128 research outputs found

    Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture:study protocol for a randomized controlled trial

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    BACKGROUND: Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture, though its safety and efficacy have never been investigated in a randomized setup. The objectives of this study are to investigate if early controlled motion of the ankle affects functional and patient-reported outcomes. METHODS/DESIGN: The study is performed as a blinded, randomized, controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged from 18 to 70 years are eligible for inclusion. The intervention group performs early controlled motion of the ankle in weeks 3–8 after rupture. The control group is immobilized. In total, 130 patients will be included from one big orthopedic center over a period of 2½ years. The primary outcome is the patient-reported Achilles tendon Total Rupture Score evaluated at 12 months post-injury. Secondary outcome measures are the heel-rise work test, Achilles tendon elongation, and the rate of re-rupture. The primary analysis will be conducted as intention-to-treat analyses. DISCUSSION: This trial is the first to investigate the safety and efficacy of early controlled motion in the treatment of acute Achilles tendon rupture in a randomized setup. The study uses the patient-reported outcome measure, the Achilles tendon Total Rupture Score, as the primary endpoint, as it is believed to be the best surrogate measure for the tendon’s actual capability to function in everyday life. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02015364. Registered on 13 December 2013. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1697-2) contains supplementary material, which is available to authorized users

    Effect of automated oxygen titration during walking on dyspnea and endurance in chronic hypoxemic patients with copd:A randomized crossover trial

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    The need for oxygen increases with activity in patients with COPD and on long-term oxygen treatment (LTOT), leading to periods of hypoxemia, which may influence the patient’s performance. This study aimed to evaluate the effect of automated oxygen titration compared to usual fixed-dose oxygen treatment during walking on dyspnea and endurance in patients with COPD and on LTOT. In a double-blinded randomised crossover trial, 33 patients were assigned to use either automated oxygen titration or the usual fixed-dose in a random order in two walking tests. A closed-loop device, O2matic delivered a variable oxygen dose set with a target saturation of 90–94%. The patients had a home oxygen flow of (mean ± SD) 1.6 ± 0.9 L/min. At the last corresponding isotime in the endurance shuttle walk test, the patients reported dyspnea equal to median (IQR) 4 (3–6) when using automated oxygen titration and 8 (5–9) when using fixed doses, p < 0.001. The patients walked 10.9 (6.5–14.9) min with automated oxygen compared to 5.5 (3.3–7.9) min with fixed-dose, p < 0.001. Walking with automated oxygen titration had a statistically significant and clinically important effect on dyspnea. Furthermore, the patients walked for a 98% longer time when hypoxemia was reduced with a more well-matched, personalised oxygen treatment

    High perceived caregiver burden for relatives of patients following hip fracture surgery

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    Purpose: To determine the profile of the main informal caregivers, evolution of the caregiver burden and influencing factors of caregiver burden at 1-year after hip fracture surgery. Methods: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed during one year following hip fracture surgery in a regional hospital. The perceived caregiver burden was assessed using the Caregiver Strain Index (CSI, 0-13 points). Results: The median (Q1-Q3) age of the 172 caregivers was 54 (47-65) years, of which 133 (77%) were woman and 94 (55%) were daughters of the patient. 79 of the 172 (46%) caregivers perceived a high level of burden (CSI ≥ 7 points) at the hospital. The corresponding CSI-data for 1-month, 3-months and 1-Year were 87 (51%), 61 (35%) and 45 (26%). A low pre-fracture functional status, post-surgery complications, older age of patients and younger age of caregivers influence caregiver burden at 1-year. Conclusions: The profile of the main caregiver of hip fracture is a woman of middle age and is the daughter of the patient. The perceived caregiver burden decreased from 1-month to 1- year. More efforts are needed to avoid post-surgical complications in order to prevent caregiver burden at 1-year. Ke

    Determination of growth, mass, and body mass index of harbour porpoises (Phocoena phocoena): Implications for conservational status assessment of populations

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    Longitudinal data on individual growth and seasonal changes in body mass, girth, and blubber thickness are rarely available for cetaceans, making it difficult to assess their population composition and individual nutritional condition. During different time intervals from 1997 to 2020, we collected longitudinal data on length, body mass, girth,and blubber thickness from seventeen harbour porpoises (Phocoena phocoena) in human care. We compared Gompertz and von Bertalanffy growth curves to collected length data at age 0–4 years for five individuals with known dates of birth. Von Bertalanffy had the lowest AICc value and was used to predict the birth year of twelve animals which age had previously been estimated based on tooth ring analysis and ossification of flipper bones. The growth curve was accurate within 1 yr. of age estimates. Within the first year, the calves grew 66%, attaining 84% of their adult length, and reached asymptotic length at age 3–4. For adults, there were large seasonal variations in body mass, body mass index, girth, and blubber thickness, with up to 28% of variation in body mass between seasons. We predicted individual body mass within ± 2 kg using measurements of length and girth, allowing estimation of body mass index of individuals with unknown mass. Our findings enable monitoring and assessments of population composition as well as nutritional condition of individual harbour porpoises, which is crucial for assessing conservational status and guiding management

    Orthopaedic physiotherapists’ perceptions of mechanisms for observed variation in the implementation of physiotherapy practices in the early postoperative phase after hip fracture: a UK qualitative study

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    Objective: To explore physiotherapists’ perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. Methods: A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. Results: Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting ‘postoperative physiotherapy’ as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. Conclusions: Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles

    Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility

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    Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5,383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. Results: Overall, 73% were female and 40% had high frailty risk. Patients who received ≥2 hours of physiotherapy (versus less) had 3% (95% Confidence Interval: 0-6%), 4% (2-6%), and 6% (1-11%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 3% (0-6%) lower adjusted probability of readmission. Recipients of exercise (versus mobilisation alone) had 6% (1-12%), 3% (0-7%), and 11% (3-18%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 6% (2-10%) lower adjusted probability of readmission. Recipients of 6-7 days physiotherapy (versus 0-2 days) had 8% (5-11%) higher adjusted probability of survival. For patients with dementia, improved probability of survival, discharge home, readmission and indoor mobility recovery were observed with greater physiotherapy access. Conclusion: Greater access to physiotherapy was associated with a higher probability of positive outcomes. For every 100 patients, greater access could equate to an additional eight patients surviving to 30-days and six avoiding 30-day readmission. The findings suggest a potential benefit in terms of home discharge and outdoor mobility recovery

    Hip Fractures - Functional assessments and factors influencing in-hospital outcome of patients with hip fracture, a physiotherapeutic perspective

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    A hip fracture is probably one of the most fatal fractures for the elderly and estimated worldwide to reach 5 million cases annually by the year 2050. Thus, continuing efforts in preventing fractures, with more research and improved treatment strategies for those who do fracture, seem crucial. The primary aims of this thesis, which comprises seven original papers, including a total of 656 patients, were to examine the reliability and validity of functional assessments used by physiotherapists of patients with different types of hip fracture, and to evaluate pre-surgery factors influencing in-hospital performances and outcome. Specifically, the ordinal-scaled prefracture functional level; New Mobility Score (NMS, 0-9), the basic mobility; Cumulated Ambulation Score (CAS, 0-6), and the continuous functional mobility, Timed Up & Go (TUG) test, were evaluated. Furthermore, the focus was on the influence of prefracture function and fracture type in addition to age, gender, mental and health status, on in-hospital performances and discharge destination. The relative intertester reliability of the NMS, and the CAS were, respectively, 0.98 and 0.95, while findings of the absolute reliability expressed by the smallest real difference indicate that a change of one point for both scores signifies a real change for a single person. The prefracture NMS functional level, in addition to age and fracture type, independently predicts or influences the in-hospital CAS-outcome and TUG-scores. Thus, a patient with a low prefracture level (NMS ≤ 6) and/or an inter- or subtrochanteric fracture was, respectively, 18 and 4 times more likely not to regain independency in basic mobility during admittance, compared to a patient with a high prefracture level and a cervical fracture, while the odds against mobility independency increased with 5% for every additional year of age. Correspondingly, patients with a low prefracture NMS and an inter- or subtrochanteric fracture, on average took, respectively, 9 and 6 seconds more to perform the TUG, while scores increased with 0.4 seconds per additional year. TUG scores were strongly influenced by the walking aid used during testing, as patients who performed the TUG with a rollator (a standardised walking aid), required on average 13.6 (95% CI, 11.2-16.1) seconds less than when using their discharge walking aid, a walker. Furthermore, TUG-scores of six subsequent timed trials, performed with a rollator, improved significantly up to and including the third trial. Finally, patients with intertrochanteric fractures presented significantly larger thigh oedema (11% increase) in the fractured limb compared with cervical fractures (4%), and the oedema was significantly correlated to scores of basic CAS-mobility (r = -0.61), postural control (sway, r = 0.67), and fractured limb knee-extension strength (% non-fractured, r = -0.77) ex-plaining between 32% and 59% of the variance (r2) in performances. In conclusion, the NMS, and CAS seem highly reliable with small changes needed to indicate real changes. Findings of the TUG-test indicate that the original TUG-manual needs modification, the fastest of three timed trials performed with a rollator is recommended for testing. The prefracture NMS level, in addition to age and fracture type, provides clinicians with a valid prediction of in-hospital outcome. Finally, our results indicate that the fracture type and the corresponding thigh oedema strongly influence physical performances, including maximal knee-extension strength of the fractured limb. Future research and rehabilitation programmes of patients with hip fracture should accommodate these findings
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