Unique EMS training opportunity: The Center for Domestic Preparedness

Complete with a mock community and former hospital, the CDP give responders the opportunity to train on emergency and disaster response

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Detection of the Novel optrA Gene Among Linezolid-Resistant Enterococci in Barcelona, Spain

Microbial Drug Resistance, Ahead of Print.


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Whole-Genome Analysis of a Human Enterobacter mori Isolate Carrying a blaIMI-2 Carbapenemase in Austria

Microbial Drug Resistance, Ahead of Print.


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Functional Outcome Scores With Standard Myoelectric Prostheses In Below-Elbow Amputees

Objective To report normative outcome data of prosthetic hand function in below elbow amputees using four different objective measurements closely related to activities of daily living (ADL). Design Seventeen patients who underwent prosthetic fitting after unilateral below-elbow amputation were enrolled in this study. Global upper extremity function was evaluated using the Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP), the Clothespin-Relocation Test (CPRT) and the Box and Block Test (BBT), which monitor hand and extremity function. Results The patients achieved a mean ARAT score of 35.06 ± 4.42 of 57. The average SHAP score was 65.12 ± 13.95 points. The mean time for the CPRT was 22.57 ± 7.50 seconds and the mean score in the BBT was 20.90 ± 5.74. Conclusions In the current economic situation of health care systems, demonstrating the effectiveness and necessity of rehabilitation interventions is of major importance. This study reports outcome data of below-elbow amputees and provides a useful guide for expected prosthetic user performance. Correspondence: Oskar C. Aszmann, MD, Div. of Plastic and Reconstructive Surgery, Dept. of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, AUSTRIA, Tel.: 0043 1 40400 69940; Fax.: 0043 1 40400 69880, Email: oskar.aszmann@meduniwien.ac.at Authors Disclosures: The authors have no competing interests to declare. This work was supported by the Christian Doppler Research Foundation a subdivision of the Austrian Federal Ministry of Economy, Family and Youth, the Austrian Council for Research and Technology Development. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Ultrasonographic Imaging for the Diagnosis and Guided Injection of the Lateral Cord of the Plantar Fascia in a Jogger

No abstract available

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Improving outcomes in oncological colorectal surgery by prehabilitation

Introduction The cornerstone in the treatment of colorectal cancer is surgery. A surgical event poses a significant risk of decreased functional decline and impaired health related quality of life. Prehabilitation is defined as the multimodal preoperative enhancement of a patient[DOUBLE HIGH-REVERSED-9 QUOTATION MARK]s condition. It may serve as a strategy to improve postoperative outcomes. Prehabilitation requires a multidisciplinary effort of medical health care professionals and a behavioral change of the patient. Methods The goal of prehabilitation is threefold: first, to reduce postoperative complications, second, to enhance and accelerate the recovery of the patient and third, to improve overall quality of life. In this article, we introduce the FIT-model illustrating a possible framework towards the implementation of both evidence-based and tailor-made prehabilitation for patients undergoing surgery for colorectal cancer. Results The model is comprised of three pillars: 'Facts' (how to screen patients and evidence on what content to prescribe), 'Integration' (data of own questionnaires assessing motivation of patients and specialists) and finally 'Tools' (which outcome measurements to use). Conclusions Developing implementable methods and defining standardized outcome instruments will help to establish a solid base for patient centered prehabilitation programs. Any party introducing prehabilitation requiring multidisciplinary teamwork and behavioral change can potentially use this framework. Address for correspondence and requests for reprints: Emma RJ Bruns, MD ORCID: 0000-0001-6967-4861, Department of surgery, Academic Medical Centre, PO Box 22660 1100 DD Amsterdam, The Netherlands, Tel: +31-20-56662670 Fax: +31-20-5669243, E-mail: e.r.bruns@amc.nl During review process: e.r.bruns@amc.nl Category: Review Conflicts of interest and source of funding: None Previous presentation of research, manuscript or abstract: None All authors confirm that they have contributed to the submission according to the requirements of the American Journal of Physical Medicine and Prehabilitation Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The influence of local anesthesia depth on procedural pain during fluoroscopically-guided lumbar transforaminal epidural injections: a randomized clinical trial

Objectives To evaluate the influence of the depth of local anesthesia application on procedural pain during lumbar transforaminal epidural steroid injection (TFESI). Design Sixty-eight patients were enrolled who were scheduled for single-level, unilateral fluoroscopically-guided lumbar TFESI. Patients were randomly allocated to receive either subcutaneous local anesthesia (group S) or deep local anesthesia (group D) for TFESI. The data related to pain and technical performance during the procedure was compared. Additionally, the incidence of injection site soreness was assessed 2 weeks after TFESI. Results Sixty-seven patients completed all assessments (group S, n=33; group D, n=34). There was no significant difference in procedural pain and discomfort level between the groups (P=0.151, P=0.183, respectively). Patients in group D showed lower behavioral pain scores (P=0.017). There was no significant difference in the numbers of needle manipulations, fluoroscopy time, and radiation dose during the procedure between the groups. Two patients in group S and three in group D complained of injection site soreness after TFESI for a few days, but there was no significant difference in its incidence (P=0.667). Conclusions Deep local anesthesia to reduce procedural pain during TFESI appears to have no significant clinical benefit compared with conventional subcutaneous local anesthesia. There is no external funding and no competing interests to declare. This study was registered at ClinicalTrials.gov (ref: NCT03308136). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Morphological differences in the upper trapezius muscle between female office workers with and without trapezius myalgia: facts or fiction? A cross-sectional study

Objective Work-related trapezius myalgia is a common musculoskeletal disorder in office workers. Prolonged low-level muscle activity during office work may lead to morphological changes in the muscle tissue, causing pain and fatigue. The aim of the present study was to investigate differences in muscle morphology between office workers with and without trapezius myalgia. Design Muscle biopsy samples were obtained from the upper trapezius of female office workers with trapezius myalgia (n=17) and healthy controls (n=15). Myosin heavy chain immunohistochemistry and Gomori trichrome stainings were performed to identify differences in muscle fiber type proportion, Feret's diameter and internal nuclear proportion. Results The myalgia group showed significantly more type IIA and IIA/IIX fibers, and less type I and IIX fibers, compared to the control group (P0.05). However, a significantly higher Feret's diameter was found for type I fibers, compared to type II fibers in both groups (P

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Resistance Training Volume Enhances Muscle Hypertrophy

PURPOSE The purpose of this study was to evaluate muscular adaptations between low-, moderate-, and high-volume resistance training (RT) protocols in resistance-trained men. METHODS Thirty-four healthy resistance-trained men were randomly assigned to 1 of 3 experimental groups: a low-volume group (1SET) performing 1 set per exercise per training session (n = 11); a moderate-volume group (3SET) performing 3 sets per exercise per training session (n = 12); or a high-volume group (5SET) performing 5 sets per exercise per training session (n = 11). Training for all routines consisted of three weekly sessions performed on non-consecutive days for 8 weeks. Muscular strength was evaluated with 1 repetition maximum (RM) testing for the squat and bench press. Upper-body muscle endurance was evaluated using 50% of subjects bench press 1RM performed to momentary failure. Muscle hypertrophy was evaluated using B-mode ultrasonography for the elbow flexors, elbow extensors, mid-thigh and lateral thigh. RESULTS Results showed significant pre-to-post intervention increases in strength and endurance in all groups, with no significant between-group differences. Alternatively, while all groups increased muscle size in most of the measured sites from pre-to-post intervention, significant increases favoring the higher volume conditions were seen for the elbow flexors, mid-thigh, and lateral thigh. CONCLUSION: Marked increases in strength and endurance can be attained by resistance-trained individuals with just three, 13-minute weekly sessions over an 8-week period, and these gains are similar to that achieved with a substantially greater time commitment. Alternatively, muscle hypertrophy follows a dose-response relationship, with increasingly greater gains achieved with higher training volumes. Corresponding author: Brad J. Schoenfeld, CUNY Lehman College, 250 Bedford Park Blvd West, Bronx, NY, 10468; email: brad@workout911.com; telephone: 718-960-1999; fax: 718-960-1999 The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and do not constitute endorsement by ACSM. This study was supported by a PSC CUNY grant from the State of New York. The authors declare no conflicts of interest. © 2018 American College of Sports Medicine

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Aftereffects of Cognitively Demanding Acute Aerobic Exercise on Working Memory

Purpose This study examined the aftereffects of cognitively demanding acute aerobic exercise on working memory in middle-aged individuals. Methods In a within-participants design, middle-aged males (n = 28) performed a 2-back task to assess working memory before, immediately after, and 30 min after the following three interventions: 1) a rest-cognition intervention, in which they performed a cognitive task on a cycle ergometer without exercising; 2) an exercise-cognition intervention, in which they simultaneously exercised on a cycle ergometer and performed a cognitive task; and 3) an exercise-only intervention, in which they only exercised on a cycle ergometer. Results The exercise-only intervention resulted in increased hit rate and decreased reaction times and intraindividual variability on correct rejection trials, suggesting that simple aerobic exercise had a beneficial impact on working memory. By contrast, the exercise-cognition intervention resulted in increased intraindividual variability on correct rejection trials, which is suggestive of cognitive fatigue resulting from the additional cognitive demands. Such a decline was not observed even in the rest-cognition condition. Conclusion Cognitive fatigue caused by additional cognitive demands during aerobic exercise may cancel beneficial post-exercise effects on working memory. Cognitively demanding acute aerobic exercise appears to be less effective than simple aerobic exercise in improving executive function. Author Note Keita Kamijo is now at Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Ibaraki, Japan, and Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan. Corresponding author: Keita Kamijo, Ph.D. 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8573 JAPAN, Phone/fax: +81-29-853-5011, E-mail: ktakamijo@gmail.com This work was supported by Shimano Inc. This work was also supported in part by MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2015-2019 from the Ministry of Education, Culture, Sports, Science and Technology (S1511017). Keita Kamijo has no conflicts of interest to disclose. Ryuji Abe is an employee of Shimano Inc. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Submitted for publication June 2018. Accepted for publication August 2018. © 2018 American College of Sports Medicine

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ACE I allele is associated with more severe portal hypertension in patients with liver cirrhosis: A pilot study

In liver cirrhosis, the renin-angiotensin-aldosterone system is involved in the pathogenesis of portal hypertension. Its effector, angiotensin II, is generated by angiotensin-converting enzyme (ACE). Serum ACE levels are affected by I/D polymorphism of its gene, with alleles I and D being associated, respectively, with lesser and greater activity of the enzyme. In cirrhotic patients carrying the ACE I allele, an increased risk for gastro-oesophageal varices was observed.

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Fentanyl-resistant gloves help keep EMS workers safe from exposure

MILWAUKEE, Jan. 27, 2018 — A new product is on the market to help protect EMS workers from deadly drug exposure. "Many times, EMS providers go into very unsecured scenes. They don't know what they're getting into," said Rhonda Baliff, of Medline Industries. The big risk when treating the victims is exposure to fentanyl, a synthetic drug found in heroin "The exposure...

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Three roles caregivers must take on to help fight opioid epidemic

NORTHFIELD, Ill., March 29, 2018 — It's troubling what medical personnel are seeing as our country's opioid problem worsens. The CDC just released their latest report on opioid overdoses and emergency departments are working furiously because of the increase – a 30 percent jump in ED visits in 2017 over 2016. We're asking emergency room staff, and paramedics and EMTs...

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Three critical areas to watch in EMS

NORTHFIELD, Ill., May 17, 2018 — Of the more than 13 million calls in Firehouse Magazine's yearly survey of fire departments and EMS agencies nearly nine million needed emergency medical services. The need for EMS is great. We're not just responding to car accidents. We're in post-acute facilities. We're collaborating with hospitals. We're seeing change. Though...

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Partnering for public safety: Savvik Buying Group and Medline announce GPO contract

NORTHFIELD, Ill., Aug. 20, 2018 — Medline EMS today announced a new partnership with Savvik Buying Group, one of the largest public safety buying groups in the country representing EMS, fire departments, and law enforcement. With the new bid-approved program, more than 8,800 members can now tap into Medline's offering of: 550,000+ high-quality medical supplies and products (gloves,...

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ACE I allele is associated with more severe portal hypertension in patients with liver cirrhosis: A pilot study

In liver cirrhosis, the renin-angiotensin-aldosterone system is involved in the pathogenesis of portal hypertension. Its effector, angiotensin II, is generated by angiotensin-converting enzyme (ACE). Serum ACE levels are affected by I/D polymorphism of its gene, with alleles I and D being associated, respectively, with lesser and greater activity of the enzyme. In cirrhotic patients carrying the ACE I allele, an increased risk for gastro-oesophageal varices was observed.

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Endoribonuclease ENDU-2 regulates multiple traits including cold tolerance via cell autonomous and nonautonomous controls in Caenorhabditis elegans [Genetics]

Environmental temperature acclimation is essential to animal survival, yet thermoregulation mechanisms remain poorly understood. We demonstrate cold tolerance in Caenorhabditis elegans as regulated by paired ADL chemosensory neurons via Ca2+-dependent endoribonuclease (EndoU) ENDU-2. Loss of ENDU-2 function results in life span, brood size, and synaptic remodeling abnormalities in addition to...

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RNF169 limits 53BP1 deposition at DSBs to stimulate single-strand annealing repair [Genetics]

Unrestrained 53BP1 activity at DNA double-strand breaks (DSBs) hampers DNA end resection and upsets DSB repair pathway choice. RNF169 acts as a molecular rheostat to limit 53BP1 deposition at DSBs, but how this fine balance translates to DSB repair control remains undefined. In striking contrast to 53BP1, ChIP analyses of...

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Could Postnatal Women’s Groups Be Used to Improve Outcomes for Mothers and Children in High-Income Countries? A Systematic Review

Abstract

Introduction Participatory postnatal women's groups have been shown to have a significant impact on maternal and neonatal mortality in low-income countries. However, it is not clear whether this approach can be translated to high-income countries (HICs). We conducted a systematic review to answer the question: "Can postnatal women's groups improve health outcomes for mothers and children in high-income countries?" Methods MEDLINE, EMBASE and Cochrane databases were searched for randomised controlled trials testing any group-based intervention during the postnatal period, in HICs. No limitations were applied to stated outcomes. Results Nine trials, including 3029 women, fulfilled the criteria. Group-based interventions, facilitated by health professionals, ranged from didactic to participant-led. Three trials addressed postnatal depression, one addressed physical activity, whilst the remainder looked at multiple health or social outcomes. Three trials reported a significant association between their intervention and at least one outcome measure. Study limitations included poor and inequitable intervention uptake, low participant retention, small sample size and incomplete intervention description. Discussion This review found limited and incompletely described evidence testing the use of postnatal group-based interventions to improve health outcomes in HICs. Promising results were reported when the obstacles of sample size and group attendance were overcome. Studies reporting positive impacts on primary outcomes reported higher attendance rates and involved a psychoeducational or cognitive behavioural component in their group approaches. Further research should design and evaluate implementation strategies, assess the use of lay support workers in community settings to improve attendance and retention, and examine the effect of the group environment on outcomes.

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Full speed ahead for single-cell analysis

Full speed ahead for single-cell analysis

Full speed ahead for single-cell analysis, Published online: 28 August 2018; doi:10.1038/s41576-018-0049-3

A study in Nature describes RNA velocity, which is a computational method to derive dynamic gene expression information from static single-cell RNA sequencing data. It provides valuable insights into developmental trajectories of cells.

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Cultivation of arterial stiffness fields in the land of the rising sun

Abstract

Arterial stiffness increases with advancing age and is an important risk factor for cardiovascular disease. As the number of research studies investigating arterial stiffness has increased dramatically over the recent years, their scope has broadened from physiological investigations to clinical domains focused on risk predictions. A number of key research studies were conducted in Japan in the formative years; however, some of these studies are unknown to most and largely forgotten. In this mini-review, some of these key formative research studies conducted in Japan by Japanese investigators are re-introduced and highlighted to provide appreciation for their pioneering work conducted in the land of the rising sun.

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Long-term outcome in patients with acute liver failure

Liver International

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Utility and limitations of non-invasive fibrosis markers for predicting prognosis in biopsy-proven Japanese NAFLD patients

Journal of Gastroenterology and Hepatology

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Serum Angiopoietin-2 predicts mortality and kidney outcomes in decompensated cirrhosis

Hepatology

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Associations of proton pump inhibitors and hospitalization due to hyponatremia: A population–based case–control study

European Journal of Internal Medicine

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Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Meimei Zhou, Fang Li, Weibo Lu, Junfa Wu, Song Pei

Abstract

Objective

To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).

Design

This is a prospective randomized controlled trial.

Setting

A rehabilitation hospital.

Participants

Participants (N=90) were randomized into NMES (n=36), TENS (n=36), or control groups (n=18).

Interventions

NMES (15Hz, pulse width 200μs) was applied to supraspinatus and deltoids (medial and posterior parts), whereas TENS (100Hz, pulse width 100μs) was used on the same areas. The surface electrodes were placed near the motor points of the supraspinatus and medial or posterior bundle of deltoids. The 4-week treatment consisted of 20 sessions, each session composed of 1 hour of stimulation per day. Routine rehabilitation program without any stimulation was administered to the control and the NMES/TENS groups. Numerical rating scale (NRS), active/passive range of motion (AROM/PROM) of shoulder, upper extremity Fugl-Meyer Assessment (FMA), modified Ashworth scale (MAS), Barthel Index (BI), and stroke-specific quality of life scale (SSQOLS) were assessed in a blinded manner at baseline, 2, 4, and 8 weeks after treatment, respectively.

Main Outcome Measures

The primary endpoint was the improvement from baseline in NRS for HSP at 4 weeks.

Results

NRS scores in NMES, TENS, and control groups had decreased by 2.03, 1.44, and 0.61 points, respectively after 4 weeks of treatment, with statistically significant differences among the 3 groups (P<.001). The efficacy of the NMES group was significantly better than that of the TENS group (P=.043). Moreover, the efficacy of NMES and TENS groups was superior to that of the control group (P<.001, P=.044, respectively). The differences in the therapeutic efficacy on shoulder AROM/PROM, FMA, MAS, BI, and SSQOLS scores were not significant among the 3 groups.

Conclusions

TENS and NMES can effectively improve HSP, the efficacy of NMES being distinctly superior to that of TENS in maintaining long-term analgesia. However, NMES was not more efficacious than the TENS or control group in improving the shoulder joint mobility, upper limb function, spasticity, the ability of daily life activity, and stroke-specific quality of life in HSP patients.

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Information/Education Pages (I/EPs)

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s):

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Clinical Assessment of Spasticity in People With Spinal Cord Damage: Recommendations From the Ability Network, an International Initiative

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Anand V. Nene, Alexandre Rainha Campos, Klemen Grabljevec, Arminda Lopes, Bengt Skoog, Anthony S. Burns

Abstract

A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed.

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Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Kimberly J. Waddell, Catherine E. Lang

Abstract

Objective

To compare self-reported with sensor-measured upper limb (UL) performance in daily life for individuals with chronic (≥6mo) UL paresis poststroke.

Design

Secondary analysis of participants enrolled in a phase II randomized, parallel, dose-response UL movement trial. This analysis compared the accuracy and consistency between self-reported UL performance and sensor-measured UL performance at baseline and immediately post an 8-week intensive UL task-specific intervention.

Setting

Outpatient rehabilitation.

Participants

Community-dwelling individuals with chronic (≥6mo) UL paresis poststroke (N=64).

Interventions

Not applicable.

Main Outcome Measures

Motor Activity Log amount of use scale and the sensor-derived use ratio from wrist-worn accelerometers.

Results

There was a high degree of variability between self-reported UL performance and the sensor-derived use ratio. Using sensor-based values as a reference, 3 distinct categories were identified: accurate reporters (reporting difference ±0.1), overreporters (difference >0.1), and underreporters (difference <−0.1). Five of 64 participants accurately self-reported UL performance at baseline and postintervention. Over half of participants (52%) switched categories from pre-to postintervention (eg, moved from underreporting preintervention to overreporting postintervention). For the consistent reporters, no participant characteristics were found to influence whether someone over- or underreported performance compared with sensor-based assessment.

Conclusions

Participants did not consistently or accurately self-report UL performance when compared with the sensor-derived use ratio. Although self-report and sensor-based assessments are moderately associated and appear similar conceptually, these results suggest self-reported UL performance is often not consistent with sensor-measured performance and the measures cannot be used interchangeably.

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Physical Activity–Based Interventions Using Electronic Feedback May Be Ineffective in Reducing Pain and Disability in Patients With Chronic Musculoskeletal Pain: A Systematic Review With Meta-Analysis

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Crystian B. Oliveira, Márcia R. Franco, Chris G. Maher, Paulo H. Ferreira, Priscila K. Morelhão, Tatiana M. Damato, Cynthia Gobbi, Rafael Z. Pinto

Abstract

Objective

To investigate the effectiveness of physical activity–based interventions using electronic feedback in reducing pain and disability compared to minimal or no interventions in patients with chronic musculoskeletal pain.

Data Sources

The following electronic databases were searched: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Web of Science, Physiotherapy Evidence Database, and main clinical trial registers.

Study Selection

Randomized controlled trials investigating the effect of physical activity interventions using electronic feedback (eg, physical activity monitors) on pain and disability compared to minimal or no interventions in adults with chronic musculoskeletal pain were considered eligible.

Data Extraction

Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the overall quality of the evidence.

Data Synthesis

Four published randomized controlled trials and 4 registered unpublished randomized controlled trials were included. At short-term follow-up, pooled estimations showed no significant differences in pain (2 trials: n=116; SMD=−.50; 95% confidence interval, −1.91 to 0.91) and disability (2 trials: n=116; SMD=−.81; 95% confidence interval, −2.34 to 0.73) between physical activity–based interventions and minimal interventions. Similarly, nonsignificant results were found at intermediate-term follow-up. According to Grading of Recommendations Assessment, Development and Evaluation, the overall quality of the evidence was considered to be of low quality.

Conclusions

Our findings suggest that physical activity–based interventions using electronic feedback may be ineffective in reducing pain and disability compared to minimal interventions in patients with chronic musculoskeletal pain. Clinicians should be cautious when implementing this intervention in patients with chronic musculoskeletal pain.

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Systematic Review on the Effects of Serious Games and Wearable Technology Used in Rehabilitation of Patients With Traumatic Bone and Soft Tissue Injuries

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Henriëtte A. Meijer, Maurits Graafland, J. Carel Goslings, Marlies P. Schijven

Abstract

Objective

To assess the effects on functional outcomes and treatment adherence of wearable technology and serious games (ie, interactive computer applications with specific purposes useful in the "real world") currently used in physical rehabilitation of patients after traumatic bone and soft tissue injuries.

Data Sources

PubMed, EMBASE, Cochrane Library, and Current Index to Nursing and Allied Health Literature were searched without publication date restrictions for the terms wearable, serious game, videogame or mobile application, and rehabilitation, exercise therapy, and physiotherapy.

Study Selection

The search yielded 2704 eligible articles, which were screened by 2 independent reviewers. Studies comparing serious games to standard therapy were included.

Data Extraction

Methodology and results of the studies were critically appraised in conformity with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data Synthesis

Twelve articles were included, all of which tested "off-the-shelf" games. No studies on "wearable-controlled" games or games specifically developed for rehabilitation could be included. Medical conditions included postoperative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only 2 studies found beneficial effects of serious games compared to conventional therapy. One of 3 studies reporting pain scores found beneficial effects of serious games compared to physiotherapy. One of 5 trials reporting treatment adherence found a statistically significant advantage in the game group compared to conventional physiotherapy. Because of heterogeneity in study design and outcome measures, pooling of data was not possible.

Conclusions

Serious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injuries. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence.

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Factors Associated With Post-Stroke Physical Activity: A Systematic Review and Meta-Analysis

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Shamala Thilarajah, Benjamin F. Mentiplay, Kelly J. Bower, Dawn Tan, Yong Hao Pua, Gavin Williams, Gerald Koh, Ross A. Clark

Abstract

Objective

To integrate the literature investigating factors associated with post-stroke physical activity.

Data Sources

A search was conducted from database inception to June 2016 across 9 databases: Cochrane, MEDLINE, ProQuest, Web of Science, PsycINFO, Scopus, Embase, CINAHL, and Allied and Complementary Medicine Database. The reference lists of included articles were screened for secondary literature.

Study Selection

Cohort and cross-sectional studies were included if they recruited community-dwelling stroke survivors and measured factors associated with physical activity.

Data Extraction

Risk of bias was evaluated using the Quality in Prognosis Studies checklist. A meta-analysis was conducted for correlates where there were at least 2 studies that reported a correlation value. Correlation values were used in an effect size measure and converted to a standardized unit with Fisher r to z transformation and conversion back to r method. Results were described qualitatively for studies that could not be pooled.

Data Synthesis

There were 2161 studies screened and 26 studies included. Age (meta r=−.17; P≤.001) and sex (meta r=−.01; P=.02) were the nonmodifiable factors that were found to be associated with post-stroke physical activity. The modifiable factors were physical function (meta r=.68–.73; P<.001), cardiorespiratory fitness (meta r=.35; P≤.001), fatigue (meta r=−.22; P=.01), falls self-efficacy (meta r=−.33; P<.001), balance self-efficacy (meta r=.37; P<.001), depression (meta r=−.58 to .48; P<.001), and health-related quality of life (meta r=.38–.43; P<.001). The effect of side of infarct, neglect, and cognition on post-stroke physical activity was inconclusive.

Conclusions

Age, sex, physical function, depression, fatigue, self-efficacy, and quality of life were factors associated with post-stroke physical activity. The cause and effect of these relations are unclear, and the possibility of reverse causality needs to be addressed.

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Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Lisa Engel, Adora Chui, Dorcas E. Beaton, Robin E. Green, Deirdre R. Dawson

Abstract

Objectives

To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments.

Data sources

Seven databases were searched in May 2015.

Study selection

Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected.

Data extraction

This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis.

Data synthesis

The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments.

Conclusions

Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.

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Psychometric Testing of a Rehabilitative Care Patient Experience Instrument

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Josephine McMurray, Heather McNeil, Alicia Gordon, Jacobi Elliott, Paul Stolee

Abstract

Objective

To evaluate the internal consistency and test-retest reliability, construct validity, and feasibility of the WatLX, a measure of the experience of patients in rehabilitative care.

Design

Multisite, cross-sectional, and test-retest self-report study.

Setting

Outpatient rehabilitative care settings.

Participants

The WatLX was administered to English-speaking, cognitively intact outpatients (N=1174) over 18 years old who had completed a program of cardiac, musculoskeletal, neurologic, stroke, pulmonary, or speech language rehabilitative care, at 2 separate time points: (1) immediately following completion of their rehabilitation program, and (2) 2 weeks later (n=29). A subsequent feasibility study was conducted with 1013 patients from 19 clinics.

Interventions

Not applicable.

Main Outcome Measures

The WatLX measures 6 concepts, previously identified as key to outpatient rehabilitative care patients' experience: (1) ecosystem issues, (2) client and informal caregiver engagement, (3) patient and health care provider relations, (4) pain and functional status, (5) group and individual identity, and (6) open-ended feedback.

Results

Reliability analyses were conducted on 2 versions of the WatLX. Using a 7-point versus a 5-point Likert scale resulted in higher internal consistency and reliability scores. Cronbach's alpha coefficients were .863 and .957 for the 5- and 7-point scale, respectively, and the ICC scores were .827 and .880, respectively. The proof of concept study recruited 1013 patients with little interruption of workflow; results displayed strong internal consistency (Cronbach's alpha coefficient =.906). There is evidence of ceiling effects.

Conclusions

The WatLX is a parsimonious question set that is feasible for administration in ambulatory rehabilitative care settings, and which shows promising psychometric properties.

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Development and Psychometric Evaluation of a Fatigability Index for Full-Time Wheelchair Users With Spinal Cord Injury

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Alina Ionela Palimaru, William E. Cunningham, Marcus Dillistone, Arturo Vargas-Bustamante, Honghu Liu, Ron D. Hays

Abstract

Objective

To develop and evaluate psychometrically a self-reported instrument assessing physical fatigability (PF) and mental fatigability (MF) in adults with spinal cord injury (SCI).

Design

Cross-sectional.

Setting

Peer-support groups at rehabilitation centers, online support groups.

Participants

Adults with SCI (N=464) in the United States.

Interventions

Not applicable.

Main Outcome Measures

The dimensional structure was assessed by confirmatory factor analysis. The relationship between item responses and fatigability was measured with item response theory (graded response model). Reliability was measured with test information functions. Differential item functioning was evaluated with Wald chi-square tests and the weighted area between the curves. Construct validity was assessed using the known groups method.

Results

An 82-item pool was developed from prior qualitative research and consultations with rehabilitation experts. A non-probability sample (N=464) was used to evaluate the psychometric properties of the PF and MF scales. The item pool was reduced to 75 based on factor loadings and R². Both scales are primarily unidimensional, despite moderate multidimensionality. There is good discrimination overall: 18 PF items and 26 MF items have high or very high discrimination power (slopes > 1.35). The measurement precision in the theta range -2.0 to 2.5 is the equivalent of 0.94 reliability for PF and 0.91 for MF. For both measures, F statistics P values were significant at P<.01, and means were higher for those with paraplegia vs quadriplegia, and for those with incomplete paraplegia.

Conclusions

The Fatigability Index is the first instrument designed to assess physical and mental fatigability in adults with SCI. The index highlights causes of fatigue and areas requiring immediate intervention. Development of short-forms and further research on representative samples are necessary.

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WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP): Factor Analysis and Internal Consistency

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Bas R. Aerts, P. Paul Kuijer, Annechien Beumer, Denise Eygendaal, Monique H. Frings-Dresen

Abstract

Objective

To test a 17-item questionnaire, the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP), for dimensionality of the items (factor analysis) and internal consistency.

Design

Cross-sectional study.

Setting

Outpatient clinic.

Participants

A consecutive sample of patients (N=150) consisting of all new referral patients (either from a general physician or other hospital) who visited the orthopedic outpatient clinic because of an upper extremity musculoskeletal disorder.

Interventions

Not applicable.

Main Outcome Measures

Number and dimensionality of the factors in the WORQ-UP.Results: Four factors with eigenvalues (EVs) >1.0 were found. The factors were named exertion, dexterity, tools & equipment, and mobility. The EVs of the factors were, respectively, 5.78, 2.38, 1.81, and 1.24. The factors together explained 65.9% of the variance. The Cronbach alpha values for these factors were, respectively, .88, .74, .87, and .66.

Conclusions

The 17 items of the WORQ-UP resemble 4 factors—exertion, dexterity, tools & equipment, and mobility—with a good internal consistency.

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Feasibility and Preliminary Validation of an Online Version of the Ohio State University Traumatic Brain Injury Identification Method

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Anthony H. Lequerica, Christian Lucca, Nancy D. Chiaravalloti, Irene Ward, John D. Corrigan

Abstract

Objective

To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).

Design

Cross-sectional.

Setting

General community.

Participants

A volunteer sample of individuals (N= 265) from the general population across the United States.

Interventions

Not applicable.

Main Outcome Measure(s)

Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale.

Results

The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007.

Conclusions

The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI.

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A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Sarah Gunn, Gerald H. Burgess, John Maltby

Abstract

Objective

To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients.

Design

Criterion standard.

Setting

A National Health Service acute acquired brain injury inpatient rehabilitation hospital.

Participants

Referred sample of adults (N=447) admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitation

Intervention

Not applicable.

Outcome Measure

Functional Independence Measure and Functional Assessment Measure.

Results

Exploratory factor analysis suggested a 2-factor structure to FIM+FAM scores, among both focal-proximate and diffuse-proximate acquired brain injury aetiologies. Confirmatory factor analysis suggested a 3-factor bifactor structure presented the best fit of the FIM+FAM score data across both aetiologies. However, across both analyses, a convergence was found towards a general factor, demonstrated by high correlations between factors in the exploratory factor analysis, and by a general factor explaining the majority of the variance in scores on confirmatory factor analysis.

Conclusions

Our findings suggested that although factors describing specific functional domains can be derived from FIM+FAM item scores, there is a convergence towards a single factor describing overall functioning. This single factor informs the specific group factors (eg, motor, psychosocial, and communication function) after brain injury. Further research into the comparative value of the general and group factors as evaluative/prognostic measures is indicated.

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Validation of the Work-Disability Physical Functional Assessment Battery

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Christine M. McDonough, Pengsheng Ni, Kara Peterik, Judith D. Hershberg, Lesli R. Bell, Leighton Chan, Diane E. Brandt, Alan M. Jette

Abstract

Objective

To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE).

Design

Cross-sectional.

Setting

Outpatient rehabilitation.

Participants

Adults (N=50) participating in physical therapy for musculoskeletal conditions.

Interventions

Not applicable.

Main Outcome Measures

Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient's physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ability ratings in the Dynamic Strength, Position Tolerance, and Mobility subsections.

Results

Participating in the study were 50 patients with 1 or more conditions (shoulder, n=21; knee, n=16; low back, n=13; ankle/foot, n=10; neck, n=8; hip, n=7). The patient-based WD-FAB scores demonstrated moderate, statistically significant correlations with the provider proxy WD-FAB report (R=.49-.65). The WD-FAB Upper Body Function scale scores demonstrated moderate strength relationships with the PWPE overall ratings. The Whole Body Mobility and Changing and Maintaining Body Position scales did not demonstrate statistically significant relationships with the PWPE overall ratings.

Conclusions

We found moderate evidence for validity for the WD-FAB Upper Body Function, Whole Body Mobility, and Changing and Maintaining Body Position scales relative to clinician report and varied evidence relative to the PWPE in this clinical sample.

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Development and Psychometric Validation of Capacity Assessment of Prosthetic Performance for the Upper Limb (CAPPFUL)

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Nathan T. Kearns, Jennifer K. Peterson, Lisa Smurr Walters, Warren T. Jackson, John M. Miguelez, Tiffany Ryan

Abstract

Objectives

(1) To develop a performance-based measure for adult upper limb (UL) prosthetic functioning through broad (ie, overall performance) and functional domain-specific (eg, control skills) assessment of commonplace activities; (2) to conduct initial psychometric evaluation of the Capacity Assessment of Prosthetic Performance for the Upper Limb (CAPPFUL).

Design

Internal consistency of CAPPFUL and interrater reliability for task, functional domain, and full-scale (sub)scores among 3 independent raters were estimated. Known-group validity was examined comparing scores by amputation level. Convergent validity was assessed between CAPPFUL and 2 hand dexterity or function tests; discriminant validity was assessed against self-reported disability.

Setting

Six prosthetic rehabilitation centers across the United States.

Participants

Subjects (N=60) with UL amputation using a prosthesis.

Interventions

Not applicable.

Main Outcome Measures

Not applicable.

Results

Interrater reliability was excellent for scoring on the task, domain, and full-scale scores (intraclass correlation coefficients=.88-.99). Internal consistency was good (α=.79-.82). Generally, subjects with higher UL amputation levels scored lower (worse) than subjects with lower UL amputation levels. CAPPFUL demonstrated strong correlations with measures of hand dexterity or functioning (r_s=−.58 to .72) and moderate correlation with self-reported disability (r=−.35).

Conclusions

CAPPFUL was designed as a versatile, low-burden measure of prosthesis performance for any UL functional prosthetic device type and any UL amputation level. CAPPFUL assesses overall performance and 5 functional performance domains during completion of 11 tasks that require movement in all planes while manipulating everyday objects requiring multiple grasp patterns. Psychometric evaluation indicates good interrater reliability, internal consistency, known-group validity, and convergent and discriminant validity.

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Sensitivity of the SCI-FI/AT in Individuals With Traumatic Spinal Cord Injury

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Tamra Keeney, Mary Slavin, Pamela Kisala, Pengsheng Ni, Allen W. Heinemann, Susan Charlifue, Denise C. Fyffe, Ralph J. Marino, Leslie R. Morse, Lynn A. Worobey, Denise Tate, David Rosenblum, Ross Zafonte, David Tulsky, Alan M. Jette

Abstract

Objective

To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI).

Design

Multisite longitudinal (12-mo follow-up) study.

Setting

Nine SCI Model Systems programs.

Participants

Adults (N=165) with SCI enrolled in the SCI Model Systems database.

Interventions

Not applicable.

Main Outcome Measures

SCI-FI/AT computerized adaptive test (CAT) (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation domains) completed at discharge from rehabilitation and 12 months after SCI. For each domain, effect size estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia.

Results

The demographic characteristics of the sample were as follows: 46% (n=76) individuals with paraplegia, 76% (n=125) male participants, 57% (n=94) used a manual wheelchair, 38% (n=63) used a power wheelchair, 30% (n=50) were ambulatory. For individuals with paraplegia, the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significantly large amount of change; in contrast, the Fine Motor Function and Wheelchair Mobility domains detected only a small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor Function, and Self-Care domains detected a small amount of change whereas the Ambulation item domain detected a medium amount of change. The Wheelchair Mobility domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change.

Conclusions

SCI-FI/AT CAT item banks detected an increase in function from discharge to 12 months after SCI. The effect size estimates for the SCI-FI/AT CAT vary by domain and level of lesion. Findings support the use of the SCI-FI/AT CAT in the population with SCI and highlight the importance of multidimensional functional measures.

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Is Going Beyond Rasch Analysis Necessary to Assess the Construct Validity of a Motor Function Scale?

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Tiffanie Guillot, Sylvain Roche, Pascal Rippert, Dalil Hamroun, Jean Iwaz, René Ecochard, Carole Vuillerot, MFM Study Group

Abstract

Objective

To examine whether a Rasch analysis is sufficient to establish the construct validity of the Motor Function Measure (MFM) and discuss whether weighting the MFM item scores would improve the MFM construct validity.

Design

Observational cross-sectional multicenter study.

Setting

Twenty-three physical medicine departments, neurology departments, or reference centers for neuromuscular diseases.

Participants

Patients (N=911) aged 6 to 60 years with Charcot-Marie-Tooth disease (CMT), facioscapulohumeral dystrophy (FSHD), or myotonic dystrophy type 1 (DM1).

Interventions

None.

Main Outcome Measure(s)

Comparison of the goodness-of-fit of the confirmatory factor analysis (CFA) model vs that of a modified multidimensional Rasch model on MFM item scores in each considered disease.

Results

The CFA model showed good fit to the data and significantly better goodness of fit than the modified multidimensional Rasch model regardless of the disease (P<.001). Statistically significant differences in item standardized factor loadings were found between DM1, CMT, and FSHD in only 6 of 32 items (items 6, 27, 2, 7, 9 and 17).

Conclusions

For multidimensional scales designed to measure patient abilities in various diseases, a Rasch analysis might not be the most convenient, whereas a CFA is able to establish the scale construct validity and provide weights to adapt the item scores to a specific disease.

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Conceptual Underpinnings of the Quality of Life in Neurological Disorders (Neuro-QoL): Comparisons of Core Sets for Stroke, Multiple Sclerosis, Spinal Cord Injury, and Traumatic Brain Injury

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Alex W.K. Wong, Stephen C.L. Lau, Mandy W.M. Fong, David Cella, Jin-Shei Lai, Allen W. Heinemann

Abstract

Objective

To determine the extent to which the content of the Quality of Life in Neurological Disorders (Neuro-QoL) covers the International Classification of Functioning, Disability and Health (ICF) Core Sets for multiple sclerosis (MS), stroke, spinal cord injury (SCI), and traumatic brain injury (TBI) using summary linkage indicators.

Design

Content analysis by linking content of the Neuro-QoL to corresponding ICF codes of each Core Set for MS, stroke, SCI, and TBI.

Setting

Three academic centers.

Participants

None.

Interventions

None.

Main Outcome Measures

Four summary linkage indicators proposed by MacDermid et al were estimated to compare the content coverage between Neuro-QoL and the ICF codes of Core Sets for MS, stroke, MS, and TBI.

Results

Neuro-QoL represented 20% to 30% Core Set codes for different conditions in which more codes in Core Sets for MS (29%), stroke (28%), and TBI (28%) were covered than those for SCI in the long-term (20%) and early postacute (19%) contexts. Neuro-QoL represented nearly half of the unique Activity and Participation codes (43%–49%) and less than one third of the unique Body Function codes (12%−32%). It represented fewer Environmental Factors codes (2%−6%) and no Body Structures codes. Absolute linkage indicators found that at least 60% of Neuro-QoL items were linked to Core Set codes (63%−95%), but many items covered the same codes as revealed by unique linkage indicators (7%−13%), suggesting high concept redundancy among items.

Conclusions

The Neuro-QoL links more closely to ICF Core Sets for stroke, MS, and TBI than to those for SCI, and primarily covers activity and participation ICF domains. Other instruments are needed to address concepts not measured by the Neuro-QoL when a comprehensive health assessment is needed.

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Assessment of Nociception and Pain in Participants in an Unresponsive or Minimally Conscious State After Acquired Brain Injury: The Relation Between the Coma Recovery Scale–Revised and the Nociception Coma Scale–Revised

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Camille Chatelle, Solveig L. Hauger, Charlotte Martial, Frank Becker, Bernd Eifert, Dana Boering, Joseph T. Giacino, Steven Laureys, Marianne Løvstad, Petra Maurer-Karattup

Abstract

Objectives

To investigate the relation between consciousness and nociceptive responsiveness (ie, Nociception Coma Scale–Revised [NCS-R]), to examine the suitability of the NCS-R for assessing nociception in participants with disorders of consciousness (DOC), and to replicate previous findings on psychometric properties of the scale.

Design

Specialized DOC program.

Setting

Specialized DOC program and university hospitals.

Participants

Participants (N=85) diagnosed with DOC.

Interventions

Not applicable.

Main Outcome Measures

We prospectively assessed consciousness with the Coma Recovery Scale–Revised (CRS-R). Responses during baseline, non-noxious, and noxious stimulations were scored with the NCS-R and CRS-R oromotor and motor subscales.

Results

CRS-R total scores correlated with NCS-R total scores and subscores. CRS-R motor subscores correlated with NCS-R total scores and motor subscores, and CRS-R oromotor subscores correlated with NCS-R total scores as well as verbal and facial expression subscores. There was a difference between unresponsive wakefulness syndrome and minimally conscious state in the proportion of grimacing and/or crying participants during noxious conditions. We replicated previous findings on psychometric properties of the scale but found a different score as the best threshold for nociception.

Conclusions

We report a strong relation between the responsiveness to nociception and the level of consciousness. The NCS-R seems to be a valuable tool for assessing nociception in an efficient manner, but additional studies are needed to allow recommendations for clinical assessment of subjective pain experience.

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Validity and Reliability of Outcome Measures Assessing Dexterity, Coordination, and Upper Limb Strength in Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay

Publication date: September 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 9

Author(s): Cynthia Gagnon, Isabelle Lessard, Bernard Brais, Isabelle Côté, Caroline Lavoie, Matthis Synofzik, Jean Mathieu

Abstract

Objective

To document in adults affected by autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) the intra- and interrater reliability, standard error of measurement, agreement, minimal detectable change, and construct validity of the 9-Hole Peg Test (NHPT), the Standardized Finger-to-Nose Test (SFNT), and grip strength.

Design

Metrologic study.

Setting

Neuromuscular rehabilitation clinic.

Participants

Genetically confirmed adult patients with ARSACS (N=42; 21 women; mean age, 38.6y).

Interventions

Not applicable.

Main Outcome Measures

Intra- and interrater reliability was determined using the intraclass correlation coefficient (ICC). Construct validity was determined by assessing the capacity of the NHPT, the SFNT, and grip strength to distinguish between participants based on sex, mobility stages, and age groups, and on performance on the Archimedes spiral and fast alternating hand movements tests.

Results

All 3 tests have shown excellent reliability (ICC=.90–.98). However, the limit of agreement was influenced by the participant's performance on the NHPT, and the minimal detectable change was very different for both hands (right=9.7 vs left=28.0). Construct validity was confirmed for the SFNT and NHPT, but it was not demonstrated for grip strength.

Conclusions

Given the metrologic properties assessed in this study, the SFNT is an excellent measure to assess upper limb coordination, whereas the NHPT must be used with caution. The grip strength is reliable but does not seem to reflect disease severity.

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Matrine has pro-apoptotic effects on liver cancer by triggering mitochondrial fission and activating Mst1-JNK signalling pathways

Abstract

Mitochondrial homeostasis is closely associated with liver cancer progression via multiple mechanisms and is also a potential tumour-suppressive target in clinical practice. However, the role of mitochondrial fission in liver cancer cell viability has not been adequately investigated. Matrine, a type of alkaloid isolated from Sophora flavescens, has been widely used to treat various types of cancer. However, the molecular effect of matrine on mitochondrial homeostasis is unclear. Therefore, the aim of the current study was to determine the role of mitochondrial fission in cell apoptosis, viability, migration and proliferation of HepG2 cells in vitro. The effect of matrine on mitochondrial fission and its mechanism were also explored. The results of our study showed that HepG2 cells treated with matrine had reduced viability, an increased apoptotic rate, a blunted migratory response, and impaired proliferation capacity. At the molecular level, matrine treatment activated mitochondrial fission, which promoted mitochondrial dysfunction, caused cellular oxidative stress, disrupted cellular energy metabolism and initiated cell apoptotic pathways. However, blockade of mitochondrial fission abolished the deleterious effects of matrine on HepG2 cells. Further, we demonstrated that the Mst1-JNK signalling axis was required for matrine-modulated mitochondrial fission. Matrine-mediated mitochondrial dysfunction was reversed by inhibiting Mst1-JNK pathways. Together, our results demonstrated that mitochondrial fission could be a potential upstream tumour-suppressive signal for liver cancer by modifying mitochondrial function and cell death. By contrast, matrine exerted an anticancer function in liver cancer by activating mitochondrial fission mediated by Mst1-JNK pathways.

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ALS-associated genes display CNS expression in the developing zebrafish

Publication date: Available online 27 August 2018

Source: Gene Expression Patterns

Author(s): Lauren A. Laboissonniere, Courtney L. Smith, Jacquelyn Mesenbrink, Rebecca Chowdhury, Abbie Burney, Margaret Lang, Matthew Sierra, Amy Stark, Gabriel Maldonado-Casalduc, Madison Muller, Jeffrey M. Trimarchi

Abstract

Amyotrophic lateral sclerosis (ALS) is characterized by progressive muscle atrophy resulting from the deterioration of motor neurons in the central nervous system (CNS). Recent genome-wide association studies have revealed several genes linked to ALS, further demonstrating the complexity of the disease. The zebrafish (Danio rerio) is an attractive model organism to study the function of the rapidly expanding number of ALS-associated genes, in part, due to the development of genome editing techniques that have facilitated specific gene targeting. Before investing in the manipulation and phenotypic examination of these genes, however, it is important to ascertain the localization of expression in this organism. We performed an expression analysis of 29 total ALS-linked genes in the developing zebrafish, specifically focusing on those genes that displayed robust and reproducible expression at multiple different timepoints. First, we classified a subset of the most robustly expressed genes into three distinct groups: head-only expression, head and weak trunk expression, and head and robust trunk expression. Then, we defined the characteristic pattern of each gene at 2, 3, and 4 days post fertilization. This analysis will facilitate improved mutant phenotype assessment in zebrafish by focusing researchers on the areas of expression.

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Full speed ahead for single-cell analysis

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Correction to: A Mixed Methods Evaluation of Early Childhood Abuse Prevention Within Evidence-Based Home Visiting Programs

The article "A Mixed Methods Evaluation of Early Childhood Abuse Prevention Within Evidence-Based Home Visiting Programs", written by M. Matone, K. Kellom, H. Griffis, W. Quarshie, J. Faerber, P. Gierlach, J. Whittaker, D. M. Rubin and P. F. Cronholm, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 27 July 2018 to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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Issue Information

Psychophysiology, Volume 55, Issue 9, September 2018.


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A rare case of acute pancreatitis caused by Candida Albicans

Abstract

We experienced a rare case of acute pancreatitis caused by Candida infection. A 52-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Blood tests revealed high amylase and hepatobiliary enzyme abnormalities, and the patient was hospitalized for acute pancreatitis. Abdominal computed tomography showed a 15-mm space-occupying lesion at the parenchyma of the pancreatic head. Endoscopic retrograde cholangiopancreatography was performed after conservative treatment, which revealed a cystic lesion with a suspected solid component inside involving both lower bile duct and pancreatic duct. Cytology of collected bile and pancreatic juice revealed innumerous hyphae and spores morphologically consistent with Candida spp., as did endoscopic ultrasound-guided fine needle aspiration biopsy of the tumor site. Empiric therapy with oral fluconazole resulted in reduction of the space-occupying lesion 3 months after discharge. However, acute pancreatitis recurred about 1 year and 6 months after discharge. After conservative treatment was carried out again, the same lesion was fenestrated by endoscopic sphincteroplasty, and its internal solid components were resected using a basket catheter. Pathological analysis confirmed the presence of fungus balls and degenerated substances. Candida Albicans was identified by fungal culture examination. After the excretion of the fungus balls, pancreatitis did not recur thereafter during outpatient follow-up.

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Hemosuccus pancreaticus from superior mesenteric artery pseudoaneurysm within perceived pancreatic mass

Abstract

Bleeding from the pancreatic duct is a rare source of gastrointestinal hemorrhage and is referred to as hemosuccus pancreaticus. Often a result of pseudoaneurysm formation from chronic pancreatitis, hemosuccus pancreaticus is a difficult diagnosis due to its peculiar clinical presentation. This is a case of a 51-year-old male with a history of chronic pancreatitis, who initially presented with a pancreatic mass found on CT scan. The mass was found to be inconclusive for malignancy on endoscopic ultrasound-guided fine needle aspiration. The patient subsequently was lost to follow-up and returned with melena and evidence of a superior mesenteric pseudoaneurysm in the previous mass on CT angiography. The pseudoaneurysm was successfully treated with endovascular embolization. Diagnosis of hemosuccus pancreaticus can be challenging due to the intermittent nature of hemorrhage and the variable clinical presentation—which initially appeared as a pancreatic neoplasm in our patient. Repeat imaging and angiography are invaluable for both the diagnosis and treatment of gastrointestinal bleeding from an unknown source in the setting of chronic pancreatitis.

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