Functional Limitations In Patients Research Articles

The Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement.

Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis. This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided t tests. Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, -0.86 to 0.16; P=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, -2.17 to -1.26; P=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, -0.45 to 0.43; P<.01). The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis. [Orthopedics. 202x;4x(x):xx-xx.].

The cancer caregiving burden trajectory over time: varying experiences of perceived versus objectively measured burden.

The objective of this study was to comprehensively understand the burden experienced by caregivers (CGs) providing home-based, end-of-life care to patients with cancer. We examined the relationship between objective and subjective burden including whether and how burden changes over time. A case series of terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for 12 months or until patient death. Data were collected every other week and in-person from CGs in their homes using quantitative surveys, diaries, and monthly structured observations. Bivariate correlations revealed a significant association between subjective burden and activities of daily living (ADLs), instrumental activities of daily living (IADL), high-intensity tasks, and time spent on ADLs; these correlations varied over time. Models examining the slope of subjective burden revealed little systematic change; spouse caregiver and patient functional limitations were positively, and Black caregiver was negatively associated with subjective burden. Generally, the slopes for measures of objective burden were significant and positive. Models showed subjective burden was positively associated with most measures of objective burden both within caregiver (concurrent measures were positively associated) and between CGs (those with higher subjective also had higher objective). Cancer caregiving is dynamic; CGs must adjust to the progression of the patient's disease. We found an association between subjective and objective burden both within and between CGs. Black CGs were more likely to report lower subjective burden compared to their White counterparts. More detailed investigation of the sociocultural components that affect caregiver experience of burden is needed to better understand how and where to best intervene with targeted supportive care services.

The effect of different pain characteristics on jaw functional limitations in patients with temporomandibular disorders.

Patients with painful temporomandibular disorders (TMD) more often experience jaw functional limitations. The study of jaw functional limitations should be primarily focused on painful TMD. The impact of TMD pain characteristics (source, chronicity and intensity) on jaw functional limitations were evaluated using Jaw Functional Limitation Scale (JFLS). This cross-sectional study reviewed the dental records and self-report questionnaires of patients with painful TMD. The pain source, chronicity and intensity were evaluated to study the TMD pain characteristics. The jaw functional limitations were analysed using the Thai version of the JFLS. A total of 176 patients with painful TMD were included in this study. The jaw functional limitations were affected only by pain intensity. Patients with TMD with severe pain intensity had significantly higher jaw functional limitations than those with mild-to-moderate pain intensity (p < .05). A significant association was observed between pain intensity and jaw functional limitations (p < .05). Mastication was highly restricted by pain intensity (odd ratio = 1.39, 95% confidence interval = 1.16-1.67). The present study found a significant effect of TMD pain intensity on jaw functional limitations. Patients with severe TMD pain intensity were more likely to experience jaw functional limitations, particularly mastication limitation. Management focusing on reduction of pain intensity may improve jaw functions in patients with TMD.

Dynamic assessment of spine movement patterns using an RGB-D camera and deep learning

In clinical practice, functional limitations in patients with low back pain are subjectively assessed, potentially leading to misdiagnosis and prolonged pain. This paper proposes an objective deep learning (DL) markerless motion capture system that uses a red–green–blue-depth (RGB-D) camera to measure the kinematics of the spine during flexion–extension (FE) through: 1) the development and validation of a DL semantic segmentation algorithm that segments the back into four anatomical classes and 2) the development and validation of a framework that uses these segmentations to measure spine kinematics during FE. Twenty participants performed ten cycles of FE with drawn-on point markers while being recorded with an RGB-D camera. Five of these participants also performed an additional trial where they were recorded with an optical motion capture (OPT) system. The DL algorithm was trained to segment the back and pelvis into four anatomical classes: upper back, lower back, spine, and pelvis. A kinematic framework was then developed to refine these segmentations into upper spine, lower spine, and pelvis masks, which were used to measure spine kinematics after obtaining 3D global coordinates of the mask corners. The segmentation algorithm achieved high accuracy, and the root mean square error (RMSE) between ground truth and predicted lumbar kinematics was < 4°. When comparing markerless and OPT kinematics, RMSE values were < 6°. This work demonstrates the feasibility of using markerless motion capture to assess FE spine movement in clinical settings. Future work will expand the studied movement directions and test on different demographics.

Bone regeneration in critical-size defects of the mandible using biomechanically adapted CAD/CAM hybrid scaffolds: An in vivo study in miniature pigs

The study aimed to analyze bone regeneration in critical-size defects using hybrid scaffolds biomechanically adapted to the specific defect and adding the growth factor rhBMP-2.For this animal study, ten minipigs underwent bilateral defects in the corpus mandibulae and were subsequently treated with novel cylindrical hybrid scaffolds. These scaffolds were designed digitally to suit the biomechanical requirements of the mandibular defect, utilizing finite element analysis. The scaffolds comprised zirconium dioxide-tricalcium phosphate (ZrO2-TCP) support struts and TCP foam ceramics. One scaffold in each animal was loaded with rhBMP-2 (100 μg/cm³), while the other served as an unloaded negative control. Fluorescent dyes were administered every 2 weeks, and computed tomography (CT) scans were conducted every 4 weeks. Euthanasia was performed after 3 months, and samples were collected for examination using micro-CT and histological evaluation of both hard and soft tissue.Intravital CT examinations revealed minor changes in radiographic density from 4 to 12 weeks postoperatively. In the group treated with rhBMP-2, radiographic density shifted from 2513 ± 128 (mean ± SD) to 2606 ± 115 Hounsfield units (HU), while the group without rhBMP-2 showed a change from 2430 ± 131 to 2601 ± 67 HU. Prior to implantation, the radiological density of samples measured 1508 ± 30 mg HA/cm³, whereas post-mortem densities were 1346 ± 71 mg HA/cm³ in the rhBMP-2 group and 1282 ± 91 mg HA/cm³ in the control group (p = 0.045), as indicated by micro-CT measurements. The histological assessment demonstrated successful ossification in all specimens. The newly formed bone area proportion was significantly greater in the rhBMP-2 group (48 ± 10%) compared with the control group without rhBMP-2 (42 ± 9%, p = 0.03). The mean area proportion of remaining TCP foam was 23 ± 8% with rhBMP-2 and 24 ± 10% without rhBMP-2.Successful bone regeneration was accomplished by implanting hybrid scaffolds into critical-size mandibular defects. Loading these scaffolds with rhBMP-2 led to enhanced bone regeneration and a uniform distribution of new bone formation within the hybrid scaffolds. Further studies are required to determine the adaptability of hybrid scaffolds for larger and potentially segmental defects in the maxillofacial region.

Efficacy of Extracorporeal Shock Wave and Pulse Electromagnetic Field Therapies in Calcaneal Spurs.

Various treatment methods are available for calcaneal spur, which can cause disability. Objective: To evaluate the efficacy of pulsed electromagnetic field therapy (PEMFT) added to extracorporeal shock wave therapy (ESWT) on pain and functional capacity in treating calcaneal spurs. Patients with calcaneal spurs who were recommended ESWT or ESWT+PEMFT and whose Foot Function Index (FFI) and visual analogue scale (VAS) values were available in their records were retrospectively analyzed. The two groups were ESWT (n=35) and ESWT+PEMFT (n=40). FFI and VAS scores were obtained from their records before treatment, after treatment, and in the third month after treatment. The two groups were similar regarding their pre-treatment FFI and VAS scores. In intra-group evaluation, statistically significant decreases were found in terms of the FFI pain, disability, and activity limitation and VAS scores in both groups after treatment and in the third month after treatment compared to the pre-treatment period. In the comparison between the groups, the post-treatment and post-treatment third-month FFI pain, disability, and activity limitation and VAS scores were significantly lower in the PEMFT+ESWT group than the ESWT group (P<0.001). A calcaneal spur is a condition that can cause pain and functional limitation in patients. Various studies have demonstrated the efficacy of ESWT in the treatment of calcaneal spurs. In our study, we observed that PEMFT added to ESWT significantly improved the pain and functionality of the patients. Further studies are needed to evaluate the efficacy of PEMFT in calcaneal spurs.

Effectiveness of Ultrasound-guided versus Anatomical Landmark-guided Genicular Nerve Block to Treat Chronic Knee Osteoarthritis: A Retrospective Cohort Study.

There is limited data on the relative effectiveness of different techniques used for administering genicular nerve block (GNB) for pain management of chronic knee osteoarthritis (OA) in the Malaysian population. This study aims to determine and compare the effectiveness of GNB administered using two pain management techniques?"anatomical landmark-guided (ALG) and ultrasound-guided (USG)?"for chronic knee OA in this population. This retrospective cohort study included 40 patients with chronic knee OA who received GNB, 20 of whom underwent treatment with the USG technique and the other 20 with the ALG technique. Pain, stiffness, and functional limitation scores were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and Numeric Rating Scale (NRS-11) at baseline and post-treatment day one, three weeks, and six weeks. Both groups reported a significant reduction in WOMAC and NRS-11 scores as per their feedback on day one, three weeks, and six weeks post-treatment. Greater reductions in WOMAC and NRS-11 scores were reported by patients who received GNB via USG than by ALG technique, the difference achieving statistical significance at six weeks after treatment (p =0.026). GNB administration using USG and ALG techniques are both effective in significantly reducing pain, stiffness, and functional limitation in patients suffering from chronic knee OA. Among the two techniques, USG appears to be more effective. Nevertheless, GNB guided by ALG continues to be a viable treatment modality, especially in healthcare settings with limited to no USG facilities.

Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution

Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.

Predictive factors of functional limitation after cardiac surgery: a retrospective cohort study

BackgroundFunctional limitation is relatively common and can negatively influence the postoperative outcome of patients after cardiac surgery. ObjectiveTo identify the predictive factors of functional limitation in patients undergoing elective cardiac surgery. MethodsRetrospective cohort study was performed to evaluate patients undergoing elective cardiac surgery. All patients underwent a cardiovascular rehabilitation protocol. Functional limitation was defined based on performance in the rehabilitation protocol following cardiac surgery. Poor performance in the cardiac surgery rehabilitation protocol defined functional limitation, whereas good performance indicated no limitation. ResultsData were collected from 548 patients; of these, 190 (34.7%) had functional limitation. In multivariate analysis, the factors associated with postoperative functional limitation were as follows: hospitalization by the public healthcare system [OR: 2.14; 95% confidence interval (CI): 1.73, 2.65]; age (OR 1.23; 95% CI: 1.15, 1.31); length of hospitalization in the intensive care unit (OR 1.03; 95% CI: 1.01, 1.05); history of previous acute myocardial infarction (OR 1.40; 95% CI: 1.13, 1.73); presence of previous comorbidities [chronic kidney disease (OR 1.56; 95% CI: 1.15, 2.10); cerebrovascular disease (OR 1.57; 95% CI: 1.19, 2.07)]; presence of expiratory muscle weakness (OR 1.54; 95% CI: 1.08, 2.20); and intercurrence of cardiorespiratory arrest during hospitalization (OR 1.76; 95% CI: 1.40, 2.22). ConclusionFunctional limitation after cardiac surgery could be predicted by multiple pre and postoperative factors, except for preoperative functionality, which does not suggest to be an independent factor for functional limitation after surgery.

A Pilot Test of the Measures of the Greek Version of Upper Extremity Functional Index in Patients with Lateral Elbow Tendinopathy.

Lateral elbow tendinopathy (LET) is a common upper limb pathology in people involved in manual occupations. The upper extremity functional index (UEFI) was specifically designed to evaluate functional limitations in patients with upper limb pathology. The UEFI was developed in English and has been translated into several languages, including Greek. However, it has been assessed only in patients with shoulder pathology. Thus, the aim of this study was to pilot-test the Greek version of the UEFI (GV-UEFI) questionnaire and assess its measurement properties in patients with LET. Thirty patients with LET were recruited and asked to fill in the GV-UEFI twice and the disabilities of arm, shoulder, and hand questionnaire (DASH) once. The internal consistency and test-retest reliability were examined using Cronbach's alpha and the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated and possible ground or ceiling effects were also examined. Convergent validity was evaluated with the Greek DASH using Pearson's correlation. Lastly, the unidimensionality of the scale was examined through principal component analysis to verify construct validity. Internal consistency was high for the GV-UEFI (Cronbach's a = 0.98) and test-retest reliability was excellent (ICC = 0.98). The SEM was 2.95 and the MDC was 6.85. Test-retest reliability of each item was good (ICC > 0.87). The correlation analysis demonstrated a strong correlation between the GV-UEFI and the DASH. No floor or ceiling effects were found. Principal component analysis verified the construct validity and the unidimensionality of the scale. The GV-UEFI was successfully tested in patients with LET. It seems that the GV-UEFI can be used reliably in Greek-speaking patients with LET. However, the measurement properties of this scale should be examined in a larger sample of LET patients.

The Changes in Psychological and Functional Limitation after Pain Neuroscience Education in Chronic Non-Specific Neck Pain: (A Quasi Experimental Study)

Background: Chronic Non-specific neck pain is a common disorder that causes ramifications from psycho-social factors. Can be related to limited cervical mobility, impaired functions, and stress at work Pain is a common human experience, and the inability to feel pain poses a risk to a person’s survival. PNE explains how pain operates fundamentally, including three core bio-psychosocial therapeutic options that are biological, psychological, and social. Objective: To study the impact of PNE on psychosocial and functional limitations in patients with chronic non-specific neck pain. Methods: The study is a quasi-experimental study comprising 85 participants, with pre-test (Group A) and post-test (Group B) receiving PNE. Results: The mean NPRS scores obtained in the PNE group were 5.63±1.3 in the pre-test and 2.3±1.2 in the post-intervention, and the mean difference was 3.33(Mean of paired differences). The mean PCS scores obtained in the PNE group were 25.09±4.31in the pre-test and 12.04±4.25 in the post-intervention, and the mean difference was 13.05. The mean NDI scores obtained in the PNE group were 30.67±17.34 in the pre-test and 7.50±3.74 in the post-intervention, and the mean difference was 23.17. It shows significant improvement in pain intensity and functional limitations. Conclusion: The present study concluded that pain neuroscience education has an impact on changing psychosocial and functional limitations in patients with chronic non-specific neck pain using the Neck Disability Index, Pain Catastrophizing Scale, Numerical Pain Intensity Scale, and Neurophysiology of Pain Questionnaire.

Comparison between two patient-reported outcome measures for patients with cervical radiculopathy: A think-aloud study

BackgroundThe Cervical Radiculopathy Impact Scale (CRIS) and Patient Specific Functional Scale 2.0 (PSFS 2.0) are patient-reported outcome measures (PROMs) used to assess activity limitations in patients with cervical radiculopathy (CR). This study a) compared the CRIS subscale 3 and the PSFS 2.0 in patients with CR with respect to completeness and patient preference, b) established the correlation between both PROMs in assessing the individual patient's level of functional limitations and c) assessed the frequency of reported functional limitations. MethodsParticipants with CR participated in semi-structured, individual, face-to-face interviews as part of a “think-aloud” process; verbalising their thoughts while completing both PROMs. Sessions were digitally recorded and transcribed verbatim for analysis. ResultsTwenty-two patients were recruited. The most frequently reported functional limitation on the CRIS was: ‘working at a computer’ (n = 17) and overhead activities' (n = 10) for the PSFS 2.0. There was significant moderate positive correlation between the scores on the PSFS 2.0 and the CRIS (Spearman's r = 0.55, n = 22 p = .008). Most patients (n = 18; 82%) preferred the ability to present their own individual functional limitations of the PSFS 2.0. Eleven participants (50%) preferred the 11-point scale of the PSFS 2.0 over the 5-point Likert scale scoring option of the CRIS. ConclusionBoth easy to complete PROMs capture functional limitations in patients with CR. Most patients prefer the PSFS 2.0 over the CRIS. The wording and layout of both PROMs need refinement to enhance user-friendliness and avoid misinterpretation.

Reduced muscle strength in patients with long-COVID-19 syndrome is mediated by limb muscle mass.

Understanding the impact of COVID-19 on muscle strength may help to elucidate the organ systems that contribute to acute and chronic COVID-19 sequelae. We questioned whether patients with postdischarge symptoms after COVID-19 had compromised muscle strength compared with a control group, and if this potential relationship was mediated by the lower appendicular lean mass index (ALMI). A total of 99 patients with long-COVID-19 and 97 control participants were screened. Maximal grip strength was assessed with a TKK 5101 digital dynamometer, and leg extension 1RM was measured using EGYM Smart Strength machines. Body composition (fat mass percentage, lean mass, visceral fat, and appendicular lean mass index) was determined using a whole body dual-energy X-ray densitometer. Results showed that grip strength and leg extension strength were significantly higher in controls than in COVID-19 survivors (mean [SD], 32.82 [10.01] vs. 26.94 [10.33] kg; difference, 5.87 kg; P < 0.001) and (mean [SD], 93.98 [33.73] vs. 71.59 [33.70] kg; difference, 22.38 kg; P < 0.001), respectively). The relationship between long-COVID syndrome and grip/leg strength levels was partly mediated by ALMI, which explained 52% of the association for grip strength and 39% for leg extension. Our findings provide novel insights into the mechanisms underlying the relationship between long-COVID syndrome and grip/leg strength levels, supporting the negative effects of long-COVID syndrome on muscle function.NEW & NOTEWORTHY The causes of post-COVID-19 syndrome are uncertain. Limb muscle wasting common to patients with COVID-19 limits daily activities and exercise. In this cross-sectional study, we found that patients with long-COVID-19 syndrome had significantly lower absolute and relative muscle strength measurements than control participants. Interestingly, we identified that these relationships were mostly mediated by limb muscle mass. Our data thus suggest that the evident reduced upper and lower muscle mass is a putative cause of-or contributor to-the functional limitation of patients with long-COVID-19 syndrome.

The post-VTE functional status scale for assessment of functional limitations in patients with venous thromboembolism: Construct validity and responsiveness in a prospective cohort study

BackgroundA large proportion of patients experience functional limitations after an acute episode of venous thromboembolism (VTE). Recently, the post-VTE functional status (PVFS) scale was proposed to capture these limitations. We performed a prospective cohort study to validate this scale. MethodsThe PVFS scale, PROMIS physical function 10a, EQ-5D-5L, and disease-specific quality of life (VEINES-QOL/Sym, PEmb-QoL) were assessed within three weeks of VTE diagnosis and after a median (IQR) follow-up of 13.4 (12.7–15.9) weeks. To evaluate construct validity of the PVFS scale, we determined correlations of PVFS scale with the other health measurements and investigated differences in patients above/below 70 years. Responsiveness was evaluated with a linear regression model, predicting change in PROMIS with change in PVFS scale. ResultsWe included 211 patients (median (IQR) age: 55.1 (44.1–67.6) years, 40 % women). Pulmonary embolism was diagnosed in 105 (49.8 %) patients and 62.6 % of events were unprovoked. The PVFS scale correlated with PROMIS physical function (Spearman's rho (r): −0.67 and −0.63, p < 0.001) and EQ-5D-5L index (r = −0.61 and −0.61, p < 0.001) at baseline and follow-up. Furthermore, PVFS correlated moderately to strongly with disease-specific quality of life. Patients >70 years had significantly higher PVFS grades at follow-up (median (IQR): 2 (0–3) vs. 1 (0–2), p = 0.010). Changes in PVFS scale over time were significantly associated with changes in PROMIS physical function. ConclusionsThe PVFS scale showed adequate construct validity and responsiveness in a prospective cohort study of patients with VTE, suggesting that it can be incorporated as additional health measurement and outcome parameter in research and clinical practice.

Exercise unmasks impaired vascular and cardiac hemodynamic in patients with hypertrophic cardiomyopathy

Abstract Background/Introduction Exertional dyspnea is a common finding in patients with Hypertrophic Cardiomyopathy (HCM), yet little data is available regarding the hemodynamic disturbances that lead to symptom development in this population. Purpose To investigate the mechanisms involved in the functional limitation of patients with HCM. Methods We prospectively studied 20 symptomatic patients with confirmed diagnosis of HCM. Assessment included NT-pro BNP levels, echocardiogram, and invasive characterization, where subjects also underwent invasive cardiopulmonary exercise testing. Results Median patient age was 57 (48–66) years old and 15 (75%) were male. Basal NT-pro BNP was elevated (748 pg/mL [406–1082]) and 8 (40%) subjects had NYHA functional Class III despite optimal medical treatment. Sarcomeric abnormal mutations were identified in 12 subjects (60%), most frequently in MYBPC3. Ultrasound imaging showed marked left ventricle (LV) hypertrophy (LV Mass Index 140 g/m2 [109–161]), with signs of LV outflow obstruction in 13 (65%) subjects. All patients displayed preserved ejection fraction (68% [61–73]). Significant mitral regurgitation was present in 5 subjects and median E/e' was 9.87 [6.43–13.14]. At rest, biventricular filling pressures were relatively normal, with upper limit mean Pulmonary Pressure (Table). Patients exercised for 6.4 (95% CI: 5.6–7.2) min, achieving a respiratory exchange ratio of 1.11 (1.02–1.17). All subjects displayed normal cardiac output at rest (5.6 L/min (3.7–7.5)), that increased during exertion, due mostly to a rise in heart rate (p&amp;lt;0.0001). Exercise doubled LV End-Diastolic Pressure from 15.3 (11.5–19.1) mmHg at baseline to 30.4 (26.6–34.3) mmHg at peak VO2 (p&amp;lt;0.0001), whereas mean pulmonary pressure increased from 21 (14–29) mmHg to 40 (33–47) mmHg (p&amp;lt;0.0001). Remarkably, although arterial hemodynamics were relatively normal at baseline, exercise induced significant increases both in the continuous (systemic vascular resistance) and pulsatile components of vascular load (Impedances, p&amp;lt;0.05; Table 1) (Figure 1). This increase in afterload during exertion has not been previously documented in HCM. The decreased compliance derived, can also play a role in the elevated filling pressures documented on exertion. Conclusion Exercise unmasks adverse hemodynamics in HCM, severely increasing LV filling pressures and showing systemic arterial dysfunction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spain.

Synovial Inflammation in Patients with Hallux Valgus is Similar to Changes Seen in Those with Hallux Rigidus

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus and hallux rigidus are common disorders that can have functional limitations for patients. Although both involve pathology centered around the first metatarsophalangeal joint (MTPJ), the surgical management for both greatly varies. Inflammatory changes in a joint play a critical role in the development of pain and dysfunction. It has been postulated previously that patients with bunion deformity can develop arthritic changes in the long-term. The purpose of this work is to study and compare the synovial tissue inflammation in patients with hallux valgus and hallux rigidus. Methods: A prospective study of patients aged 25 to 75 years undergoing either surgical management of hallux valgus or hallux rigidus between January 2021 and December 2021 was conducted following IRB approval. Tissue samples from the synovium were collected at the time of procedure and sent for processing and histology. The samples were graded in a blinded fashion based on the degree of inflammation. Morphological features of the synovectomy specimens undergoing histopathologic analysis were scored by synovial lining cell layer hyperplasia, the extent of inflammatory synovium infiltration, as well as pannus formation via activation of synovial stroma and resident cells. All parameters were graded from 0 (absent), 1 (slight), 2 (moderate), to 3 (strong). Statistical analysis was conducted to compare the level of inflammation between patients who had hallux valgus and those that had hallux rigidus. Results: A total of twenty-one samples were collected. One sample was excluded as there was inadequate tissue for analysis. There were eight patients with hallux rigidus and twelve patients with hallux valgus. Mean age at the time of sample collection was 59.3 years (SD=11.9). There was no significant difference in the synovium inflammatory scores (M=5.0, SD=2.25) between the two groups, t(18)= 1.704, p=.106, ([CI .95]: -0.388, 3.722). Moreover, Cohen's effect size value (d=0.78) suggests medium to high practical significance. Conclusion: Understanding the intra-articular impact of hallux valgus is important when considering treatment options. The amount of inflammation in the synovial tissue of hallux valgus patients in this study was similar to that of patients with hallux rigidus suggesting that there is intra-articular inflammation in patients with hallux valgus. Further work will need to be performed to determine if this increased inflammation influences outcomes or has an effect on treatment.

Effectiveness of High Intensity Hilthera 4.0 Laser Treatment on Patients with Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. Conservative lines of treatment include non-steroidal anti-inflammatory drugs, corticosteroid injections, Physiotherapy, stretching exercises and using heel pads or orthotics. The purpose of the study is to investigate the effects of high intensity Hilthera 4.0 laser treatment on pain and functional capacity in patients with acute plantar fasciitis. Total 30 participants were randomly recruited and were evaluated before the first treatment session and after 8 sessions of treatment with Hilthera 4.0 Laser. Treatment Parameters are frequency (Hz) 25, one shot emission (MJ) 500, and a total energy 3000W for 15 minutes each session. Outcome measures are VAS score for measuring Pain and Foot Function Index score for measuring Foot Function. IBM SPSS version 16.0 software was used for statistical analysis. Paired sample t-tests are used to measure the pre and post test results. Results shows that there is a significant difference in VAS Score and Foot Function Score pre and post treatment with ‘p’ value &lt; 0.05 when Hilthera 4.0 laser is used for pain and Foot function in patients with Plantar Fasciitis. In conclusion Hilthera 4.0 Laser Therapy is effective in treating pain and Functional limitation in patients with Plantar Fasciitis. KEY WORDS: Plantar Fasciitis, Hilthera 4.0 Laser Therapy, VAS Score, Foot Function Index Score

Virtual reality and motor control exercises to treat chronic neck pain: A randomized controlled trial

AimTo compare the effects of virtual reality (VR) and motor control (MC) exercises. MethodsForty-one participants with chronic neck pain (CNP) were randomized into the VR or MC group. Both groups performed 18 sessions over 6 weeks. The primary outcomes were pain intensity (visual analogue scale), pain pressure thresholds (PPTs), joint position sense error (JPSE), and muscle performance. The secondary outcomes were the Profile Fitness Mapping Questionnaire (ProFitMap-Neck), Hospital Anxiety-Depression Scale (HADS), and quality of life (SF-36). Data were analysed using T-Tests, and Fisher's Exact Test. Mean (standard deviation), median (interquartile range), effect size and %95 confidence interval (CI) were reported. ResultsThe results of Independent T-Tests showed that VR was advantageous in terms of PPTs of the C1/C2 and C5/C6 articular pillar bilaterally and large effect size (Cohen's d > 0.8, p < 0.05). Moreover, VR was more effective in decreasing JPSE (Cohen's d > 0.08; mean difference changes between −2.91 and −1.24, %95 CI -4.47 to 0.80) and functional limitation (ProFitMap-Neck) (Cohen's d = 0.7, mean difference 8.27, %95 CI 0.20 to 16.35). The results of T-Tests demonstrated that neither intervention was superior in terms of pain intensity, muscle performance, symptoms (ProFitMap-Neck), HADS, or SF-36 (Cohen's d < 0.5). ConclusionsVR can be applied for improving proprioception and for decreasing cervical articular pain in CNP patients. In addition, VR may be more effective for decreasing functional limitations in patients. Clinicians can choose MC exercises with or without VR for improving pain, muscle performance, symptoms, anxiety/depression, and quality of life.

Durable functional limitation in patients with coronavirus disease-2019 admitted to intensive care and the effect of intermediate-dose vs standard-dose anticoagulation on functional outcomes

IntroductionPatients affected with severe forms of coronavirus disease 2019 (COVID-19) suffer from a wide range of sequelae, from limited airway diseases to multiple organ failure. These sequelae may create exercise limitation, impair the daily activity and thus impact the mental health and the social life. However, the extent of functional limitations and depressive symptoms are understudied especially in patients with COVID-19 after intensive care unit (ICU) hospitalization. MethodsThe Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) was a clinical trial that randomized ICU patients with COVID-19 to intermediate-dose vs standard-dose anticoagulation. In the current study, we assessed the interval change in 30-day and 90-day functional limitations based on the post-COVID-19 functional status scale (PCFS) and depressive symptoms based on the Patient Health Questionnaire-2 (PHQ-2) in the trial participants. We also assessed the effect of intermediate-dose vs standard-dose prophylactic anticoagulation on the functional outcomes and depressive symptoms. ResultsOf 600 randomized patients in INSPIRATION, 375 (age: 62 years; 42% women) participated in the functional status study. 195 patients died during the 90-day follow up (191 by day 30). Among survivors, between day 30 and day 90, the proportion of patients with moderate-to-severe functional limitation (PCSF grade 3-or-4) decreased from 20.0% to 4.8% (P <0.001) and PHQ-2 ≥ 3 decreased from 25.5% to 16.6% (P = 0.05). The proportion of patients with no functional limitations (PCFS grade 0) increased (4.2% to 15.4%, P<0.001). Intermediate-dose compared with standard-dose prophylactic anticoagulation did not impact the 90-day proportion of patients with PCFS grade 3-or-4 (5.3% vs 4.2%; odds ratio (OR), 1.20, [95% CI, 0.46–3.11]; P = 0.80) or PHQ-2 ≥ 3 (17.9% vs 15.3%; OR, 1.14, [95% CI, 0.79–1.65]; P = 0.14), with similar results when accounting for study center. ConclusionIn patients with COVID-19 admitted to the ICU, functional limitations and depressive symptoms were common at 30-day follow-up and had some improvement by 90-day follow-up among survivors. Intermediate-dose compared to standard-dose prophylactic anticoagulation did not improve functional outcomes.

Successful psychopharmacotherapy of anxiety and depressive disorders improve functional limitations in patients with rheumatoid arthritis

To compare changes in functional limitations in patients with rheumatoid arthritis (RA) and comorbid anxiety and depressive disorders (ADD) treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or psychopharmacotherapy (PPT), and to determine predictors of HAQ treatment response. 128 RA-patients were enrolled, 86% were women with a mean age of 47.411.3 (MSD) years and a median of RA duration 96 [48; 228] months. Disease activity was assessed using DAS28, functional limitations using Health Assessment Questionnaire (HAQ). The Minimal Clinical Important Difference in HAQ was considered to be 0.22. ADD were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-pts in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with MontgomeryAsberg Depression Rating Scale and Hamilton Anxiety Rating Scale. RA-pts with ADD were divided into the following treatment groups: 1 сsDMARDs (n=39), 2 сsDMARDs + PPT (sertraline or mianserine; n=43), 3 сsDMARDs + bDMARDs (n=32), 4 сsDMARDs + bDMARDs + PPT (sertraline or mianserine; n=9); 83 (67.5%) patients were assessed at 5-years follow-up. Multivariable logistic regression was performed to determine predictors of HAQ treatment response. Only remission of anxiety and depressive symptoms at 5-yrs endpoint (OR 6.6, 95% CI 1.7824.43, p=0.005), higher baseline HAQ (OR 2.61, 95% CI 1.126.11, p=0.027) and lower baseline BMI (OR 0.9, 95% CI 0.850.96, p=0.001) were independently associated with HAQ treatment response at 5-years follow-up. While ADD do affect functional limitations in patients with RA, PPT tends to attenuate the negative impact of ADD on RA outcomes, and RA patients with functional limitations should therefore be screened for depression and long-term PPT should be recommended.