BackgroundTo evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR).MethodsSix electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients’ profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach.ResultsWe identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): − 0.25; 95% confidence interval (CI): − 0.48, − 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: − 11.18, − 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies.ConclusionThere is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

Background and objective Approximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain. Databases and data treatment A systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations. Results Eight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; p<0.001] and neck pain (2 studies; n: 6,560; OR: 1.24; 95% CI: 1.05 to 1.47; p = 0.01) compared to those without diabetes. Results from one longitudinal cohort study suggested that diabetes is not associated with the risk of developing future neck, low back or spinal pain. Conclusions Diabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established. Systematic review registration PROSPERO registration CRD42016050738 .

ObjectiveThe aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis.DesignSystematic review and meta-analysis.Data source and eligibility criteriaA systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty.Data extractionTwo independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications.Results62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) −0.43; 95% CI −0.67 to −0.19; P<0.001) and long term post-surgery (SMD −0.36; 95% CI −0.47 to −0.24; P<0.001), as well as less disability at long term post-surgery (SMD −0.32; 95% CI −0.36 to −0.28; P<0.001). They also report fewer postsurgical complications at short term (OR 0.48; 95% CI 0.25 to 0.91; P<0.001) and long term (OR 0.55; 95% CI 0.41 to 0.74; P<0.001) along with less postsurgical infections after hip arthroplasty (OR 0.33; 95% CI 0.18 to 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006).ConclusionsPresurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed.PROSPERO registration numberCRD42016032711.

Purpose: Innovative technology has brought affordability and convenience to people with chronic diseases, but the evidence in musculoskeletal (MSK) rehabilitation is insufficient. This systematic review aims to evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). Methods: Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7 th , 2018. Two reviewers independently applied inclusion criteria to select potential randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention, for people following THR/TKR. Two reviewers independently extracted trial details, including patients' clinical profile, intervention, outcomes, attrition and adverse events (AEs). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. Trials deemed clinically homogeneous were grouped in meta-analyses using a random-effects model. Results: We identified 21 eligible studies assessing telerehabilitation, game-based therapy or web-based therapy, of which 17 studies (N ¼ 2188) were of post-TKR rehabilitation, 4 (N ¼ 783) of post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain on a visual analogue scale (mean difference (MD): -0.25; 95% confidence interval (CI): -0.48, -0.02; quality of evidence: moderate) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: -11.18, -2.88; quality of evidence: low) in people undergoing TKR. No between-group differences were observed in hospital readmissions or treatment-related adverse events in those undergoing TKR/THR. Conclusions: There is moderate-quality evidence that technologybased rehabilitation results in small but significant effects over usual rehabilitation in reducing pain post-TKR, but not in post-THR. These interventions are technically feasible, well-accepted and can be used safely in people undergoing TKR/THR. 637EFFECTS OF INFRARED RADIATION AND SHORTWAVE DIATHERMY ON THE PATIENTS WITH CHRONIC LOW BACK PAIN DUE TO OSTEOARTHRITIS OF THE LUMBAR SPINE M.A. Shakoor, Sr.. Bangabandhu Sheikh Mujib Med. Univ., Dhaka, BangladeshPurpose: The purpose of the study was to find out the effectiveness of Infrared Radiation (IRR) and Shortwave Diathermy in the patients with chronic low-back pain due to osteoarthritis of the lumber spine. Methods: The patients with chronic LBP were included from the department of Physical Medicine & Rehabilitation usually referred from various other departments of Bangabandhu Sheikh Mujib Medical University ( BSMMU), Dhaka from March 01, 2010 to July 31, 2015 and also referred from doctors outside the hospital. At first, detailed ...