8 research outputs found
Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial
BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management
Customer loyalty programmes A research report
Rev. ed.SIGLEAvailable from British Library Document Supply Centre-DSC:q97/05845 / BLDSC - British Library Document Supply CentreGBUnited Kingdo
Parametrization of the contribution of mono- and bidentate ligands on the symmetric C=O stretching frequency of fac-[Re(CO)3]+ complexes
A ligand parameter, IRP(L), is introduced in order to evaluate the effect that different monodentate and bidentate ligands have on the symmetric C≡O stretching frequency of octahedral d6 fac-[Re(CO)3L3] complexes (L = mono- or bidentate ligand). The parameter is empirically derived by assuming that the electronic effect, or contribution, that any given ligand L will add to the fac-[ReCO3]+ core, in terms of the total observed energy of symmetric C≡O stretching frequency (νCOobs), is additive. The IRP(CO) (i.e., the IRP of carbon monoxide) is first defined as one-sixth that of the observed C≡O frequency (νCOobs) of [Re(CO)6]+. All subsequent IRP(L) parameters of fac-[Re(CO)3L3] complexes are derived from IRP(L) = 1/3[νCOobs − 3IRP(CO)]. The symmetric C≡O stretching frequency was selected for analysis by assuming that it alone describes the “average electronic environment” in the IR spectra of the complexes. The IRP(L) values for over 150 ligands are listed, and the validity of the model is tested against other octahedral d6 fac-[M(CO)3L3] complexes (M = Mn, 99Tc, and Ru) and cis-[Re(CO)2L4]+ species and by calculations at the density functional level of theory. The predicted symmetric C≡O stretching frequency (νCOcal) is given by νCOcal = SR[∑IRP(L)] + IR, where SR and IR are constants that depend upon the metal, its oxidation state, and the number of CO ligands in its primary coordination sphere. A linear relationship between IRP values and the well-established ligand electrochemical parameter EL is found. From a purely thermodynamic point of view, it is suggested that ligands with high IRP(L) values should weaken the M−CO bond to a greater extent than ligands with low IRP(L) values. The significance of the results and the limitations of the model are discussed