Classifying Outcome Measures According to the International Classification of Functioning, Disability and Health: a Pilot Study.

at which level of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) (WHO 2001) a selection of low back pain outcome tools measure. The ICF describes several categories of impact, those on body systems, activity, participation in life roles as well as environmental and personal factors. These categories can be used to relate an outcome measure to the level of the intervention. The results of a study may be compromisedif the outcome measure does not correspond to the level of intervention. For example, a treatment designed to reduce pain should be measured by a tool that measures at a body systems level while an intervention designed to improve return to work needs to measure at the participation level. In order to conduct a trial examining the effects of rehabilitation strategies after lumbar surgery it has been necessary to examine the qualities of commonly used low back pain outcome measures in light of the ICF. Confusion exists as to whether the entities of activity and participation are separate (Dahl 2002). Several attempts have been made to distinguish between the two but as yet, no consensus exists (Granlund2004). It was therefore necessary to define activity and participation and to validate this with a group of qualified health practitioners. J Williamson, C Bulley, F. Coutts, F. MacMillansch_phypub913pu

Myofascial trigger points and innervation zone locations in upper trapezius muscles

Background Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius. Methods We screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject's trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants. Results No significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 5.8 mm. Conclusions According to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.In this volume a range of distinguished contributors provide an original analysis of the book in Scotland during a period that has been until now greatly under-researched and little understood.The issues covered by this volume include the professionalisation of publishing, its scale, technological developments, the role of the state, including the library service, the institutional structure of the book in Scotland, industrial relations, union activity and organisation, women and the Scottish book, and the economics of publishing. Separate chapters cover Scottish publishing and literary culture, publishing genres, the art of print culture, distribution, and authors and readers. The volume also includes an innovative use of illustrative case studies.sch_phy14pub3360pub17

Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial

** From Crossref via Jisc Publications Router.Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8-weeks post surgery, and 14-weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45-minutes). Results: Consistently greater improvements (F2,98-=-4.3 to 24.8; P-<-0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8--2.9-seconds vs. 4.6--2.6-seconds); balance (2.1--0.9 vs. 0.7--1.2); joint position error (13.8--7.3 vs. 6.2--9.1); Knee Outcome Survey Activities of Daily Living Scale (44.2--11.3 vs. 26.1--11.4); and pain (5.9--1.3-cm vs. 4.6--1.1-cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3-6.5. Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.sch_phy32pub5225pub

Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: A secondary analysis of a controlled clinical trial

Background There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR.Methods A controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3–5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery).Results Patients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), respectively (p < 0.005); Knee ROM did not offer clinically relevant changes (p: ns) between groups over time. At 14 weeks post-surgery, the SMT group’s and control group’s performances differed by relative effect sizes (Cohen’s d) ranging between 0.64 and 1.06.Conclusion A prescribed equivalent time spent in SMT compared to usual practice, delivered within a home-based environment, elicited superior restoration of muscle strength, activation and size in patients following TKR.https://doi.org/10.1186/s12891-019-2575-320pubpu

Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches

This pilot double blind randomised controlled study aimed to investigate whether the midvastus (MV) approach without patellar eversion in total knee arthroplasty (TKA) resulted in improved recovery of function compared to the medial parapatellar (MP) approach. Patients were randomly allocated to either the MV approach or the MP approach. Achievements of inpatient mobility milestones were recorded. Knee kinematics, muscle strength, Timed Up and Go, WOMAC, and daily step count were assessed before and up to six months after surgery. Cohen's effect sizesch_phy[1] W. G. Hamilton, S. Sritulanondha, and C. A. Engh Jr., Results of prospective, randomized clinical trials comparing standard and high-flexion posterior-stabilized TKA: a focused review,- Orthopedics, vol. 34, no. 9, pp. e500-e503, 2011. [2] T. Sumino, H. R. Gadikota, K. M. Varadarajan, Y.-M. Kwon, H. E. Rubash, and G. Li, Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis,- International Orthopaedics, vol. 35, no. 9, pp. 1309- 1319, 2011. [3] Z. Liu and H. Yang, Comparison of the minimally invasive and standard medial parapatellar approaches for total knee arthroplasty: systematic review and meta-analysis,- The Journal of International Medical Research, vol. 39, no. 5, pp. 1607-1617, 2011. [4] I. Alcelik, M. Sukeik, R. Pollock, A. Misra, A. Naguib, and F. S. Haddad, Comparing the mid-vastus and medial parapatellar approaches in total knee arthroplasty: a meta-analysis of short term outcomes,- The Knee, vol. 19, no. 4, pp. 229-236, 2012. [5] C. R. Costa, A. J. Johnson, S. F. Harwin,M. A.Mont, and P.M. Bonutti, Critical review of minimally invasive approaches in knee arthroplasty,- The Journal of Knee Surgery, vol. 26, no. 1, pp. 41-50, 2013. [6] R. Juosponis, S. Tarasevicius, A. Smailys, and R. J. Kalesinskas, Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial,- International Orthopaedics, vol. 33, no. 5, pp. 1233-1237, 2009. [7] F. R. Kolisek, P.M. Bonutti,W. J. Hozack et al., Clinical experience using a minimally invasive surgical approach for total knee arthroplasty : early results of a prospective randomized study compared to a standard approach,- Journal of Arthroplasty, vol. 22, no. 1, pp. 8-13, 2007. [8] R. R. Karpman and H. L. Smith, Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty : a prospective, randomized study,- Journal of Arthroplasty, vol. 24, no. 5, pp. 681-688, 2009. [9] T. Karachalios, D. Giotikas, N. Roidis, L. Poultsides, K. Bargiotas, and K.N.Malizos, Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial,- Journal of Bone and Joint Surgery Series B, vol. 90, no. 5, pp. 584-591, 2008. [10] B. J.Nestor, C. E. Toulson, S. I. Backus, S. L. Lyman,K. L. Foote, and R. E. Windsor, Mini- midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty,- The Journal of Arthroplasty, vol. 25, no. 6, pp. 5.e1-11.e1, 2010. [11] S. P. Guy, M. A. Farndon, J. L. Conroy, C. Bennett, A. J. Grainger, andN. J. London, A prospective randomised study of minimally invasive midvastus total knee arthroplasty compared with standard total knee arthroplasty,- The Knee, vol. 19, no. 6, pp. 866-871, 2012. [12] S. L. Jarvis, A. K. Johnson-Wo, B. R. Onstot et al., Differences between standard and minimally invasive parapatellar surgical approaches for total knee arthroplasty in the tasks of sitting and standing,- The Journal of Knee Surgery, vol. 26, no. 4, pp. 249- 256, 2013. [13] World Health Organization, International Classification of Functioning, Disability and Health,WHO, Geneva, Switzerland, 2001. [14] D. M. Kennedy, P. W. Stratford, J. Wessel, J. D. Gollish, and D. Penney, Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty,- BMC Musculoskeletal Disorders, vol. 6, article 3, 2005. [15] M. P. Kadaba, H. K. Ramakrishnan, and M. E.Wootten, Measurement of lower extremity kinematics during level walking,- Journal of Orthopaedic Research, vol. 8, no. 3, pp. 383-392, 1990. [16] P. M. Grant, P. M. Dall, S. L. Mitchell, and M. H. Granat, Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults,- Journal of Aging and Physical Activity, vol. 16, no. 2, pp. 201-214, 2008. [17] J. Cohen, Statistical Power Analysis for the Behavioural Sciences, Lawrence Erlbaum Associates, Hillsdale, NJ, USA, 2nd edition, 1988. [18] S. A. Bridgman, G. Walley, G. MacKenzie, D. Clement, D. Griffiths, and N. Maffulli, Sub-vastus approach is more effective than a medial parapatellar approach in primary total knee arthroplasty: a randomized controlled trial,- The Knee, vol. 16, no. 3, pp. 216-222, 2009. [19] P. Essving, K. Axelsson, L. Otterborg et al., Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia: a randomized controlled trial with 40 patients,- ActaOrthopaedica, vol. 83,no. 6, pp. 634-641, 2012. [20] P.Mukherjee, J. Press, andM. Hockings, Mid-vastus vs medial para-patellar approach in total knee replacement-time to discharge,- The Iowa Orthopaedic Journal, vol. 29, pp. 19-22, 2009. [21] M. Maru, G. Akra, I. McMurtry, and A. Port, A prospective comparative study of the midvastus and medial parapatellar approaches for total knee arthroplasty in the early postoperative period,- European Journal of Orthopaedic Surgery and Traumatology, vol. 19, no. 7, pp. 473-476, 2009. [22] R. E. White Jr., J. K. Allman, J. A. Trauger, and B. H. Dales, Clinical comparison of the midvastus and medial parapatellar surgical approaches,- Clinical Orthopaedics and Related Research, no. 367, pp. 117-122, 1999.2014pub3916pu

Prevalence and impacts of upper limb morbidity after treatment for breast cancer: a cross-sectional study of lymphedema and function.

A cross-sectional study screened lymphedema, impaired upper limb function (ULF) and quality of life (QOL) in women post-breast cancer. Women attending review appointments who had completed surgery, chemotherapy and radiotherapy, were without recurrence, and could complete questionnaires in English were invited. Medical records were reviewed and questionnaires completed: the Morbidity Screening Tool (MST), Disability of the Arm, Shoulder and Hand questionnaire (DASH), and Functional Assessment of Cancer Therapy for breast cancer QOL questionnaire (FACTB+4). The vertical perometer (400T) measured percentage upper limb volume difference (%LVD), with 10% or greater difference diagnosed as lymphedema. Of 617 participants (mean age 62.3y, SD 10.0; mean time since treatment 63.0 months, SD 46.6), sufficient questionnaire data were available for 613 and perometry data for 417. Using the MST, 21.9% self-reported impaired ULF, 19.8% lymphedema, and 9.2% both. Based on %LVD, 26.5% had lymphedema. Histogram analysis for individuals in the first eight twelve-month intervals after treatment found impaired ULF prevalence peaked at three to five years and lymphedema at three years. Significantly worse function (DASH) and QOL (FACT B+4) resulted for those with morbidity (p&lt;0.000). This provides evidence that impaired ULF and lymphedema negatively affect QOL years after treatment and are not necessarily linked.sch_phy1pub3633pub

Comparison of breast cancer-related lymphedema (Upper Limb Swelling) prevalence estimated using objective and subjective criteria and relationship with quality of life

This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95-10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema. 2013 Catherine Bulley et al.sch_phy2013pub3233pub80756

The polygenic nature of telomere length and the anti-ageing properties of lithium

Telomere length is a promising biomarker for age-related disease and a potential anti-ageing drug target. Here, we study the genetic architecture of telomere length and the repositioning potential of lithium as an anti-ageing medication. LD score regression applied to the largest telomere length genome-wide association study to-date, revealed SNP-chip heritability estimates of 7.29%, with polygenic risk scoring capturing 4.4% of the variance in telomere length in an independent cohort (p = 6.17 × 10-5). Gene-enrichment analysis identified 13 genes associated with telomere length, with the most significant being the leucine rich repeat gene, LRRC34 (p = 3.69 × 10-18). In the context of lithium, we confirm that chronic use in a sample of 384 bipolar disorder patients is associated with longer telomeres (p = 0.03). As complementary evidence, we studied three orthologs of telomere length regulators in a Caenorhabditis elegans model of lithium-induced extended longevity and found all transcripts to be affected post-treatment (p  0.05). Consequently, this suggests that lithium may be catalysing the activity of endogenous mechanisms that promote telomere lengthening, whereby its efficacy eventually becomes limited by each individual's inherent telomere maintenance capabilities. Our work indicates a potential use of polygenic risk scoring for the prediction of adult telomere length and consequently lithium's anti-ageing efficacy

Association of complement and coagulation pathway proteins with treatment response in first-episode psychosis: a longitudinal analysis of the OPTiMiSE clinical trial

Background and Hypothesis Treatment response to specific antipsychotic medications is difficult to predict on clinical grounds alone. The current study hypothesizes that the baseline complement pathway activity predicts the treatment response and investigates the relationship between baseline plasma biomarkers with treatment response to antipsychotic medications. Study Design Baseline plasma samples were collected from first episode of psychosis patients (n = 243) from a multi-center clinical trial. The participants were treated with amisulpride for 4 weeks. Levels of complement and coagulation proteins at baseline were measured using both data-dependent and data-independent mass spectrometry approaches. The primary outcome was remission status at 4 weeks and the secondary outcomes included change in psychotic and functional symptoms over the period of treatment. In addition, immunoassays were performed at baseline for complement C1R, as well as for activation markers C4a and sC5b-9. Study Results The plasma level of complement variant C4A was significantly associated with remission at 4 weeks. Moreover, higher levels of several complement and coagulation pathway proteins were associated with a reduction in psychotic symptoms and an improvement in functioning. Immunoassays showed an association of baseline levels of C1R and C4a as well as complement activation marker sC5b-9 levels with treatment response. Conclusion The results demonstrated that the response to antipsychotic treatment might be related to pre-treatment levels of plasma complement and coagulation pathway proteins. This is consistent with independent evidence associating immune dysfunction with the pathophysiology of psychosis. Moreover, these results inform the development of novel therapeutic approaches that target the complement system for psychosis