An assessment of the impact of herb-drug combinations used by cancer patients

Background Herb/Dietary Supplements (HDS) are the most popular Complementary and Alternative Medicine (CAM) modality used by cancer patients and the only type which involves the ingestion of substances which may interfere with the efficacy and safety of conventional medicines. This study aimed to assess the level of use of HDS in cancer patients undergoing treatment in the UK, and their perceptions of their effects, using 127 case histories of patients who were taking HDS. Previous studies have evaluated the risks of interactions between HDS and conventional drugs on the basis on numbers of patient using HDSs, so our study aimed to further this exploration by examining the actual drug combinations taken by individual patients and their potential safety. Method Three hundred seventy-five cancer patients attending oncology departments and centres of palliative care at the Oxford University Hospitals Trust (OUH), Duchess of Kent House, Sobell House, and Nettlebed Hospice participated in a self-administered questionnaire survey about their HDS use with their prescribed medicines. The classification system of Stockley’s Herbal Medicine’s Interactions was adopted to assess the potential risk of herb-drug interactions for these patients. Results 127/375 (34 %; 95 % CI 29, 39) consumed HDS, amounting to 101 different products. Most combinations were assessed as ‘no interaction’, 22 combinations were categorised as ‘doubt about outcomes of use’, 6 combinations as ‘Potentially hazardous outcome’, one combination as an interaction with ‘Significant hazard’, and one combination as an interaction of “Life-threatening outcome”. Most patients did not report any adverse events. Conclusion Most of the patients sampled were not exposed to any significant risk of harm from interactions with conventional medicines, but it is not possible as yet to conclude that risks in general are over-estimated. The incidence of HDS use was also less than anticipated, and significantly less than reported in other areas, illustrating the problems when extrapolating results from one region (the UK), in one setting (NHS oncology) in where patterns of supplement use may be very different to those elsewhere

Association of Cut-Point Free Metrics and Common Clinical Tests Among Older Adults After Proximal Femoral Fracture

\ua9 2025 by the authors.Highlights: What are the main findings? Clinical lower limb assessments (both subjective and objective) were more discriminative in differentiating between the four PFF recovery groups in older adults. Older adults in the acute proximal femoral fracture recovery group demonstrated lower physical activity intensity compared to those in later recovery groups, with the differences being more pronounced for shorter-duration MX metrics (M1–M5). What is the implication of the main finding? The cut-point free method (e.g., MX metrics) is useful for measuring the physical activity magnitude of older adults recovering from proximal femoral fractures. Higher lower limb capacity and perception outcomes were strongly correlated with greater daily activity intensity, particularly in older adults at later stages of proximal femoral fracture recovery. Wearable and lightweight devices facilitate real-world physical activity (PA) assessments. MX metrics, as a cut-point-free parameter, evaluate acceleration above which the most active X minutes are accumulated. It provides insights into the intensity of PA over specific durations. This study evaluated the association of MX metrics and clinical tests in older adults recovering from proximal femoral fracture (PFF). Analyses were conducted on the PFF cohort from the baseline assessment of the Mobilise-D project using an accelerometer-based device. Participants (N = 396) were categorized into four recovery groups: acute, post-acute, extended recovery, and long-term recovery. Mobility capacity was assessed through the 6 min walking test (6MinWT), Short Physical Performance Battery (SPPB), 4-m walking test (4MWT), and hand grip (HG) strength. Mobility perception was evaluated using the Late-Life Function and Disability Instrument (LLFDI). Eight MX metrics (M1–M90) were calculated using the GGIR package in R. Results showed a moderate to strong positive correlation between M1 and M30 and lower limb mobility capacity tests and mobility perception (Lower Extremity domains) particularly in the extended and long-term recovery groups. MX metrics can be used for measuring PA intensity among older adults recovering from PFF. Hence, MX metrics have a high potential for clinical use as personalized PA targets in PFF rehabilitation

Mobilise-D insights to estimate real-world walking speed in multiple conditions with a wearable device

This study aimed to validate a wearable device’s walking speed estimation pipeline, considering complexity, speed, and walking bout duration. The goal was to provide recommendations on the use of wearable devices for real-world mobility analysis. Participants with Parkinson’s Disease, Multiple Sclerosis, Proximal Femoral Fracture, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and healthy older adults (n = 97) were monitored in the laboratory and the real-world (2.5 h), using a lower back wearable device. Two walking speed estimation pipelines were validated across 4408/1298 (2.5 h/laboratory) detected walking bouts, compared to 4620/1365 bouts detected by a multi-sensor reference system. In the laboratory, the mean absolute error (MAE) and mean relative error (MRE) for walking speed estimation ranged from 0.06 to 0.12 m/s and − 2.1 to 14.4%, with ICCs (Intraclass correlation coefficients) between good (0.79) and excellent (0.91). Real-world MAE ranged from 0.09 to 0.13, MARE from 1.3 to 22.7%, with ICCs indicating moderate (0.57) to good (0.88) agreement. Lower errors were observed for cohorts without major gait impairments, less complex tasks, and longer walking bouts. The analytical pipelines demonstrated moderate to good accuracy in estimating walking speed. Accuracy depended on confounding factors, emphasizing the need for robust technical validation before clinical application. Trial registration: ISRCTN – 12246987

Relative difference among 27 functional measures in patients with knee osteoarthritis : an exploratory cross-sectional case-control study

Background: To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient's situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures' selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods: We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61years, 64% women) referred by general physicians to a hospital's osteoarthritis-school, and 31 healthy participants (mean age 55years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen's d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins' scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results: Very large differences between patients and controls were found on the Pain numeric rating scale(1), the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)(2), as well as the orebro Musculoskeletal psychosocial scale(3) (P<0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test(4) and Accelerometer registered vigorous-intensity physical activity in daily life(5) (P<0.001). Respectively, these measures clustered on ICF as follows: (1)body function, (2)all three ICF-dimensions, (3)body function and participation, (4)activity, and (5)participation. Limitations: The limited sample excluded elderly patients with severe obesity. Conclusions: Very large differences across all ICF dimensions were indicated for the KOOS and orebro questionnaires together for patients aged 45-70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions

Relative difference among 27 functional measures in patients with knee osteoarthritis: an exploratory cross-sectional case-control study

Abstract Background To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient’s situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures’ selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61 years, 64% women) referred by general physicians to a hospital’s osteoarthritis-school, and 31 healthy participants (mean age 55 years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen’s d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins’ scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results Very large differences between patients and controls were found on the Pain numeric rating scale1, the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)2, as well as the Örebro Musculoskeletal psychosocial scale3 (P &lt; 0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test4 and Accelerometer registered vigorous-intensity physical activity in daily life5 (P &lt; 0.001). Respectively, these measures clustered on ICF as follows: 1body function, 2all three ICF-dimensions, 3body function and participation, 4activity, and 5participation. Limitations The limited sample excluded elderly patients with severe obesity. Conclusions Very large differences across all ICF dimensions were indicated for the KOOS and Örebro questionnaires together for patients aged 45–70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions. </jats:sec

Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: an exploratory cross-sectional study

AbstractBackgroundTo improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints.MethodsThe design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen’sdwere applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance.ResultsThe most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] −0.73 [−1.26,-0.20], − 0.74 [−1.26,-0.21], −0.71 [−1.24,-0.19], respectively;p &lt; 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint–strength directions: the involved leg’s ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg’s ankle dorsal flexion (p &lt; 0.05). There was no significant difference for 17 of 24 tests.ConclusionsFor patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings.</jats:sec

Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive : an exploratory cross-sectional study

Background: To improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints. Methods: The design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen's d were applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance. Results: The most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] -0.73 [-1.26,-0.20], -0.74 [-1.26,-0.21], -0.71 [-1.24,-0.19], respectively; p &lt; 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint-strength directions: the involved leg's ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg's ankle dorsal flexion (p &lt; 0.05). There was no significant difference for 17 of 24 tests. Conclusions: For patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings

Relative difference among 27 functional measures in patients with knee osteoarthritis : an exploratory cross-sectional case-control study

Background: To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient's situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures' selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods: We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61years, 64% women) referred by general physicians to a hospital's osteoarthritis-school, and 31 healthy participants (mean age 55years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen's d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins' scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results: Very large differences between patients and controls were found on the Pain numeric rating scale(1), the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)(2), as well as the orebro Musculoskeletal psychosocial scale(3) (P&lt;0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test(4) and Accelerometer registered vigorous-intensity physical activity in daily life(5) (P&lt;0.001). Respectively, these measures clustered on ICF as follows: (1)body function, (2)all three ICF-dimensions, (3)body function and participation, (4)activity, and (5)participation. Limitations: The limited sample excluded elderly patients with severe obesity. Conclusions: Very large differences across all ICF dimensions were indicated for the KOOS and orebro questionnaires together for patients aged 45-70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions

MOESM1 of Relative difference among 27 functional measures in patients with knee osteoarthritis: an exploratory cross-sectional case-control study

Additional file 1. Additional methods information regarding measurement instruments, data processing, and statistics applied in Vaarbakken et al. (2019)