Title Effectiveness of conservative and microdiscetomy treatment for patients with lumbar disc herniation Background Lumbar disc herniation is a common cause of the radiating leg pain and related disabilities that affects people mostly in the middle age. Patients that suffer from lumbar disc herniation respond well to conservative treatment, but for some amount of them surgery could be considered if conservative care is failed after 6 weeks. Although variety of conservative methods that common available in the treatment of lumbar disc herniation, there is conflicting evidence that one type of treatment is clearly superior to others and disagreement over superiority of either surgical intervention or longer conservative treatment for patients with persistent symptoms lasting more than 6 weeks without serious neurological deficit. Aim The main purpose of this thesis is to assess the efficacy of main types of conservative and surgery treatments of the lumbar disc herniation and factors that influence clinical outcomes in patients undergoing this treatment. Method This thesis is a literature review, reviewing articles from relevant journals and books. The relevant sources were searched and collected from database of PubMed, Cochrane library and ScienceDirect from beginning of 2012 to the middle of...

Bakgrund: Besvär från akillessenan är ett vanligt problem hos såväl motionärer som elitidrottare och kan leda till båda smärta och funktionsförlust. Excentrisk träning är en vanlig behandlingsmetod i klinik, trots att evidensen är begränsad och motstridig. Syfte: Att kartlägga vilken evidens som finns för excentrisk träning som behandling av akillestendinopati. Metod: Systematisk litteraturstudie. Sökningen genomfördes i databasen PubMed. Studierna granskades med PEDro-skalan och den sammanlagda evidensen graderades enligt GRADEstud. Resultat: Litteratursökningen resulterade i att 7 studier med totalt 448 deltagare inkluderades. Studierna fick medelhög-hög kvalitet enligt PEDro. Evidensen för excentrisk träning vid 8-16 veckor var måttligt hög (+++) och vid 52 veckor mycket låg (+). Excentrisk träning hade en lägre effekt än hälinlägg och akupunktur mätt med VISA-A vid 8-16 veckor. Effekten av excentrisk träning mätt med VISA-A hade en likvärdig effekt som passiv stretch och tung långsam styrketräning vid 8-16 veckor. Vid 52 veckor var effekten mätt med VISA-A densamma av excentrisk träning som proloterapiinjektioner och tung långsam styrketräning. Konklusion: Excentrisk träning kan ha en effekt vid achillestendinopati. Effekten är densamma som eller lägre sett till poäng på VISA-A än andra behandlingsmetoder och skulle kunna bero på naturlig läkning över tid eller deltagandet i en studie. Evidensen för excentrisk träning graderades vid 8-16 respektive 52 veckor till måttligt hög (+++) och mycket låg (+). Detta grundar sig på studier av medelgod till hög kvalitet. / Background: Achilles tendon issues is a common problem among athletes on all levels. The problem can cause pain and loss of function. Eccentric exercise is a somewhat gold standard and often used in the clinical setting although the level of evidence is limited and conflicting. Objective: Map the evidence of eccentric exercise as a treatment for achilles tendinopathy. Method: A systematic review. The search was conducted in the Pubmed database. The included studies were analyzed using the PEDro scale and the evidence was graded using the GRADEstud. Results: The literature search identified 7 studies that were included with a total of 448 participants. The studies received a moderate-high quality on PEDro. The level of evidence at 8-16 weeks was moderate (+++) and at 52 weeks very low (+). Eccentric exercise had a lower effect than heel lifts and acupuncture measured with VISA-A. Eccentric exercise had a similar effect on VISA-A as passive stretch and heavy slow resistance. At 52 weeks the effect of eccentric exercise was the same as prolotherapy injections and heavy slow resistance. Conclusion: Eccentric exercise might have an effect as treatment for achilles tendinopathy, but the effect is the same or lower than other treatment options measured with VISA-A and might depend on the natural healing process or the participation in a study. The level of evidence for eccentric exercise was graded at 8-16 and 52 weeks respectively, as moderate (+++) and very low (+). This is based on studies of moderate to high quality.

Title: Evaluation of the effect of conservative approach in the treatment of scoliosis Objective : The purpose of this thesis is to summarize scoliosis issue, natural history, causes, consequences and effectiveness of conservative therapy. Based on the critical literature review there was an intention to evaluate effects of physiotherapy intervention in the treatment of scoliosis and compare individual physical therapy approaches. Methods: This thesis is a descriptive analysis based on a literature review. Results: Based on the research paper only twelve articles met our criteria that address the effect of exercise to influence scoliosis and its consequences. The most commonly used conservative approaches included: Schroth concept, FITS, SEAS, SIR, Klapp-Cotrell concept, Vojta method, program of active self- correction and task- oriented exercise, forward head corrective exercise program, MedX Rotary Torso Machine and LTX 3000. Despite that fact, each approach showed some effect, it is not possible to say which approach is the most effective. Keywords: scoliosis, conservative treatment, Cobb angle, physiotherapy

Title: Flexor tendon pulley lesion as a most frequent injury in sport climbing Specification of the problem: This thesis is focused on the most frequent injury of the hand in sport climbing. It describes the mechanism of the injury and possibilities of conservative and surgical treatment according to the given guidelines in dependence on its relevance. Objectives: The aim of this thesis is the literary review of accessible literary resources from the field of anatomy, kinesiology and biomechanics of the hand and flexor tendon pulley in connection with a sport activity. Furthermore it is aimed on an analysis why is the flexor tendon pulley injury the most frequent injury in sport climbing, and on methods how to treat this injury in the most effective way from the beginning till the return to the full performance based on therapeutic guidelines created by Dr. Schöffl nad Dr. Hochholzer. This thesis should serve as a therapeutic manual for the Czech sport climbers suffering from this type of injury, which is generally very often underestimated and not treated sufficiently. Methods: This diploma thesis has descriptively-analytical character and is structured as a literary review. Keywords: tendon pulley, hand, sport climbing, physiotherapy, conservative treatment

No description available.

Background: Neck pain is a major public health with great effects on both the individual and society. Cervical radiculopathy is a relatively common form of neck pain with neurological symptoms. Physical therapy is often the first treatment but there is paucity in literature reviews investigating the effects of physical therapy. Objective: To assess the effects of physical therapy for cervical radiculopathy. Methods: A literature search was conducted in PubMed, CINAHL, PEDro and Web of Science. A total of 12 RCT articles were included in the study. The articles were reviewed based on the aims of the study and the PEDro scale. Results: Eight studies of moderate quality and four high quality. Most studies used the same outcome measures. Most common interventions were traction and manual therapy. Outcomes were varied with some reporting positive effects and others no change. Treatment periods, number of sessions and follow-up varied. In most cases, the positive results wore off at follow-up and differences between groups less pronounced. Conclusions: The quality of RCTs investigating cervical radiculopathy is variable. There is limited evidence suggesting that physical therapy treatment can have a measurable and significant long-term effect on cervical radiculopathy. / Bakgrund: Nacksmärta är ett allvarligt folkhälsoproblem med stor effekt på både den enskilde och samhället. Cervikal radikulopati är en relativt vanlig form av nacksmärta med neurologiska symtom. Fysioterapi är ofta den första behandlingen för detta tillstånd men det är brist på litteraturstudier som undersöker fysioterapins effekter. Syfte: Att undersöka effekterna av fysioterapi för cervikal radikulopati. Metod: Litteratursökningar gjordes i PubMed, CINAHL, PEDro och Web of Science. Totalt inkluderades 12 RCT artiklar i studien. Artiklarna granskades utifrån studiens frågeställningar samt PEDro kvalitetsgranskningsmall. Resultat: Åtta studier var av måttlig kvalitet och fyra hög kvalitet. De flesta studier använde samma utfallsmått och alla uppmätte smärta, funktionshinder och funktion. De två vanligaste behandlingarna var traktion och manuell terapi. Resultaten av insatserna varierade då vissa rapporterade positiva effekter och andra ingen förändring. Behandlingsperioder, antal sessioner samt uppföljning varierade. I de flesta fall, så avtog de positiva resultaten vid uppföljning och skillnaden mellan grupperna blev mindre uppenbara. Konklusion: Denna litteraturöversikt påvisade att kvaliteten på de RCT studier som undersöker cervikal radikulopati varierar. Resultaten visar att det finns begränsad evidens som tyder på att fysioterapi kan ha en mätbar och betydande inverkan på cervikal radikulopati i längden.

Orientador: Antonio Carlos Paes / Resumo: Introdução: Os números relacionados à letalidade na lesão renal aguda (LRA) em cães e gatos de acordo com a etiologia são pouco conhecidas. Este é o primeiro estudo que avaliou as evidências disponíveis sobre a LRA para ajudar na tomada de decisões na prática clínica. Objetivos: Avaliar a letalidade da LRA em cães e gatos de acordo com a etiologia, infecciosa ou não infecciosa, e também em cães e gatos que estavam recebendo tratamento dialítico ou conservador. Métodos: Pesquisas em Medline, EMBASE e LILACS até julho de 2016 e revisão de listas de referências dos trabalhos incluídos. Os critérios de inclusão foram estudos em série de casos que avaliaram o tratamento de dialítico ou conservativo em cães e gatos com LRA independentemente da etiologia e letalidade por todas as causas relatada. A proporção agrupada e o intervalo de confiança (IC) são apresentados para cada resultado. A significância estatística foi definida com a não sobreposição dos intervalos de confiança de 95%, obtidos para cada intervenção. Resultados: Dezenove séries de casos envolvendo 1.233 animais foram elegíveis. As proporções agrupadas para a letalidade global, independentemente do tratamento e da etiologia, foram: gatos 52,6% e cães 45,0%. Os valores de letalidade de acordo com o tratamento foram numericamente maiores nos cães e gatos que receberam diálise quando comparado com o tratamento conservador. As diferenças significativas foram observadas devido à não-sobreposição das IC 95%, mostrando maiores... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Evidence related to lethality in acute kidney injury (AKI) in cats and dogs accordingly to the etiology are little known. This is the first study that evaluated the available evidence on AKI to allow decision-making in clinical practice. Objectives: To evaluate the lethality rate in cats and dogs with AKI accordingly to the etiology (i.e. infectious versus non-infectious), and the incidence of lethality in cats and dogs that were receiving either dialytic or conservative treatment. Methods: Searches of Medline, EMBASE, and LILACS to July 2016 and review of reference lists of previous review. Inclusion criteria were case series studies evaluating dialytic or conservative treatment in cats and dogs with AKI, regardless the etiology and all-cause lethality reported. The pooled proportion and the confidence interval (CI) are shown for each outcome. Statistical significance was defined if the 95% confidence intervals obtained for each intervention did not overlap. Results: 19 case series involving 1,233 animals proved eligible. The pooled proportions for overall lethality regardless the treatment and etiology were: cats 52.6% and dogs 45.0%.The rates of lethality accordingly the treatment were higher in the cats and dogs that receiving dialysis, regardless the etiology when comparing with conservative treatment, however there was no significant difference. Effect differences were seen due to the non-overlap of the 95% CIs showing higher proportions of mortality in AKI ... (Complete abstract click electronic access below) / Doutor

Abstract The nature of symptoms and signs of sciatica, genetic factors, and efficacy of periradicular infiltration were studied in 160 nonoperated patients with unilateral sciatica of 3 to 28 weeks duration. Back and leg pain (100-mm VAS), disability (Oswestry), and quality-of-life (NHP) were evaluated. ENMG and 1.5-T MRI were performed on every patient. Presence of the Trp2 and Trp3 alleles of collagen IX was determined from blood samples. After informed consent, patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine, or saline. The final follow-up assessment was 1 year after the intervention. Economic analysis was based on data gathered from the patients, medical records and the National Insurance Register. At baseline, symptoms of sciatica did not correlate with the type of displacement of the symptomatic disc in MRI, or the presence of the Trp2 or Trp3 alleles. In the case of the Trp2 allele, there was a non-significant tendency for the presence of a radial tear at the L4–5 level. A significant genotype-phenotype association was found for the Trp3 allele: 15 of 34 (44%) patients with the Trp3 allele were positive for thoracolumbar Scheuermann's disease in MRI compared to 19% for sciatic patients without the allele (p = 0.003). Periradicular infiltration with methylprednisolone-bupivacaine produced a significant treatment effect compared to saline at 2 weeks for leg pain, straight leg raising, lumbar flexion and patient satisfaction. At 6 months, saline was superior to steroid in back and leg pain. By 1 year, 18 patients in the methylprednisolone group and 15 in the saline group had received surgical treatment. Subgroup analysis revealed that the short-term effect of the steroid treatment was most pronounced for contained herniations and symptomatic lesions situated at the L4–5 (or L3–4) disc level. Patients with a contained herniation were less likely to undergo back surgery when receiving the steroid treatment and they also had significantly fewer days on sick leave from 3 to 6 months. Counter-effectiveness was most pronounced for extrusions. The results indicate that disability among sciatic patients may be present even when MRI findings are minor; and vice versa, prominent MRI findings may not associate with any symptoms. However, MRI seems to be useful for identifying patients with the Trp3 allele. On the basis of the treatment intervention results, periradicular infiltration with a combination of steroid and anaesthetic may be recommended for sciatica as it offers at least short-term pain relief. Furthermore, in the case of contained herniations the steroid injection is cost-effective and may also prevent surgery. However, this subgroup analysis calls for a verification study.

Title: Current approaches in conservative treatment of scoliosis - literature review Objective: The goal of this diploma thesis is evaluate the most efective current within a combination of a bracing with exercises therapy. Next goal is to summarize matters of adolescent idiopathic scoliosis disease, especially outline of clinical picture, causes and predisposition for origin these deformity and last but not least options in conservative treatment. Methodics: This diploma thesis is processed as literature review from available literary resources. First part of thesis contains all of theoretical bases and knowledge about adolescent idiopathic scoliosis. Second part has a decriptive-analytical charakter and contains analysis of studies, which was used a bracing supplemented by exercises treatment. Results: Established criteria after finish of review fulfill only nine studies, which interest about efectivness of treatment by bracing in pacient with adolescent idiopathic scoliosis. Because the way of studies and their very low number of studies, is not possible to evaluate results of studies and conclusively interpret, which one is the most effective access. Nevertheless in all of this studies was demonstrated higher efficancy by therapy with probands undergoing a bracing along with active exercise...

Bakgrund: I dagsläget finns det brist på studier som innefattar hur vårdnadshavare upplever barnens korsettbehandling. Behandlingen är effektiv men barnens psykiska- och fysiska hälsa påverkas negativt. Vårdnadshavare har en essentiell roll i korsettbehandlingen, därför är det betydelsefullt att identifiera de problem som upplevs av dem.   Syfte och frågeställningar: Syftet med studien är att redogöra för barnens upplevelse av korsettbehandlingen, ur vårdnadshavarnas perspektiv. Genom att identifiera det som anses vara mest problematiskt och vilka aspekter som kan åtgärdas kan upplevelsen av korsettbehandlingen förbättras.   Metod: En kvalitativ innehållsanalys i form av semistrukturerade intervjuer utgjorde studien. Fem vårdnadshavare intervjuades i Jönköping. Inklusionskriterierna innefattade vårdnadshavare till barn som behandlats med korsett samt som inte har några funktions- eller kognitiva nedsättningar.   Resultat: Ur analysen identifierades fyra olika huvudteman: destruktiva faktorer, konstruktiva faktorer samt information och tillgänglighet. Vårdnadshavarna uttryckte att korsettens design var den mest problematiska faktorn som påverkade barnets upplevelse av behandlingen.               Slutsats: Samtliga vårdnadshavare upplevde korsettbehandlingen olika. Det genomgående temat för samtliga var destruktiva faktorer som påverkat upplevelsen. Identifiering av problematiken kan förbättra upplevelsen av korsettbehandlingen. / Background: There is a lack of studies that include how parents experience their children's brace treatment. The treatment is effective but contributes to negative impact on children's mental and physical health. Parents have an essential role in the brace treatment, therefore it is important to explore their experience.  Purpose: The purpose of the study is to evaluate the children's experience of the brace treatment, from the parent’s perspective. By addressing what is considered most problematic and what aspects that can be changed, it may improve the experience of the brace treatment.    Method: A qualitative analysis based on semi-structured interviews composed the study. Five parents were interviewed in Jönköping. The inclusion criteria included parents of children treated with brace who had no functional or cognitive impairments.   Results: Four main themes appeared from the analysis: destructive factors, constructive factors, information and accessibility. The design of the brace was expressed as the most problematic factor that affected children's experience of the treatment according to the parents.   Conclusion: All parents experienced the brace treatment differently. The main topic was destructive factors that affected their experience. Future studies should identify problems associated with the treatment so the experience can be improved.