Subjective Functional Status Research Articles

High long-term failure rates after arthroscopic Bankart repair in younger patients with recurrent shoulder dislocations: A plea for early treatment.

To determine arthroscopic Bankart repair outcomes and recurrence risk factors at a minimum 5-year follow-up. Retrospective assessment of prospectively collected data, single-cohort study of patients who underwent arthroscopic Bankart repair with a minimum 5-year follow-up. Demographical and preoperative instability features were collected. Primary outcome was recurrent instability set as dislocation or subluxation. Secondary outcomes were revision surgery, postoperative instability degree according to Manta criteria, objective and subjective clinical and functional status, assessed by the Rowe, Western Ontario Shoulder Index (WOSI) and Subjective Shoulder Value (SSV) scores. Return to sport and postoperative sports activity at the final follow-up were also recorded. One-hundred and seventy-two patients, 82% men, average age at surgery 29.5 ± 9.2 years, were included. At a mean follow-up of 8.3 ± 2.6 years, recurrent instability occurred in 53 of 172 patients (30.8%). Revision surgery was required in 23/53 (43.4%) of shoulder with recurrent instability. Recurrence occurred within the first 2 years postoperative in 49% of the shoulders, whereas 51% of recurrences occurred after this period. Recurrence took place after a traumatic event in 25% and 56%, respectively. Recurrence rates were higher in patients who underwent surgery after two or more dislocations (p = 0.029). Patients younger at the time of first dislocation, younger at surgery and those with a higher preoperative degree of instability also showed significantly higher rates of recurrence (p = 0.04, p = 0.02, p = 0.03). Postoperative ROWE, WOSI and SSV scores were significantly worse in patients with recurrent instability (p < 0.001). Return-to-sports rate was also lower in patients with postoperative recurrence (p < 0.001). The arthroscopic Bankart repair was associated with a high long-term recurrence rate, and its effectiveness decreased over time. The lowest recurrence rates in arthroscopic Bankart repair were achieved in older patients with only one prior instability episode and a lower instability degree. Level IV.

The FITNESS study: longitudinal geriatric assessment, treatment toxicity, and biospecimen collection to assess functional disability among older adults with lung cancer.

Older adults with chronic disease prioritize functional independence. We aimed to describe the feasibility of capturing functional disability and treatment toxicity among older adults with lung cancer using a longitudinal comprehensive geriatric assessment (CGA) and molecular biomarkers of aging. This prospective study included adults ≥60years with any newly diagnosed non-small-cell lung cancer. Participants were recruited from central Ohio (2018-2020). Study assessments included the Cancer and Aging Research Group CGA (CARG-CGA), short physical performance battery (SPPB), and the blessed orientation-memory concentration (BOMC) test at baseline, 3, 6, and 12months. Activities of daily living (ADLs) and instrumental ADLs (IADLs), quality of life (QoL, PROMIS 10), and treatment toxicity were captured monthly. Stool and blood were collected to characterize the gut microbiome and age-related blood biomarkers. This study enrolled 50 participants with an average age of 71.7years. Ninety-two percent of participants were Caucasian, 58% were male, and all were non-Hispanic. Most had advanced stage (stage III/IV: 90%; stage I/II: 10%), with adenocarcinoma the predominant histologic subtype (68% vs. 24% squamous). First-line treatments included chemotherapy (44%), immune checkpoint inhibitors (ICIs, 22%), chemotherapy and ICIs (30%), or tyrosine kinase inhibitors (4%). The median baseline CARG toxicity score was 8 (range 2-12). Among patients with treatment-related toxicity (n = 49), 39 (79.6%) cases were mild (grade 1-2), and 10 (20.4%) were moderate to severe (≥ grade 3). Treatment toxicity was greater among those with a CARG score ≥8 (28.0% vs. 13.6%). Higher IADL independence, QoL, and SPPB scores at baseline were positively associated with Candidatus Gastranaerophilales bacterium, Lactobacillus rogosae, and Enterobacteria phage P4. Romboutsia ilealis, Streptococcus, and Lachnoclostridium sp An138 and T cell lag3 and cd8a were associated with worse IADLs, QoL, and SPPB scores at baseline. A longitudinal CGA and biomarker collection is feasible among older adults undergoing lung cancer treatment. Gut microbe and T cell gene expression changes correlated with subjective and objective functional status assessments. Future research will test causality in these associations to improve outcomes through novel supportive care interventions to prevent functional disability.

HEPPI: a randomized controlled trial of the efficacy of a cognitive-emotional intervention for homebound older adults

Objectives This randomized controlled trial aimed to assess the efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI), a home-delivered cognitive-emotional intervention, among the homebound older population presenting with mild cognitive impairment and depressive or anxiety symptoms. Methods Participants were randomly assigned either to the intervention group or the treatment-as-usual group and completed baseline, post-intervention, and three-month follow-up assessments. Changes in episodic memory and symptoms of depression and anxiety were the primary outcomes. Secondary outcomes included changes in global cognition, attentional control, subjective memory complaints, functional status, and quality of life. Data were analyzed on an intention-to-treat basis employing a linear mixed models approach. ClinicalTrials.gov identifier: NCT05499767. Results Compared with the treatment-as-usual group, the HEPPI group reported significant immediate improvement in cognition, mood, and daily functional performance. Positive effects of HEPPI were maintained over the follow-up phase only in depressive symptomatology, perceived incapacity to perform advanced instrumental activities of daily living, and self-reported emotional ability. A significant impact of the intervention on the subjective memory complaints level was observed only three months after the intervention. Conclusions This study suggests that HEPPI may be a promising home-delivered cognitive-emotional intervention to help homebound older adults improve their mental health.

Effect of low-intensity resistance training with blood flow restriction on functional status in knee osteoarthritis

Background: Knee osteoarthritis is a joint pathology with high prevalence, resulting from the increase of aging and obesity in the world population. Articular cartilage destruction can cause pain and eventually reduces activities of daily living and affects functional status in subjects with knee osteoarthritis. Exercise interventions in knee-OA aimed at increasing knee extensor muscle strength involve high-intensity resistance training but may result in joint pain due to high-compressive forces. Other alternative method includes low-intensity resistance training performed with blood flow restriction, a potential intervention for a patient who does not tolerate high loads due to lower mechanical stress. This study aims to determine the effects of blood flow restriction with low-intensity resistance training on the quadriceps for six weeks on functional status in knee-OA patients. Methods: Twenty-eight patients aged 50-70 years old with knee-OA in Physical Medicine and Rehabilitation Outpatient Clinic Soetomo Hospital Surabaya were randomized into control and treatment groups. Both groups underwent a 6-week supervised training program consisting of LI-RT (30% 1-RM) two sessions/week. The treatment group received an additional application of blood flow restriction using a cuff on 1/3 of the upper thigh with 50 mmHg occlusion pressure. Both groups were assessed for functional status by self-reported WOMAC questionnaire before and after the protocol. Results: Both training methods were able to reduce WOMAC pain and improve physical function subscales significantly, but WOMAC stiffness subscales only reduced significantly in low-intensity resistance training with blood flow restriction. There were no significant differences between groups for any domain from WOMAC, nor any significant differences between delta scores (all P &gt; 0.05). Conclusion: Low-intensity resistance training with and without blood flow restriction was similarly effective in enhancing functional status in subjects with knee osteoarthritis.

The effectiveness of combining ultrasound therapy with splinting and exercise therapy for patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) can cause patients to experience negative symptoms that can significantly affect their ability to use their hands to perform daily activities. This study aimed to compare the effectiveness of a combination of splinting and exercise therapy with or without ultrasound therapy in improving CTS symptoms and the functional status of patients.&#x0D; Methods: This randomized pre and post-test control group design study was conducted in private physiotherapy practices in the Denpasar area from August to September 2022. Twenty-four subjects with unilateral CTS were randomly divided into an Intervention Group (n=12; splinting, exercise therapy, and ultrasound therapy) and a Control Group (n=12; splinting and exercise therapy only). Splinting was used all day and night for four weeks. Exercise therapy was given three times per week for four weeks. Ultrasound therapy was given once a day, three times per week, for four weeks. The subject's symptoms and functional status before and after treatment were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), which consists of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS).&#x0D; Results: Significant improvements were found in SSS and FSS in Group 1 (SSS: p=0.000; FSS: p=0.000) and Group 2 (SSS: p=0.000; FSS: p=0.000), and a significant between-group difference was found in SSS (p=0.000) and FSS (p=0.001).&#x0D; Conclusion: The addition of ultrasound therapy to splinting and exercise therapy is more effective than that in improving the symptoms and functional status of patients with CTS.

Comparison of muscle energy technique and mobilization with movement to reduce pain and improve functional status in subjects with anterior innominate ilio-sacral dysfunction

ObjectiveThis study aimed to compare Muscle energy technique (METs) and Mobilization with movement (MWM) for pain reduction and improving functional status in subjects with anterior innominate iliosacral dysfunction. MethodologyThirty-six patients with anterior innominate iliosacral dysfunction were randomly assigned to both groups. Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Index (MODI) were used to measure pain and functional disability. Four weeks of treatment sessions were given to each participant. ResultsThe findings of this study have revealed that statistically, differences were present within and between two groups (p-value <0.05) in the Numeric Pain Rating Score and Modified Oswestry Disability Index. After 4 weeks of treatment, pain intensity decreased and functional ability increased to a greater extent in the MET group, with a mean value of 3.05 ± 0.96 for pain and 23.82 ± 4.39 for modified Oswestry index as compared to the MWM group with a mean value of 4.58 ± 1.06 for pain and 30.29 ± 5.89 for modified Oswestry index in mobilization with movement group. ConclusionThis study concluded that both Muscle Energy Technique and Mobilization with Movement techniques are effective in reducing pain and improving functional ability in patients with Anterior Innominate Iliosacral dysfunction. But when both groups were compared with each other Muscle Energy Techniques were more effective than Mobilization with Movement.

Feasibility, Acceptability, and Preliminary Efficacy of A Cognitive-Emotional Intervention Program in Homebound Older Adults: A Pilot Randomized Controlled Trial

ABSTRACT Objectives To conduct a pilot randomized controlled trial to assess the feasibility, acceptability, and preliminary efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI) among homebound older adults with mild cognitive impairment and depressive or anxious symptomatology. Methods Fifty-one participants were randomly assigned to the intervention group or to the wait-list control group and completed baseline and post-intervention assessments. Feasibility and acceptability were the primary outcomes. Secondary outcomes included changes in cognitive function, depressive and anxiety symptoms, subjective memory complaints, functional status, and quality of life. Intervention effects were assessed both at a group level (two-way mixed ANOVA) and at an individual level (Reliable Change Index). Results The HEPPI was a feasible and acceptable non-pharmacological intervention. Compared to the wait-list control group, the intervention group showed significant improvement in cognitive, emotional, and functional domains at post-intervention. Differences between groups in the distributions by clinical change categories were observed. Conclusions Results provide evidence of the HEPPI’s feasibility, acceptability, and preliminary efficacy in increasing the cognitive and functional performance of homebound older adults and reducing their psychological symptomatology. Clinical Implications Home-delivered cognitive-emotional interventions may be a promising and acceptable mental health approach for homebound older adults, improving their cognitive and emotional functioning.

Effects Of Active Release Technique and Active Isolated Stretching on Muscles of Upper Cross Syndrome

Upper cross syndrome is a condition in which there exist a muscle imbalance in upper quadrant, involving weakness of some muscles and tightness of others. In UCS, levator scapulae muscle, upper fibers of trapezius muscle, and pectoralis minor get stiff and shortened from their original length occasionally involving pectoralis major muscle. Objectives: To compare the effect of Active release technique and active isolated stretching on the muscles of upper cross syndrome. Methods: This study was a single blinded randomized clinical trial. Muscle length measurement by Vernier calipers and measuring tape between standard bony landmarks, NDI (neck disability index), Cervical rotation ROM, Cranio-vertebral angle &amp; Numeric Pain Rating Scale (NPRS) tools for screening will be used for data collection. Recorded values were analyzed for any change using SPSS 21.0 version. Results: In ART the mean value of NPRS was 2.21 ± 1.49 and in AIS was 2.31 ± 1.35. For ART group the mean NDI score was 15.12 ± 8.83 and for AIS group was 16.1250 ± 5.3898. The mean of cranio-vertebral angle in AIS group was 47.2125 ± 1.9373 and in ART group was 48.1819 ± 1.6483 which is nearer to normal CV angle. Conclusions: The study concluded that both Active release technique (ART) and Active isolated stretching (AIS) are effective methods of treatment. It was indicated that Active release technique (ART) was helpful in pain relief, improving range, cranio-vertebral angle, muscle length and functional status in subjects with Upper-cross syndrome (UCS).

Home-based primary care visits by nurse practitioners.

With rapidly growing numbers of homebound older adults, the need for effective home-based health interventions is increasingly recognized. Advanced practice registered nurses (NPs) are one of the most common providers of home-based primary care. Limited information is available to address the scope and nature of NP-led home-based primary care and associated outcomes. To synthesize research evidence of NP visits in home-based primary care. Six electronic databases-PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Web of Science, and Scopus-were searched to identify peer-reviewed research articles addressing home-based primary care interventions led by NPs. Independent screening resulted in 17 relevant articles from 14 unique studies to include in the review. Nurse practitioners provided health assessments, education, care planning and coordination primarily by face-to-face home visits. Despite a variability in terms of study design, setting, and sample, NP-led home-based primary care was in general associated with less hospitalization and fewer emergency department visits. Evidence was mixed in relation to patient-reported outcomes such as subjective health, functional status, and symptoms. Costs and patient or caregiver satisfaction were additional outcomes addressed, but the findings were inconsistent. Recent policy changes to authorize NPs to independently assess, diagnose, and order home care services directly affect how NPs approach home-based primary care programs. Our findings support NP-led home-based primary care to decrease consequential health utilization and suggest the need for further evaluating the care models in diverse populations with more patient-reported and caregiver outcomes.

The Relationship between Physical Activity Level and Functional Status of Subjects with High Spinal Cord Injury.

Background. Spinal cord injuries are one of disability in Poland and in the world. Methods: 80 subjects with a transverse injury of the cervical spinal cord were enrolled in the study. The study group included men aged 20–50, 33.1 ± 7.5. A total of 40 (50%) of the subjects comprised the physically active group (AG)—subjects doing wheelchair sport twice a week for 90 min a day. The physically inactive group (IG) comprised 40 (50%) subjects who had not participated in any sports activities. Statistical analyses were carried out using Shapiro-Wilk W-test and Mann-Whitney U test. Results. Significant differences were found between the physically active and inactive men with regard to their functionality status. The biggest differences were found for turning over (p < 0.001) and in adopting a sitting position (p < 0.001). Persons in the AG group had better results in all assessed activities. The biggest differences were observed in the field of toilet and dressing up: tooth-brushing p < 0.007 and washing the top part of the body p < 0.002. Conclusions. People participating in regular physical activity–wheelchair rugby–after spinal cord injury have a better relationship with better fitness, greater independence and a better functional status.

Nutritional Status Assessment of Selected Male Cancer Patients In Cochin, Kerala

The study was conducted for the assessment of nutritional, functional status and, Quality of Life (QoL) of selected male cancer patients undergoing cancer therapy. A purposive sampling method was adopted and an interview schedule was used to elicit data. The nutritional status assessment was conducted by incorporating modified Subjective Global Assessment (SGA), QoL, and functional status of the patients. The findings suggested that head and neck cancer was the leading type of cancer followed by lung, stomach and oesophagus cancer and a vast majority of patients were in the terminal stages of cancer. The Subjective Global Assessment (SGA) revealed that majority of the patients belonged to mildly-moderately nourished category. Majority study subjects had an inadequate nutrient intake with respect to energy, protein, fat, calcium and iron. A statistically significant difference was observed between the actual and suggested nutrient intake. The mean values of physical, social/family, emotional and functional well-being using the FACT-G scale were computed to be 29,26.5, 24, and 175.5, respectively showing that QoL was poor among study subjects, thus impacting cancer therapy. The assessment of nutritional status and physical, social, emotional and functional well-being in cancer patients is crucial for early detection of malnutrition and poor well-being thus facilitating further deterioration and improving the outcome of cancer therapy.

To Study the effect of Traditional Back Exercises vs Exercise Ball Exercise on Pain Intensity, Core Endurance and Limitation of Activities in Individuals with Nonspecific Low Back Pain: A Comparative Study

Aims: Non specific Low back pain is defined as pain without any known pathology which affects almost all the leading occupation where body's awkward posture, twisting and stress forces are commonly encountered across the globe and it is highly prevalent 60% to 70% in a year. Studies have shown various exercise regimen individual effect on the same but superiority of regimen out of these is not clear.&#x0D; Study Design: Comparative Study&#x0D; Place and Duration of Study: Ahmedabad Institute of Medical Sciences, Duration 2013-15&#x0D; Objective: To assess and compare the effect of core stability exercise, back school program and Swiss ball exercise on Pain, core endurance and Functional disability.&#x0D; Methodology: A group of 24 patients having non-specific low back pain between age groups 18-40 were randomly selected and allocated in to two groups. Group A(n=12) received traditional exercise whereas Swiss ball exercise was given to Group B(n=12). The subjects were treated for two weeks. Baseline data for VAS, Core endurance and MODI were taken on day1 and at the end of two weeks&#x0D; Result: The results were analyzed by wilcoxon signed rank test within both groups. Both groups showed significant improvement in VAS, core endurance and MODI at the end of 2weeks.Comparison between both the Group A and Group B was done by Mann- whitney U test and statistically no significant difference was seen in VAS, core endurance and MODI between the groups&#x0D; Conclusion: The study concluded that both the exercises are equally effective in reducing pain intensity, improves core endurance and functional status in subjects with non specific low back pain

A community-based study of prevalence and functional status of major depressive disorder in an industrial area.

Background:Depression is a significant public health issue that needs to be taken care of, as it poses a great economic burden on the society at large. Early identification and treatment of the patients will reduce mental morbidity and disability.Aim:The aim is to study the prevalence and functional status of subjects with major depressive disorder in the community.Materials and Methods:After identification of the sample population, the sociodemographic details were recorded. Subsequently, assessment was carried out by General Health Questionnaire (GHQ), Patient Health Questionnaire-9 (PHQ-9), Functional Status Questionnaire (FSQ), and Mini Mental State examination (MMSE).Results:A total of 2000 subjects were screened using the GHQ and PHQ and 544 subjects were selected. These 544 subjects were further assessed with FSQ and MMSE. Out of the 544 subjects, 65.1% had a GHQ score of <14, 22.1% had a score between 15 and 19, and 12.9% had a score of >20. The PHQ-9 score was found to be <5 in 28.9% subjects, 5–14 in 64.3% subjects, and >14 in 6.8% subjects. Majority of the sample population was in the warning zone according to the FSQ. The MMSE scores were ≥23 in 86% and ≤22 in 14% of the patients. Over 65% of the subjects were relatively mentally healthy. Out of the remaining 35%, 22% of the subjects required screening for psychiatric disorders and 13% of them did require active psychiatric intervention.Conclusions:It would be beneficial to the community if a database is created regarding the psychiatric disorders such as depression prevalent in the community and their functional status so that the effective measures can be implemented to minimize the suffering by providing effective psychiatric care at the earliest and follow them up in the long run.

Linguistic-cognitive and communicative-pragmatic features of a politician’s speech activity in a discursive position “after power”

The cognitive and speech activity of the linguistic personality of a politician in the discursive position “after power” has a number of significant differences in comparison with the stages “before power” and “in power”. Its general cognitive and communicative-pragmatic character that can be described as accumulative-syncretic, adaptive and agonal, is due, firstly, to the seamless combination of substantive-thematic and speech signals of the personal and political past experiences. These experiences are projected onto the issues of the supra-individual present and included in the forecasts of the social future. These signals are present in texts generated by the politician during the post-power period. There is a subject-object “stratification” with a different balance of a subject and/or object functional status in the structure of the linguistic personality of the post-power politician. As a (proactive) subject of cognition and communication, the politician “after power” creates his/her own texts, primarily memoirs and (oral) political speeches. Becoming the object of evaluation, the politician verbally responds to them as a mental-speech subject of speech utterances in communicative situations of interviews, political discussions, public responses to articles of other politicians or comments of journalists that are close or distant to the other side of the communication. At the same time, being an object, not only with social and professional functions, but also personal qualities of the ex-politician are publicly discussed, which indicates the mandatory combination of institutional, professional and individual (third-party) assessment parameters in the structure of his/her personality.

Study of the effects of adapted Tango and multidimensional intervention in pREvention of dementia in agiNG: developing healTHy lifestyle programs (STRENGTH Project)\u2014the experimental protocol of a prospective randomised controlled trial

BackgroundDementia represents a key health issue for older adults, with negative consequences on psycho-social and functional status. Treatments that counteract cognitive deficits in mild cognitive impairment (MCI) are needed to prevent or delay it.AimTo describe the experimental protocol of the STRENGTH Project. This study investigates a multimodal intervention in older adults with MCI to improve cognitive, functional, biochemical and psycho-social aspects.MethodsThe prospective randomised controlled trial will enrol 300 subjects with MCI (age ≥ 60 years). Participants will be randomly assigned to: (a) the experimental group, which will undergo sessions of adapted tango, music therapy, engagement in social activities, cognitive intervention and psycho-education for 6 months or (b) the control group, which will receive psycho-education and advice on healthy lifestyle for 6 months. All outcomes will be analysed before intervention (baseline), immediately after termination (follow-up 1), after 6 months (follow-up 2) and after 2 years (follow-up 3).DiscussionWe expect that the findings of this multidisciplinary study will be useful to optimize clinical and psycho-social interventions for improving cognitive and functional status of subjects with MCI.ConclusionsThis project could have a meaningful impact on National Health Systems by providing clues on multidisciplinary management of older adults affected by cognitive decline to prevent dementia.

Course and predictors of upper leg muscle strength over 48 months in subjects with knee osteoarthritis: Data from the osteoarthritis initiative

Weakness of upper leg muscles has a negative impact on future disease and functional status in subjects with knee osteoarthritis (OA). The aims of the present study were to (i) describe the course of muscle strength over 48 months and (ii) identify baseline predictors for a decline in upper leg muscle strength over time in subjects with knee OA. Data were obtained from the Osteoarthritis Initiative (OAI) database, a multicenter, observational study of knee OA. Upper leg muscle strength (in N/kg) was measured at baseline, 24 and 48 months. Potential baseline predictors included demographics, OA-specific and health and lifestyle related factors. Linear mixed model analyses were performed. A total of 1390 subjects with knee osteoarthritis were included. A statistically significant decline of muscle strength was found between baseline and 24 months (B=-0.186, 95%CI [-0.358,-0.014], p=0.03), but not between other time points (24-48 months p=0.89, and baseline and 48 months p=0.058). Predictors of a decline in muscle strength over time included demographic predictors (older age, being female, higher body mass index (BMI)), one lifestyle predictor (lower dietary protein intake) and one OA-specific predictor (radiographic severity). Muscle strength declined over time in subjects with knee OA. The identified predictors may help clinicians to select and treat subjects with knee OA at risk of a decline in muscle strength.

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis.

Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw. Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed. Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8. Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients. Level of Evidence This is Level IV study.

Postoperatif tibia plato kırıklı hastalarda Tıbbi Sonuç Çalışması Kısa Form 36 (SF-36) ile konvansiyonel objektif sonuç ölçekleri arasındaki ilişki.

Objective: Patient-based outcome measures are actively utilized within the subjective health status and functional status of life. The aim of this study was to evaluate the correlation between existing Knee Society Score(KSS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Medical Outcomes Study Short Form-36 (SF-36) and to evaluate their correlation with each other as well as to evaluate their measurement capabilities.Materials and Methods: In the study, we have retrospectively evaluated 43 healthy knees and 43 operated knees of a total of 43 patients with Schatzker type 2 and type 3 tibial plateau fractures that were treated surgically between July 2010 and March 2016 in our clinic. Patients were evaluated weekly with SF-36 General Physical Functional Score and also with the WOMAC, KSS and KOOS scoring systems, which are scoring systems that are used to address specifically the problems with the knee joint. Result and Conclusion: The KSS Functional Score and the KOOS Daily Functional Score were found to be reliable for the functional evaluation of the knee joint. We believe that the numerical scoring system used by WOMAC Functional Scoring causes distraction and we believe that the measurement effectiveness is reduced as a result. As a result of this study, we think that we need to be very careful when selecting and using evaluation scales where the responses are first matched to numerical values.

Determining the Effects of a 4-Week Structured Strength and Flexibility Exercise Program on Functional Status of Subjects with Osteoporosis.

Osteoporosis is a systemic disease resulting in low bone mineral density, increased risk of fractures, and falls, muscle weakness, and compromised balance. Nutrition and physical exercise have been shown to be effective in the treatment of low bone mineral density and, with more severe osteoporosis, as adjuncts to pharmaceutical treatments. However, living with osteoporosis may diminish an individual's ability and confidence to perform activities that enhance bone density. This study investigated the following question: In women with osteoporosis, will there be a greater improvement in balance, lower-extremity strength, mobility, and confidence in performing ambulatory activities after participating in a structured exercise program as compared to a control group? This was a prospective comparative trial in which 48 women who had a confirmed diagnosis of osteoporosis were enrolled in either an exercise group (a 4-week exercise program) or a control group (no structured exercise). Functional outcomes using valid and reliable tools were measured before and after exercise in the study group and at comparable times in the control group. Differences in function were assessed by paired t tests to evaluate group differences in functional outcomes. Of the 48 women recruited, 45 completed the study. Women in the exercise group (n = 27) demonstrated an increase in balance and lower-extremity strength over women in the control group (n = 18). Both groups showed an increase in mobility but no change in confidence in ambulation. This study showed that women with osteoporosis demonstrated improved balance and lower-extremity strength after participating in a structured exercise program. These changes may be important in improving overall functional status.

Objective functional assessment using the "Timed Up and Go" test in patients with lumbar spinal stenosis.

OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the "Timed Up and Go" (TUG) test. Currently, only a few studies report pre- and postoperative TUG test assessments in patients with lumbar spinal stenosis (LSS).METHODSA prospective two-center database was reviewed to identify patients with LSS who underwent lumbar decompression with or without fusion. The subjective functional status was estimated using PROMs for pain (visual analog scale [VAS]), disability (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQoL; 12-Item Short-Form Physical Component Summary [SF-12 PCS] and the EQ-5D) preoperatively, as well as on postoperative day 3 (D3) and week 6 (W6). Objective functional impairment (OFI) was measured using age- and sex-standardized TUG test results.RESULTSSixty-four patients (n = 32 [50%] male, mean age 66.8 ± 11.7 years) were included. Preoperatively, they reported a mean VAS back pain score of 4.1 ± 2.7, VAS leg pain score of 5.4 ± 2.7, RMDI of 10.4 ± 5.3, ODI of 41.9 ± 16.2, SF-12 PCS score of 32.7 ± 8.3, and an EQ-5D index of 0.517 ± 0.226. The preoperative rates of severe, moderate, and mild OFI were 4.7% (n = 3), 12.5% (n = 8), and 7.8% (n = 5), respectively, and the mean OFI T-score was 116.3 ± 23.7. At W6, 60 (93.8%) of 64 patients had a TUG test result within the normal population range (no OFI); 3 patients (4.7%) had mild and 1 patient (1.6%) severe OFI. The mean W6 OFI T-score was significantly decreased (103.1 ± 13.6; p < 0.001). Correspondingly, the PROMs showed a decrease in subjective VAS back pain (1.6 ± 1.7, p < 0.001) and leg pain (1.0 ± 1.8, p < 0.001) scores, disability (RMDI 5.3 ± 4.7, p < 0.001; ODI 21.3 ± 16.1, p < 0.001), and increase in HRQoL (SF-12 PCS 40.1 ± 8.3, p < 0.001; EQ-5D 0.737 ± 0.192, p < 0.001) at W6. The W6 responder status (clinically meaningful improvement) ranged between 81.3% (VAS leg pain) and 29.7% (EQ-5D index) of patients.CONCLUSIONSThe TUG test is a quick and easily applicable tool that reliably measures OFI in patients with LSS. Objective tests incorporating longer walking time should be considered if OFI is suspected but fails to be proven by the TUG test, taking into account that neurogenic claudication may not clinically manifest during the brief TUG examination. Objective tests do not replace the subjective PROM-based assessment, but add valuable information to a comprehensive patient evaluation.