients’ ability to perform and recover. The objective of the current study is to determine subjective compliance of an innovative posture wearable technology.

Methods: 128 Volunteers underwent subjective evaluation after wearing the FDA registered IFGfit wearable technology. After trying on the apparel, they were asked to complete a subjective questionnaire, which included questions on demographic information, back or neck complaints prior to wearing the garment, history of physical therapy, comfort level and perceived posture improvement while and after wearing the shirt.

Results: The comfort level survey results showed that 93 percent of the sample, (n=111), reported a comfort level rating of good or excellent while wearing the garment, and that 88 percent of participants, (n=108), reported that their posture had improved very much or quite a bit after wearing the apparel. Exploratory analyses showed that previous level of back pain and comfort level were not correlated, rs (126)=.133, p=.134, nor was there a correlation between previous back, neck and shoulder pain and perceived posture improvement level, rs(126)=.092, p=.304.

Conclusion: Over 90% of participants reported high comfort levels and an improvement in their posture after taking it off. The positive user response suggests that this apparel technology has the potential to alleviate and prevent posture related back pain on a large scale with high patient compliance.

Scapular fractures tend to occur at an infrequent rate, 0.7% of all fractures, and typically occur due to highvelocity trauma. Secondary pathology from a scapular fracture can include neurovascular injury to structures around the shoulder. To document a case of secondary neuropathy following a scapular fracture in an American Football college athlete. This case study documents the successful return to sport following a seven-month rehabilitation program of a college football player who sustained a scapular fracture with suprascapular neuropathy. Protecting the fractured scapula was the initial goal. Therapeutic exercise and manual therapy focused on improving scapula stabilization, rotator cuff strength, and function. Finally, a return to play program was introduced to prepare the athlete to return to the field. Seven-month post-injury, the athlete returned to play without restrictions after full strength returned. Secondary neuropathy following a scapular fracture resulted in prolonged weakness of the rotator cuff muscles and impaired scapular stability and scapulohumeral rhythm. These impairments affect an athlete’s ability to protect them from high-velocity impact. Therefore, the athlete should not be allowed to return to play until these impairments are addressed.

Objective: We can demonstrate the presence of a movement pattern as a behavior for presenting signs and symptoms which is being distinct from a medical aetiology for presenting signs and symptoms. Subsequent to being able to demonstrate the presence of a symptomatic legacy movement pattern behavior causative for presenting signs of symptoms, this enables us to highlight the existence and subsequent access to a paradoxical asymptomatic recovered movement pattern. Both patterns are sensory-based which is instantly demonstrable in self-reporting by the client and observable and testable by the therapist.

Methods: A random consecutive sample of thirty individuals (18 to 82 years) presented to a community physiotherapy musculoskeletal outpatient service, having been referred by their medical practitioner as part of the service pathway. Informed consent was obtained to gather information. Each individual was able to congruently self report their presenting lumbar/lower body signs and symptoms. Collection of audio-visual data in a workshop setting enabled us to both capture and demonstrate functional sit-to-stand movement patterns, presenting (legacy) patterns and the instant recovered pattern for each individual. We chose a within-subject, and within group fully crossed mixed methods study design.

Results: All thirty participants were instantly symptom free and sign free whilst accessing the recovered pattern. We were able to observe and distinguish between a medical and movement pattern aetiology for presenting signs and symptoms for each and every individual. Both movement patterns –legacy and recovered - were congruently self-reported by each participant and objectively testable instantly in real-time by the physiotherapist.

Conclusion: We have demonstrated the clients’ ability to access an asymptomatic recovered pattern of movement, subjectively self-reported in sensory-based evidence by the client, and objectively testable by the therapist, in being that change is instant. Therefore, the question of the persistence of the pattern of movement behavior in recovery is more than a question of behavior and capability.

As part of our role as physiotherapists, we are now in a strong position to support the changes in the development of social attitudes, and provide strategies in relation to recovery based on a future orientated outcome model, as opposed to supporting an ongoing a causal limitation in experience for the client.

Objective: Only a few studies have investigated the factors associated with the development of post-stroke lower limb edema. This study aimed to clarify the risk factors for lower limb edema after a stroke using the depth of surface imprint as a proxy measure of the severity of pitting edema.

Methods: Sixty-five patients with chronic stroke (39 men and 26 women; average age, 70.9 ± 13.8 years) were enrolled, with 35 healthy elderly individuals (11 men and 24 women; average age, 71.9 ± 5.1 years) included in the control group. All stroke patients were medically stable. Our stroke group included patients with a history of cardiac disease and diuretics use. Depth of the surface imprint was produced by a 20-N compression force applied with a digital force gauge for 10 s to the dorsum of the foot.

Results: The depth of the imprint was greater in the stroke group, bilaterally, than in the control group. Age was positively correlated with the depth of the imprint on the non-hemiplegic side in the stroke group.

Conclusion: Our findings indicate that a main risk factor for lower limb edema in chronic stroke may be a decreased function of the skeletal muscle pump due to paralysis and/or immobility.