Transcutaneous electrostimulation for osteoarthritis of the knee

BACKGROUND: Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Transcutaneous electrical nerve stimulation (TENS), interferential current stimulation and pulsed electrostimulation are used widely to control both acute and chronic pain arising from several conditions, but some policy makers regard efficacy evidence as insufficient. OBJECTIVES: To compare transcutaneous electrostimulation with sham or no specific intervention in terms of effects on pain and withdrawals due to adverse events in patients with knee osteoarthritis. SEARCH STRATEGY: We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL and PEDro up to 5 August 2008, checked conference proceedings and reference lists, and contacted authors. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that compared transcutaneously applied electrostimulation with a sham intervention or no intervention in patients with osteoarthritis of the knee. DATA COLLECTION AND ANALYSIS: We extracted data using standardised forms and contacted investigators to obtain missing outcome information. Main outcomes were pain and withdrawals or dropouts due to adverse events. We calculated standardised mean differences (SMDs) for pain and relative risks for safety outcomes and used inverse-variance random-effects meta-analysis. The analysis of pain was based on predicted estimates from meta-regression using the standard error as explanatory variable. MAIN RESULTS: In this update we identified 14 additional trials resulting in the inclusion of 18 small trials in 813 patients. Eleven trials used TENS, four interferential current stimulation, one both TENS and interferential current stimulation, and two pulsed electrostimulation. The methodological quality and the quality of reporting was poor and a high degree of heterogeneity among the trials (I(2) = 80%) was revealed. The funnel plot for pain was asymmetrical (P < 0.001). The predicted SMD of pain intensity in trials as large as the largest trial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in pain scores between electrostimulation and control of 0.2 cm on a 10 cm visual analogue scale. There was little evidence that SMDs differed on the type of electrostimulation (P = 0.94). The relative risk of being withdrawn or dropping out due to adverse events was 0.97 (95% CI 0.2 to 6.0). AUTHORS' CONCLUSIONS: In this update, we could not confirm that transcutaneous electrostimulation is effective for pain relief. The current systematic review is inconclusive, hampered by the inclusion of only small trials of questionable quality. Appropriately designed trials of adequate power are warranted

Exercise for rheumatoid arthritis of the hand

Background. Rheumatoid arthritis is an inflammatory polyarthritis that frequently affects the hands and wrists. Hand exercises are prescribed to improve mobility and strength, and thereby hand function. Objectives. To determine the benefits and harms of hand exercise in adults with rheumatoid arthritis. Search methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, Embase, CINAHL, AMED, Physiotherapy Evidence Database (PEDro), OTseeker, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to July 2017. Selection criteria. We considered all randomised or quasi‐randomised controlled trials that compared hand exercise with any non‐exercise therapy. Data collection and analysis. We used standard methodological procedures as outlined by the Cochrane Musculoskeletal Group. Main results. We included seven studies involving 841 people (aged 20 to 94 years) in the review. Most studies used validated diagnostic criteria and involved home programmes. Very low‐quality evidence (due to risk of bias and imprecision) from one study indicated uncertainty about whether exercise improves hand function in the short term (< 3 months). On a 0 to 80 points hand function test (higher scores mean better function), the exercise group (n = 11) scored 76.1 points and control group (n = 13) scored 75 points. Moderate‐quality evidence (due to risk of bias) from one study indicated that exercise compared to usual care probably slightly improves hand function (mean difference (MD) 4.5, 95% confidence interval (CI) 1.58 to 7.42; n = 449) in the medium term (3 to 11 months) and in the long term (12 months or beyond) (MD 4.3, 95% CI 0.86 to 7.74; n = 438). The absolute change on a 0‐to‐100 hand function scale (higher scores mean better function) and number needed to treat for an additional beneficial outcome (NNTB) were 5% (95% CI 2% to 7%); 8 (95% CI 5 to 20) and 4% (95% CI 1% to 8%); 9 (95% CI 6 to 27), respectively. A 4% to 5% improvement indicates a minimal clinical benefit. Very low‐quality evidence (due to risk of bias and imprecision) from two studies indicated uncertainty about whether exercise compared to no treatment improved pain (MD ‐27.98, 95% CI ‐48.93 to ‐7.03; n = 124) in the short term. The absolute change on a 0‐to‐100‐millimetre scale (higher scores mean more pain) was ‐28% (95% CI ‐49% to ‐7%) and NNTB 2 (95% CI 2 to 11). Moderate‐quality evidence (due to risk of bias) from one study indicated that there is probably little or no difference between exercise and usual care on pain in the medium (MD ‐2.8, 95% CI ‐ 6.96 to 1.36; n = 445) and long term (MD ‐3.7, 95% CI ‐8.1 to 0.7; n = 437). On a 0‐to‐100 scale, the absolute changes were ‐3% (95% CI ‐7% to 2%) and ‐4% (95% CI ‐8% to 1%), respectively. Very low‐quality evidence (due to risk of bias and imprecision) from three studies (n = 141) indicated uncertainty about whether exercise compared to no treatment improved grip strength in the short term. The standardised mean difference for the left hand was 0.44 (95% CI 0.11 to 0.78), re‐expressed as 3.5 kg (95% CI 0.87 to 6.1); and for the right hand 0.46 (95% CI 0.13 to 0.8), re‐expressed as 4 kg (95% CI 1.13 to 7). High‐quality evidence from one study showed that exercise compared to usual care has little or no benefit on mean grip strength (in kg) of both hands in the medium term (MD 1.4, 95% CI ‐0.27 to 3.07; n = 400), relative change 11% (95% CI ‐2% to 13%); and in the long term (MD 1.2, 95% CI ‐0.62 to 3.02; n = 355), relative change 9% (95% CI ‐5% to 23%). Very low‐quality evidence (due to risk of bias and imprecision) from two studies (n = 120) indicated uncertainty about whether exercise compared to no treatment improved pinch strength (in kg) in the short term. The MD and relative change for the left and right hands were 0.51 (95% CI 0.13 to 0.9) and 44% (95% CI 11% to 78%); and 0.82 (95% CI 0.43 to 1.21) and 68% (95% CI 36% to 101%). High‐quality evidence from one study showed that exercise compared to usual care has little or no benefit on mean pinch strength of both hands in the medium (MD 0.3, 95% CI ‐0.14 to 0.74; n = 396) and long term (MD 0.4, 95% CI ‐0.08 to 0.88; n = 351). The relative changes were 8% (95% CI ‐4% to 19%) and 10% (95% CI ‐2% to 22%). No study evaluated the American College of Rheumatology 50 criteria. Moderate‐quality evidence (due to risk of bias) from one study indicated that people who also received exercise with strategies for adherence were probably more adherent than those who received routine care alone in the medium term (risk ratio 1.31, 95% CI 1.15 to 1.48; n = 438) and NNTB 6 (95% CI 4 to 10). In the long term, the risk ratio was 1.09 (95% CI 0.93 to 1.28; n = 422). Moderate‐quality evidence (due to risk of bias) from one study (n = 246) indicated no adverse events with exercising. The other six studies did not report adverse events. Authors' conclusions. It is uncertain whether exercise improves hand function or pain in the short term. It probably slightly improves function but has little or no difference on pain in the medium and long term. It is uncertain whether exercise improves grip and pinch strength in the short term, and probably has little or no difference in the medium and long term. The ACR50 response is unknown. People who received exercise with adherence strategies were probably more adherent in the medium term than who did not receive exercise, but with little or no difference in the long term. Hand exercise probably does not lead to adverse events. Future research should consider hand and wrist function as their primary outcome, describe exercise following the TIDieR guidelines, and evaluate behavioural strategies

Reliability and validity of the AGREE instrument used by physical therapists in assessment of clinical practice guidelines

BACKGROUND: The AGREE instrument has been validated for evaluating Clinical Practice Guidelines (CPG) pertaining to medical care. This study evaluated the reliability and validity of physical therapists using the AGREE to assess quality of CPGs relevant to physical therapy practice. METHODS: A total of 69 physical therapists participated and were classified as generalists, specialist or researchers. Pairs of appraisers within each category evaluated independently, a set of 6 CPG selected at random from a pool of 55 CPGs. RESULTS: Reliability between pairs of appraisers indicated low to high reliability depending on the domain and number of appraisers (0.17–0.81 for single appraiser; 0.30–0.96 when score averaged across a pair of appraisers). The highest reliability was achieved for Rigour of Development, which exceeded ICC> 0.79, if scores from pairs of appraisers were pooled. Adding more than 3 appraisers did not consistently improve reliability. Appraiser type did not determine reliability scores. End-users, including study participants and a separate sample of 102 physical therapy students, found the AGREE useful to guide critical appraisal. The construct validity of the AGREE was supported in that expected differences on Rigour of Development domains were observed between expert panels versus those with no/uncertain expertise (differences of 10–21% p = 0.09–0.001). Factor analysis with varimax rotation, produced a 4-factor solution that was similar, although not in exact agreement with the AGREE Domains. Validity was also supported by the correlation observed (Kendall-tao = 0.69) between Overall Assessment and the Rigour of Development domain. CONCLUSION: These findings suggest that the AGREE instrument is reliable and valid when used by physiotherapists to assess the quality of CPG pertaining to physical therapy health services

Harnessing interactive technologies to improve health outcomes in juvenile idiopathic arthritis

Background: Children and adolescents with Juvenile Idiopathic Arthritis (JIA) typically have reduced physical activity level and impaired aerobic and anaerobic exercise capacity when compared to their non-JIA counterparts. Low intensity exercise regimens appear to be safe in children with JIA and may results in improvements in overall physical function. Poor adherence to paediatric rheumatology treatment may lead to negative clinical outcomes and possibly increased disease activity. This includes symptoms such as pain, fatigue, quality of life, longer term outcomes including joint damage, as well as increase of healthcare associated costs. Low adherence to medications such as methotrexate and biological-drugs remains a significant issue for paediatric rheumatologists, with alarming reports that less than half of the children with JIA are compliant to drug-therapy. Main body: The recent advances in interactive technology resulting in a variety of wearable user-friendly smart devices may become a key solution to address important questions in JIA clinical management. Fully understanding the impact that arthritis and treatment complications have upon individual children and their families has long been a challenge for clinicians. Modern interactive technologies can be customised and accessed directly in the hands or wrists of children with JIA. These secured networks could be accessible 'live' at anytime and anywhere by the child, parents and clinicians. Multidisciplinary teams in paediatric rheumatology may benefit from adopting these technologies to better understand domains such as patient biological parameters, symptoms progression, adherence to drug-therapy, quality of life, and participation in physical activities. Most importantly the use of smart devices technologies may also facilitate more timely clinical decisions, improve self-management and parents awareness in the progression of their child's disease. Paediatric rheumatology research could also benefit from the use of these smart devices, as they would allow real-time access to meaningful data to thoroughly understand the disease-patterns of JIA, such as pain and physical activity outcomes. Data collection that typically occurs once every 1 or 3 months in the clinical setting could instead be gathered every week, day, minute or virtually live online. Arguably, few limitations in wearing such interactive technologies still exist and require further developments. Conclusion: Finally, by embracing and adapting these new and now highly accessible interactive technologies, clinical management and research in paediatric rheumatology may be greatly advanced.sch_pod1. Australian Institute of Health and Welfare, [AIHW]. What is juvenile arthritis? 2015. http://www.aihw.gov.au/juvenile-arthritis. Accessed 24 May 2016. 2. Bouaddi I, Rostom S, El Badri D, Hassani A, Chkirate B, Amine B, et al. Impact of juvenile idiopathic arthritis on schooling. BMC Pediatr. 2013; doi:10.1186/1471-2431-13-2. 3. Laila K, Haque M, Islam MM, Islam MI, Talukder MK, Rahman SA. Impact of Juvenile Idiopathic Arthritis on School Attendance and Performance. American Journal of Clinical and Experimental Medicine. 2016; doi:10.11648/j.ajcem.20160406.15 4. Schatz BR. National Surveys of population health: big data analytics for mobile health monitors. Big Data. 2015; 1;3(4):219-229. 5. Cingi C, Yorgancioglu A, Cingi CC, Oguzulgen K, Muluk NB, Ulusoy S, et al. The physician on call patient engagement trial- (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients. Forum Allergy Rhinol 2015; doi:10.1002/alr.21468. 6. Stinson JN, Jibb LA, Nguyen C, Nathan PC, Maloney AM, Dupuis LL, et al. Construct validity and reliability of a real-time multidimensional smartphone app to assess pain in children and adolescents with cancer. Pain. 2015; doi:10.1097/j.pain.0000000000000385. 7. Tong A, Jones J, Craig JC, Singh-Grewal D. Children's experiences of living with juvenile idiopathic arthritis: a thematic synthesis of qualitative studies. Arthritis Care Res, 2012; doi:10.1002/acr.21695 8. Nishiguchi S, Ito H, Yamada M, Yoshitomi H, Furu M, Shinohara A, et al. Selfassessment of Rheumatoid Arthritis Disease Activity Using a Smartphone Application. Development and 3-month Feasibility Study. J Rheumatol. 2010; doi:10.3899/jrheum.091327. 9. de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012; doi:10.1002/14651858.CD007459. 10. Majeed-Ariss R, Baildam E, Campbell M, Chieng A, Fallon D, Hall A, et al. Apps and Adolescents: A Systematic Review of Adolescents' Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions. J Med Internet Res. 2015; doi:10.2196/jmir.5043. 11. Szer IS, Kimura Y, Malleson PN, Southwood TR. Arthritis in children and adolescents: juvenile idiopathic arthritis. New York: Oxford University Press; 2006. 12. Bugni VM, Ozaki LS, Okamoto KY, Barbosa CM, Hilrio MO, Len CA, et al. Factors associated with adherence to treatment in children and adolescents with chronic rheumatic disease. J Pediatr (Rio J). 2012; doi:10.2223/JPED.2227 13. Pelajo CF, Sgarlat CM, Lopez-Benitez JM, Oliveira SK, Rodrigues MC, Sztajnbok FR, et al. Adherence to methotrexate in juvenile idiopathic arthritis. Rheumatol Int. 2012; doi:10.1007/s00296-010-1774. 14. Nickels A, Dimov V. Innovations in technology: social media and mobile technology in the care of adolescents with asthma. Curr Allergy Asthma Rep. 2012; doi:10.1007/s11882-012-0299-7. 15. Koster ES, Philbert D, de Vries TW, van Dijk L, Bouvy ML. I just forget to take it-: asthma self-management needs and preferences in adolescents. J Asthma. 2015; doi: 10.3109/02770903.2015.1020388. 16. Crosby LE, Barach I, McGrady ME, Kalinyak KA, Eastin AR, Mitchell MJ. Integrating interactive web-based technology to assess adherence and clinical outcomes in pediatric sickle cell disease. Anemia. 2012; doi:10.1155/2012/492428. 17. Lelieveld OT, van Brussel M, Takken T, van Weert E, van Leeuwen MA, Armbrust W. Aerobic and anaerobic exercise capacity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2007; doi:10.1002/art.22897 18. Singh-Grewal, D, Schneiderman-Walker, J, Wright, V, Bar-Or, O, Beyene, J, Selvadurai, H, et al. (2007). The Effects of Vigorous Exercise Training on Physical Function in Children With Arthritis: A Randomized, Controlled, Single-Blinded Trial. Arthritis Care and Research. 2007; doi:10.1002/art.23008. 19. Raustorp A, Pagels P, Froberg A, Boldemann C. Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect? Acta Paediatr. 2015; doi:10.1111/apa.13027. 20. ACMA, Australia's mobile digital economy - ACMA confirms usage, choice, mobility and intensity on the rise, a.C.A.M: authority editor; 2013. 21. Google. Google Cloud Platform Security [Internet]. Google. 2016. https:// cloud.google.com/security. Accessed 13 Oct 2016. 22. Apple. iOS Security - Report No.: 9.3 or Later. 2016; https://www.apple.com/ business/docs/iOS_Security_Guide.pdf. Accessed 13 Oct 2016.15pub4780pub

Consensus on exercise reporting template (Cert): Modified delphi study

© 2016 American Physical Therapy Association. Background. Exercise interventions are often incompletely described in reports of clinical trials, hampering evaluation of results and replication and implementation into practice. Objective. The aim of this study was to develop a standardized method for reporting exercise programs in clinical trials: the Consensus on Exercise Reporting Template (CERT). Design and Methods. Using the EQUATOR Network’s methodological framework, 137 exercise experts were invited to participate in a Delphi consensus study. A list of 41 items was identified from a meta-epidemiologic study of 73 systematic reviews of exercise. For each item, participants indicated agreement on an 11-point rating scale. Consensus for item inclusion was defined a priori as greater than 70% agreement of respondents rating an item 7 or above. Three sequential rounds of anonymous online questionnaires and a Delphi workshop were used. Results. There were 57 (response rate=42%), 54 (response rate=95%), and 49 (response rate=91%) respondents to rounds 1 through 3, respectively, from 11 countries and a range of disciplines. In round 1, 2 items were excluded; 24 items reached consensus for inclusion (8 items accepted in original format), and 16 items were revised in response to participant suggestions. Of 14 items in round 2, 3 were excluded, 11 reached consensus for inclusion (4 items accepted in original format), and 7 were reworded. Sixteen items were included in round 3, and all items reached greater than 70% consensus for inclusion. Limitations. The views of included Delphi panelists may differ from those of experts who declined participation and may not fully represent the views of all exercise experts. Conclusions. The CERT, a 16-item checklist developed by an international panel of exercise experts, is designed to improve the reporting of exercise programs in all evaluative study designs and contains 7 categories: materials, provider, delivery, location, dosage, tailoring, and compliance. The CERT will encourage transparency, improve trial interpretation and replication, and facilitate implementation of effective exercise interventions into practice

Photoinduced Architectural Transformation of Noncovalent Fluorescent Photochromic Organic Nanoparticles as Evidenced by Amplified Fluorescence Photoswitching

International audienceDual nanoparticles endowed with emission photoswitching ability are produced by the flash coprecipitation of fluorophores and photochromes in water in order to investigate the mutual interplay between the self-assembled photoactive units as a function of their respective ratio. Photophysical studies show that high fluorophore/photochrome ratios favor very fast on/off fluorescence photoswitching, while the opposite is true for recovering emission thanks to the strong antenna effects permitted by the spatially confined entities in nanoparticles. Attempts to regenerate the initial state upon visible irradiation reveal unexpected structural transformations, which result from the noncovalent dye self-assemblies. Morphological investigations support phototriggered photochrome clustering within and around the fluorescent core of the dual nanoparticles after a UV-vis cycle or irradiation, causing partitioning of the photoactive units. The photoinduced morphological changes provide attractive prospects in the fabrication of smart drug delivery systems where active material release by external stimuli represents a very dynamic research area

[Malignant pleural mesothelioma: 2013 state of the art].

International audienceMalignant pleural mesothelioma (MPM) is a bad-prognosis cancer raising difficult issues according to diagnosis. Reliable histological diagnosis indeed requires large-sized pathological samples obtained by thoracoscopy, and need diagnosis certification by the MESOPATH national expert pathological committee. MPM epidemiology shows a rising incidence among females, whereas an incidence plateau has been reached for males in France. The incidence peak is still predicted for 2030 decade in UK, Australia and North America, because of the asbestosis massive use in their industry until the end of 1980 decade. Pleural carcinogenesis is better understood with the recent discovery of BAP1 susceptibility gene although no oncogenic driver has been ever uncovered for targeted therapies, although several more or less targeted biological therapies are currently tested in early phase or more advanced-phase trials. Surgery is more and more questioned, since radical surgery is currently abandoned, whereas debulking or cyto-reduction surgery has been proposed within a multimodality approach also including adjuvant chemotherapy and radiotherapy but still need prospective trials. Pemetrexed and cisplatin-based chemotherapy remains the reference treatment, which has proved in mesothelioma some efficacy on overall survival in randomized trials, with a 13-15 months median-overall survival. Final results of the large phase 3 clinical trial "MAPS" sponsored by French collaborative Intergroup (IFCT) evaluating the effect of bevacizumab addition to pemetrexed-cisplatin doublet will be released in early 2015, since 445 patients have been included by November 2013