Physical Pain Relief Research Articles

Evaluating Short-Term Patient-Reported Outcome Measures Following Total Hip and Knee Replacement: A Comprehensive Review.

Total hip replacement (THR) and total knee replacement (TKR) are widely performed surgical procedures to alleviate pain and improve function in patients with joint-related diseases. Short-term patient-reported outcome measures (PROMs) have become a key metric in assessing the success of these surgeries from the patient's perspective, focusing on early recovery, pain management, mobility, and quality of life. This comprehensive review evaluates the significance of short-term PROMs following THR and TKR, highlighting commonly used tools such as the Oxford Hip Score (OHS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short-form health survey (SF-36). The analysis explores the impact of various factors, such as age, preoperative health status, and surgical technique, on short-term outcomes. Findings from recent studies indicate that while patients generally report improvements in physical function and pain relief within the first six months post-surgery, individual outcomes can vary significantly. Factors like early rehabilitation, mental health, and the presence of postoperative complications can influence the trajectory of recovery and satisfaction levels. Moreover, the review addresses the limitations of current PROMs, including variability in reporting and sensitivity to different patient populations. This review emphasizes the need for more personalized and standardized approaches to PROM assessment to better capture patient experiences and optimize postoperative care. Future research should focus on integrating PROMs with long-term follow-up data and digital health tools to track real-time patient progress, thus enhancing the overall quality of care for THR and TKR patients. Short-term PROMs play a vital role in understanding patient outcomes and guiding clinical practice for joint replacement surgeries.

Exploring arts-health ecologies in the very remote Barkly Region of Australia.

This article explores links between arts, health, and wellbeing for diverse First Nations and non-Indigenous peoples living in the very remote Barkly Region of the Northern Territory in Australia. The article stems from a major 3-year study of the Barkly arts sector conducted in partnership with Barkly Regional Arts and Regional Development Australia Northern Territory. Key findings relate to an arts-health ecology evident in the region, the interdependence between artists' own health and their arts activity, the value of arts spaces as places of safety and refuge, and the potential of the arts to promote cultural and intercultural healing and development. We discuss these findings in the context of relevant literature and make suggestions for future arts-health and wellbeing related research, policy and practice in rural and remote contexts. This study employed an ecological mixed-methods research design, including quantitative and qualitative survey and interview data collection as well as collaborative, data-driven thematic analysis. The ecological approach was used to map a variety of creative practices through a broad range of art forms. Commercial, amateur and subsidised art and creative practices were included in this study and represented the multicultural population of the Barkly Region (both First Nations and non-Indigenous peoples). Arts and creativity in the region were recognized as a complex ecology that saw individuals, businesses, organisations and government working in different ways to sustain culture and contribute to social and economic development. Research participants from diverse cultural backgrounds recognised health and wellbeing benefits of arts and creative activity. Arts participation and engagement were reported to have intrinsic individual health and wellbeing effects such as mental health and mindfulness, emotional regulation, enjoyment, and relief of physical and emotional pain and stress alongside promoting spiritual connection to self, culture and community. The study indicates that the arts can also shape powerful determinants of health and wellbeing such as employment, poverty, racism, social inclusion, and natural and built environments. Barkly arts-health ecology featured extensive involvement from health and human service and arts organisations, which provided a strong foundation for inclusive, healing and holistic regional development. This study has outlined how arts and creative activity contribute to holistic regional development in the Barkly desert region, an area with a high percentage of First Nations peoples. Arts and creative activity were reported to have intrinsic health and wellbeing effects for individuals, which included mental health and mindfulness, emotional regulation, enjoyment, and relief of physical and emotional pain and stress as well as promoting spiritual connection to self, others and environment. Arts activities were also seen to shape powerful determinants of health and wellbeing such as employment, poverty, racism, social inclusion, and natural and built environments.

Home care needs assessment among caregivers of children and adolescents with osteogenesis imperfecta: a cross-sectional study

BackgroundChildren and adolescents with complex medical issues need home care services; however, few studies have provided insight into the unmet home care needs of the families of patients with osteogenesis imperfecta (OI). In this study, we aimed to assess the home care needs of caregivers of children and adolescents with OI and the associated factors.MethodsA self-administered questionnaire was administered online to 142 caregivers of patients with OI aged 3–17 years between May and October 2022 from 25 provinces in China. The questionnaire comprised 15 questions on demographic variables and 14 questions on home care needs. Chi-square analysis was used to compare group differences for categorical variables. Multivariate binary logistic regression analysis was conducted to examine predictors of caregivers’ home care needs.ResultsThe study findings indicated that 81.5% of caregivers had high home care needs. The three leading types of home care needs were helping the child carry out physical fitness recovery exercises at home (72.5%), understanding precautions regarding treatment drugs (72.5%), and relieving the child’s pain (70.4%). OI patients’ poor self-care ability (adjusted odds ratio = 5.9, 95% confidence interval = 1.8–19.0) was related to caregivers’ high level of home care needs.ConclusionsThe findings of this study suggest that future scientific research and nursing guidance should focus on OI patients’ physical training, medication management, pain relief, fracture prevention, and treatment. In addition, caregivers of patients with poor self-care ability should receive special attention in the development of interventions. This study can help with addressing the unmet home care needs of caregivers of children and adolescents with OI. It is vital to develop a personalized intervention plan based on patients’ self-care ability.

Identification of Nursing Outcomes and Quality Indicators for Home Health Care in Older Adults with End-Stage Cancer.

This study aimed to identify nursing outcomes and quality indicators for older adults with end-stage cancer receiving home health care. Nineteen experts and professional caregivers, including palliative doctors, nursing faculty, advanced practice nurses, and registered nurses, participated in the Delphi technique. Final medians and interquartile ranges were calculated. Seven components with 43 nursing outcomes and quality indicators for older adults with end-stage cancer were developed, encompassing physical pain relief, symptom management, physical well-being, complication prevention, psychosocial support, caregiver and family roles in end-of-life care, and advance care planning. The caregiver and family's role in end-of-life care had the most indicators, reflecting the significance of family involvement in Thailand's cultural context. Consistent implementation of these indicators is crucial, and correlational analysis of indicator scores can enhance their validity.

“There’s Healing in Music”: Veteran Perceptions of Music Interventions for Their Chronic Musculoskeletal Pain

Background/Objective: For veterans suffering from chronic musculoskeletal pain, finding alternative treatments to analgesics is critical for safer, more effective pain management. While music interventions have shown promise for acute pain, their acceptability for chronic pain and telehealth delivery needs more rigorous examination.
 Methods: The Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia (FAMILIA) study randomized 60 veterans with chronic musculoskeletal pain to receive usual care, telehealth music listening (ML), or telehealth music imagery (MI). ML involved independent listening to songs of each participant’s choosing, while MI consisted of one-on-one music therapist-led sessions combining ML, imagery, and verbal processing. To complement quantitative analysis of patient-reported outcomes, qualitative interviews of participants were conducted to understand perceived benefits, acceptability, barriers, and facilitators of study interventions. We analyzed 15 interviews using thematic analysis to assess acceptability of the music interventions.
 
 Results: All interviewees perceived mental-emotional benefits and almost all experienced physical pain relief during their music listening or therapy sessions. However, many noted that the pain relief was short term, and for some veterans randomized to ML, certain songs evoked negative associations. Participants also benefited from study participation and its formal structure, in contrast to their prior informal music listening experiences. Planned study activities like participant check-ins with staff and interactions with therapists fostered a deeper understanding of how music can be therapeutic and increased veterans’ confidence in their own ability to use music therapeutically. Study acceptability was further evidenced by interviewees’ intention to continue using music listening and imagery techniques after study completion and their strong support for expanding access to music interventions to other veterans.
 Conclusion/Implications: The FAMILIA study not only supports telehealth music interventions as acceptable treatments for chronic musculoskeletal pain, but the reported physical pain and mental-emotional benefits necessitate a larger, fully powered study.

진저롤 성분이 중년 여성의 무릎 통증에 미치는 영향

This study aimed to investigate the diverse effects of gingerol, a component of ginger, on knee pain, body temperature, and health-related quality of life in middle-aged women. Sixteen women aged 55-66 were divided into two groups of eight for the experiment. Statistical analysis was conducted using SPSS 22.0 to calculate the mean (M) and standard deviation (SD) for all variables. To examine the changes over time and pre-post results, as well as interaction effects, paired t-tests were performed, with a significance level set at .05. The findings of this study are as follows: Firstly, there was a statistically significant difference in the changes in gingerol component administration for knee pain among the experimental group only (p < .05). Secondly, there were no statistically significant differences in body temperature changes in the leg muscles before and after application in both groups (p>.05). Thirdly, there was a statistically significant difference between the experimental group and the control group in terms of health satisfaction (p<.05). Additionally, in the domain of life satisfaction, a statistically significant difference was observed between the experimental group and the control group (p<.05). These results indicate that the gingerol component of ginger contributes to a reduction in knee pain among middle-aged women, leading to both physical pain relief and increased psychological well-being in terms of life satisfaction. Based on these findings, it is deemed essential to approach human health management by conducting diverse studies, considering factors such as time periods, specific pain areas, and different age groups.

Research on the Effectiveness and Efficacy of the Music Therapy Methods in the Treatment of Depression

Due to the side effects or unsuitability of traditional therapies for some patient groups, there is a need for a new form of depression treatment. Therefore, society has turned its attention to music therapy, which has been shown to have significant effects in the treatment of mental illness and depression. This paper categorizes music therapy methods into active and passive music therapy methods for separate exploration and comparison. Active music therapy methods are further divided into improvisation, creative (composition), and re-creative. The effectiveness of passive music therapy methods in the treatment of depression mainly lies in improving patients sleep and promoting beneficial emotions. The effectiveness of active music therapy methods mainly includes the relief of physical pain, the increase of positive emotions, the relief of anxiety, and the increase of social interaction ability. The receptive therapy group reaches the peak of treatment effect faster, but the active therapy group has a higher peak effect.

Application of the Pilates method and kinesiotherapeutic approach in pregnant women with low back pain: an integrative review

The gestational period is characterized by several changes in the female body, which come from mechanical and/or hormonal activities. A number of changes take place with the main objective of maintaining and facilitating the healthy development of the fetus. Low back pain is one of the main musculoskeletal complaints referred to during pregnancy, and it is estimated that more than 50% of pregnant women are affected by low back pain, especially in the third trimester of pregnancy. Physiotherapy, through kinesiotherapy and the Pilates method, enables the treatment of gestational low back pain, as well as the prevention of this disorder. Thus, the general objective of the research is to investigate the benefits of the Pilates method and kinesiotherapy in pregnant women with low back pain. Therefore, the specific objectives are to know the biomechanical changes of the gestational period, to understand the most common pathological changes that occur in the pregnancy period, to understand the so-called gestational low back pain, to know about the importance of physiotherapy in the care of pregnant women and to learn about the Pilates method and kinesiotherapy applied in this phase of female life. It is, therefore, an integrative review of the literature of a qualitative nature, and, for its preparation, the following descriptors were used: "Pregnant women", "Lumbar pain", "Pilates method", "Exercise therapy" in Portuguese , English and Spanish. The work was produced in the year 2022, between the months of March and May. The years 2012 to 2022 were established as a delimitation, with emphasis and preference being given to research from the last 5 years. The databases consulted were: Scientific Electronic Library Online (SciELO), PEDRo and the Virtual Health Library (BVS). The main finding of this research was the evidence that the Pilates method is extremely superior to the non-treatment used by the control groups of randomized clinical trials for the treatment of gestational musculoskeletal pain. The Pilates method was also beneficial for controlling the progression of diastasis, increasing mobility, functionality and functional capacity, increasing strength and resistance of the abdominal and pelvic floor muscles. It was also evidenced that the regular practice of physical exercises is recommended for pregnant women, being the moderate intensity, the duration of 150 minutes per week distributed in the frequency of 3 days a week, in sessions that vary between 30 and 60 minutes. Furthermore, it is concluded that kinesiotherapy and the Pilates method have been applied for the treatment and prevention of gestational low back pain. Both are necessary for the improvement of physical conditioning, sleep improvement, pain relief and musculoskeletal discomfort caused by the gestational process.

Herbal Medicine Hewei Jiangni Decoction Is Noninferior to Oral Omeprazole for the Treatment of Nonerosive Gastroesophageal Reflux Disease: A Randomized, Double-Blind, and Double-Dummy Controlled Trail.

Objectives Conventional approaches for patients with nonerosive gastroesophageal reflux disease (NERD) were not satisfactory. This study aimed to evaluate the effectiveness and mechanisms of Chinese herbal medicine Hewei Jiangni Decoction (HWJND) as a novel and promising regimen for NERD. Methods A total of 128 patients with NERD were randomly assigned to the Treatment group and Control group. The patients from the Treatment group were administered HWJND (81 g) plus dummy omeprazole (20 mg) daily for 8 weeks, and the others were given dummy HWJND granules (81 g) plus omeprazole (20 mg). The clinical efficacy was assessed using the gastroesophageal reflux disease questionnaire (GERD-Q) scale, patient reported outcomes (PRO) scale, and short form health survey 36 (SF-36) scale at week 4. Moreover, its pharmacological and molecular mechanisms were elucidated based on network pharmacology and molecular docking. Results Due to case shedding and other reasons, 109 patients, including 56 in the Treatment group and 53 in the Control group completed this study. Our results showed that HWJND significantly improved heartburn, regurgitation, epigastric pain, nausea, and sleep disturbance, which led to a significant reduction of GERD-Q scores in NERD patients. In addition, PRO scores of NERD patients with HWJND administration were improved, and sufficient relief of physical role, body pain, general health, social function, and mental health on the SF-36 scale was also observed in patients after HWJND treatment. We further showed that the curative effect of HWJND was close to that of omeprazole, except for the better improvement of general health and social function. What's more, the main active ingredients of HWJND included quercetin, beta-sitosterol, naringenin, baicalein, and kaempferol were retrieved, and the protective effects of HWJND against NERD may be closely related to targets such as TNF, IL6, IL1B, MMP9, CXCL8, and EGFR, which were mainly enriched in IL-17 signaling pathway and TNF signaling pathway. Conclusion Our findings demonstrate that HWJND is noninferior to oral omeprazole for the treatment of patients with NERD, plays a therapeutic role through multiple targets and diverse pathways, and holds promise for complementary and alternative therapy for the treatment of NERD. This trial is registered with http://www.chictr.org.cn, Chinese Clinical Trials Registry [ChiCTR2200055960].

Which Factors Are Considered by Patients When Considering Total Joint Arthroplasty? A Discrete-choice Experiment.

Which Factors Are Considered by Patients When Considering Total Joint Arthroplasty? A Discrete-choice Experiment.

'Is there anything wrong with my teeth and gums?' The challenges of the dental examination and care planning.

Patients attend dental professionals with the aim of improving the quality of their lives; they want to be healthier or healthy. This may range from the relief of physical pain, discomfort, or reduced function, to managing the emotional distress of dissatisfaction with appearance. Health, according to the World Health Organisation, is 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', and oral health therefore becomes an essential component of this definition. To meet these aims, dental practitioners should be concerned with the desires and expectations of their patients, as well as their clinical needs. To achieve this, a wide range of knowledge and skills must be employed to first make a diagnosis, then by making clinical decisions to arrive at a care plan that is appropriate for each individual patient and yet remains within the scope of practice as determined by the General Dental Council. Each stage of the interaction between provider and patient - examination care planning, and disease management - presents physical, clinical and ethical challenges. Further, having established the status of the soft and hard tissues, decisions must be made as to whether it is appropriate to leave the patient with some level of disease process or impairment of function rather than attempt to eliminate it entirely. Enhancements, the ever-increasing demand for cosmetic dentistry, and the tension that is created between the desire of the patient and the clinical, moral and ethical obligations of the practitioner, challenge the dentist not to transition from being a professional into the world of commercialism. This article addresses these challenges.

Экзистенциальная терапия шумерско-аккадской цивилизации: чему учит опыт предков?

Therapy of existential distress of incurable patients is no less important task of palliative medicine than, in fact, relief ofphysical pain. At the same time, the unreliability of the means used in this field, noted by experts, forces us to pay attention to their al-ternative in the form of psychedelics-entheogens, whose therapeutic potential, judging by the content of world mythology, was well known to our distant ancestors. The research of this storehouse of information about the historical experience of mankind could explain a lot about the "historical amnesia" of society in relation to these substances, and perhaps change something in the current campaign for the benefit of the dying. Aim: to investigate the reason for the prohibition of the archaic practice of using entheogens and to find out the source of modern thanatophobia on the model of the first high civilization of Sumer and Akkad in human history.Methods: Analysis of literary sources, the historical method, a systematic approach.Results: The role of the use of entheogens in the therapy of thanatophobia is determined. The destructive influence on the produc-tion sphereof the archaic tradition of free access to these substances within the cult, which threatened the very existence of civilization, is proved.Conclusion: The proposed brief analysis of the well-known plot of Mesopotamian mythology "The Flight of Etana" allows us to see in it literary and artistic evidence of the effectiveness of the archaic tradition of using entheogens as a means of thanatophobia ther-apy. At the same time, the contradictory nature of the influence of this practice on the spiritual, psychological and socio-economic foundations of the Sumerian-Akkadian civilization is revealed, the reason for the objective-historical ban on the use of entheogens is explained, with an illustration of the existential consequences of this event for the population of the Mesopotamia.

Physical Activity as Prediction of Functional Ability among Elderly

Aim: Falling can have serious consequences for older persons, but fear of falling is also a current problem. The aim of the study is to assess the incidence of falls and fear of falling among older adults, as well as to study the connection of falls and fear of falling with functional ability, body mass index (BMI) and age.Methods: The participants of this study are older persons ( > 60 years) who live in the city of Rijeka, are mobile and have no symptoms of dementia. The relationship between falls, fear of falling, body mass index (BMI) and functional ability was measured using various indicators. Assessment of physical functioning and pain relief was made using the COOP/WONCA questionnaire. Falls and fear of falling were assessed using questions with different response options.Results: The results of the study showed that participants who reported experiencing fear of falling (FoF) had a higher BMI (p = 0.018) and did not feel physically healthy (70%). Participants who lived with a partner reported experiencing FoF at a lower rate (36.4%). The most frequently reported functional problems were visual problems (46.2%) and walking difficulties (40.0%).Conclusions: A large percentage of older persons struggle with the effects of aging, which include various health problems that can increase the risk of falling and FoF. Prescription of physical activity and engaging in it could improve functional ability and have an important effect on healthy aging. This could be the starting point from which key stakeholders can plan different types of public health interventions, prescribing physical activity to maintain functional ability that enables well-being in old age.

Application areas and effects of aquatic therapy WATSU – A survey among practitioners

IntroductionWATSU (WaterShiatsu) is a treatment administered in warm water. The present study investigated if and how frequently scientifically studied application areas and effects of WATSU occur in practice, whether similar effectiveness of WATSU is observed in trials and practice, and whether practitioners can contribute additional application areas and effects of WATSU. MethodsApplication areas and effects of WATSU reported in a recent systematic review were extracted verbatim to be assessed in a worldwide multilingual cross section online survey, generating quantitative and qualitative data. A pre-test and retest were conducted to ensure quality and evaluate the questionnaire's psychometric properties. ResultsAnswers of 191 respondents were processed. All proposed 26 application areas and 20 effects were confirmed, each with relatively high ratings of observed effectiveness of WATSU. WATSU was frequently applied in healthy individuals (including during pregnancy), and individuals in various pain- (e.g., low back pain, neck pain, myofascial pain, fibromyalgia) and stress-related (e.g., stress, depression, sleep disorders, fatigue, anxiety disorders) conditions. Frequently confirmed effects were physical relaxation, relief of physical tension, pain relief, increased mobility and flexibility, improved quality of life, spiritual experiences, and increased psychological health. Respondents contributed 73 additional application areas and effects (both, mental and physical) of WATSU. ConclusionsApplication areas and effects of WATSU are consistently employed practically and scientifically. Respondents’ ratings of effectiveness of WATSU match tentative research efforts. WATSU is cautiously recommended for the use in pain- and stress-related conditions. Short- and long-term effectiveness of WATSU need to be evaluated in high level intervention studies.

Clinical and Biomarker Predictors for Avascular Necrosis in Sickle Cell Disease

IntroductionSickle cell disease (SCD) affects 1 in 365 African Americans and approximately 25 million people world-wide. A common skeletal system complication is avascular necrosis (AVN), which can cause substantial pain and a reduced quality of life. While early management of AVN is focused on increasing range of motion with physical therapy and pain relief, there are no clear predictors for who is more likely to develop AVN and earlier institution of these preventive measure could help decrease disease progression. Vascular endothelial growth factor (VEGF) is a biomarker of endothelial injury and may indicate reduced vascular supply to the femoral or humeral head. Here we describe potential risk factors and biologic pathways for AVN in SCD, as understanding these may lead to improvements in future monitoring, early detection, and early intervention practices.MethodsWe investigated clinical and laboratory risk factors associated with AVN in a cohort of 435 SCD patients from our center. Blood samples, clinical, and laboratory data were collected at the time of enrollment during a clinic visit. Genotyping for alpha thalassemia was performed by PCR and the serum concentration of VEGF was measured by ELISA. AVN status was confirmed by review of the medical record and available imaging. We conducted a cross-sectional analysis comparing categorical and linear variables by AVN status using the chi-square and Kruskal-Wallis test, respectively. The independent association of the clinical and laboratory variables with AVN status was determined by logistic regression analysis. The initial model included variables with a P-value < 0.1 on univariate analysis and the final model was ascertained by stepwise forward and backward selection. Median values and interquartile range (IQR) are provided.ResultsThe median age of the cohort was 32 (IQR, 24 - 43) years, 57% (250/435) were female, and 46% (198/435) were on hydroxyurea. AVN was observed in 34% (149/435) of SCD patients. SCD patients with AVN were older, had more frequent vaso-occlusive crises requiring medical attention, and had a higher body mass index (Table I) (P ≤ 0.002). We measured VEGF in 241 of the SCD patients with serum samples available at the time of enrolment. Serum VEGF concentrations trended higher in SCD patients with versus without AVN (420 vs. 359 pg/mL, respectively; P = 0.078). In the multivariate analysis model, AVN was independently associated with increased number of vaso-occlusive crises (OR 1.1, 95% CI: 1.0 - 1.14; P = 0.02), AST concentration (natural log OR 0.5, 95% CI: 0.2 - 0.9; P = 0.03), VEGF concentration (natural log OR 1.4, 95% CI: 1.0 - 1.9; P = 0.047), and tobacco use (OR 1.9, 95% CI: 0.9 - 3.7; P = 0.078).DiscussionIn conclusion, we demonstrate a high prevalence of AVN in an adult cohort of SCD patients. The presence of AVN was independently associated with a greater frequency of vaso-occlusive pain episodes, which may demonstrate a shared pathophysiology between AVN and vaso-occlusion that merits further investigation. We demonstrate that serum VEGF concentrations are higher in SCD patients with AVN and may be a clinical tool to identify those at high-risk and for earlier intervention for this complication. [Display omitted] DisclosuresGordeuk: Modus Therapeutics: Consultancy; Novartis: Research Funding; Incyte: Research Funding; Emmaus: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; CSL Behring: Consultancy. Saraf: Pfizer: Research Funding; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Factors associated with health-related cannabis use intentions among a community sample of people who inject drugs in Los Angeles and San Francisco, CA 2016 to 2018

ObjectiveCannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute. MethodsData come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016−18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute. ResultsThe most common cannabis use motivations reported by people who inject drugs was to “get high,” relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use. ConclusionPeople who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.

Aerobic capacity and fatigability are associated with activity levels in women with hip osteoarthritis.

Physical activity is important for physical function and pain relief in people with lower extremity osteoarthritis (OA). Unfortunately, people with OA are not as active as their peers without OA. The objective of this study was to determine whether aerobic capacity and fatigability are associated with physical activity in women with hip OA. We conducted a cross-sectional analysis of 36 women with hip OA. We assessed aerobic fitness as predicted VO2 max from a 6-minwalk test. We assessed fatigability using a treadmill test. Finally, we assessed self-reported physical activity using the UCLA activity scaleand quantified steps per day and activity intensity using accelerometers. We used Pearson correlations to determine associations. We used regression analysis to determine whether fatigability mediated the association between aerobic fitness and physical activity. On average, subjects were moderately active via the UCLA score (5.2 ± 1.3 out of 10). Aerobic fitness (R = 0.582, p < .001) and fatigability (R = 0.516, p =.003) were significantly correlated with UCLA scores. However, aerobic fitness was the best predictor of UCLA scores, as well as sedentary time,and time spent in light activity. Fatigability was not a mediator between aerobic fitness and UCLA scores. Aerobic fitness and fatigability may be modifiable barriers to physical activity in people with OA. Future interventional studies should examine whether improving aerobic fitness improves physical activity or fatigability.

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register.

Patient-reported outcome measures (PROMs) after total hip arthroplasty (THA), can be influenced by patient characteristics (case-mix factors). We used the Dutch Arthroplasty Register (LROI) to determine the effect of case-mix on improvement of PROMs after primary THA. We included all primary THAs (n = 22,357) performed in the Netherlands between 2014 and 2018. The Hip disability and Osteoarthritis Outcome Score Physical function short form (HOOS-PS), Oxford Hip Score (OHS), EQ-5D index score and thermometer, and Numeric Rating Scales (NRS) measuring pain during activities and at rest, were recorded. The difference between preoperative and 3- and 12-month postoperative scores was calculated (delta-PROM) and used as primary outcome variable. Multivariable linear regression was used to examine the association between patient characteristics (age, sex, ASA score, body mass index (BMI), Charnley class, smoking, and previous operations to the affected hip) and PROMs. Cohens' d was used to measure effect size. Postoperative improvement (delta-PROM) on HOOS-PS, OHS, EQ-5D, and pain relief were significantly higher in patients <60 years, in patients with female gender, a high ASA score (III-IV), a BMI >30 kg/m2, and patients without a previous operation to the hip. Cohen's d indicated clinically small differences (0.2). Patients benefiting most in terms of postoperative improvement of self-reported physical functioning, pain relief and quality of life after primary THA were young, female, with a high ASA or BMI score, and without previous operations to the hip.

Enhanced recovery after cesarean delivery: a challenge for anesthesiologists.

Enhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.

Accolade TMZF trunnion corrosion and mechanical failure 9 yr after primary surgery: A case report and treatment options

Accolade TMZF trunnion corrosion and mechanical failure 9 yr after primary surgery: A case report and treatment options