Measuring Quality of Life in patients with Rotator Cuff Disorders

Rotator cuff disorders (RCDs) are a common musculoskeletal problem with a higher prevalence in women and after the age of 60. Due to the increasing need for patient-centered care, researchers have been directed towards the use of patient reported outcomes (PROs) to evaluate the progress of patient recovery, as the experience varies across individuals. Recently, the Western Ontario Rotator Cuff Index was reduced in items to create the shortened version of the Western Ontario Rotator Cuff Index (Short-WORC). However, the Short-WORC’s psychometrics have yet to be evaluated. Therefore, this mixed-methods thesis aimed to evaluate the psychometric properties of the Short-WORC in a patient population of RCDs. First, we created the framework of evaluation by synthesizing the literature on the cultural adaptions of the WORC. Then, we quantitatively assessed the reliability and validity, and qualitatively assessed the content validity of the Short-WORC in a prospective rotator cuff population. Overall, the findings suggestthat the Short-WORC demonstrates evidence of validity, reliability and sensitivity to change when measuring quality of life in rotator cuff pathology. Findings suggest the appropriate recommendations and advancement of clinical research in rotator cuff pathology

Psychometric properties of the global rating of change scales in patients with neck disorders: A systematic review with meta-analysis and meta-regression

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective The purpose of this systematic review was to critically appraise and synthesise the psychometric properties of Global Rating of Change (GROC) scales for assessment of patients with neck pain. Design Systematic review. Data sources A search was performed in four databases (MEDLINE, EMBASE, CINAHL, SCOPUS) until February 2019. Data extraction and synthesis Eligible articles were appraised using Consensus-based Standards for the selection of health Measurement Instruments checklist and the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form. Results The search obtained 16 eligible studies and included in total 1533 patients with neck pain. Test-retest reliability of global perceived effect (GPE) was very high (intraclass correlation coefficient=0.80 to 0.92) for patients with whiplash. Pooled data of Pearson\u27s r indicated that GROC scores were moderately correlated with neck disability change scores (0.53, 95% CI: 0.47 to 0.59). Pooled data of Spearman\u27s correlations indicated that GROC scores were moderately correlated with neck disability change scores (0.56, 95% CI: 0.41 to 0.68). Conclusions This study found excellent quality evidence of very good-to-excellent test-retest reliability of GPE for patients with whiplash-associated disorders. Evidence from very good-to-excellent quality studies found that GROC scores are moderately correlated to an external criterion patient-reported outcome measure evaluated pre-post treatment in patients with neck pain. No studies were found that addressed the optimal form of GROC scales for patients with neck disorders or compared the GROC to other options for single-item global assessment. PROSPERO registration number CRD42018117874

Interpretation and content validity of the items of the numeric rating version short-WORC to evaluate outcomes in management of rotator cuff pathology: a cognitive interview approach

Background The shortened version of the Western Ontario Rotator Cuff Index (Short-WORC) is a patient reported outcome measure that evaluates quality of life (QoL) of patients with rotator cuff pathology. However, formal content validation of the full or Short-WORC has not been reported. This study aims to understand how 1) people interpret and calibrate responses to items on the Short-WORC and 2) compensatory strategies that might enhance function and thereby affect responses. Methods This study uses cognitive interviewing, a qualitative methodology that focuses on the interpretation of questionnaire items. Patients with rotator cuff disorders (n = 10), clinicians (n = 6) and measurement researchers (n = 10) were interviewed using a talk aloud structured interview that evaluated each of the 7 items of the Short-WORC. All interviews were recorded and transcribed verbatim by one researcher (R.F). Analysis was done through an open coding scheme using a previously established framework. Results Overall, the items on the Short-WORC were well received by participants. Through the interviews, the 6 themes of: Comprehension, Inadequate response definition, Reference Point, Relevance, Perspective Modifiers and Calibration Across Items emerged. The items of working above the shoulder (90%), compensating with the unaffected arm (88%) and lifting heavy objects (92%) were the most relevant to participants. Participants calibrated their scores on the items of sleeping and styling (19%) the most. Perspective modifiers of gender, influenced the calibrations of items of styling your hair (30%) and dressing or undressing (19%). Compensatory strategies of task-re allocation and using assistive devices/resources were frequently mentioned by participants. Overall, participants had minor comprehension issues, but found the 7- items of the Short-WORC to be relevant to QoL. Conclusions Therefore, the findings demonstrate that the Short-WORC is not cognitively complex, but varies with patient perspectives. Overall, the Short-WORC provides evidence of demonstrating strong content validity when used for rotator cuff disorder patients

Padrões fisiológicos hematológicos para Bugios-ruivos (Alouatta guariba clamitans): revisão de literatura: Physiological hematological patterns for howler monkeys (Alouatta guariba clamitans): literature review

As avaliações hematológicas são de suma importância na medicina veterinária, e, em animais ex situ, exames periódicos são necessários para monitorar a sanidade e bem-estar do plantel. Porém, para muitas espécies de animais silvestres, ainda é um desafio encontrar valores de referência padronizados para todos os componentes sanguíneos. Partindo deste princípio, o objetivo desta revisão é relatar os padrões fisiológicos hematológicos e bioquímicos para Bugios-ruivos (Alouatta guariba clamitans) hígidos descritos na literatura nacional e internacional. Os dados obtidos em diferentes estudos foram planilhados e discutidos na presente revisão. Considerando o grande número de animais pertencentes ao gênero Alouatta sp., conclui-se necessários novos estudos com aprofundamento da padronização de valores fisiológicos hematológicos, bioquímicos e hemostáticos, para obtenção de valores de referência de  de animais hígidos da espécie Alouatta guariba clamitans, facilitando assim a distinção para o diagnóstico de patologias. Porém, ainda há poucos estudos conduzidos sobre a hematologia de primatas não-humanos de uma forma geral, levando em consideração as variáveis como idade, dieta, gênero, condições ambientais e estado reprodutivo, evitando assim a inferência de dados obtidos para outras espécies de primata-não-humanos do novo mundo

Uso de Musa spp. no tratamento antiparasitário em animais: Revisão de literatura: Use of Musa spp. as an antiparasitic treatment in animals: Literature review

A fitoterapia caracteriza-se na utilização de substratos naturais, em diferentes preparações, para melhora de estados patológicos, seja na atenuação ou na cura dos mesmos, bem como na sua profilaxia. A fitoterapia é uma alternativa ao uso de anti-helmínticos, embora financeiramente acessível para o caso de algumas plantas, normalmente está associada ao conhecimento empírico, portanto carece de maiores estudos científicos para determinar a eficácia das diversas espécies de plantas com potencial antiparasitário.  Dentre elas está a bananeira (Musa spp.) que vem sendo citada como um fitoterápico com atividade anti-helmíntica principalmente por possuir em sua composição taninos que exercem ação direta sobre helmintos, interferindo no ciclo natural destes parasitas. Partindo desse princípio, o objetivo da presente revisão é descrever os estudos científicos que utilizaram Musa spp. como alternativa para o tratamento antiparasitário em Medicina Veterinária. Os estudos descritos na presente revisão apresentam resultados, bem como metodologias distintas entre si, embora as análises coproparasitológicas tenham sido semelhantes entre todos os estudos revisados. Todavia as formas e os intervalos de administração, quantidade/dose e frequência diferenciam-se entre estudos, e poucos realizaram testes de toxicidade da Musa spp. Portanto a utilização da Musa spp. como antiparasitário ainda carece de estudos na medicina veterinária, bem como estudos sobre a sua toxicidade, dosagem e frequência de administração.&nbsp

Effect of breastfeeding on malocclusions: a systematic review and meta-analysis

AIM: The objective of this systematic review was to investigate if breastfeeding decreases the risk of malocclusions. METHODS: Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: a) ever versus never; b) exclusive versus absence of exclusive; c) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias. RESULTS: Forty-eight studies were included in the systematic review and 41 were included in the overall meta-analysis (n =27,023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those with shorter breastfed (OR 0.40; 95% CI 0.29; 0.54). CONCLUSION: Breastfeeding decreases the risk of malocclusions.Karen Glazer Peres, Andreia Morales Cascaes, Gustavo Giacomelli Nascimento, and Cesar Gomes Victor