摘要:

Objective:To investigate the effectiveness of ultrasound treatment and trigger point injections in combination with neck-stretching exercises on myofascial trigger points of the upper trapezius muscle.Design:Depression and anxiety associated with chronic pain were assessed using the Beck Depression Inventory (BDI) and the Taylor Manifest Anxiety Scale (TMAS). The study population comprised 102 patients who had myofascial trigger points in one side of the upper trapezius. The patients were randomly assigned to one of three groups: group 1 received ultrasound therapy to trigger points in conjunction with neck-stretching exercises; group 2 received trigger point injections and performed neck-stretching exercises; and group 3, the control group, performed neck-stretching exercises only. Treatment effectiveness was assessed using subjective pain intensity (PI) with a visual analog scale, pressure pain threshold (PT) with algometry, and range of motion (with a goniometer) of the upper trapezius muscle.Results:Compared with the control group, patients in groups 1 and 2 had a statistically significant reduction in PI, an increase in PT, and an increase in range of motion. There were no statistically significant differences between treatment groups 1 and 2. Although not statistically significant, patients in the control group had better results at the 3-mo follow-up. The BDI scores indicated depression in 22.9% of the patient, with 4.8% of the patients having severe depression. High anxiety scores on the TMAS were present in 89.3% of the patients. When BDI and TMAS scores were compared with PI or PT levels, no significant correlations were found, but when compared with pain duration before treatment, correlations were significant.Conclusions:Patients with myofascial pain syndrome had higher scores for anxiety than for depression. When combined with neck stretching exercises, ultrasound treatment and trigger point injections were found to be equally effective.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Botulinum toxin A inhibits presynaptic release of acetylcholine at the neuromuscular junction and has reportedly been successful in the treatment of spastic disorders. This prospective study attempted to determine whether botulinum toxin A injection resulted in clinically measurable gains for 4 mo.Design:Measurements were obtained from 32 children (range, 1-18 yr; average age, 6.9 yr) with hemiplegic or quadriplegic cerebral palsy before and at 1, 3, and 4 mo after botulinum toxin A injections. Spasticity was measured using the Modified Ashworth Scale for 12 different joints.Results:Results showed that spasticity as measured by Ashworth scores for elbow and wrist extension clearly declined (P< 0.02) by 1 mo after botulinum toxin A injection, and diminished spasticity continued for 3-4 mo. Caregivers reported improvement in subjectively rated management, appearance, and function. However, patient response to botulinum toxin A injection was not predictable. Age had no significant relationship to gains.Conclusions:Further research is needed on the use of botulinum toxin A to diminish spasticity and improve function.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the extent to which the history and physical examination predict the outcome of the electrodiagnostic (EDX) evaluation in patients with suspected lumbosacral radiculopathy.Design:Data for 170 subjects referred for low-back and lower limb symptoms were prospectively collected at five EDX laboratories. The sensitivity, specificity, positive and negative predictive values, and odds ratios were determined for symptoms and neurologic signs.Results:Symptoms were not significantly associated with an EDX study or a lumbosacral radiculopathy. The physical examination was better at predicting that an EDX study would be abnormal in general than it was at predicting a lumbosacral radiculopathy in particular. Of those subjects with normal physical examinations, 15%-18% still had abnormal EDX findings.Conclusions:In a population of patients referred for an EDX study, the history and physical examination alone cannot reliably predict electrodiagnostic outcome.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the percentage of international normalized ratios (INRs) maintained within the therapeutic range for patients receiving chronic anticoagulation treatment with warfarin during inpatient rehabilitation.Design:A consecutive, 4-month, retrospective chart review of all patients receiving oral anticoagulation treatment was conducted in a large academic rehabilitation center. The percentage of INRs within and out of the therapeutic range, frequency of blood samples, length of therapy, and warfarin dose prescribed by physicians were calculated. A total of 181 patients receiving chronic anticoagulation treatment were identified. A total of 3709 blood samples were analyzed. In 74 patients, the primary physician recommended a therapeutic range (Group 1). In the remaining 107 patients, no therapeutic range was specified, and a target INR range of 2.0-3.0 was assumed (Group 2).Results:In Group 1, the INRs were in the recommended range in 38.2% of all blood samples. In Group 2, 37.6% of all blood drawn was within an INR range of 2.0-3.0. Statistical analysis showed that no better accuracy was obtained when the INR range was predefined by a physician (Group 1) or assumed to be in the 2.0-3.0 range (Group 2;P= 0.839).Conclusions:Despite frequent physician monitoring, this study demonstrates the difficulty in maintaining INRs within therapeutic ranges for patients receiving oral anticoagulation. An overall tendency for underdosing is observed. Improvement is necessary, given the high morbidity and mortality associated with insufficient anticoagulation in rehabilitation inpatients.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Subcutaneous heparin is commonly used as a prophylaxis against deep venous thrombosis in a wide variety of hospitalized patients. As with most medications, heparin has a significant side effect profile; heparin-induced hyperkalemia is an unusual but well described side effect. To increase awareness of heparin-induced hyperkalemia and of those patients at greatest risk, we present two cases of documented hyperkalemia induced by heparin and reconfirmed by drug rechallenge.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID