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20-year outcomes of high tibial osteotomy: Determinants of survival and functional outcome
Get PDFBackground: High tibial osteotomy (HTO) is a successful joint-preserving procedure for the treatment of medial compartment osteoarthritis. Long-term survivorship of HTO ranges from 40% to 85%. There are consistent factors that predict failure.
Purpose: To determine the 20-year survival of HTO and identify predictors of failure.
Study Design: Case series; Level of evidence, 4.
Methods: A total of 100 consecutive patients with medial bone-on-bone arthritis were prospectively studied to provide long-term patient-reported outcome measures after lateral closing-wedge HTO and determine the time to failure. Failure was defined as conversion to arthroplasty (total knee arthroplasty or unicompartmental knee arthroplasty) or revision HTO.
Results: At 20 years, HTO survival was determined in 95 patients, and 5 were lost to follow-up. The overall survivorship of HTO at 20 years was 44%. The significant factors that were associated with better survivorship were age \u3c55 years, body mass index \u3c30, and Western Ontario and McMaster Universities Osteoarthritis Index pain score \u3e45. These factors were used to define the favorable candidates. In the favorable candidates, survivorship was 100% at 5 years, after which there was a gradual decline to 62% survival at 20 years. Of those with HTO survival, 32 of 33 (97%) reported satisfaction with surgery, with a mean Knee injury and Osteoarthritis Outcome Score Pain score of 91 and Activities of Daily Living score of 97.
Conclusion: HTO is a successful surgical option to treat medial compartment osteoarthritis and prevent the need for arthroplasty in young patients. The most suitable candidates for HTO are aged \u3c55 years, are not obese, and have not progressed to severe symptomatic disability
The association between neuroimaging data and presence of lateropulsion after stroke
No full textBackground: Post-stroke lateropulsion is prevalent and has been associated with varied lesion locations, but existing imaging studies are limited by small participant cohorts. Evidence to guide lateropulsion rehabilitation is also limited. Improved understanding of lesion localization associated with lateropulsion post-stroke may inform more targeted intervention approaches.
Objectives: This study investigated the associations between stroke neuroimaging data and presence of lateropulsion at inpatient rehabilitation admission. Methods: This prospective, observational study included participants aged ≥65 years, admitted for inpatient stroke rehabilitation. Using routinely collected clinical neuroimaging data, stroke type, location, and volume were reported, and their association with lateropulsion presence (Four-Point Pusher Score − 4PPS) at admission was explored.
Results: Of 144 included participants, 82 (56.9%) had lateropulsion (4PPS ≥1). Lateropulsion presence was univariately associated with hemorrhagic stroke (p = 0.002), frontal cortical involvement (OR = 2.17, 95%CI 1.02–6.46), and white matter involvement (OR = 2.45, 95%CI 1.24–4.85), particularly frontal white matter (p = 0.021). Lesions involving the posterior limb of the internal capsule (OR = 2.88, 95% CI 1.14–7.27) and those involving the entire thalamus (OR = 1.0, p = 0.03) were associated with lateropulsion presence. When stratified by stroke type, no specific location was significantly associated with lateropulsion presence in hemorrhagic strokes. Among participants with ischemic stroke, involvement of the pre-central gyrus (OR = 2.45, 95%CI 1.05–5.76), post-central gyrus (OR = 2.76, 95%CI 1.15–6.60), inferior parietal cortex (OR = 3.95, 95%CI 1.43– 10.90), and supramarginal gyrus (OR = 3.73, 95%CI 1.25–11.13) were associated with lateropulsion presence. The stroke laterality and size were not significantly associated with lateropulsion presence.
Conclusions: The findings indicate a role of network disconnection in the post-stroke lateropulsion presence. Future, larger-cohort lesion-network mapping studies are recommended
Are we asking the right questions to people with Achilles tendinopathy? The best questions to distinguish mild versus severe disability to improve your clinical management
No full textObjective: Determine the capacity of individual items on the Tendinopathy Severity Assessment – Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment – Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy. Design: Cross-sectional. Participants: Seventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both).
Outcome measures: The discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted.
Results: All 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to ‘warm-up’ following inactivity.
Conclusions: Pain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response
Associations between physical activity, sedentary behaviour and cognitive domain performance of people living with mild cognitive impairment in the community
No full textIntroduction: Physical activity is known to positively influence cognitive performance. For adults with mild cognitive impairment (MCI), the relationship between physical activity levels and cognitive performance is unknown. This cross-sectional study aimed to determine if cognitive performance [as measured by the Montreal Cognitive Assessment (MoCA)] of people living in the community with MCI is associated with their physical activity levels or sedentary behaviour.
Methods: ActivPAL™ accelerometers were used to objectively measure physical activity and sedentary behaviour for seven full days. Cognitive performance was measured using the MoCA.
Consumer and community involvement: No involvement other than as research participants RESULTS: Eighty-two participants from the Balance on the Brain randomised controlled trial were included. Most participants were retired (88%), with 33 (40%) reporting a fall in the last year. The median MoCA score was 24 (IQR 22-26). Participants achieved a mean of 6296 (±2420) steps per day and were sedentary for 10.6 (±2) hours per day. The only physical activity outcomes that had a fair, positive correlation were moderate- to vigorous-intensity physical activity measures of total stepping time and total number of steps (with a cadence of ≥100 steps/min) with the orientation MoCA domain score (r(82) = 0.36, p ≤ 0.001 and r(82) = 0.37, p ≤ 0.001, respectively). Higher total sedentary time had a weak, positive correlation with better visuospatial/executive performance (r(82) = 0.23, p = 0.041). The orientation outcomes remained significant when analysed in an adjusted logistic regression model.
Conclusion: This study found that performance in the MoCA orientation domain had a fair-positive correlation with moderate-intensity physical activity (i.e., stepping time and step count with a cadence of ≥100 steps/min) as measured by a thigh-worn accelerometer for community-dwelling older adults with MCI. When considering the relationship between cognitive domains and sedentary behaviour, consideration may be needed regarding whether cognitive enhancing activities (such as crosswords and other brain games) are being performed, which may confound this relationship. Further investigation is required to confirm these results
Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations
No full textPurpose: People with advanced or metastatic cancer and their caregivers may have diferent care goals and face unique challenges compared to those with early-stage disease or those nearing the end-of-life. These MASCC-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people afected by advanced or metastatic cancer.
Methods: An expert panel comprising MASCC and ASCO members was formed. Standards and recommendations relevant to the provision of quality survivorship care for people afected by advanced or metastatic cancer were developed through conducting: (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modifed Delphi consensus process.
Results: A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including 8 people with lived experience) across 33 countries (33% were low-to-middle resource countries) participated in the Delphi study and achieved≥94.8% agreement for seven standards (1. Person-Centred Care; 2. Coordinated and Integrated Care; 3. Evidence-Based and Comprehensive Care; 4. Evaluated and Communicated Care; 5. Accessible and Equitable Care; 6. Sustainable and Resourced Care; 7. Research and Data-Driven Care) and≥84.2% agreement across 45 practice recommendations.
Conclusion: Standards of survivorship care for people afected by advanced or metastatic cancer are provided. These MASCCASCO standards will support optimization of health outcomes and care experiences by providing guidance to stakeholders in cancer care (healthcare professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers. Practice recommendations may be used to facilitate future research, practice, policy, and advocacy eforts
The characteristics of the implicit body model of the trunk
No full textKnowing where the body is in space requires reference to a stored model of the size and shape of body parts, termed the body model. This study sought to investigate the characteristics of the implicit body model of the trunk by assessing the position sense of midline and lateral body landmarks. Sixty-nine healthy participants localised midline and lateral body landmarks on their thorax, waist and hips, with perceived positions of these landmarks compared to actual positions. This study demonstrates evidence of a significant distortion of the implicit body model of the trunk, presenting as a squatter trunk, wider at the waist and hips. A significant difference was found between perceived and actual location in the horizontal (x) and vertical (y) directions for the majority of trunk landmarks. Evidence of a rightward bias was noted in the perception of six of the nine body landmarks in the horizontal (x) direction, including all midline levels. In the vertical (y) direction, a substantial inferior bias was evident at the thorax and waist. The implicit body model of the trunk is shown to be distorted, with the lumbar spine (waist-to-hip region) held to be shorter and wider than reality
Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study
No full textIntroduction: Delirium is a serious acute neurocognitive condition that is common in palliative care units and yet under-addressed. To improve delirium care in this setting, we will develop and pilot a monitoring system that integrates the Delirium Clinical Care Standard, Palliative Care Outcomes Collaboration (PCOC) methods, and perspectives of patients, carers and staff.
Methods: This paper reports the protocol for a two-stage, exploratory, sequential mixed-methods implementation study. Stage 1 data collection includes Delirium Standard-aligned process mapping and clinical audits, and Critical Incident Technique interviews with patients, carers and staff with a recent experience of delirium. We will present integrated stage 1 findings to stakeholders then collaboratively develop a delirium monitoring system that aligns with the Delirium Standard and PCOC methods. In stage 2, we will pilot the new system and repeat stage 1 data collection and analyses, adding PCOC and adverse event measures. Implementation principles and strategies such as audit and feedback and education will be applied. We developed simplified participants information sheets and consent forms for interview and process mapping participants, who will provide written informed consent; and waiver of consent to collect clinical audit, PCOC and adverse event data from patients’ medical records is approved. At study end, we will report implementation, effectiveness and safety outcomes, including systemic utility of the delirium monitoring system for wider testing and use to meet the Delirium Standard in palliative care units. Quantitative data analyses will include descriptive and inferential statistics and qualitative analyses will incorporate thematic content analysis aligned to the Critical Incident Technique. Mixed methods data integration will be at the end of each stage.
Discussion: This protocol paper describes the mixed methods, systems integration, and innovative measures and study processes of the MODEL-PC study. We also share data collection tools and a simplified information sheet and consent form for patients
Definitive single-stage surgery for treating diabetic foot osteomyelitis: a protocolized pathway including antibiotic bone graft substitute use
No full textBackground: Diabetic foot ulcers (DFUs) are a challenging complication of diabetes mellitus, often leading to poor clinical outcomes and significant socioeconomic burdens. We evaluated the effectiveness of a definitive single-stage protocolized surgical management pathway, including the use of local antibiotic bone graft substitute, for the treatment of infected DFUs with associated osteomyelitis.
Methods: A retrospective cohort study was conducted. Medical records were extracted(from January 2017 to December 2020) to establish a database consisting of patients who underwent surgical intervention for the treatment of an infected DFU with osteomyelitis .Patients were divided into conventional (control) and protocolized (intervention) surgical groups depending on the treatment received. Clinical outcomes were assessed over a12-month follow-up period.
Results: A total of 136 consecutive patients were included (conventional = 33,protocolized = 103). The protocolized group demonstrated a statistically significant reduc-tion in the mean number of operations performed per patient (1.2 vs. 3.5) (P \u3c 0.001) and ashorter accumulative hospital length of stay (12.6 vs. 25.1 days) (P \u3c 0.001) compared tothe conventional group. Major amputation rates were significantly lower in the protocolizedgroup (2% vs. 18%) (P \u3c 0.001). Within 12 months of surgical intervention, the protocolized group exhibited an ulcer healing rate of 89%, with a low rate of recurrence (3%).
Conclusion: The protocolized surgical pathway, including local antibiotic bone graft substitute use, demonstrated superior outcomes compared to conventional management for the treatment of infected DFUs with osteomyelitis. Further research is needed to evaluate the cost-effectiveness and generalizability of this approach