Functional Disability Scores Research Articles

Association Between Recent Criminal Legal Involvement and Functional Status Among US Adults with Diabetes: 2015-2019.

Diabetes is a significant public health concern with significant implications for health equity. Functional disability undermines disease control and may be associated with the relationship between criminal legal involvement and poor chronic disease outcomes, but this relationship has not been studied. This study examined the association between recent criminal legal involvement and functional disability among a nationally representative sample of US adults with diabetes. Adult respondents to the National Survey of Drug Use and Health (2015-2019) who reported a diagnosis of diabetes were included in this analysis examining the association between three forms of recent criminal legal involvement (past year arrest, or supervision on probation or parole) and functional disability, as measured by the World Health Organization Disability Assessment Score 2.0. In multivariate linear regression analyses adjusted for relevant socio-demographic and clinical confounders, the functional disability score increased by 2.7 (95% CI, 1.6-3.9) for those with past year arrest compared to no past year arrest; 1.2 (95% CI, -0.1, 2.6) for those with past year probation compared to no past year probation; and 0.4 (95% CI, -1.1, 1.8) for those with past year parole compared to no past year parole. Recent criminal legal involvement, specifically past year arrest, is associated with greater functional disability, which may serve as an important mediator for poor health outcomes in patients with diabetes. Future research should examine this pathway and prioritize interventions to improve both functional disability and glycemic control among individuals with diabetes and recent criminal legal involvement.

The association between age and functional disability in US adults with lifetime exposure to the criminal legal system, 2015–2019

ImportanceAs the global population ages, the proportion of individuals living with functional disability is increasing. Evidence suggests that functional disability is associated with worse health outcomes and is concentrated in populations with high rates of concurrent social risk factors such as criminal legal involvement (CLI), making it an increasingly important issue for advocates of health equity. ObjectiveTo determine whether age is associated with functional disability in a nationally representative sample of United States adults with lifetime exposure to the criminal legal system. DesignCross-sectional survey data from the National Survey of Drug Use and Health, 2015–2019. SettingNationally representative survey data. ParticipantsUS adults who reported lifetime history of arrest (N = 37,279). ExposureRespondents were categorized into age groups: younger adults (age 18–49); middle-aged adults (age 50–64); and older adults (age ≥ 65). Main outcome measureFunctional disability as measure by the World Health Organization Disability Assessment Score 2.0 (WHO-DAS 2.0). A higher score indicates a greater degree of functional disability. ResultsThe sample included 37,279 US adults with lifetime CLI of whom 60.0 % were younger adults, 28.5 % were middle-aged adults, and 11.5 % were older adults. The mean, unadjusted functional disability score for younger adults was 5.0 (95 % CI, 4.9, 5.1); for middle-aged adults it was 4.2 (95 % CI, 4.0, 4.4); and for older adults it was 3.2 (95 % CI, 2.9, 3.5). In models adjusted for sociodemographic and clinical confounders, differences were attenuated but remained statistically significant, indicating increased functional disability in the younger age groups. Conclusion and relevanceOur findings suggest that among adults with CLI, functional disability is distributed by age in a pattern distinct from the general population. A large number of young adults have CLI, and the findings suggest that prevalence of functional disability is exceedingly high in this marginalized group. Future studies should examine if substance use and mental health conditions contribute to these findings, and policy makers should examine if flexible interventions tailored to the needs of those with disability improve reentry outcomes for young adults with CLI.

Effect of William Exercise and Blackburn Exercise in Patients with Chronic Low Back Pain: A Randomized Control Trial

Background: Low back pain (LBP) physiotherapy treatment, mostly focuses on low back area and lower limb. Fewer physiotherapists and studies correlate the upper back and LBP. The present study was conducted to see the effect of lumbar stabilization (William) exercise and scapular stabilization (Black burn) exercise in chronic low back pain (CLBP) patients. Methods: Total 28 subjects were allocated randomly by the lottery method in two different treatment groups, Group-A (William exercise + black burn exercise group) and Group-B (William exercise). Pain intensity was measured by numeric pain rating scale (NPRS), and functional disability score by Roland - Morris disability questionnaire (RMDQ). Statistical analysis was done using SPSS V.20. Result: Within group analysis showed statistically significant difference in NPRS score(Z =-3.320, p < 0.001), RMDQ score(Z = -3.300, p < 0.001) in group A. Whereas NPRS score (Z = -3.341, p < 0.001), RMDQ score (Z = -3.202, p < 0.001) in group B. Comparison of baseline data showed no statistically significant difference in NPRS score (U=89, p=0.668) and RMDQ score (U=84, p=0.518) in both the groups. At the end of 4 weeks of intervention, data showed statistically significant difference in NPRS score (U=51.5, p=0.024) and RMDQ score (U=52.5, p=0.035) between both the groups. Conclusion: This study concludes that William exercise is good for the CLBP patients but William exercise and Blackburn exercise shows superior results in pain reduction and also reduced back related disability and restored functioning in CLBP patients. Keywords: Low back pain, William exercise, Scapular stabilization, black burn exercise

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US

BackgroundThe intersection of race/ethnicity with disability is a critical dimension of mental health outcomes in later ages that remains under-investigated. ObjectiveWe examined the role of race-ethnicity in moderating the associations between functional disabilities and subsequent depression among Americans 51 and older and stratified into the two age-groups of midlife (51-64) and older adults (≥65). MethodsUsing a nationally representative sample of community-dwelling Americans (≥51; n=7,475) in the 2016-2018 Health and Retirement Study, we conducted bivariate and multivariable regression analyses. Racial-ethnic groups included non-Hispanic (NH) Black, Hispanic, and NH White and a binary (0/1) outcome defined subsequent depression in 2018. The total number of difficulties on the Nagi, Lawton, and Katz disability scales represented baseline (2016) functional disabilities with a secondary four-level (no/mild/severe with assistance/severe without assistance) disability indicator incorporated to examine the role of assistance with daily living. ResultsAcross age-groups, subsequent depression was significantly more prevalent among NH Whites with functional disabilities compared to counterparts reporting no disabilities. Compared to NH Black and Hispanic counterparts, midlife NH Whites were three times more likely to report subsequent depression with each unit increase in the functional disability score, after adjusting for covariates. However, we observed no such racial-ethnic differences among older adults. Among the 51+ severe with no assistance group, adjusted odds of subsequent depression among NH Whites was 2.5 times higher than minority counterparts. ConclusionHealth programs and environmental adaptations supporting functional care needs in later ages could be beneficial for improving mental health of adults with disabilities.

Radiofrequency vs Steroid Injections for Spinal Facet and Sacroiliac Joint Pain: A Systematic Review and Meta-Analysis.

Pain management for spinal facet joint (SFJ) and sacroiliac joint (SIJ) pain is challenging, often requiring interventions like radiofrequency ablation (RFA) or corticosteroid injections (CI). This study aims to assess and compare the effectiveness of CI and RFA in treating SFJ and SIJ pain. We combine these treatments due to their shared pathophysiology, similar therapeutic interventions, and the necessity for an integrated approach to spinal pain management. Literature search from PubMed, Scopus, CENTRAL and Google Scholar for published studies upto 31st December 2023, and reporting data of patients who were treated using CI of RFA for SFJ and SIJ pain. Pooled standardized mean difference (SMD) with a 95% Confidence Interval (CI) was calculated. Our meta-analysis incorporated thirteen studies. Overall, patients, treated with CI had a higher pain intensity score compared to patients treated with RFA (SMD=0.92; 95% CI: 0.19 to 1.65) at 3 months, and at 6 months (SMD=1.53; 95% CI: 0.66 to 2.40) after the treatment. No significant association was reported at 12 months (SMD=1.47; 95% CI: -0.03 to 2.97). Subgroup analysis based on joint types revealed increased pain intensity scores in patients who were treated with CI for SIJ (SMD=1.25; 95% CI: 0.39 to 2.11) and SFJ (SMD=1.33; 95% CI: 0.09 to 2.57) pain. A negative but not significant effect was detected in patients, treated with CI for cervical joint pain (SMD=-0.40; 95% CI: -0.90 to 0.10). Patients treated with CI exhibited higher functional disability score compared to patients treated with RFA at 3 months (SMD=1.28; 95% CI: 0.20 to 2.35) post-treatment. This study suggests that RFA may offer superior pain relief with longer duration compared to steroid injections for spinal facet and sacroiliac joint pain. Decision regarding specific interventions should be individualized and consider patient preferences, clinical context, and potential risks.

Safety and Efficacy of Staged, Bilateral Focused Ultrasound Thalamotomy in Essential Tremor

Unilateral magnetic resonance-guided focused ultrasound ablation of ventralis intermedius nucleus of the thalamus for essential tremor reduces tremor on 1 side, but untreated contralateral or midline symptoms remain limiting for some patients. Historically, bilateral lesioning produced unacceptable risks and was supplanted by deep brain stimulation; increasing acceptance of unilateral focused ultrasound lesioning has led to interest in a bilateral option. To evaluate the safety and efficacy of staged, bilateral focused ultrasound thalamotomy. This prospective, open-label, multicenter trial treated patients with essential tremor from July 2020 to October 2021, with a 12-month follow-up, at 7 US academic medical centers. Of 62 enrolled patients who had undergone unilateral focused ultrasound thalamotomy at least 9 months prior to enrollment, 11 were excluded and 51 were treated. Eligibility criteria included patient age (22 years and older), medication refractory, tremor severity (Clinical Rating Scale for Tremor [CRST] part A score ≥2 for postural or kinetic tremor), and functional disability (CRST part C score ≥2 in any category). A focused ultrasound system interfaced with magnetic resonance imaging allowed real-time alignment of thermography maps with anatomy. Subthreshold sonications allowed target interrogation for efficacy and off-target effects before creating an ablation. Tremor/motor score (CRST parts A and B) at 3 months for the treated side after treatment was the primary outcome measure, and secondary assessments for efficacy and safety continued to 12 months. The mean (SD) population age was 73 (13.9) years, and 44 participants (86.3%) were male. The mean (SD) tremor/motor score improved from 17.4 (5.4; 95% CI, 15.9-18.9) to 6.4 (5.3; 95% CI, 4.9 to 7.9) at 3 months (66% improvement in CRST parts A and B scores; 95% CI, 59.8-72.2; P < .001). There was significant improvement in mean (SD) postural tremor (from 2.5 [0.8]; 95% CI, 2.3 to 2.7 to 0.6 [0.9]; 95% CI, 0.3 to 0.8; P < .001) and mean (SD) disability score (from 10.3 [4.7]; 95% CI, 9.0-11.6 to 2.2 [2.8]; 95% CI, 1.4-2.9; P < .001). Twelve participants developed mild (study-defined) ataxia, which persisted in 6 participants at 12 months. Adverse events (159 of 188 [85%] mild, 25 of 188 [13%] moderate, and 1 severe urinary tract infection) reported most commonly included numbness/tingling (n = 17 total; n = 8 at 12 months), dysarthria (n = 15 total; n = 7 at 12 months), ataxia (n = 12 total; n = 6 at 12 months), unsteadiness/imbalance (n = 10 total; n = 0 at 12 months), and taste disturbance (n = 7 total; n = 3 at 12 months). Speech difficulty, including phonation, articulation, and dysphagia, were generally mild (rated as not clinically significant, no participants with worsening in all 3 measures) and transient. Staged, bilateral focused ultrasound thalamotomy significantly reduced tremor severity and functional disability scores. Adverse events for speech, swallowing, and ataxia were mostly mild and transient. ClinicalTrials.gov Identifier NCT04112381.

Microwave ablation of synovial hypertrophy in recurrent monoarthritis: the results of extended cohort and long-term follow-up

Abstract Objectives Recurrent monoarthritis (RM) is a major challenge of many rheumatic diseases. Ablation is a well-known technique in the treatment of benign or malign lesions of different aetiologies. We aimed to investigate the success and safety of microwave ablation (MWA) as an adjunctive therapy in a cohort of medical treatment-resistant RM. Methods Patients with RM associated with different inflammatory diseases were included. MWA was performed after measuring the size of synovial hypertrophy with 15 or 20 W power and different durations until microbubbles were shown, indicating necrosis. Both clinical and radiologic data were recorded. Results We applied MWA in total of 24 knee joints of 10 female and 12 male patients aged between 22 and 71 years. Median IA aspiration (IAA) need in the last 6 months before MWA was 5 (0–15). The median follow-up was 10 (3–16) months. Overall IAA count in the last 6 months before MWA in total of 144 months was 129, and decreased to 7 in post-MWA in total of 226 months (0.89 vs 0.03 per month, P &amp;lt; 0.001). The second MWA session was needed for three patients and a third session for one. Functional disability and pain scores were improved significantly (median score from 9 to 1, P &amp;lt; 0.00001, in both). In MRI, follow-up significant regression in synovial hypertrophy size was shown especially after the 6th month. No complication was observed during the procedure or follow-up. Conclusion As a less invasive technique compared with the surgical approach, MWA of synovial hypertrophy showed significant clinical improvement in RM safely. MWA seems promising as a treatment option candidate in the management of RM.

Prevalence of Upper Extremity Pain among Tabla Players working in Islamabad/Rawalpindi

Background: Upper extremity pain is a significant concern among musicians, particularly those involved in repetitive and high-stress activities such as playing the tabla. This study aims to assess the prevalence and risk factors of upper extremity pain and associated functional disabilities in tabla players based in Islamabad and Rawalpindi. Objective: To determine the prevalence of upper extremity pain and functional disability among tabla players and to identify associated risk factors. Methods: A cross-sectional descriptive survey was conducted at music schools, academies, and churches in Islamabad and Rawalpindi. The study spanned five months from June 23, 2023, following the approval of the synopsis. A sample size of 100 male tabla players aged 19-38 years, with at least two years of playing experience and a minimum of two practice sessions per week, was selected using a non-probability convenient sampling technique. Data collection tools included the Visual Analogue Scale (VAS) for pain assessment and the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire for evaluating functional limitations. Participants with a history of upper extremity diseases, surgical history, trauma, or congenital deformities were excluded. Descriptive analysis was performed using SPSS version 25, with frequencies, percentages, and p-values calculated to determine statistical significance. Results: Among the participants, 40% were aged 19-23 years, 26% were aged 24-28 years, 31% were aged 29-33 years, and 3% were aged 34-38 years. The prevalence of upper extremity pain was 89%, and functional disability was 88%. Pain levels varied with playing hours per week: 11% reported no pain, 16% had mild pain, 67% experienced moderate pain, and 6% had severe pain. Functional disability scores were similarly distributed across playing hours, with 11% reporting no disability, 16% mild disability, 67% moderate disability, and 6% severe disability. The relationship between playing hours and both VAS and DASH scores was statistically significant (p-values 0.045 and 0.032, respectively). Conclusion: The study revealed a high prevalence of upper extremity pain and functional disability among tabla players, significantly impacting their quality of life. Key risk factors included repetitive movements, abnormal posture, prolonged practice hours, poor technique, age, and gender. These findings underscore the need for preventive strategies and targeted interventions to reduce musculoskeletal disorders in this population.

Suicidal ideation in people with multiple sclerosis and its association with coping self-efficacy

BackgroundChronic neurological disease such as multiple sclerosis (MS), is a significant risk factor for psychological distress, which can result in suicidal behaviour. Suicidal ideation (SI) is considered a harbinger of suicide-related mortality. However, so far, little is known about the role of protective factors against SI in MS. ObjectiveThis study aims to assess the association between coping self-efficacy and SI when controlled for sociodemographic variables, clinical variables, sleep-related problems, and depression. MethodsThe study sample consisted of 162 people with MS, was predominantly female (75.9 %), the mean age was 40.9 ± 11.4 years, the mean disease duration was 11.7 ± 7.1 years, and the mean functional disability score was 3.55 ± 1.1. We used the Coping Self-Efficacy scale (CSE), the General Health Questionnaire-28 (GHQ-28), the Expanded Disability Status Scale (EDSS), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the Multidimensional Fatigue Inventory (MFI). Multiple linear regressions were utilized to statistically analyse the data. ResultsAll assessed coping self-efficacy dimensions were significantly associated with SI in MS when controlled for sociodemographic variables, clinical variables, sleep-related problems, and depression. Furthermore, all assessed coping self-efficacy dimensions were able to alleviate the negative association between income, depression and SI. ConclusionPeople with MS may significantly benefit from psychological support aimed at promoting coping self-efficacy and utilization of various coping strategies. Problem-focused coping, coping focused on getting support, and coping focused on stopping unpleasant thoughts and feelings seem to have comparable associations with SI, and thus interventions aimed at empowering any of these dimensions may be beneficial in diminishing the severity of SI.

Comparative effects of shockwave therapy and Maitland lumbar mobilization on pain, disability, and range of motion in patients with mechanical low back pain: A pilot study

Objectives: Low back pain (LBP) has been considered a neuromusculoskeletal issue that affects a wide variety of populations around the globe at some stage in their life. This paper aimed to see the comparative effects of shockwave therapy and Maitland lumbar mobilizations on pain severity, disability, and range of motion (ROM) values in subjects with mechanical LBP. Methods: A randomized clinical trial was carried out involving 26 subjects divided into two groups using a random number generator table. After baseline therapy (lumbar stretches and core strengthening exercises), shockwave therapy was administered to Group A (2000 shocks/session, pressure of 2 bars, frequency 10 Hz), while Group B received Maitland lumbar mobilizations (starting from Grade 1, with 3–4 sets of oscillations with 40 counts/set, two sets of oscillation to one level below and above the affected vertebras). Both therapeutic interventions were administered for 30 days, twice a week (total of eight sessions) for individual groups. Results: Numeric pain rating scale, Oswestry LBP disability index, lumbar flexion, and extension ROM pre- and post-treatment values showed significant differences with P &lt; 0.05. A greater difference in mean values was observed in group B receiving Maitland mobilization as compared to group A receiving shockwave therapy. Between-group analysis showed a statistically significant difference in both groups with P &lt; 0.005. Conclusion: Both groups showed significant effects in reducing pain levels, functional disability scores, and improving flexion and extension ROM values. However, participants receiving Maitland mobilization showed more significant improvement in all variables than shockwave therapy.

Comparative Effectiveness of Muscle Energy Technique (MET) With or Without Proprioceptive Neuromuscular Facilitation (PNF) Pattern in Lumbosacral Dysfunction

Lumbosacral dysfunction is a condition affecting the lumbar and sacral regions of the spine, causing back pain, limited range of motion, sensory deficits, and motor impairments. It can be caused by degenerative changes, traumatic injuries, congenital anomalies, or abnormal biomechanics. Objective: The objective of this study was to compare the effects Muscle Energy Technique (MET) alone and with combination of PNF in treating lumbosacral syndrome. Methods: The study was a quasi-experimental design over the duration of 8 weeks. Purposive sampling was employed with a sample size of 40 patients, divided equally into Group A (N= 20) who received MET combined with PNF and Group B (N= 20) that only received MET. We used Oswestry Disability Index (ODI), Numeric Pain Rate Scale (NPRS) and goniometer to assess disability, pain, and range of motion (ROM). We analyzed the data using IBM SPSS version 23.0. Results: Outcome measures including pain intensity, functional disability, and range of motion, were assessed at baseline and post-intervention (8 weeks). The group A showed significant improvements in all outcome measures compared to the group B at post-intervention assessments (p &lt; 0.05), pain intensity decreased by 60-80%. Functional disability scores were reduced by 60-75% in the group A, while the group B showed only 40% significant change. Moreover, the group A exhibited a substantial increase in lumbosacral range of motion compared to the group B. Conclusions: The study reveals that both MET alone and MET combined with PNF effectively improve pain, functional disability, and lumbar range of motion in lumbosacral dysfunction patients.

Compare the Effects of Bowen Technique and Muscle Energy Technique on Hamstrings Tightness in Patients with Chronic Low Back Pain

Background: Chronic low back pain (CLBP) is a prevalent condition affecting a significant portion of the global population, leading to decreased quality of life and increased healthcare utilization. Previous research has identified manual therapies, such as the Muscle Energy Technique (MET) and the Bowen Technique, as potential interventions for reducing pain and improving functional outcomes in patients with CLBP. These techniques focus on reducing muscular tightness and improving flexibility, which are often implicated in the etiology of low back pain. Objective: The aim of this study was to compare the effects of the MET and the Bowen Technique on hamstring tightness and pain reduction in patients with CLBP. Methods: This randomized controlled trial included 62 participants with CLBP, who were divided into two groups to receive either the MET or the Bowen Technique. The interventions were administered over an 8-week period, with sessions occurring three times per week. Outcome measures included hamstring flexibility (measured by the Active Knee Extension Test), pain intensity (measured by the Visual Analogue Scale), and functional disability (measured by the Oswestry Disability Index). Data were analyzed using repeated measures ANOVA and independent t-tests. Results: Both groups showed significant improvements in all measured outcomes. Participants in the MET group demonstrated a greater reduction in pain intensity from baseline to 8 weeks (5.5161±1.20750 to 1.4839±1.15097, P&lt;0.000) compared to the Bowen Technique group (7.2258±0.88354 to 0.2581±0.51431, P&lt;0.000). Similarly, hamstring flexibility and functional disability scores improved significantly in both groups, with the MET group showing slightly more substantial improvements in functional disability. Conclusion: The study concluded that both the MET and the Bowen Technique are effective interventions for reducing pain and improving hamstring flexibility in patients with CLBP. However, the MET showed a slight advantage in improving functional disability outcomes.

Low Dose Amantadine and Escitalopram in Progressive Supranuclear Palsy and Multiple System Atrophy

Background: Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are less responsive to usual antiparkinsonian drugs. Purpose: To assess the treatment outcome of the combination of low-dose amantadine and escitalopram in the study population. Methods: A retrospective study of PSP and MSA patients from June 2021 to December 2022 treated with the dose of amantadine 100 mg and escitalopram 5 mg per day with a follow-up of 2 months at a tertiary care centre in India. The primary outcome measure was a change in the PSP and MSA severity rating scale scores, while cognition, neuropsychiatric symptoms and functionality scale scores were secondary outcomes on follow-up visits. Repeated measures ANOVA and Friedman rank test were used to analyse the data. Results: A total of 21 patients (8 PSP and 13 MSA), including 19 males, with a mean age of 72.84 years, were included. The mean total PSP rating scale score had a significant decline from baseline to week 2 and 8 ( p &lt; .001), along with the scores for limb symptoms ( p &lt; .001), ocular ( p = .001), history ( p = .003), gait ( p = .007), mentation ( p = .014) and bulbar ( p = .018) symptoms. Similarly, the mean score of the MSA rating scale significantly decreased on follow-up visits ( p &lt; .001). The cognition, functional disability and behavioural symptoms scores also had significant improvement with p &lt; .01. Conclusion: The PSP and MSA patients had clinically significant improvement with the combination treatment in both motor and non-motor domains. Further prospective trials for longer durations are needed to establish the effect size and stability of response.

Optimizing Recovery After Carpal Tunnel Syndrome Release Surgery: The Role of Counseling in Pain Management and Perioperative Functional Enhancement.

Preoperative patient education is pivotal in improving patient outcomes during the perioperative phase, involving a thorough explanation of what patients can expect. This enhances adherence and reduces perioperative anxiety. In orthopedics, carpal tunnel syndrome, a common and painful hand condition, is effectively managed through surgical release under local anesthesia. Inadequate counseling before such procedures may intensify intraoperative anxiety and increase pain responses. Thus, this research aims to investigate the effects of comprehensive preoperative counseling on various parameters in carpal tunnel release surgery. A case-control study design was adopted for this study. A retrospective analysis of patients who underwent carpal tunnel release surgery was performed. These patients were categorized into two distinct groups: one group received comprehensive counseling during their clinic visits, while the other group reported receiving less effective counseling. Evaluation encompassed patient-related factors, disease-related aspects, and perioperative variables for both groups. The study comprised 681 participants, with 526 (77.2%) being females, 421 (61.8%) undergoing surgery on the right side, and 519 (76.2%) employed in non-manual occupations. Moreover, 559 (82.1%) were non-smokers, while approximately two-thirds of the cohort had both diabetes and hypertension. The average age of participants was 52 years, and they reported a mean functional disability score of 7.2 out of 10. The comprehensive preoperative counseling group consisted of 333 patients, while the other group included 348 patients. The analysis revealed statistically significant differences between the two groups, including reduced intra-procedural anxiety (p = 0.043), decreased intraoperative pain (p = 0.005), lower rates of wound complications (p = 0.022), and improved self-reported pain relief (p = 0.3). Our study emphasizes the crucial role of preoperative counseling in improving patient experiences during perioperative care, leading to reduced anxiety, milder pain responses, fewer complications, decreased reliance on postoperative pain medication, and increased self-reported pain relief. Level III, Case-control retrospective study.

Effectiveness of Abdominal Hollowing Exercises Versus Conventional Physical Therapy for Low Back Pain in Caregivers of Spinal Cord Injury Patients

Effectiveness of Abdominal Hollowing Exercises Versus Conventional Physical Therapy for Low Back Pain in Caregivers of Spinal Cord Injury Patients

Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain

Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain.

Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

Sarcopenia in Egypt: epidemiology of sarcopenia risk among older adults presenting with fragility fractures—an initiative by the Egyptian Academy of Bone Health

Purpose(1) This was a multi-center, cross-sectional, observational study. Both old men and postmenopausal women over 50 years old who were admitted with an osteoporotic fracture (whether hip fracture or major osteoporosis) were consecutively recruited for this work and managed under the Fracture Liaison Service. All the patients were assessed for their sarcopenia risk (SARC-F), fracture risk (FRAX), and fall risk (FRAS) as well as functional disability (HAQ). The aim was to assess the prevalence of sarcopenia risk among older adult Egyptians presenting with fragility fractures. (2) To identify the relation between sarcopenia risk with the risk of falling as well as sustaining a fragility fracture.ResultsTwo hundred and thirty-six patients (69 males, 167 females) were included in this work. The mean age was 70.1 (SD = 9.2) years. The prevalence of sarcopenia was 69.7%. The sarcopenia risk score was positively correlated with the FRAX score (p = 0.01). The prevalence of high sarcopenia risk was 78% of the patients presenting with a high 10-year probability of major osteoporosis fracture as well as a 10-year probability of hip fracture. The sarcopenia risk score was positively correlated with the increased fall risk (p = 0.01) as scored by the FRAS scale. There was a significant relation (p < 0.05) between the functional disability score and the SARC-F score. This was persistent when assessed in relation to fall risk.ConclusionThis study highlighted the high sarcopenia risk in the patients presenting with fragility fractures. Identification of patients at increased risk of sarcopenia should be a component of the standard practice.

An Open-Label Administration of Bioavailable-Form Curcumin in Patients With Pelizaeus-Merzbacher Disease

BackgroundTwo preclinical studies using mouse models of Pelizeaus-Merzbacher disease (PMD) have revealed the potential therapeutic effects of curcumin. In this study, we examined the effects of curcumin in patients with PMD. MethodsWe conducted a study administering an open-label oral bioavailable form of curcumin in nine patients genetically confirmed to have PMD (five to 20 years; mean 11 years) for 12 months (low doses for two months followed by high doses for 10 months). We evaluated changes in clinical symptoms as the primary end point using two scales, Gross Motor Function Measure (GMFM) and the PMD Functional Disability Score (PMD-FDS). The level of myelination by brain magnetic resonance imaging (MRI) and the electrophysiological state by auditory brainstem response (ABR) were evaluated as secondary end points. The safety and tolerability of oral curcumin were also examined. ResultsIncrease in GMFM and PMD-FDS were noted in five and three patients, respectively, but overall, no statistically significant improvement was demonstrated. We found no clear improvement in their brain MRI or ABR. No adverse events associated with oral administration of curcumin were observed. ConclusionsAlthough we failed to demonstrate any significant therapeutic effects of curcumin after 12 months, its tolerability and safety were confirmed. This study does not exclude the possibility of therapeutic effects of curcumin, and a trial of longer duration should be considered to compare the natural history of the disease with the effects of curcumin.

Prospective observational study to assess the validity of the functional disability score in patients with blepharospasm, hemifacial spasm and synkinesis treated with botulinum toxin injection

Prospective observational study to assess the validity of the functional disability score in patients with blepharospasm, hemifacial spasm and synkinesis treated with botulinum toxin injection