Patients were encouraged to press as firmly as possible. Patients completed the HAQ score form To improve the ability of the HAQ to discern changes in hand function in patients with hand OA, 2 additional items were included and analyzed separately: wringing a cloth and opening a jar of jam Statistical analysis was performed using GraphPad Prism statistical software version 2. Values and scores were tested for Gaussian distribution normality test. Group characteristics. Grip strength. Baseline values of grip strength for both groups were comparable. Grip strength of both hands was slightly, but not significantly, higher in the control group mean for the right hand was 0.
After 3 months, grip strength improved statistically significantly in the JPE group to 0. Change of grip strength in the joint protection and exercise JPE and control groups. The mean of improvement measured in bar for the right hand was 0. The mean for the left hand was 0. Grip strength development over 3 months. Each patient is represented by 1 line. VAS values for general pain were not significantly different between baseline and 3 months in either group data not shown. On the visual analog scale, 13 patients of the joint protection and exercise JPE group reported improvement in global hand function, whereas 7 patients did not improve.
HAQ scores, scores of individual HAQ domains relevant to hand function, and the 2 additional items were analyzed separately. No differences between the JPE and the control group were detected in any of these analyses data not shown. The average exercise time was 11 minutes per day range, 2—30 minutes. Neither improvement in grip strength nor improvement in global hand function by VAS correlated with exercise time data not shown. Exercises were well tolerated; few periods of mild discomfort, such as an increase in pain, were reported. We found a statistically significant increase in grip strength in both hands in the JPE group.
In contrast, no such changes were seen in the controls.
Moreover, global hand function by VAS showed improvement in a significantly higher number of persons in the intervention group as compared with the control group. This includes HAQ scores in items relevant to hand function and 2 additional items related to hand function and grip strength.
We selected grip strength, a variable representing impairment level, as the primary outcome measure for this study because it has been found to better represent the actual disability disability with personal assistance or use of assistive devices or personal assistance than the HAQ In the literature, grip strength has been frequently regarded to reflect a certain aspect of hand function in persons with RA In RA, grip strength is commonly limited by pain and cannot easily be interpreted simply as function of muscle force production In OA, the increase in grip strength is more likely to represent better hand function, which is consistent with the improvement of the VAS score for everyday hand function.
Our results show a moderate, but significant, effect of our JPE intervention program on grip strength. The control group, which received an intervention that gave only verbal information without pointing out the possible value of a joint protection and an exercise program, essentially did not improve at all during the observation period of 3 months.
Because the exercise program contained no elements aimed specifically at increasing grip strength, the results are all the more remarkable. Resistive exercises might have led to a greater increase in strength, but we felt that they could also have caused further damage to the cartilage of the hand joints. Particularly in standard programs such as the ones used in this study, adding resistive training, which imposes the same resistance to every participant, might produce negative effects on hand joints in persons with low muscle strength. Very high grip strength has been found to be related to an increased risk of developing hand OA, whereas appropriate hand strengthening may help prevent or even treat hand OA Because the question referring to pain levels did not specifically ask for pain in the hands, it cannot be excluded that some of the answers could be related to pain in other joints, such as from knee or hip OA.
The HAQ was selected as the assessment tool because no other standardized questionnaire specific for hand OA is currently available. The HAQ has been developed to assess quality of life and daily function in persons with various forms of inflammatory arthritis. To make the HAQ more specific for hand OA, two additional items were included 20 and analyzed separately. Despite this modification, the HAQ might not be an adequate questionnaire for persons with hand OA, even if variables concerning only hand function were analyzed. Further research is needed to develop a specific questionnaire for persons with hand OA.
Some methodologic problems might have affected the results. It was not possible to fully blind the participants.
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The participants were told that they would get an intervention for hand OA, but were not told into which group they were randomized. Assessments, however, were performed by a blinded assessor who was unaware of the group to which the participant had been randomized. Furthermore, only persons willing to participate were included. To estimate the adherence of the participants, exercise diaries were used.
The JPE intervention consisted of 2 different parts: joint protection and hand home exercises. According to our clinical experience, a combination of both was most likely to improve the situation of patients with hand OA. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study.
Search ADS. Nonpharmacological treatments in early rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis.
Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials.
Resistance training improves cardiovascular risk factors in obese women despite a significative decrease in serum adiponectin levels. Effects of strength training on neuromuscular function and disease activity in patients with recent-onset inflammatory arthritis. Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis.
Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Assessment of a sixteen-week training program on strength, pain, and function in rheumatoid arthritis patients. The American Rheumatism Association revised criteria for the classification of rheumatoid arthritis. Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Sensorimotor changes and functional performance in patients with knee osteoarthritis. Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films.
Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. Exercise can reverse quadriceps sensorimotor dysfunction that is associated with rheumatoid arthritis without exacerbating disease activity. Effects of detraining subsequent to strength training on neuromuscular function in patients with inflammatory arthritis. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis.
Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Effects of static and dynamic shoulder rotator exercises in women with rheumatoid arthritis: a randomised comparison of impairment, disability, handicap, and health. Minimal detectable change of measures of knee extension force obtained by handheld dynamometry from five patient groups: a systematic review.
Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis. Clinically important change in the visual analog scale after adequate pain control. Supervised aerobic exercise is more effective than home aerobic exercise in female Chinese patients with rheumatoid arthritis.
Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Positive effects of exercise on falls and fracture risk in osteopenic women. Effect of exercise on extraskeletal risk factors for hip fractures in elderly women with low BMD: a population-based randomized controlled trial. A home-based two-year strength training period in early rheumatoid arthritis led to good long-term compliance: a five-year followup.
A dynamic exercise programme to improve patients' disability in rheumatoid arthritis: a prospective randomized controlled trial. Reporting of harm in randomized, controlled trials of nonpharmacologic treatment for rheumatic disease. Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin.
Effects of resistance or aerobic exercise training on interleukin-6, C-reactive protein, and body composition. Strength training versus aerobic interval training to modify risk factors of metabolic syndrome. All rights reserved. For Permissions, please email: journals. Issue Section:. Download all figures. AddSuppFiles-1 - doc file. Comments 0. Add comment Close comment form modal.
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Buljina et al. Flint-Wagner et al. Hakkinen et al. Komatireddy et al. Lemmey et al. McMeeken et al. Because of this, accurate measurement of the ROM of the cervical spine can be an objective indicator of neck disease [ 8 ]. Cupping therapy is an ancient treatment that applies suction onto the skin. Historically, cupping therapy has been used not only for musculoskeletal disorders but also for many diseases such as gynecology, ear diseases, and lung diseases [ 3 ].
Applying cupping therapy increases the threshold for immediate pressure pain, accelerates the removal of waste and toxins from the body, and stimulates metabolism, resulting in vasodilation and devoted blood circulation. This has been shown to be effective for muscle relaxation and chronic neck pain [ 10 ]. Previous studies have scientifically proved the effects of McKenzie stretching and cupping.
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However, there have been many studies to investigate changes in cervical spine angles and pain thresholds with the McKenzie stretching, and cupping therapy has been studied in terms of changes in angle and ROM of the cervical spine. The purpose of this study was to investigate the differences in the angle of the cervical spine and the pain thresholds around the cervical vertebrae by applying the McKenzie exercise and the cupping therapy. Participants in this study were 12 males and 6 females students in their twenties who were studying at Sahmyook University. The subjects who participated in the experiment were selected as those who voluntarily agreed to the experiment and those who had no restrictions on the ROM of the neck, those without disk disorder, and those who had no open wounds at the sites where the cupping therapy was applied.
In this experiment, a cross-over design was used in which each treatment was sequentially applied at a time interval to each of the experimental groups. In this design, subjects were subjected to continuous intervention, and the effects of each intervention were compared.
The advantage of this experimental design is that it can compare the effects of the intervention within the subjects of one group rather than comparing the results between different groups and can reduce the measurement variance. In order to minimize the learning effect of the subjects, the single blind method was applied which does not allow the subjects to be aware of the purpose of the study Figure 1. The right hand was placed on the opposite side shoulder and head-turning was performed sin a sitting position. This was repeated in the opposite direction.
To assess the maximal muscle contraction of the subject, a 7-second contraction was performed 10 times for each operation. The above operation was applied for a total of 8 minutes. The time, posture and frequency of administration were supervised to ensure that all subjects were able to perform same as much as possible [ 11 ].
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A plastic cup of 25 to 50 mm size was selected according to the application area of the subject. After applying the plastic cup to the site, air was taken out by the compressor to create a vacuum state. The application time of the cupping was applied for 8 minutes. The smartphone was placed on a tripod and positioned horizontally. Setting the distance between the shoulder tip of the subject and the tripod was 1.
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A1: Investigator A measured the craniovertebral angle by palpating the spinous process of C7 and pointed it to the finger. A2: To measure the head position angle, investigator A pointed to the jugular notch with the fingertip. Investigator B measured the angle between the jaw and the jugular notch around the tragus of ears. After assuming a sitting position on the chair, the subject measured the pressure pain threshold according to the pressure of the upper trapezius using an Algometer J-tech Medical, Midvale, UT, USA.
The same investigator measured three consecutive times and calculated the mean values. The most severe painful trigger point on the left and right upper trapezius were measured before and after each treatment. Active ROM of the subject was measured by placing the foot on a fixed chair and attaching it to the floor with both hands stretched out lightly towards the knees. Measurements were done once before and after. To investigate the effect of each treatment method on the dependent variables, the paired t-test was used to calculate and compare the mean values of the measurements.
Independent t-test was performed to verify the difference between before and after intervention. This study consisted of 18 subjects including 12 males and 6 females. The average age of subjects was Both the angle A1 and A2 had no significant difference Table 2. The pain threshold was decreased by 0. The left upper trapezius was decreased by 5. In the comparison of the difference both pain threshold.
We found significant difference between the groups p Table 2. In the comparison of the difference cervical extension, both lateral flexion. We found significant difference between the groups p Table 3. Among the various causes of cervical spinal pain, mechanical dysfunction is the most common cause, and dysfunction of the intervertebral joints reduces the mobility of the cervical spine segments. If the clinical diagnosis is judged to be a functional dysfunction of the intervertebral joint, joint mobilizations or chiropractic are selected for the treatment.
Many of the therapists have developed cupping therapy for the treatment of musculoskeletal disorders through diverse studies that expected to be a new trend in the field of sports medicine when applied in conjunction with movement patterns or functional exercises [ 10 ]. Clare et al. Increased load on the cervical spine muscles and joints caused by FHP is a major cause of work-related musculoskeletal pain and disease [ 15 ]. FHP is associated with pain, fatigue, and limited movement of the cervical vertebrae in relation to muscle imbalance [ 16 ].
To cope with these problems, Sling exercises [ 17 ], McKenzie exercises [ 11 ], and the hold-relax method of proprioceptive neuromuscular stimulation [ 18 ] have been used and are effective on cervical spine angles, in maximizing muscle strength of deep neck flexors, and controlling the level of pain. In this study, the effects of the McKenzie stretching and cupping treatments were assessed after a single intervention, which resulted in minimal effects on the structural changes of the skeleton.
It is anticipated in the future studies that a long-term repeated treatment would be more effective. Although pain does not cause neurotrophic muscle weakness, such as cervical neuromuscular lesions, it limits not only the ROM of the joints, but also causes many obstacles to daily activities [ 19 ]. In this study, after the McKenzie stretches, pain thresholds decreased with no significant difference in the upper right trapezius and a significant decrease in the upper left trapezius. This was due to poor blood supply and muscle ischemia.
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