Flexor tendon repair : rehabilitation adherence, outcome and complications

Flexor tendon injuries in the finger (zones 1 and 2) are problematic due to high rates of both rupture of the repair and of soft tissue adhesions resulting in poor range of motion. Both complications often result in reoperations and worse outcome of the injury. Rehabilitation after flexor tendon repair is a balancing act for the patient. The exercise and daily activities of the hand need to be at enough force to avoid soft tissue adhesion forming which restrict finger motion but still with low enough force to avoid rupture of the repaired tendon. This creates high demands on patient’s adherence while coping with the injury in everyday life. The literature describes the importance of adherence but, there is little evidence in terms of how to improve and understand patient adherence to flexor tendon rehabilitation. Risk factors for the two most common reasons for reoperations have been studied but there is a lack of studies including detailed variables about the repair, the injury and the patient. The outcome after flexor tendon repair is often reported as a classification into a category; poor, fair, good or excellent based on the finger range of motion. This classification could be criticized as being too simplistic for a complex injury, but still there is little known about how the patients´ perceptions of their outcome corresponds to these classifications. The overall aim of this thesis was to improve and explore rehabilitation adherence and outcome, including a smartphone intervention and patients´ perspectives, and to explore complications after flexor tendon repair and rehabilitation. In paper 1, a total of 101 patients were included at the start of early active motion rehabilitation after their flexor tendon repair. Patient were randomised to rehabilitation with the aid of a smartphone application or according to standard rehabilitation. Patients adherence, self-efficacy and range of motion were then assessed at baseline, and two, six and 12 weeks after repair. There were no overall differences between the groups in range of motion, adherence, or self-efficacy. In paper 2, Seventeen patients with flexor tendon repairs were interviewed after three months of early active motion rehabilitation. The interviews were then transcribed and analysed according to deductive content analysis based on the health belief theory. The results are described in six categories: perceived susceptibility to loss of hand function; perceived severity of the injury; perceived relationship between cost, benefits and efficacy of rehabilitation; perceived self-efficacy; relationship between patient and practitioner; and external factors. In paper 3 data was collected from the Swedish national hand surgery registry (HAKIR) and Statistics Sweden (SCB) on a cohort of patients with flexor tendon repair between 2010 and 2019. A total of 1375 patients were identified and followed for at least one year to assess reoperation due to rupture or tenolysis. The result showed that 5% of patients had been reoperated due to rupture and 4.8% due to tenolysis. There was an increased risk of rupture in male patient, age above 25 and in patients where the FPL tendon had been repaired. If both the FDP and FDS tendons were repaired, it increased the risk for both tenolysis and rupture. With increasing income, the frequency of tenolysis increased. In paper 4 we collected data from HAKIR on patient with flexor tendon repair between 2010 and 2020. We then used data on patients with a complete set of data from the patient questionnaires and functional assessments of range of motion at three and 12 months after repair. The patient questionnaire included the HQ-8, Quick-DASH and perceived satisfaction with results. We assessed 215 patients at three months after repair, and 150 patients at 12 months. We calculated the association between patient reported outcome and the Original Strickland classification. As perceived stiffness increased the OR of being in a higher Strickland level decreased, although perceived stiffness could only discriminate between the independent levels of fair and good. An increased Quick-DASH score decreased the OR of being in a higher Strickland level, although only between fair and poor results at three months. As perceived satisfaction with result increased, the OR of being in a higher Strickland level also increased. But perceived satisfaction could only discriminate between the levels of fair and good at twelve months. In conclusion, the smartphone application did not increase the adherence, self-efficacy or range of motion during the first three months of rehabilitation. Patients’ perceptions of the injury, the rehabilitation, and the context and support during rehabilitation affects adherence. Several risk factors were associated with reoperation due to rupture or tenolysis, namely male sex, age above 25, injury to FPL or both FDP and FDS. Patient-reported outcome only corresponded with some independent levels of Strickland and the classification of range of motion into poor, fair, good and excellent may thus add little value to the patients. Understanding the risk factors, the constructs related to adherence and patient-reported outcome may give important knowledge to surgeons and therapists when treating patients with flexor tendon injuries

Comments on Li et al. Effects of in Utero Exposure to Dicyclohexyl Phthalate on Rat Fetal Leydig Cells. Int. J. Environ. Res. Public Health 2016, 13, 246

Profiling the expression levels of genes or proteins in tissues comprising two or more cell types is commonplace in biological sciences. Such analyses present particular challenges, however, for example a potential shift in cellular composition, or ‘cellularity’, between specimens. That is, does an observed change in expression level represent what occurs within individual cells, or does it represent a shift in the ratio of different cell types within the tissue? This commentary attempts to highlight the importance of considering cellularity when interpreting quantitative expression data, using the mammalian testis and a recent study on the effects of phthalate exposure on testis function as an example

Dense water formation in the Greenland Sea between 1999 and 2009

A 10-year continuous hydrographic data record from moored profilers located in the central Greenland Sea between 1999 and 2009 were used to examine the mixed-layer depth evolution through winter as well as interannual variability in water column properties and convection depth. The water column has become significantly warmer and more saline through the decade. The depth of convection each winter was a result of heat loss to the atmosphere, the water column stratification, and lateral fluxes of heat and salt. Even though the mixed-layer depth differed from year to year the evolution through each winter showed a similar pattern which could be separated into three distinct phases. Most of the mixed-layer cooling took place during the first phase. In the second phase the mixed layer deepened rapidly before it stabilized and restratified in the third phase at the end of the winter. The high temporal resolution of the data set allowed for a detailed investigation of the mixed layer and its direct response to atmospheric forcing on short time scales. The effect of short, intense atmospheric events, called cold air outbreaks, on the mixed layer depended strongly on which phase they occurred within. While strong atmospheric forcing in the first phase of the convection process mainly cooled the mixed layer, it led to a significant mixed-layer deepening during the second phase. Experiments done with a one-dimensional mixed-layer model suggested that intense events of heat loss early in winter are more favorable for deep convection to occur.Masteroppgave i meteorologi og oseanografiGEOF399MAMN-GEO

Nullpunktet?

How does art produce subjectivity, and does art always work for a better production of subjectivity? With an outset in an ethnographic study and participatory observation of youth encountering practices of contemporary art in upper secondary school, the article introduces Félix Guattari’s concepts regarding serial and singular processes of subjectivation, passages from territory to deterritorialization, and the role the poetic function plays in the production of subjectivity. As the study indicates, poetic practices involved in the production of subjectivity can work for better or worse. In other words, art cannot be immediately beneficial for democracy, the environment, or individual or collective mental health and wellbeing; yet the methods and processes of art are disruptive, allowing for the possibility of subjectivation.publishedVersio

Surrogacy and Adoption:An Empirical Investigation of Public Moral Attitudes

Surrogacy and adoption are both family-making measures subject to extensive domestic and international regulation. In this nationally representative survey study (N = 1552), we explore public attitudes to various forms of surrogacy and adoption in the United Kingdom, in response to an early proposal to allow “double donor” surrogacy as part of the ongoing legal reform project. We sought to both gauge public moral support for adoption and surrogacy generally, the effect that prospective parents’ fertility had on this support, and the extent to which the public would find equivalencies between “double donor” surrogacy (DDS) and planned private adoption (PPA) to be morally significant. Our findings indicate that whilst there is broad baseline support for all forms of adoption and surrogacy, this support increases significantly when one or both prospective parents are infertile. These findings also suggest that the language in which a family-making arrangement is characterized has a greater influence on moral support for the arrangement than practical features such as the biological relationship (or absence thereof) between one/both parents and the child