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Kim K, Song J, Chu H, Kwon R, Park S, Kwon J, Hong HJ, Lee Y, Kwon S, Kang K, Leem J, Kim CH. Ultrasound-Guided vs Non-Guided Pharmacopuncture for Cervical Myofascial Pain Syndrome: A Multi-Center Prospective Comparative Study Protocol. J Pain Res 2025; 18:1417-1431. [PMID: 40130203 PMCID: PMC11930919 DOI: 10.2147/jpr.s509236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 03/12/2025] [Indexed: 03/26/2025] Open
Abstract
Purpose Cervical Myofascial Pain Syndrome (CMPS) is a common musculoskeletal disorder that significantly impacts daily life due to pain and restricted movement. This study focuses on Ultrasound-Guided Pharmacopuncture(UGP) to release fascial restrictions and alleviate nerve compression. By utilizing real-time ultrasound imaging, UGP is expected to enhance treatment accuracy, reduce adverse events, and improve clinical outcomes. This study aims to assess the efficacy and safety of UGP compared to Non-Guided Pharmacopuncture (NGP) in patients with acute CMPS. Patients and Methods This multi-center prospective observational comparative study evaluates the efficacy and safety of UGP versus NGP in patients with acute CMPS. A minimum of 100 patients with acute CMPS (≤7 days since symptom onset) will be recruited from two hospitals and five Korean medicine clinics. Participants will be randomly assigned to either the UGP group (receiving ultrasound-guided pharmacopuncture with Hominis Placenta(HP) solution) or the NGP group (receiving non-guided pharmacopuncture with HP solution). A single treatment session will be conducted, with pre- and post-treatment assessments using the Numerical Rating Scale (NRS), Pressure Pain Threshold (PPT), and Range of Motion (ROM). Additionally, a follow-up safety assessment will be conducted via telephone 24-36 hours post-treatment. Discussion and Conclusion This study is the first to evaluate the efficacy and safety of ultrasound-guided HP pharmacopuncture for acute CMPS in a multi-center prospective comparative study. The findings are expected to provide comprehensive evidence supporting ultrasound-guided pharmacopuncture as an effective treatment for myofascial pain and may expand its clinical applications, particularly in Korean medicine clinics.
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Affiliation(s)
- Kwangho Kim
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
| | - Juhwan Song
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
| | - Hongmin Chu
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Mapo Hongik Korean Medicine Clinic, Seoul, Korea
| | - Robin Kwon
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Department of Korean Medicine, Jinjeop Hanyang Hospital, Namyangju, Korea
| | - Seongjun Park
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Mullae Majubom Korean Medicine Clinic, Seoul, Korea
| | - Junhui Kwon
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Anjung Korean Medicine Clinic, Seoul, Korea
| | - Hyeon Joon Hong
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Gwanghwamun Kyung Hee Korean Medicine Clinic, Seoul, Korea
| | - Youngyun Lee
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Kangnyung Korean Medicine Clinic, Anyang, Korea
| | - Sanghyuk Kwon
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Department of Korean Medicine, Jinjeop Hanyang Hospital, Namyangju, Korea
| | - Kyungho Kang
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Yangjae Chungwoo Korean Medicine Clinic, Seoul, Korea
| | - Jungtae Leem
- Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan, Korea
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Korea
| | - Cheol-Hyun Kim
- The Academy of Korean Medicine Clinical Anatomy, Seoul, Korea
- Department of Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, Korea
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Rusanov A, Vitomskyi V, Roi I, Borzykh N, Kudrin A. Dynamics of disability and pain indicators under the influence of physical therapy for adhesives capsulitis and myofascial pain syndrome. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:55-61. [PMID: 38431808 DOI: 10.36740/wlek202401108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Aim: To compare the effectiveness of end-range mobilization and therapeutic exercises, used in combination with ischemic compression, on disability and pain indicators among patients with adhesive capsulitis of the shoulder joint and thoracic myofascial pain syndrome. PATIENTS AND METHODS Materials and Methods: The study involved 68 patients. Goniometry of the shoulder joint, assessment of pain in myofascial trigger points, and the Shoulder Pain and Disability Index questionnaire were used before and after physical therapy. The duration of physical therapy comprised 3 weeks. Physical therapy of the first group of patients consisted of end-range mobilization and ischemic compression. Patients of the second group performed therapeutic exercises and ischemic compression. RESULTS Results: Both groups demonstrated positive dynamics of shoulder joint mobility, Shoulder Pain and Disability Index and pain in trigger points. However, the final results of the studied indicators were better in the first group of patients. CONCLUSION Conclusions: Physical therapy based on the combination of end-range mobilization and ischemic compression had a more positive impact on disability and pain indicators for adhesive capsulitis of the shoulder joint and myofascial pain syndrome as compared to the combination of therapeutic exercises and ischemic compression.
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Affiliation(s)
- Andrii Rusanov
- NATIONAL UNIVERSITY OF UKRAINE ON PHYSICAL EDUCATION AND SPORT, KYIV, UKRAINE; GI ≪INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE≫, KYIV, UKRAINE
| | - Volodymyr Vitomskyi
- NATIONAL UNIVERSITY OF UKRAINE ON PHYSICAL EDUCATION AND SPORT, KYIV, UKRAINE
| | - Iryna Roi
- GI ≪INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE≫, KYIV, UKRAINE
| | - Natalia Borzykh
- GI ≪INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE≫, KYIV, UKRAINE
| | - Anton Kudrin
- GI ≪INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE≫, KYIV, UKRAINE
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Ying CL, Lee TM, Chen PY, Samy W, Au LY, Siu CH. The Effect of ISBT-Bowen Therapy in the Treatment of Myofascial Neck Pain-a Randomized, Single-Blinded Clinical Trial. Int J Ther Massage Bodywork 2023; 16:29-38. [PMID: 37265536 PMCID: PMC10212568 DOI: 10.3822/ijtmb.v16i2.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background Myofascial pain syndrome (MPS) is the most common diagnosis in patient presenting with chronic non-specific neck pain. It affects people's work performance, productivity, and quality of life. To date, there is little research evaluating the effectiveness of non-invasive techniques, such as ISBT-Bowen Therapy in managing neck MPS. Objectives To investigate the effectiveness of Bowen therapy in managing myofascial pain syndrome with symptoms lasting for more than six weeks. The study will also examine the long-term effect of ISBT-Bowen Therapy on functional enhancement, quality of life, and physical and mental well-being. Methods This is a prospective, single-blinded randomized controlled trial (RCT). A total of 90 myofascial neck pain patients were recruited and randomized to receive 8 sessions of ISBT-Bowen Therapy over a 12-week period (n = 45) or to continue their usual conventional treatment (n = 45). Pressure pain threshold (PPT), cervical range of motion (CROM), numerical rating pain scores, Neck Disability Index (NDI), SF-12 Health Survey (SF-12) Version 2, Generalized Anxiety Disorder 7-item (GAD7), and Patient Health Questionnaire (PHQ9) were measured at baseline, 12 weeks, and 24 weeks after baseline. Results When compared with the control group, PPT significantly increased after ISBT-Bowen Therapy at 12 and 24 weeks. CROM on flexion, lateral flexion, and rotation were greatly improved at 12 weeks after Bowen therapy, and maintained at 24 weeks, except left lateral flexion. NDI, GAD7, and PHQ9 were all reduced after Bowen Therapy at both 12 and 24 weeks. Both Physical and Mental Component Summary scores of SF-12 were improved after Bowen therapy at 12 and 24 weeks. Conclusions This study confirmed the efficacy of ISBT-Bowen Therapy for patients with MPS. It alleviates pain, improves functional outcomes, enhances quality of life, and relieves mood symptoms.
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Affiliation(s)
- Chee L.A Ying
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
| | - Tsz M.A Lee
- Department of Occupational Therapy, Prince of Wales Hospital, Hong Kong
| | - Pik Yu Chen
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
| | - Winnie Samy
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
| | - Lap Y.F Au
- Department of Occupational Therapy, Prince of Wales Hospital, Hong Kong
| | - Chi H.D Siu
- Department of Occupational Therapy, Prince of Wales Hospital, Hong Kong
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Yu H, Côté P, Wong JJ, Shearer HM, Mior S, Cancelliere C, Randhawa K, Ameis A, Carroll LJ, Nordin M, Varatharajan S, Sutton D, Southerst D, Jacobs C, Stupar M, Taylor-Vaisey A, Gross DP, Brison RJ, Paulden M, Ammendolia C, Cassidy JD, Marshall S, Bohay RN, Stapleton J, Lacerte M. Noninvasive management of soft tissue disorders of the shoulder: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. Eur J Pain 2021; 25:1644-1667. [PMID: 33942459 DOI: 10.1002/ejp.1788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Objective of this study is to develop an evidence-based guideline for the noninvasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. METHODS This guideline is based on high-quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience is clinicians; target population is adults with shoulder pain. RESULTS When managing patients with shoulder pain, clinicians should (a) rule out major structural or other pathologies as the cause of shoulder pain and reassure patients about the benign and self-limited nature of most soft tissue shoulder pain; (b) develop a care plan in partnership with the patient; (c) for shoulder pain of any duration, consider low-level laser therapy; multimodal care (heat/cold, joint mobilization, and range of motion exercise); cervicothoracic spine manipulation and mobilization for shoulder pain when associated pain or restricted movement of the cervicothoracic spine; or thoracic spine manipulation; (d) for shoulder pain >3-month duration, consider stretching and/or strengthening exercises; laser acupuncture; or general physician care (information, advice, and pharmacological pain management if necessary); (e) for shoulder pain with calcific tendinitis on imaging, consider shock-wave therapy; (f) for shoulder pain of any duration, do not offer ultrasound; taping; interferential current therapy; diacutaneous fibrolysis; soft tissue massage; or cervicothoracic spine manipulation and mobilization as an adjunct to exercise (i.e., range of motion, strengthening and stretching exercise) for pain between the neck and the elbow at rest or during movement of the arm; (g) for shoulder pain >3-month duration, do not offer shock-wave therapy; and (h) should reassess the patient's status at each visit for worsening of symptoms or new physical, mental, or psychological symptoms, or satisfactory recovery. CONCLUSIONS Our evidence-based guideline provides recommendations for non-invasive management of shoulder pain. The impact of the guideline in clinical practice requires further evaluation. SIGNIFICANCE Shoulder pain of any duration can be effectively treated with laser therapy, multimodal care (i.e., heat/cold, joint mobilization, range of motion exercise), or cervicothoracic manipulation and mobilization. Shoulder pain (>3 months) can be effectively treated with exercises, laser acupuncture, or general physician care (information, advice, and pharmacological pain management if necessary).
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Affiliation(s)
- Hainan Yu
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Pierre Côté
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jessica J Wong
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Heather M Shearer
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Silvano Mior
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Arthur Ameis
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Linda J Carroll
- School of Public Health and Injury Prevention Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY, USA
| | - Sharanya Varatharajan
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Deborah Sutton
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Danielle Southerst
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Craig Jacobs
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Division of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Maja Stupar
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Anne Taylor-Vaisey
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert J Brison
- Clinical Research, Kingston General Hospital, Kingston, Ontario, Canada.,Department of Emergency Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Mike Paulden
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlo Ammendolia
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Work and Health, Toronto, Ontario, Canada
| | - J David Cassidy
- Divison of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard N Bohay
- Western University, London, Ontario, Canada.,College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Michel Lacerte
- Université de Montréal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases 2021; 9:2077-2089. [PMID: 33850927 PMCID: PMC8017503 DOI: 10.12998/wjcc.v9.i9.2077] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.
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Affiliation(s)
- Qi-Wang Cao
- Department of Algology, The Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410016, Hunan Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Lin Wang
- Department of Algology, Affiliate Hospital of the Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - You-Qing Huang
- Department of Algology, The Second Affiliate Hospital of the Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Dong-Lin Jia
- Department of Algology, Peking University Third Hospital, Beijing 100083, China
| | - Hao Jiang
- Department of Algology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yan Lv
- Department of Algology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510089, Guangdong Province, China
| | - Rong-Guo Liu
- Department of Algology, Fujian Provincial Hospital, Fujian Shengli Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Ying Li
- Department of Algology, Affiliate Hospital of the Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wen Shen
- Department of Algology, Affiliate Hospital of the Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
| | - Ling-Zhi Yu
- Department of Algology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong Province, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410001, Hunan Province, China
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Li L, Stoop R, Clijsen R, Hohenauer E, Fernández-de-Las-Peñas C, Huang Q, Barbero M. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain 2020; 36:955-967. [PMID: 32841969 DOI: 10.1097/ajp.0000000000000875] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to conduct an updated systematic review of diagnostic criteria for myofascial trigger points (MTrPs) used in clinical trials of physical therapy interventions from 2007 to 2019. METHODS MEDLINE and Physiotherapy Evidence Database (PEDro) were searched using the following MeSH keywords: "trigger points," "trigger point," "myofascial trigger point," "myofascial trigger points," "myofascial pain," and "myofascial pain syndrome." The MeSH keywords were combined by using Boolean operators "OR"/"AND." All physiotherapy clinical trials including patients with musculoskeletal conditions characterized by at least 1 active MTrP or latent MTrP in any body area were selected. We pooled data from an individual criterion and criteria combinations used to diagnose MTrPs. The protocol was developed in accordance with the PRISMA-P guidelines. RESULTS Of 478 possibly relevant publications, 198 met the inclusion criteria. Of these 198 studies, 129 studies (65.1%) stated specifically the diagnostic criteria used for MTrPs in the main text, 56 studies (28.3%) failed to report any method whereby MTrP was diagnosed, and 13 studies (6.6%) adopted expert-based definitions for MTrPs without specification. Of 129 studies, the 6 criteria applied most commonly were: "spot tenderness" (n=125, 96.9%), "referred pain" (95, 73.6%), "local twitch response" (63, 48.8%), pain recognition (59, 45.7%), limited range of motion" (29, 22.5%), and "jump sign" (10, 7.8%). Twenty-three combinations of diagnostic criteria were identified. The most frequently used combination was "spot tenderness," "referred pain," and "local twitch response" (n=28 studies, 22%). CONCLUSIONS A number of the included studies failed in properly reporting the MTrP diagnostic criteria. Moreover, high variability in the use of MTrP diagnostic was also observed. Spot tenderness, referred pain, and local twitch response were the 3 most popular criteria (and the most frequently used combination). A lack of transparency in the reporting of MTrP diagnostic criteria is present in the literature. REGISTRY This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO number: CRD42018087420.
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Affiliation(s)
- Lihui Li
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- School of Medicine, Southern University of Science and Technology, Shenzhen
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Rahel Stoop
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
| | - Ron Clijsen
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erich Hohenauer
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Qiangmin Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
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7
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Guzmán-Pavón MJ, Cavero-Redondo I, Martínez-Vizcaíno V, Fernández-Rodríguez R, Reina-Gutierrez S, Álvarez-Bueno C. Effect of Physical Exercise Programs on Myofascial Trigger Points-Related Dysfunctions: A Systematic Review and Meta-analysis. PAIN MEDICINE 2020; 21:2986-2996. [PMID: 33011790 DOI: 10.1093/pm/pnaa253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points. METHODS A systematic search was conducted in Pubmed, Web of Science, and Scopus. Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included. Risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect sizes (ES) and their 95% confidence interval (95% CI) for pain intensity, pressure pain threshold, range of motion, and disability. RESULTS A total of 24 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES were -0.47 (95% CI = -0.61 to -0.33) for pain intensity, 0.63 (95% CI = 0.31 to 0.95) for pressure pain threshold, 0.43 (95% CI = 0.24 to 0.62) for range of motion, and -0.18 (95% CI = -0.45 to 0.10) for disability. CONCLUSIONS Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.
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Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | | | - Sara Reina-Gutierrez
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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8
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Comparison of the Efficacy of Botulinum Toxin, Local Anesthesia, and Platelet-Rich Plasma Injections in Patients With Myofascial Trigger Points in the Masseter Muscle. J Oral Maxillofac Surg 2020; 79:88.e1-88.e9. [PMID: 33045182 DOI: 10.1016/j.joms.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Masticatory myofascial trigger points (TrP) are one of the major causes of nondental pain in the orofacial region. Intramuscular injections are considered the first-line treatment for myofascial TrPs. The objectives of this study were to evaluate and compare the effectiveness of local anesthesia (LA), botulinum toxin (BTX), and platelet-rich plasma (PRP) injections for the treatment of myofascial TrPs in the masseter muscle. METHODS In this retrospective study, the sample was composed of patients with myofascial TrPs in masseter muscle who were treated between 2016 and 2019. Patients were divided into 3 groups according to treatment methods: group I (LA injection), group II (BTX injection), and group III (PRP injection). Primary outcome variable was the average pain level at rest and while chewing, and pressure pain intensity (PPI), Jaw Functional Limitation Scale (JFLS) value, and quality-of-life (measured using Oral Health Impact Profile-14 (OHIP-14)) were secondary outcomes. The outcome variables were assessed at diagnosis, and 1, 3, and 6 months post-treatment. RESULTS The study consisted of 82 patients (group I, 27; group II, 26; group III, 29). At 1 and 3 months, improvement in all parameters was recorded in all groups. Groups I and II showed superior improvement in all parameters compared with group III at 3 months. Improvements in VAS pain, JFLS, and OHIP-14 values were significantly better in group II than group I at 3 months (P = .009; P = .004; P = .002). At 6 months, significant improvement in VAS pain, JFLS, and OHIP-14 (P = .008; P < .001; P < .01) values was recorded only in group II. CONCLUSIONS All procedures successfully improved the symptoms of TrPs in the masseter muscle at 1 and 3 months. However, BTX injection seemed superior at the 3-month follow-up and remained effective up to 6 months.
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Ghasemi M, Mosaffa F, Hoseini B, Behnaz F. Comparison of the Effect of Bicarbonate, Hyaluronidase, and Lidocaine Injection on Myofascial Pain Syndrome. Anesth Pain Med 2020; 10:e101037. [PMID: 32944559 PMCID: PMC7472162 DOI: 10.5812/aapm.101037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background Myofascial pain syndrome is a chronic syndrome that occurred in a local or focal part of the body. The basis for myofascial pain syndrome is the presence of myofascial trigger point or points, producing pain in clinical examinations. Objectives This study aimed to compare the effect of injection of bicarbonate, hyaluronidase, and lidocaine on myofascial pain syndrome. Methods The patients were randomly allocated to three groups of bicarbonate, hyaluronidase, and lidocaine. The injection was done at two painful regions of trapezius muscle with a sonography guide for each patient. The values of visual analogue scale (VAS), pre-injection range of motion (ROM), immediately after injection, second and fourth week were measured. Results The analysis showed that there were no significant differences between the three groups for age, gender, BMI, and height (P > 0.05). Repeated measures one-way ANOVA (week * group) 4 * 3 was used to compare the effect of bicarbonate, hyaluronidase, and lidocaine on VAS and range of motion (ROM) before injection, immediately after injection, second and fourth week. The results showed that the main effect of group and week is significant for VAS (P < 0.05). This study showed that the values of VAS were significantly different between the three groups during the fourth weeks of the study. Moreover, the patients experienced more pain decline in the hyaluronidase group during weeks before injection, after injection, second and fourth week, which indicated the permanent effect of this medication on pain decline. Conclusions Injection of lidocaine leads to a significant reduction in pain immediately after injection; however, the decline was not permanent and disappeared in the following four weeks. But VAS reduction in hyaluronidase group more than bicarbonate and lidocaine groups.
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Affiliation(s)
- Mahshid Ghasemi
- Anesthesiology Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faramarz Mosaffa
- Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Hoseini
- Anesthesiology Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faranak Behnaz
- Department of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Assistant Professor of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Effect of Inhalation Aromatherapy on Pain, Anxiety, Comfort, and Cortisol Levels During Trigger Point Injection. Holist Nurs Pract 2020; 34:57-64. [DOI: 10.1097/hnp.0000000000000350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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GARINIS P, NIKOVA A, BIRBILIS T. [Not Available]. MAEDICA 2019; 14:220-226. [PMID: 31798736 PMCID: PMC6861709 DOI: 10.26574/maedica.2019.14.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives:Cervicogenic headache is a chronic cause of pain with a symptomatology varying between neck pain, instability while walking, dizziness, vertigo, ear pain, eye pain, and unilateral tinnitus, which is leading to increased morbidity and use of analgesics. Currently, the contribution of the local infusion of lidocaine in the treatment of cervicogenic headache is very significant. Material and methods:In this pilot study, eight patients with cervicogenic headache were examined between February 2017 and August 2017 and treated with a three-scale method combining: 1) transcutaneous electric nerve stimulation (TENS); 2) minimally invasive methods of lidocaine injections and nerve blocks; and 3) stretching of the cervical and trapezoidal muscles. Results:The results show that the combined three-step therapy decreases both pain intensity based on VAS score and constant use of analgesics. Conclusion:Three-step therapy can be conducted in one session or multiple sessions and appear to constitute a minimally invasive technique that decreases analgesic use, reducing not only their adverse effects and interactions with other pharmaceutics but also the cost of their use.
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Affiliation(s)
- Pavlos GARINIS
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandrina NIKOVA
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece,Department of Surgical Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - Theodossios BIRBILIS
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
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Parthasarathy S, Sundar S, Mishra G. Assessment of predisposing factors in myofascial pain syndrome and the analgesic effect of trigger point injections - A primary therapeutic interventional clinical trial. Indian J Anaesth 2019; 63:300-303. [PMID: 31000895 PMCID: PMC6460974 DOI: 10.4103/ija.ija_6_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Myofascial pain syndrome (MPS) is a common cause of chronic musculoskeletal pain, characterised by myofascial trigger points (TPs). TP injection is an established technique for management of MPS. In this study, we analysed the efficacy of myofascial TP injection of lignocaine and the influencing biomechanical factors on MPS. Methods After obtaining ethical committee approval, we included the first 100 adult patients of MPS with failed physical therapy aged above 18 years, and with TPs in the trapezius, infraspinatus, and/or the levator scapulae muscles and Visual analog scale (VAS) >4. TP injection of 2% (2 ml) lignocaine was performed. Visual analogue scale (VAS) scores were recorded immediately and after 1 month. Number of repeat TP injections and use of oral analgesic in one month was noted. Results were analysed with the analysis of variance test. Results The mean VAS reduced significantly both immediately and 1 month after therapeutic injections (8.57 ± 0.77, 2.67 ± 1.43 and 2.82 ± 1.4, respectively, P < 0.01). Keeping the palm below the head during sleep was the major contributing factor for myofascial TP, followed by slanting the neck to use mobile phones. Repeat TP injection was used in 4% of cases. Conclusion TP injection of 2 ml of 2% lignocaine along with correction of predisposing biomechanical factors provided significant pain relief for MPS in patients with failed physical therapy without any side effects.
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Affiliation(s)
- S Parthasarathy
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India
| | - Siyam Sundar
- Department of Anaesthesiology, Kovai Medical Centre Hospitals, Coimbatore, Tamil Nadu, India
| | - Gayatri Mishra
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India
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Effect of Local Anesthetic Versus Botulinum Toxin-A Injections for Myofascial Pain Disorders: A Systematic Review and Meta-Analysis. Clin J Pain 2018; 35:353-367. [PMID: 30589660 DOI: 10.1097/ajp.0000000000000681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Myofascial pain is a chronic pain disorder characterized by the presence of painful localized regions of stiff muscle and/or myofascial trigger points. Intramuscular myofascial trigger point injections are considered first-line treatments for myofascial pain. Common injectates include local anesthetics and botulinum toxin-A (BTX-A). The objective of this systematic review was to compare the effectiveness of local anesthetics and BTX-A on pain intensity in patients with myofascial pain. METHODS A comprehensive systematic search of 3 databases, EMBASE, CENTRAL, and Medline was conducted. The search was comprised of words to describe "myofascial pain" and "injections." We performed a meta-analysis comparing local anesthetic and BTX-A injections across these follow-up week periods: 0 (immediately following the injection), 1 to 2, 3 to 4, 5 to 6, 7 to 8, 9 to 10, 11 to 12, 16, 18, 24 weeks with local anesthetics and BTX-A as subgroups. We also performed subgroup analyses comparing the effectiveness of local anesthetic injections and BTX-A injections at various muscle locations and comparing the effectives of single versus multiple injection sessions. RESULTS In total, 33 studies were included. A qualitative analysis suggested that local anesthetics and BTX-A were inconsistently effective at mitigating pain across all follow-up periods. The meta-analyses revealed that local anesthetic injections were more effective than BTX-A at mitigating pain intensity. Multiple injection sessions of local anesthetics were more beneficial than a single session. CONCLUSIONS Additional studies are needed to determine sources of heterogeneity mediating the observed differences in effectiveness of local anesthetic and BTX-A injections among the studies. Additional replicative studies are also needed to delineate the relative efficacy and effectiveness of local anesthetic and BTX-A injection. The quantitative results of this study suggest that patients overall experience more pain relief with local anesthetic injections.
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Culpi M, Martinell ABMC. Desativação de pontos-gatilho no tratamento da dor miofascial. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc13(40)1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A síndrome da dor miofascial (SDM) é causa de dor e limitações, sendo bastante prevalente na população. Seu diagnóstico se dá pela apresentação clínica e exame físico, sendo a dor no local o principal sintoma, que conta com uma irradiação característica conforme o músculo acometido. Devido a esta irradiação, a condição pode mimetizar outras situações clínicas comuns e deve ser lembrada como diagnóstico diferencial. Sua identificação e tratamento podem ser feitos de forma simples e o profissional da atenção primária está apto a realizá-los, no entanto, ainda é muito negligenciada, por ser condição pouco estudada. Seu tratamento inclui fármacos, mudanças de estilo de vida, técnicas de fisioterapia e de agulhamento, sendo que este pode ser a seco ou com injeção de substâncias. O agulhamento com infiltração anestésica parece ser técnica eficaz na desativação de pontos-gatilho musculares e aparenta ser superior às demais em alguns estudos, com a vantagem de ser menos doloroso em sua realização. O objetivo deste estudo é realizar uma revisão da literatura sobre a SDM, levando em conta o quadro clínico, o diagnóstico e o tratamento, retratando resultados com diversas técnicas de agulhamento e comparando-as entre si e com demais técnicas.
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Luh JJ, Huang WT, Lin KH, Huang YY, Kuo PL, Chen WS. Effects of Extracorporeal Shock Wave-Mediated Transdermal Local Anesthetic Drug Delivery on Rat Caudal Nerves. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:214-222. [PMID: 29107354 DOI: 10.1016/j.ultrasmedbio.2017.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Cavitation plays a substantial role in the clinical effects of extracorporeal shock wave therapy (ESWT). It is also generally accepted as a major mechanism in sonophoresis. To identify the enhancing effect of extracorporeal shock wave-mediated transdermal drug delivery, 24 Wistar rats were randomly assigned to four groups: (i) topical application of a eutectic mixture of local anesthetics (EMLA); (ii) 1-MHz ultrasound; (iii) ESWT pre-treatment combined with EMLA application; (iv) ESWT concurrent with EMLA application on rat tails. The degree of anesthesia was assessed using the amplitude and latency of sensory nerve action potentials within 5 min after a 60-min EMLA application. The results indicated that ESWT pre-treatment and concurrent ESWT accelerated the anesthetic effects of the EMLA cream on the tail nerve (p < 0.05). This finding might indicate that shock wave-mediated transdermal drug delivery is possible during the ESWT period.
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Affiliation(s)
- Jer-Junn Luh
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC
| | - Wan-Ting Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Kwan-Hwa Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Therapy, Tzu Chi University, Hualien City, Taiwan, ROC
| | - Yi-You Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan, ROC
| | - Po-Ling Kuo
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC; Department of Electrical Engineering, National Taiwan University, Taipei City, Taiwan, ROC
| | - Wen-Shiang Chen
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC.
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Xia P, Wang X, Lin Q, Cheng K, Li X. Effectiveness of ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis. J Pain Res 2017; 10:545-555. [PMID: 28331357 PMCID: PMC5349701 DOI: 10.2147/jpr.s131482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this review was to assess the therapeutic effect of ultrasound (US) on myofascial pain syndrome (MPS). DATE SOURCES PubMed, Embase, and Cochrane Library were searched to find relevant studies from January 1966 to May 2016 using keywords. Four investigators performed the data extraction. STUDY SELECTION Randomized controlled trials (RCTs) investigating the outcomes of pain and physical function between MPS patients receiving and not receiving US were selected by two researchers independently. DATA EXTRACTION Data were extracted from the RCTs. Risk of bias and study quality were evaluated following the recommendations of Cochrane Collaboration. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. DATA SYNTHESIS A total of 10 studies involving 428 MPS patients were included. US therapy significantly reduced pain intensity (SMD [CI]=-1.41 [-2.15, -0.67], P=0.0002) and increased pain threshold (SMD [CI]=1.08 [0.55, 1.60], P<0.0001), but had no significant effect on cervical range of motion (ROM) of lateral flexion (SMD [CI]=0.40 [-0.19, 0.99], P=0.19), rotation (SMD [CI]=0.10 [-0.33, 0.52], P=0.66), or extension or flexion (SMD [CI]=0.16 [-0.35, 0.68], P=0.53). Heterogeneity between studies was mainly attributed to differences in the follow-up time, parameter of US, course of treatment, and the control group. The overall risk of bias from the included studies was high, and the evidence proving these effect calculations were assessed as low quality. CONCLUSION Owing to the high risk of bias and the across-trial heterogeneity of the studies, the current evidence is not clear enough to support US as an effective method to treat MPS. Clinical trials with methodological rigorousness and adequate power are needed to confirm it in the future.
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Affiliation(s)
- Peng Xia
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaoju Wang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Qiang Lin
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Kai Cheng
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xueping Li
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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