Active Extension Range Research Articles

Effectiveness of supervised physiotherapy versus a home exercise program in patients with distal radius fracture: a randomized controlled trial with a 2-year follow-up

ObjectiveTo determine in the long term whether supervised physiotherapy is more effective than a home exercise program for functional improvement and pain relief in patients with distal radius fracture (DRF). DesignRandomized controlled trial. SettingRehabilitation hospital. ParticipantsA total of 74 patients older than 60 years with extra-articular DRF were randomly allocated into two groups. InterventionsThe experimental group received 6 weeks of supervised physiotherapy (n = 37) and the control group received 6 weeks of home exercise program (n = 37). Main outcome measuresThe primary outcome was wrist/hand function assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire; secondary outcomes were the pain visual analogue scale (VAS), grip strength and wrist flexion–extension active range of motion. ResultsAll patients completed the trial. For the primary outcome, at 6-weeks and 1-year follow-up, the PRWE questionnaire showed a mean difference between groups of 18.6 (95% CI 12.8 to 24.3) and 18.5 points (95% CI 12.7 to 24.2) respectively, these differences are clinically important. Conversely, at 2-year follow-up this effect decreases to 3.3 points (95% CI −2.4 to 9.0). For secondary outcomes, at 6-weeks and 1-year follow-up, in all measurements the effect size range from medium to large. Conversely, at 2-year follow-up only grip strength showed large effect size in favor of supervised physiotherapy, the rest of outcomes did not show difference between groups. ConclusionAt the 6-week and 1-year follow-up, supervised physiotherapy was more effective for functional improvement and pain relief compared with a home exercise program in patients older than 60 years with extra-articular DRF. However, this effect decreases over time, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy. Trial registrationBrazilian registry of clinical trials UTN no. U1111- 1249-2492. Registered 17 March 2020. Contribution of the Paper•Current evidence has shown controversial results regarding the effectiveness of supervised physiotherapy versus a home exercise program in elderly patients with DRFs.•At the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief.•However, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy in these patients.

Functional Peptides for Plant Disease Control.

Plant disease control requires novel approaches to mitigate the spread of and losses caused by current, emerging, and re-emerging diseases and to adapt plant protection to global climate change and the restrictions on the use of conventional pesticides. Currently, disease management relies mainly on biopesticides, which are required for the sustainable use of plant-protection products. Functional peptides are candidate biopesticides because they originate from living organisms or are synthetic analogs and provide novel mechanisms of action against plant pathogens. Hundreds of compounds exist that cover an extensive range of activities against viruses, bacteria and phytoplasmas, fungi and oomycetes, and nematodes. Natural sources, chemical synthesis, and biotechnological platforms may provide peptides at large scale for the industry and growers. The main challenges for their use in plant disease protection are (a) the requirement of stability in the plant environment and counteracting resistance in pathogen populations, (b) the need to develop suitable formulations to increase their shelf life and methods of application, (c) the selection of compounds with acceptable toxicological profiles, and (d) the high cost of production for agricultural purposes. In the near future, it is expected that several functional peptides will be commercially available for plant disease control, but more effort is needed to validate their efficacy at the field level and fulfill the requirements of the regulatory framework.

Equity and justice as central components of climate change adaptation

Equity and justice as central components of climate change adaptation

Does well-being differ across customer value cocreation practice styles? An empirical study in a chronic health context

PurposeDrawing on an extensive range of activities across different types, including mandatory (customer), mandatory (customer or organisation), voluntary in-role and voluntary extra-role activities, this study aims to identify different health-care customer value cocreation practice styles based on the combinations of value cocreation activities they undertake and empirically examine how customers adopting different styles differ in terms of well-being and satisfaction.Design/methodology/approachThe study was conducted across health customers with a variety of chronic conditions. Data were collected from three focus groups and an online survey.FindingsFive customer practice styles, namely, the highly active, other-oriented, provider-oriented, self-oriented and passive compliant customers, were revealed. While a moderate to a high level of activities is often recommended as it is associated with higher levels of physical, psychological, existential and social well-being and customer satisfaction, the results also suggest there is no single ideal style as different styles may be associated with the same level of outcomes.Research limitations/implicationsAs customers cocreate value differently, it is crucial to understand the underlying heterogeneity and its implications to outcomes.Practical implicationsHighly active and provider-oriented are the two styles that should be particularly encouraged because of their association with positive outcomes. Personalised strategies need to be developed and resources need to be put in place to build productive relationships amongst service providers, customers and peers and to increase the perceived value of such interactions so as to shift customers towards more active styles.Originality/valueThe study advances the understanding of customer value cocreation and its link to well-being by empirically deriving five distinct practice styles and demonstrating how they differ across meaningful well-being and satisfaction dimensions.

Effects of kinesiotape on pain, range of motion, and functional status in patients with osteoarthritis: a randomized controlled trial.

This study aimed to determine the effects of kinesiotape (KT) on pain, range of motion, and functional status in patients with osteoarthritis of the knee. In this randomized controlled trial, patients with knee osteoarthritis, based on American College of Rheumatology criteria, and Kellgren-Lawrence grade 2 or 3 criteria were selected. Visual analogue scale and active range of motion were the primary outcome measures. Timed Up and Go test and 6-min walk test, were the secondary outcome measures. Evaluation was performed at baseline (T0), after 1 hr (T1), and after 72 hr (T2). We recruited 27 patients with osteoarthritis (age, 57.33±8.72 years; 63% female; body mass index, 29.7±4.3 kg/m2) who were randomly assigned into KT or sham-KT groups. There was a significant group by time interaction for the visual analogue scale (P< 0.001, η2=0.593), active range of motion (flexion) (P<0.001, η2=0.492), active range of motion (extension) (P<0.001, η2=0.351), 6-min walk test (P<0.001, η2=0.568), and Timed Up and Go test (P=0.026, η2=0.136). Between-group comparisons revealed significant differences between KT and sham-KT in visual analogue scale and Timed Up and Go test in T1 and T2 assessments, with changes in knee flexion (P<0.002) and extension active range of motion (P<0.010) and 6-min walk test (P<0.044) at 72-hr posttreatment. This study showed that, 1 hr of KT is an effective treatment for decreasing pain and improving active range of motion and physical function at a 72-hr follow-up in patients with osteoarthritis.

Extraction, Characterization and Identification of Major Chemical Components of Areca Nut Extract at its Different Stages

The medicinal properties shown by different plants are due to phytochemicals present in the plant. These phytochemicals are the most vital source for the treatment of various diseases. Different phytochemicals have an extensive range of activities, which help to enhance the immune system and give resistance to the body to protect against attack of harmful pathogens. It is well accepted fact that even areca plant seed is also a good source of phytochemicals and hence planned to examine the phytochemicals present in its different stages, that is, tender areca nut (TACN), mature areca nut (MACN) and dry areca nut (DACN). All the three stages of areca nut extract were examined for tannin, phenols, flavonoids, alcohols, acids, amines and nitro groups. They showed positive results for all the tests. Trace elements such as Cu, Fe, Zn, Cr, Ni, Pb are present in small amount when compared to Na and K, and are identified by Atomic Adsorption Spectroscopy. FTIR analysis revealed the presence of functional groups such as –OH. –NH, -CH, >C=O, >C=C C-O-C and –NO groups in the areca nut extract. Extracts were investigated through GC-MS for identification of the chemical composition of extract, on comparison with results obtained from FTIR, and molecular mass nine, fourteen and five compounds were identified in TACN, MACN and DACN extracts, respectively.

Antibacterial Activity of &amp;lt;i&amp;gt;Citrus sinensis&amp;lt;/i&amp;gt; and &amp;lt;i&amp;gt;Solanum lycopersicum&amp;lt;/i&amp;gt; on Wound Isolated from Hospitals in Kaduna Metropolis Kaduna Nigeria

The increasing failure of chemotherapeutics and antibiotic resistance exhibited by pathogenic microbial infectious agents has lead to the screening of several medicinal plants for their potential antimicrobial activity. The medicinal properties shown by different medicinal plants are due to the phytochemicals present in the plant. These phytochemicals are the most vital sources for the treatment of destructive diseases. Different phytochemicals have an extensive range of activities, which helps to enhance the immune system and give resistance against long term disease to protect the body from harmful pathogens. To determine the antibacterial activity of <i>Citrus sinensis</i> and <i>Solanum lycopersicum</i> on wound isolated from Hospitals in Kaduna Metropolis Kaduna Nigeria was the main purpose of this study. Ethanolic and aqueous extracts of powdered <i>C. sinensis</i> peel and fresh fruit of <i>S. lycopersicum</i> were used for the qualitative measurement of various phytochemicals present in these plants. The phytochemical screening of the extracts yielded positive results for carbohydrates, glycosides, cardiac glycosides, saponins, triterpene, tannins, flavonoids and alkaloids. Wound swab samples of patients from five (5) selected hospitals within Kaduna metropolis yielded <i>Bacillus cereus, Myroides Species</i> and <i>Staphylococcus lentus</i>. The <i>Citrus sinensis</i> ethanolic and aqueous extracts as well as the <i>Solanum lycopersicum</i> ethanolic and aqueous extracts demonstrated a broad spectrum antibacterial activity against the three pathogenic bacteria of wound origin. The result of the tests indicate that orange peel ethanolic extract, tomato aqueous extract and tomato ethanolic extract showed the highest inhibition against <i>Bacillus cereus</i> 22mm, 20mm and 15mm respectively while highest inhibition of orange peel aqueous extract 19.5mm was recorded for <i>Myroides spp</i>. Lowest inhibition of tomato aqueous extract and tomato ethanolic extract were recorded for <i>Staphylococcus lentus</i> 15.2mm and 13.17mm respectively. Orange peel ethanolic extract and orange peel aqueous extract did not inhibit the growth of <i>Bacillus cereus</i> and <i>Staphylococcus lentus</i> respectively. Extracts which exhibited high activities against one or several pathogenic wound isolates were further assayed for minimum inhibitory concentration (MIC). The present study concludes that orange peel ethanolic, tomato aqueous and tomato ethanolic extracts showed highest antibacterial activity against the organism <i>Bacillus cereus</i> while orange peel aqueous showed highest antibacterial activity against <i>Myroide spp</i>. and there was a significant difference in the level of inhibition among the organisms isolated.

Outcome of Patellar Tendon Versus 4-Strand Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Prospective Randomized Trials

To compare clinical outcomes of anterior cruciate ligament (ACL) reconstruction and investigate whether the clinical results of 4-strand hamstring tendon (HT) reconstruction are still inferior to that of the patellar tendon (PT). We performed a comprehensive systematic review and meta-analysis of the English literature on PubMed, Scopus, Web of Science, and the Cochrane register for papers that compared clinical outcomes of PT versus HT for ACL reconstruction. Outcome measures analyzed included rate of rerupture, KT-1000, International Knee Documentation Committee grade, Lachman, pivot shift, Lysholm score, Tegner Activity Scale, anterior knee pain, and discomfort on kneeling. We included 19 studies from an initial 1,168 abstracts for the systematic review, and, eventually, 19 studies were included in the meta-analysis. The study population consisted of a total of 1784 patients. The average follow-up duration was 58.8months. We found significant differences in favor of the HT technique in the domains of anterior knee pain, kneeling pain, and restriction in the range of active extension ("extension deficit"). We found no differences between the PT and HT technique in terms of rerupture rate. There were no clinically significant differences for the outcomes of Lysholm score and Tegner Activity Scale as well as the KT-1000 side-to-side at maximum manual force. Contemporary 4-strand HT ACL reconstruction is comparable with the PT technique in terms of clinical stability and postoperative functional status across most parameters studied. The HT technique carries lower risk of postoperative complications such as anterior knee pain, kneeling discomfort, and extension deficit. Primary ACL reconstruction using the 4-strand HT technique achieves clinical results that are comparable with the PT technique with significantly less postoperative complications. Level I, systemic review and meta-analysis of Level I studies.

Distinction between pathological and functional co-activation during active upper limb movements in hemiparetic children

Children with spastic unilateral cerebral palsy (SUCP) have an involved upper limb (IUL) restricted in active range of motion and in velocity when performing elbow extension, due to a combination of muscle impairments. One of them is excessive muscle co-activation (CA). CA usually has a functional role, particularly in joint stabilization. The aim of this study is to identify when pathological CA occurs during active elbow extension of the IUL to highlight its impact on movement restriction and to discriminate impaired muscles. Thirteen typically developing (TD) children and 13 children with SUCP performed active elbow extension/flexions at 3 externally paced frequencies. Elbow angle and velocity were computed using a subject-specific model tracking the position of 29 upper limb markers. With these data, the extension movement was decomposed into the Extension Acceleration Phase (EAP) (velocity increase) and the Extension Deceleration Phase (EDP) (velocity decrease). The percentage of CA for the brachioradialis (BR)/triceps and biceps/triceps couples for each phase was extracted from the surface electromyographic signals. Statistical analysis was conducted using linear mixed effects models. During the EAP, excessive and positive frequency-dependent CA was found in the SUCP group, whereas CA in the TD group was low and invariant. These results point to pathological CA in the SUCP group, probably linked to restricted velocity. During the EDP, only excessive BR/triceps CA was found in the SUCP group. CA was positive frequency-dependent in both groups. These results point to mostly functional CA, for joint stabilization at the end of the movement. However, BR seems to stand out in its possible involvement in extension active range of motion restriction. This study provides insight into pathological CA in children with SUCP. Perspectives include individual clinical interpretation of the results, to assist in each child's therapeutic decision.

English

Creatine monohydrate (CrM) is considered a safe nutritional supplement. The loading phase of CrM supplementation is associated with shifts in total body water and plasma volume that may affect blood pressure. However, few studies have measured blood pressure during the loading phase of CrM supplementation. Purpose: The aim of this study was to determine if CrM supplementation in normotensive college-aged males induces a daily blood pressure increase during the supplementation-loading phase. Methods: Participants’ blood pressure, shoulder extension active range of motion (AROM), arm girth, arm volume, plasma volume, blood volume, hematocrit, and hemoglobin were measured daily for five days of supplementation (4x5gxd -1 x5d) of either CrM (n=12) or placebo (P; n=12). Results: The CrM group did not experience significant changes in systolic blood pressure (mmHg) (CrM 126.67±1.94 Day5 ; P 125.50±2.61 Day5 ) or diastolic blood pressure (mmHg) (CrM 83.83±2.19 Day5 ; P 82.33±2.07 Day5 ) compared to P. A significant T x Tx interaction (p=0.001) and Tx effect (p=0.03) support decreased AROM (cm) in the CrM group compared to P (CrM 38.3±2.19 Day 1 , CrM 34.0±2.01 Day5 ; P 41.02±2.49 Day 1 , P 43.2±2.47 Day5 ). An increase in arm volume (ml) in the CrM group (CrM 2443±99.44 Day 1 , CrM 2470±92.21 Day5 ) vs. the P group (P 2372±74.44 Day 1 , P 2374±74.61 Day5 ; p=0.026) was observed. An increase in plasma volume (%Δ from baseline) (p=0.014) (CrM 1.48±2.60 Day2 , CrM 6.03±4.03 Day5 ; P 3.25±2.74 Day2 , P 5.05±2.91 Day5 ) and a decrease in hematocrit (%) (p=0.026) (CrM 0.47±0.01 Day 1 , 0.45±0.01 Day5 ; P 0.46±0.01 Day 1 , 0.45±0.01 Day5 ) were observed. Conclusion: Findings suggest CrM supplementation in the loading phase does not affect blood pressure in normotensive college-aged males. CrM reduces shoulder extension AROM presumably due to increased tissue volume secondary to fluid shifts.

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods: Early Clinical Outcomes and Implications.

Background:To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures.Methods:Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively.Results:At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion (ROM) of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. Compared with the contralateral hand, the grip strength of the injured hand was 94.0 ± 9.6%. X-rays showed that the arch of the second to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings.Conclusion:The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and fifth metacarpal fractures with good early clinical outcomes and no significant complications.

Treatment of Proximal Interphalangeal Joint Flexion Contracture: Combined Static and Dynamic Orthotic Intervention Compared With Other Therapy Intervention: A Randomized Controlled Trial

To test the effectiveness of static and dynamic orthoses using them as an exclusive treatment for proximal interphalangeal (PIP) joint flexion contracture compared with other hand therapy conservative treatments described in the literature. 60 patients who used orthoses were compared with a control group that received other hand therapy treatments. Clinical assessments were measured before the experiment and 3 months after and included active PIP joint extension and function. A significant improvement in the extension active range of motion at the PIP joint in the second measurement was found in both groups, but it was significantly greater in the experimental group. Improvement in function (Disabilities of the Arm, Shoulder, and Hand score) between the first and second assessment was similar in the control and experimental groups. Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in the PIP joint active extension, but the improvement did not correlate with increased function as perceived by the patient. Therapeutic I.

Home-based movement therapy in neonatal brachial plexus palsy: A case study

Study designCase report. IntroductionThe value of movement-based therapy in peripheral nerve injury conditions such as neonatal brachial plexus palsy (NBPP) is unclear. Purpose of the studyTo determine the effectiveness of a home-based movement therapy program in a 17 year old female patient with a right NBPP pan-plexopathy. MethodsHome training consisted of arm reaching and object manipulation tasks using devices which recorded performance. Training occurred for 1 h/day, 5 days/week for 6 weeks with periodic webcam supervision. Pre- and post clinical, functional and kinematic assessments were performed in a laboratory setting. ResultsFollowing training, shoulder flexion and elbow extension active range of motion increased by 13° and 9°, respectively, and functional ability also improved. Reach movement duration decreased significantly with a concomitant improvement in movement coordination. ConclusionsThese results demonstrate that movement therapy has the potential to improve motor function in NBPP years after the initial insult. Level of evidence4

Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren’s contracture: A prospective case study

ObjectiveTo examine the potential for treatment of palmar adhesions associated with Dupuytren’s contracture using instrument-assisted cross-frictional massage (CFM) and stretching. MethodsThis was a prospective case study. The primary intervention consisted of a 2-min multi-planar CFM over the affected area of the palm, followed by a 2-min maximal finger-extension stretch. ResultsFollowing eight weeks of treatment there were increases in both passive and active extension range of motion of the digits, reduction in the visibility of palmar adhesions, and subjective improvements in hand function. ConclusionsThis treatment protocol may offer a substitute for the current invasive surgical and injection procedures that are available.

Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial

The recovery of quadriceps muscle force and function after total knee arthroplasty (TKA) is suboptimal, which predisposes patients to disability with increasing age. The purpose of this investigation was to evaluate the efficacy of quadriceps muscle neuromuscular electrical stimulation (NMES), initiated 48 hours after TKA, as an adjunct to standard rehabilitation. This was a prospective, longitudinal randomized controlled trial. Sixty-six patients, aged 50 to 85 years and planning a primary unilateral TKA, were randomly assigned to receive either standard rehabilitation (control) or standard rehabilitation plus NMES applied to the quadriceps muscle (initiated 48 hours after surgery). The NMES was applied twice per day at the maximum tolerable intensity for 15 contractions. Data for muscle strength, functional performance, and self-report measures were obtained before surgery and 3.5, 6.5, 13, 26, and 52 weeks after TKA. At 3.5 weeks after TKA, significant improvements with NMES were found for quadriceps and hamstring muscle strength, functional performance, and knee extension active range of motion. At 52 weeks, the differences between groups were attenuated, but improvements with NMES were still significant for quadriceps and hamstring muscle strength, functional performance, and some self-report measures. Treatment volume was not matched for both study arms; NMES was added to the standard of care treatment. Furthermore, testers were not blinded during testing, but used standardized scripts to avoid bias. Finally, some patients reached the maximum stimulator output during at least one treatment session and may have tolerated more stimulation. The early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.

Contrasting approaches to recruitment in primary care research

AimTo describe approaches to recruitment, key challenges and strategies to improve recruitment among research organizations in the UK.BackgroundRecruiting research participants is challenging. Less than one-third of studies recruit to target on time.MethodsDescriptive survey with 31 participants from 22 public and private sector organizations.FindingsWe identified a range of recruitment pathways, highlighting the extensive range of activities required throughout the process. Methods reported to improve recruitment were related to project management, context and resources. There were differences in emphasis between sectors concerning prioritization of staff roles, feasibility work and marketing.ConclusionsOrganizations involved in primary care research adopt diverse approaches, yet cross-fertilization between groups is limited

Victorian Hospital Pharmacy Technician Workforce Survey

ABSTRACTAimTo collect data to assist in the preparation of a revised enterprise bargaining agreement and award for Victorian hospital pharmacy technicians.MethodAn electronic questionnaire was sent to a representative at each hospital pharmacy service in Victoria who then circulated the questionnaire within their department for completion by every person employed as a hospital pharmacy technician.ResultsThe survey confirmed that Victorian hospital pharmacy technicians undertake an extensive range of activities. Findings of note included: 28% had more than 10 years experience as a hospital pharmacy technician; 24% had less than 2 years experience; 32% had, or were undertaking Certificate III or IV in Health Service Assistance qualifications. Respondents working in hospitals with less than 200 beds were more likely to have Certificate III in Health Service Assistance qualifications. 47% of the 126 respondents indicated that they support clinical pharmacy activities as part of their day‐to‐day activities. 76% were paid award rates. Technicians paid above award rates had the following characteristics: more than 5 years experience; Certificate III or IV in Health Service Assistance qualifications; employed as grade 2 technicians; work in metropolitan hospitals and work in hospitals with less than 200 beds. 40% were involved in supporting clinical pharmacy and 40% undertook management activities. Respondents estimated that in total they spent 80% of their time on distribution services; 9% of their time on management services and 10% supporting clinical pharmacy services.ConclusionThis survey demonstrated that in Victoria there is a disconnection between the work performed by hospital pharmacy technicians, their qualifications and their remuneration. It is hoped that a revised enterprise bargaining agreement and award will provide incentives and a career structure that encourages many to pursue formal qualifications.

Progress in clinical governance: findings from the first NPCRDC National Tracker survey of Primary Care Groups/Trusts

In April 1999, 481 English Primary Care Groups (PCGs) were created. The National Primary Care Research and Development Centre is leading a three year longitudinal study, in conjunction with the King’s Fund, to track the development of PCGs. The implementation of clinical governance is an important responsibility of PCGs. This survey aimed to describe initial progress in implementing clinical governance in primary care, and to describe barriers to change. Data were collected in autumn 1999, using a questionnaire to clinical governance leads, in a random sample of 72 PCGs. PCGs have put considerable effort into the development of clinical governance and an extensive range of activities were planned for tracking quality of care. However, PCGs face barriers in implementing clinical governance and they must foster a culture of engaged participation by practices and practice staff. PCGs must also be given the time and resources needed to implement clinical governance.