Difficulty Sitting Research Articles

Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study

BackgroundThere are limited tools to measure the burden of disease and effectiveness of medical/surgical interventions in patients with cryptoglandular fistulas. The aim of this study was to explore concepts that are relevant and important to patients with complex cryptoglandular fistulas (CCF) and to develop a patient-centred, disease-specific, patient-reported outcome measure (PROM) to assess symptom burden and impacts of CCF.MethodsA targeted literature review was conducted, followed by one-to-one telephone interviews with five colorectal surgeons (USA, n = 3; UK, n = 1; Spain, n = 1) and 20 US adult patients with CCF to inform the development of a conceptual model and a CCF-specific PROM. The targeted literature review informed the development of the preliminary conceptual model and identified a PROM in the literature that was used as a reference to generate the draft CCF-specific PROM. The colorectal surgeon interviews provided insights on the experience of patients with CCF to refine the conceptual model, formulate probing questions for use in patient interviews, and to develop the draft CCF-specific PROM. Patients’ descriptions of their experiences with symptoms and the impacts on their lives and evaluation of the draft CCF-specific PROM in concept elicitation and cognitive interviews were used to develop the final conceptual model and final CCF-specific PROM.ResultsTen symptoms (odour, pain during bowel movement, abscess, post-operative pain, discharge/drainage/leakage, anal/perianal pain, inflammation/swelling, skin irritation, bleeding and itchiness) and 11 impacts (discomfort, inability to exercise, embarrassment, difficulty sitting, worry about disease, adapted life to maintain hygiene, negatively impacted social life/isolation, inability to perform daily activities, reduced interest in sex, negatively impacted intimate relationships and negatively impacted mood) were reported as most salient by patients. The patient experience, clinician perspective, and literature review provided input to item generation. Evaluation of relevance and patient understanding through cognitive interviews with patients provided evidence for the content validity of the new patient-reported outcome measure: the 20-item Complex Cryptoglandular Fistula Questionnaire™ (CCFQ-20™).ConclusionThe CCFQ-20™ is a new clinician-guided, patient-validated, disease-specific patient-reported outcome measure that measures disease impact and quality of life in patients with CCF.

Impact of perineal pain and delivery related factors on interference with activities of daily living until 1 month postpartum: A longitudinal prospective study

BackgroundInterference with activities of daily living can negatively impact maternal practices both physically and psychologically. This study aimed to explore the patterns of interference with activities of daily living and perineal pain among Japanese women until 1 month postpartum. Furthermore, we aimed to describe how both perineal pain and delivery-related factors were associated with interference with activities of daily living.MethodsThis study was part of a larger prospective longitudinal study conducted at five maternity hospitals in Japan. The participants were 293 women who had full-term vaginal deliveries and singleton infants. Participants self-evaluated their perineal pain and interference with activities of daily living using a 100 mm visual analogue scale and ‘behaviour that interferes with daily life scale’ at day 1, day 5, and 1 month postpartum. We used a linear mixed model to calculate the fixed-effects parameter estimates and their 95% confidence intervals. Interference with activities of daily living, which included difficulty sitting, difficulty moving, and difficulties with excretion and cleanliness, were set as the dependent variables.ResultsThe final analysis included 184 participants with a mean age of 31.5±4.5 years. Perineal pain and the three sub-scales of interference with activities of daily living reduced from day 1 to 5 postpartum, and further from day 5 to 1 month postpartum (perineal pain, p<0.01, p<0.01; difficulty sitting, p<0.01, p<0.01; difficulty moving, p<0.01, p<0.01; difficulties with excretion and cleanliness, p<0.01, p<0.01). These tendencies did not change, even adjusted for independent variables using a mixed model. In the mixed model for follow-up data, perineal pain was a significantly and positively associated with three sub-scales of interference with activities of daily living, even after adjusted for perineal injury and episiotomy.ConclusionsPositive relationships were observed between perineal pain and interference with activities of daily living until 1 month postpartum, although both reduced. To promote maternal role attainment through child-rearing since early postpartum, midwives should pay additional attention to mothers’ perineal pain as it could negatively affect their daily life and child-rearing.

A-041 Everyone is Worse than Average: Base Rates of ADHD Impairments Among College Students.

Abstract Objective Individuals presenting with concerns of Attention Deficit Hyperactivity Disorder (ADHD) report non-specific symptoms and may seek academic or disability accommodations. However, simply having a diagnosis is not equivalent to having a disability that justifies accommodations. The legal definition of disability is poorly understood by clinicians. Guidance for determining the need for accommodations promotes self-report as the primary source of information in decision making and suggests using “most people in the general population” as a reference point when making decisions. Unfortunately, this benchmark is not well defined, and the population base rates of functional impairments commonly reported in ADHD evaluations have not been established. The present study sought to evaluate the base rates of commonly self-reported impairments among non-treatment seeking college students. Method Undergraduate students (N = 282; 72.3% female; 90.1% Caucasian) completed an online inventory of 32 education-related functional impairments commonly reported during ADHD evaluations. Students indicated how frequently they experienced symptoms on a 6-point scale (Never to Very Often). Results College students reported education impairments at a startlingly high rate. Of the 32 impairments, 22 were endorsed as “often” or higher by over 25% of students, and 30 were endorsed as “sometimes” or higher by over 25% of students. Conclusions Results suggest that functional impairments reported in ADHD evaluations that may be used in accommodation decision making are very common among college students. Common impairments included difficulty focusing or concentrating, needing to study more than others, and difficulty sitting in class. Results shed light on the need for clearer guidelines for determining accommodations.

Hip Disability and Osteoarthritis Outcome Score (HOOS): A Cross-Cultural Validation of the Brazilian Portuguese Version Study.

Objective Translated and validated outcome instruments are of great importance, since they can be used for researchers studying different populations with the same problem. The objective of the present study was to translate, culturally adapt and validate the Hip Disability and Osteoarthritis Outcome Score (HOOS) into Brazilian Portuguese. Methods The HOOS was translated from English into Brazilian Portuguese, translated back into English, and submitted to an experts committee. It was administered to 100 patients with hip osteoarthritis. The psychometric evaluation included factor analysis; internal reliability measures, test-retest reliability at 7 days, and construct validity comparison with the Brazilian version of the Graded Chronic Pain Scale (GCPS). Results Factor analyses demonstrated a five-factor solution. The test-retest reliability showed a high degree of internal consistency for the five subscales ( pain and physical difficulties , 0.97 at baseline and 0.93 at 7 days; pain and difficulty sitting, lying down and getting up , 0.93 at baseline and 0.89 at 7 days; difficulty flexing the knee , 0.92 at baseline and 0.83 at 7 days; difficulty walking , 0.88 at baseline and 0.87 at 7 days; quality of life , 0.80 at baseline and 0.35 at 7 days). The construct validity was established during the comparison of the Brazilian version of the GCPS. Conclusions A Brazilian version of the HOOS was developed with adequate reliability and validity. It will facilitate evaluation of the hip within a large patient population and across cultures.

Combination of Anterior and Posterior Subcutaneous Internal Fixation for Unstable Pelvic Ring Injuries: The “Hula Hoop Technique”

Unstable pelvic ring lesions are usually treated with internal fixation. In patients presenting clinical instability or soft tissue complication risk, external fixation is a safe treatment option. However, pin tract infection, insufficient biomechanical properties, difficulty sitting and changing decubitus are important drawbacks related to the treatment. The present study reports the association of anterior and posterior subcutaneous internal fixation by applying spine-designed implants on the pelvic ring disruption: supra- acetabular pedicle screws with an interconnecting rod (Infix), plus posterior transiliac fixation with the same system, which the authors have named the “Hula Hoop Technique”.

Pain During Prolonged Sitting Is a Common Problem in Persons With Patellofemoral Pain.

Study Design Retrospective cohort. Background Although persons with patellofemoral pain (PFP) often report pain with prolonged sitting, little is known about the prevalence and characteristics of sitting pain. Objectives To describe the proportion of persons with PFP who experience problems with prolonged sitting and to determine patient characteristics associated with sitting pain. Methods Four hundred fifty-eight participants with a diagnosis of PFP from 4 separate studies were included. Item 8 of the Anterior Knee Pain Scale was used to define the presence of problems with prolonged sitting with knee flexion, based on 3 categories: (1) "no difficulty," (2) "pain after exercise," or (3) "problems with prolonged sitting." Differences in demographic and clinical variables between categories were evaluated using Kruskal-Wallis tests (P<.05). Results Two hundred forty-nine (54.4% of the study sample) participants reported problems with prolonged sitting, and 121 (26.4%) reported sitting pain after exercise. Compared to those with no difficulty sitting (n = 88), participants classified as having problems with prolonged sitting were significantly younger (P = .038), more likely to be female (P = .033), had a lower body mass index (P = .027), reported higher pain severity (P<.001) and lower Anterior Knee Pain Scale scores (P<.001), and more frequently reported problems with squatting (P<.001). Conclusion Problems with prolonged sitting are evident in more than half of persons with PFP. Findings highlight the need to identify and adequately manage PFP associated with prolonged sitting. Further research should explore mechanisms of sitting pain and evaluate targeted interventions to reduce PFP with prolonged sitting. Level of Evidence Symptom prevalence study, level 2b. J Orthop Sports Phys Ther 2016;46(8):658-663. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6470.

Depth of Pleural Effusion in Thoracentesis: Comparison of Lateral, Posterolateral and Posterior Approaches in the Supine Position.

BackgroundIn patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax.ObjectivesTo compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis.Materials and MethodsFirst, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-to-large effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed.ResultsIn each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the mid-axillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P < 0.001). In thirteen effusions (40.6%), DPE was greater than 1 cm in both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%).ConclusionSafety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

Quando três gerações adoecem simultaneamente

Introduction: Disease may be a cause or consequence of loss of family homeostasis. The general practitioner plays a special role in identifying family risk factors and recognizing resources and coping strategies during illness. This may be difficult when several family members are ill simultaneously. Case description: A. is a 37 year-old, Caucasian female, belonging to a nuclear family, in phase IV of the Duvall cycle. In May 2012, after the birth of her second child, she experienced sweating, weakness and weight loss. Four months later, she experienced evening fever and cough. She presented to the Family Health Unit in November and was referred for diagnostic tests. She was then referred to the Hematology Service of a local hospital. In December the diagnosis of non-Hodgkin lymphoma was made. A. was hospitalized several times for chemotherapy and her daughters remained in the care of her husband. The husband performed many required tasks and assumed all parental responsibility, minimizing the effects of the absence of the mother. In January, A.’s mother, was diagnosed with colorectal cancer and was admitted for surgery in the same hospital. Referral to the same hospital allowed visits between mother and daughter. On February, the eldest daughter aged 6 years had ENT surgery and the 9 month-old daughter had difficulty sitting. In June, A. completed her chemotherapy and the 13-month old daughter still had delayed motor and language development. Comment: The health care team, in order to maintain family function and minimize the impact of several diseases on the family, sought to mobilize and manage existing resources and empower different family members in developing new skills.

アトピー性脊髄炎による運動障害に対するリハビリテーション

We report a patient displaying several symptoms of myelitis associated with atopic dermatitis. The patient, a 35-year-old female, initially suffered from gait titubation that gradually developed into motor disturbance. She underwent many tests (blood, cerebrospinal fluid, electromyography, and brain, cervical, and lumbar spinal cord and muscle MRIs) at several hospitals, including a university institution, over the course of two years until she finally came to our hospital. However, her disease was never identified by these tests, and she was referred to our hospital to start rehabilitation for her disability which was believed to be caused by disuse syndrome. On first examination, muscle hypertonia of both legs, hypoesthesia of all extremities, difficulty sitting, and a low performance level of ADL were observed. Judging by the factors (e.g. age, neurological symptoms), we considered that the patient was not suffering disuse syndrome, and recommended that she attend another medical college hospital for a thorough investigation. The disease was finally diagnosed as atopic myelitis, as indicated by the test results (e.g. hyperIgEemia). She could sit without a back rest and undertake gait training between parallel bars after steroid pulse therapy at the hospital. While she undertook rehabilitation at our hospital, we applied some approaches to adapt to her fluctuating symptoms (e.g. making short leg braces for both legs, injection of botulinum toxin A (BOTOX®) in the leg). We recognized we should gather as much information as possible given the rarity of the disease.

Two-year results for scoliosis secondary to Duchenne muscular dystrophy fused to lumbar 5 with segmental pedicle screw instrumentation

BackgroundInstrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in patients with Duchenne muscular dystrophy since the development of the intrailiac post. It is recommended for correcting pelvic obliquity. However, caudal extent of instrumentation and fusion has remained a matter of considerable debate. This study was performed to determine the efficacy and safety of stopping segmental pedicle screw constructs at L5 during surgical treatment of scoliosis associated with Duchenne muscular dystrophy (DMD). MethodsFrom May 2005 to June 2007, a total of 20 consecutive patients underwent posterior spinal fusion and segmental pedicle screw instrumentation only to L5 for scoliosis secondary to DMD. All patients had progressive scoliosis, difficulty sitting, and back pain before surgery. A minimum 2-year follow-up was required for inclusion in this study. Assessment was performed clinically and with radiological measurements. The Cobb angles of the curves and spinal pelvic obliquity were measured on the coronal plane. Thoracic kyphosis and lumbar lordosis were measured on the sagittal plane. These radiographic assessments were performed before surgery, immediately after surgery, and at a 3-month interval thereafter. The operating time, blood loss, and complications were evaluated. Patients were questioned about whether they had difficulty sitting and felt back pain before surgery and at 6 weeks, 1 year, and 2 years after surgery. ResultsA total of 20 patients, aged 11–17 years, were enrolled. The average follow-up period was 37 months. Preoperative coronal curves averaged 70° (range 51°–85°), with a postoperative mean of 15° (range 8°–25°) and a mean of 17° (range 9°–27°) at the last follow-up. Pelvic obliquity improved from 13° (range 7°–15°) preoperatively to 5° degrees (range 3°–8°) postoperatively and 6° (range 3°–9°) at the last follow-up. Good sagittal plane alignment was recreated and maintained. Only a small loss of correction of scoliosis and pelvic obliquity was noted. The mean operating time was 271 min (range 232–308 min). The mean intraoperative blood loss was 890 ml (range 660–1260 ml). The mean total blood loss was 2100 ml (range 1250–2880 ml). There was no major complication. All patients reported that difficulty sitting and back pain were alleviated after surgery. ConclusionSegmental pedicle screw instrumentation and fusion only to L5 is safe and effective in patients with DMD scoliosis of <85° and pelvic obliquity of <15°. Good sagittal plane alignment was achieved and maintained. All patients benefited from surgery in terms of improved quality of life. There was no major complication.

Herbal Therapy: Children With Adhd (Attention Deficit Hyperactivity Disorder) And Depression

Herbal Therapy: Children With Adhd (Attention Deficit Hyperactivity Disorder) And Depression

Urethral Prolapse in a Reproductive-Aged Woman After Exercise

In Brief Background: Urethral prolapse is an uncommon condition seen in pediatric and postmenopausal females. This is the first reported case of urethral prolapse in a healthy, nulliparous, reproductive-aged woman after strenuous exercise. Case: A 29-year-old nulliparous, African-American woman presented with 3 days of vaginal pressure and pain, dysuria, and difficulty sitting. These symptoms occurred acutely after strenuous exercise. Examination revealed urethral prolapse and a urethral diverticulum. A short course of conservative therapy decreased symptoms. The patient was successfully treated with manual reduction under general anesthesia, along with correction of the urethral diverticulum. She has remained asymptomatic for more than 9 months. Conclusion: This case strengthens the theory that weak connective tissue combined with repeated increases in intraabdominal pressure is a primary cause of urethral prolapse. Treatment is varied, but manual reduction has been shown to be effective. Resection should be reserved for recurrent or infarcted cases. This is the first reported case of urethral prolapse in a reproductive-aged woman after exercise.

The Use of Lumbar Harness Traction to Treat a Patient with Lumbar Radicular Pain: A Case Report

The purpose of this case study is to describe an intervention using standing lumbar harness traction to treat a patient with lumbar radicular pain. A 60-year-old male presented with a 3 month history of right buttock and posterior thigh pain. The patient had positive unilateral straight leg raise and slump tests, and ankle evertor weakness. He exhibited symptom alleviation with lumbar deloading tests. His main functional limitation was difficulty sitting. The patient was seen for five visits. Initial intervention included standing harness traction. The patient's status, including neurological signs and symptoms, was monitored. Passive psoas stretching and instruction in self-stretch for psoas, gastrocnemius, and soleus was later included. Functional instruction and training in body mechanics and back care was carried out prior to discharge. Harness traction reduced neurological signs and radicular pain in this patient. He exhibited good functional recovery after five visits. Harness traction intervention should be considered in patients with complaints of low back and leg pain who exhibit symptom alleviation with lumbar deloading tests.

Function after amputation, arthrodesis, or arthroplasty for tumors about the knee.

We studied the function of twenty-two patients who had had a malignant skeletal tumor adjacent to the knee. An above-the-knee amputation was done in seven; a resection arthrodesis, in nine; and a replacement arthroplasty, in six. The patients all walked at a similar speed (sixty-one to sixty-six meters per minute), which is slower than normal (eighty meters per minute). They all walked with comparable efficiency at three velocities: the mean consumption of oxygen was 0.210 milliliter per kilogram of body weight per meter at free velocity, 0.215 milliliter per kilogram of body weight per meter when they walked 25 per cent faster, and 0.211 to 0.240 milliliter per kilogram of body weight per meter when they walked 50 per cent faster. The three groups of patients and a normal control group consumed oxygen at similar rates. The patients who had had an amputation were very active, and they were the least worried about damaging the affected limb, but they had difficulty walking on steep, rough, or slippery surfaces. The patients who had had an arthrodesis had a more stable limb and performed the most demanding physical work and recreational activities, but they had difficulty sitting. The patients who had had an arthroplasty led sedentary lives and were the most protective of the limb, but they were the least self-conscious about the limb.