Musculoskeletal careYasser A Elmotaleb Gazar, Sherif Ismail, Saad Ghanem, Taha Ibrahim Aladrosy, Adel Ibrahim Azzam
BACKGROUND: The comparative effectiveness of adjunctive physical modalities alongside exercise for ankylosing spondylitis (AS) remains inadequately evaluated. OBJECTIVE: To compare the relative association of focused extracorporeal shock wave therapy (ESWT) versus therapeutic ultrasound, both added to identical exercise-based rehabilitation, with long-term functional outcomes in AS. METHODS: This assessor-blinded randomized comparative trial (conducted March 2024-August 2025) evaluated 106 AS patients with chronic lumbar stiffness (90 completed 12-month follow-up). Participants received either focused ESWT (weekly × 4 weeks, n = 45) or ultrasound (3 × /week × 4 weeks, n = 45), alongside identical 12-week supervised exercise and stable pharmacotherapy. The primary outcome was functional capacity (BASFI). Secondary outcomes included disease activity (BASDAI), pain, spinal mobility (modified Schober) and disability (DFI). This trial was not prospectively registered and lacked an exercise-only control arm; therefore, findings should be interpreted as exploratory. RESULTS: Both groups improved significantly across all outcomes (p < 0.001). At 12 months, the ESWT group was associated with lower BASFI scores (2.2 ± 1.8 vs. 3.7 ± 2.3; p = 0.001; Cohen's d = 0.72) and lower disability (DFI: p = 0.003; d = 0.63) than the ultrasound group. Lumbar mobility differed nominally (p = 0.030) but did not survive correction for multiple secondary comparisons. No significant between-group differences were observed for BASDAI (p = 0.424) or pain (p = 0.284). CONCLUSIONS: When added to identical exercise and pharmacotherapy, focused ESWT was associated with greater long-term functional improvement compared with therapeutic ultrasound. However, in the absence of an exercise-only control, the incremental benefit of either modality over exercise alone cannot be determined. Given the lack of prospective registration and other methodological limitations, these preliminary findings require confirmation through properly registered trials before any clinical recommendations can be made.
BACKGROUND: Elderly patients with cervical radiculopathy present therapeutic challenges owing to comorbidities and medication-related risks. Long-term pharmacotherapy and surgical interventions are often suboptimal, necessitating evaluation of optimized pulsed radiofrequency strategies under image guidance. OBJECTIVES: This superiority trial compared the efficacy and safety of ultrasound-guided cervical nerve root high-voltage pulsed radiofrequency (HVP-PRF) versus conventional pulsed radiofrequency (C-PRF) for pain management in elderly patients with cervical radiculopathy. METHODS: This single-center, parallel-group, assessor-blinded randomized controlled trial enrolled patients aged 60-85 years with cervical radiculopathy, randomly assigned (1:1) to HVP-PRF (70 V) or C-PRF (45 V). Procedures were performed under ultrasound guidance with sensory/motor stimulation confirmation and temperature ≤42°C. The primary outcome was change in upper-limb radiating pain on the Numeric Rating Scale (ΔNRS) from baseline to 3 months. Secondary outcomes included Neck Disability Index (NDI), neck pain NRS, Patient Global Impression of Change, responder rates, rescue analgesia use, and adverse events. Follow-up occurred at 1 week, 1, and 3 months. RESULTS: A total of 104 patients were randomized and 101 received treatment. At 3 months, HVP-PRF demonstrated significantly greater radiating pain improvement versus C-PRF (adjusted mean difference 1.24, 95% CI 0.46-2.02, P=0.002). Functional improvement (NDI) was superior in the HVP-PRF group at 3 months (AMD 6.47, 95% CI 2.11-10.83, P=0.004). Responder rates (≥50% pain reduction) were higher with HVP-PRF at 3 months (68.75% vs. 42.22%, OR 3.01, P=0.011) and 6 months (65.22% vs. 43.18%, OR 2.52, P=0.035). Rescue analgesic use was lower in the HVP-PRF group during 1-3 months intervals (both P<0.05). Adverse event rates were comparable (27.45% vs. 32.00%). CONCLUSION: Under ultrasound visualization and electrical stimulation-based target confirmation with temperature control ≤42°C, HVP-PRF provided greater and more durable relief of upper limb radiating pain compared with C-PRF in elderly patients with cervical radiculopathy, with a comparable safety profile.
Pain practice : the official journal of World Institute of PainTigran Kesayan, Vida Motamedi, Jessica Hanflink, Patrick Assi, Salam Kassis
BACKGROUND: Surgical site infections (SSI) associated with spinal cord stimulation (SCS) implants pose risks of morbidity, mortality, and increased healthcare costs. Immunocompromised patients are especially vulnerable due to impaired immune responses, delaying diagnosis and increasing complications. Current guidelines recommend SCS explantation for deep or inadequately treated superficial SSI, though the role of capsulectomy remains underexplored despite its use in other fields like plastic surgery and cardiology. CASE PRESENTATION: We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64-year-old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed. Staphylococcus schleiferi, likely linked to pet exposure, was identified. Case 2 involved a 52-year-old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post-implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases. CONCLUSION: These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high-risk populations, perhaps by eliminating biofilm associated with the capsule.
Pain practice : the official journal of World Institute of PainGeert Oldenbeuving, Monique C M Schel-Huisman, Jeroen S Vos, Anastasios Kyriazopoulos
INTRODUCTION: Spinal cord stimulation (SCS) is an effective method for pain relief in patients with Persistent Spinal Pain Syndrome (PSPS) type II. International guidelines recommend preoperative imaging to assess spinal anatomy for placement of thoracic SCS leads. This study examines the clinical implications of routine preoperative imaging in patients scheduled for thoracic percutaneous SCS lead placement. METHODS: A single-center retrospective study of MRIs was performed in patients who were planned for SCS lead placement in a period from January 2020 to March 2023. The study excluded lead revisions and cervical or dorsal root lead placements. We examined the impact of imaging findings on procedural planning and execution, categorizing the clinical impact as minor (additional imaging or consultation) or major (cancellation or technical modification of the procedure). We also evaluated the correlation between abnormalities in the epidural space and periprocedural (but not postprocedural) complications such as dural puncture or improper lead positioning at Th7. RESULTS: Of the 167 patients who underwent MR imaging, 129 continued with SCS lead placement. The major reason for not proceeding with lead placement was patient and/or physician preference for conservative treatment. MRI revealed abnormalities in 58 patients-22 in the relevant epidural space and 36 incidental findings. In 29 of the patients (17.4% of total) these abnormalities had no clinical consequences. There were minor consequences in 23 patients (13.8% of total) and major consequences in 6 patients (3.6% of total). Major consequences included the decision to perform a primary surgical implantation in one patient, changes in epidural entry level in two patients, surgical decompression in two patients, and cancellation of the procedure in one patient. Of all MRI findings with clinical implications, 14 of 29 (48.2%) (and 3 of 6 for major consequences) were visible on prior imaging. Although not specifically powered for this correlation, statistical analysis using a Fisher exact test found no significant association between epidural abnormalities on MRI and the occurrence of dural puncture, the inability to place the lead at the desired position, or perioperative neurological sequelae. CONCLUSION: Routine preoperative MRI before thoracic SCS lead placement often detects abnormalities with major consequences in 3.6% of cases. In half of these cases, the abnormalities could not be identified on previous imaging, all of which were in the thoracic region. There was no association between epidural abnormalities and periprocedural complications in our data.
Pain practice : the official journal of World Institute of PainÇiğdem Yalçın, Mehmet Alper Salman, Güldane Turhan, Suna Aşkın Turan
OBJECTIVE: Pulsed radiofrequency of the dorsal root ganglion (DRG) is an established treatment for chronic lumbosacral radicular pain, yet comparative evidence on monopolar versus bipolar configurations, particularly regarding quality-of-life outcomes, remains limited. This study aims to compare the analgesic and quality-of-life effects of bipolar versus monopolar pulsed radiofrequency of the lumbosacral DRG. METHODS: We conducted a mixed retrospective and prospective observational review of 143 patients with chronic radicular pain due to lumbosacral disc herniation who underwent DRG pulsed radiofrequency in 2022 and 2023. Patients received either bipolar (n = 79) or monopolar pulsed radiofrequency (n = 64). Pain intensity was recorded using the Numeric Rating Scale at baseline and at 1st, 2nd, and 6th month post-procedure. Quality of life was assessed with Short Form-36 (SF-36) at baseline and 6 months. Any potential complications were recorded to evaluate the safety of procedures. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. All patients exhibited significant reductions in pain scores over time (p < 0.001). However, bipolar pulsed radiofrequency produced significantly greater pain relief at all follow-up points, with mean pain scores at 6 months of 2.32 versus 4.78 in the monopolar group (p < 0.001). At 6 months, bipolar pulsed radiofrequency also resulted in significantly higher SF-36 scores across all eight domains and in total score (583.61 vs. 425.29, p < 0.001). DISCUSSION: Bipolar pulsed radiofrequency of the lumbosacral DRG was associated with greater improvements in pain and quality of life compared with the monopolar modality in patients with chronic lumbosacral radicular pain. These show the potential of bipolar PRF to enhance clinical and functional outcomes in this population.
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of NursingSusana Malgrat-Caballero, Maite Franco, Oriol Planesas-Pérez, Estefania Garbero Garcia, Eleonora Alexandrova, Maria Z Techera, M Perea-Garcia, Belen Sendra Cri…
INTRODUCTION: Urinary incontinence (UI) is a prevalent geriatric syndrome that significantly affects the physical, psychological, and social well-being of older adults. Non-pharmacological interventions are recommended as the first-line approach, especially in frail older adults. DESIGN: This was a prospective pre-post observational study. METHODS: The study included sixty-one patients with rehabilitable UI who were admitted to an intermediate care hospital. The nurse-led multidisciplinary program integrated education, hygiene-dietary measures, pelvic floor physiotherapy, behavioral strategies, and transcutaneous electrical nerve stimulation (TENS). The primary outcomes were UI severity (International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)), voiding awareness, diurnal and nocturnal voids, disposable absorbent product use, functional status (Barthel Index), cognitive status (Pfeiffer test), and quality of life (EQ-5D). Data were collected at baseline and discharge. RESULTS: Data from 61 participants were analyzed. Significant improvements were observed in the ICIQ-SF scores (16.72 ± 3.39 vs. 9.10 ± 5.86; p < 0.001), daytime voiding awareness (83.6% vs. 100%; p = 0.002), nocturnal voiding awareness (66.7% vs. 88.5%; p = 0.002), nocturnal voids (3.46 ± 2.22 vs. 2.35 ± 1.68; p < 0.001), Barthel Index (49.83 ± 23.84 vs. 70.33 ± 19.59; p < 0.001), and EQ-5D scores (0.39 ± 0.28 vs. 0.56 ± 0.26; p < 0.001). The use of disposable absorbent products decreased from 98.36% to 62.30% (p = 0.065). The patient's cognitive status remained stable. The mean satisfaction with the program was 8.53/10. CONCLUSIONS: A nurse-led, multidisciplinary, non-pharmacological intervention effectively reduced UI severity, increased voiding awareness, enhanced functional autonomy, and improved the quality of life in older adults. These findings support the implementation of individualized, evidence-based programs in intermediate care settings. CLINICAL RELEVANCE: Non-pharmacological interventions led by advanced practice nurses provide effective, patient-centered management of urinary incontinence, improving autonomy and quality of life while potentially reducing healthcare costs.
Pain practice : the official journal of World Institute of PainDanilo Donati, Lucia D'Auria, Vincenzo Ricci, Paolo Boccolari, Roberto Tedeschi, Luigi Tarallo
OBJECTIVE: Complex regional pain syndrome (CRPS) is a complex and multifaceted condition in which pain may be neuropathic, nociplastic, nociceptive, or mixed in nature. This review aims to summarize the available pharmacological and non-pharmacological strategies for managing neuropathic pain in CRPS Types I and II. METHODS: Scopus, PubMed, Cochrane Library, and Google Scholar were searched for randomized controlled trials, meta-analyses, case series, and case reports addressing the management of CRPS, with a focus on neuropathic pain. Studies were analyzed from the perspective of pharmacological and non-pharmacological approaches, with attention to differences between CRPS Type I and II. RESULTS: Gabapentin (Level 1 evidence) and physiotherapy (Level 2 evidence) showed the strongest support among the treatments reviewed. Evidence remains limited or inconsistent for other pharmacological options (e.g., anticonvulsants other than gabapentin, opioids, antidepressants, ketamine, botulinum toxin) and for non-pharmacological interventions (e.g., mirror therapy, spinal cord stimulation, acupuncture). No significant differences in treatment efficacy were identified between CRPS Type I and II. CONCLUSION: Given the complex and heterogeneous nature of CRPS, a multimodal, individualized treatment approach is recommended. Further well-structured studies are needed to strengthen the evidence base for the management of neuropathic pain in CRPS.
NMR in biomedicineFrederique Dupuis, David B Berry, Lara Havandjian, Armin Zavareh, Zachary Brumm, Anirudh Anand, Samuel R Ward, Kamshad Raiszadeh, Bahar Shahidi
Chronic low back pain (LBP) is the leading cause of disability worldwide, yet responses to exercise-based rehabilitation vary substantially and remain not well characterized. Impaired activation of the lumbar paraspinal muscles has been proposed as a mechanism limiting rehabilitation treatment response. Intravoxel incoherent motion (IVIM) magnetic resonance imaging assesses muscle diffusion and perfusion after exercise, offering physiological markers of dynamic function. In a previous pilot study, we reported that acute exercise-induced IVIM responses were reduced in individuals with LBP and that thresholds in diffusion (D) and pseudodiffusion (D*) parameters could predict those who would or would not respond to an exercise-based rehabilitation program. The present study aimed to prospectively validate these findings in a larger, independent cohort. Thirty-seven individuals with chronic LBP underwent IVIM before and after an acute standardized lumbar extension exercise, followed by a 12-week rehabilitation program. Participants were classified as responders or nonresponders based on changes in disability after 12 weeks (Δ Oswestry Disability Index Score ≥ or < 0). In line with the pilot study, responders exhibited higher increase in D following acute exercise than nonresponders (p = 0.05). Previously identified thresholds for D and D* did not discriminate between responders and nonresponders within this new cohort (Sn < 0.40 and Sp = 0.65). Exploratory analyses revealed that baseline disability moderated IVIM responses, as a marked increase in D was primarily observed in responders with low baseline disability, whereas individuals with higher disability showed attenuated responses. New significant thresholds were explored within the validation cohort while controlling for disability levels. An increase ≥ 0.014 × 10-3 mm2/s for D predicted who would respond to the exercise-based program, with a Sn of 0.59 and a Sp of 0.90 (area under the curve [AUC] 0.72, 95%CI 0.55 to 0.90, p = 0.02). These findings confirm that acute IVIM responses are associated with rehabilitation outcomes but may be better understood as part of a broader, integrative framework characterizing the physiological mechanisms associated with treatment response. Integrating physiological and clinical factors to better understand variability in treatment response will help guide more personalized approaches to LBP rehabilitation.
Clinical physiology and functional imagingMason A Howard, Paola M Rivera, Sean M Lubiak, Christopher E Proppe, Jeffrey T Schmidt, Thalia L Fraifer, Ezra D Shobe, Ethan C Hill
The purpose of this investigation was to assess muscle size and perceptual responses following acute bouts of low-load blood flow restriction resistance exercise performed with a 75-repetition (1 × 30, 3 × 15), 3 sets to failure, and a 1 set to failure protocols. Nineteen females randomly performed a 75-repetition, 3 sets to failure, and 1 one set to failure low-load blood flow restriction protocols consisting of unilateral, submaximal (30% of maximal voluntary isometric contraction), isokinetic (90°·s-1), leg extension muscle actions. The minimal difference (MD) was used to determine real changes in each dependent variable from pretest to posttest. There were no significant (p = 0.191-0.567) interactions, main effects of Condition (p = 0.108-0.931), or main effects of Muscle (p = 0.103-0.958) for muscle thickness (MTH), cross-sectional area (CSA), or echo intensity (EI) of the rectus femoris or vastus lateralis. Across the protocols, the changes in MTH, CSA, and EI exceeded the minimal difference for 16-19, 18-19, and 11-19 of the 19 participants, respectively. Following the final set of each protocol, 3 sets to failure (8.94 ± 1.07 au) resulted in a greater rating of perceived exertion compared to the 1 set to failure (8.02 ± 1.08 au) and 75-repetition (8.05 ± 1.35 au) protocols. All three protocols resulted in comparable acute changes in muscle size; however, the 3 sets to failure resulted in the greatest perceptual response. Therefore, comparable acute muscle size responses can be achieved with the 75-repetition protocol or one set performed to failure with a reduced level of exertion.
Pain practice : the official journal of World Institute of PainSteven Falowski, Jack Smith
INTRODUCTION: Intermittent passive recharge burst therapy is an established therapy to optimize pain relief and mitigate the problems associated with battery life and charging burden. Newer programming parameters have been explored to provide patients with this targeted burst therapy in multiple areas. These areas are programmed separately to optimize pain relief for a complex patient population and those with multi-area pain. This study examined single vs. multi-area passive recharge burst therapy in a neurostimulation naive population during percutaneous SCS trial. METHODS: This study was performed at a single institution by a single trialing physician. Candidates for the study were enrolled on a consecutive basis for any painful condition in the management of chronic intractable pain of the back, trunk and limbs. Subjects were randomized to receive either single area burst therapy or two-area burst therapy-with both subject and physician blinding. Programming was adjusted mid-trial based on optimizing pain relief and could include up to four-area burst. Patient outcomes included VAS, percent pain relief, proceeding to implant, and PROMIS-29 scores. RESULTS: All planned 30 patients completed follow up. The average VAS pain score was 70.2 at baseline and 22.2 at the end of the trial. The average pain relief at mid-trial was 53%, which improved to 67% at the end of the trial with conversion to multi-area programming. There was an overall 87% trial to permanent conversion ratio, with 83% of the patients ending trial on multi-area burst therapy. Analysis of PROMIS-29 scores demonstrates the most significant improvements in pain intensity, pain interference, physical function, sleep, and anxiety. CONCLUSION: Multi-area passive recharge burst has demonstrated a high rate of trial success with significant pain and symptom relief. In addition, there were improvements in pain intensity, pain interference, physical function, sleep, and anxiety. Multi-area passive recharge burst therapy is a viable option to be utilized during a trial to improve patient outcomes and optimize trial success.
Journal of neurologySophia P Schulze, Benedict Katzenberger, Daniela Koller, Doreen Huppert, Eva Grill, Ralf Strobl
BACKGROUND: Specific exercises and lifestyle-related recommendations are used to manage vertigo, dizziness, and balance disorders (VDB), but evidence on adherence and its determinants in older adults is limited. This study examined adherence changes and associations with condition-related and patient-related factors from 3 to 12 months after therapeutic recommendations. METHODS: We used data from the MobilE-TRA 2 prospective cohort of adults aged ≥60 years treated for VDB at a tertiary referral centre in Germany. The participants were assessed at baseline and followed up after 3 and 12 months. Self-reported adherence was measured using a five-point Likert scale and dichotomised at predefined cut-offs. Perceived dizziness-related handicap was assessed using the Dizziness Handicap Inventory (DHI). Longitudinal associations were analysed using logistic generalised linear mixed-effects models with random intercepts. RESULTS: Overall, 337 participants were included (53% women; mean age 71 years). In adjusted analyses, adherence to specific exercises was lower at 12 than at 3 months (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.12-0.67). Higher baseline DHI scores were significantly associated with higher adherence to specific exercises (OR 1.03; 95% CI 1.00-1.06), but not with lifestyle-related recommendations (OR 1.00; 95% CI 0.98-1.02). Male gender was associated with lower adherence to lifestyle-related recommendations (OR 0.37; 95% CI 0.16-0.88), while higher self-efficacy was associated with higher adherence (OR 1.65; 95%CI 1.02-2.66). CONCLUSIONS: Adherence differed by recommendation type, participant characteristics and over time in older adults with VDB. These findings may inform strategies to support adherence in VDB beyond initial follow-up.
OBJECTIVE: To evaluate the effects of exercise modality and weekly exercise dose on peripheral brain-derived neurotrophic factor (BDNF) and depressive symptoms in middle-aged and older adults with mild cognitive impairment (MCI), and to examine the robustness of the dose-specific predictions from the primary quadratic model across alternative dose-response functions. METHODS: PubMed, Embase, Web of Science, the Cochrane Library, and APA PsycInfo were searched from inception to 13 April 2026. Randomized controlled trials involving adults aged 50 years or older with MCI and reporting BDNF or depression-related outcomes were included. Effect sizes were expressed as Hedges' g. Separate Bayesian random-effects network dose-response meta-analyses were conducted for BDNF, overall depressive symptoms, and modality-specific depressive symptoms. The quadratic model was used as the primary model to predict intervention effects at different exercise doses. Linear, Emax, and natural cubic spline models were fitted as functional-form sensitivity analyses. RESULTS: Twenty-eight studies involving 2,262 participants were included. In the primary quadratic analysis, the largest model-predicted effect on BDNF occurred at 440 MET-min/week (posterior mean, 0.752; 95% credible interval [CrI], 0.287 to 1.249), whereas the largest model-predicted effect on depressive symptoms occurred at 670 MET-min/week (posterior mean, 0.382; 95% CrI, 0.147 to 0.674). Dancing and multicomponent exercise showed comparatively favourable estimates at selected dose levels, whereas estimates for Tai Chi, walking, and yoga were less precise. Functional-form sensitivity analyses identified different dose locations for the maximum predicted effects. Therefore, 440 and 670 MET-min/week represent the maximum prediction points for BDNF and depressive symptoms, respectively, under the primary quadratic model, rather than established optimal exercise doses. CONCLUSION: Exercise interventions were associated with increased peripheral BDNF levels and improved depressive symptoms in middle-aged and older adults with MCI. The primary quadratic model predicted the largest effects at 440 MET-min/week for BDNF and 670 MET-min/week for depressive symptoms, suggesting a potentially non-linear dose-response relationship. Although these prediction points are important findings of the quadratic analysis, cross-model sensitivity indicates that they should be used to inform future dose-ranging research rather than be regarded as confirmed clinical optima.
Hernia : the journal of hernias and abdominal wall surgeryMatas Pažusis, Linas Venclauskas, Petras Mikučionis, Vytautas Streckis, Mindaugas Kiudelis
INTRODUCTION: Incisional hernias remain a common postoperative problem for general surgeons. In recent years, early postoperative rehabilitation has gained increasing attention as a potential strategy to enhance recovery following abdominal wall reconstruction. This study aimed to evaluate whether structured early postoperative rehabilitation improves objectively measured abdominal wall and trunk muscle functional recovery after open retromuscular (Rives-Stoppa) incisional hernia repair while maintaining postoperative safety. MATERIALS AND METHODS: Thirty adults undergoing elective open retromuscular (Rives-Stoppa) repair of European Hernia Society W2 incisional hernias were randomized to structured postoperative rehabilitation (n = 15) or standard postoperative care (n = 15). Baseline and approximately 2-month postoperative trunk muscle performance were assessed using Biodex dynamometry. The rehabilitation program consisted of supervised, progressive exercises initiated at postoperative week 3 and delivered according to the standardized study protocol. The primary analyses compared individual patient-level changes in trunk flexor and extensor peak torque between groups at angular velocities of 60°/s and 90°/s using the Mann-Whitney U test. Secondary outcomes included additional dynamometric parameters and postoperative clinical outcomes. RESULTS: Thirty patients were included in the analysis. Between-group comparisons demonstrated a statistically significant difference only for the change in trunk flexor peak torque at 90°/s, favoring the rehabilitation group (Δ + 34.3 vs. - 3.8 N·m; Mann-Whitney U = 80.0, p = 0.023). Between-group differences were not statistically significant for trunk flexor peak torque at 60°/s (p = 0.081), trunk extensor peak torque at 60°/s (p = 0.224), or trunk extensor peak torque at 90°/s (p = 0.254). Because four primary peak-torque comparisons were performed without adjustment for multiplicity, the isolated statistically significant finding should be interpreted cautiously. No apparent increase in postoperative complications was observed in the rehabilitation group. Two recurrences occurred during the 12-month follow-up, both in the control group. However, the study was not powered to evaluate recurrence. CONCLUSIONS: Structured early postoperative rehabilitation was associated with a greater improvement in trunk flexor peak torque at 90°/s compared with standard postoperative care. No statistically significant between-group differences were observed for the other assessed peak-torque outcomes. Given the small sample size, baseline imbalances, multiple unadjusted comparisons, and effort-dependent nature of dynamometric testing, the findings should be considered exploratory and hypothesis-generating. Larger adequately powered randomized trials incorporating patient-centered outcomes are required.
Journal of visualized experiments : JoVEMinjie Wang, Yifei Xu, Yuwen Zhang, Kangjing Wei, Haojing Wang, Yi Zhang, Hao Xu, Liqun Yang, Huashun Cui
Osteoarthritis is a chronic degenerative joint disease that commonly affects the knee and causes pain, swelling, stiffness, and functional limitation. Synovial inflammation and changes in periarticular muscles contribute to disease initiation and progression. Clinical evidence suggests that electroacupuncture may alleviate local inflammation and modulate cartilage metabolism. In this study, knee osteoarthritis was induced in mice by surgical destabilization of the medial meniscus. Outcomes were assessed using a multimodal protocol comprising the rotarod test, ultrasound, infrared thermography, magnetic resonance imaging, and histological staining. Joint cavity volume and skin temperature were monitored longitudinally, and endpoint magnetic resonance imaging and Safranin O-Fast Green staining were used to assess periarticular muscle signal changes and cartilage pathology. Electroacupuncture was associated with improved motor performance, reduced joint swelling, higher local skin temperature, less pronounced periarticular muscle signal changes on magnetic resonance images, and lower cartilage degeneration scores. These findings support the use of this multimodal protocol to assess electroacupuncture-associated outcomes in a preclinical mouse model.
INTRODUCTION: Persons with substance use disorders (SUDs) have markedly increased risk for lifestyle-related diseases and reduced life expectancy. Initial findings suggest that high-intensity physical training (HIT) represents an efficient and effective training modality for improving physical and functional capacity for persons with SUDs. However, acheiving such improvements depends not only on the availability of such training modalities but also on adherence, which remains insufficiently understood in this population. Thus, to extend the benefits of HIT to additional persons within this population, there is a need for a broader, deeper, and more patient-centred understanding of their experiences with HIT integrated into specialised treatment, including facilitators and barriers to adherence. METHODS AND ANALYSIS: This protocol article presents an ongoing qualitative collaborative health service study where inpatients with SUDs are interviewed in-depth about their experiences of and adherence to HIT by semi-structured interview guides. Approximately 20 inpatients with SUDs will be purposively recruited based on relevant background variables and inclusion criteria to ensure breadth in experiences: 10 who have adhered to supervised HIT as part of specialised SUD treatment and 10 who have not. Depth will be supported through in-depth interviewing, reflexive field notes, and collaborative thematic analysis with persons with lived experiences. ETHICS AND DISSEMINATION: The study has received ethical approval from Regional Committees for Medical and Health Research Ethics (Reference ID: 2019/501). By strengthening the knowledge base on factors influencing adherence and non-adherence in HIT as part of clinical practice, the findings may support patient's adherence to HIT integrated in SUD treatment in a more person-centred way, ultimately benefiting the physical and functional capacity for additional persons with SUDs. Findings will be disseminated together with persons with lived experiences via conferences, peer-reviewed publications, as well as popular-scientific communication and media. Finally, the findings may generate theoretically informative insights into patients' experiences and mechanisms influencing adherence to HIT, as well as novel concepts and insights needed for new research directions within an increasingly prioritised field in specialised SUD treatment.
BMJ openBin Wang, Qiaojun Zhang, Peng Li, Haifeng Yuan, Yumeng Xu, Ben Ma, Xiaohui Lei, Kai Wan, Lei Lu, Jing Yang, Siduo Zhang, Guanglin Yan, Peijia Fu, Jianlong Ni, …
INTRODUCTION: Ankle sprain is one of the most common sports injuries. Approximately 40% of patients with anterior talofibular ligament (ATFL) rupture develop chronic ankle instability, characterised by persistent balance dysfunction. Although virtual reality-based balance training has shown beneficial effects in non-surgical populations with chronic ankle instability, its efficacy in patients after ATFL repair remains unclear. This study aims to evaluate the effects of virtual reality-based balance training on motor function recovery in patients after ATFL repair. METHODS AND ANALYSIS: This study is a prospective, single-centre, assessor-blinded, parallel-group randomised controlled trial. Sixty-eight patients after unilateral ATFL repair will be randomly assigned (1:1) to an experimental group (virtual reality-based balance training plus conventional rehabilitation) or a control group (conventional balance training plus conventional rehabilitation). Both groups will receive a 4 week intervention, three times per week, consisting of 30 min of conventional ankle rehabilitation plus 30 min of balance training. The primary outcome is the change in the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score. Secondary outcomes include ankle joint position sense, isokinetic muscle strength, static balance, dynamic balance and safety. Assessments are performed at baseline, postintervention (4 weeks after baseline) and follow-up (8 weeks after baseline). Outcome assessors will be blinded to group allocation. Data will be analysed on an intention-to-treat basis using linear mixed-effects models. PROTOCOL VERSION: 1.0, 3 November 2025. ETHICS AND DISSEMINATION: The study protocol has been approved by the Institutional Review Board of the Second Affiliated Hospital of Xi'an Jiaotong University (approval no. 2026 Lun Shen 043, protocol version: 1.0, 3 November 2025). The study will be conducted in accordance with the Declaration of Helsinki. Written informed consent will be obtained from all participants. Regardless of the results, the findings will be submitted for publication in a peer-reviewed journal and presented at national and international academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR2600125841.
PURPOSE: To investigate the biomechanical characteristics of lateral decubitus and sitting lumbar rotational manipulations (LRM) by combining experimental force measurements with finite element analysis (FEA), with a particular focus on regional stress and displacement distributions and areas of stress concentration that may have relevance for future clinical and safety studies. METHODS: Twenty healthy volunteers were randomly assigned to receive either lateral decubitus or sitting LRM. Practitioner-generated forces were recorded using instrumented gloves, and preliminary cluster analysis was performed to explore distinct operational patterns. The measured loading parameters were then used to define the loading conditions in a validated lumbar finite element model to compare stress and displacement distributions in the intervertebral discs and facet cartilage across the two techniques and five clusters. RESULTS: Preliminary cluster analysis identified two clusters for the lateral decubitus technique (shoulder-hip coordinated and hip-dominant) and three for the sitting technique (shoulder-waist coordinated, shoulder-dominant, and gentle-loading). No significant left-right differences in practitioner-generated forces were observed for the lateral decubitus technique (all P > 0.05). For the sitting technique, the force applied at the shoulder was lower on the left than on the right (62.56 ± 15.58 vs. 77.70 ± 7.72 N; t = -10.088, P < 0.001), whereas the force applied at the waist was higher on the left than on the right [32.80 (27.75-38.20) vs. 26.06 (22.66-33.54) N; Z = 2.129, P = 0.042]. FEA showed distinct mechanical patterns between the two techniques. Across the two lateral decubitus clusters, the maximum intervertebral disc stress ranged from 7.87 to 13.40 MPa and the maximum deformation from 7.22 to 12.31 mm, with the main mechanical effects concentrated at L3/4-L4/5. Across the three sitting clusters, the maximum disc stress ranged from 5.87 to 8.09 MPa and the maximum deformation from 11.68 to 16.44 mm, with greater displacement mainly involving L1/2-L2/3. A similar contrast was observed in the facet cartilage, with the lateral decubitus technique generally producing higher peak stress but lower deformation than the sitting technique. CONCLUSION: Lateral decubitus and sitting LRM produced distinct regional biomechanical patterns. Lateral decubitus manipulation was characterized by a higher-stress/lower-displacement profile predominantly involving the lower lumbar spine, whereas sitting manipulation showed a lower-stress/higher-displacement profile with greater involvement of the upper lumbar spine. These findings provide a quantitative biomechanical basis for further investigation of technique-specific loading characteristics, tissue safety, and individualized clinical application. CLINICAL TRIAL NUMBER: Not applicable.
Neurochemical researchTian Ma, Huating Zhou, Yabo Liu, Xianglin Cheng, Ming Li
Global population aging leads to a growing clinical demand for interventions against age-related cognitive decline (ARCD), including mild cognitive impairment (MCI, termed senescence-associated cognitive impairment [SACI] in this review)-a prodromal pathological stage preceding Alzheimer's disease (AD) and vascular dementia. Chronic microglia-mediated neuroinflammation, predominantly triggered by excessive NLRP3 inflammasome activation, acts as a key upstream mediator of hippocampal neuronal injury and gradual cognitive decline in preclinical aging models.Manual acupuncture and electroacupuncture (EA) exert reproducible neuroprotective effects against cognitive deficits, yet a comprehensive, multi-layered regulatory framework unifying NLRP3-centered molecular mechanisms of acupuncture remains absent from current literature. This review systematically summarizes NLRP3‑dependent pathological cascades in SACI and outlines four synergistic signaling axes through which acupuncture may modulate excessive NLRP3‑dependent inflammatory responses to potentially alleviate neurotoxic inflammatory injury.Persistent overactivation of the NLRP3 inflammasome triggers self-amplifying inflammatory feedback cycles in hippocampal tissue through four interrelated pathological processes: impaired autophagic clearance, disrupted mitochondrial homeostasis, persistent endoplasmic reticulum (ER) stress, and caspase-1/GSDMD-mediated neuronal pyroptosis.Acupuncture counteracts NLRP3-dependent neural injury through synergistic multi-target modulation: (1) activation of AMPK/mTOR signaling to restore defective autophagy; (2) suppression of the ROS-TXNIP cascade to block NLRP3 transcriptional priming and protein oligomerization; (3) phenotypic reprogramming of microglia from pro-inflammatory M1 toward anti-inflammatory M2 states; (4) inhibition of pyroptotic execution by blunting caspase-1 maturation and GSDMD proteolytic cleavage. Collectively, available pre‑clinical evidence suggests these signaling axes constitute a bidirectionally‑interconnected hypothetical protective network that may mitigate chronic neuroinflammation.A meta analysis integrating nine eligible randomized controlled trials (published 2015-2025) involving 614 participants was performed. After subject dropout, 599 participants completed the studies. Pooled analyses of heterogeneous acupuncture/electroacupuncture RCTs revealed that intervention was associated with short‑term improvements in MoCA and MMSE scores and reduction in peripheral pro‑inflammatory cytokine IL‑6. Pooled effect sizes were moderately larger in MCI subgroups compared with patients with early AD. Nevertheless, substantial methodological heterogeneity existed across included trials, and these short term observational findings cannot confirm durable disease modifying benefits.Severe methodological heterogeneity across existing trials-including inconsistent acupoint prescriptions, divergent EA stimulation parameters, and variable treatment cycles-impairs cross-study comparability and translational reproducibility. Herein, we synthesize high‑quality preclinical and clinical evidence to propose a provisional consensus‑oriented translational reference protocol for electroacupuncture, intended for standardized mechanistic research rather than routine clinical intervention.Collectively, the NLRP3 inflammasome constitutes a tractable therapeutic target for acupuncture-mediated SACI intervention. Acupuncture exerts pleiotropic neuroprotection by dampening NLRP3-dependent neuroinflammation, alongside complementary NLRP3-independent regulatory pathways. This review‑meta‑analysis provides preliminary translational theoretical evidence for a provisional electroacupuncture intervention framework targeting NLRP3‑mediated neuroinflammation in MCI and early‑AD. Future high‑quality, multi‑center RCTs are warranted to validate these preliminary findings.
INTRODUCTION: Neurodevelopmental impairments and physical deconditioning are the most common long-term morbidities in congenital heart disease (CHD). Holistic interventions including combined neuro-cardiac training may improve physical and mental health in youth with CHD. METHODS AND ANALYSIS: This is a European multicentre, two-arm randomised controlled study to test the efficacy of a home-based neuro-cardiac rehabilitation programme including physical activity and neuropsychological training versus the standard of care in children, adolescents and young adults with complex CHD. Patients aged 8-25 years who underwent infant surgical and/or catheter-based cardiac interventions will be randomly allocated to either an intervention group including a 12-week home-based cardiovascular rehabilitation and executive function training or to a control group. All participants will undergo a baseline assessment and a 12-month follow-up. The primary outcome is the difference in change in the Pediatric Quality of Life Inventory self-reported health-related quality of life score between baseline and final assessment for the intervention versus the control group. Secondary outcomes include standardised neuropsychological measures of executive function, social cognition and mental health. Cardiovascular secondary outcomes include cardiopulmonary fitness parameters such as maximum oxygen uptake, muscular strength and level of physical activity. Efficacy of the intervention will be evaluated by comparing within-subject group differences from baseline to 12-month follow-up, using an intention-to-treat analysis. ETHICS AND DISSEMINATION: The trial protocol was first approved by the sponsor's drawn National Ethics Committee (CPP Paris-III, number 2023-A00038-37) and registered on Clinicaltrial.gov (number NCT05670132). It was also approved by Ethics Committees in Germany (Technische Universitat Munchen, number 2023-276-S-KH) and Belgium (UCLouvain, number B4032025000116). TRIAL REGISTRATION NUMBER: NCT05670132.
OBJECTIVES: To explore women's lived experiences of physiotherapy for pregnancy-related pelvic girdle pain (PPGP), including how the care received corresponded to their needs and expectations. DESIGN: Qualitative study using an inductive phenomenological approach. Individual semi-structured interviews were analysed using Giorgi's Descriptive Phenomenological Psychological Method. SETTING: Primary care physiotherapy clinic in Gothenburg, Sweden. PARTICIPANTS: 10 women who had received physiotherapy for clinically verified PPGP were interviewed between March 2022 and September 2023. Participants were recruited from a primary care physiotherapy clinic and interviews were conducted by telephone or videoconference. RESULTS: Women's experiences of physiotherapy extended beyond symptom management and encompassed validation, reassurance and support in navigating the healthcare system. Three interrelated themes were identified: On the threshold to physiotherapy, describing how pain, reduced functioning, uncertainty about symptom legitimacy and social support influenced care-seeking; A positive and reassuring encounter, highlighting the importance of being listened to, receiving individualised advice and meeting a physiotherapist with expertise in PPGP; and Need for proactive and collaborative maternity care, emphasising the value of early information, timely access to physiotherapy, improved collaboration between midwives and physiotherapists and more flexible care pathways. Even when symptom relief was limited, participants considered individualised guidance, reassurance and validation meaningful outcomes of care. CONCLUSIONS: Women experienced tailored physiotherapy for PPGP as meaningful and reassuring. Their experiences of seeking physiotherapy were shaped by access to information, social support and guidance within the maternity healthcare system. Early information about PPGP, timely access to physiotherapy and continuity of care was described as important aspects of care, suggesting that these areas could be considered when developing care for women with PPGP.
Current urology reportsHayley Premo, Meghan Cooper
PURPOSE OF REVIEW: This manuscript aims to provide an overview of minimally invasive treatment for overactive bladder (OAB) in men, highlighting how concomitant bladder outlet obstruction in men can complicate management and lead to underutilization of these therapies in this patient population. RECENT FINDINGS: The 2024 AUA/SUFU guidelines now allow practitioners to offer minimally invasive therapy as an upfront treatment for OAB. Recent studies have closely examined the efficacy of several key procedures, including intradetrusor onabotulinumtoxin-A (BTX-A), sacral neuromodulation (SNM), and tibial nerve stimulation via percutaneous or implantable devices. All three modalities are effective in terms of improving OAB symptoms, however the evidence base is largely female-derived. This highlights the ongoing need for adequately powered, male-specific clinical trials to address this disparity and help guide individualized treatment planning.
OBJECTIVE: To examine associations between a 4-week seated dual-task (DT) ergometer program and cognitive and mobility outcomes in older convalescent rehabilitation inpatients. MATERIALS AND METHODS: This retrospective observational study included 125 rehabilitation episodes involving older adults undergoing inpatient convalescent rehabilitation , primarily for orthopaedic disorders and stroke. Participants received seated DT ergometer training (n = 79) or conventional recumbent ergometer exercise (n = 46) for 4 weeks. Primary outcomes were the Mini-Mental State Examination (MMSE), Trail Making Test-Japanese Part A (TMT-J Part A), 10-m DT walking time, and the Timed Up and Go test (TUG). Analysis of covariance models adjusted post-training outcomes for baseline values, age, and diagnosis using HC3 robust standard errors. RESULTS: Adjusted between-group differences (DT minus conventional exercise) were nonsignificant for MMSE (0.08 points; 95% confidence interval [CI], -0.78 to 0.93; p = 0.862), TMT-J Part A (-6.59 s; 95% CI, -22.06 to 8.87; p = 0.403), DT walking time (-0.89 s; 95% CI, -2.77 to 0.99; p = 0.354), and TUG (-0.97 s; 95% CI, -2.62 to 0.67; p = 0.246). The six-sessions-per-week sensitivity analysis yielded consistent results. Exploratory analyses showed greater improvements in DT walking time (p = 0.003) and TUG (p = 0.016) in the MMSE ≥27 stratum. Within standard TMT-J limits, adjusted Part A time was shorter in the DT group (p = 0.035), whereas the unadjusted change-score comparison was nonsignificant (p = 0.182). CONCLUSIONS: Seated DT ergometer training did not demonstrate a clear advantage over conventional ergometer exercise in cognitive or mobility outcomes. Exploratory findings are hypothesis-generating. Prospective randomized studies with standardized training exposure are needed.
Lasers in medical scienceAyşe Tuğba Eminsoy Avcı, İpek Eraslan Akyüz, Hüseyin Sinan Topçuoğlu
This study aimed to comparatively evaluate the effectiveness of different irrigation solutions and activation techniques in removing calcium hydroxide (CH) from standardized artificial grooves located in the apical third of root canals. Ninety extracted single-rooted human maxillary central incisors were instrumented using a standardized preparation protocol. Artificial grooves were created in the apical third of split roots and filled with CH paste. Specimens were randomly divided into two irrigation groups: 1.5% sodium hypochlorite (NaOCl) + 0.1% octenidine dihydrochloride (OCT) or 1.5% NaOCl + 17% ethylenediaminetetraacetic acid (EDTA). Each group was further subdivided according to the activation technique: conventional needle irrigation (CNI), passive ultrasonic activation (PUA), or laser-activated irrigation (LAI). Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (α = 0.05). Significant differences were observed among the groups (p < 0.001). OCT combined with PUA showed the lowest residual CH scores and performed significantly better than OCT + CNI. OCT demonstrated superior CH removal compared with EDTA under CNI and PUA conditions. The OCT + PUA protocol was the most effective approach for CH removal.
Clinical oral investigationsDavid Han, Christopher Chun, Catherine Kim, Laurel Martinez, Jooyoung Song
OBJECTIVES: To characterize indications for endodontic microsurgery (EMS) and compare the relative proportion of these indications across two calendar periods before and after the practice's adoption of laser-activated irrigation (LAI). MATERIALS AND METHODS: A retrospective time-period comparison of consecutive EMS cases (n = 1,672) treated by six endodontists (April 2019-August 2025) was analyzed. Two periods were prespecified based exclusively on the date of surgery: Before-Laser Treatment (BLT) and After-Laser Treatment (ALT) following implementation of an Er, Cr: YSGG intracanal LAI protocol (August 2022). Each surgical tooth was assigned one or two predefined reasons. Proportions were compared between periods using Generalized Estimating Equations (GEE) adjusting for patient clustering, demographics, tooth class, and provider. RESULTS: The most frequent indications overall were large post (22.2%), uncleaned accessory canal (21.8%), and excessive calcification (14.4%). In adjusted models, the proportion of EMS cases attributed to uncleaned accessory canals decreased from 26.6% (204/767) in BLT to 17.7% (160/905) in ALT (adjusted OR = 0.49; 95% CI 0.37 to 0.65; P < .001). Conversely, the proportion of EMS cases attributed to excessive calcification increased from 10.8% (83/767) to 17.3% (157/905) (adjusted OR = 1.65; 95% CI 1.21 to 2.25; P = .002). CONCLUSIONS: In this practice-based case series, the ALT period was associated with a lower proportion of EMS cases performed for uncleaned accessory canals. By contrast, the proportion of EMS cases attributed to excessive calcification was higher in the ALT period. Causal inference regarding LAI effectiveness is limited by the time-period design and the lack of non-surgical denominator. CLINICAL RELEVANCE: Following the adoption of laser-activated irrigation (LAI) in non-surgical endodontics, uncleaned accessory anatomy constituted a smaller relative share of subsequent microsurgical cases. Conversely, clinicians should anticipate a continued substantial burden of calcification- and post-related surgical challenges.
Southern medical journalRobyn L Reese, George G A Pujalte, Manisha Salinas, Andre Abadin, Ryan Milon, Michael R Mayo
The aim of this review was to outline critical considerations for physicians caring for older adults engaged in sports and exercise. The number of older adults in the United States is projected to increase, requiring physicians to deepen their understanding of geriatric exercise to provide optimal care. Enhanced physical activity among older adults is associated with improved strength, endurance, functionality, stress reduction, and cognitive health. Physicians can evaluate patient readiness for exercise through physical examinations, echocardiography, exercise stress tests, and bone mineral density tests. A recommended regimen includes 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic activities weekly, alongside twice-weekly muscle-strengthening exercises. Physiologic changes and slower healing rates in older adults heighten their injury risks, however. As such, physicians should ensure a safe exercise environment to minimize these risks while maximizing health benefits. With proper guidance, older adults can enhance their quality of life through tailored exercise programs.
INTRODUCTION: Aging is associated with progressive changes in the musculoskeletal system, contributing to reduced joint mobility, flexibility, and motor function. These alterations may compromise autonomy in older adults, favoring musculoskeletal pain, functional limitations, and increased risk of falls. In this context, stretching is commonly included in adapted physical activity and rehabilitation programs for older individuals. OBJECTIVE: To critically analyze the available evidence regarding the usefulness of stretching in older adults, with particular focus on joint mobility, physical function, pain, and functional autonomy. METHODS: A narrative review of the literature was conducted by consulting databases PubMed/MEDLINE, Scopus and Cochrane Library, prioritizing clinical guidelines, systematic reviews, meta-analyses, and consensus statements, complemented by relevant clinical studies investigating the effects of stretching in older adults. Particular attention was paid to studies addressing static stretching, dynamic stretching, and proprioceptive neuromuscular facilitation, with emphasis on clinically and functionally relevant outcomes. RESULTS: Available evidence suggests relatively consistent benefits of stretching on range of motion and flexibility. Some studies also report favorable effects on perceived stiffness, musculoskeletal pain, and selected aspects of motor function. However, findings regarding improvements in overall functional performance, balance, and fall prevention remain less consistent. CONCLUSIONS: Stretching does not appear to represent a stand-alone intervention for maintaining physical function in older adults, but it may be considered a complementary component within multicomponent exercise programs. Its clinical usefulness seems greater when the aim is to improve joint mobility, perceived stiffness, and movement quality, particularly in subjects with reduced mobility or baseline functional limitations.
Neurosurgical focusCatherine M Garcia, Shane Shahrestani, Sohrab Gollogly, Wouter I Schievink, Corey T Walker
Spontaneous intracranial hypotension (SIH) is most commonly caused by spinal CSF leaks, with ventral dural defects frequently requiring surgical repair when conservative measures fail. Endoscopic transforaminal approaches have emerged as minimally invasive alternatives to traditional open techniques, but the physiological consequences of continuous irrigation in the presence of a dural defect remain poorly understood. The authors report the case of a 36-year-old woman with recurrent SIH due to a persistent ventral T11-12 CSF leak despite prior laminectomy, revision repair, and multiple targeted interventions. She underwent transforaminal endoscopic discectomy and ventral dural repair. During the procedure, under continuous gravity-assisted irrigation, she developed sudden, severe, and reproducible hypertension with her systolic blood pressure reaching 275 mm Hg, refractory to anesthetic deepening and multiple antihypertensive agents. Irrigation cessation resulted in immediate hemodynamic normalization, while irrigation reintroduction led to recurrence of the hypertensive response. The procedure was completed after minimizing irrigation, and the patient stabilized postoperatively without further hemodynamic instability. The authors propose that this phenomenon reflects direct transmission of irrigation-induced epidural pressure into the intrathecal space through the persistent dural defect, resulting in acute intracranial pressure elevation and sympathetic activation. In contrast to standard endoscopic cases, chronic CSF leak states may create a compartmentalized and fibrotic epidural environment with reduced compliance and impaired outflow, predisposing the epidural space/operative field to rapid pressure accumulation even under low-pressure irrigation systems. This case highlights a previously underrecognized mechanism of intraoperative hemodynamic instability during endoscopic spine surgery and underscores the importance of considering altered pressure dynamics in patients with CSF leaks. Surgeons should maintain a high index of suspicion for irrigation-related complications in this population and consider strategies to minimize inflow pressure, optimize outflow, and promptly interrupt irrigation in the setting of unexplained physiological changes. These findings have important implications for surgical planning, intraoperative management, and the safe expansion of endoscopic techniques in CSF leak repair.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAhmed M Elfahl, Heba M Elfeky
BACKGROUND: Non-specific neck pain (NSNP) is a frequent issue that can negatively affect both mobility and function. Recently, there has been growing interest in newer therapeutic approaches, including rib mobilization and diaphragm release techniques, as potential ways to address NSNP and support better outcomes for those affected. PURPOSE: To find out the immediate effects of how (DRT) combined with (RMT) affects the level of pain and the extent to which patients' functional abilities are improved in cases of NSNP. METHODS: For this prospective RCT, 96 participants aged 20 to 45 years were randomly assigned to one of three equal groups based on their pain score (VAS). Group B engaged in (DRT) for 40 minutes, three times weekly for 8 weeks, in contrast to Group A, which got both RMT combined with DRT. Group C (active control) received advice and some exercises. Measurements were collected before and after the intervention; the primary outcomes included pain severity, evaluated using a visual analog scale (VAS); active neck range of motion (ROM), measured with a cervical range of motion (CROM) device; and neck flexion endurance. Additionally, the secondary outcome of neck-related disability was assessed using the Neck Disability Index (NDI). RESULTS: No statistically significant difference was identified among the three groups at baseline; nevertheless, a treatment effect emerged after 8 weeks (p = 0.001 and f-value = 4.15, ƞ2 = 0.306). A statistically significant time-treatment interaction was seen when comparing the pre- and post-treatment periods in groups A and B (p = 0.001, f-value = 3.16, ƞ2 = 0.251). CONCLUSION: The addition of rib mobilization to diaphragm release techniques in patients with non-specific neck pain resulted in statistically significant improvements in pain intensity, cervical flexion, right lateral rotation, left lateral rotation, right rotation, and neck flexor endurance, with moderate to large effect sizes for pain reduction and cervical motion. However, no statistically significant differences were observed between groups for cervical extension, left rotation, or the Neck Disability Index (NDI), and only a marginal clinical improvement in NDI was noted in Group A. The observed benefits in the combined intervention group may not be attributable solely to rib mobilization. The increased treatment complexity and greater therapist interaction inherent in the combined approach could also have influenced the outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07133646.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyEllen Cristine Ferreira da Silva, Wenderson de Souza Morais, Rodrigo Luiz Carregaro, Patricia Azevedo Garcia, Josevan Cerqueira Leal, Felipe Augusto Dos Santos…
BACKGROUND AND PURPOSE: Cognitive impairment manifests early in Parkinson's disease (PD), adversely affecting patients' daily activities and mental health. Utilizing exergames via the Xbox 360 Kinect (XBK) console presents a promising therapeutic avenue to mitigate cognitive decline in PD. This study aimed to assess the efficacy of the XBK system in enhancing cognitive performance and reducing anxiety levels among individuals with PD. METHOD: A non-randomized controlled trial, controlled, single-blind clinical trial was conducted. Forty-three PD participants were selected through convenience sampling and non-randomly assigned to either the XBK experimental group (n = 23) or the Control Group (n = 23). Participants underwent pre, post, and 30-day post-intervention evaluations using the Digit Span Tests, Semantics, Verbal Fluency Test, and Beck Anxiety Inventory. The control group received no intervention, while the experimental group underwent 10 sessions employing four XBK games. This study was approved by the Institutional Ethics Committee of the University of Brasília (Approval No. 2.109.826). Analysis of variance (ANOVA 2 × 3) with Sidak post hoc test and Bonferroni correction was utilized to examine intergroup outcomes. RESULTS: The XBK-trained group exhibited enhancements in short-term memory post-intervention (p = 0.04) and at follow-up (p = 0.01), as well as operational memory post-intervention (p = 0.006) and at follow-up (p = 0.001), although without significant between-group differences. Although no significant interaction effect was observed (p = 0.126), a reduction in anxiety levels was verified up to 30 days post-training (p = 0.03), exclusively within the XBK group, accompanied by a significant between-group difference (p = 0.01), also in follow-up. DISCUSSION: Although the intervention did not demonstrate a superior effect compared with the control group, our findings suggest that training with the Xbox 360 Kinect may have the potential to reduce anxiety in individuals with Parkinson's disease. Further research through randomized clinical trials is necessary to validate these findings and evaluate the long-term benefits of this intervention. TRAIL REGISTRATION: University of Brasília, CAAE: 12248513.9.0000.0030. N°: 2.109.826 https://ensaiosclinicos.gov.br/rg/RBR-7h6b8mg.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyKim Michéle Feder, Lonny Stokholm, Hans Bjarke Rahr, Kim Gordon Ingwersen, Marianne Djernes Lautrup
BACKGROUND: Breast cancer survival has improved substantially, yet many women continue to experience late effects that may require physiotherapy. Shoulder impairment, lymphedema, and fatigue are among the most common physiotherapy-relevant late effects following primary breast cancer treatment. Understanding how guideline treatments for breast cancer influence these impairments is essential for the early identification of high-risk patients and the development of targeted rehabilitation strategies. PURPOSE: To investigate the association between Danish guideline treatments for breast cancer and the risk of three physiotherapy-relevant self-reported late effect dimensions 3-7 years postoperatively. METHODS: National cohort study of 5729 women who underwent surgical treatment for primary breast cancer between 2015 and 2019. Participants completed a questionnaire 3-7 years postoperatively addressing shoulder impairment, lymphedema, and fatigue. Treatment codes were extracted from the Danish National Patient Registry and categorized according to Danish guideline regimens for surgery and radiotherapy. Logistic regression analyses, adjusted for relevant confounders, were performed to estimate associations, and absolute risks were calculated. RESULTS: Compared with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB) with radiotherapy, treatment combinations involving mastectomy or axillary lymph node dissection (ALND) with radiotherapy were associated with approximately threefold higher odds of self-reported late effects. The highest risk was observed after mastectomy and SLNB with radiotherapy (ORadj 3.10, 95% CI 2.48-3.88), followed by mastectomy with ALND and radiotherapy (ORadj 2.90, 95% CI 2.02-4.15) and BCS with ALND and radiotherapy (ORadj 2.76, 95% CI 2.25-3.39). Shoulder impairment was consistently the most frequent self-reported late effect across all treatment types. DISCUSSION: Guideline treatments involving mastectomy, and/or ALND in combination with radiotherapy substantially increased the risk of self-reported late effects, particularly shoulder impairment. These findings highlight the need for early targeted physiotherapy interventions and improved detection strategies to mitigate late effects in breast cancer survivors.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyTsung-Hsien Wang, Ying-Po Hsu, Cheng-Shin Tsai
BACKGROUND AND PURPOSE: Prolonged weaning-characterized by failure in three consecutive spontaneous breathing trials (SBTs) and requiring over 7 days of mechanical ventilation post-initial SBT-presents a critical clinical challenge often exacerbated by intensive care unit-acquired weakness (ICU-AW) and impaired airway clearance. Mobilization and chest physiotherapy (CPT) are promising therapeutic strategies. This study evaluated the association between a combined mobilization and CPT protocol and weaning outcomes in subjects requiring prolonged mechanical ventilation using a retrospective historical control design. METHODS: This retrospective cohort study analyzed 202 subjects who need a requirement for prolonged mechanical ventilation exceeding 21 days admitted to Respiratory Care Center (RCC). Outcomes were compared between a historical control cohort (2018/01/01-2020/01/01; n = 100), which received standard medical care without mobilization or CPT, and an intervention cohort (2020/01/01-2022/03/01; n = 102), which received the combined protocol. The primary outcome was occurrence of weaning failure; the secondary outcome was RCC mortality occurrence. Multivariable logistic regression was performed to determine independent predictors of weaning failure occurrence. RESULTS: Multivariable logistic regression demonstrated that receiving mobilization and CPT was independently associated with lower weaning failure occurrence (OR 0.22, 95% CI [0.10, 0.49], p < 0.001), and Acute Physiology and Chronic Health Evaluation II (OR 1.08, 95% CI [1.01, 1.15], p = 0.018) were also associated with higher weaning occurrence, whereas age (OR 1.02, 95% CI [0.99, 1.02], p = 0.174) and GCS (OR 1.03, 95% CI [0.95, 1.11], p = 0.442) were not. No significant difference was detected in RCC mortality occurrence with non-adjusted comparison (OR 1.58, 95% CI [0.54-4.63], p = 0.398). DISCUSSION: Receiving mobilization and CPT was independently associated with lower odds of weaning failure occurrence in RCC, likely due to improved pulmonary hygiene and reduced ICU-acquired weakness. RCC mortality occurrence did not differ between groups, supporting safety.
BACKGROUND: The participation of clinicians in clinical research is necessary, but balancing research and clinical duties can be challenging. We explored chiropractors' experiences of participating in a clinical trial on spinal manipulation of the neck in primary health care (PHC). METHODS: A qualitative design was adopted, underpinned by social interactionism. Five virtual focus group interviews were performed between August-November 2023, including 15 chiropractors, who were involved in a clinical trial in PHC. Thematic analysis was applied. RESULTS: The interviewees were motivated to participate in the clinical trial to contribute to professional development through investigating the use of spinal manipulation. However, patient recruitment and adherence to the treatment protocol were more difficult than anticipated, especially when patients realised that the treatment would be determined by randomisation and because the chiropractors had to deliver the sham/placebo interventions. The interviewed chiropractors continually negotiated conflicting obligations of clinicians, co-researchers, and breadwinners, shifting loyalties between these roles in response to situational demands. CONCLUSIONS: The clinicians' motivations to take part in the trial varied but were in general rooted in a wish to contribute to strengthening the chiropractic profession. The negotiation of multiple roles and shifting loyalties rendered them moral agents. Our findings illustrate the social and relational nature of participating as a co-researcher in a trial conducted in a chiropractic PHC context. Our study also highlights a need for better support systems for research in PHC. This calls for political and organisational will to establish systems that provide necessary support to researchers and clinical co-researchers.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAlice Jugand, Maxi Miciak, Parker Lay, Michael H Bernstein, Leo Druart
BACKGROUND AND PURPOSE: Therapeutic alliance (TA) refers to mutuality and congruence concerning the bonds, goals, and tasks shared between the physiotherapist and patient. It relies on positive connections through partnership, communication, empathy, and mutual respect. TA is recognized as a central factor in the success of rehabilitation; however, most research remains rooted in psychological frameworks. In physiotherapy, the use of touch or physical activity creates unique relational dynamics that have not been studied in the French healthcare context. Thus, this study aims to identify and describe the characteristics of the TA in French physiotherapy. METHODS: A qualitative interpretive description design was chosen for its flexible, practice-oriented approach suitable for exploring complex clinical phenomena. Inductive analysis allowed themes to emerge from participants' experiences without a preconceived framework. Individual semi-structured interviews were conducted with private practice musculoskeletal physiotherapists and rehabilitation patients. Interview transcripts were analyzed using inductive thematic analysis to identify key themes. Rigor was enhanced through reflexive journaling, peer debriefing, and an audit trail. RESULTS: Thirteen interviews were completed. Three main themes were identified-"foster trust," "find meaning and collaborate," and "weigh going the extra mile and boundaries"-all encompassed by an overarching theme of creating a climate of safety. In addition to common TA qualities, physiotherapy-specific factors emerged: centrality of the body in care, frequent appointments, informal interactions, and social support. French contextual factors were also noted, such as extended patient contact time and the physician's influential role. DISCUSSION: The resulting framework supports reflection on relational practices and deepens understanding of the TA in physiotherapy in relation to other disciplines such as psychotherapy or cultural contexts.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAliaa M Elabd, Yara N Marwan, Omar M Elabd, Waleed T Mansour, Doaa A Elimy, Zeinab A Ali, Engy B Moustafa, Nesma M Allam, Kerolous I Kelini
BACKGROUND AND PURPOSE: Neck pain is prevalent in postpartum women due to postural stress and muscle dysfunction. Although postural correction exercises are widely used, adding manual therapy techniques such as positional release and Tui-Na may enhance outcomes. However, comparative evidence, particularly using surface electromyography (sEMG), remains limited. This study examined the effects of Tui-Na (TN) versus positional release techniques (PRT) added to postural correction exercises (PCEs) on postpartum neck pain. METHODS: Sixty women with postpartum neck pain were randomly assigned to three groups for 4 weeks of prescribed treatment. Group A (control) received PCEs, while either PRT or Tui-Na were added to PCEs for Groups B and C, respectively. The primary outcome was neck pain intensity measured by the Visual Analogue Scale (VAS). Secondary outcomes included the Neck Disability Index (NDI) and upper trapezius electromyographic characteristics (normalized root mean square [RMS] and median frequency [MDF]). A two-way repeated-measures MANOVA was used for statistical analysis. RESULTS: Significant multivariate effects were observed for group effects (F = 4.798, p < 0.001, partial η2 = 0.147), time (F = 851.51, p < 0.001, partial η2 = 0.968), and group-by-time interaction (F = 3.87, p < 0.001, partial η2 = 0.122). Pain intensity was significantly reduced in both groups B (p = 0.035) and C (p = 0.003) when compared to group A. UT-MDF was significantly increased in group C when compared to groups A (p < 0.001) or B (p = 0.02). All groups demonstrated significant within-group improvements in all outcome measures. DISCUSSION: Both Tui-Na and PRT combined with PCEs improved pain and disability in postpartum women with neck pain. Compared with PRT, Tui-Na demonstrated greater improvements in pain intensity and upper trapezius EMG frequency characteristics. However, these findings should be interpreted cautiously because of the short intervention period and lack of long-term follow-up. TRIAL REGISTRATION: NCT07261605.
Journal of visualized experiments : JoVEYunzhao Ji, Yinxiao Lv, Yanli Li, Xueli Ma, Luning Xiong, Yuzhou Han
This study presents a structured protocol combining respiratory and Kegel exercises for postoperative rehabilitation following laparoscopic hysterectomy and retrospectively evaluates the protocol's association with recovery outcomes. Ninety-four patients treated between January 2022 and August 2023 were retrospectively evaluated according to the postoperative rehabilitation documented in their medical records: 47 received combined respiratory and Kegel exercises in addition to routine rehabilitation (observation group), and 47 received routine rehabilitation alone (control group). The combined program was initiated on postoperative day 1 after clinical stabilization and continued during hospitalization and after discharge for 2 months; the exact postoperative hour of the first rehabilitation session was not consistently documented in the retrospective records. Because the study was retrospective, random sequence generation, allocation concealment, and prospective blinding were not performed. Baseline demographic and clinical characteristics showed no evident between-group imbalance. The observation group had earlier first flatus, earlier resumption of oral intake, and a shorter postoperative hospital stay. At the 2-month follow-up, the observation group showed fewer pelvic floor symptom indicators and better sustained- and rapid-contraction pelvic floor muscle performance. Acute postoperative pain at 12 h and 24 h was lower in the observation group. Because oral intake, first flatus, and the 12 h pain assessment occurred before or around rehabilitation initiation, these early postoperative findings were interpreted as descriptive between-group differences rather than effects attributable to the rehabilitation intervention. The observation group also had higher Incontinence Quality of Life scores and lower Pelvic Floor Impact Questionnaire-7 scores, indicating a more favorable quality-of-life profile. Receipt of combined respiratory and Kegel exercise rehabilitation was associated with more favorable postoperative recovery, although the retrospective single-center design requires cautious interpretation and prospective confirmation.
Swiss dental journalAugusto José Alves, Camila das Virgens Braz, Eriston Lorran da Silva Mourão, Julio Eustáquio Melo Oliveira, Nathan Rodrigues Souza, Paula Cristina Pelli Paiva,…
Temporomandibular disorders (TMDs) are among the most common causes of chronic orofacial pain. Although photobiomodulation therapy (PBMT), traditionally referred to as low-level laser therapy (LLLT), and transcutaneous electrical nerve stimulation (TENS) are widely used conservative modalities, their comparative efficacy remains uncertain due to inconsistent evidence. This systematic review compared the efficacy of both therapies and critically appraised the reporting quality and selected methodological characteristics of the included clinical studies. A systematic review was conducted in accordance with PRISMA guidelines, with the protocol registered in PROSPERO. Clinical trials comparing TENS and PBMT were searched in Medline, Web of Science, Scopus, Cochrane, and Embase databases using the descriptors "low-level laser therapy," "photobiomodulation," "transcutaneous electrical nerve stimulation," and "temporomandibular joint disorders," without restrictions on publication year or language. The reporting quality and selected methodological characteristics of the included studies were critically appraised using a CONSORT-based assessment framework. A total of 402 records were identified, of which 14 met the inclusion criteria, comprising 620 patients with joint pain, muscle pain, and/or disc displacement. A greater number of included studies reported numerically larger improvements in pain relief and maximum jaw opening following PBMT than TENS. However, twelve of the fourteen included studies were classified as Level III, indicating limited reporting quality according to the adapted CONSORT-based methodological appraisal framework. Substantial heterogeneity in diagnostic characteristics, treatment protocols, and outcome assessment limited direct comparisons between interventions. Overall, the available evidence suggests that both PBMT and TENS may improve pain and mandibular function in patients with temporomandibular disorders. However, these findings should be interpreted cautiously, as the absence of quantitative synthesis and the substantial clinical and methodological heterogeneity preclude definitive conclusions regarding the comparative efficacy or superiority of either modality.
Pakistan journal of pharmaceutical sciencesJiali Lou, Guoli Zhang, Wei Zhang, Ling Ye
BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is a medical emergency that can significantly impact patients' quality of life, often accompanied by anxiety and depression. Although pharmacotherapy is a common treatment, its effectiveness in improving both auditory and psychological outcomes remains limited. Acupuncture, especially electroacupuncture (EA), has shown potential in treating SSNHL and related affective disorders, but its adjunctive role with pharmacotherapy needs further investigation. OBJECTIVES: This randomized controlled trial aimed to evaluate the incremental benefits of adding EA to standard pharmacotherapy on audiological and psychological outcomes in patients with SSNHL accompanied by anxiety or depression. METHODS: A randomized controlled trial was conducted involving 78 SSNHL patients, divided equally into two groups: P group (n=39) and EA+P group (n=39). The EA+P group received additional EA therapy for 7 days besides the pharmacological treatments. Baseline demographics, pure tone audiometric thresholds (0.25, 0.5, 1, 2, 4, 8 kHz) and psychological scores (HAMD, HAMA) were recorded. Pre-treatment and post-treatment assessments were performed to evaluate changes in hearing thresholds and mental health outcomes. RESULTS: The EA+P group showed significant improvements at all frequencies (p < 0.001). Hearing gain was significantly greater in the EA+P group across all frequencies (p ≤ 0.044). Besides, the EA+P group demonstrated significant reductions in HAMD and HAMA scores (p < 0.001), whereas the P group showed no significant changes (p ≥ 0.051). CONCLUSIONS: Combined EA+P therapy significantly improves hearing recovery and reduces psychological symptom in SSNHL patients with anxiety and depression compared to drug treatment alone. This suggests a synergistic benefit of integrating acupuncture with conventional treatment.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAdriana Marcela Jacome Hortua, Luis Felipe Anaya Duarte, Aura M Cáceres, Zully Rocio Rincon, Cristhian López, Alejandra Mendoza-Monsalve, Edgar Fabián Manrique…
BACKGROUND: Hospital-associated deconditioning (HAD) affects up to 30% of older adults during acute hospitalization, leading to functional and cognitive decline and adverse long-term outcomes. PURPOSE: To develop and pilot "Let's Move," an implementation-oriented early exercise program designed to support mobility in hospitalized patients. METHODS: An action-research study was conducted at a tertiary hospital in two stages: (i) program design based on an electronic health record (EHR) needs assessment and targeted protocol review; and (ii) pilot implementation among clinically stable adults aged ≥ 18 years, hospitalized for ≥ 48 h, without physiotherapy referral. Outcomes included Hopkins Highest Level of Mobility (JH-HLM) functional status, adherence, and safety, complemented by qualitative interviews and a focus group. RESULTS: In Stage 1, 1399 adult inpatients without rehabilitation referral were identified (median age, 65 years [IQR, 46-78]; length of stay, 3 days [IQR, 2-4]) with circulatory diseases predominating (57.18%). Among 26 participants enrolled in the pilot, 17 were evaluable for adherence, with 13 (76.5%) classified as adherent. Walking ≥ 75 m was the most frequent JH-HLM assessment category, no adverse events or in-hospital deaths occurred, and 25/26 participants (96.2%) achieved individualized goals. Qualitative findings supported relevance and feasibility and informed refinements, including sessions every 2 days and standardized educational materials. DISCUSSION: "Let's Move" is a structured early-mobilization program developed through action research that integrates brief patient education with low-intensity exercise for routine inpatient care. It provides a practical workflow to support early mobility and warrants broader evaluation to assess its effectiveness and scalability.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyShashwath P Naidu, Anjali Suresh, Sarulatha Haridass, Karvannan Harikesavan
BACKGROUND AND PURPOSE: Current guidelines for the management of lumbar radiculopathy recommend patient education, staying active, manual therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments. Physiotherapy-specific interventions for low back pain that radiates to the leg include specific trunk muscle activation, muscle strengthening and endurance, movement control, centralisation, directional preference exercises and nerve mobilisation. While exercise therapy is widely recognised as an effective non-invasive intervention, there is currently limited evidence for a standardised framework that integrates different evidence-based exercise approaches and clinical expertise into a structured, practically applicable protocol. The purpose of this study was to develop and content-validate a structured, evidence-based exercise framework for the physiotherapy management of lumbar radiculopathy. METHODS: A comprehensive review of the literature supplemented by expert input with at least 10 years of experience was conducted to identify commonly prescribed exercise interventions for lumbar radiculopathy. Based on the identified impairments and functional deficits associated with the condition, an initial draft framework, which included trunk stabilization, mobility and flexibility training, was constructed. The draft framework was then subjected to expert validation using the content validity index (CVI) and modified kappa to confirm the relevance and perceived ease of performance of exercise by 10 physiotherapists. RESULTS: The 4-stage exercise framework demonstrated excellent agreement with high CVI (100%-90%) and modified kappa (1-0.90). While some exercises of phase 2 and phase 3 were considered slightly difficult to perform, they were relevant for the condition. DISCUSSION: The developed exercise framework exhibited excellent content validity, supporting its relevance and perceived ease of performance in physiotherapy practice for managing patients with lumbar radiculopathy.
Neurosurgical focusGardashkhan Karımzada, Mehmet İlker Özer, Demet Evleksiz, Adem Doğan, Röyal Mehdiyev, Cahit Kural, İlker Solmaz, Cheol Wung Park
OBJECTIVE: This study aimed to evaluate the effect of adrenaline-containing irrigation on visual clarity, surgical efficiency, and perioperative hemodynamic safety during unilateral biportal endoscopic lumbar decompression (UBELD). Adrenaline has previously been successfully used by orthopedic surgeons in arthroscopic surgery, with positive effects on visual clarity observed. Achieving visual clarity in spinal endoscopic surgery is challenging. Improving visual clarity is critical for minimizing complications and achieving successful outcomes. METHODS: A retrospective comparative study was conducted involving 61 consecutive patients who underwent single-level UBELD. Adrenaline-containing saline irrigation (1 mg/3 L saline) was administered to 29 patients, while standard saline irrigation was administered to 32 patients. Surgical duration, irrigation volume, visual clarity scores, perioperative hemodynamic parameters, and clinical outcomes were compared between the groups. Visual clarity was independently assessed by two blinded surgeons with unilateral biportal endoscopic experience using a 10-point numeric rating scale. Interrater reliability was evaluated using the intraclass correlation coefficient (ICC). RESULTS: Baseline demographic and clinical characteristics were comparable between groups. The epinephrine group had significantly shorter operative times (mean 58.8 [SD 8.7] vs 71.8 [SD 9.1] minutes, p < 0.001), lower irrigation volume requirements (mean 23.4 [SD 3.0] vs 25.9 [SD 3.6] L, p = 0.003), and higher visual clarity scores (mean 8.2 [SD 1.6] vs 6.8 [SD 1.9], p = 0.002). Interrater reliability in visual clarity assessment was excellent (ICC = 0.92). No significant differences were observed between groups in perioperative mean arterial pressure, heart rate, or postoperative visual analog scale scores. A transient intraoperative hypertensive episode was observed in 1 patient in the epinephrine group, but this resolved after discontinuation of adrenaline irrigation. CONCLUSIONS: Adrenaline-containing irrigation was associated with improved visual clarity, reduced need for irrigation, and shorter operative duration without causing significant hemodynamic instability during UBELD surgery. Prospective randomized studies are required to confirm the independent effect of adrenaline while controlling for time- and procedure-related confounding factors.