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Effect of intermittent vs. daily calorie restriction on changes in weight and patient-reported outcomes in people with multiple sclerosis.
Fitzgerald, KC, Vizthum, D, Henry-Barron, B, Schweitzer, A, Cassard, SD, Kossoff, E, Hartman, AL, Kapogiannis, D, Sullivan, P, Baer, DJ, et al
Multiple sclerosis and related disorders. 2018;23:33-39
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Multiple sclerosis (MS) is a disease of the central nervous system. Dietary modification is emerging as a safe intervention to potentially modify disease course. The main aim of this study was to assess the safety and feasibility of an intermittent fasting diet in people with MS. Secondary outcomes explored the effects of calorie restriction (CR) diets on body weight and anthropometric characteristics as well as on patient-reported outcomes including fatigue, sleep and mood. The study is a pilot randomised controlled feeding study of three different types of diets. Each participant (n=36) was randomized to 1 of 3 diets: a control diet (placebo), a daily CR diet and intermittent CR diet. Results indicate that daily CR diet was associated with marginally greater weight loss than the intermittent CR diet. Both CR diets were associated with trends toward improvements in cardiometabolic outcomes. Furthermore, CR diets were associated with in improvements in emotional well-being. Authors conclude that CR and weight loss represent interventions for clinically relevant symptoms due to MS, such as emotional well-being, without adding meaningful risks or adverse outcomes.
Abstract
An intermittent fasting or calorie restriction diet has favorable effects in the mouse forms of multiple sclerosis (MS) and may provide additional anti-inflammatory and neuroprotective advantages beyond benefits obtained from weight loss alone. We conducted a pilot randomized controlled feeding study in 36 people with MS to assess safety and feasibility of different types of calorie restriction (CR) diets and assess their effects on weight and patient reported outcomes in people with MS. Patients were randomized to receive 1 of 3 diets for 8 weeks: daily CR diet (22% daily reduction in energy needs), intermittent CR diet (75% reduction in energy needs, 2 days/week; 0% reduction, 5 days/week), or a weight-stable diet (0% reduction in energy needs, 7 days/week). Of the 36 patients enrolled, 31 (86%) completed the trial; no significant adverse events occurred. Participants randomized to CR diets lost a median 3.4 kg (interquartile range [IQR]: -2.4, -4.0). Changes in weight did not differ significantly by type of CR diet, although participants randomized to daily CR tended to have greater weight loss (daily CR: -3.6 kg [IQR: -3.0, -4.1] vs. intermittent CR: -3.0 kg [IQR: -1.95, -4.1]; P = 0.15). Adherence to study diets differed significantly between intermittent CR vs. daily CR, with lesser adherence observed for intermittent CR (P = 0.002). Randomization to either CR diet was associated with significant improvements in emotional well-being/depression scores relative to control, with an average 8-week increase of 1.69 points (95% CI: 0.72, 2.66). CR diets are a safe/feasible way to achieve weight loss in people with MS and may be associated with improved emotional health.
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Association between eating behaviour and diet quality: eating alone vs. eating with others.
Chae, W, Ju, YJ, Shin, J, Jang, SI, Park, EC
Nutrition journal. 2018;17(1):117
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Selecting foods for a day is easily influenced by the social environment and eating together or alone plays a big role in that decision. The study aims to evaluate the association between diet quality of the modern Korean adult population based on the eating behaviour and the socioeconomic factors that influence their diet quality. The study is a cross-sectional study which included 3365 men and 5258 women aged between 19 and 64 years. The study included demographic, socioeconomics, and health behaviour factors as covariates. Results indicate that diet quality is influence by eating behaviour. Authors observed that when Korean adults ate without a companion, their diet quality was significantly lower than those who consistently ate with others. Furthermore, from the higher education to lower education level, the diet quality declined when they eat alone. Authors conclude that many Korean adults are experiencing low diet quality when they eat alone. The study provides evidence to promote interventions to improve diet quality among the public.
Abstract
BACKGROUND To discover the association between eating alone and diet quality among Korean adults who eat alone measured by the mean adequacy ratio (MAR), METHODS The cross-sectional study in diet quality which was measured by nutrient intakes, indicated as MAR and nutrient adequacy ratio (NAR) with the Korean National Health and Nutrition Examination Survey (KNHANES) VI 2013-2015 data. Study population was 8523 Korean adults. Multiple linear regression was performed to identify the association between eating behaviour and MAR and further study analysed how socioeconomic factors influence the diet quality of those who eat alone. RESULTS We found that the diet quality of people who eat alone was lower than that of people who eat together in both male (β: - 0.110, p = 0.002) and female participants (β: - 0.069, p = 0.005). Among who eats alone, the socioeconomic factors that negatively influenced MAR with the living arrangement, education level, income levels, and various occupation classifications. CONCLUSIONS People who eat alone have nutrition intake below the recommended amount. This could lead to serious health problems not only to those who are socially disadvantaged but also those who are in a higher social stratum. Policy-makers should develop strategies to enhance diet quality to prevent potential risk factors.
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Orthorexia nervosa: A behavioral complex or a psychological condition?
Strahler, J, Hermann, A, Walter, B, Stark, R
Journal of behavioral addictions. 2018;7(4):1143-1156
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Orthorexia nervosa (ON) is a condition characterised by an obsession for 'healthy eating' and avoidance of 'unhealthy food' with the violation of these rigid dietary rules being associated with shame, anxiety and distress. Whilst numerous studies have evidenced its existence, there is debate as to whether it is a behavioural phenomenon or a mental health condition like other eating disorders. Anecdotally, there are reports of physiological impacts (such as weight loss), psychological impacts (such as emotional instability) and social impacts (such as social isolation), which are similar to clinical eating disorders. This cross-sectional study aimed to explore whether ON is of clinical relevance, and if it can be distinguished from other mental health conditions. An online survey including orthorexic behaviours was completed by 713 subjects (80% female) aged 18-75 years. 4% showed significant orthorexic eating alongside lower levels of life satisfaction, wellbeing and higher levels of stress. Depression and obsessive compulsive tendencies were also found in 48% and 30% of those with ON respectively. The authors conclude that there are strong overlaps between ON, mental health conditions and disturbed eating behaviours, questioning whether it should be a mental health condition in its own right.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Orthorexia nervosa has been associated with other mental health conditions, including depression and obsessive compulsive disorder.
- Given this association, and the desire for individuals with the condition to seek validation of their orthorexic eating, healthcare practitioners should make appropriate referral to ensure the safety and wellbeing of these individuals.
- Debate continues on whether orthorexia nervosa should be viewed as a mental health condition and eating disorder or a behavioural phenomenon.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Orthorexia nervosa (ON) is gaining increasing interest in research and clinical practice. Whilst research has evidenced its existence, there is still an active debate of whether it should be viewed as a mental health condition and eating disorder in its own right. Diagnoses may be useful for some individuals to make sense of the symptoms they are experiencing, reduce their feelings of isolation and to help them take steps to get the right support needed to improve their health. In a similar way to other eating disorders, orthorexia nervosa has been associated with other mental health conditions including depression and obsessive compulsive disorder.
Clinical practice applications:
Whether defined as an eating disorder in its own right or not, orthorexia nervosa nevertheless is likely to have an impact on wellbeing, life satisfaction and stress. It is an important condition or behavioural phenomenon for practitioners to be aware of, particularly in nutrition fields that may attract those individuals looking for more information or endorsement of their desired orthorexic eating. Given its association with other mental health conditions, safety and appropriate referral should be made to ensure the wellbeing of these individuals.
Considerations for future research:
Research on orthorexia nervosa is considerably smaller compared to other eating disorder conditions and behaviours. Further empirical evidence is needed to support the debate as to whether it is an eating disorder in its own right, or a behavioural phenomenon, and further insight needed to establish its full impact on physical and psychological health.
Abstract
BACKGROUND AND AIMS Numerous studies have provided evidence for orthorexia nervosa (ON), an eating pattern characterized by an almost manic obsession for and fixation on healthy eating, to be of epidemiological relevance. However, there is scientific debate on whether it is merely a behavioral or lifestyle phenomenon as compared to a mental disorder. Aim of this cross-sectional study was to explore whether ON is of epidemiological and clinical relevance, and whether ON can be distinguished from other mental health disorders and healthy lifestyle features. METHODS An online survey including a measure of orthorexic behaviors [Duesseldorf Orthorexia Scale (DOS)], well-being and distress, eating behaviors, pathological eating, anxiety and depression, addictive behaviors, obsessive-compulsive symptoms, personality, and health behaviors was completed by 713 subjects (79.8% women, 18-75 years, median age: 25 years). RESULTS Twenty-seven subjects (3.8%, 21 women) showed significant orthorexic eating (DOS ≥ 30). ON cases reported lower well-being, lower satisfaction with life, and higher current stress levels than non-ON cases. The highest percentage of variation in ON was explained by pathological eating (R2 = .380), followed by eating style, Mediterranean diet, compulsive symptoms, and subjective social status. Importantly, ON provided hardly any additional predictive value for well-being when also considering pathological eating. DISCUSSION AND CONCLUSIONS Our data confirmed the epidemiological and clinical relevance of orthorexic behaviors, but the strong conceptual overlap with other mental health problems and pathological eating raise initial doubts as to whether ON is a distinct mental health disorder category. This co-occurrence, unique symptoms, and underlying processes need further exploration by comparing ON cases with patients with other mental disorders.
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Patient-Reported Outcome of Physical Therapy in Amyotrophic Lateral Sclerosis: Observational Online Study.
Meyer, R, Spittel, S, Steinfurth, L, Funke, A, Kettemann, D, Münch, C, Meyer, T, Maier, A
JMIR rehabilitation and assistive technologies. 2018;5(2):e10099
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Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. The disease is characterized by a loss of motor neurons resulting in progressive motor deficits and paralysis of the muscles that control limb movement, swallowing, and breathing. The aim of the study was to evaluate the frequency and duration of physical therapy sessions among ALS patients, determine the most bothersome motor symptoms, and identify recommendation levels for physical therapy. The study was a prospective, longitudinal, observational study that recruited a consecutive cohort of participants. The mean age of all participants at baseline was 59.2 years with a relatively long disease duration of 27 months. Results did not show a significant correlation between the recommendation of physical therapy and the extent (duration and frequency) of its application. There was no evidence that decline in well-being, motor function, or levels of activity significantly degrade the overall recommendation of physical therapy. Authors conclude that palliative (relieving pain without dealing with the cause of the condition) and multidisciplinary approaches should be encouraged during the education, training, and qualification of physical therapists to implement the changing perceptions of physical therapy.
Abstract
BACKGROUND Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular strength and functional maintenance is not fully understood. OBJECTIVE The purpose of this study was to examine patients' perception of physical therapy during symptom progression using an internet assessment approach. METHODS A prospective, longitudinal, observational study was performed. Recruitment took place in an ALS center in Berlin, Germany. Online self-assessment was established on a case management platform over 6 months. Participants self-assessed the progression of the disease with the ALS Functional Rating Scale-Revised (ALSFRS-R) and tracked the efficacy of targeted physical therapy using Measure Yourself Medical Outcome Profile (MYMOP). We used the net promoter score (NPS) to inquire into recommendation levels of physical therapy. RESULTS Forty-five participants with ALS were included in the study. Twenty-seven (60.0%) started the online assessment. The mean duration of physical therapy sessions per week was 142.7 minutes (SD 60.4) with a mean frequency of 2.9 (SD 1.2) per week. As defined by MYMOP input, the most concerning symptoms were reported in the legs (62.2%), arms (31.1%), and less frequently in the torso (6.7%). As expected for a progressive disease, there was a functional decline of 3 points in the ALSFRS-R at the end of the observation period (n=20). Furthermore, the MYMOP showed a significant loss of 0.8 in the composite score, 0.9 in the activity score and 0.8 in the targeted symptom. In spite of functional decline, the recommendation for physical therapy jumped from a baseline value of 20 NPS points to a very high 50 points at the end of study (P=.05). CONCLUSIONS Physical therapy is perceived as an important treatment method by patients with ALS. Despite functional deterioration, patients are satisfied with physical therapy and recommend this intervention. The results also underline how the meaning of physical therapy changes throughout the disease. Physical therapy in ALS has to be regarded as a supportive and palliative health care intervention beyond functional outcome parameters.
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Neurohealth Properties of Hericium erinaceus Mycelia Enriched with Erinacines.
Li, IC, Lee, LY, Tzeng, TT, Chen, WP, Chen, YP, Shiao, YJ, Chen, CC
Behavioural neurology. 2018;2018:5802634
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The individual compounds within culinary mushrooms has gained much interest and enthusiasm due to their potential health benefits when applied to specific illness or ailments. This particular paper reviews the effects of erinacine compound found in a particular mushroom named Hericium erinaceus (known as Lion’s Mane) and its health properties with regards to aging associated diseases of the nervous system, such as Parkinson’s disease, depression and Alzheimer’s disease. Animal studies reportedly show that erinacines stimulate the synthesis of nerve growth factor, which can prolongs the survival of neurons and reduce the consequence of neurodegenerative diseases. The studies discussed are encouraging to read and offer hope to those with a predisposition to or suffering from such diseases. However, more research in this field is required.
Abstract
Hericium erinaceus, an ideal culinary-medicinal mushroom, has become a well-established candidate in promoting positive brain and nerve health-related activities by inducing the nerve growth factor from its bioactive ingredient. Among its active compounds, only erinacine A has confirmed pharmacological actions in the central nervous system in rats. Hence, this review has summarized the available information on the neurohealth properties of H. erinaceus mycelia enriched with erinacines, which may contribute to further research on the therapeutic roles of these mycelia. The safety of this mushroom has also been discussed. Although it has been difficult to extrapolate the in vivo studies to clinical situations, preclinical studies have shown that there can be improvements in ischemic stroke, Parkinson's disease, Alzheimer's disease, and depression if H. erinaceus mycelia enriched with erinacines are included in daily meals.
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Prevalence and determinants of physical activity in a mixed sample of psychiatric patients in Saudi Arabia.
Alosaimi, FD, Abalhasan, MF, Alhabbad, AA, Fallata, EO, Haddad, BA, AlQattan, NI, Alassiry, MZ
Saudi medical journal. 2018;39(4):401-411
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Physical activity has been shown to considerably reduce the burden of several non-communicable disorders (are diseases of long duration and generally slow progression), such as heart disease, stroke, diabetes, and breast and colon cancers. The aim of the study is to estimate the prevalence of physical activity among a mixed group of patients with psychiatric illnesses in Saudi Arabia. Furthermore, the study sought to evaluate the associations between physical activity, patients with different psychiatric diagnoses and the use of psychotropic medications. The study is a cross-sectional observational study that recruited 1185 patients seeking psychiatric advice, with an average age of 38.0±13.0 years. Results indicate a low prevalence of physical activity in a large, mixed sample of patients with psychiatric illnesses in both inpatient and outpatient settings in Saudi Arabia. Authors conclude that physical activity levels vary according to the type of psychiatric disease and the medications used. They outline that it is important to assess the physical activity status in patients with psychiatric illnesses and promote physical activity programs among psychiatric patients.
Abstract
OBJECTIVES To estimate prevalence of physical activity and its associations with various psychiatric disorders and the use of psychotropic medications. METHODS A cross-sectional observational study was carried out between July 2012 and June 2014. Patients were enrolled from a number of hospitals located in 5 regions of the Kingdom of Saudi Arabia. RESULTS A total of 1185 patients were included in current analysis: 796 were outpatients, and 389 were inpatients. Out of 1,185 patients, 153 (12.9%) were physically active. Much higher rates of physical activity were reported among males than females (15.9% versus 9.6%, p less than 0.001). According to the univariate analysis, higher rates of physical activity were positively correlated with primary bipolar disorders, the use of antianxiety medications and, to a lesser extent, use of antipsychotic medications, but they were negatively correlated with primary anxiety disorders, use of antidepressant medications, and use of multiple psychotropic medications. The associations between physical activity and primary bipolar disorders (odds ratio [OR]=2.47, p=0.002), use of antianxiety medications (OR=3.58, p=0.003), and use of multiple psychotropic medications (OR=0.33, p less than 0.001) remained significant after adjusting for demographic and clinical characteristics. CONCLUSION We report a variable but generally low prevalence of physical activity among a large, mixed sample of psychiatric patients in Saudi Arabia. These findings may highlight the importance of assessing physical activity status of psychiatric patients and the critical need for physical activity promotion programs among this group of disadvantaged patients.
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Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials.
Silva, MAVD, São-João, TM, Brizon, VC, Franco, DH, Mialhe, FL
PloS one. 2018;13(11):e0206294
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Many behavioural interventions have been implemented in order to increase physical activity levels among adults. Despite these efforts, there is often a large gap between setting goals and attaining goals. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of using theory-based strategies on goal attainment in promoting physical activity among adults (specifically implementation intentions or if-then planning). Particular interest was given to the impact of reinforcements during the intervention and follow-up period for coping with obstacles. A total of 13 randomised controlled trials were included. Implementation intentions consisted of two strategies. Firstly, action planning which was designed to increase awareness of possible future situations where behaviours could be achieved. Secondly, coping planning which focused on barriers that might impede the goal behaviour, and ways to overcome these possible barriers. According to the current literature, application of the theory-based goal setting promoted physical activity behaviours, and this was heightened among those who received reinforcement of plans to increase physical activity during the follow-up period.
Abstract
OBJECTIVE The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults. METHODS This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers. RESULTS The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement. CONCLUSION The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482.
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Psychological, pharmacological, and combined treatments for binge eating disorder: a systematic review and meta-analysis.
Ghaderi, A, Odeberg, J, Gustafsson, S, Råstam, M, Brolund, A, Pettersson, A, Parling, T
PeerJ. 2018;6:e5113
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It is estimated that between 1% and 4% of the population suffer from binge eating disorder (BED), which is characterised by episodes of binge eating and a lack of control over eating. People with BED tend to have lower mental wellbeing and are more likely to be overweight or obese, leading to increased risk of related diseases such as type 2 diabetes. Treatments for BED include psychological treatments such as cognitive behavioural therapy (CBT), and medication such as selective serotonin re-update inhibitors (SSRIs) and weight-loss medication, as well as medications that are normally prescribed for attention deficit disorders, addictions and epilepsy. The aim of this review was to evaluate previous trials on the effectiveness of a range of psychological, pharmacological and combined treatments for BED. The authors looked at 45 trials which included over 4,000 participants. They found moderate support for the effectiveness of CBT and guided self-help for the treatment of BED in stopping or reducing the frequency of binge eating. Overall, there was a lack of long-term follow-ups, with no data on the long-term effect of medications. Interesting, the use of SSRIs did not have a significant impact on depressed mood in people with BED and lisdexamfetamine was the only intervention associated with a reduction in BMI (an expected finding as this medication is associated with some loss of appetite). There were very few studies that directly compared psychological treatments with medication, and a lack of evidence on the effectiveness of treatment in younger adults and teenagers. The authors concluded that more long-term studies are needed in the treatment of BED (included exploring quality of life), standardised assessments of BED and people from underrepresented populations (e.g. adolescents).
Abstract
OBJECTIVE To systematically review the efficacy of psychological, pharmacological, and combined treatments for binge eating disorder (BED). METHOD Systematic search and meta-analysis. RESULTS We found 45 unique studies with low/medium risk of bias, and moderate support for the efficacy of cognitive behavior therapy (CBT) and CBT guided self-help (with moderate quality of evidence), and modest support for interpersonal psychotherapy (IPT), selective serotonin reuptake inhibitors (SSRI), and lisdexamfetamine (with low quality of evidence) in the treatment of adults with BED in terms of cessation of or reduction in the frequency of binge eating. The results on weight loss were disappointing. Only lisdexamfetamine showed a very modest effect on weight loss (low quality of evidence). While there is limited support for the long-term effect of psychological treatments, we have currently no data to ascertain the long-term effect of drug treatments. Some undesired side effects are more common in drug treatment compared to placebo, while the side effects of psychological treatments are unknown. Direct comparisons between pharmaceutical and psychological treatments are lacking as well as data to generalize these results to adolescents. CONCLUSION We found moderate support for the efficacy of CBT and guided self-help for the treatment of BED. However, IPT, SSRI, and lisdexamfetamine received only modest support in terms of cessation of or reduction in the frequency of binge eating. The lack of long-term follow-ups is alarming, especially with regard to medication. Long-term follow-ups, standardized assessments including measures of quality of life, and the study of underrepresented populations should be a priority for future research.
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Postural sensorimotor training versus sham exercise in physiotherapy of patients with chronic non-specific low back pain: An exploratory randomised controlled trial.
McCaskey, MA, Wirth, B, Schuster-Amft, C, de Bruin, ED
PloS one. 2018;13(3):e0193358
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Chronic low back pain is a leading cause of years lived with disability. Sensorimotor training (SMT) involves exercises that retrain the musculo-skeletal system to reduce muscular imbalance and improve proprioception. SMT has become a popular method for low back pain rehabilitation, however no study has looked into its effectiveness when supplemented with physiotherapy. The aim of this exploratory randomised trial was to investigate the effects of SMT in rehabilitation of chronic low back pain in 22 patients. Two trial arms received 9x30 minute physiotherapy sessions supplemented with either 15 minutes SMT or 15 minutes low-intensity training as control. Pain level and functional status were assessed at baseline, pre-intervention, post-intervention and 4-week follow-up. This trial found that in patients with chronic low back pain, SMT provided no added benefit to pain reduction and functional improvement compared with control. Based on these findings the authors suggest potential benefits of SMT for long-term functional status but further larger trials with increased SMT sessions are needed to better understand this association.
Abstract
Sensorimotor training (SMT) is popularly applied as exercise in rehabilitation settings, particularly for musculoskeletal pain. With insufficient evidence on its effect on pain and function, this exploratory randomised controlled trial investigated the potential effects of SMT in rehabilitation of chronic non-specific low back pain. Two arms received 9x30 minutes physiotherapy with added interventions: The experimental arm received 15 minutes of postural SMT while the comparator arm performed 15 minutes of added sub-effective low-intensity training. A treatment blinded tester assessed outcomes at baseline 2-4 days prior to intervention, pre- and post-intervention, and at 4-week follow-up. Main outcomes were pain and functional status assessed with a 0-100mm visual analogue scale and the Oswestry Disability Questionnaire. Additionally, postural control was analysed using a video-based tracking system and a pressure plate during perturbed stance. Robust, nonparametric multivariate hypothesis testing was performed. 22 patients (11 females, aged 32 to 75 years) with mild to moderate chronic pain and functional limitations were included for analysis (11 per arm). At post-intervention, average values of primary outcomes improved slightly, but not to a clinically relevant or statistically significant extent. At 4-week follow-up, there was a significant improvement by 12 percentage points (pp) on the functional status questionnaire in the SMT-group (95% confidence intervall (CI) = 5.3pp to 17.7pp, p < 0.001) but not in the control group (4 pp improvement, CI = 11.8pp to 19.2pp). However, group-by-time interaction effects for functional status (Q = 3.3, 19 p = 0.07) and pain (Q = 0.84, p = 0.51) were non-significant. Secondary kinematic outcomes did not change over time in either of the groups. Despite significant improvement of functional status after SMT, overall findings of this exploratory study suggest that SMT provides no added benefit for pain reduction or functional improvement in patients with moderate chronic non-specific low back pain. TRIAL REGISTRATION ClinicalTrials.gov NCT02304120 and related study protocol, DOI: 10.1186/1471-2474-15-382.
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Combination of Exercise and Acupuncture Versus Acupuncture Alone for Treatment of Myofascial Pain Syndrome: A Randomized Clinical Trial.
Eftekharsadat, B, Porjafar, E, Eslamian, F, Shakouri, SK, Fadavi, HR, Raeissadat, SA, Babaei-Ghazani, A
Journal of acupuncture and meridian studies. 2018;11(5):315-322
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Myofascial pain syndrome (MPS) is a chronic condition in which connective tissue is inflamed and trigger points along muscle bands are hyper-sensitive. Previous studies have demonstrated that both exercise and acupuncture are effective for managing MPS. The purpose of this study was to investigate whether physical activity produced an additive effect in 64 patients receiving acupuncture for MPS. Participants were randomised to receive ten sessions of acupuncture or physical activity in addition to acupuncture. Pain measurements and quality of life questionnaires were completed and assessed. This single blind randomised study found that both exercise and acupuncture led to similar reductions in pain. Contrary to the hypothesis, there was no significant difference between the two groups, suggesting physical activity did not produce additive beneficial effect. Based on these results, the authors conclude both exercise combined with acupuncture or acupuncture alone are effective in managing MPS.
Abstract
Myofascial pain syndrome (MPS) is a common musculoskeletal disorder. This study was designed to compare the effects of aerobic exercise plus acupuncture with acupuncture alone in treatment of patients with MPS. Sixty-four patients (55 female and 9 male) with MPS in their neck and shoulders participated in the study with mean age of 33.1 ± 6.4 years. Participants were randomly allocated to aerobic exercise plus acupuncture (n = 32) or acupuncture alone (n = 32) groups. Outcome measurements included visual analog scale, pressure pain threshold, neck disability index, and quality of life that was measured with QoL-SF36 scale. Each group received 10 sessions of acupuncture in combination with aerobic exercise or acupuncture alone. The outcome measures were evaluated at baseline, at the end of the last treatment session, and at 1-month follow-up visit. While participants were waiting for their 1-month follow-up visit, the patients who received combination therapy were asked to continue their aerobic exercise by jogging 40 minutes a day. Although mean visual analog scale, pressure pain threshold, neck disability index, and QoL-SF36 were significantly improved in both groups (p < 0.001), there was no statistically significant difference among the measures between the two groups throughout the evaluated sessions. The interaction effect of time and groups did not show any significant difference among the outcome measures (p > 0.29).