ObjectiveTo explore the effect of dynamic neuromuscular stabilization technique for chronic non-specific low back pain. MethodsFrom July 2019 to June 2020, 60 patients with chronic non-specific low back pain who underwent rehabilitation at the outpatient clinic of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine were prospectively selected. All patients were divided into trial group and control group by random number table method. There were 30 cases in each group. The control group used rehabilitation education and core muscle strength training. The trial group used dynamic neuromuscular stabilization of chest and abdomen combined with breathing control training on the basis of the treatment plan of the control group. The Visual Analogue Scale (VAS) score, Oswestry Dability Index (ODI), abdominal pressure stability, xiphoid level thoracic mobility and axillary level thoracic mobility were compared between the two groups of patients. ResultsAll the 60 patients in this study completed the trial, and there was no recurrent case during treatment, after treatment or during follow-up. There was no statistically significant difference in age, gender, height, weight, body mass index, or course of disease between the two groups (P>0.05). Taking VAS score as the dependent variable, the result of generalized estimating equations showed that the difference in VAS score between the trial group and the control group was statistically significant (χ2=4.132, P=0.042), and the VAS scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ2=1618.814, P<0.001; χ2=1573.419, P<0.001); the between-group comparisons at different time points showed that the difference in VAS score between the two groups at 12 weeks of follow-up was statistically significant (P<0.001), and the remaining between-group differences were not statistically significant (P>0.05). Taking ODI score as the dependent variable, the result of generalized estimating equations showed that the difference in total ODI score between the two groups was statistically significant (χ2=11.063, P=0.001), and the ODI scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ2=524.694, P<0.001; χ2=717.236, P<0.001); the between-group comparisons at different time points showed that there were statistically significant differences between the two groups at 8 weeks of treatment and at 12 weeks of follow-up (P<0.001). After treatment, the improvement of stability value of abdominal pressure [(−4.93±8.14) vs. (−1.33±4.78) mm Hg (1 mm Hg=0.133 kPa)], the improvement of xiphoid level thoracic mobility [(1.87±0.62) vs. (1.52±0.70) cm] and the improvement of axillary level thoracic mobility [(1.78±0.62) vs. (0.92±0.45) cm] in the trial group were better than those in the control group (P<0.05).ConclusionThe dynamic neuromuscular stabilization technique can improve the dysfunction and relieve the symptoms of patients with chronic non-specific low back pain, and it is worthy of promotion.
Anterior cruciate ligament (ACL) injury is one of the most common and typical sports injuries. Neuromuscular proprioceptive training has been widely used in clinical practice in recent years due to its significant therapeutic effects, but the correlation between proprioception and ACL injury is still lacking in-depth exploration. ACL injury can result in the loss of mechanoreceptors, which in turn affects proprioceptive signal afferents, resulting in impaired neuromuscular control. Impaired neuromuscular control, in turn, can cause ligamentous structures to be overburdened beyond their stretch thresholds, leading to proprioceptive impairment, creating a vicious cycle. Based on neuromuscular control theory, this article further discusses the relationship between proprioception and ACL injury, aiming to provide new ideas for rehabilitation after ACL injury.
ObjectiveTo systematically review the effectiveness of non-depolarizing neuromuscular blockers for the prevention of succinylcholine-induced myalgia in clinical practice. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2014), WanFang Data, CBM and CNKI were searched to collect the randomized controlled trails (RCTs) about non-depolarizing neuromuscular blockers for the prevention of succinylcholine-induced myalgia from inception to March 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 11 RCTs involving 666 patients were included. The results of meta-analysis showed that:the pre-treatment of non-depolarizing neuromuscular blockers prevented succinylcholine-induced myalgia at 24 h after surgery (RR=0.46, 95%CI 0.39 to 0.55, P<0.000 01); however, the effectiveness of non-depolarizing neuromuscular blockers for prevention of succinylcholine-induced myalgia at 48 h after surgery was still unclear. ConclusionCurrent studies suggests that both rocuronium and atracurium are effective for the prevention of succinylcholine-induced myalgia. However, due to limited quantity and quality of the included studies, more high-quality studies are needed to verify the abovementioned conclusion.
In China, chronic respiratory diseases (CRD) are characterized by high prevalence, disability rate, and mortality rate, imposing a severe disease burden. Home non-invasive ventilation (HNIV) therapy can improve ventilation, alleviate respiratory muscle fatigue, enhance oxygenation and carbon dioxide retention, delay the progression of various CRD, and even improve survival. However, there is currently a lack of long-term management standards and standardized guidance for patients receiving HNIV therapy in China. The Respiratory Therapy Group of the Chinese thoracic Society and Chinese Association of Rehabilitation Medicine, has summarized 11 questions related to HNIV for different diseases, answered various questions, and put forward modification suggestions. This consensus aims to provide references for frontline clinical staff, promote the standardization of HNIV application in China, and improve the level of treatment.Summary of recommendationsQuestion 1. For which patients is HNIV suitable?Recommendation: HNIV is recommended for patients with ventilatory dysfunction due to various causes, such as: obstructive sleep apnea syndrome [high-quality evidence, strong recommendation], chronic obstructive pulmonary disease [high/moderate-quality evidence, strong recommendation], obesity hypoventilation syndrome [moderate/low-quality evidence, strong recommendation], and neuromuscular diseases [low-quality evidence, strong recommendation].Question 2. When should HNIV be initiated?Recommendation: The timing for initiating HNIV therapy should be based on a comprehensive assessment of disease diagnosis, severity, symptoms, and comorbidities. Early standardized intervention is a crucial measure for improving prognosis and reducing long-term disease burden. Specific recommended indications are listed in Table 2. [high/moderate quality evidence, strong recommendation]Question 3. How should health education on HNIV be conducted?Recommendation: All HNIV patients should receive educational training. The five-step training method is recommended as the preferred approach for educating HNIV patients and their families. [Moderate-quality evidence, weak recommendation]Question 4. How to properly select a home non-invasive ventilator?Recommendations: When selecting a home non-invasive ventilator, patients should first consult a professional physician or respiratory therapist to obtain specialized advice based on their specific condition. Physicians should make decisions by comprehensively considering the patient’s disease type and severity, ventilator modes and parameters, synchrony, comfort, remote monitoring requirements, and financial circumstances. Refer to Table 3 for ventilation mode selection based on different diseases.Question 5. How should accessories for HNIV be selected?Recommendation: Mask selection should be based on disease type, dynamic assessment of the patient’s breathing pattern, and patient preference, with regular reassessment of fit during follow-up [High/moderate-quality evidence, strong recommendation]. Active heated humidifiers are recommended as the first choice for HNIV patients [Low-quality evidence, weak recommendation].Question 6. How should HNIV parameters be set and adjusted?Recommendation: Parameter adjustments should be performed in hospital and community settings. Long-term home use should only commence after confirming appropriate and safe settings. Avoid patients or caregivers making arbitrary adjustments that may cause adverse events. [Moderate-quality evidence, strong recommendation]Pressure settings for NIV should be tailored to the patient’s underlying disease and clinical objectives. Additional parameters including backup rate, inspiratory sensitivity, pressure rise time, and expiratory sensitivity must also be configured. The setup process is summarized in Figure 1. [Moderate-quality evidence, strong recommendation]Question 7. What is the recommended daily usage duration for HNIV?Recommendation: For patients using HNIV due to sleep apnea or sleep-related hypoventilation, it is recommended to use the device for at least 4 hours daily on more than 70% of nights, with usage duration covering sleep periods as much as possible. For patients using HNIV due to chronic hypercapnia, daily use of at least 5 - 6 hours is required, with priority given to nighttime use. [Low-quality evidence, weak recommendation]Question 8. When should respiratory support be adjusted during HNIV?Recommendation: Assess the efficacy of HNIV based on clinical and physiological criteria to determine whether to continue ventilatory support [Moderate-quality evidence, strong recommendation]. If disease progression or complications arise, and HNIV can no longer maintain effective ventilation, discontinue HNIV and seek hospital care promptly [Low-quality evidence, strong recommendation]. HNIV should not be discontinued in patients requiring intermittent or continuous HNIV during exercise [Moderate-quality evidence, strong recommendation].Question 9. How should complications associated with HNIV be managed?Recommendation: Common complications of noninvasive ventilation include skin pressure injury, air leak, patient-ventilator asynchrony, and thick sputum. These should be actively prevented and managed during HNIV. [Moderate-quality evidence, strong recommendation]Question 10. How should the effectiveness of HNIV be assessed and followed up?Recommendation: Close monitoring and follow-up are recommended for patients receiving home noninvasive ventilation. Monitoring indicators and follow-up frequency are summarized in Table 6. [Moderate-quality evidence, GPS]Question 11. How should the management pathway for HNIV be established and optimized?Recommendations: Establish a tiered, dynamic, and individualized HNIV management pathway based on patient condition characteristics, technical support availability, and home care capabilities: ① For high-risk acute exacerbation/unstable patients: Primarily use the traditional "hospital-community-home" model supplemented by self-management; for low-risk acute exacerbation/stable patients: Primarily use self-management with IoT-based remote monitoring where feasible. ② Dynamically adjust based on disease stage: intensify in-person training during the initial phase and gradually transition to remote monitoring during the stable phase; ③ Promote multidisciplinary collaboration, utilize smart devices for real-time monitoring, and ensure data security; ④ Enhance patient self-management capabilities through standardized education and regular follow-ups. [Low-quality evidence, GPS]