Effectiveness of craniosacral therapy,Bowen therapy,static touch and standard exercise program on sleep quality in fibromyalgia syndrome:A randomized controlled trial

Background:Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS);however,high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.Objective:Craniosacral therapy (CST),Bowen therapy and exercises have been found to influence the autonomic nervous system,which plays a crucial role in sleep physiology.Given the paucity of evidence concerning these effects in individuals with FMS,our study tests the effectiveness of CST,Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS.Design,setting,participants and intervention:A placebo-controlled randomized trial was conducted on132 FMS participants with poor sleep at a hospital in Bangalore.The participants were randomly allocated to one of the four study groups,including CST,Bowen therapy,standard exercise program,and a manual placebo control group that received static touch.CST,Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks;the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks.After 12 weeks,all study participants performed the standard exercises at home for another 12 weeks.Main outcome measures:Sleep quality,pressure pain threshold (PPT),quality of life and fibromyalgia impact,physical function,fatigue,pain catastrophizing,kinesiophobia,and positive–negative affect were recorded at baseline,and at weeks 12 and 24 of the intervention.Results:At the end of 12 weeks,the sleep quality improved significantly in the CST group (P=0.037) and Bowen therapy group (P=0.023),and the PPT improved significantly in the Bowen therapy group(P=0.002) and the standard exercise group (P<0.001),compared to the static touch group.These improvements were maintained at 24 weeks.No between-group differences were observed for other secondary outcomes.Conclusion:CST and Bowen therapy improved sleep quality,and Bowen therapy and standard exercises improved pain threshold in the short term.These improvements were retained within the groups in the long term by adding exercises.CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS.

Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism

Purpose:Static progressive stretch(SPS)can be applied to treat chronic joint stiffness.However,the impacts of subacute application of SPS to the distal lower limbs,where deep vein thrombosis(DVT)is common,on venous thromboembolism remain unclear.This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.Methods:A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022.Patients with unilateral lower limb comminuted para-articular fractures,transferred to rehabilitation ward for further treatment within 3 weeks after operation,followed up more than 12 weeks since initial manual physiotherapy,and diagnosed DVT by ultrasound before rehabilitation course were included in the study.Patients with polytrauma,without evidence of previous peripheral vascular disease or incompetence,had medication for thrombosis treatment or prophylaxis before the operation,detected with paralysis due to nervous system impairment,infected after operation during the regime,or with acute progression of DVT were excluded.The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation.Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups.SSPS 28.0 and GraphPad Prism 9 were used for data processing.Ap<0.05 was set significant difference.Results:In total of 154 patients with DVT participating in this study,75 of them were treated with additional SPS for postoperative rehabilitation.The participants in the SPS group showed improved range of motion(12.3°±6.7°).However,in the SPS group,there was no difference in thrombosis volume between the start and termination(p=0.106,p=0.787,respectively),although difference was seen intra-therapy(p<0.001).Contingency analysis revealed the pulmonary embolism incidence(OR=0.703)in the SPS group compared to the mean physiotherapy.Conclusion:The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.