1,721,119 research outputs found
The Place of Botulinum Toxin in Spastic Hemiplegic Shoulder Pain after Stroke: A Scoping Review
No full textStroke is a common pathology worldwide, with an age-standardized global rate of new strokes of 150.5 per 100,000 population in 2017. Stroke causes upper motor neuron impairment leading to a spectrum of muscle weakness around the shoulder joint, changes in muscle tone, and subsequent soft tissue changes. Hemiplegic shoulder pain (HSP) is the most common pain condition in stroke patients and one of the four most common medical complications after stroke. The importance of the appropriate positioning and handling of the hemiplegic shoulder for prevention of HSP is therefore of high clinical relevance. Nevertheless, HSP remains a frequent and disabling problem after stroke, with a 1-year prevalence rate up to 39%. Furthermore, the severity of the motor impairment is one of the most important identified risk factors for HSP in literature. Spasticity is one of these motor impairments that is likely to be modifiable. After ruling out or treating other shoulder pathologies, spasticity must be assessed and treated because it could lead to a cascade of unwanted complications, including spastic HSP. In clinical practice, Botulinum toxin A (BTA) is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives the opportunity to target specifically selected muscles. It thereby provides the possibility of a unique patient tailored focal and reversible treatment for post stroke spasticity. This scoping review aims to summarize the current evidence of BTA treatment for spastic HSP. First, the clinical manifestation and outcome measures of spastic HSP will be addressed, and second the current evidence of BTA treatment of spastic HSP will be reviewed. We also go in-depth into the elements of BTA application that may optimize the therapeutic effect of BTA. Finally, future considerations for the use of BTA for spastic HSP in clinical practice and research settings will be discussed
The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain : a systematic review
No full textAbstract: Objective: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. Data sources: Electronic databases (PubMed, Web of Science, Embase and PsycINFO) were searched until 14 January 2019. Study selection: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. Results: A total of 23 articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatization or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. Conclusion: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability
Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders
Full text linkShoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions
The development of shoulder pain in competitive swimmers
No full textAbstract: Shoulder pain is common across the lifespan of the competitive swimmer, often resulting in athletes leaving the sport or being severely restricted in performance. Yet despite the establishment of a high incidence, uncertainty remains regarding the cause of the swimmer\u2019s shoulder pain and there is still significant debate over the factors that contribute to its development. Even more so, epidemiological data going all the way back to the 1980\u2019s does not appear to show any reduction in shoulder injury burden. The lack of knowledge regarding its etiology and the clinical heterogeneity of the swimmers\u2019 shoulder has reduced the ability to define and devise successful interventions. Knowledge of its risk factors, however, may offer guidance in the development of such strategies but this requires a prospective evaluation of the characteristics that may potentially contribute to shoulder pain. Consequently, the main objective of our research was to identify predictors of swimmers\u2019 shoulder and develop and validate a multivariable prognostic model for the prediction of shoulder pain in swimmers. To complete this investigation, five concomitant studies were undertaken. The first two studies aimed to evaluate the evidence in the literature for factors associated with the swimmer\u2019s shoulder pain. Based on the findings we selected clinically relevant variables that were well-documented in the literature for inclusion in our prospective research protocol. The third and fourth study aimed to examine the reliability of the measurements for thoracic rotation range of motion and latissimus dorsi muscle flexibility that had yet to be established in a setting appropriate to the swimmer. These studies formed the platform for our main investigation, a longitudinal prospective research for the purposes of identifying predictors of shoulder pain. Our approach was to recruit 200 competitive swimmers between the ages of 10 and 40 years who trained for an average of at least four hours per week. We recruited swimmers in collaboration with the Flemish Swimming Federation. Swimmers who met the predefined criteria were considered eligible for inclusion in our prospective cohort study, and also recruited for the assessment of measurement reliability. The subjects had a comprehensive physical exam completed by the main investigator to measure demographic, psychosocial, musculoskeletal, training-related and biomechanical characteristics of interest at baseline and again after 6, 12, 18 and 24 months. Swimming volume was prospectively recorded by the swimming coach during the season. Further, a protocol for the measurement of thoracic spine rotation range of motion and latissimus dorsi muscle flexibility using a bubble-filled inclinometer was tested for reliability during baseline assessment. Excellent intra-rater reliability was found for both measurements conducted on young competitive swimmers (ICC thoracic rotation test 0.91-0.96; ICC latissimus dorsi test 0.91-0.94). Further, our prospective investigation confirmed a significant relationship between shoulder pain and regional level competitive swimming (OR 0.19, 95% CI 0.058-0.629); acute to chronic workload ratio (OR 4.89, 95% CI 1.00-18.54); posterior shoulder muscle endurance (OR .96, 95% CI 0.92-0.99) and hand entry position error (OR .37, 95% CI 0.155-0.906). Based on the results of our series of investigations we advise against large increases in swim-training volume, especially between successive training levels from the young to the adolescent competitive swimmer. We recommend year-round monitoring of both the swimmer\u2019s internal and external training load as well as implemented regular stroke assessment. Furthermore, dry-land exercises focusing on the endurance capacity of the posterior shoulder muscles appear warranted. Our prediction model showed good discriminative ability between swimmers at higher risk of shoulder pain and those who are not. It consists of parameters that can easily be measured in a swimming setting and that can aid in informing and facilitate counselling of swimmers at risk. We recommend external validation of our model prior to the development of clinical reasoning and treatment programs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Frozen shoulder : present and future
No full textAbstract: Frozen Shoulder: Present and Future provides insights into one of the most mysterious diseases of the human body, frozen shoulder, a condition characterized by severe shoulder pain and functional restriction of shoulder motion. About 4% of the general population develops a frozen shoulder, with numbers rising to 59% in patients with diabetes mellitus. It curiously only develops between the age of 40 and 60 years, affects more women than men, and seems to be more common in patients with sedentary jobs. Disease duration varies between 1 and 3 years and consequently has a large impact on health and economic well-being
Frozen shoulder : potential prognostic factors and natural history
No full textAbstract: Frozen shoulder (FS) is a common shoulder disorder, with increasing prevalence and incidence in the last two decades. There is a large variability in disease duration, with an incomplete recovery in a subset of patients. Broadening of our insight in FS could offer other therapeutic approaches to increase treatment efficacy. Subgroups of patients might be present and multiple factors are suggested that might explain the variable prognosis, including autonomic nervous system involvement, central pain mechanisms, and metabolic factors. First, a narrative review was conducted to provide an overview of current knowledge about diagnosis and assessment, effective and potential new conservative interventions, and hypotheses regarding the pathophysiology in patients with FS. Next, in Chapter 2, the results of the diagnostic accuracy of an improved version of the coracoid pain test, are presented. Besides the original approach, two alternative approaches were explored. The following chapters (Chapter 3-4) provide evidence for differences between affected and unaffected shoulders within patients with FS and between patients with FS and healthy controls by means of our case-control studies for both local and systemic factors: muscle strength, scapular upward rotation, joint proprioception, static and dynamic scapular observation, glycosylated blood glucose levels, local and distant allodynia, primary and secondary hyperalgesia, temporal summation, conditioned pain modulation, pain catastrophizing, pain hypervigilance, and autonomic symptoms. The natural history of these factors and candidate prognostic factors were examined in our longitudinal prospective observational study (n=149) with a follow-up of 9 months with 3-month intervals and are presented in Chapter 5-7. Additionally, longitudinal correlations between these factors were examined. Factors influencing treatment outcome after physical therapy were summarized in our systematic review in Chapter 8, while in the final chapter (Chapter 9), the results of our meta-analysis regarding the effectiveness of exercise therapy in patients with FS were summarized. The results of this dissertation provide evidence that the instrument-assisted coracoid pain test may aid in the diagnosis of FS and that a more holistic approach of patients with FS may be key to improved treatment results. Additionally, it seems there is an early improvement in several factors, independent of treatment received. Several central and systemic factors appear to play a role during FS and were found to be prognostic for shoulder pain and disability and quality of life, but seem to be outcome dependent. Finally, exercise therapy was found to be effective for improving ROM, pain, and function, but long-term results are lacking
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