Limb Conditions Research Articles

Treatment Patterns for Plantar Fibromatosis in the United States: A Retrospective Observational Study

Category: Midfoot/Forefoot; Other Introduction/Purpose: Plantar fibromatosis (PF) is a rare disease affecting the plantar aponeurosis, characterized by disordered fibrous tissue and subsequent formation of subcutaneous nodules on the foot/feet. There are no established clinical guidelines for management of PF symptoms, and real-world evidence on treatment patterns among PF patients in the United States (US) is scarce. This retrospective observational study used a comprehensive approach to identify newly diagnosed PF patients and describe subsequent conservative (non-surgical) and surgical treatment patterns. Methods: Patients with evidence of PF from ICD-9/10 diagnosis codes in IQVIA’s PharMetrics® Plus were identified between January 2015-March 2020 and linked to IQVIA’s Ambulatory Electronic Medical Records (AEMR) to confirm diagnosis, using PF- specific SNOMED diagnosis codes or problem name; the earliest evidence of PF was the diagnosis date. Further, eligible patients were required to have continuous enrollment (CE) in a health plan for 12 months before diagnosis (baseline), 24 months of CE after diagnosis (follow-up), evidence of PF ≥30 days after first diagnosis, and age ≥18 years on diagnosis date. Patients with prior diagnosis of PF (through 2014) or other select lower limb conditions during baseline were excluded. Baseline demographic/clinical characteristics and conservative treatment utilization prior to PF diagnosis were assessed. Proportion of patients receiving PF- related conservative and surgical treatment, frequency of use, and time from diagnosis to initiation of first treatment were reported during follow-up. Results: The incident PF cohort (N=620) had mean (SD) age of 52.2(9.9) years and 63.2% were women. Most common baseline comorbidities were thyroid diseases (14.2%), diabetes without complications (12.3%), and smoking (12.3%); 19.0% had evidence of foot or ankle pain/stiffness. During baseline, 53.5% of patients received prescribed analgesic medications (30.6% received opioids). Most patients (91.1%) received conservative treatment after PF diagnosis, including analgesics and physical/occupational therapy (Figure 1A). Among all treatment modalities, time to initiation (months) was shortest for orthotics (median:0.5; IQR:5.5), injectable corticosteroids (median:2.0; IQR:9.2) and prescribed NSAID (median:2.5; IQR:9.1; Figure 1B). Among 42 patients (6.8%) receiving PF-related surgery, conservative treatments were common both before surgery (83.3%; median time from diagnosis to surgery:6.0 months) and after surgery (92.9%). Conclusion: Most newly diagnosed PF patients received conservative treatments within the first 3 months after diagnosis. Analgesic use was high during baseline as well as follow-up. During the 24 months after diagnosis, few patients received surgery and conservative treatment modalities often continued after surgery. Overall, continued and widespread conservative management among PF patients indicates lack of treatment options for PF. Further studies on treatment patterns in US patients aged ≥65 years are needed.

264 Observational Study of Clinical Impact of E-Scooter Injuries at Major Trauma Centre

Abstract Aim Is to focus on frequency E-scooter associated injuries especially open fractures and to see its burden on health system. Method Data of E-scooter injuries was extracted from trauma database from November 2017 to July 2022. Outcome measures were type of injuries: site of bony fractures, closed Vs open fracture, number of operations, complications and Length of Hospital Stay. Results Number of patients enrolled was 104. The mean age was 34.3 years and 78.8% were males. The main mechanism of injury was riding 91%. Patients with bony injuries were 65.4% with 22.1% of them were open fractures. Most common bony injuries were lower limb only fractures 45.6%, then upper limb only injuries 39.7%. Head and neck injuries composed 23.1% of the reported injuries including: intracranial haemorrhages (9.6%), extensive traumatic brain injury (3.8%), hematoma/lacerations (3.8%), cervical spine fractures (1.9%) and skull fractures (1.9%). Mean duration of hospital stay was 8.6 days and 9.6% patients needed ITU admission. Number of patients presented as trauma calls were 55.8%. Patients that needed surgical intervention either under Orthopaedics or other specialities were 52.9% and 21.2% of total patients had complications either due to surgical intervention or long hospital stay. Conclusions E-scooter riding can lead to serious injuries that can end with limb or life-threatening conditions. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.

Provocative maneuvers demonstrate excellent accuracy in the “virtual” diagnosis of carpal tunnel syndrome among people with upper limb conditions—a short technical report

Provocative maneuvers demonstrate excellent accuracy in the “virtual” diagnosis of carpal tunnel syndrome among people with upper limb conditions—a short technical report

The Impact of Upper Limb Injury or Conditions on Daily Occupations: A Qualitative Inquiry

The study aimed to explore six public service users’ perspectives on the impact their upper limb injury or condition has on their everyday lives while receiving occupational therapy intervention at a public hospital in the context of the Northern Cape of South Africa. An interpretivist phenomenological approach was employed. Data was collected using reflexive photography and semi-structured interviews. Three main themes were generated during inductive reasoning, namely the impact on role fulfillment, change in occupational task performance and the factors impacting performance in preferred occupations. Participants confirmed that to present a contextually relevant and responsive service, Occupation-Based Hand Therapy (OBHT) approaches must be considered.

Reshaping the full body illusion through visuo-electro-tactile sensations.

The physical boundaries of our body do not define what we perceive as self. This malleable representation arises from the neural integration of sensory information coming from the environment. Manipulating the visual and haptic cues produces changes in body perception, inducing the Full Body Illusion (FBI), a vastly used approach to exploring humans' perception. After pioneering FBI demonstrations, issues arose regarding its setup, using experimenter-based touch and pre-recorded videos. Moreover, its outcome measures are based mainly on subjective reports, leading to biased results, or on heterogeneous objective ones giving poor consensus on their validity. To address these limitations, we developed and tested a multisensory platform allowing highly controlled experimental conditions, thanks to the leveraged use of innovative technologies: Virtual Reality (VR) and Transcutaneous Electrical Nerve Stimulation (TENS). This enabled a high spatial and temporal precision of the visual and haptic cues, efficiently eliciting FBI. While it matched the classic approach in subjective measures, our setup resulted also in significant results for all objective measurements. Importantly, FBI was elicited when all 4 limbs were multimodally stimulated but also in a single limb condition. Our results behoove the adoption of a comprehensive set of measures, introducing a new neuroscientific platform to investigate body representations.

Venous Thromboembolism and Bleeding after Transurethral Resection of the Prostate (TURP) in Patients with Preoperative Antithrombotic Therapy: A Single-Center Study from a Tertiary Hospital in China.

Venous thromboembolism (VTE) and postoperative hemorrhage are unavoidable complications of transurethral resection of the prostate (TURP). At present, more and more patients with benign prostate hyperplasia (BPH) need long-term antithrombotic therapy before operation due to cardiovascular diseases or cerebrovascular diseases. The purpose of this study was to investigate the effect of preoperative antithrombotic therapy history on lower extremity VTE and bleeding after TURP. Patients who underwent TURP in the Department of Urology, Xiangya Hospital, Central South University, from January 2017 to December 2021 and took antithrombotic drugs before operation were retrospectively analyzed. The baseline data of patients were collected, including age, prostate volume, preoperative International Prostate Symptom Score (IPSS), complications, surgical history within one month, indications of preoperative antithrombotic drugs, drug types, medication duration, etc. Main outcome measures included venous thromboembolism after TURP, intraoperative and postoperative bleeding, and perioperative blood transfusion. Secondary outcome measures included operation duration and postoperative hospitalization days, the duration of stopping antithrombotic drugs before operation, the recovery time of antithrombotic drugs after operation, the condition of lower limbs within 3 months after operation, major adverse cardiac events (MACEs), and cerebrovascular complications and death. A total of 31 patients after TURP with a long preoperative history of antithrombotic drugs were included in this study. Six patients (19.4%) developed superficial venous thrombosis (SVT) postoperatively. Four of these patients progressed to deep vein thrombosis (DVT) without pulmonary thromboembolism (PE). Only one patient underwent extra bladder irrigation due to blockage of their urinary catheter by a blood clot postoperatively. The symptoms of hematuria mostly disappeared within one month postoperatively and lasted for up to three months postoperatively. No blood transfusion, surgical intervention to stop bleeding, lower limb discomfort such as swelling, MACEs, cerebrovascular complications, or death occurred in all patients within three months after surgery. Short-term preoperative discontinuation may help patients with antithrombotic therapy to obtain a relatively safe opportunity for TURP surgery after professional evaluation of perioperative conditions. The risks of perioperative bleeding, VTE, and serious cardiovascular and cerebrovascular complications are relatively controllable. It is essential for urologists to pay more attention to the perioperative management of these patients. However, further high-quality research results are needed for more powerful verification.

Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program.

Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking. To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions. This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement. At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p<0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment. This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.

Electrical Stimulation of Distal Tibial Nerve During Stance Phase of Walking May Reverse Effects of Unilateral Paw Pad Anesthesia in the Cat.

Cutaneous feedback from feet is involved in regulation of muscle activity during locomotion, and the lack of this feedback results in motor deficits. We tested the hypothesis that locomotor changes caused by local unilateral anesthesia of paw pads in the cat could be reduced/reversed by electrical stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve during stance. Several split-belt conditions were investigated in four adult female cats. In addition, we investigated the effects of similar distal tibial nerve stimulation on overground walking of one male cat that had a transtibial, bone-anchored prosthesis for 29months and, thus, had no cutaneous/proprioceptive feedback from the foot. In all treadmill conditions, cats walked with intact cutaneous feedback (control), with right fore- and hindpaw pads anesthetized by lidocaine injections, and with a combination of anesthesia and electrical stimulation of the ipsilateral distal tibial nerve during the stance phase at 1.2× threshold of afferent activation. Electrical stimulation of the distal tibial nerve during the stance phase of walking with anesthetized ipsilateral paw pads reversed or significantly reduced the effects of paw pad anesthesia on several kinematic variables, including lateral center of mass shift, cycle and swing durations, and duty factor. We also found that stimulation of the residual distal tibial nerve in the prosthetic hindlimb often had different effects on kinematics compared with stimulation of the intact hindlimb with paw anesthetized. We suggest that stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve provides functionally meaningful motion-dependent sensory feedback, and stimulation responses depend on limb conditions.

Exploring the Interplay: Kinesiophobia Prevalence and its Relationship with Cognitive Impairment following Upper Limb Fractures

Context: Pain-related fear is more disabling than pain itself. Assessment of kinesiophobia should be practiced as a regular basis for any traumatic painful conditions. As upper limb fractures are most prevalent among all the other types of fractures, this study aims to assess the prevalence of kinesiophobia in posttraumatic upper limb conditions and its correlation with cognitive status. Aim: The aim of this study was to determine the prevalence of kinesiophobia in upper limb traumatic fractures and observe its correlation with cognitive status. Settings and Design: This cross-sectional study was conducted at tertiary care hospital, and data were obtained from the orthopedics department of the hospital. Subjects and Methods: Three hundred (n = 300) patients with upper limb fractures were screened for kinesiophobia and cognitive impairment. Kinesiophobia was assessed using Tampa Scale for Kinesiophobia and cognition was assessed using Mini–Mental State Examination Scale. Statistical Analysis: Descriptive statistics were applied and frequency distribution in percentages to see the prevalence of kinesiophobia in upper limb fractures. Karl’s Pearson’s coefficient correlation test was applied to evaluate the correlation between cognitive status. Results: There is an inverse negative correlation between cognitive status and kinesiophobia (r = 0.06, P = 0.002). There was 58% of overall prevalence in upper limb fractures but the highest was observed in fractures of the shoulder complex which was 32%. Conclusions: The overall prevalence of kinesiophobia in upper limb fractures was high, however, it was highest in fractures of the shoulder complex with compound fractures. This study also concludes that reduced cognitive status leads to increased kinesiophobia.

Development and initial application of a harmonised multi-jurisdiction work injury compensation database.

Workers' compensation schemes provide funding for wage replacement and healthcare for injured and ill workers. In Australia, workers' compensation schemes operate independently in different jurisdictions, making comparisons of health service use challenging. We sought to develop and deploy a new database of health service and income support data, harmonising data from multiple Australian workers' compensation jurisdictions. We worked with workers' compensation authorities from six Australian jurisdictions to combine claims, healthcare, medicines and wage replacement data for a sample of compensated workers with claims for musculoskeletal conditions. We designed a structured relational database and developed a bespoke health services coding scheme to harmonise data across jurisdictions. The Multi-Jurisdiction Workers' Compensation Database contains four data sets: claims, services, medicines and wage replacement. The claims data set contains 158,946 claims for low back pain (49.6%), limb fracture (23.8%) and non-specific limb conditions (26.7%). The services data set contains a total of 4.2 million cleaned and harmonised services including doctors (29.9%), physical therapists (56.3%), psychological therapists (2.8%), diagnostic procedures (5.5%) and examinations and assessments (5.6%). The medicines data set contains 524,380 medicine dispenses, with 208,504 (39.8%) dispenses for opioid analgesics. The development of this database presents potential opportunities to gain a greater understanding of health service use in the Australian workers' compensation sector, to measure the impact of policy change on health services and to provide a method for further data harmonisation. Future efforts could seek to conduct linkage with other data sources.

MESS Scale for Combat Limb Injury: Amputation or Salvage?

Summary. Combat injury of the limbs is characterized by multilevel open combined tissue damages, the severity of which in some cases makes it impossible the salvage tactics.&#x0D; Objective: based on the analysis of literature, to investigate the possibility of using MESS (the mangled extremity severity score - assessment of the severity of a broken limb) when establishing indications for early amputation of a severely injured limb due to a combat trauma.&#x0D; Materials and Methods. A literature search was conducted on the PubMed database according to the established criteria. Data were taken from the selected sources: the number of amputation/save cases and the weighted average MESS amputation/save value. A weighted average MESS with a 95% confidence interval (CI) and a coefficient of variation were calculated.&#x0D; Results. A total of 189 sources according to the established criteria were identified for the period 1990-2021, in which MESS was applied; 7 sources were selected for analysis. The generalizing value (weighted average) for MESS for amputations was 7.3; 95% CI (6.27-8.33); the coefficient of variation was 4.1. While preserving the limb, the calculations showed a MESS value of 4.9; 95% CI (4.49-5.31); the coefficient of variation was 8.4.&#x0D; Conclusions. The use of the MESS makes it possible to assess the condition of the injured limb; the value of 7 or above is a reliable predictor for amputation.

Analysis of pain intensity and postural control for assessing the efficacy of shock wave therapy and sonotherapy in Achilles tendinopathy – A randomized controlled trial

BackgroundThe troublesome symptoms of Achilles tendinopathy prompt patients to seek effective forms of conservative treatment. The main aim of the study was to determine the therapeutic efficacy of shock wave and ultrasound therapies for Achilles tendinopathy in reducing pain intensity. Treatment efficacy was also assessed using objective posturographic measurements. MethodsThirty-nine patients patients were randomly allocated to one of three experimental groups that received shock wave therapy (group A), ultrasound therapy (group B) and placebo ultrasound (group C). Posturographic measurements and subjective assessment of pain intensity were taken prior to therapy and at weeks 1 and 6 of therapy completion. FindingsA comparison of percentage change in activity-related pain from baseline to 6 weeks post-therapy revealed a significantly greater pain reduction in group A compared to group B. The three-way ANOVA demonstated an effect of treatment type on all posturographic variables. The Bonferroni post-hoc test showed the means of all variables were significantly smaller for group A than group B. Limb condition also had an effect on the center-of-pressure trajectories in anteroposterior plane; the post-hoc test showed the mean values of the variables were significantly greater for the non-affected compared to affected limb. InterpretationShock wave therapy was significantly more effective than sonotherapy for alleviation of activity-related pain of Achilles tendinopathy. An association was also shown between shock wave therapy and more efficient postural control in patients with Achilles tendinopathy. The parameters of center-of-pressure trajectories in the sagittal plane were significantly greater for the non-affected compared to affected limb.The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).

The Prevalence Rate of Adult Sarcopenic Obesity and Correlation of Appendicular Skeletal Muscle Mass Index with Body Mass Index, Percent Body Fat, Waist-Hip Ratio, Basal Metabolic Rate, and Visceral Fat Area.

Background: This study aimed to investigate the prevalence rate of adult sarcopenic obesity and discuss its predisposing factors. Methods: A total of 14,608 participants including 7521 men and 7087 women aged 18-93 years were enrolled in this study. The definition of sarcopenia was based on appendicular skeletal muscle mass index (ASMI) standards (≤7.0 kg/m2 for men and ≤5.7 grams/m2 for women). The definition of obesity followed percent body fat (PBF) ≥25% for men and ≥35% for women. Sarcopenic obesity was defined as the combination of sarcopenia and obesity diagnosis. Risk factors for the onset of sarcopenic obesity were analyzed by logistic regression analysis, followed by diagnostic value assessment. Results: There were 496 cases of sarcopenic obesity, including 308 male patients and 188 female patients. The overall prevalence rate was 3.4%, with 4.10% for men and 2.65% for women. Compared with nonsarcogenic obesity group, the subjects with sarcogenic obesity showed shorter height and circumference of limbs, arm muscle, neck, chest, waist and hip, lighter weight, lower body mass index (BMI), bone mineral content (BMC), skeletal muscle mass, basal metabolic rate (BMR), body cell mass, fitness score and ASMI, and higher body fat mass, PBF, waist-hip ratio (WHR), visceral fat area (VFA), extracellular fluid/total body fat, and extracellular water/total body water (ECW/TBW; P < 0.01). Based on logistic regression analysis, BMI, BMC, PBF, WHR, BMR, VFA, fitness score, lean balance trunk, lean balance left leg, ASMI, ECW/TBW and the circumference of left arm, left leg, arm muscle, chest waist and hip were considered as risk factors for sarcogenic obesity (P < 0.05). After receiver operating characteristic (ROC) curve analysis of basic condition, muscle mass, and limb condition, ASMI [area under the curve (AUC) = 0.75] showed relatively high diagnostic value for adult sarcopenic obesity; other indicators (AUC <0.75) showed moderate diagnostic value for adult sarcopenic obesity, except for fitness score. According to joint ROC analysis, combination of BMC, PBF, VFA, and ASMI (AUC = 0.78) showed high diagnostic value for adult sarcopenic obesity. ASMI was correlated with BMI (r = 0.246, P < 0.001), BMC (r = 0.798, P < 0.001), WHR (r = 0.197, P < 0.001), BMR (r = 0.932, P < 0.001), PBF (r = -0.761, P < 0.001), and VFA (r = -0.530, P < 0.001). In adult patients with sarcopenic obesity, a decrease in ASMI indicators may be accompanied by a decrease in BMI, BMC, WHR, and BMR as well as an increase in PBF and VFA. Conclusion: The prevalence rate of adult sarcopenic obesity was 3.40%. ASMI was closely correlated with BMI, BMC, PBF, WHR, BMR, and VFA, which may serve as early indicators in the diagnosis of adult sarcopenic obesity.

Electrical muscle stimulation in young adults: effect of muscle volume on brain-derived neurotrophic factor levels.

Electrical muscle stimulation (EMS) is known to be effective at stimulating brain-derived neurotrophic factor (BDNF) levels, but the relationship between the volume of muscle stimulated and BDNF levels is not clear. The purpose of this study was to quantify BDNF as a function of muscle volume stimulated in young adults. Twelve young adults (male, n = 9, age = 27.3 ± 5.5years) were enrolled in this study. Participants completed three testing conditions in randomized order: 23min of maximum tolerated bilateral stimulation of (1) the quadriceps muscle or (2) the musculature of the entire lower limbs and (3) control testing and retesting after 23min without an intervention. Blood samples were collected before, immediately after, 20min after, and 40min after the intervention when EMS was applied to the thighs or the entire lower limb conditions. Serum obtained from blood collection was used for BDNF analysis. The delta value of BDNF for the test and retest in the control condition was - 42.1 ± 73.8pg/mL, and there was no significant difference between the test and retest BDNF. Compared to stimulation of the quadriceps muscle, stimulation of the entire lower limbs produced significantly higher BDNF at 20min post-treatment than those at pre-treatment or 40min post-treatment, and BDNF was also significantly higher immediately post-treatment than those at pre-treatment. Only stimulation of the quadriceps muscle did not induce a significant change between pre- and post-treatment. Our findings suggest that the volume of muscle stimulation is important for increased BDNF.

Clinical practice guidelines for the management of patients with complex regional pain syndrome: a systematic appraisal using the AGREE II instrument.

Aim: Complex regional pain syndrome (CRPS) is a debilitating, painful condition of limbs that often arises after an injury and is associated with significant morbidity. Materials & methods: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, used to assess the quality of clinical practice guidelines (CPGs), was used to evaluate sevenCRPS management guideline. Results: Out of the sevenCPGs evaluated using the AGREE II instrument, only one from Royal College of Physicians was found to have high-quality consensus guidelines for diagnosis and management of CRPS. Conclusion: Future CPGs should be backed by systematic literature searches, focus on guidelines clinical translation into clinical practice and applicability to the desired patient population.

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan.

BackgroundPlantar fasciitis develops as a consequence of irritation of the plantar fascia, which is responsible for supporting the arches and absorbing shock. Multiple factors can contribute to plantar fasciitis, but the most common factor is overuse stress. The classical presentation is a sharp pain that is felt at the plantar aponeurosis (near the area of its insertion on the medial process of the calcaneal tuberosity), and it is possible to find a heel spur (osteophyte) in some cases. Most treatments for plantar fasciitis are ineffective and unsatisfactory for patients.ObjectiveTo estimate the prevalence and assess risk factors for plantar fasciitis among the population of the Jazan region.MethodsA cross-sectional online survey was conducted on the population of the Jazan region. An online Google form questionnaire was prepared and distributed to the study population. Data was then entered and analyzed using IBM SPSS (Statistical Package for the Social Sciences) Statistics, version 21.0.ResultsA total of 695 participants were enrolled in the study. Out of that, 350 (50.4%) of the participants were males, while 345 (49.6%) were females. About the age of the participants, 507 (72.9%) were younger than 40 years of age. Participants with hypertension were 43 (6.2%), and 37 (5.3%) participants had diabetes. In terms of occupation, 120 (17.3%) worked in healthcare, 187 (26.9%) taught, and 43 (6.2%) served in the military. A great quantity of standing or walking was necessary for the jobs for 127 people (18.3%), while moderate amounts were recorded for 273 people (39.3%). The most commonly reported lower limb conditions were: pes planus (low arches) in 26 (3.7%) participants; and weakness of the gastrocnemius, soleus, and intrinsic foot muscles. The most commonly reported exercises were walking for 499 (71.8%) participants and jogging for 97 (14%) participants. The prevalence of plantar fasciitis was found to be 37% of the participants. Regarding the Foot and Ankle Outcome Score (FAOS) survey, the mean symptoms subscale score was 57.81 + 11.28, the mean pain subscale score was 72.87±20.84, the mean daily living subscale score was 72.73 ± 22.25, the mean sports and recreation subscale score was 76.83 ± 23.06, and the mean quality of life subscale score was 70.23 ± 25.17. Multivariate logistic regression was done and the following factors predicted a higher rate of plantar fasciitis: being 40 to 55 years old (p < 0.001, odds ratio = 2.15), being 56 to 65 years old (p = 0.037, odds ratio = 3.58), being obese (p = 0.031, odds ratio = 2.16), having weakness of the gastrocnemius, soleus, and the intrinsic foot muscles (p = 0.003, odds ratio = 7.39), jobs requiring a great amount of time standing or walking (p < 0.001, odds ratio = 3.17), and jobs requiring a moderate amount of time standing or walking (p = 0.012, odds ratio = 1.83). Being male predicted a lower rate of plantar fasciitis (p < 0.001, odds ratio = 0.52).ConclusionPlantar fasciitis is a prevalent and disabling condition with considerable effects on quality of life. Jobs that require long hours of walking or standing were associated with an increased risk of developing plantar fasciitis. Middle age, prolonged exercise, and gastrocnemius muscle tightness were also associated with plantar fasciitis. Efforts should be directed towards health education of the population regarding the risk factors and management of plantar fasciitis.

The Welfare of Traveller and Gypsy Owned Horses in the UK and Ireland.

Simple SummaryTravellers and Gypsies are recognised ethnic groups in the UK and Ireland. Horse ownership is an important part of their lives; however, poor horse welfare is often perceived to be associated with these horse-owning communities. Nevertheless, studies on the welfare of Traveller and Gypsy-owned horses are lacking. The welfare of 104 horses in the UK and Ireland was evaluated using a horse welfare protocol that assessed health conditions, resource provision, management and horse behaviour. In order to potentially understand how a horse was feeling, Qualitative Behaviour Assessment (QBA) was used to evaluate their body language. Most horses were found to have good body condition, a healthy coat and few skin problems or joint issues, however, 27% of horses were found to have neglected hooves. In the voluntary animal approach test, most horses showed a friendly response. Positive QBA terms were more prevalent than negative terms, therefore, the emotional state of Traveller and Gypsy owned horses was deemed to be positive overall. An association between QBA and various horse welfare measures was identified, e.g., improved mood was associated with better water availability. Findings in this study did not support previous negative perceptions of horse welfare in Traveller and Gypsy horse owning communities.Travellers and Gypsies are recognised ethnic groups in the UK and Ireland. Horse ownership is an important cultural tradition, however, practices associated with poor welfare are often perceived to be linked to these horse owning communities. Despite this, empirical studies on the welfare status of Traveller and Gypsy owned horses are lacking. To determine the welfare status of Traveller and Gypsy owned horses, 104 horses were assessed using a bespoke horse welfare protocol. This protocol assessed animal, resource and management-based measures. In addition, Qualitative Behaviour Assessment (QBA) identified horses’ emotional state. Results indicated that 81% of horses had an optimal body condition score, with no horse recorded as very thin/fat. The absence of limb conditions (95%), ocular (98%) and nasal (93%) discharges were evident in most horses, and 81% of horses responded positively to the voluntary animal approach test. The most commonly observed welfare issues were hoof neglect (27%), with hoof cracks/breakages (19%) being the most prevalent. QBA indicated that positive emotional states were more commonplace than negative. A relationship between QBA and other horse welfare measures was observed, e.g., improved mood was associated with better water availability. This research provides novel data in the under-researched area of the welfare of Traveller and Gypsy owned horses and counters perceptions of a poor welfare state in this group of horses.

Effectiveness of occupational therapy interventions on function and satisfaction with occupational performance among adults with conditions of the hand, wrist, and forearm: a protocol for a systematic review

Background: Functional hand use post injury is important in enabling a person’s engagement in daily living tasks. Without proper treatment, there may be difficulties in self-care, engaging in job roles, or leisure pursuits. Occupational therapists are key health care practitioners for people with upper limb conditions. This systematic review aims to appraise and summarise current evidence regarding effectiveness of occupational therapy interventions among adults with conditions of the hand, wrist, and forearm. Methods: A systematic review of randomised control trials and quasi randomised controlled trials will be completed. MEDLINE OVID, CINAHL, CENTRAL, COCHRANE, PUBMED and EMBASE databases will be systematically searched. Grey literature will be searched for via Google Scholar. Studies will be included if they include provision of occupational therapy to adults with a hand, wrist, or forearm condition when compared to treatment as usual or an alternative treatment option. The primary outcome will be function. Secondary outcomes will include satisfaction with occupational performance, quality of life, pain experience, and participation. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions will be used to categorise outcomes. The Cochrane Risk of Bias 2 (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework will be utilised to assess quality. A pooled meta- analysis will be completed using RevMan, depending on the uniformity and availability of data. Results: This review aims to synthesise high quality evidence to identify the effectiveness of occupational therapy interventions with patients with a hand, wrist, or forearm condition, categorising outcomes in relation to the ICF Core Set for Hand Conditions. Conclusions: By synthesising the evidence there is potential for improved evidence base for clinicians; improved outcomes for patients; as well as potential economic benefit. This study is registered with PROSPERO: CRD42022337070.

Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery: A Systematic Review.

More than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews. However, a gap in the literature exists regarding how nonpharmacological interventions can mitigate cognitive impairment in adults undergoing cardiac surgery. The aim of this study was to explore the effectiveness of nonpharmacological interventions to reduce the detrimental effects of cardiac surgery on cognitive function in patients after cardiothoracic surgery. CINAHL, MEDLINE, PubMed, EMBASE, PsycINFO, and Web of Science databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 2011 to February 2022. Nineteen studies were included in this review. Researchers defined cognitive impairment differently across studies. Various interventions were used to reduce cognitive impairment post cardiothoracic surgery, with the most common being remote ischemic limb conditioning. The interventions used to reduce cognitive impairment were heterogeneous in outcomes, measurements, and time of assessment, but only 2 interventions were associated with a reduction in cognitive impairment. This review is a unique synthesis of the quality of interventions that address broader components of cognition. Researchers used various interventions to reduce cognitive impairment; the outcomes, instruments, and time interval for measurements were heterogeneous. Researchers should conduct future studies at multiple time intervals, using a comprehensive measure of cognitive impairment to better understand the impact of cognitive impairment interventions postoperatively.

Hand and Upper Extremity

In pediatric hand and upper extremity surgery, numerous situations arise where there is variability or doubt in which code to use for a particular procedure. Was that an open reduction or closed reduction with percutaneous fixation of a fracture? Should we code trigger fingers and thumbs the same way? And, when is post-axial polydactyly a reconstruction versus excision? This JPOSNA Coding Corner will present case scenarios encountered by pediatric orthopaedic surgeons who care for common upper limb conditions. The intent is to provide guidance to aid proper surgical billing; however, it is important the ultimate code selection reflects the procedure performed and supporting documentation.