Objective Tests Of Function Research Articles

Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury: The Results of a Randomized Controlled Trial.

Lower-extremity injuries can result in severe impairment and substantial years lived with a disability. Persistent pain and psychological distress are risk factors for poor long-term outcomes and negatively influence the recovery process following a traumatic injury. Cognitive-behavioral therapy (CBT) interventions have the potential to address these risk factors and subsequently improve outcomes. This study aimed to evaluate the effect of a telephone-delivered cognitive-behavioral-based physical therapy (CBPT) program on physical function, pain, and general health at 12 months after hospital discharge following lower-extremity trauma. The CBPT program was hypothesized to improve outcomes compared with an education program. A multicenter, randomized controlled trial was conducted involving 325 patients who were 18 to 60 years of age and had at least 1 acute orthopaedic injury to the lower extremity or to the pelvis or acetabulum requiring operative fixation. Patients were recruited from 6 Level-I trauma centers and were screened and randomized to the CBPT program or the education program early after hospital discharge. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. The secondary outcomes were objective physical function tests (4-square step test, timed stair ascent test, sit-to-stand test, and self-selected walking speed test), PROMIS Pain Intensity and Pain Interference, and the Veterans RAND 12-Item Health Survey. Treatment effects were calculated using targeted maximum likelihood estimation, a robust analytical approach appropriate for causal inference with longitudinal data. The mean treatment effect on the 12-month baseline change in PROMIS PF was 0.94 (95% confidence interval, -0.68 to 2.64; p = 0.23). There were also no observed differences in secondary outcomes between the intervention group and the control group. The telephone-delivered CBPT did not appear to yield any benefits for patients with traumatic lower-extremity injuries in terms of physical function, pain intensity, pain interference, or general health. Improvements were observed in both groups, which questions the utility of telephone-delivered cognitive-behavioral strategies over educational programs. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Long Term Comparison of Hamstring Tendon Autograft and Tibialis Anterior Tendon Allograft Use in ACL Reconstruction

Aim: In the early 2000s, the optimal graft for anterior cruciate ligament (ACL) reconstruction was a subject of uncertainty. Today, autografts have become the gold standard in this procedure. Aim of this study is to contribute to the existing knowledge by conducting a comprehensive comparison of the long-term clinical outcomes between hamstring allografts and anterior tibialis tendon allografts (ATT) in the context of ACL reconstruction. Material and Method: This study was conducted based on individuals who were operated on with the diagnosis of symptomatic ACL rupture 10 years ago. Participants were randomly assigned to undergo ACL reconstruction using either hamstring autografts or anterior tibialis allografts. All allografts were procured from a single tissue bank, underwent aseptic processing, and were fresh-frozen without terminal irradiation. Patient assessments included questionnaires based on the Lysholm knee scoring scale (LKSS) and the International Knee Documentation Committee (IKDC) subjective knee score. Objective functional tests, such as the Lachman test and pivot-shift, were performed, accompanied by a comprehensive physical examination of the knee. Results: A total of 60 patients, comprising 58 males and 2 females, with a mean age of 29.48±6.2, were included in the study. Predominant symptoms reported were pain and giving-way phenomena. Significantly different LKSS values were observed between the preoperative and postoperative periods for both anterior tibialis allograft and hamstring autograft patients (p

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial

BackgroundKnee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA.MethodologyA randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee’s functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests—the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05.ResultOf the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM − 4.15; TSE − 4.42; KSE − 3.78), during stair ascent (MWM − 3.89; TSE − 4.88; KSE − 3.56) and descent (MWM − 3.78; TSE − 4.05; KSE − 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM − 7.05; TSE − 7.16; KSE − 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05).ConclusionIn this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA.Trial noClinicalTrials.gov = NCT04099017 23/9/2019.

Application of clinical indicators in evaluating vestibular compensation efficacy in benign recurrent vestibular vertigo patients with short-term personalized vestibular rehabilitation

BackgroundShort-term personalized vestibular rehabilitation (ST-PVR) can establish stable vestibular compensation. However, there is a lack of a clear definition for clinical indicators that can dynamically reflect the progress of vestibular rehabilitation (VR).ObjectiveTo explore the clinical indicators suitable for evaluating the effectiveness of ST-PVR in treating benign recurrent vertigo (BRV).MethodsIn total, 50 patients diagnosed with BRV were enrolled. All patients received the ST-PVR treatment program. At 2 and 4 weeks after rehabilitation, subjective scales, including the visual analogue scale (VAS), dizziness handicap inventory scale (DHI), activities‐specific balance confidence scale (ABC) and generalized anxiety disorder (GAD-7) were assessed. Objective vestibular function tests were performed. VR grading was determined.ResultsAt 2 weeks after rehabilitation, significant enhancements were observed in VAS, DHI, ABC, GAD-7, UW, vHIT results, and VR grading scores (p < 0.05). The sensory organization test (SOT) results demonstrated statistically significant improvements at 2 weeks and 4 weeks after rehabilitation (p < 0.05).Conclusion and significanceBoth subjective scales and partial examination results in objective assessment can serve as indicators to dynamically monitor the compensatory process of vestibular function in patients with BRV. The VR efficacy grading score, which incorporates the above indicators, allows for quantification of the changes that occur during the vestibular rehabilitation process.

FEASIBILITY OF A COMMUNITY-LEVEL PHYSICAL ACTIVITY STRATEGY FOR OLDER ADULTS WITH MOTORIC COGNITIVE RISK SYNDROME

Abstract The motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow walking speeds and subjective memory complaints. To date, the feasibility of a community-based physical activity (PA) program for improving outcomes in MCR has not been examined. To address this knowledge gap, we conducted a translational randomized controlled trial (RCT) of 24-weeks of PA or a healthy aging education (HE) control intervention delivered within the existing infrastructure of an urban senior center in Greater Boston. A senior center employee was trained to administer the multimodal group-based PA program that included moderate-intensity aerobic walking, strength, flexibility and balance training. A total of 79 older adults attended the senior center for a screening visit of whom 25 met the MCR criteria and were randomized to PA or HE (mean age: 74.4 ± 7 yrs; BMI: 32.4 ± 7 kg/m2; 85% female; 3MSE score: 92.4 ± 7; gait speed: 0.52 ± 0.1 m/sec; SPPB score 4.8 ± 1.9). Due to COVID-19 the study was terminated early, however participants successfully completed baseline and follow-up study assessments that included objective tests of physical function and an iPad-based cognitive testing battery. Participants could appropriately adhere to the study interventions (overall attendance rate: PA: 69.3% vs. HE:70.1% at study termination). No study-related adverse events occurred. Trends for improved executive cognitive performance were exhibited in PA compared to HE. Our study provides important preliminary information to aid the design of larger-scale RCTs to preserve the independence of vulnerable older adults with MCR in community-based settings.

SENSORIMOTOR IMPAIRMENTS AND DEMENTIA: A CROSS-SECTIONAL ANALYSIS OF NATIONAL HEALTH AND AGING TRENDS STUDY

Abstract Sensory impairments in vision and hearing are linked to dementia in older adults. However, this association has not been investigated in conjunction with motor function performance. We examined cross-sectional sensory and motor function and dementia status data from 1,765 participants in the National Health and Aging Trends Study (NHATS R11, 2021) (32.7% aged ≥80 years; 55% women) who completed objective physical function and sensory testing. Motor function was defined using grip strength (kg), gait speed (m/s), standing balance, and chair stand speed (stands/sec). Sensory function was defined using hearing (pure tone average for better ear (BPTA) (dB)) and vision (contrast sensitivity (logCS)). Dementia was categorized as possible or probable using NHATS dementia classification. Survey-weighted logistic regression models estimated the likelihood of dementia by impairment in sensory and motor function, adjusted for demographic and medical conditions. 185 (10.5%) participants had possible or probable dementia. In models incorporating both motor and sensory impairments, impaired standing balance (&amp;lt;3 standing balance score in SPPB) and slow walking speed (&amp;lt;0.8m/s) were associated with higher odds of dementia (OR=1.75; 95%CI 1.10-2.79; and 2.39 95%CI 1.37-4.15, respectively), while hearing impairment (BPTA&amp;gt;25dB) and contrast sensitivity (&amp;lt;1.55logCS) were not associated with higher prevalence of dementia. In this nationally representative sample of older US adults, results suggest motor function is more strongly associated with dementia relative to sensory function among participants able to complete physical function testing. Future research is needed to understand how the associations of sensory and motor function with dementia change from mid-to-late life.

Desain dan Simulasi Model Predictive Control pada Sistem Pembagian Daya untuk Kendaraan Listrik Hibrida Fuel Cell – Baterai

This research examines the performance of implementing Model Predictive Control (MPC) in the energy management system of fuel cell – battery hybrid electric vehicles. Three parameter variations were carried out on the MPC controller, namely variations in the horizon value, objective function, and weighting in the objective function. In testing variations in the horizon value of the designed MPC controller, it shows that the higher the horizon value used, the SOC and the final SOC are faster and closer to the optimal SOC determined by compensating for higher hydrogen consumption. Testing of objective function variations shows that the objective function implemented on the MPC controller influences the system response characteristics. It was found in objective function testing that optimal use of fuel cell power produces fuel cell power output with a working efficiency range of 57% - 60% when compared to other objective functions that work in the efficiency range of 49.2% - 57%. Finally, in testing variations in weighting values, it was found that the higher the weighting of an expression in the objective function, the more the optimizer will penalize the expression so that the solver will minimize the expression in the optimization process. Therefore, the MPC controller parameter values ​​need to be paid attention to so that the response characteristics are in accordance with the design. which are desired. It should be noted that this research does not use a speed prediction model so it is assumed that the speed is known without any uncertainty.

Comparative study of vestibular function preservation in manual versus robotic-assisted cochlear implantation

Objective To compare vestibular outcomes in cochlear implant (CI) surgery, between robotic-assisted insertion of the electrodes versus manual insertion. Methods We performed a monocentric retrospective study. From March 2021, the robotic system RobOtol© was used for all CI cases. We compared this robotic-assisted insertion group with a manual insertion group of patients who received a CI between July 2020 and March 2021. Primary objective was vestibular outcome. We used objective vestibular function tests: caloric testing, Vestibular Evoked Myogenic Potential (VEMP), and Video Head Impulse Test (VHIT). Secondary objectives were postoperative complications including patient-reported postoperative vertigo. Results We found no statistically significant difference between the two groups in terms of caloric testing, VEMP or VHIT outcomes. In patient-reported outcomes, there was significantly more vertigo in the manual insertion group compared with robotic-assisted insertion. Conclusion It is hypothesized that a non-traumatic insertion would cause less vestibular dysfunction postoperatively. Larger prospective studies are required to determine whether robotic-assisted CI insertion has a significant impact on vestibular outcomes in CI surgery.

Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy.

Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients. Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. 4 (retrospective case series review).

Depression, Inflammation, and Intestinal Permeability: Associations with Subjective and Objective Cognitive Functioning throughout Breast Cancer Survivorship.

About one-in-three breast cancer survivors have lingering cognitive complaints and objective cognitive impairment. Chronic inflammation and intestinal permeability (i.e., leaky gut), two risk factors for cognitive decline, can also fuel depression-another vulnerability for cognitive decline. The current study tested whether depression accompanied by high levels of inflammation or intestinal permeability predicted lower subjective and objective cognitive function in breast cancer survivors. We combined data from four breast cancer survivor studies (n = 613); some had repeated measurements for a total of 1015 study visits. All participants had a blood draw to obtain baseline measures of lipopolysaccharide binding protein-a measure of intestinal permeability, as well as three inflammatory markers that were incorporated into an inflammatory index: C-reactive protein, interleukin-6, and tumor necrosis factor-α. They reported depressive symptoms on the Center for Epidemiological Studies depression scale (CES-D), and a binary variable indicated clinically significant depressive symptoms (CES-D ≥ 16). The Kohli (749 observations) and the Breast Cancer Prevention Trial (591 observations) scales assessed subjective cognitive function. Objective cognitive function tests included the trail-making test, Hopkins verbal learning test, Conners continuous performance test, n-back test, FAS test, and animal-naming test (239-246 observations). Adjusting for education, age, BMI, cancer treatment type, time since treatment, study visit, and fatigue, women who had clinically elevated depressive symptoms accompanied by heightened inflammation or intestinal permeability reported poorer focus and marginally poorer memory. However, poorer performance across objective cognitive measures was not specific to inflammation-associated depression. Rather, there was some evidence of lower verbal fluency; poorer attention, verbal learning and memory, and working memory; and difficulties with visuospatial search among depressed survivors, regardless of inflammation. By themselves, inflammation and intestinal permeability less consistently predicted subjective or objective cognitive function. Breast cancer survivors with clinically significant depressive symptoms accompanied by either elevated inflammation or intestinal permeability may perceive greater cognitive difficulty, even though depression-related objective cognitive deficits may not be specific to inflammation- or leaky-gut-associated depression.

Comprehensive Approach to Core Training in Sports Physical Therapy: Optimizing Performance and Minimizing Injuries.

This clinical commentary explores the significance of a comprehensive approach to core training in sports physical therapy, focusing on optimizing performance and minimizing injuries. The core, encompassing multiple regions from the scapula to the glutes and beyond, plays a vital role in athletic performance and injury prevention. The commentary provides a thorough understanding of the various "cores" in the body, highlighting their primary functions and the importance of core stability. The commentary delves into the anatomy of the core, its primary functions, common injuries, and clinical evaluation techniques. It aims to define the role of core stability in athletic activities and discusses the prevalence and characteristics of core injuries in various sports such as baseball, basketball, football, hockey, and soccer. Furthermore, the clinical evaluation section describes subjective and objective assessments, functional testing, and special tests used to identify core injuries and determine their root causes. The author introduces a personalized dynamic core assessment to evaluate multiplanar stabilization and proposes a four-phase intervention program called the "Core Four Pyramid Principles." This program includes activation, stabilization, integration, and perturbation phases, each with specific entry criteria, goals, and targeted exercises. This commentary contributes to the body of literature by providing a comprehensive overview of core training in sports physical therapy, highlighting the significance of a systematic and evidence-based approach, and introducing the "Core Four Pyramid Principles" as a guideline for designing effective core training programs for sports therapists to optimize core function, stability and overall athletic performance while reducing the risk of injuries amongst their athletes.

Poster 349: Outcomes Following ACL Reconstruction with Concomitant Meniscus Allograft Transplantation Versus Isolated ACL Reconstruction

Objectives: Meniscus allograft transplantation (MAT) is used in the setting of ACL reconstruction to restore proper arthrokinematics and load distribution for the meniscus deficient knee. Objective outcomes following ACL reconstruction with concomitant MAT in athletic populations are scarcely reported and highly variable. Thus, the purpose of this study was to compare patient outcomes using an objective functional performance battery, self-reported outcomes, and return to activity rates between individuals undergoing an ACL reconstruction with concomitant MAT and the outcomes of patients undergoing isolated ACL reconstruction. We hypothesized that patients in the ACL reconstruction with MAT group would exhibit lower performance on objective functional tests, delayed time to release to activity, and lower return to activity rates when compared to those undergoing isolated ACL reconstruction. Methods: A single surgeon ACL database (n = 1,431) was utilized to identify patients undergoing ACL reconstruction with concomitant MAT from 2014-2019. A comparison group undergoing an isolated ACL reconstruction were identified to serve as a known control. Baseline patient and surgical demographics data were collected. Patients completed an objective functional performance battery at the time of return to activity which included range of motion (ROM), single leg squat performance, single leg hop test performance, subjective function (International Knee Documentation Committee score (IKDC)), and psychological readiness (ACL Return to Sports After Injury scale (ACL-RSI). Between limb comparisons were assessed using limb symmetry indices (LSI). Injury surveillance was conducted for two-years and included the Single Assessment Numeric Evaluation (SANE), re-injury rates, complications, and current level of sports participation. Between group comparisons at time of return to activity and two years were analyzed using generalized linear models utilizing an a-priori alpha level of .05. Results: Forty-four patients were included in the ACL reconstruction with concomitant MAT group along with 45 in the isolated ACL reconstruction group (Figure 1). Baseline demographic differences existed between groups with the MAT group being significantly older ( P=.001), having a higher BMI ( P=.001), and a lower MARX score (p=.001) (Table 1). The MAT group had a significantly delayed release to activity timeline (10.8 ±3.2mo vs 7.8 ±1.8mo, P = .001) and reported significantly lower IKDC scores (82.4 ±13.8 vs 93.7 ±10.1, P = .001) and ACL-RSI scores (62.8 ±21.3 vs 80.3 ±9.7, P = .001) at time of release to activity (Table 2). Likewise, the MAT group had significantly greater flexion ROM deficits (6.4 ±5.6 deg. vs 3.0 ±2.6 deg., P = .011) and lower single-leg hop symmetry (90.2 ±12.3% vs 97.1 ±5.3%, P = .001). At two- year follow-up the MAT group also demonstrated a significantly lower return to activity rate (69.7% vs 95%, P=.001), lower rate of participation in Level 1 sports (9.1% vs 63.3%, P=.001), and lower SANE scores (80.9 ±16.1 vs 92.5 ±8.3, P = .001) (Table 3). No significant differences existed between groups for ACL graft re-injury rates. Conclusions: The majority of patients undergoing ACL reconstruction with concomitant MAT are able to return to at least level 3 sports at two years post-surgery with low risk of graft re-injury. Patients receiving a concomitant MAT exhibit lower return to sport rates, delayed time to release to activity, and lower subjective function compared to those undergoing an isolated ACL reconstruction. Clinicians should consider patient expectations, surgical demographics, functional outcomes, extended rehabilitation timelines, and lower return to activity rates when counseling patients return to activity following ACL reconstruction with MAT. [Table: see text][Table: see text][Table: see text]

491-P: Corneal Nerve Sensitivity—Early Detection of Diabetic Peripheral Neuropathy (DPN)

Introduction: Density of sub-epithelial corneal nerves have been promoted as a surrogate marker for early diagnosis of DPN. As an alternative, we developed an objective functional test of corneal sensitivity (Invest Ophthalmol Vis Sci. 2016, 57: 2412-9). In this study we provide verification of this methodology in human subjects with DPN. Methods: Following verification of DPN, response to a drop of isotonic vs. 5% NaCl (hypertonic) solution was recorded (primary endpoint). Ratio of time that the eyelids were closed from 10s to 60s following application of each solution were quantified using an image analysis program. Results: We examined 24 subjects with type 2 diabetes and 12 age-matched controls. The presence of DPN in diabetes vs. control subjects was verified by completing the Michigan Neuropathy Screening Instrument questionnaire and lower extremity examination including amplitude and conduction velocity of the sural nerve. The presence of eye discomfort was examined for each subject by completing the DEQ5 and Ocular Surface Disease Index (OSDI) questionnaires. DPN was confirmed in all subjects with diabetes as well as presence of mild to moderate ocular surface disease. Two control subjects had mild ocular surface disease but no peripheral neuropathy. Cochet-Bonnet filament esthesiometer examination revealed significant corneal sensitivity impairment in subjects with diabetes vs. control subjects (5.64 ± 0.08 vs. 5.97 ± 0.03 cm, respectively). Corneas of subjects with diabetes were also significantly less sensitive vs. controls to application of hypertonic solution (0.18 ± 0.01 vs. 0.29 ± 0.04, respectively). Data is presented as mean ± S.E.M. There was no difference in sensitivity to the isotonic solution. Conclusion: Corneal nerves that penetrate the epithelium and sprout near the surface of the eye and are the first to exhibit the "dying-back" phenomenon associated with DPN. Clinical evaluation of the sensitivity of these nerves could be a valuable method for early detection of DPN. Disclosure M.A.Yorek: Consultant; Novo Nordisk. M.Correia: Research Support; Eli Lilly and Company, Novartis, Novo Nordisk. R.Kardon: None. P.Poolman: Stock/Shareholder; FaceX LLC. Funding U.S. Department of Veterans Affairs (RX000889)

ПОСТ-COVID-19 ІНТЕРСТИЦІЙНІ ЗАХВОРЮВАННЯ ЛЕГЕНЬ ЯК ПРОЯВ ПОСТКОВІДНОГО СИНДРОМУ

The aim was to study the clinical features of post-COVID-19 interstitial lung disease (ILD) and to determine the prospects for the use of the antifibrotic drug nintedanib in patients with moderate and severe COVID-19. Material and methods. A prospective cohort study was conducted in 266 patients (≥ 18 years old) with moderate and severe COVID-19 who were hospitalized and discharged after treatment at the Volyn Regional Clinical Hospital between September and November 2021. The study design included telephone contact with patients one year after hospital discharge to collect the complaints and history data related to postCovid syndrome. The patients with persistent respiratory symptoms were invited for an examination. A questionnaire, assessment of objective status, laboratory and functional tests were performed. The study included a group of patients (n = 25) with post-COVID-19 interstitial lung disease as a sequela of severe coronavirus infection. In all cases, interstitial pneumonia with a radiological pattern of chronic organizing pneumonia was established by computer tomography. All patients with post-COVID-19 ILD received glucocorticosteroid (GC) therapy with methylprednisolone 16 mg/day for 3–6 months with a gradual dose reduction until complete withdrawal. In addition, 9 patients with postCOVID-19 ILD received off-label antifibrotic therapy with the nintedanib 300 mg daily for 3 months. Statistical analysis was performed by means of SPSS Statistics 26 using the binomial test, the asymptotic T-test for the probability of success in two independent Bernoulli trial schemes, and the non-parametric Kolmogorov-Smirnov, Mann-Whitney U, and median tests. Results and discussion. In 9.4 % (n = 25) of patients post-COVID-19 ILD was diagnosed: 76 % (n = 19) — COVID-19 associated ILD; 16 % (n = 4) — systemic connective tissue disease (SCTD) triggered by COVID-19; 8% (n = 2) misdiagnosed pre-COVID-19 ILD. Radiological pattern of fibrosis-like lesions was established in 64% (n = 16); true fibrotic radiological pattern of pulmonary fibrosis (PF) — in 36 % (SCTD — 4 cases, other ILD — 2 cases). It was found that CPAP respiratory support did not significantly correlated with the presence of a radiological pattern of PF (p = 0.774) and the progression of postCOVID-19 ILD (p = 0.146). No significant correlation was found between the presence of a radiological pattern of PF and the gender of patients (p = 1.000 and p = 0.146, respectively) or age (p = 0.881 or p = 0.885). Despite the presence of autoimmune markers in number of cases and the diagnosis of SCTD, there was no correlation between PF pattern and SCTD ILD (p = 0.146 and p = 1.000). The use of nintedanib (n = 9) for 3 months in the remote period of severe COVID-19 disease did not changed the radiological pattern of PF (p = 1.000) and the progression of post-COVID-19 ILD (p = 0.180), same as the blood oxygen saturation post 6-minute walking test (p = 0.411 according to the median test and p = 0.329 according to the Mann-Whitney U test). There was no effect on the dyspnea index as well (p = 0.451 or p = 0.422). In our opinion, anti-fibrotic therapy in post-COVID-19 ILD should only be prescribed on individual basis for more than 3 months in the presence of a clinically significant PF radiological pattern. This recommendation requires further investigation. Key words: post-COVID-19 interstitial lung disease, post-covid syndrome, pulmonary fibrosis, nintedanib.

An analysis of the incidence, risk factors, and timing of development of cyclops lesions after anterior cruciate ligament reconstruction

BackgroundCyclops lesions are a known complication following anterior cruciate ligament reconstruction (ACLR) with a described incidence between 1.9% to 10.9%. The objective of this study was to identify the incidence, timing, and variables that correlated with development of a cyclops lesion, and if objective functional testing differed between patients with and without cyclops lesions. Methods313 consecutive patients who underwent ACLR and participated in Lower-Extremity Assessment Protocol (LEAP) testing at a single, academic institution were analyzed. Retrospective chart review was performed to identify patient demographic factors, medical comorbidities, and potential peri-operative risk factors. Postoperative functional outcome metrics and patient reported outcomes were collected per the institution’s LEAP testing protocol. Binary logistic regression was utilized to identify risk factors for cyclops lesions. Objective functional outcomes and patient reported outcomes were compared between patients with and without cyclops lesions. Results23/313 (7.35%) patients developed a cyclops lesion following ACLR, of which 17 (73.91%) were found to be symptomatic. Concomitant meniscal repair correlated with an increased likelihood of developing a cyclops lesion (p = 0.040); no other risk factors significantly differed between cohorts. There were no clinically relevant extension deficits or differences in objective functional performance measures at six months post-operatively between study cohorts. ConclusionsConcomitant meniscal repair may be associated with the development of cyclops lesions due to restrictive postoperative range of motion protocols; however no other pre- or intra-operative factors demonstrated significant correlation. Presence of a cyclops lesion should be considered with late loss of knee extension after ACLR.

Extending the no objective testing rules to patients triaged by the ESC 0/1-hour algorithms

Abstract Background It is unclear which patients, after rule-out of non-ST elevation myocardial infarction (NSTEMI) with the European Society of Cardiology (ESC) 0/1h-algorithms, require further objective anatomical or functional cardiac testing and which do not. Purpose To test the safety and efficacy of the no-objective-testing (NOT)-rules after NSTEMI rule-out by the well-validated ESC 0/1h-algorithms. Methods We prospectively enrolled adult patients presenting with acute chest pain to 12 emergency departments (ED) in five European countries in an international, prospective, diagnostic multicenter study. The final diagnosis of major adverse cardiovascular events (MACE), defined as nonfatal acute coronary syndromes (NSTEMI or unstable angina) or cardiovascular death was centrally adjudicated by two independent cardiologists applying the 4th Universal Definition of myocardial infarction using all information including cardiac imaging and serial measurements of high-sensitivity cardiac troponin (hs-cTn) T/I. The primary endpoints were the safety and efficacy of the NOT-rules for the rule-out of MACE within 30-days follow-up including index events. Secondary endpoints included MACE within 365 and 730 days. Results Among 4804 and 4569 eligible patients with available 0h and 1h hs-cTnT-Elecsys or hs-cTnI-Architect concentrations, 2783 (58%) and 2252 (49%) patients were eligible for application of the NOT-rules after rule-out of NSTEMI by the respective ESC hs-cTnT/I-0/1h-algorithm. The first rule (weighted score including age, sex, cardiovascular risk factors, previous MI or known coronary artery disease (CAD), nitrate use) identified 26% of patients, had a sensitivity of 100% (95% CI 98.3–100%), a negative predictive value (NPV) of 100% (95% CI, n.c.) for hs-cTnT-Elecsys and 99.4% (95% CI 96.7–99.9%) and 99.8% (95% CI 98.8–99.9%) for hs-cTnI-Architect, respectively. The dichotomized second (age &amp;lt;50y, no previous MI or known CAD, &amp;lt;3 risk factors, no nitrate use) and even simpler third rule (nitrate use omitted) both identified 31% of patients with 99.5% (95% CI 97.4–99.9%) sensitivity and a NPV of 99.9% (95% CI 99.2–99.9%) for hs-cTnT-Elecsys. Sensitivities were 98.8% (95% CI 95.7–99.9%) and NPV 99.7% (95% CI 98.9–99.9%) for hs-cTnI-Architect. High safety was confirmed with consistently very high sensitivities and NPV for 365-day and 2-year MACE. Conclusion All three NOT-rules performed very well for rule-out of MACE. The third NOT-rule best balanced feasibility, safety and efficacy by identifying nearly one out of three patients as low-risk, who may not require further cardiac testing. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Swiss Heart Foundation, University of Basel.

Comparing Hop And Stop Test Data Scores Between Female Recreational And Collegiate Athletes

Return to sport or recreational activity are goals for many individuals recovering from a knee injury or surgical intervention. Numerous functional tests exist to assist clinicians and rehabilitation specialists in determining the appropriate timing for return-to-play (RTP) or resumption of recreational activity. However, it is not well defined how these performance-based measures (PBMs) relate to the recreationally active female population. PURPOSE: To compare recreationally active female (RA) and female collegiate athlete (CA) performances on the Hop and Stop test; while distinguishing differences within the RA group and the performance measures between the two groups. METHODS: A quasi-experimental, single factor, comparison group design to observe fifty recreationally active females between the ages of 18-25 from a healthy population. Subjects performed three successful trials of a Hop and Leap using metric measures. The max(avg) score was taken to calculate a Hop % Height (H%Ht) (force production) and Stop-to-Hop ratio (SHr) (force absorption). The recreationally active female ratios were compared to collegiate female athlete ratio scores (collected in a parallel study by the same authors). Yeun’s Robust independent t-tests were used to compare H%Ht and SHr scores between the female groups and assess the variability of the ratio scores within groups. Confidence intervals established the expected range of H%Ht and SHr scores for the RA population. RESULTS: Significant differences were observed in H%Ht and SHr (both p < .001) between the RA and CA groups. The H%Ht Mean ± SD variability for the RA and CA groups were 72.3 ± 11.1% and 86.0 ± 8.2%, respectively, while SHr values were 111.7 ± 12.7% and; 100.10 ± 7.0%. The RTP criterion values are as follows: RA group: H%Ht = 65%; SHr = 105%. CA group: H%Ht = 85%; SHr = 96%. CONCLUSIONS: The Hop and Stop test provided objective data regarding force production and force absorption. A decision for RTP is a multi-faceted one, and PBMs should play an integral role alongside clinical judgment, multiple objective measurements, subjective input, and functional testing. Female collegiate athletes perform differently from the recreationally active female in force production and force absorption. As such, criterion values for H%Ht and SHr should differ for the two populations.

Paper 81: Quadriceps Tendon Autograft Yields Good Outcomes for Revision ACL Reconstruction after Failed Patellar Tendon Autograft

Objectives:Few studies have examined the viability of the quadriceps tendon autograft as a revision graft option following failed primary bone-patellar tendon-bone (PT) autograft reconstruction. Potential concerns include further disruption to the knee extensor mechanism, inhibition of the quadriceps muscle, and increased complication and reinjury rates. The purpose of this study was to assess knee extension strength, functional outcomes, patient reported outcomes, and return to play after revision ACL reconstruction using free quadriceps tendon autograft after a failed primary reconstruction using bone-patellar tendon-bone (PT) autograft.Methods:A retrospective case series was conducted in accordance with Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines using a prospective single surgeon ACL database (n = 1,514) that included 48 patients receiving revision ACL reconstruction using free QT autograft after failure of primary PT autograft ACL reconstruction from 2015-2019. Exclusion criteria are listed in Figure 1, and included ages <15 years or > 55 years, bi-cruciate ligament injuries, and meniscal allograft transplant. Baseline patient demographics and surgical variables were collected and included preinjury level of function (Marx Score). Functional and self-reported outcomes were obtained at the time of return to play and consisted of: single-leg squat symmetry, hip abduction strength, single-leg hop tests, agility testing, and isokinetic knee extension strength (60°, 180°, and 300°/sec). Self-reported outcomes at the time of return to play included the International Knee Disability Committee (IKDC-2000) scale and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) psychological readiness survey. Return to play was defined as the time (mo) required to reach a threshold of 90% limb symmetry on objective functional testing compared to the contralateral extremity and ultimately, the surgeon’s discretion. Injury and complication surveillance was conducted for 2-years postoperatively, and patients were contacted via email or phone survey at 24-months to obtain functional status and single answer numeric evaluation (SANE) scores. Descriptive statistics were calculated using SPSS (version 26, IBM Inc, NY, USA).Results:Baseline patient demographics are listed in Table 1 for the 48 patients (mean age 23.9 ±9.5 years; 14/34 female/male) enrolled in the study. Isokinetic knee extension strength was 84.3 ±17.1% at 60°/sec, 88.6 ±16.4% at 180°/sec, and 92.0 ±19.5% at 300°/sec. The mean knee function SANE score at 2-years was 88.9 ±12.2%. All patients went through return to play testing prior to returning to sport. The mean time to return to play was 8.9 ±1.8 mo, and the mean 24-month assessment was conducted at 24.6 ±2.3 mo. Limb symmetry index scores ranged from 94.1%-102.6% across all objective functional tests (Table 2), and self-reported knee function via the IKDC-2000 was 86.3±16.8. Three patients were lost to follow up (6.3%) at 2-years, and of the 45 patients remaining in the study, 3 sustained graft reinjuries (6.7%). Two-year complications are listed in Table 3, and included meniscal tear (2.2%), DVT (4.4%), loss of motion requiring surgical lysis of adhesions (4.4%), anterior knee pain (11.1%), and symptomatic removal of hardware (2.2%).Conclusions:Free quadriceps tendon autograft is a viable autograft option for revision ACL reconstruction for failed PT autograft allowing return to high function without compromising knee extension strength with a low failure and complication rate. Two-year graft reinjury rates for revision ACL reconstruction with free QT autograft are similar or favorable to other autograft options previously reported in the literature in a revision setting. Additionally, functional outcomes are comparable to revision reconstructions using PT autograft and good to excellent outcomes can be obtainedTable 1.Patient DemographicsFig 1.Study DesignTable 2.Level of Return to SportTable 3.Return to Play Functional Performance Outcomes

Prognostic importance of the 6 min walk test in light chain (AL) amyloidosis

ObjectivesIn AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is...

Paper 11: Return to Sport Testing vs Time-Based Clearance in Posterior Shoulder Instability

Objectives:Recurrent pain, instability and loss of function is a challenging complication that can occur after arthroscopic treatment of posterior shoulder instability and SLAP tears in athletes. Many surgeons allow return to sport after a designated arbitrary postoperative time point. Recent evidence has demonstrated that a majority of athletes have residual strength and functional limitations at 6 months postoperatively – the time at which most time-based protocols allow full return to sport1. Recent data has also been presented that patients undergoing arthroscopic Bankart repair who are required to meet objective return to sport testing criteria have a 4x lower rate of recurrent anterior instability than those who return based on time elapsed since surgery2. Considering these findings, the purpose of this study is to investigate the use of a similar objective return to sport testing protocol on recurrence rates following arthroscopic surgery for posterior shoulder instability and SLAP tears. We hypothesized that patients who meet objective return to sport criteria would have a lower rate of reoperation and recurrence of symptoms compared to those who did not undergo the testing and were cleared to return based on time from surgery.Methods:Consecutive patients (Group 1) who underwent arthroscopic posterior shoulder stabilization surgery with or without SLAP repair by a single surgeon from 2016 to 2019, had a minimum of 1 year follow up, and completed functional and strength testing to evaluate readiness for return to sport were included in this retrospective case-controlled study. These patients were compared to a control group of historical consecutive cases (Group 2) from 2012-2016 who did not undergo return to sports testing and were cleared for sports after a minimum of 6 months following surgery. Failure was defined as recurrent symptoms of pain or instability requiring reoperation. Exclusion criteria were: patients undergoing isolated anterior stabilization procedures with or without concomitant SLAP tears, multidirectional instability, and open procedures. Chi-square, Fisher exact tests and two-tailed Students T-test were performed. Statistical significance was set at p<0.05.Results:There were 33 patients in Group 1 who underwent return to sport testing, and 90 patients in Group 2, the historical control. There were no differences between groups regarding sex (p=0.46), hand dominance (p=0.16), side affected (p= 0.69. The average age of Group 1 (20.8 +/- 4 yrs) was significantly younger than Group 2 (31.6 +/- 9.1 yrs, p< 0.00001). Patients who underwent return to sport criteria-based testing protocol had a rate of recurrent symptoms of pain or instability of 12.1% compared to 18.9% for those who did not (p= 0.43). Similarly, there were no reoperations for in Group 1, while three patients in group 2 (3.3%) underwent revision surgery for recurrent symptoms. This difference, however, did not reach statistical significance (p= 0.5633).Conclusions:In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. This may be related to an overall lower rate of reoperation in patients undergoing arthroscopic posterior stabilization or SLAP repairs in general compared to those undergoing arthroscopic anterior stabilization and differences in tolerance and presentation of recurrent posterior instability/SLAP tears versus anterior instability. It is possible that criteria-based return to sport testing prior to clearance to return to sport may be less critical for improving failure rates following arthroscopic posterior stabilization and SLAP repair than for anterior stabilization. Alternatively, given low reoperation rates overall, future studies investigating the role of return to sport testing after arthroscopic surgery for posterior shoulder instability and SLAP repairs may need to include more patients in order to detect differences related to the testing protocol. Objective functional testing may be a viable alternative to arbitrary, time-based criteria for returning to sport in patients who have undergone arthroscopic posterior shoulder stabilization and SLAP repairs.