Background: Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators. Purpose: To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder. Study Design: Systematic review and network meta-analysis. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion. Results: Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness. Conclusion: Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes.
The corticomuscular coupling (CMC) characterization between the motor cortex and muscles during motion control is a valid biomarker of motor system function after stroke, which can improve clinical decision-making. However, traditional CMC analysis is mainly based on the coherence method that can’t determine the coupling direction, whereas Granger Causality (GC) is limited in identifying linear cause–effect relationship. In this paper, a time-frequency domain copula-based GC (copula-GC) method is proposed to assess CMC characteristic. The 32-channel electroencephalogram (EEG) signals over brain scalp and electromyography (EMG) signals from upper limb were recorded during controlling and maintaining steady-state force output for five stroke patients and five healthy controls. Then, the time-frequency copula-GC analysis was applied to evaluate the CMC strength in both directions. Experimental results show that the CMC strength of descending direction is greater than that of ascending direction in the time domain for healthy controls. With the increase of grip strength, the bi-directional CMC strength has an increasing trend. Meanwhile, the bi-directional CMC strength of right hand is larger than that of left hand. In addition, the bi-directional CMC strength of stroke patients is lower than that of healthy controls. In the frequency domain, the strongest CMC is observed at the beta frequency band. Additionally, the CMC strength of descending direction is slightly larger than that of ascending direction in healthy controls, while the CMC strength of descending direction is lower than that of ascending direction in stroke patients. We suggest that the proposed time-frequency domain analysis approach based on copula-GC can effectively detect complex functional coupling between cortical oscillations and muscle activities, and provide a potential quantitative analysis measure for motion control and rehabilitation evaluation.
Background: Transcranial direct current stimulation (tDCS) and neural mobilization (NM) are widely used in clinical practice as two effective treatment. However, there have existed few studies of the combination of these two treatments, particularly in cervical radiculopathy (CR). To explore the value of combined tDCS and NM for the management of pain, disability, and quality of life (QoL) in patients with CR, authors designed this study.Methods: According to certain inclusion criteria, 36 subjects were selected from 224 patients with CR enrolled in Zhejiang Provincial People's Hospital between June 2021 and December 2021. Subjects were divided into two groups based on the treatment they had already received at the hospital. Patients in the combined tDCS group received tDCS and NM therapy, while patients in the NM group received NM therapy alone. Visual analog scale (VAS), Neck Disability Index (NDI), and EuroQuol-5 dimensions (EQ-5D) scores were assessed at baseline, immediately after treatment, and at the 4-week follow-up to evaluate pain, neck disability, and the QoL of patients. SPSS 22.0 software (IBM Corp., Armonk, NY, USA) is used as main tool for data analysis.Results: A total of 36 patients were enrolled (19 in the combined tDCS group and 17 in the NM group).The baseline VAS, NDI, and EQ-5D scores in the combined tDCS group were 54.3±16.4 mm, 35.1±14.7, and 0.62±0.15, respectively, while the baseline VAS, NDI, and EQ-5D scores in the NM group were 54.0±16.5 mm, 31.8±12.8, and 0.64±0.15, respectively. There was no significant difference in baseline data between the two groups. At the 4-week post-treatment follow-up, the VAS score was significantly lower in the combined tDCS group than in the NM group (24.5±16.1 and 40.7±17.3 mm, respectively, P=0.008), and the NDI was also significantly lower in the combined tDCS group than in the NM group (16.1±11.5 vs. 26.6±17.7, P=0.045). There was no significant difference between the combined tDCS and NM groups in EQ-5D (0.75±0.15 vs. 0.69±0.09, P=0.192).Conclusions: Compared with NM therapy alone, combined tDCS and NM therapy may play a role in pain relief and neck disability improvement in CR patients.
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