6 research outputs found
Magnetic resonance imaging criteria for the assessment of the rotator cuff after repair: a systematic review
PURPOSE: The purpose of this systematic review was to detect the reliability of
the currently available magnetic resonance imaging measurements used in the
evaluation of repaired rotator cuff.
METHODS: Search was performed using major electronic databases from their
inception to February 2014. All studies reporting post-operative magnetic
resonance assessment after rotator cuff repair were included. After the
identification of available magnetic resonance criteria, reliability studies were
further analysed. Descriptive statistics were used to summarize findings.
Methodological quality was assessed using the Quality Appraisal of Reliability
Studies checklist.
RESULTS: One hundred and twenty studies were included in the review. Twenty-six
different criteria were identified. Ten studies reported inter-observer
reliability, and only two assessed intra-observer reliability of some of the
identified criteria. Structural integrity was the most investigated criterion.
The dichotomized Sugaya's classification showed the highest reliability (k =
0.80-0.91). All other criteria showed moderate to low inter-observer reliability.
Tendon signal intensity and footprint coverage showed a complete discordance.
Intra-observer reliability was high for the presence of structural integrity, and
moderate to low for all other criteria. Methodological quality was high only for
one study and moderate for three studies.
CONCLUSIONS: Twenty-six different criteria described by multiple classification
systems have been identified for the magnetic resonance assessment of rotator
cuff after repair. Reliability of most of them has not been analysed yet. With
the data available, only the presence of structural integrity showed good intra-
and inter-observer agreement.
LEVEL OF EVIDENCE: Systematic review of descriptive and qualitative studies,
Level IV
Prognostic factors influencing the outcome of rotator cuff repair: a systematic review
Purpose To identify prognostic factors significantly
associated with rotator cuff repair outcome and define the
strength of these associations.
Methods Search was performed using electronic databases.
Studies reporting prognostic factors affecting rotator
cuff repair outcome were included. Primary outcomes
were: structural integrity, Disabilities of the Arm, Shoulder
and Hand score, American Shoulder and Elbow Surgeons
score, and Constant score. Each other outcome was considered
as secondary outcome. Descriptive statistics was used.
When possible, meta-analyses were performed. Methodological
quality was assessed using the Quality In Prognosis
Studies Tool. A best evidence synthesis was performed
using the Grading of Recommendations Assessment,
Development and Evaluation framework adapted to prognostic
studies.
Results Sixty-four studies were included. Methodological
quality was high only for twelve studies. The overall
quality of evidence was low to very low. Meta-analyses
were possible only for seven studies. Older age and
larger tears size were found to affect retear risk. Results were controversial for fatty infiltration, acromioclavicular
joint or biceps procedures, acromiohumeral distance,
delamination of tendon edges, musculotendinous junction
position, number of tendons involved, and tendon
length, quality and retraction. Baseline scores and workers
compensation claim predicted functional outcomes.
Subjective outcome was also affected by patient\u2019s
expectations.
Conclusions Despite the large number of outcomes
and prognostic factors evaluated by a relative small number
of studies, almost not prognostic in design, it was not
possible to reach any definitive conclusion regarding the
most relevant predictors of outcome of rotator cuff repair.
Moreover, the low methodological quality of the included
studies and, subsequently, the low quality of evidence, seriously
affected the strength of recommendation of the present
review. Based on data available, retear risk is mainly
affected by older age and larger tears size. Baseline scores
and work compensation claim are the most significant predictors
for functional outcomes.
Level of evidence Systematic review of level I\u2013IV prognostic
studies, Level IV
Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort
Objective To assess the feasibility of the family paediatrician’s (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.Design, setting and participants Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60–90 days after childbirth). Moreover, on the third visit (5–7 months after childbirth) the FP was asked to answer ‘yes’ or ‘no’ to a question on the parental postpartum depression, based on his knowledge and on the acquired information.Results In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as ‘likely depressed’. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69).Conclusions The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care.Trial registration number NCT03894566; Pre-results