Predicting Risk for Adverse Outcomes Following Distal Radius Fracture

Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules or assessing the risk of these adverse outcomes following DRF. The first manuscript outlines a theoretical framework (RACE - Reducing pain, Activating, Cognitive reshaping, Empowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF. The Patient-Rated Wrist Evaluation (PRWE) is a condition-specific measure for DRF used in research as well as clinical practice to measure pain and functions in individuals with different wrist/hand injuries. The second manuscript contributes to the literature by providing the first systematic literature review that synthesizes the evidence regarding the psychometric properties of the PRWE. The review determined that the PRWE has excellent reliability, construct validity, and responsiveness in individuals with DRF. The third manuscript indicates that the baseline pain intensity is an independent predictor of chronic pain in individuals with DRF. The results also suggest that the individuals who score ≥35/50 on the pain scale of the PRWE at baseline have 8 times greater risk for developing chronic wrist/hand pain compared to those who score \u3c 35/50. The fourth and fifth manuscripts describe results of a two step study. The fourth manuscript is a structured literature synthesis that identified suitable measures for predicting the risk of falls and fall-related osteoporotic fractures following DRF. The fifth manuscript summarizes the results of preliminary analysis of psychometric properties of selected fall risk measures identified in the fourth manuscript. The fifth manuscript also provides feasibility and sample size requirements for conducting a fall prevention trial in individuals with DRF

Systematic review of home physiotherapy after hip fracture surgery

OBJECTIVE: To compare the benefits of home physiotherapy, institution-based physiotherapy and no physiotherapy following hip fracture surgery. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: Two reviewers independently extracted data from 5 included studies. Standardized mean differences were pooled for health-related quality of life and performance-based outcomes. Review Manager Version 5 was used for data analysis. RESULTS: Analysis of the 5 included studies indicated that home physiotherapy was better than no physiotherapy and similar to outpatient physiotherapy in improving patient-reported health-related quality of life. Performance-based outcomes were marginally better following outpatient physiotherapy compared with home physiotherapy 3 and 6 months after surgery. The risk of bias was high for most outcomes due to methodological issues in the included studies. Discussion: There was a trend of better results with increasing intensity of physiotherapy intervention, but this did not convert into significant effect sizes. The results of this review do not build a strong consensus for recommending one mode of physiotherapy over the others. The quality of evidence was low mainly due to the high risk of bias in the included studies. CONCLUSION: In light of no strong consensus, physiotherapists should continue to follow their current workplace practice policies for determining suitable discharge settings

Cross-cultural Adaptation and Psychometric Testing of the Hindi Version of the Patient-rated Wrist Evaluation

The purpose of this study was to perform cross-cultural adaptation and Hindi translation of the patient-rated wrist evaluation (PRWE) and assess psychometric properties of the PRWE-Hindi. Cross-cultural adaptation and Hindi translation of the PRWE was performed using standardized guidelines. Intraclass correlation coefficient (ICC) was used for assessing test–retest reliability, and Cronbach’s alpha (CA) was used for assessing the internal consistency of the PRWE-Hindi. Construct validity was assessed by examining the correlations between the PRWE-Hindi and grip strength, wrist range of movements, and self-reported pain and disability. A total of 50 patients with distal radius fracture were recruited and assessed three times (baseline, two to three days later, and four to five weeks later). PRWE-Hindi demonstrated excellent test–rest reliability (ICC=0.81) and internal consistency (CA=0.89). Moderate to low correlations (r\u3c0.7) were observed between the PRWE-Hindi and other measures of pain and disability. Our results indicated that PRWE-Hindi is a reliable and valid tool and can be used in patients with wrist/hand injuries whose primary language is Hindi

The Implications of Chronic Pain Models for Rehabilitation of Distal Radius Fracture

Distal radius fracture (DRF) is the most common fracture and usually occurs as a result of a fall. Most patients recover following DRF with minimal residual pain or disability; however, a small subset of patients continue to experience pain and disability even one year after the injury. Currently, there are no practice guidelines for early identification and treatment of patients who are potentially at greater risk of developing these adverse outcomes. As a result, hand therapy management of patients following DRF does not incorporate screening of these at-risk patients. The objective of this paper is to apply constructs from learned helplessness and cognitive-behavioural models of chronic pain in assessing the psychosocial risk profile of patients following DRF. We have also integrated key findings derived from studies addressing personal and life-style factors in assessing this risk profile. This framework is proposed as a basis to categorize patients as higher or lower psychosocial risk for developing chronic pain and disability following DRF. We outline a model depicting the RACE approach (Reducing pain, Activating, Cognitive reshaping, Empowering) towards the management of patients following DRF. The model suggests that patients with minimal psychosocial risk factors are managed based on their injury profile and those with higher psychosocial risk are treated with the risk-based RACE approach. Using a biopsychosocial RACE approach to prognosis and treatment, hand therapy intervention can be customized for patients recovering from DRF. In future, researchers can conduct clinical trials to compare the RACE-based treatment approach to routine hand therapy in mitigating the risk of chronic pain and disability in patients with elevated risk profile for adverse outcomes following DRF

Matrix Free approach for Raviart-Thomas anisotropic Tensor Product Finite Elements

In this thesis, we develop techniques for fast, efficient cell based operator evaluation of Raviart-Thomas finite elements and thereby extend the existing implementation of matrix free framework in deal.ii. The extensions allow the framework to also support anisotropic vector-valued finite elements in addition to existing isotropic Lagrangian finite elements. Tests on finite element operators in divergence conforming spaces for Mixed diffusion equation and Stokes equations show that the method is sufficiently accurate (relative error 10e-16) and for RT2 is already twice as fast as corresponding sparse matrix based solution

A Systematic Review of the Health-related Quality of Life Measures following Total Knee Arthroplasty

To perform systematic review and appraisal of common patient-reported outcomes (PROs) used in measuring aspects of health-related quality of life (HRQOL) following total knee arthroplasty (TKA). Especially, the study aimed to examine whether these common PROs assess the domains of HRQOL as described in the theoretical frameworks of the HRQOL

Performance Analysis and Improvement of WPAN MAC for Home Networks

The wireless personal area network (WPAN) is an emerging wireless technology for future short range indoor and outdoor communication applications. The IEEE 802.15.3 medium access control (MAC) is proposed to coordinate the access to the wireless medium among the competing devices, especially for short range and high data rate applications in home networks. In this paper we use analytical modeling to study the performance analysis of WPAN (IEEE 802.15.3) MAC in terms of throughput, efficient bandwidth utilization, and delay with various ACK policies under error channel condition. This allows us to introduce a K-Dly-ACK-AGG policy, payload size adjustment mechanism, and Improved Backoff algorithm to improve the performance of the WPAN MAC. Performance evaluation results demonstrate the impact of our improvements on network capacity. Moreover, these results can be very useful to WPAN application designers and protocol architects to easily and correctly implement WPAN for home networking

Facial Recognition in Public Areas

The security of information nowadays is very significant and difficult, so there are a number of ways to improve security. Especially in public areas like airports, railway sta-tions, Universities, ATMs, etc. and security cameras are presently common in these areas. So, in this paper, we are presenting how Facial recognition can be used in public areas like airports, toll gates, offices, etc. We are comparing or matching a face of a person who we want to detect, with the video which is recorded through CCTV. There are certain algorithms to detect faces from video like through HAAR cascades, eigenface, fisher face, etc. open-source computer vision library is used for facial recognition

Concurrent Validation of the DASH and the QuickDASH in Comparison to Neck-Specific Scales in Patients With Neck Pain

Study Design. Concurrent validity study. Objective. To examine the validity of the Disabilities of Arm, Shoulder, and Hand (DASH) and the QuickDASH in patients with neck pain in comparison with the Neck Disability Index (NDI), the Cervical Spine Outcome Questionnaire (CSOQ), and the Visual Analogue Scale (VAS) for pain. To examine the agreement between the DASH and the QuickDASH and assess whether the QuickDASH can be used instead of full DASH in patients with neck pain. Summary of Background Data. NDI is commonly used for measuring neck-related disability in patients with neck pain; but it does not offer to assess the potential for upper extremity disability. Methods. Patients with neck pain (N = 66) were assessed on one occasion. They completed the NDI and the DASH, and 42 of them completed the CSOQ. The QuickDASH scores were extracted from the full DASH. Correlations were tested between both versions of the DASH, the NDI, the subscales of the CSOQ, and the VAS-pain. Correlations were considered high with r \u3e0.75. Ranked item difficulty analysis was performed for both versions of the DASH and the NDI. The Bland and Altman technique was used to assess the nature and size of score differences between 2 versions of the DASH. Results. Item ranks identified the DASH and the QuickDASH items to be as problematic to patients as NDI items. Both the versions of DASH showed high correlation (0.82-0.83) with the NDI and moderate correlation with the CSOQ and VAS-pain. The mean QuickDASH scores were higher (2.77 points) compared to the full DASH. Conclusion. Though the QuickDASH reported higher disability compared to the full DASH in this patient group, high correlation between the QuickDASH and the NDI and agreement between both versions of the DASH provide preliminary evidence that the QuickDASH can be used to measure upper extremity disability in patients with neck pain