The Effect of Functional Movement Control on Patient-Reported Outcomes in Individuals with Non-Arthritic Hip Pain

Purpose: Both the single leg squat test and step-down test assess for deficiencies relating to the hip and surrounding musculoskeletal structures and could be useful in the evaluation of functional movement control for individuals with non-arthritic hip pain. The purpose of this study is to determine if individuals with non-arthritic hip pain that improve functional movement control during the single leg squat test and step-down test have better patient-reported outcomes than those that do not improve, following the implementation of a rehabilitation intervention and a standardized home-exercise program. Subjects: Forty-six individuals (31 females; 15 males) with a mean age of 30 years (range = 14-61; SD = 12) were included in this retrospective study. These individuals were patients of an orthopaedic surgeon who were clinically diagnosed and conservatively treated for non-arthritic hip pain from chondrolabral lesions caused by FAI, dysplasia and/or structural abnormalities. Participants must have had evaluations for both the initial and follow-up test performance of the single leg squat test and step-down test, following the implementation of a rehabilitation intervention and a standardized home-exercise program. Materials/Methods: The following information was retrospectively collected from an outcomes registry: age, gender, height, weight, body mass index (BMI), side of involved hip, duration of symptoms, intra-articular diagnosis, current pain level (VAS), hip outcome score for limitations in activities of daily living (HOS-ADL) and sports-related activities (HOS-SRA), percent global rating for activities of daily living (% - ADL) and sports-related activities (% - SRA), the categorical assessment of function, patient satisfaction, the individual’s decision to proceed with surgical intervention or not, and evaluations of test performance for the single leg squat test and step-down test from both the initial and follow-up clinical evaluations. The research data for the current study was de-identified so that subjects could not be identified, directly or through identifiers linked to the subjects. A one-tail, independent t-test and a one-way analysis of covariance (ANCOVA) with a pre-determined alpha set of 0.05 were performed for each continuous patient-reported outcome (VAS, HOS-ADL, HOS-SRA, % - ADL, % - SRA). A Fisher’s exact test with a pre-determined alpha set of 0.05 was performed for each categorical patient-reported outcome (categorical rating of function, patient satisfaction, and choice for surgical intervention or not). Results: There was a statistically significant difference (p≤.022) between individuals that improved and those that did not improve their functional performance for the following measures: VAS for SLST and SDT, HOS-ADL for the SLST and SDT, HOS-SRA for the SLST and SDT, % - ADL for the SLST and SDT, and % - SRA for the SLST. There was not a statistically significant difference for the % - SRA for the SDT (p=.094). There was a statistically significant relationship (p≤.004) between those individuals that improved and those that did not improve their functional performance for both the SLST and SDT with patient satisfaction and surgery. There was not a statistically significant relationship between those individuals that improved and those that did not improve their functional performance for both the SLST and SDT with their categorical rating of function (p≥.117). Conclusions: Individuals that improved their functional movement control during performance of the SLST and SDT reported less pain, higher scores for functional ability in their daily and sports-related activities, higher scores for their global rating of functional ability in their daily and sport-related activities, higher patient satisfaction with the prescribed rehabilitation intervention and standardized home-exercise program, and lower rates of surgical intervention, than those that did not improve. Clinical Relevance: The results of this study suggest that individuals who improved their functional movement control are more likely to report less pain and greater functional ability in their daily and sports-related activities following a prescribed rehabilitation intervention and standardized home-exercise program. A significant number of individuals who improved their functional movement control reported greater satisfaction with the prescribed rehabilitation intervention as well as lower rates of surgical intervention, than those that did not improve. There is potential significance for the routine addition of the SLST and SDT into the clinical assessment of non-arthritic hip pain and dysfunction as measures of function. This study also supports the use of a rehabilitation intervention and a standardized home-exercise program to acutely improve outcomes for those with non-arthritic hip pain

The Future of Francophone Africa Without the Aid and Influence of its Former Colonial Power, France

French colonialism dramatically changed sub-Sahara Africa in the region now called Francophone Africa. In 1960 the French granted the francophone countries independence but French influence did not end. France\u27s neo- colonial influence caused many problems for the newly independent countries including economic dependence, unwanted boundaries and the establishment of an elite class. The Africans themselves have been struggling with mismanagement, corruption and political and economic instability. Recent breaks in Franco-African relations has caused the French to take a step back from its high level of influence in Africa. In order for francophone Africa to prosper without the aid and influence of France, it must reform internally and provide stability through education and constitutional reform. Then the francophone countries should bring trade to a regional level so that all the African states can develop together without the exploitation of, and dependency upon, the western powers

An efficient consistency management algorithm for real-time mobile collaboration

Real time mobile collaboration involves two or more co-workers operating concurrently on a shared document using independent mobile devices. The replicated architecture is attractive for such applications since it does not rely on a central server and a user can continue to work on his or her own local document replica even during disconnection period. Several consistency management algorithms have been proposed, however the resource usage of such algorithms, which is critical in a mobile environment, has not been formally studied. Mobile devices are constrained in terms of memory and processing power, and operate in networking environments with limited bandwidth and transient connectivity. Therefore, algorithms that use resources more effectively improve the quality of the user experience in a mobile environment. ISO 9126-1 considers software to be efficient if it provides a balance between performance, and resource utilisation while performing its function. Therefore, this paper evaluates the efficiency of existing techniques, and proposes a more efficient consistency management algorithm. The new algorithm leverages existing techniques which are shown to be efficient and incorporates a novel history management strategy called partial history copy. Different combinations of these techniques are tested and compared to determine which one is most efficient and thus suitable for mobile usage

Secondary care interface:optimising communication between teams within secondary care to improve the rehabilitation journey for older people

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital’s rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan–Do–Study–Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation

The Impact of Depression on Patient Outcomes in Hip Arthroscopic Surgery.

Background: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement. Hypothesis: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and 12-item Short-Form Health Survey (SF-12) when consenting for surgery. At 2-year follow-up, patients were emailed the iHOT, the VAS, and a rating scale of surgical satisfaction. Initial SF-12 mental component summary (MCS) scores Results: A total of 781 patients achieved the approximate 2-year milestone (mean follow-up, 735 ± 68 days), with 651 (83%) having 2-year outcome data available. There were 434 (67%) female and 217 (33%) male patients, with a mean age of 35.8 ± 13.0 years and a mean body mass index of 25.4 ± 8.8 kg/m Conclusion: A large number of patients who underwent hip arthroscopic surgery presented with symptoms of depression, which negatively affected self-reported function, pain levels, and satisfaction on initial assessment and at 2-year follow-up. Surgeons who perform hip arthroscopic surgery may need to identify the symptoms of depression and be aware of the impact that depression can have on surgical outcomes

Are CT-derived muscle measurements prognostic, independent of systemic inflammation in good performance status patients with advanced cancer?

The present study examined the relationships between CT-derived muscle measurements, systemic inflammation, and survival in advanced cancer patients with good performance status (ECOG-PS 0/1). Data was collected prospectively from patients with advanced cancer undergoing anti-cancer therapy with palliative intent. The CT Sarcopenia score (CT-SS) was calculated by combining the CT-derived skeletal muscle index (SMI) and density (SMD). The systemic inflammatory status was determined using the modified Glasgow Prognostic Score (mGPS). The primary outcome of interest was overall survival (OS). Univariate and multivariate Cox regressions were used for survival analysis. Three hundred and seven patients met the inclusion criteria, out of which 62% (n = 109) were male and 47% (n = 144) were ≥65 years of age, while 38% (n = 118) were CT-SS ≥ 1 and 47% (n = 112) of patients with pre-study blood were inflamed (mGPS ≥ 1). The median survival from entry to the study was 11.1 months (1–68.1). On univariate analysis, cancer type (p < 0.05) and mGPS (p < 0.001) were significantly associated with OS. On multivariate analysis, only mGPS (p < 0.001) remained significantly associated with OS. In patients who were ECOG-PS 0, mGPS was significantly associated with CT-SS (p < 0.05). mGPS may dominate the prognostic value of CT-derived sarcopenia in good-performance-status patients with advanced cancer

Lactate dehydrogenase: Relationship with the diagnostic GLIM criterion for cachexia in patients with advanced cancer

Background: Although suggestive of dysregulated metabolism, the relationship between serum LDH level, phenotypic/aetiologic diagnostic Global Leadership Initiative on Malnutrition (GLIM) criteria and survival in patients with advanced cancer has yet to examined. Methods: Prospectively collected data from patients with advanced cancer, undergoing anti-cancer therapy with palliative intent, across nine sites in the UK and Ireland between 2011–2016, was retrospectively analysed. LDH values were grouped as <250/250–500/>500 Units/L. Relationships were examined using χ2 test for linear-by-linear association and binary logistics regression analysis. Results: A total of 436 patients met the inclusion criteria. 46% (n = 200) were male and 59% (n = 259) were ≥65 years of age. The median serum LDH was 394 Units/L and 33.5% (n = 146) had an LDH > 500 Units/L. LDH was significantly associated with ECOG-PS (p < 0.001), NLR (p < 0.05), mGPS (p < 0.05) and 3-month survival (p < 0.001). LDH was significantly associated with 3-month survival independent of weight loss (p < 0.01), BMI (p < 0.05), skeletal muscle mass (p < 0.01), metastatic disease (p < 0.05), NLR (p < 0.05) and mGPS (p < 0.01). Discussion: LDH was associated with performance status, systemic inflammation and survival in patients with advanced cancer. LDH measurement may be considered as an aetiologic criteria and become a potential therapeutic target in the treatment of cancer cachexia