Effectiveness of physiotherapy exercise following total knee replacement: Systematic review and meta-analysis

© 2015 Artz et al. Background: Rehabilitation, with an emphasis on physiotherapy and exercise, is widely promoted after total knee replacement. However, provision of services varies in content and duration. The aim of this study is to update the review of Minns Lowe and colleagues 2007 using systematic review and meta-analysis to evaluate the effectiveness of post-discharge physiotherapy exercise in patients with primary total knee replacement. Methods: We searched MEDLINE, Embase, PsycInfo, CINAHL and Cochrane CENTRAL to October 4th 2013 for randomised evaluations of physiotherapy exercise in adults with recent primary knee replacement. Outcomes were: patient-reported pain and function, knee range of motion, and functional performance. Authors were contacted for missing data and outcomes. Risk of bias and heterogeneity were assessed. Data was combined using random effects meta-analysis and reported as standardised mean differences (SMD) or mean differences (MD). Results: Searches identified 18 randomised trials including 1,739 patients with total knee replacement. Interventions compared: physiotherapy exercise and no provision; home and outpatient provision; pool and gym-based provision; walking skills and more general physiotherapy; and general physiotherapy exercise with and without additional balance exercises or ergometer cycling. Compared with controls receiving minimal physiotherapy, patients receiving physiotherapy exercise had improved physical function at 3-4 months, SMD -0.37 (95% CI -0.62, -0.12), and pain, SMD -0.45 (95% CI -0.85, -0.06). Benefit up to 6 months was apparent when considering only higher quality studies. There were no differences for outpatient physiotherapy exercise compared with home-based provision in physical function or pain outcomes. There was a short-term benefit favouring home-based physiotherapy exercise for range of motion flexion. There were no differences in outcomes when the comparator was hydrotherapy, or when additional balancing or cycling components were included. In one study, a walking skills intervention was associated with a long-term improvement in walking performance. However, for all these evaluations studies were under-powered individually and in combination. Conclusion: After recent primary total knee replacement, interventions including physiotherapy and exercise show short-term improvements in physical function. However this conclusion is based on meta-analysis of a few small studies and no long-term benefits of physiotherapy exercise interventions were identified. Future research should target improvements to long-term function, pain and performance outcomes in appropriately powered trials

Two randomized trials of effect of live attenuated influenza vaccine on pneumococcal colonization

The human nasopharynx is frequently colonized by Streptococcus pneumoniae (the pneumococcus), serving as the reservoir for transmission, a state which necessarily precedes invasive pneumococcal infection. Influenza infection increases pneumococcal colonization density and dysregulates host immune responses, increasing the risk of secondary bacterial pneumonia and death

Revisiting the Other Side of Eden (ROSE) – rural domestic violence project report

The former Eden District, roughly corresponding to the geographic area of the Eden Valley, is a significantly rural area with the lowest population density in England. The ONS notes that significant rurality may be an obstacle to accessing specialist services (ONS 2011) a concern that persists today (ONS 2023). Published over 20 years ago, ‘The Other Side of Eden’ (TOSE) uncovered the complexity of the situation relating to domestic violence (DV) in the area (King & Warbrick 2001). The findings of this report were meant to serve local organisations, members of the Eden Forum Against Domestic Violence - to improve the provisions for victims/survivors (Rouncefield, 2012). The original research carried out by academics at St Martin’s college, a University of Cumbria legacy institution, found that the wide dispersal of the community in the rural area of Eden District and sporadic public transport further limited access to key services, including those who could assist victims of domestic violence. At the same time, the close community bonds in small villages often worked against those wishing to escape domestic violence, making it harder to leave. Finally, the original research uncovered deficits in training and knowledge around DV amongst key service providers, including police. Over the past six years, Criminology staff and students have used the former Eden District case as a basis for ongoing tracking of changes to the findings of the report, under the umbrella of ‘ROSE – Revisiting the Other Side of Eden’. The aim of the project was to understand the dimensions of rural domestic violence. Some of the objectives included tracking the changes that have taken place since TOSE research took place, assessing the current provisions and barriers against the findings of the original report. We also hoped to identify areas of focus which were not present in the previous research, attending to the concept of ‘rurality’ in both its geographical and social aspects. By making ROSE a pedagogic tool in the classroom, this ‘close to home’, rural crime-oriented project on domestic violence and abuse was also aimed at empowering future justice advocates through action responses to teaching on DV&A (McQueeny, 2016). A strand of the work involved a rolling review of literature, with a thought experiment in applying it to the local, Cumbrian reality based on students’ experiences and knowledge. The successive student cohorts also undertook waves of documentary and mapping research, based on their interests or current conditions

Genome-wide association study of Tourette Syndrome

Tourette Syndrome (TS) is a developmental disorder that has one of the highest familial recurrence rates among neuropsychiatric diseases with complex inheritance. However, the identification of definitive TS susceptibility genes remains elusive. Here, we report the first genome-wide association study (GWAS) of TS in 1285 cases and 4964 ancestry-matched controls of European ancestry, including two European-derived population isolates, Ashkenazi Jews from North America and Israel, and French Canadians from Quebec, Canada. In a primary meta-analysis of GWAS data from these European ancestry samples, no markers achieved a genome-wide threshold of significance (p<5 × 10−8); the top signal was found in rs7868992 on chromosome 9q32 within COL27A1 (p=1.85 × 10−6). A secondary analysis including an additional 211 cases and 285 controls from two closely-related Latin-American population isolates from the Central Valley of Costa Rica and Antioquia, Colombia also identified rs7868992 as the top signal (p=3.6 × 10−7 for the combined sample of 1496 cases and 5249 controls following imputation with 1000 Genomes data). This study lays the groundwork for the eventual identification of common TS susceptibility variants in larger cohorts and helps to provide a more complete understanding of the full genetic architecture of this disorder

Partitioning the Heritability of Tourette Syndrome and Obsessive Compulsive Disorder Reveals Differences in Genetic Architecture

The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained

Do short screencasts improve student learning of mathematics?

'I really like this form of support. I would be delighted to [...] see any and all topics covered by such screencasts.' The above comment was made by an MSc student after watching two screencasts on undergraduate calculus. They were produced as part of an MSOR Network funded mini-project to develop and evaluate screencasts on advanced calculus topics. The sentiment expressed was reflected in many other students' comments. This paper reports the outcomes of this project

Beyond intention: do specific plans increase health behaviours in patients in primary care? A study of fruit and vegetable consumption

Increasing evidence suggests that implementation intentions are effective in moving people towards achieving health behaviour goals. However, the type of health behaviours for which they work best is unclear. Furthermore, implementation intentions appear to be less effective when studied in clinical rather than student populations. This prospective study tested implementation intentions with a complex, repeated health behaviour in a patient sample. A total of 120 cardiac patients in the UK were asked to increase their daily fruit and vegetable consumption by two portions and to maintain this over 3 months. Participants were randomly assigned to three groups (control, Theory of Planned Behaviour (TPB) questionnaire, TPB questionnaire+implementation intention) and telephoned at 7, 28 and 90 days follow-up to record daily consumption (24-h recall measure); 94 participants completed the study. Daily fruit and vegetable consumption increased from 2.88 portions (SD=1.67) at recruitment to 4.28 portions (SD=2.25) at 90 days. A 4x3 (time by group) mixed design ANCOVA was computed with daily fruit and vegetable consumption at recruitment entered as a covariate. This revealed a significant time effect (F (3, 270)=29.79, pAdherence Fruit and vegetables Implementation intentions UK Intervention Theory of planned behaviour

Supported community exercise in people with long-term neurological conditions: a phase II randomized controlled trial

OBJECTIVE: Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to participation in exercise. This study examines the feasibility and safety of supporting community exercise for people with long-term neurological conditions using a physical activity support system. DESIGN: A phase II randomized controlled trial using computer-generated block randomization, allocation concealment and single blind outcome assessment. SETTING: Oxfordshire and Birmingham community Inclusive Fitness Initiative gyms. SUBJECTS: Patients with a long-term neurological condition. INTERVENTIONS: The intervention group (n = 51) received a 12-week, supported exercise programme. The control group (n = 48) participants received standard care for 12 weeks and were then offered the intervention. MAIN MEASURES: Physical activity, adherence to exercise, measures of mobility, health and well-being. RESULTS: Forty-eight patients (n = 51) completed the intervention, achieving 14 gym attendances (range 0-39) over the 12 weeks. Overall activity did not increase as measured by the Physical Activity Scale for the Elderly (change score mean 14.31; 95% confidence interval (CI) −8.27 to 36.89) and there were no statistically significant changes in body function and health and well-being measures. CONCLUSIONS: People with long-term neurological conditions can safely exercise in community gyms when supported and achieve similar attendance to standard exercise referral schemes, but may reduce other life activities in order to participate at a gym

Effect of Live Attenuated Influenza Vaccine on Pneumococcal Carriage

Abstract The widely used nasally-administered Live Attenuated Influenza Vaccine (LAIV) alters the dynamics of naturally occurring nasopharyngeal carriage of Streptococcus pneumoniae in animal models. Using a human experimental model (serotype 6B) we tested two hypotheses: 1) LAIV increased the density of S. pneumoniae in those already colonised; 2) LAIV administration promoted colonisation. Randomised, blinded administration of LAIV or nasal placebo either preceded bacterial inoculation or followed it, separated by a 3-day interval. The presence and density of S. pneumoniae was determined from nasal washes by bacterial culture and PCR. Overall acquisition for bacterial carriage were not altered by prior LAIV administration vs. controls (25/55 [45.5%] vs 24/62 [38.7%] respectively, p=0.46). Transient increase in acquisition was detected in LAIV recipients at day 2 (33/55 [60.0%] vs 25/62 [40.3%] in controls, p=0.03). Bacterial carriage densities were increased approximately 10-fold by day 9 in the LAIV recipients (2.82 vs 1.81 log 10 titers, p=0.03). When immunisation followed bacterial acquisition (n=163), LAIV did not change area under the bacterial density-time curve (AUC) at day 14 by conventional microbiology (primary endpoint), but significantly reduced AUC to day 27 by PCR (p=0.03). These studies suggest that LAIV may transiently increase nasopharyngeal density of S. pneumoniae. Transmission effects should therefore be considered in the timing design of vaccine schedules. Trial registration The study was registered on EudraCT (2014-004634-26) Funding The study was funded by the Bill and Melinda Gates Foundation and the UK Medical Research Council