Low back pain : a comparative study on the value of core training versus traditional strengthening exercises

This randomised controlled trial (RCT) employed a pre-test/post-test design to compare the effects of core training (Pilates method) and traditional back exercises on a population with low back pain (LBP). Therapeutic intervention related to the Pilates method has recently become popular, but there is little evidence to prove it works. In this study, 120 individuals with LBP were allocated to three different groups. Group A was the control group, Group B was given modified Pilates intervention and Group C received traditional back exercises. All three groups were given a posture re-education session and back-care advice. After the initial session, the control group had individual sessions on posture re-education. The other groups undertook a six-week course of either modified Pilates or general back exercise classes. The modified Pilates group was taught how to use the core muscles, incorporating stabilisation with increasing functional movements. The back exercise group did similar exercises without learning to specifically stabilise. The Oswestry Low Back Pain Disability Questionnaire (ODQ) and the Visual Analogue Scale (VAS) were used as measures for pain and functional disability. Post-test ODQ readings showed no significant difference for pain-related function whilst VAS readings revealed a significant improvement in pain levels in all three groups, with the control group showing the best scores. However, the six-month follow-up scores showed that only the modified Pilates group continued to improve. At this stage, the control group was beginning to regress and the back exercise group was almost back to baseline measures. It was therefore concluded that core stability exercises have better long-term effects than traditional back exercisespeer-reviewe

How Does a Standing Exercise Programme Focusing on Hip-Abduction Strength Affect Anterior Knee Pain in Runners?

Outline: Anterior Knee Pain (AKP) is the most prevalent injury in running. Growing evidence suggests that hip muscle imbalance plays a role in the development of AKP. Gluteus Medius (GMed) is the main abductor of the hip and also stabilises the pelvis during gait. Studies show that hip-abduction strength is decreased in populations with AKP. This relates to increased hip-adduction, hip internal rotation and knee abduction, which are associated with higher patellofemoral contact pressures. Objective: The main aim of this study is to determine whether a standing exercise programme will improve hip-abductor strength. The second aim of the study is to determine whether there will be a decrease in running-related pain after completing a six-week standing exercise programme. Design: Within-participant pre-test/post-test comparative trial.Setting: The Sport’s Clinic at the Malta Football Association. Ta Qali National Stadium (Malta).Main outcome measures: GMed torque was measured using a Biodex® System 3 isokinetic dynamometer as demonstrated by Brent et al (2013). The Numerical Rating Scale was used to measure pain related to running. Results: Pre-test torque scores were higher on the affected side. Scores on the affected side improved by 22.81% from a mean baseline average of 96.00Nm/kg to 117.86Nm/kg, (p-value 0.013). Scores on the unaffected side improved by 27.97% from a mean baseline average of 90.14Nm/kg to 115.29Nm/kg (p-value 0.031). Post-test scores were more balanced between limbs. Pain scores decreased from 5.29 as measured on the NRS to 1.00 (p-value 0.000). Conclusion: Standing exercises aimed at strengthening the hip-abductors may prove to be a valid intervention for prevention and rehabilitation of AKP. However, better quality studies are needed in order to validate this

Diagnostic utility and outcomes of inpatient investigations for syncope in a regional setting

Background: Syncope is a common presentation to the emergency department with a wide spectrum of aetiology. The identification of the underlying cause can be diagnostically challenging, as are the choice of investigations and the decision for inpatient versus outpatient disposition. Aims: This study aimed to evaluate the aetiology of syncope as documented, the diagnostic yield of inpatient investigations and outcomes for adult patients admitted for syncope. Methods: A single-centred, retrospective cohort study was conducted in adult patients admitted for syncope within a 2-year period. A total of 386 patients were identified after exclusion. Information regarding syncope aetiology, investigations and outcomes were established via chart review of electronic records. Results: The most common cause of syncope was neural-mediated (43%), followed by orthostatic (36.5%) and cardiogenic (20.5%). The investigations performed in order of frequency included: telemetry electrocardiogram (ECG) (75.4%), computed tomography head non-contrast (58.8%), transthoracic echocardiogram (TTE) (20.2%), computed tomography pulmonary angiogram (CTPA) (6.5%), MR brain (3.9%), electroencephalogram (1.3%) and carotid ultrasound (0.3%). Telemetry ECG, TTE and CTPA led to the diagnosis of syncope in a minority of patients only. As a result, 17.5% of patients had a new intervention on discharge, 5.4% were readmitted for syncope and 9.6% of patients died. Conclusions: In the context of the inpatient evaluation of syncope, this study supports the use of telemetry ECG and TTE. Neuroimaging demonstrates a low diagnostic yield for the cause of syncope, but it may have a role to play in excluding other pathologies. Our study does not support the routine use of CTPA, EEG or carotid ultrasound in the evaluation of syncope

Importance of 3-dimensional imaging in the early diagnosis of chondroblastic osteosarcoma

The aim of this report is to present a case of chondroblastic osteosarcoma located in the right maxillary premolar region of a 17-year-old female patient. The initial clinical presentation and 2-dimensional (2D) radiographic methods proved inadequate for a definitive diagnosis. However, a cone-beam computed tomography scan revealed a hyperdense, heterogeneous lesion in the right maxillary premolar region, exhibiting a characteristic “sun-ray” appearance. To assess soft tissue involvement, a medical computed tomography scan was subsequently conducted. A positron emission tomography scan detected no metastasis or indications of secondary tumors. T1- and T2-weighted magnetic resonance imaging showed signal heterogeneity within the lesion, including areas of low signal intensity at the periphery. Histological examination conducted after an incisional biopsy confirmed the diagnosis of high-grade chondroblastic osteosarcoma. The patient was then referred to an oncology department for chemotherapy before surgery. In conclusion, these findings suggest that early diagnosis using 3-dimensional imaging can detect chondroblastic osteosarcoma in its early stages, such as before metastasis occurs, thereby improving the patient’s prognosis.peer-reviewe

Unconditional and conditional monetary incentives to increase response to mailed questionnaire : a randomised controlled study within a trial (SWAT)

Rationale, aims, and objectives: High response rates to research questionnaires can help to ensure results are more representative of the population studied and provide increased statistical power, on which the study may have been predicated. Improving speed and quality of response can reduce costs.Method: We conducted a randomised Study Within A Trial (SWAT) to assess questionnaire response rates, reminders sent and data completeness with unconditional compared to conditional monetary incentives. Eligible individuals were mailed a series of psychological questionnaires as a follow-up to a baseline host trial questionnaire. Half received a £5 gift voucher with questionnaires (unconditional) and half were promised the voucher after returning questionnaires (conditional).Results: Of 1079 individuals, response rates to the first follow-up questionnaire were 94.2% and91.7% in the unconditional and conditional monetary incentive groups respectively (OR 1.78, 95% CI0.85 to 3.72). There were significantly greater odds of returning repeat questionnaires in the unconditional group at six months (OR 2.97, 95% CI 1.01 to 8.71; p = 0.047) but not at 12 months(OR 1.12, 95% CI 0.44 to 2.85). Incentive condition had no impact at any time point on the proportion of sent questionnaires that needed reminders. Odds of incomplete questionnaires were significantly greater at three months in the unconditional compared to the conditional incentive group (OR 2.45, 95% CI 1.32 to 4.55; p = 0.004).Conclusions: Unconditional monetary incentives can produce a transitory greater likelihood of mailed questionnaire response in a clinical trial participant group, consistent with the direction of effect in other settings. However, this could have been a chance finding. The use of multiple strategies to promote response may have created a ceiling effect. This strategy has potential to reduce administrative and postage costs, weighed against the cost of incentives used, but could risk compromising the completeness of data

Psychological impact of lung cancer screening using a novel antibody blood test followed by imaging: the ECLS randomised controlled trial

Background: The Early CDT®-Lung antibody blood test plus serial CT-scans for test-positives reduces late-stage lung cancer presentation. This study assessed psychological outcomes of this approach.Methods: Randomised controlled trial (n=12,208) comparing psychological outcomes 1-12 months post-recruitment in a subsample (n=1032) of test-positive (TPG), test-negative (TNG) and control groups (CG).Results: Compared to TNG, TPG had lower positive affect (Difference between means (DBM), 3-months (3m):-1.49 (-2.65, - 0.33)), greater impact of worries (DBM 1m:0.26 (0.05, 0.47); 3m:0.28 (0.07, 0.50)), screening distress (DBM 1m:3.59 (2.28, 4.90); 3m:2.29 (0.97, 3.61); 6m:1.94 (0.61, 3.27)) worry about tests (OR 1m:5.79 (2.66, 12.63) and more frequent lung cancer worry (Odds ratio (OR) 1m:2.52 (1.31, 4.83); 3m:2.43 (1.26, 4.68); 6m:2.87 (1.48, 5.60)). Compared to CG, TPG had greater worry about tests (OR 1m:3.40 (1.69, 6.84)). TNG had lower negative affect (log-transformed DBM 3m:-0.08 (-0.13, -0.02)), higher positive affect (DBM 1m:1.52 (0.43, 2.61); 3m:1.43 (0.33, 2.53); 6m:1.27 (0.17, 2.37)), less impact of worries (DBM 3m:-0.27 (-0.48, -0.07)) and less frequent lung cancer worry (OR 3m:0.49 (0.26, 0.92)). Conclusions: Negative psychological effects in TPG and positive effects in TNG were short-lived and most differences were small

Lung cancer CT screening: psychological responses in the presence and absence of pulmonary nodules

Objectives: To determine the psychological response (thoughts, perceptions and affect) to a diagnosis of pulmonary nodules following a novel antibody blood test and computed tomography (CT) scans within a UK population. Materials and methods: This study was nested within a randomised controlled trial of a blood test (Early CDT®-Lung test), followed by a chest x-ray and serial CT-scanning of those with a positive blood test for early detection of lung cancer (ECLS Study). Trial participants with a positive Early CDT®-Lung test were invited to participate (n=338) and those agreeing completed questionnaires assessing psychological outcomes at 1, 3 and 6 months following trial recruitment. Responses of individuals with pulmonary nodules on their first CT scan were compared to those without (classified as normal CT) at 3 and 6 months follow-up using random effects regression models to account for multiple observations per participant, with loge transformation of data where modelling assumptions were not met. Results: There were no statistically significant differences between the nodule and normal CT groups in affect, lung cancer worry, health anxiety, illness perceptions, lung cancer risk perception or intrusive thoughts at 3 or 6 months post-recruitment. The nodule group had statistically significantly fewer avoidance symptoms compared to the normal CT group at 3 months (impact of events scale avoidance (IES-A) difference between means -1.99, 95%CI -4.18, 0.21) than at 6 months (IES-A difference between means 0.88, 95%CI -1.32, 3.08; p-value for change over time =0.003) with similar findings using loge transformed data. Conclusion: A diagnosis of pulmonary nodules following an Early CDT®-Lung test and CT scan did not appear to result in adverse psychological responses compared to those with a normal CT scan

Lung cancer screening: does pulmonary nodule detection affect a range of smoking behaviours?

Background Lung cancer screening can reduce lung cancer mortality by 20%. Screen-detected abnormalities may provide teachable moments for smoking cessation. This study assesses impact of pulmonary nodule detection on smoking behaviours within the first UK trial of a novel auto-antibody test, followed by chest x-ray and serial CT scanning for early detection of lung cancer (Early Cancer Detection Test-Lung Cancer Scotland Study). Methods Test-positive participants completed questionnaires on smoking behaviours at baseline, 1, 3 and 6 months. Logistic regression compared outcomes between nodule (n=95) and normal CT groups (n=174) at 3 and 6 months follow-up. Results No significant differences were found between the nodule and normal CT groups for any smoking behaviours and odds ratios comparing the nodule and normal CT groups did not vary significantly between 3 and 6 months. There was some evidence the nodule group were more likely to report significant others wanted them to stop smoking than the normal CT group (OR across 3 and 6 month time points: 3.04, 95%CI 0.95, 9.73; p=0.06). Conclusion Pulmonary nodule detection during lung cancer screening has little impact on smoking behaviours. Further work should explore whether lung cancer screening can impact on perceived social pressure and promote smoking cessation