Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome.</p> <p>Methods/Design</p> <p>This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization.</p> <p>The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks.</p> <p>Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments for the shoulder, direct and indirect costs, and sick leave due to shoulder complaints will be recorded in a shoulder log-book.</p> <p>Discussion</p> <p>To our knowledge this is the first trial comparing individualized physiotherapy based on a defined decision making process to a standardized exercise protocol. Using high-quality methodologies, this trial will add evidence to the limited body of knowledge about the effect of physiotherapy in patients with SIS.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN86900354</p

How private is private information?:The ability to spot deception in an economic game

First Online: 22 February 2016We provide experimental evidence on the ability to detect deceit in a buyer–seller game with asymmetric information. Sellers have private information about the value of a good and sometimes have incentives to mislead buyers. We examine if buyers can spot deception in face-to-face encounters. We vary whether buyers can interrogate the seller and the contextual richness. The buyers’ prediction accuracy is above chance, and is substantial for confident buyers. There is no evidence that the option to interrogate is important and only weak support that contextual richness matters. These results show that the information asymmetry is partly eliminated by people’s ability to spot deception

Competition and Prosociality: A Field Experiment in Ghana

Competitive bonuses are commonly used to promote higher productivity in the workplace. Yet, these types of incentives could have negative spillovers on coworkers' prosocial behavior in subsequent tasks. To investigate this question, we conduct a lab-in-the-eld experiment in Ghana. In a between-subjects design, participants complete a real-eort task under a competitive, threshold, or random payment while holding payment dierentials constant across treatments. Before and after, we measure prosociality through a public goods and a social value orientation game. Competition reduces prosociality when the dispersion of payments is high. However, when there is less at stake, competition does not aect prosociality

Investigations in generalized osteoarthritis. Part 2: Special histological features in generalized osteoarthritis (histological investigations in Heberden's nodes using a histological score)

SummaryObjectiveIn accordance with the literature, our previous epidemiological, clinical and genetical investigations have confirmed a correlation between generalized osteoarthritis (GOA) and Heberden's nodes. Heberden's nodes can be considered as genetic markers for the existence of a generalized osteoarthritic predisposition. The present study's concern was to establish whether there are special histological features in this disease.MethodsLayered sections of 218 distal finger joints from 56 deceased persons were investigated using a histological–histochemical score modified by Mankin.ResultsIn Heberden's nodes, we found all the typical degradative sequences of the osteoarthritic process but also some specific modifications. The osteoarthritis (OA) starts with a subchondral ossification and manifests a reactive tidemark flaking. At this time, the surface of the cartilage is not yet destroyed. Later on, there is progression of general degradation. Significant differentiation from the control group is possible using a histological score.ConclusionsIn patients with Heberden's nodes, the OA starts with the subchondral ossification. Heberden's nodes are the specific manifestation of GOA in the distal finger joints. Further studies are therefore required to assess whether the same pathogenetic mechanism can be seen in OA of the large joints in GOA