BACKGROUND: Adhesive capsulitis is a debilitating condition which causes the capsule of the gleno-humeral joint to thicken and contract progressively. The effectiveness of various non-operative methods has been demonstrated to improve the pain, range of motion (ROM) and functional status of patients with adhesive capsulitis. OBJECTIVE: This study aims to review recent evidence on the efficacy of physiotherapy interventions in the treatment of adhesive capsulitis. METHODS: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and Cochrane databases were searched for studies published since 2013. The search terms included: Frozen shoulder, adhesive capsulitis, physical therapy, rehabilitation, manual therapy, mobilization, exercise, education, and electrotherapy. The search was limited to studies published in English and studies that used human subjects. RESULTS: Quality scores of 33 articles were reviewed according to the Sackett’s critical appraisal criteria and the grades of recommendation were determined for physiotherapy interventions used in the studies. CONCLUSION: The empirical evidence suggests that certain physical therapy techniques and modalities are strongly recommended for pain relief, improvement of ROM, and functional status in patients with adhesive capsulitis, while others are either moderately or mildly recommended. However, the efficacy of one treatment modality over another is uncertain. The poor methodological rigors demonstrated in most of the reviewed studies emphasize the urgent need of properly conducted, adequately sampled randomized controlled trials with adequate follow up to determine the superior combination of treatment.

AimKidney disease of unknown aetiology (CKDu) has been a health problem in the rural farming community of the North Central province of Sri Lanka since the 1990s and various environmental factors have been postulated as contributing factors for this disease. The aim of our study was to find out whether farmers undergo dehydration which would lead to concentration of urine and the water soluble potentially toxic substance in the kidney, leading to damage of the renal tubules. Therefore, we studied a sample of healthy farmers who were CKDu‐free to determine whether they were dehydrated.MethodsSample included healthy male paddy farmers of Padaviya in the Anuradhapura district. Plasma and urine osmolarity were recorded upon waking up in the morning and evening during the non‐farming and farming seasons. Basic statistics and a 2 × 2 anova was done to test the interaction of time of day with farming activity.ResultsFarmers were dehydrated according to the plasma osmolarity especially in the mornings, irrespective of whether they were farming or not. Approximately 40% of the sample also demonstrated acute dehydration at the end of the day due to farming activity as indicated by both plasma and urine osmolarity and specific gravity.ConclusionThis study revealed that the farmers of the Padaviya area were either dehydrated or at the upper limit of euhydration sometime during the day irrespective of their activities during the day.

BackgroundPost-operative pain relief in cleft surgery should be efficient and effective. The Face, Leg, Activity, Cry and Consolability (FLACC) scale is a validated tool for post-operative pain assessment in patients who cannot express themselves verbally. The objective of this study was to assess the effectiveness of the analgesic protocol practiced at the Dental Hospital Peradeniya, using FLACC scale during the first 24 hours following cleft surgery. Methods and materialSample included 193 patients who underwent primary repair of cleft lip and palate. They were given paracetamol two hours before surgery and 0.1mg/kg intravenous morphine during surgery. Infra-orbital nerve blocks for cleft lip surgeries, greater palatine nerve blocks for cleft palate surgeries and rectal diclofenac suppository (1.5 mg/kg) if above six months of age were added. The surgical site was infiltrated with 1% lignocaine in adrenaline. Oral paracetamol was used post-operatively. Cuddling, carrying, lullaby singing and nursing by mother was used as nonpharmacological strategies in the ward. Pain assessment was done at 5 min after recovery from anaesthesia and then at 30 minutes, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, 3.5 hours, 4 hours, 5 hours and 6 hours after recovery, and then at 8 am and 12 noon on the day following surgery using the FLACC scale. ResultsThe number of patients with severe to profound pain reduced gradually following recovery, except for a minor resurgence of pain at 2.5 hours. At the end of first 24 hours, 92.7% of patients had no pain according to the FLACC scale while only less than 1% had severe pain. ConclusionThe combined protocol of pharmacological and non-pharmacological strategies used at the Cleft Centre was highly effective for relief of post-operative pain in cleft surgeries.

Background: Distraction techniques are identified as cognitive processes that interfere with pain perception by preventing transmission of pain signals to the brain. The focus of these techniques is to direct the attention of the patient to a different stimulus other than the pain sensation. Dry needling (DN) is a mildly invasive technique which is used to treat pain associated with Myofacial trigger points (MTrPs). Even though previous studies have evaluated the influence of distraction techniques on the pain perception during various interventions, the effects during DN are not available in literature. Objectives: This study evaluated the influence of distraction technique on the perception of pain during MTrP-DN technique and also the influence of age and gender on the differences of pain perception. Methods: Sixty patients with non-specific neck pain were randomly assigned to either the control or interventional groups. Only DN was performed for the control group, while patients in the intervention group, were asked to count backwards from 10 to 1 while slowly breathing in and out without letting their attention be distracted during the DN. The level of pain perception was evaluated immediately after DN by using numeric rating scale (NRS). The ethical approval was obtained by the Ethics Committee of the National Hospital, Kandy. Results: A significant difference was noted (p<0 0.05) in NRS pain scores between control and the intervention groups regardless of the gender and the age category. Conclusion: The counting down distraction technique appears to be effective in improving pain perception during DN in the patients with non-specific neck pain.