OBJECTIVE: To observe the clinical effect of Fu's subcutaneous needling based on anatomy train theory for nonspecific low back pain (NLBP). METHODS: A total of 120 patients with NLBP were randomized into an anatomy train Fu's subcutaneous needling group (40 cases, 3 cases dropped out), a conventional acupuncture group (40 cases, 2 cases dropped out) and a conventional Fu's subcutaneous needling group (40 cases, 2 cases dropped out). Acupuncture was applied at ashi points and bilateral Shenshu (BL23) and Dachangshu (BL25) in the conventional acupuncture group, once every other day, 3 times a week. Fu's subcutaneous needling was applied at lumbodorsal myofascial trigger points (MTrPs) in the Fu's subcutaneous needling group, once every 3 days, twice a week. On the basis of the treatment in the Fu's subcutaneous needling group, Fu's subcutaneous needling was applied at MTrPs along the posterior superficial line and lateral line in the anatomy train Fu's subcutaneous needling group, once every 3 days, twice a week. All groups were treated for 2 weeks. Before and after treatment, the scores of numeric rating scale (NRS) and Oswestry disability index (ODI) were observed, the distance of Schober test was measured and the endurance of trunk extensors was assessed in the 3 groups. RESULTS: After treatment, in the 3 groups, the NRS and ODI scores were decreased compared with those before treatment (P<0.05), the Schober test distance was increased compared with that before treatment (P<0.05), the static and dynamic muscle endurance was increased compared with that before treatment (P<0.05). After treatment, in the anatomy train Fu's subcutaneous needling group, the NRS and ODI scores were lower than those in the conventional acupuncture group and the conventional Fu's subcutaneous needling group (P<0.05), the Schober test distance was longer than that in the conventional acupuncture group and the conventional Fu's subcutaneous needling group (P<0.05), the static and dynamic muscle endurance was superior to that in the conventional acupuncture group and the conventional Fu's subcutaneous needling group (P<0.05). CONCLUSION Fu's subcutaneous needling based on anatomy train theory can effectively relieve the pain symptom, enhance quality of life, improve lumbar motion and lumbar muscle function in patients with NLBP.
Humans ; Low Back Pain/physiopathology* ; Female ; Male ; Adult ; Acupuncture Therapy/methods* ; Middle Aged ; Acupuncture Points ; Young Adult ; Treatment Outcome ; Aged

OBJECTIVE: To retrieve and collate the earliest recorded texts in ancient acupuncture-moxibustion prescriptions for chest obstruction and heart pain, and explore the acupoint composition principles. METHODS: The Excel 2016 software was used to build a data set of ancient textual records on acupuncture-moxibustion prescriptions for chest obstruction and heart pain. After the terminology related to etiology, pathogenesis, accompanying symptoms, acupoints, and treatment methods unified, the frequency statistical analysis and association rule algorithms were applied to analyze the implicit association patterns among various elements of syndrome differentiation, treatment selection, and acupoint selection in ancient prescriptions from multiple dimensions. RESULTS: The basic acupoints of high frequency in ancient acupuncture-moxibustion treatment for chest obstruction and heart pain were Daling (PC7), Neiguan (PC6), Taixi (KI3), Taichong (LR3), Shangwan (CV13), Yongquan (KI1), and Xinshu (BL15). The prescription was mostly composed of yuan-source points. Besides, the combinations of two of five-shu points, five-shu points with luo-connecting points, and yuan-source points with luo-connecting points were common. The high-frequency points were from the pericardium meridian of hand-jueyin, conception vessel, kidney meridian of foot-shaoyin, liver meridian of foot-jueyin, and bladder meridian of foot-taiyang, generally distributed on the yin part of the arm, abdominal region, the yin part of foot, the back, and the yin part of the leg. Zhigou (TE6), Zusanli (ST36), Baihui (GV20), and Jiuwei (CV15), as well as the specific acupoint combinations, were used for chest obstruction and heart pain due to qi stagnation. Moxibustion was more suitable for chest obstruction and heart pain caused by qi reversion, cold and qi stagnation. Shaohai (HT3) was invariably selected when hand tremor was accompanied; Zhongchong (PC9) combined with Daling (PC7) was selected specially for feverish sensation in the palms. Moxibustion was exclusively applied to Shangwan (CV13), and Taixi (KI3) was often stimulated with moxibustion. At Neiguan (PC6) and Daling (PC7), moxibustion was delivered in combination with acupuncture (high confidence was presented in acupuncture). CONCLUSION In ancient acupuncture-moxibustion treatment for chest obstruction and heart pain, the points of the pericardium meridian of hand-jueyin are predominant, coordinated with those of the liver meridian of foot-jueyin, kidney meridian of foot-shaoyin, conception vessel, and bladder meridian of foot-taiyang. It follows the principles of acupoint selection, "the pericardium acting on behalf of the heart", "regulating qi as the priority", "combination of yuan-source points with luo-connecting points", and "selecting nearby points along the affected meridians".
Humans ; Moxibustion/history* ; Acupuncture Therapy/history* ; Acupuncture Points ; History, Ancient ; Data Mining ; Chest Pain/history* ; Prescriptions/history* ; Meridians

OBJECTIVE: To explore the pain-location interaction between pressure-sensitive points on the body surface and traditional acupoints in patients with chronic non-specific low back pain (CNLBP) under different disease courses, using Euclidean distance and multivariate statistical analysis. METHODS: A pressure-sensitive point detection was performed on 30 CNLBP patients with varying disease courses. A constant pressure was applied using an FDK20 algometer within a designated lumbar area, a total of 50 points were tested, and the tested points were numbered; the visual analogue scale (VAS) pain score was recorded simultaneously. MatlabR2022a9.12. software was used to extract the positions of pressure-sensitive points, and preprocessing and normalization of point location and VAS scores data were conducted. Under constraint conditions (VAS≥8.0 ∩ Euclidean distance to acupoint≤0.5), the proportion of pressure-sensitive points within the Euclidean distance threshold to each acupoint (PVD_acupoint) was calculated, followed by multivariate statistical analysis. RESULTS: ①Constrained analysis of PVD_acupoint showed that PVD_{Qihaishu (BL24)} and PVD_{Dachangshu (BL25)} were positively correlated with disease course (r=0.55, P<0.01). ②Factor analysis and silhouette analysis revealed that PVD_{Shenshu (BL23)} and PVD_{Dachangshu (BL25)} exhibited trends consistent with disease course progression (P>0.05), with different degree (P<0.01). CONCLUSION The PVD_acupoint value based on Euclidean distance can characterize the pressure sensitivity features of traditional acupoints associated with disease. Multivariate statistical analysis of PVD_acupoint confirms that selecting the acupoint combination of Shenshu (BL23) and Dachangshu (BL25) for CNLBP is associated with the distribution of surrounding pressure-sensitive points and the pathological characteristics of the condition.
Humans ; Acupuncture Points ; Low Back Pain/physiopathology* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Acupuncture Therapy ; Young Adult ; Pressure

INTRODUCTION: Elevated troponin, while essential for diagnosing myocardial infarction, can also be present in non-myocardial infarction conditions. The myocardial-ischaemic-injury-index (MI3) algorithm is a machine learning algorithm that considers age, sex and cardiac troponin I (TnI) results to risk-stratify patients for type 1 myocardial infarction. METHOD: Patients aged ≥25 years who presented to the emergency department (ED) of Singapore General Hospital with symptoms suggestive of acute coronary syndrome with no diagnostic 12-lead electrocardiogram (ECG) changes were included. Participants had serial ECGs and high-sensitivity troponin assays performed at 0, 2 and 7 hours. The primary outcome was the adjudicated diagnosis of type 1 myocardial infarction at 30 days. We compared the performance of MI3 in predicting the primary outcome with the European Society of Cardiology (ESC) 0/2-hour algorithm as well as the 99th percentile upper reference limit (URL) for TnI. RESULTS: There were 1351 patients included (66.7% male, mean age 56 years), 902 (66.8%) of whom had only 0-hour troponin results and 449 (33.2%) with serial (both 0 and 2-hour) troponin results available. MI3 ruled out type 1 myocardial infarction with a higher sensitivity (98.9, 95% confidence interval [CI] 93.4-99.9%) and similar negative predictive value (NPV) 99.8% (95% CI 98.6-100%) as compared to the ESC strategy. The 99th percentile cut-off strategy had the lowest sensitivity, specificity, positive predictive value and NPV. CONCLUSION The MI3 algorithm was accurate in risk stratifying ED patients for myocardial infarction. The 99th percentile URL cut-off was the least accurate in ruling in and out myocardial infarction compared to the other strategies.
Humans ; Male ; Female ; Emergency Service, Hospital ; Middle Aged ; Electrocardiography ; Machine Learning ; Singapore ; Chest Pain/blood* ; Troponin I/blood* ; Myocardial Infarction/blood* ; Risk Assessment/methods* ; Aged ; Algorithms ; Acute Coronary Syndrome/blood* ; Adult ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVE

The Oswestry Disability Index (ODI)–English is a valid and reliable instrument for disability measurement in low back pain (LBP) patients. There is no existing ODI–Ilokano that evaluates LBP patients. This study aimed to cross-culturally adapt the ODI–English into Ilokano.

The ODI–English was cross-culturally adapted into Ilokano through a process that included forward translation, synthesis of the translations, back translation, expert committee review, and testing of the pre-final version.

Forward translation focused on capturing the essence of terms related to pain intensity, personal care, and daily activities, achieving consensus on phrases that accurately mirrored the original English meanings. Subsequent synthesis refined these translations, emphasizing idiomatic and conceptual equivalence over literal interpretations, particularly in nuanced areas like sleep disturbance and social life activities. Backward translation processes aligned Ilokano and English terms, especially for pain intensity and personal care, ensuring consistency across languages. The expert committee review addressed spelling, word choice, and sentence structure, making strategic adjustments for cultural relevance. Pilot testing with participants from Ilocos Norte and Ilocos Sur, Philippines highlighted comprehension challenges with specific terms, leading to adaptations like replacing 'milya' and 'yarda' with metric units and retaining culturally sensitive terms with supplementary English explanations.

This study refined the ODI–English into a culturally adapted Ilokano version, focusing on semantic, idiomatic, and cultural equivalence. Incorporating pilot testing feedback, such as modifying measurement units and addressing sensitive terms, highlighted the thorough adaptation process. The collaborative translation efforts and diverse patient input ensured a culturally resonant ODI version for Ilokano speakers. This adaptation enhances physical therapy practices by improving patient assessments and advocates for adapting patient-reported outcomes to diverse cultures, advancing patient-centered care.

BACKGROUND

The COVID-19 pandemic brought insurmountable changes, leading to work demands and resource limitations that placed additional physical and occupational stress.

This study aimed to determine the change in the occurrence and intensity of musculoskeletal discomfort among selected university faculty members. It also determined the association of sociodemographic and anthropometric factors, workplace conditions, and involvement in physical activity with musculoskeletal pain.

This is an analytical cross-sectional study conducted from June 2022 to May 2023 that surveyed university faculty members from Metro Manila and Metro Cebu. Outcome measures include sociodemographic data, anthropometric measures of weight, height, body mass index, workplace conditions, exercise participation, and musculoskeletal discomfort using the Cornell Musculoskeletal Discomfort Questionnaire.

Data from 120 participants, mostly female, with an average BMI of 27.78 ± 12.09 kg/m2 and 11.82 ± 10.39 years of teaching experience revealed increased computer usage and reduced teaching hours during the Pandemic lockdown. There was also prevalent musculoskeletal discomfort (MSD), particularly in the neck, shoulder, and upper back. Factors associated with increased MSD were female gender, longer computer use, and pre pandemic MSD history.

This study underscores the significance of addressing ergonomic factors and work conditions to mitigate MSD risks among educators during challenging situations.

BACKGROUND

Low back pain is a major global cause of disability, typically treated through traditional onsite rehabilitation. However, the advancement of telerehabilitation during the COVID-19 pandemic presents an opportunity to examine its effectiveness as a treatment option for low back pain. This study aims to seek and explore the experiences and perspectives of healthcare professionals about onsite or online management of LBP.

The study will employ a phenomenological qualitative study design that will use quota sampling to recruit a total of 16 participants, equally distributed among rehabilitation doctors, physical therapists, barangay healthworkers, and patients with low back pain, coming from hospitals and centers affiliated with the University of Santo Tomas in Metro Manila. Key informant interviews that follow a semi-structured interview format will be conducted either on-site or online, depending on the preference of the invited informant. The NVivo data analysis software will be utilized to produce codes and outline themes from the gathered data.

The research is expected to highlight the nuanced interplay between individual viewpoints and contextual factors that influence decision-making in rehabilitation settings, besides identifying these themes. Findings will be instrumental in informing best practices for managing low back pain, thereby helping physical therapists determine the most effective treatment approach—whether through telerehabilitation or traditional on-site care. The study can provide actionable recommendations through grounding the implications of the analysis to the anticipated findings that might affect the rehabilitation practices and patient outcomes in the Philippines.

Pain is one of the common non-motor symptoms in patients with Parkinson disease and is characterized by early onset， a high incidence rate， and diverse types of discomfort， which seriously affects the quality of life of patients. Based on the related concepts of pain in Parkinson disease and the current status of research in China， this article reviews the commonly used non-pharmaceutical interventions for alleviating pain in patients and their mechanisms， in order to provide a basis for developing pain management regimens.
Parkinson Disease ; Pain

BACKGROUND

Walking is widely recognized for its benefits in pain management, disability reduction, and psychological well-being, primarily due to its cost-effectiveness and accessibility. However, comprehensive qualitative insights into the full extent of its benefits remain insufficient. Chronic low back pain (CLBP) significantly impairs daily activities, requiring a multifaceted intervention approach, as advocated by the Biopsychosocial (BPS) model and the International Classification of Functioning, Disability, and Health (ICF) framework.

This systematic review aims to evaluate the perceptions and experiences related to walking among adults suffering from CLBP, understand the barriers and facilitators influencing walking behaviors, analyze behavioral patterns, and examine internal motivators for walking.

This systematic review will include both published and unpublished qualitative studies with participants aged >18 with CLBP persisting > 3 months, where walking is utilized as the primary or secondary intervention. Databases, including PubMed, EBSCO Host, Science Direct, ProQuest, MEDLINE, Epistemonikos, Cochrane Database, and Web of Science, will be searched without language or year restrictions. The screening will involve an independent dual review of the title/abstract and full texts, followed by a critical appraisal. Data extraction and synthesis will employ a meta-aggregation approach, with findings assessed via the ConQual approach.

Synthesized findings will guide evidence-based practice. Recommendations will provide actionable insights to address gaps in qualitative research on walking, promoting a holistic, patient-centered approach to treatment.

CRD42024509069.

In Mayer-Rokitansky-K0ster-Hauser (MRKH) syndrome, the development of the uterus and some parts of the vagina is either completely absent or reduced. It is a rare congenital anomaly, and affects one in 4,000-5,000 female births and commonly presents as primary amenorrhea. Approximately 6% - 10% of these patients with MRKH syndrome report persistent pelvic pain, which may be attributed to the presence of myomas, endometriosis, adenomyosis or hematometra caused by a functioning endometrial tissue in a uterine remnant. This paper presents the case of a 37 year old nulligravid who experienced severe cyclic hypogastric pain, and was subsequently diagnosed with MRKH syndrome with adenomyosis. Clinical evaluation and definitive management of the index case are discussed.
Human ; Female ; Adult: 25-44 yrs old ; mullerian failure ; mullerian aplasia ; adenomyosis ; pelvin pain