Improvement In Functional Level Research Articles

HOME-BASED REHABILITATION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN THE KURDISTAN REGION OF IRAQ: EPIDEMIOLOGY AND OUTCOMES

IntroductionOver the past 30 years multiple wars and embargos have reduced healthcare resources, infrastructure, and staff in Iraq. Subsequently, there are a lack of physiotherapists to provide rehabilitation after an anterior cruciate ligament reconstruction (ACLR). The implementation of home-based rehabilitation programmes may provide a potential solution to this problem. This study, set in in the Kurdistan region of Iraq, describes the epidemiology and outcomes of anterior cruciate ligament reconstruction (ACLR) followed by home-based rehabilitation alone.MethodsA cohort observational study of patients aged ≥ 16 years with an ACL rupture who underwent an ACLR under a single surgeon. This was performed arthroscopically using a hamstring autograft (2 portal technique). Patients completed a home-based rehabilitation programme of appropriate simplicity for the home setting. The programme consisted of stretching, range of motion and strengthening exercises based on criterion rehabilitation progressions. A full description of the programme is provided at: https://ngmvcharity.co.uk/.Demographics, mechanisms of injury, operative findings, and outcome data (Lysholm, Tegner Activity Scale (TAS), and revision rates) were collected from 2016 to 2021. Data were analysed using descriptive statistics.ResultsThe cohort consisted of 545 patients (547 knees), 99.6% were male with a mean age of 27.8 years (SD 6.18 years). The mean time from diagnosis to surgery was 40.6 months (SD 40.3). Despite data attrition Lysholm scores improved over the 15-month follow-up period, matched data showed the most improvement occurred within the first 2 months post-operatively. A peak score of 90 was observed at nine months. Post-operative TAS results showed an improvement in level of function but did not reach pre-injury levels by the final follow-up. At final follow-up, six (1.1%) patients required an ACLR revision.ConclusionPatients who completed a home-based rehabilitation programme in Kurdistan had low revision rates and improved Lysholm scores 15 months post-operatively. To optimise resources, further research should investigate the efficacy of home-based rehabilitation for trauma and elective surgery in low- to middle-income countries and the developed world.

The effects of different taping methods on patellofemoral alignment, pain and function in individuals with patellofemoral pain: A randomized controlled trial.

Athletic taping has long been a physiotherapeutic application in individuals with patellofemoral pain (PFP). However, the therapeutic effects of local and proximal taping have not been fully determined. To evaluate the effects of two different taping techniques applied in addition to exercise on patellofemoral alignment, pain, and function in individuals with PFP. Randomized controlled trial. An outpatient hospital clinic. Individuals with PFP aged 18-50 years (n = 36). Group 1 underwent only the exercise program. Group 2 underwent the exercise plus McConnell patellar taping (MPT), and Group 3 underwent the exercise plus femoral rotational taping (FRT) (6 weeks). Bisect offset index (BOI) and patellar tilt angle (PTA) were measured in relaxed and maximum voluntary contractions of the quadriceps muscle (MVCq) using magnetic resonance imaging. Pain intensity was assessed by the Visual Analog Scale for three conditions: at daytime rest, during activity, and at nighttime. Functional level was assessed by the Kujala Patellofemoral Scoring System. Significant improvements in the BOI of Group 2 at rest (p = .015; r = 0.593) and in PTA of Group 3 at MVCq (p = .010; r = 0.613) were found. Improvements in pain under all three conditions were significant within groups (all, p values < .050 and r > 0.5). The change in pain was similar between groups (all, p values > .05). All groups showed significant improvement in functional level (all, p values < .010 and r > 0.5). However, the increase in Group 3 was higher than that in Group 1 (p = .019). This study shows that MPT and FRT applications increase functionality and can affect patellofemoral alignment in different ways. In the treatment of PFP, more successful results can be obtained with appropriate taping techniques for the local and proximal region.

Discontinuing cannabis use: Symptomatic and functional outcomes in people with an established psychotic disorder.

For people with psychotic disorders, the negative outcomes associated with continuing cannabis use would suggest that discontinuing such use may be beneficial for their symptomatic and functional recovery. However, existing evidence that discontinuation is associated with better clinical outcomes is inconsistent and it remains unclear whether discontinuing use is associated with improvements in outcomes for people with an established psychotic disorder. In this 3-5-year longitudinal study we examined baseline and follow-up symptomatic and functional profiles of 371 people with an established psychotic disorder, comparing those who continued to use cannabis with those who discontinued use after baseline assessment. At follow-up, one third (33.3%) of baseline cannabis users had discontinued use. Discontinuation was associated with significantly lower odds of past-year hallucinations and a mean improvement in level of functioning (Personal and Social Performance Scale) compared to a decline in functioning in continuing users. No significant differences in severity of negative symptoms were observed. With few longitudinal studies examining symptomatic and functional outcomes for people with established psychotic disorders who continue to use cannabis compared to those who discontinue use, our findings that discontinuing cannabis was associated with significant clinical improvements fill gaps in the evidence-base.

The first national program of remote cardiac rehabilitation - goal achievements, adherence, and responsiveness in elderly patients

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sheba medical center Background Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative program in the field of telemedicine. RCR is included in the health basket. Many believe that telemedicine programs better fit younger patients, whose technological literacy is higher than older patients. Older patients are also thought to have difficulty consuming technology-based programs and meeting program goals. The objectives of this study were as follows: 1) To study patterns of physical activity, goal achievement, and improvement in functional level among RCR participants over 65 compared with younger patients. 2) To study the variables that can predict better patient adherence and compliance with the rehabilitation program. Methods A retrospective study of post-myocardial infarction patients enrolled in six-month RCR program. The activity of the patients was monitored using a smart watch. The data were collected and analyzed by a special telemedicine system. RCR program goals were: (i)150 minutes of aerobic activity per week; (ii) 120 minutes of the activity within the target heart rate; (iii) 8000 steps per day. Predictive models were created to evaluate variables predicting adherence and compliance with the program. Results 306 participants, 80 of them were elderly (average age 70 ± 3.38). At the end of the program, there was a significant improvement (p &amp;lt;0.001) in the functional capacity of all participants. The elderly improved from 8.11 ± 2.8 to 11.25 ± 12.6 METs, while the final METs results in the elderly group were similar to other participants. During all program months, the elderly showed better achievement of program goals compared to younger ones (p &amp;lt;0.01). We found that age of patients is a clear predictor (p &amp;lt;0.01) of early dropout from the program and goals achievements – the higher the age, the fewer dropouts and better achievement. Conclusions Elderly can successfully participate in telemedicine rehabilitation programs, and such programs are beneficial for them. Age is not a limitation, but a predictor for better achievement of goals and compliance with the RCR program.

Psychiatric Acute Day Hospital as an Alternative to Inpatient Treatment.

For the first time in the Swiss health care system, this evaluation study examined whether patients with acute psychiatric illness who were admitted for inpatient treatment could be treated in an acute day hospital instead. The acute day hospital is characterized by the possibility of direct admission of patients without preliminary consultation or waiting time and is open every day of the week. In addition, it was examined whether and to what extent there are cost advantages for day hospital treatment. Patients who were admitted to the hospital with a referral to an inpatient admission were treated randomly either fully inpatient or in the acute day hospital. As a pilot study, 44 patients were admitted to the study. Evidence of efficacy could be provided for both treatment settings based on significant reduction in psychopathological symptoms and improvement in functional level in the course of treatment. There were no significant differences between the two settings in terms of external assessment of symptoms, subjective symptom burden, functional level, quality of life, treatment satisfaction, and number of treatment days. Treatment in the day hospital was about 45% cheaper compared to inpatient treatment. The results show that acutely ill psychiatric patients of different symptom severity can be treated just as well in an acute day hospital instead of being admitted to the hospital. In addition, when direct treatment costs are considered, there are clear cost advantages for day hospital treatment.

Isokinetic Evaluation of Shoulder Strength and Endurance after Reverse Shoulder Arthroplasty: A Comparative Study

ObjectiveThe present study aimed to compare the isometric strength and endurance of shoulder abduction and internal and external rotation between operated shoulders and nonoperated, contralateral shoulders of patients who underwent reverse shoulder replacement due to unilateral rotator cuff tear arthropathy. Patients and methodsWith a diagnosis of cuff tear arthropathy, 41 consecutive patients (mean age of 70.8 years; age range, 57 to 84; 36 females, 5 males) who underwent unilateral reverse shoulder arthroplasty were reviewed based on functional and radiological data. In all cases, cuff tear arthropathy was unilateral and contralateral shoulder was asymptomatic, with normal shoulder function. The average length of follow-up was 34 months (range of 12–67).To assess patients' functional level, the Constant score and the Disabilities of the Arm, Shoulder, and Hand (the Quick-DASH) outcome measure were used preoperatively and at the final examination.The primary outcomes of the present study were measurement of isokinetic strength and endurance of shoulder abduction and internal and external rotation using an isokinetic evaluator. ResultsPatients exhibited marked improvement in functional level as reflected by a significant increase in the mean Constant score from 38 preoperatively to 65 at the final follow-up (p = 0.03). The functional improvement was supported by a decrease in the mean Quick-DASH from 64 preoperatively to 26 at the final follow-up (p = 0.018).In the comparison of the isokinetic strength and endurance of shoulder abduction, no statistical difference was observed between operated shoulders and contralateral shoulders (p > 0.05). However; the strength and endurance of internal and external rotation were lower in operated shoulders than in contralateral shoulders (p < 0.05). Similarly, there was no statistically significant difference in comparisons of the durability of abduction (p > 0.05); however, the durability of internal and external rotation were significantly lower in operated shoulders (p < 0.05). ConclusionIn terms of durability and strength of abduction, similar results with the unaffected shoulder may be accomplished; nonetheless, the surgeon should be aware that durability and strength of rotation would be weak. Level of evidenceLevel III, Therapeutic Study.

491: Neurodevelopmental assessment in patients who underwent prenatal fetoscopic and open fetal neural tube defect repair

To compare neurodevelopmental outcomes in infants who had undergone prenatal neural tube defect (NTD) repair by either a Fetoscopic or by an Open hysterotomy approach 41 infants were included (22 Fetoscopic and 19 Open) in this prospective longitudinal cohort study. Neurodevelopmental outcomes were assessed using the Developmental Profile 3 (DP-3) screening test, which evaluates 5 domains of development as documented in an interview with the patient’s parents. Results were compared to reference values. Infants were categorized as “Delayed and Below Average” if the standard score (SS) was ≤ 84 and “Average and Above average ” if the SS was ≥ 85. In addition, infants were clinically evaluated by a Developmental Pediatrician in our Spina Bifida Clinic, with a full evaluation and documented the motor development and the disparity (if any) between the anatomic and functional levels of the lesion. The Capute Scales test evaluates visual-motor problem solving (CAT Developmental Quotient -DQ-) and language abilities (CLAMS DQ). Results were categorized as “Delayed” if DQ <70, “Borderline” if DQ 70-84, and “Normal” if DQ > 84. Motor DQ scores were determined by the Gesell Developmental Scale The DP-3 test was performed on 22 infants after Fetoscopic repair and on 14 after Open repair (Table 1). Fetoscopically repaired infants were assessed at an earlier age than their Open counterparts, but no differences in neurodevelopmental outcome were detected. The Capute Scales were performed on 14 Fetoscopic and on 19 Open repair infants at a similar age (Table 2). No differences in CAT DQ, CLAMS DQ, Motor DQ or classification of developmental outcomes were detected. Improvement in functional level by 3 or more was noted in 33.3% of the Fetoscopic group and in 26.3% of the Open group (p=0.7) There were no significant differences in neurodevelopmental outcome between those infants who underwent a Fetoscopic NTD repair as compared to their Open repair counterpartsView Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes.

Previous reports from the Management of Myelomeningocele Study demonstrated that prenatal repair of myelomeningocele reduces hindbrain herniation and the need for cerebrospinal fluid shunting, and improves motor function in children with myelomeningocele. The trial was stopped for efficacy after 183 patients were randomized, but 30-month outcomes were only available at the time of initial publication in 134 mother-child dyads. Data from the complete cohort for the 30-month outcomes are presented here. Maternal and 12-month neurodevelopmental outcomes for the full cohort were reported previously. The purpose of this study is to report the 30-month outcomes for the full cohort of patients randomized to either prenatal or postnatal repair of myelomeningocele in the original Management of Myelomeningocele Study. Eligible women were randomly assigned to undergo standard postnatal repair or prenatal repair <26 weeks gestation. We evaluated a composite of mental development and motor function outcome at 30 months for all enrolled patients as well as independent ambulation and the Bayley Scales of Infant Development, Second Edition. We assessed whether there was a differential effect of prenatal surgery in subgroups defined by: fetal leg movements, ventricle size, presence of hindbrain herniation, gender, and location of the myelomeningocele lesion. Within the prenatal surgery group only, we evaluated these and other baseline parameters as predictors of 30-month motor and cognitive outcomes. We evaluated whether presence or absence of a shunt at 1 year was associated with 30-month motor outcomes. The data for the full cohort of 183 patients corroborate the original findings of Management of Myelomeningocele Study, confirming that prenatal repair improves the primary outcome composite score of mental development and motor function (199.4 ± 80.5 vs 166.7 ± 76.7, P= .004). Prenatal surgery also resulted in improvement in the secondary outcomes of independent ambulation (44.8% vs 23.9%, P= .004), WeeFIM self-care score (20.8 vs 19.0, P= .006), functional level at least 2 better than anatomic level (26.4% vs 11.4%, P= .02), and mean Bayley Scales of Infant Development, Second Edition, psychomotor development index (17.3% vs 15.1%, P= .03), but does not affect cognitive development at 30 months. On subgroup analysis, there was a nominally significant interaction between gender and surgery, with boys demonstrating better improvement in functional level and psychomotor development index. For patients receiving prenatal surgery, the presence of in utero ankle, knee, and hip movement, absence of a sac over the lesion and a myelomeningocele lesion of ≤L3 were significantly associated with independent ambulation. Postnatal motor function showed no correlation with either prenatal ventricular size or postnatal shunt placement. The full cohort data of 30-month cognitive development and motor function outcomes validate in utero surgical repair as an effective treatment for fetuses with myelomeningocele. Current data suggest that outcomes related to the need for shunting should be counseled separately from the outcomes related to distal neurologic functioning.

The Short-Term Effect of Extracorporeal Shock Wave in Treating Plantar Fasciitis : RCT = التأثير قصير الأجل لاستعمال الموجات التصادمية في علاج اللفافة الأخمصية

Background: Plantar fasciitis (PF) is one of the common musculoskeletal problems worldwide that has been treated using the extracorporeal shock wave therapy (ESWT). The purpose of this study was to investigate the short-term effectiveness of ESWT in reducing pain and improving function in people with PF. Materials and Methods: A sample of 34 subjects with PF (21 female) was randomly assigned to either the ESWT treatment group (n=15) or the placebo control group (n=19). Each subject received 3 sessions of ESWT 1 week apart with a clasp on the heel for the placebo control group. Pain and functional level were examined using the Visual Analog Scale (VAS) and the Roles and Maudsley Score (RM) respectively at baseline, end of treatment and 3 weeks after the last intervention session. Results: Participants in the ESWT treatment group had significant improvement in both VAS and RM at the end of the treatment and follow up. Whereas participants in the placebo group did not improve significantly at the end of the treatment neither in VAS nor in RM scores while reported significant improvement at the follow up in both outcome measures. When comparing results between groups, pain scores were higher in the placebo group at the end of treatment and follow up. However, no significant differences were observed between groups in outcome measures. Conclusions: The use of ESWT demonstrated successful reduction in pain and improvement in functional level with individuals suffering from PF after a short-term follow up.

Antisecretory therapy with no improvement in functional level in Ménière’s disease

Conclusion Antisecretory factor-inducing (AF) specially processed cereals (SPC) were not shown to significantly improve the functional level in patients with MD. Objectives The aim of this study was to evaluate the effect of AF-inducing SPC in patients suffering from Ménière’s disease (MD). Methods A randomized double-blinded, placebo-controlled cross-over study was conducted. All patients had a 2 months intake of SPC and control cereal with a 2 months washout period in between. The severity of MD was classified according to the American Academy of Otolaryngology-Head and Neck Surgery (AOO-HNS) functional scale, and the frequency of attacks was registered. Results Thirty-two patients completed the study. No carryover effect was found. In both functional level and frequency of attacks no significant effect of SPC was found. Seventeen patients showed improvement in functional level when treated with SPC (mean improvement = 0.9 points) and 14 when treated with placebo (mean improvements = 0.7 points). No patients showed worsening in functional level during treatment with SPC, but three showed worsening when treated with placebo. Seventeen patients reported fewer attacks when treated with SPC, and 22 when treated with placebo. Three patients reported more frequent attacks when treated with SPC, and three when treated with placebo. A non-parametric comparison and a parametric analysis supported the findings.

Antisecretory Factor–Inducing Therapy Improves Patient-Reported Functional Levels in Meniere's Disease

The aim of this study was to evaluate the effectiveness of specially processed cereal (SPC) as a suitable adjunctive treatment for Meniere's disease. We performed a randomized double-blinded, placebo-controlled, crossover study in a tertiary referral center of patients who had a diagnosis of Meniere's disease based on the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). The main outcome measure was the AAO-HNS Functional Level Scale (FLS). Thirty-nine patients completed the study without any reported complications. The mean pretreatment FLS score for the entire study cohort was 3.8 (median, 4; range, 1 to 6). The overall FLS score improved significantly (p < 0.001), to 2.8 (median, 3), after SPC treatment. No patients showed worsening on the FLS during SPC or placebo treatment. Of the 39 patients, 23 showed improvement on the FLS, and no change was observed in the remaining 16. The median improvement on the FLS in these 23 patients was 2 points (mean, 1.7; range, 1 to 4). The mean FLS score after placebo cereal treatment was not significantly different from baseline (p = 0.452), but was significantly higher than that after SPC treatment (mean, 3.7; p < 0.001). The marginal difference observed between the baseline FLS score and the placebo FLS score was due to the fact that 5 patients reported 1-point improvements on the FLS after placebo treatment. Nevertheless, significantly fewer patients improved on placebo than on SPC (p < 0.001). Treatment with SPC appears to be well tolerated by most patients (91%) without any complications. More than half (59%) of the study cohort reported subjective improvement in functional level.

Intratympanic steroids for Ménière's disease or syndrome

Ménière's disease is a disorder characterised by hearing loss, tinnitus and disabling vertigo.The use of intratympanic steroids to reduce the severity of these symptoms has been gaining popularity. To assess the effectiveness of intratympanic steroids on the frequency and severity of attacks of vertigo, on chronic symptoms such as tinnitus, imbalance and hearing loss, and on the progression of these symptoms in patients with definite Ménière's disease or syndrome, as defined by the AAO-HNS Committee. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 13 January 2011. Randomised controlled trials of intratympanic dexamethasone versus placebo in patients with Ménière's disease. Two authors independently assessed trial risk of bias and extracted data. We contacted study authors for further information where possible. A single trial containing 22 patients, with a low risk of bias was included.This trial found that after 24 months, compared with placebo, the use of intratympanic dexamethasone demonstrated a statistically significant improvement in vertigo as defined by a respective improvement in functional level (90% versus 42%), class (82% versus 57%), change in Dizziness Handicap Inventory scores (60.4 versus 41.3) and mean vertigo subjective improvement (90% versus 57%).The treatment regime described by the authors involved daily injections of dexamethasone solution 4 mg/ml for five consecutive days. These results were clinically significant. No complications were reported. The results of a single trial provide limited evidence to support the effectiveness of intratympanic steroids in patients with Ménière's disease. This trial demonstrated a statistically and clinically significant improvement of the frequency and severity of vertigo measured 24 months after the treatment was administered. It is important to note that there were a few aspects of the study which we were unable to clarify with the study authors.

Bilateral lung transplantation for pediatric idiopathic pulmonary arterial hypertension: A multi‐center experience

Many children with idiopathic pulmonary arterial hypertension (IPAH) experience disease progression despite advanced medical therapy. In these children, heart-lung or bilateral lung transplantation (BLTx) remain the only therapeutic options when other treatments fail. Data on functional outcome after BLTx in children with IPAH are limited. We report a multi-center experience of BLTx for pediatric IPAH. We performed a retrospective study including 25 centers within the International Pediatric Lung Transplant Collaborative. Children with IPAH who underwent BLTx were included (1996-2006). Twenty-three children underwent BLTx for IPAH, most of whom were in WHO class III or IV level of function pre-transplantation. At 6 months post-transplantation, 82% of children reported improvement in level of function to WHO class I. The median FEV(1) was 89% (12-126) of predicted at 12 months post-transplantation. Ten patients (44%) developed BOS at a median of 42 months (3-85), of whom five died at a median of 27 months (4-86) post-transplantation. Overall mortality was 4% at 3 months post-transplantation. The median survival for children in this cohort was 45 months (2-123). Our data suggest that BLTx is a valuable therapeutic option for children with end-stage IPAH with outcomes comparable to that after heart-lung transplantation in children with pulmonary arterial hypertension or those patients undergoing lung transplantation for other indications. In the majority of children, a good cardiopulmonary function is possible following BLTx, making BLTx a good therapeutic option and maximizing donor organ utilization by allowing more hearts to be available for children needing cardiac transplantation.

Prevalence and Comorbidities of Somatoform Disorders in a Rural California Outpatient Psychiatric Clinic

This study examines the prevalence and comorbidities of somatoform disorders in a rural setting with a diverse ethnic population. A retrospective chart review was conducted of active psychiatric outpatients in a clinic located in a rural community. Data abstracted included demographic variables, multi-axial diagnoses (DSM-IV-TR), length of treatment, psychotropic medications, and number of medications discontinued because of side effects. Improvement in level of function with treatment was measured by change in global assessment of functioning (GAF) scores. Of 737 records reviewed, 37 (5%) contained a diagnosis of somatoform disorder. The most common comorbidities in the somatoform group were depression (P < .01), hypertension (P < .01), and arthritis (P < .05). The somatoform group was significantly more likely to have a chronic medical illness (P < .01) and history of surgeries (P < .05). The somatoform group patients' ΔGAF was one fourth the ΔGAF scores in all other psychiatric outpatients (1.41 vs 6.79, P < .01). The somatoform group changed medications more often because of side effects (1.35 times vs 0.71 times, P < .01), received a greater number of psychotropic medications (2.05 vs 1.62, P < .05), and was more likely to be taking an antidepressant (P < .05) than the nonsomatoform group. Somatoform disorder patients had a higher prevalence of depression, chronic medical conditions, and surgeries. They responded less favorably to treatment when compared to patients without a somatoform disorder, and manifested a decreased tolerance to medication side effects. Female gender, fewer years of education, and Latino ethnicity did not increase the probability of having a somatoform disorder.

Long-term Clinical Outcome of Open Meniscal Allograft Transplantation

Background Meniscal allograft transplantation is an accepted treatment for the symptomatic postmeniscectomized knee in younger patients; however, long-term data are scarce on clinical outcome. Hypothesis Cryopreserved meniscal allograft transplantations can, in the long term, be a good alternative for the symptomatic postmeniscectomized knee in younger patients. Study Design Case series; Level of evidence, 4. Methods Sixty-three meniscal allografts (40 lateral and 23 medial) were transplanted with an open procedure in 57 patients. Clinical outcome and failure rate were evaluated at 13.8 ± 2.8 years. Mean age at time of transplantation was 39.4 ± 6.9 years. Results Eight medial and 10 lateral allografts failed (overall failure rate, 29%). Overall Lysholm scores significantly improved from 36 ± 18 preoperatively to 61 ± 20 at long-term follow-up. Scores were not significantly different in the following subgroups: medial allografts, female patients, and left treated knees. All subgroups had poor scores at mean follow-up of 13.8 years, except the male patients group, which had a fair score. Short-term Lysholm scores were 79 ± 19 at 3.1 ± 1.5 years. All subgroups demonstrated a significant difference between short- and long-term Lysholm scores. There were no significant differences in Lysholm scores between posttransplanted survivors and posttransplanted nonsurvivors who received a total knee arthroplasty. For 2 other measures—the Knee injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee scoring system—significant decline was present between men and women only. Conclusion Long-term follow-up results show that meniscal allograft transplantation is a beneficial procedure. Good improvements in clinical function and pain relief have been shown at short-term follow-up in this population. Despite the deterioration in function scores over time, there is still improvement in level of function at long-term follow-up but not at a high level. As such, meniscal allograft transplantation is a good salvage option for the treatment of degenerative arthritis of the symptomatic post-meniscectomized knee. Meniscal allograft transplantation can be used to postpone total knee arthroplasty in younger patients.

Endolymphatic sac-vein decompression for intractable meniere's disease: long term treatment results

We sought to determine the long-term efficacy of endolymphatic sac-vein decompression surgery on patients with classic Meniere's disease. Using the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium criteria, starting stage, functional level, vertigo class, and hearing results were addressed. We studied 68 patients with classic Meniere's disease from a tertiary, private otology-neurotology practice. Patient data were gathered by retrospective chart review, questionnaire, and patient interview. All patients underwent endolymphatic sac-vein decompression with an average follow-up period of 55 months. Median functional level before surgery was level 4, improving to level 2 after surgery. Eighty-one percent of patients showed improvement in functional level, 12% remained stable, and 7% declined. Long-term vertigo control was 47% in class A, 25% in class B, 9% in class C, 3% in class D, and 16% in class F. Twenty percent of patients were in hearing stage I Meniere's disease; 31%, stage II; 44%, stage III; and 5%, stage IV. Eighteen percent of patients showed improvement in hearing class, 64% were stable, and 18% declined. Endolymphatic sac-vein decompression surgery is a safe, nondestructive surgical option for Meniere's disease that offers durable control of vertigo and stabilization of hearing for the majority of symptomatic patients. The beneficial long-term outcome of the endolymphatic sac-vein decompression supports its continued use as a first-line treatment option in intractable Meniere's disease.

Endolymphatic sac-vein decompression for intractable Meniere's disease: long term treatment results.

We sought to determine the long-term efficacy of endolymphatic sac-vein decompression surgery on patients with classic Meniere's disease. Using the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium criteria, starting stage, functional level, vertigo class, and hearing results were addressed. We studied 68 patients with classic Meniere's disease from a tertiary, private otology-neurotology practice. Patient data were gathered by retrospective chart review, questionnaire, and patient interview. All patients underwent endolymphatic sac-vein decompression with an average follow-up period of 55 months. Median functional level before surgery was level 4, improving to level 2 after surgery. Eighty-one percent of patients showed improvement in functional level, 12% remained stable, and 7% declined. Long-term vertigo control was 47% in class A, 25% in class B, 9% in class C, 3% in class D, and 16% in class F. Twenty percent of patients were in hearing stage I Meniere's disease; 31%, stage II; 44%, stage III; and 5%, stage IV. Eighteen percent of patients showed improvement in hearing class, 64% were stable, and 18% declined. Endolymphatic sac-vein decompression surgery is a safe, nondestructive surgical option for Meniere's disease that offers durable control of vertigo and stabilization of hearing for the majority of symptomatic patients. The beneficial long-term outcome of the endolymphatic sac-vein decompression supports its continued use as a first-line treatment option in intractable Meniere's disease.

OPIOID USE IN THE MANAGEMENT OF CHRONIC PAIN

Opioids are a necessary and effective component of the management of chronic non-cancer-related pain in some patients. Careful structuring, monitoring, and documentation of care are important, but the therapeutic use of opioids is uncomplicated in the majority of patients using opioids and is gratifying for both the patient and the treating physician when it results in significant reduction in pain, improvement in level of function, and a higher quality of life. Opioid therapy is most often successful when combined with other pharmacologic and nonpharmacologic interventions as indicated by the type of pain and the context in which it occurs.

Assertive outreach for frequent users of psychiatric hospitals: a meta-analysis.

A meta-analysis was conducted on nine studies of an assertive outreach model for frequent users of psychiatric hospitals. Four studies used experimental or quasi-experimental designs and five used pre-post designs. Findings at one-year follow-up were examined for retention in community mental health services, psychiatric inpatient days, quality of life, and client level of functioning. Eighty-four percent of assertive outreach clients were still receiving mental health services after one year, compared to 54% of controls. In two thirds of the programs, the mean annual rate of inpatient days declined by 50% or more. The overall experimental effect size for quality of life was negligible, although changes over time for assertive outreach clients were more encouraging. Similarly, improvement in level of functioning was found for assertive outreach clients. The study examining experimental differences in level of functioning obtained a nonsignificant moderate effect.

Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua.

Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.