This randomized study showed no difference in the impact on patient quality of life between ureteral stents composed of firm or soft polymer.

What's known on the subject? and What does the study add?• One of the suggested factors for stent-related symptoms is that excess distal intravesical stent mass may cause bladder irritation. There is a lack of studies investigating this in a randomised controlled fashion using a validated questionnaire.• This study compared two of the most commonly used length of stents (a 30 cm multi-length vs a 24 cm long stent) and showed no significance difference in stent-related symptoms in patients with either of these stents. Objective• To investigate whether excessive redundant intravesical stent component contributes to the severity of stent-related symptoms in patients with a ureteric stent. We compared stent-related symptoms in patients who had either a standard 24 cm or multi-length ureteric stent. Patients and Methods• In all, 162 patients with upper urinary tract calculi requiring ureteric stent insertion were randomised to receive either a 6 F ¥ 24 cm Contour TM or multi-length 6 F ¥ 22-30 cm Contour VL TM stent.• Patients were requested to complete the validated Bristol Ureteric Stent Symptom Questionnaire (USSQ) at 1 and 4 weeks after stent insertion and 4 weeks after removal.• The mean scores for each domain of the USSQ for both groups were compared using the Student's t-test.• Any adverse events, e.g. stent migration, early removal of stent due to stent-related symptoms and failure of stent insertion, were also recorded. Results• In all, 153 patients who had successful stent insertion were requested to complete the USSQ and 74% of patients returned at least the week 1 questionnaire.• At 1 and 4 weeks with the stent in situ, comparison of the mean scores showed no significant difference in urinary symptoms, pain, general health, work performance, sexual dysfunction and number of days patients stayed in bed or reduced their routine activities. • Three (2%) patients had their stent removed early due to stent-related symptoms and five (3%) had failed stent insertion. Conclusions• This study did not find any difference in symptoms between the 24 cm or multi-length Contour stents. However, the study was not powered to detect small differences particularly for the pain symptom domain.• Stents should only be used sparingly and the stent dwell-time should be minimised.

Osteitis pubis among soccer athletes is a disabling painful condition and it is difficult to manage without integrating a multimodal treatment approach. There is limited scientific evidence on the effectiveness of exercise in treating Osteitis pubis especially when it progress to a chronic painful condition. The purpose of this case report is to discuss the successful multimodal physiotherapeutic management for a 15-year old soccer athlete diagnosed with stage-IV Osteitis pubis. Land and water based active core muscle strengthening exercises, Proprioceptive neuromuscular facilitation techniques (PNF) and Manual Therapy are some of the essential components incorporated in multimodal intervention approach with emphasis to water based strength and endurance training exercises. The athlete was able to make progress to a successful recovery from his chronic painful condition and accomplished the clearly established clinical outcomes during each phase of rehabilitation.

International classification of Functioning, Disability and Health has adapted a biopsychosocial model for management of chronic low back pain patient (CLBP). The influence of psychological factors seems to be important in the transition from acute to chronic low back pain (> 3 months). In particular, pain-related fear and pain catastrophizing are believed to be important factors for disability. A number of studies have shown that pain-related fear is a strong predictor of self-reported disability in both acute and chronic low back pain. This situation has led to the dependency of clinicians on radio-diagnostic procedures for decision making, which often increases the financial burden. Research has evidenced that physicians and physical therapists, often fail to recognize psychological illnesses. The aim of this article is to describe the importance of fear avoidance behavior and to evaluate the immediate effect of cognitive behavioral therapy (CBT) during evaluation of patients with CLBP. An initial physical examination of a 24-year old female patient with CLBP, showed painful guarded movements over the lumbo-pelvic region, but the outcomes of her Fear-Avoidance Belief Questionnaire (FABQ) showed strong cues for psychological illness. Based on clinical reasoning, the patient was educated in terms of cognitive reconstruction. Interestingly after some CBT sessions, her spine guarding pattern was disappeared and that helped us to carry a more specific physical examination. After a few weekly therapeutic sessions of CBT, significant changes were seen in all outcome measures. It has been concluded that probably, by using specific biopsychosocial training, positive results in fear avoidance behavior can be achieved. Hence the psychotherapeutic management approach is considered as a useful economical tool in low back pain.

Recent evidences suggest functional thoracic hyperkyphosis (FTH) could be a different approach in the management of subacromial impingement syndrome (SIS). This case study aims firstly with the development of evidence informed FTH model for SIS. Secondly this study aimed to develop well defined multimodal physical therapy intervention for FTH and its related mechanical consequences in elderly patient with chronic SIS. As a result, Level IV positive evidence was found in both the short and long-term pain and disability of chronic SIS, using FTH model with 26 months of follow-up.