Background. Epidural spinal electrical stimulation at the lumbar spinal level evokes rhythmic muscle activation of lower-limb antagonists, attributed to the central pattern generator. However, the efficacy of noninvasive spinal stimulation for the activation of lower-limb muscles is not yet clear. This review aimed to analyze the feasibility and efficacy of noninvasive transcutaneous spinal cord stimulation (tSCS) on motor function in individuals with spinal cord injury. Methods. A search for tSCS studies was made of the following databases: PubMed; Cochrane Registry; and Physiotherapy Evidence Database (PEDro). In addition, an inverse manual search of the references cited by the identified articles was carried out. The keywords transcutaneous, non-invasive, electrical stimulation, spinal cord stimulation [Mesh term], and spinal cord injury were used. Results. A total of 352 articles were initially screened, of which 13 studies met the inclusion criteria for systematic review. The total participant sample comprised 55 persons with spinal cord injury. All studies with tSCS provided evidence of induced muscle activation in the lower and upper limbs, and applied stimulation at the level of the T11-T12 and C4-C7 interspinous space, respectively. All studies reported an increase in motor response measured by recording surface electromyography, voluntary movement, muscle strength, or function. Conclusions. Although this review highlights tSCS as a feasible therapeutic neuromodulatory strategy to enhance voluntary movement, muscle strength, and function in patients with chronic spinal cord injury, the clinical impact and efficacy of electrode location and current intensity need to be characterized in statistically powered and controlled clinical trials.

To examine the safety and effectiveness of extracorporeal shockwave therapy (ESWT) for reducing pain and improving functionality in people with knee osteoarthritis (KOA). The Cochrane Library, PubMed, CINAHL, Physiotherapy Evidence Database (PEDro) and Google Scholar were systematically searched for randomized trials published up to September 30th of 2019. The main outcome measures to evaluate the treatment effect were pain, as reported on a visual analogue scale (VAS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were the range of motion (ROM) and walking tests. A quantitative analysis was conducted using the inverse variance method and the random effects model. Fourteen studies were included (n = 782 participants and 877 knees). Moderate quality of evidence showed that ESWT causes a decrease on the pain VAS [mean difference (MD) = 1.7 cm; confidence interval (CI) 95%: 1.1-2.3] and WOMAC (MD = 13.9 points; CI 95%: 6.9-20.8). The effect of ESWT using medium energetic density was greater than with low or high density in the WOMAC (Chi² = 9.8, p = 0.002) and bordered statistical significance on the VAS (Chi² = 3.8, p = 0.05). Very low quality of evidence showed that ESWT causes moderate improvement in the knee ROM (MD = 17.5°; CI 95%: 9.4-25.5) and walking test [standardized mean difference (SMD) = 0.58; CI 95%: 0.35-0.81]. ESWT is an effective treatment for improving pain and functionality in patients with KOA in the short term with few minor side effects. Further clinical trials should include longer follow-up periods and be designed to lower the risk of bias.

High-intensity laser therapy (HILT) is one of the therapeutic approaches used in the treatment of musculoskeletal disorders (MSD). The main objective of this study was to examine the effectiveness of HILT for reducing pain and improving functionality in people with MSD. Ten databases were systematically searched for randomized trials published up to 28 February 2022. Randomized clinical trials (RCTs) assessing the effectiveness of HILT on MSD were included. The main outcome measures were pain and functionality. In total, 48 RCTs were included in the qualitative synthesis and 44 RCTs in the quantitative analysis. HILT showed a decrease on the pain VAS (mean difference (MD) = −1.3 cm; confidence interval (CI) 95%: −1.6 to −1.0) and an improvement in functionality (standardized mean difference (SMD) = −1.0; CI95%: −1.4 to −0.7), with low and moderate quality of evidence, respectively. A greater effect was observed when compared with control than with other conservative treatments, both on pain (χ2 = 20.6; p < 0.001) and functionality (χ2 = 5.1; p = 0.02). Differences in the effectiveness of HILT were found depending on the location (χ2 = 40.1 p < 0.001), with further improved functionality in MSD of the knee and shoulder. HILT is an effective treatment for improving pain, functionality, range of motion, and quality of life in people with MSD, although these findings must be treated with caution due to the high risk of bias in the studies. Further clinical trials should be well designed to lower the risk of bias.

Numerous neurological dysfunctions are accompanied by an undesirable increase of nerve activity, such as neuropathic pain or spasticity. There have been several studies over the last years on peripheral nerve block using high-frequency alternating currents, which could become a therapeutic alternative for such nerve hyperactivity. The main aim of this systematic review was to determine the optimal parameters of the electrical currents for producing peripheral nerve conduction block, the underlying neurophysiological mechanisms, and their possible adverse effects. Of the 49 included studies, 30 were animal experiments, 13 were computer simulations, and 6 were clinical trials. High-frequency alternating currents using frequencies of >4–5kHz effectively block nerve conduction. However, depending on the type of axon or nerve diameter, the minimum frequency required to produce the nerve block could be >20kHz. Electrodes design, electrode-axon distance, and temperature are variables that affect the block threshold. There is no consensus about the block mechanism, although it has been showed that the frequency is a key factor to produce K+ channels activation or Na+ channels inactivation. The nerve block produced by currents quickly reverts without causing further damage to the nerve. Studies in humans are necessary to further validate what preclinical studies have already shown.

To determine the effectiveness of Kinesio taping compared to compression garments during maintenance phase of complex decongestive therapy for breast cancer–related lymphedema. Randomized, cross-over, controlled trial. Outpatient tertiary-level hospital rehabilitation setting. Randomized sample of 30 women with breast cancer–related lymphedema. Participants received two interventions, Kinesio taping and compression garment, both lasting four weeks, whose order was randomized by blocks. A four-week washout period was established prior to the interventions and between them. The main outcome was the lymphedema Relative Volume Change. Secondary outcomes were range of motion of arm joints, self-perception of comfort, and lymphedema-related symptoms (pain, tightness, heaviness, and hardness). The decrease in the Relative Volume Change was greater in the Kinesio taping intervention (–5.7%, SD = 2.0) compared to that observed using compression garments (–3.4%, SD = 2.9) (P < 0.001). The range of motion of five upper-limb movements increased after applying taping (between 5.8° and 16.7°) (P < 0.05), but not after compression (P > 0.05). In addition, taping was perceived as more comfortable by patients (between 2.4 and 3 points better than compression in four questions with a 5-point scale (P < 0.001)) and further reduced lymphedema-related symptoms compared to compression (between 0.96 and 1.40 points better in four questions with a 6-point scale (P < 0.05)). Kinesio taping was more effective than compression garments for reducing the lymphedema volume, with less severe lymphedema-related symptoms, better improvement of upper-limb mobility, and more comfort.

Objectives: To evaluate the effectiveness of high-intensity laser therapy on shoulder pain and function in subacromial impingement syndrome. Design: Clinical controlled trial with alternate allocation. Setting: Hospital Department of Rehabilitation. Subjects: A total of 46 participants with subacromial impingement syndrome. Intervention: Participants were sequence allocated to an intervention group (high-intensity laser therapy + exercise therapy) and control group (sham-laser + exercise therapy) and received 15 sessions (five days a week during three weeks). Main measures: Patiens were evaluated at baseline, after 15 sessions, and at one month and at three months after completing the intervention. The main outcome variables were pain and functionality as measured by visual analogue scale; pressure pain threshold; Shoulder Pain and Disability Index; Constant-Murley Score; and QuickDASH. Secondary outcomes were number of sessions at discharge and drug use. Results: A total of 21 patients in high-intensity laser therapy group (56.7 ± 8.9 years) and 22 patients in sham-laser group (61.3 ± 8.9 years) concluded the study. Visual analogue scale (cm) at baseline, one-month, and three-months were 6.2 ± 0.5, 3 ± 2.6, and 2.6 ± 2.4 for the control group and 5.4 ± 1.5, 3.6 ± 1.3, and 1.8 ± 1.7 for experimental group, respectively. Shoulder Pain and Disability Index (points) at baseline, one-month, and three-monts were 51.8 ± 16.1, 16.3 ± 16.1, and 13.6 ± 17.1 in the control group and 41.8 ± 20.6, 20.5 ± 19.7, 11 ± 14.5 in experimental group, respectively. No differences were found between groups ( P > 0.05). Conclusion: The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.