Level Of Evidence 1b Research Articles

Cerebral Bypass Surgery: Level of Evidence and Grade of Recommendation.

Cerebral bypasses are categorized according to function (flow augmentation or flow preservation) and to characteristics: direct, indirect or combined bypass, extra-to-intracranial or intra-to-intracranial bypass, and high-, moderate- or low-capacity bypass. We critically summarize the current state of evidence and grades of recommendation for cerebral bypass surgery. The current indications for cerebral bypass are discussed depending on the function of the bypass (flow preservation or augmentation) and analyzed according to level of evidence criteria. Flow-preservation bypass plays an important role in managing complex intracranial aneurysms (level of evidence 4; grade of recommendation C). Flow-preservation bypass is currently only very rarely indicated in the treatment of cerebral tumors involving major cerebral arteries (level of evidence 5; grade of recommendation D). The trend has evolved in favor of partial resection and radiotherapy. To preserve the flow, the bypass is always a direct bypass.Flow-augmentation bypass is currently recommended for Moyamoya patients with ischemic symptoms and compromised hemodynamics (level of evidence 4; grade of recommendation C) and patients with hemorrhagic onset (level of evidence 1B; grade of recommendation A). Flow-augmentation bypass is currently not recommended for patients with recently symptomatic carotid artery occlusion, even in the setting of compromised cerebral hemodynamics (level of evidence 1A; grade of recommendation A), but may be considered in patients with hemodynamic failure and recurrent medically refractory symptoms as a final resort (level of evidence 5; grade of recommendation D). The results of recent randomized clinical trials narrow the indication for cerebral bypass in the setting of ischemic cerebrovascular disease. However, cerebral bypass is still very useful for managing complex intracranial aneurysms (not amenable to selective clipping or endovascular therapies) and is the only treatment option for managing symptomatic patients with Moyamoya vasculopathy and impaired brain hemodynamics.

Effectiveness of Lavendula stoechas essential oil in treatment of mild to moderate carpal tunnel syndrome: A randomized controlled trial

Study DesignRandomized controlled trial. IntroductionCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. To date, no previous study has evaluated the efficacy of topical Lavendula stoechas (Lavender) oil in CTS patients. Purpose of the StudyTo investigate the effectiveness of topical Lavender essential oil in pain intensity, isometric pinch strength, electrophysiological features, and functional status of patients with mild to moderate CTS. MethodsForty eight patients with mild to moderate CTS were enrolled in this randomized placebo-controlled trial. Group A was treated with night wrist orthotic and topical lavender oil ointment. Group B was treated with night wrist orthotic and a placebo ointment. Patients were evaluated at baseline, and after 40 days of intervention with Boston CTS questionnaire (BCTQ), visual analog scale (VAS) for pain, pinch grip strength, power grip, median compound motor action potential latency, and median sensory nerve action potential latency. ResultsAt the end of the study period, both groups improved significantly in terms of BCTQ, VAS, isometric pinch powers, and electrodiagnosis study parameters. However, group A showed significantly greater improvements in BCTQ (mean difference, 0.39 ± 0.31 vs 0.6 ± 0.35; P = .03), VAS (3.37 ± 1.86 vs 1.33 ± 2.07; P = .001), and pinch grip strength (0.73 ± 0.63 vs 0.27 ± 0.54; P = .01) than group B. No significant differences in power grip, median compound motor action potential latency, and median sensory nerve action potential latency were seen between the 2 groups. ConclusionThis study was the first trial of topical lavender oil used in patients with CTS. Wrist orthotic combined with topical lavender oil was more effective than orthotic and placebo in treatment of mild to moderate CTS. Level of Evidence1b.

Reliability of measurement of the carpal tunnel and median nerve in asymptomatic subjects with ultrasound

BackgroundMorphology of the carpal tunnel changes with varying wrist postures and compressive forces applied to the wrist. These changes may affect the morphology and pressure on the median nerve and could be used as part of the treatment of the carpal tunnel syndrome patients. Reliability of the ultrasonographic measurements of the median nerve has been widely studied. However, there is a lack of investigation regarding reliability of ultrasonographic measurements of the carpal tunnel. ObjectiveThe purpose of this study was to assess intra-tester and inter-tester reliability of measurement of dimensions of the carpal tunnel and median nerve with ultrasound in asymptomatic volunteers. DesignA cross-sectional methodological study. MethodsAspects measured were mediolateral and anteroposterior diameters, flattening ratio, circularity, perimeter and cross-section area of the carpal tunnel and median nerve. ResultsIntra-tester reliability was excellent for the carpal tunnel (ICCs from 0.91 to 0.97) and for the median nerve (ICCs from 0.79 to 0.94) measurements. The flattening ratio of the median nerve showed good agreement (ICC = 0.68). Inter-tester reliability was excellent for the carpal tunnel measurements (ICCs from 0.76 to 0.95) and, for the cross sectional area, the perimeter and mediolateral diameter of the median nerve, the ICC values were 0.89, 0.84 and 0.81, respectively. ConclusionIn the context of this study, ultrasound was a reliable instrument for measuring carpal tunnel and median nerve dimensions in asymptomatic subjects. Level of evidence1b

Effectiveness of a fine motor skills rehabilitation program on upper limb disability, manual dexterity, pinch strength, range of fingers motion, performance in activities of daily living, functional independency, and general self-efficacy in hand osteoarthritis: A randomized clinical trial

Study DesignA randomized clinical trial. IntroductionRehabilitation treatments for improving fine motor skills (FMS) in hand osteoarthritis (HOA) have not been well explored yet. Purpose of the StudyTo assess the effectiveness of a rehabilitation program on upper limb disability, independence of activities of daily living (ADLs), fine motor abilities, functional independency, and general self-efficacy in older adults with HOA. MethodsAbout 45 adults (74-86 years) with HOA were assigned to an experimental group for completing an FMS intervention or a control group receiving conventional occupational therapy. Both interventions were performed 3 times/wk, 45 minutes each session, during 8 weeks. Upper limb disability, performance in ADLs, pinch strength, manual dexterity, range of fingers motion, functional independency, and general self-efficacy were assessed at baseline, immediately after treatment, and after 2 months of follow-up. ResultsFMS group showed significant improvements with a small effect size on manual dexterity (P ≤ .034; d ≥ 0.48) and a moderate-high effect on range of index (P ≤ .018; d ≥ 0.58) and thumb (P ≤ .027; d ≥ 0.39) motion. The control group showed a significant worse range of motion over time in some joints at the index (P ≤ .037; d ≥ 0.36) finger and thumb (P ≤ .017; d ≥ 0.55). ConclusionsA rehabilitation intervention for FMS may improve manual dexterity and range of fingers motion in HOA, but its effects on upper limb disability, performance in ADLs, pinch strength, functionality, and self-efficacy remain uncertain. Specific interventions of the hand are needed to prevent a worsening in range of finger motion. Level of Evidence1b.

The Efficacy of Probiotic in Adults with Acute Infectious Diarrhea

Diarrhea is a global health problem with high morbidity and mortality. In developing countries, acute diarrhea is most commonly caused by infectious pathogens. Regardless of the cause, diarrhea is primarily treated by fluid replacement therapy to decrease the risk of dehydration and death, although it does not affect the duration of diarrhea. Probiotics are able to shorten the duration of diarrhea in children, but its efficacy in adults is unclear. This study aimed to evaluate the benefit of probiotic in reducing the duration of acute diarrhea in adults as compared to placebo. Systematic search was done using four databases: PubMed, Scopus, ProQuest, and Embase, without limit on the year of publication. Randomized clinical trials were selected as the appropriate study design to answer the clinical question and two studies were considered relevant for appraisal. In conclusion, probiotics could improve the recovery of acute infectious diarrhea in adults (level of evidence 1b) however more studies should be carried out since only very few strains of probiotics have been investigated. Normal 0 false false false IN X-NONE X-NONE

The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome

Study DesignProspective cohort. IntroductionAssessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. Purpose of the StudyTo evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. MethodsForty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. ResultsSDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. ConclusionsIntrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. Level of Evidence1b.

Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study

Study DesignRandomized clinical study. IntroductionSupervised physical therapy (PT) and home exercise programs (HEPs) are frequently used in the rehabilitation of patients with distal radius fracture (DRF). However, there is no consensus as to whether unsupervised HEP provides comparable benefits to those achieved by supervised PT. Purpose of the StudyTo compare the improvements in pain and functional status between a supervised PT program and unsupervised HEP in DRF patients older than 60 years. MethodsA total of 74 patients were randomized into 2 groups. One group received 12 sessions of supervised PT (n = 37), and the other group followed an exercise program at home (n = 37). Three evaluations were performed, before the initiation of treatment, at 6-week, and 6-month follow-up. The study conducted a statistical power analysis to detect an intergroup difference score of 15 points on the Patient-Rated Wrist Evaluation (PRWE). The t-test or Mann-Whitney test was used, and it was set with a significance level of .05. ResultsThe supervised PT group showed clinically significant differences in the total PRWE score at 6 weeks (17.67 points, P = .000) in the PRWE function score (15.2 points, P = .000) and in the PRWE pain score (5.6 points, P = .039). There was also a significant difference in the total PRWE score at 6-month follow-up (17.05 points, P = .000) in the PRWE function score (14.5 points, P = .000) and in the PRWE pain score (2.5 points, P = .35). ConclusionsA supervised PT program is more effective for improving function in the short- and medium-term when compared with HEP in patients older than 60 years with DRF extraarticular without immediate complications. Level of Evidence1b

Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: A randomized controlled trial

Study DesignRandomized controlled trial. Purpose of the StudyTo study the effect of adding rotator cuff (RC) muscles strengthening to joint mobilization and transcutaneous electrical nerve stimulation (TENS) in patients with adhesive capsulitis. MethodsA prospective, parallel-group, randomised clinical trial was conducted on 42 patients. One group received TENS and joint mobilization and in the other group RC muscles strengthening was added. Treatment was given for 12 sessions within 4 weeks. ResultsWhen compared between the groups statistically significant changes were seen in all the outcome measures in the group that received RC muscle strengthening exercises vs TENS and mobilization. VAS 12.76 ± 1.04 vs 4.05 ± 1.32; SPADI 34.66 ± 6.69 vs 54.29 ± 12.17; PFPS 3.06 ± 0.80 vs 4.70 ± 0.81; and ROM (elevation >125 vs >110 degrees and rotations >70 vs >48 degrees). ConclusionsAddition of a structured RC strengthening program to TENS and joint mobilization in the treatment of adhesive capsulitis resulted in improvement in pain, ROM and function. Level of Evidence1b.

The added value of pretreatment DW MRI in characterization of salivary glands pathologies

ObjectiveTo evaluate the added value of diffusion weighted magnetic resonance imaging (DW-MRI) in characterization of salivary gland lesions. Study designA prospective study was carried out between January 2013, and March 2015. MethodsThe study included 46 patients. The consultant radiologist, who reviewed the scans to comment on the apparent diffusion coefficient (ADC) value and ADC histogram was blind to the suspected pathology. Radiological findings were then compared to clinical and histological findings. ResultsThe diagnostic performance of DW-MRI for identification of malignant lesions showed that the sensitivity, specificity, and positive and negative prediction value were 100%, 92%, 91.3%, and 100%, respectively. ConclusionThe specific ability of DW-MRI to probe tissue microstructures is an interesting complement to the currently used imaging procedures in the characterization, and even grading of malignancies. ADC mapping is an easy, cost effective promising tool that has neither radiation exposure, nor amalgam artifacts and can be used in helping characterization of salivary glands lesions. Level of evidence1B.

Voice rehabilitation for laryngeal cancer patients: Functional outcomes and patient perceptions.

Laryngeal cancer and its treatment, despite management with organ-preservation treatments, is known to negatively affect voice and functional outcomes. The aim of this study was to determine whether functional outcomes and patient perceptions were improved by combining organ preservation with post treatment function rehabilitation. Randomized controlled trial. Sixty-one patients with carcinoma in situ (Tis) to T4 size laryngeal cancers treated with radiotherapy were prospectively recruited. Thirty patients were randomized into the voice rehabilitation (VR) group and 31 received no VR (control group). The VR group underwent 10 speech pathology sessions postradiotherapy. Voice function was evaluated pre-VR and at 6 and 12 months follow-up using the auditory-perceptual Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and patient perception measures. The control group demonstrated significant deterioration in vocal roughness (P = 0.02) between 6 to 12 months, whilst the VR group did not, resulting in a significant difference (P < 0.01) between the two groups at 12 months. A between-group significant difference (P = 0.02) was also observed for breathiness at 12 months. Patient perceptions of improved vocal quality, acceptability, hoarseness, vocal fatigue, and ashamed (of voice) pre- to post-VR improved significantly (P < 0.02) in the VR group, although significant difference (P = 0.03) between groups was observed post-VR for hoarseness only. For this study group representing Tis to T4-size laryngeal cancers, patients receiving voice rehabilitation post radiotherapy demonstrated no functional decline in vocal roughness and perceived their voice to improve to a greater extent post-VR than the control group. 1b. Laryngoscope, 126:2029-2035, 2016.

Validity of the Upper Limb Neurodynamic Test 1 for the diagnosis of Carpal Tunnel Syndrome. The role of structural differentiation

BackgroundSeveral studies have analysed the use of the Upper Limb Neurodynamic Test 1 (ULNT1) for diagnosing Carpal Tunnel Syndrome (CTS) obtaining weak diagnostic accuracy, which could be related to the lack of consensus in the selected diagnostic criteria of ULNT1. ObjectiveTo determine the concurrent validity of ULNT1 in comparison to Nerve Conduction Studies (NCS) for the diagnosis of CTS, considering the structural differentiation (SD) as an essential part of the diagnosis. DesignProspective diagnostic test study. MethodsIndividuals with suspected CTS referred for NCS were invited to voluntarily participate in the study. Each participant was tested with NCS and ULNT1. ULNT1 result was considered positive when the patient's clinical symptoms were reproduced during the test and symptoms changed during contralateral neck side bending (SD). Results58 Participants (17 men, 44 women) with suspected CTS and a total of 95 limbs were examined using the NCS and ULNT1. Sensitivity of the ULNT1 was 57.9%, specificity was 84.2%, and the positive and negative likelihood ratios were 3.67 and 0.50 respectively. ConclusionResults obtained in the study may indicate the ability of the ULNT1 to generate small shifts from pre-test to post-test probability. However, imprecision in the CIs limits interpretation from the data. Level of evidence1b.

Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial

Study designRandomized Controlled Trial (RCT). IntroductionEngagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PurposeThe purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. MethodA single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. ResultsFollowing a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. ConclusionThis study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients. Level of evidence1b.

Progesterone for Prevention of Preterm Birth--Evidence-based Indications

The prevention and treatment of preterm birth remains an unsolved problem in modern obstetrics. Progesterone has a variety of actions on the myometrium and the cervix, among others inhibition of myometrial contractility and a cervix strengthening effect by inhibiting the production of proinflammatory cytokines and prostaglandins as well as by reducing the synthesis of proteins, which play a crucial role in initiating labour. Consequently, progesterone may be a promising candidate for the prevention of preterm birth. We searched PubMed from 1956 to August 2014 using a combination of key words and text words related to preterm birth and progesterone. ('progesterone', progestins, 17-OHPC). The aim of the literature search was to determine evidence-based indications for the use of progesterone in the prevention of preterm birth. (i) Patients with a singleton pregnancy and history of preterm birth should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) from 16+0 to 36+0 weeks of gestation (alternatively 250 mg intramuscular 17-OHPC weekly): level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone reduces the incidence of preterm birth <34 and <37 weeks of gestation and perinatal mortality significantly. (ii) Patients with singleton pregnancies and a sonographically short cervix (≤25 mm) before 24 weeks of gestation should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) until 36+6 weeks of gestation: level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone leads to a significant reduction in the incidence of preterm birth <28, <33, and <35 weeks of gestation and is associated with a significant reduction of neonatal morbidity. (III) There is a lack of evidence to recommend vaginal progesterone or intramuscular 17-OHPC for primary tocolysis or for "adjunctive" tocolysis (in combination with conventional tocolytic agents). (IV) There is a growing body of evidence that vaginal progesterone (400 mg/day) after successful tocolysis ("maintenance therapy") is a promising option for prolongation of pregnancy: level of evidence 1b, grade of recommendation +. (V) Data from the literature are insufficient to recommend progesterone in patients with preterm rupture of membranes or in the perioperative management of patients requiring transvaginal cervical cerclage. (VI) The vaginal administration of progesterone is well-tolerated by the patients and has only minor maternal side effects, whereas intramuscular injections of 17-OHPC are associated with a significant higher rate of side effects (e. g. local pain, nausea, diarrhoea). It is mandatory to inform patients on the off-label use of progesterone in pregnancy. Prophylactic progesterone administration is an evidence-based method for the prevention of preterm birth in women with a previous preterm birth and in pregnant women with a sonographically short cervix (≤25 mm) before 24 weeks of gestation. Vaginal progesterone is favoured over intramuscularly applied 17-OHPC, especially because of the lower rate of maternal side effects. Whether progesterone is an effective approach for the treatment of preterm birth as a tocolytic agent (primary, adjunctive) or for maintenance therapy after arrest of preterm labour has to be shown in further well-designed randomised and controlled trials with adequate statistical power.

Microdebrider-assisted intracapsular tonsillectomy in adults with chronic or recurrent tonsillitis.

We compared the effectiveness and morbidity of microdebrider-assisted total intracapsular tonsillectomy (ICTE) with conventional extracapsular tonsillectomy (ECTE) in adults with chronic or recurrent tonsillitis. Prospective randomized surgical trial. Adult patients with recurrent or chronic tonsillitis who underwent tonsillectomy between July 2010 and July 2012 in the Department of Otorhinolaryngology-Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria, were consecutively included. Patients were randomized to receive either ICTE or ECTE. Patients and examiners were blinded to the surgical procedure. Effectiveness was assessed with the Tonsil and Adenoid Health Status Instrument (TAHSI). Various parameters of perioperative morbidity and the occurrence of tonsillar remnants were recorded. In the 104 randomized patients, the average TAHSI score was 34.6 ± 11.7 before and 2.2 ± 5.7 after 6 months following tonsillectomy (P < 0.001). TAHSI scores improved equally in patients receiving conventional ECTE (33.6 points; 95% confidence interval (CI), 29.5 to 37.6) and in patients with ICTE (31.8 points; 95% CI, 27.7 to 35.9; between groups P = 0.6). Posttonsillectomy hemorrhage was more frequent following conventional ECTE (P = 0.03). Following ECTE, patients required more pain medication then following ICTE (P < 0.05). Tonsillar remnants were significantly more frequent after ICTE (P < 0,001). However, presence of tonsillar remnants had no influence on postoperative THASI scores (P > 0.5). Tonsillectomy reduced symptoms of chronic or recurrent tonsillitis in adults with remarkable effectiveness. Microdebrider-assisted ICTE reduced symptoms as effectively as conventional ECTE. ICTE was associated with lower morbidity, but residual tonsils occurred in almost half of patients, costs were higher, and the intracapsular approach was more intricate and time-consuming. 1b.

Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: Systematic Review and Meta-Analysis.

Fibromyalgia (FM) is a prevalent chronic pain syndrome with few effective therapeutic options available. Repetitive transcranial magnetic stimulation (rTMS) is an emerging therapeutic alternative for this condition; however, results have been mixed. To evaluate the efficacy of rTMS on FM, a comprehensive systematic review and meta-analysis were performed. Relevant published, English and Portuguese language, randomized clinical trials (RCT) comparing rTMS (irrespective of the stimulation protocol) to sham stimulation for treating FM pain intensity, depression, and/or quality of life (QoL) were identified, considering only those with low risk for bias. Trials available until April 2014 were searched through MEDLINE, EMBASE, the Cochrane Library Databases, and other 26 relevant medical databases covering from every continent. The outcomes for pain, depression, and QoL assessed closest to the 30th day after rTMS treatment were extracted, and changes from baseline were calculated to compare the effects of rTMS vs. placebo. One hundred and sixty-three articles were screened, and five with moderate to high quality were included. rTMS improved QoL with a moderate effect size (Pooled SMD = -0.472 95%CI = -0.80 to -0.14); it showed a trend toward reducing pain intensity (SMD = -0.64 95%CI = -0.31 to 0.017), but did not change depressive symptoms. In comparison with sham stimulation, rTMS demonstrated superior effect on the QoL of patients with FM 1 month after starting therapy. However, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved with this effect, which does not seem to be mediated by changes in depression, but that may involve pain modulation. Level of evidence 1b.

Linking of the Patient Rated Elbow Evaluation (PREE) and the American Shoulder and Elbow Surgeons – Elbow questionnaire (pASES-e) to the International Classification of Functioning Disability and Health (ICF) and Hand Core Sets

Study designContent analysis-ICF linking. IntroductionThe Patient Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons society – Elbow form (ASES-e) are the two commonly used elbow pain and disability self-report measures (PROs). The content of these questions have never been analyzed in light of the International Classification of Functioning Disability and Health (ICF) which is the current standard to describe health and health-related states. PurposeThe purposes of this study were to analyze the conceptual basis of the PREE and the ASES-e by linking the meaningful concepts in these PROs to the ICF using standardized linking rules and to determine the extent to which the ICF core set for hand conditions cover the content of elbow questionnaires using summary ICF linkage indicators. MethodsTwo raters linked the two PROs to the ICF using the linking rules proposed by Cieza and colleagues. Percentage agreement was calculated between the raters. Summary linkage indicators proposed by MacDermid were used to estimate the extent to which the ICF core set for hand conditions cover the content of the elbow questionnaires. ResultsAll the items of the PREE (Measure to ICF linkage – 100%) and all but one item of the pASES-e (Measure to ICF linkage – 95%) were linked to the ICF. The satisfaction item on the ASES-e was not-covered by the ICF. Percentage agreement on linking between the raters was 96% and 95% for the PREE and the pASES-e respectively. The unique linkage of the PREE and the pASES-e to the unique codes on the brief and comprehensive core set were lower than absolute linkage to the core set for hand conditions. The PROs represented less than 20% of the comprehensive core set and more than 70% of the brief core set. While for the unique core set disability representation the 2 PROMs represented 100% brief core set unique disability codes and less than 35% of the comprehensive core set unique disability codes. ConclusionThe PREE and the ASES-e are aligned with the ICF framework and the core sets for hand conditions. The ICF Core Set devised for hand conditions may also be useful for elbow conditions. Level of evidence1b

Effects of oral prednisolone on recovery after tonsillectomy.

To evaluate the effect of oral prednisolone on recovery from tonsillectomy. Prospective, randomized, controlled trial of 198 consecutive patients, aged 4 years and older, with no previous or known contraindications to steroid therapy. All 198 patients scheduled for elective tonsillectomy with or without adenoidectomy from April 2013 to April 2014 were included. The participants were then randomly assigned to receive a postoperative course of prednisolone 0.25 mg/kg/d or no prednisolone over 7 days. During the first postoperative day, pain, type of diet (none, fluid, soft, normal), type of activity (none, bed rest, quiet, restricted, normal), presence of nausea and vomiting, postoperative bleeding rate, and sleep disturbance were assessed using questionnaires. All patients were followed up on days 7 and 14 by endoscopic photographic examination of both tonsillar fossa and by completion of questionnaires. No statistically significant differences in pain, diet, activity, rate of minor bleeding, nausea/vomiting, fever, or sleep disturbance were observed between the groups on day 1. On day 7, however, in pediatric patients, differences in pain (P = .001), diet (P = .001), activity (P = .004), mean area of re-epithelialization (P = .000), fever (P = .04), and sleep disturbance (P = .04) were observed. On day 14, differences in the mean area of re-epithelialization (P = .000, .001) remained in both pediatric and adult patients. Oral prednisolone may be beneficial during recovery from tonsillectomy without causing any serious complications.

Patient-centered care and distal radius fracture outcomes: A prospective cohort study analysis

Study designProspective cohort. IntroductionEffects of patient-centered care on distal radius fracture recovery lacks evidence. Purpose of the studyTo understand from the perspective of a patient with a distal radius fracture: if the Patient Perception of Patient-Centeredness Questionnaire (PPPC) subscales apply to distal radius fracture populations; the strongest and weakest areas of patient-centered care; changes in patient perceptions of patient-centeredness during recovery; and, correlations between aspects of patient-centered care and patient reported pain and disability. MethodsPatients with distal radius fractures (n = 129; mean age = 54.03, SD = 14.63) completed the Patient Rated Wrist Evaluation (PRWE) and PPPC, at baseline (less than 10 days post-fracture) and at three months post-injury. Outcome measure responses were factor analyzed and tested for correlations. ResultsFactors identified were titled Clinician-Patient Dialogue, representing communication components of patient-centered care, and Clinician-Patient Alliance, representing partnership components of patient-centered care. Small significant correlations (r = 0.22) between PRWE and PPPC responses were observed with Clinician-Patient Alliance more correlated at baseline and Clinician-Patient Dialogue at follow-up. DiscussionImportant aspects of the patient-clinician dynamic were identified. ConclusionsCommunication between clinician and patient was perceived most favorably at baseline; and partnership improved by three months. Level of evidence1b.

The push-off test: Development of a simple, reliable test of upper extremity weight-bearing capability

Study designLongitudinal clinical measurement study. IntroductionThe push-off test (POT) is a novel and simple measure of upper extremity weight-bearing that can be measured with a grip dynamometer. There are no published studies on the validity and reliability of the POT. The relationship between upper extremity self-report activity/participation and impairment measures remain an unexplored realm. PurposeThe primary purpose of this study is to estimate the intra and inter-rater reliability and construct validity of the POT. The secondary purpose is to estimate the relationship between upper extremity self-report activity/participation questionnaires and impairment measures. MethodsA convenience sample of 22 patients with wrist or elbow injuries were tested for POT, wrist/elbow range of motion (ROM), isometric wrist extension strength (WES) and grip strength; and completed two self-report activity/participation questionnaires: Disability of the Arm, Shoulder and the Hand (DASH) and Work Limitations Questionnaire (WLQ-26). POT's inter and intra-rater reliability and construct validity was tested. Pearson's correlations were run between the impairment measures and self-report questionnaires to look into the relationship amongst them. ResultsThe POT demonstrated high inter-rater reliability (ICC affected = 0.97; 95% C.I. 0.93–0.99; ICC unaffected = 0.85; 95% C.I. 0.68–0.94) and intra-rater reliability (ICC affected = 0.96; 95% C.I. 0.92–0.97; ICC unaffected = 0.92; 95% C.I. 0.85–0.97). The POT was correlated moderately with the DASH (r = −0.47; p = 0.03). While examining the relationship between upper extremity self-reported activity/participation questionnaires and impairment measures the strongest correlation was between the DASH and the POT (r = −0.47; p = 0.03) and none of the correlations with the other physical impairment measures reached significance. At-work disability demonstrated insignificant correlations with physical impairments. ConclusionThe POT test provides a reliable and easily administered quantitative measure of ability to bear the load through an injured arm. Preliminary evidence supports a moderate relationship between loading bearing measured by the POT and upper extremity function measured by the DASH. Level of evidence1b

British HIV Association guidelines for HIV‐associated malignancies 2014

<scp>B</scp>ritish <scp>HIV</scp> Association guidelines for <scp>HIV</scp>‐associated malignancies 2014