Treatment Outcome Measures Research Articles

Effectiveness of Virtual Reality on Rehabilitation of Chronic Non-Specific Low Back Pain Patients.

Virtual reality (VR) is used extensively for musculoskeletal conditions, but its efficacy in chronic low back pain still needs more investigation. To discuss the effectiveness of VR on selected outcomes in Chronic Non-Specific Low Back Pain (CNSLBP). Thirty-five patients with CNSLBP joined this study. Postural correction exercises using the TBed VR gaming system in addition to hamstring stretching were employed, and moist heat on the low back was applied. Pre- and post-intervention values of pain, ROM, function, and balance (overall stability index) were obtained using the numerical rating pain scale (NPRS), Oswestry Disability Index, back range of motion (BROM), and Biodex system. Satisfaction level on a 1-10 scale and the degree of commitment to the exercise sessions were assessed after the intervention. The patients completed the intervention period and outcome measures sessions. Paired t-tests reported statistically significant improvements and high effect size in pain, ROM, function, and balance after the end of the treatment (p < 0.001, Cohen's d > 0.69). The level of satisfaction was 9.25 ± 0.766, and the commitment to exercise sessions was high (98.75% attendance rate). Applying postural correction using TBed VR gaming in addition to heat and stretching may improve pain, range of motion, function, and balance in patients with chronic low back pain.

Occupational therapists views on GAS-light as an outcome measure in community adult mental health

PurposeThe paper aims to gain understanding of perceived benefits and barriers to GAS-light as an occupational therapy outcome measure in community adult mental health. The study explored occupational therapists’ views on the client-centred nature of GAS-light and whether it is an applicable outcome measure for group intervention. It also aimed to understand how occupational therapists use of GAS-light informed their practice and the wider multidisciplinary team perspective.Design/methodology/approachThe study used a phenomenological design. This comprising of a focus group of occupational therapists experienced in using the tool, followed by framework analysis. Focus group questions were derived from literature.FindingsThree main themes were identified to reflect experiences relating to the GAS-light tool as an outcome measure; value in process, occupational narrative and language and expertise.Practical implicationsThe paper is indicative of practical implications regarding the use of the GAS-light tool with community mental health clients and therapists, including the perceived value in the process, the language used by the therapist and level of expertise.Originality/valueThis paper fulfils an identified need to contribute towards an evidence base for occupational therapy and mental health.

Virtual reality and functional training effect on contractile properties of lower leg muscles and postural stability

Purpose. Tensiomyography is a noninvasive and reliable method to identify the differences in skeletal muscle responses. Poor lower leg muscles cause poor postural stability, leading to the risk of injury in athletes. The study aims to investigate the aftereffect of a six-week virtual reality environment and functional training program on the contractile properties of lower-leg muscles and postural stability index. Material and methods. A comparative pre-test and post-test study design was selected for this study. Twenty-four male athletes were taken part in the study. The participants were randomly divided into a virtual reality intervention-training group (n=12) or a functional training group (n=12). The virtual reality environment training was provided using the CAREN integrated virtual reality system with a D-flow application from Motek. Functional training for static and dynamic postural stability was performed with various open and closed-eye exercises in the physical therapy lab. The contractile properties of lower-leg muscles were measured using tensiomyography. The postural stability index was assessed using a stadiometer. The assessments were performed before and after six weeks of training. A paired sample t-test was used to determine differences between pretest and posttest intervention outcome measures, and sample t-test was also applied to determine differences between groups after six weeks of training. Results. Results indicated significant differences between pretest and posttest measurement in virtual reality training group for displacement (t=2.81, p=.043), (t=-6.92, p=&lt;.001) in gastrocnemius lateral and medial muscle respectively, and sustain time (t=2.29, p=.042) in souls muscle. The postural stability with close eye was significant (t=2.61, p=.024). The functional training group showed significant differences for sustain time (t=-18.86, p=&lt;.001) in gastrocnemius lateral, and relaxation time (=3.24, p=.008), delay time (t=3.07, p=.011), and sustain time (t=-19.74, p=&lt;.001) in gastrocnemius medial, and sustain time (t=3.17, p=.009) in souls muscle. The postural stability was having insignificant differences. Conclusion. The virtual reality environment and functional training, help to improve performance, and tensiomyography could be used to assess and evaluate the parameters that could be helpful for optimizing training load in the performance enhancement process of athletes.

The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial.

To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. gov identification number: NCT05456555.

Harnessing cell-free orphan non-coding RNAs as a predictive measure of long-term survival in neoadjuvant breast cancer therapy.

585 Background: Pathologic complete response (pCR) is a valuable metric for predicting survival following neoadjuvant therapy (NAT) in breast cancer; however, blood-based biomarkers may refine the prediction of treatment outcomes and inform follow-up treatment decisions. Orphan non-coding RNAs (oncRNAs) are a novel category of small RNAs that are present in tumors and largely absent in healthy tissue. Here, we explore the feasibility of a tumor-naive oncRNA-based liquid biopsy assay for predicting distant recurrence-free survival (DRFS) in breast cancer patients using a standard blood draw. Methods: Our cohort included 538 high-risk breast cancer patients from the multicenter I-SPY2 trial having serum available after NAT and before surgery (timepoint T3). Of the 538 patients (mean age: 48.8 ± 10.3), 191 (36%) achieved pCR. We isolated small RNA from 0.8 mL of patient serum and sequenced it at an average depth of 50 million 100-bp single-end reads. We used our catalog of tumor-derived oncRNAs, discovered in The Cancer Genome Atlas, to develop an AI model for predicting tumor burden based on tumor size. Our AI model was trained on oncRNA profiles from an independent cohort of 719 serum samples collected at diagnosis from individuals with cancer. We assessed tumor burden by oncRNA in the I-SPY2 cohort at T3 and associated this measure with DRFS using robust cutpoints established for each of the two pCR groups: high- ( n=70) and low-burden ( n=468) cutpoints were verified through cross-validation and almost all folds converged on a single value, which we used in our analysis. Results: The continuous oncRNA-derived tumor burden at T3 had a hazards ratio (HR) of 2.4 (95% CI: 1.1–5.1) for predicting DRFS. This measure remained significant in multivariate Cox models that included pCR (HR = 2.7 [1.3–5.6]) or residual cancer burden (RCB II/III versus 0/I; HR = 3.4 [1.6–7.1]). Patients with pCR had a 3-year DRFS of 94%; patients with pCR having low ( n=180) versus high ( n=11) oncRNA burden resulted in 95% and 73% 3-year DRFS, respectively (HR = 7.4 [2.3–24]). Those without pCR had a 3-year DRFS of 78% and stratification by oncRNA burden resulted in 85% and 71% 3-year DRFS for the low ( n=288) and high ( n=59) burden groups, respectively (HR=2.4 [1.5–3.9]). Importantly, we saw no restricted mean survival time difference (RMST) at 3 years between those with and without pCR among the high oncRNA burden group (0.1-month difference, p=0.97). Conclusions: We demonstrate the utility of a tumor-naive, oncRNA-derived tumor burden AI model as a predictive measure of treatment outcome and as a prognostic biomarker that can be used in addition to pCR to further stratify patients as low or high risk of recurrence. Integration of our oncRNA assay with existing biomarkers and clinicopathologic variables, has the potential to add value for predicting outcomes and prioritizing patients that would benefit from additional care.

Examining patient reported outcome measures for phantom limb pain: measurement use in a sample of Veterans with amputation

Purpose Phantom limb pain (PLP) is treated with medications and non-drug treatments. Best clinical practices for measuring treatment outcomes have not been defined. The objective of this study was to evaluate the internal consistency of patient-reported outcomes measures (PROMs) in a sample of Veterans with lower limb amputation. Materials and Methods The Veteran phone survey included administering PROMs [1) PLP numeric rating scale (NRS), 2) general pain NRS, 3) Pain, Enjoyment, and General Activity (PEG) scale, 4) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form 6b Replacement, 5) PROMIS Short Form Depression 4a and 6) PROMIS Short Form Anxiety 4a]. Results Fifty Veterans (48 male, 2 female; average age: 66 years) completed PROMs. In our sample, 40 Veterans (80%) experienced PLP with an average PLP NRS of 5 (±3.4). Internal consistency of each measure was good to excellent based on Cronbach’s alpha co-efficient of >0.80. Correlations were moderate between PLP NRS and all other measures (≤0.32). Although many Veterans expressed bothersome PLP, the scores reflecting pain interference and impact on function were lower than pain intensity. Consistent use of outcome measures is needed to determine the effect of interventions for amputation-related pain.

Exploring the use of co-speech hand gestures as treatment outcome measures for aphasia

ABSTRACT Background Research on aphasia treatments that directly target conversation skills have been on the rise in the recent past. Despite the ubiquitous nature of gestures in everyday conversations and their possible compensatory and/or supportive functions for adults with aphasia, the conversational treatment outcome measures continue to rely on spoken language alone. Aims We aimed to explore the feasibility of using co-speech hand gestures as a treatment outcome measure in Clyde, an individual with chronic and severe Wernicke’s aphasia. Methods & Procedures Using a multiple-probe single-case experimental research, we examined data from one participant with aphasia (Clyde) who was a part of a larger study involving 3 people with aphasia (Devanga, 2020). 10-minute conversations between Clyde and clinician, and Clyde and his spouse, were completed during 3 baseline probes, 3 treatment probes and 3 maintenance probes. Clyde also completed a 15-session Collaborative Referencing Intervention (CRI; Devanga etal., 2021) with the clinician. The 18 conversation samples were videorecorded, transcribed, and analysed. Outcomes & Results The outcomes analysed included overall gesture frequency and type (i.e., referential vs. non-referential) across sessions (baseline – treatment – maintenance) and partner familiarity (clinician – spouse). We also compared the gesture outcomes with the spoken language measure, CIUconv (Correct Information Units). Overall gesture frequency was higher with the clinician than the spouse, and the frequency of referential gestures were higher than the non-referential gestures with both partners. With the onset of treatment, we found that overall gesture frequency decreased and #CIUconv increased with the clinician, however there were minimal variations across phases with the spouse. Additionally, with the onset of treatment, referential gestures decreased, and non-referential gestures increased with both partners. Conclusions Findings from this exploratory study provide preliminary support to using co-speech hand gestures as treatment outcome measures for aphasia. Clinical implications including comparisons of gestural outcomes with spoken language outcomes and their implementation are discussed. Further research on differences in gesture use among aphasia types and severities and patterns of change in gesture use with aphasia treatment is warranted.

The Development of a European Multidisciplinary Cleft Lip and Palate Registry by the European Reference Network CRANIO: Experiences, Barriers, And Facilitators.

The European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders aims to improve care for patients with such afflictions, including cleft lip and palate (CL/P) across Europe. Cleft treatment remains varied throughout European centers, inhibiting meaningful comparison of treatment outcomes. To overcome these issues, a European-wide common CL/P dataset and registry was developed, facilitating standardized treatment endpoints and outcome measures for international comparison and benchmarking of CL/P centers. Questionnaires and semi-structured interviews were used to determine the set-up of the registry. Previous CL/P initiatives were analyzed to create an initial dataset, refined through consensus meetings. In total, 87 cleft specialists working in specialized CL/P centers from 16 European nations participated. Consensus on a common dataset was reached. A "Level 1" dataset, with mandatory clinical and patient-reported outcome measures, and "Level 2" dataset with additional outcome measures. Finally, 2 dashboards were developed for data dissemination. The development of the European CL/P common dataset and registry tackled challenges with resource disparities, variations in specialists within CL/P teams, regulatory differences in patient data usage, patient-reported outcome measures availability in European languages, and use of assessment tools. This study described the successful development of the European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders CL/P common dataset and registry. This achievement will help improve patient care and outcomes for patients with CL/P in Europe. Furthermore, this study provides useful information for initiatives with similar aims.

H-Wave® Device Stimulation for Chronic Neck Pain: A Patient-Reported Outcome Measures (PROMs) Study.

Chronic neck pain (cNP) is one of the leading causes of disability worldwide, often being refractory to conventional forms of treatment. Various forms of electrical stimulation have been proposed to decrease pain and improve function. Patient-reported outcome measures (PROMs) for treatment of cNP have rarely been published. An independent retrospective statistical analysis of PROMs data for users of H-Wave® device stimulation (HWDS), prospectively collected by the device manufacturer over a 4-year period, was conducted. Final surveys for 34,192 pain management patients were filtered for pain chronicity limited to 3-24months and device use of 22-365days, resulting in 11,503 patients with "all diagnoses"; this number was further reduced to 1482 patients with cNP, sprain, or strain. Neck pain was reduced by 3.13 points (0-10 pain scale), with significant (≥20%) relief in 86.6%. Function/activities of daily living (ADL) improved in 96.19%, while improved work performance was reported in 84.76%. Medication use decreased or stopped in 65.42% and sleep improved in 60.39%. Over 95% reported having expectations met or exceeded, service satisfaction, and confidence in device use, while no adverse events were reported. Subgroup analyses found positive benefit associations with longer duration of device use. Near-equivalent outcomes were self-reported by cNP HWDS patients as for (previously published) chronic low back pain (cLBP) patients. HWDS provided effective and safe cNP relief, improvements in function and ADL, along with additional benefits including decreased medication use, better sleep, and improved work performance.

Electrophysiological Correlates of Dentate Nucleus Deep Brain Stimulation for Poststroke Motor Recovery.

While ipsilesional cortical electroencephalography has been associated with poststroke recovery mechanisms and outcomes, the role of the cerebellum and its interaction with the ipsilesional cortex is still largely unknown. We have previously shown that poststroke motor control relies on increased corticocerebellar coherence (CCC) in the low beta band to maintain motor task accuracy and to compensate for decreased excitability of the ipsilesional cortex. We now extend our work to investigate corticocerebellar network changes associated with chronic stimulation of the dentato-thalamo-cortical pathway aimed at promoting poststroke motor rehabilitation. We investigated the excitability of the ipsilesional cortex, the dentate (DN), and their interaction as a function of treatment outcome measures. Relative to baseline, 10 human participants (two women) at the end of 4-8 months of DN deep brain stimulation (DBS) showed (1) significantly improved motor control indexed by computerized motor tasks; (2) significant increase in ipsilesional premotor cortex event-related desynchronization that correlated with improvements in motor function; and (3) significant decrease in CCC, including causal interactions between the DN and ipsilesional cortex, which also correlated with motor function improvements. Furthermore, we show that the functional state of the DN in the poststroke state and its connectivity with the ipsilesional cortex were predictive of motor outcomes associated with DN-DBS. The findings suggest that as participants recovered, the ipsilesional cortex became more involved in motor control, with less demand on the cerebellum to support task planning and execution. Our data provide unique mechanistic insights into the functional state of corticocerebellar-cortical network after stroke and its modulation by DN-DBS.

Opportunities to optimise care and choice in joint replacement surgery using a digitally delivered, holistic PreHab pathway.

To describe the implementation and evaluation of a hospital-initiated, community-based, digital prehabilitation program (My PreHab Program: MPP) for adults referred for elective joint replacement. MPP was implemented July 2022 and comprises a personalised digital health screen that guides the provision of self-management resources. Adults (>18years) referred and accepted, or already waitlisted, for total knee/hip replacement surgery were eligible. Individuals requiring category 1 (urgent) or emergency surgery and those without a mobile phone were excluded. Implementation and intervention outcome measures (program adoption, equity of reach, fidelity, acceptability, appropriateness, feasibility, engagement, preliminary surgical outcomes) were explored via study-specific measures and hospital records. Of those invited (N = 689), 77.8% participated. Participants and non-participants were similar in key demographic variables except regional invitees were more likely to participate than metropolitan (88.0% vs 75.4%, p = .002) and non-participants tended to be older (median age = 69.0 vs 64.0, p = .005). Participants reported on average four modifiable risk factors: most commonly chronic pain (79.1%), obesity (57.3%), and frailty (40.9%). Most participants (80.4%) reviewed all resources provided and reported action/intention to address issues identified (90.9%). Participants perceived MPP as acceptable (3.2/5), appropriate (3.3/5), and feasible (3.4/5). Early trends for participants progressing to surgery (n = 33) show a reduced length of stay (MPP = 4.3, baseline = 5.3 days). MPP demonstrated high adoption, fidelity, and participant engagement. It is acceptable, appropriate and feasible and has the potential to be scaled-up digitally at low-cost. Modifiable risk factors were prevalent and early indications suggest this preoperative intervention may benefit both patients and the healthcare system.

Exploring Aromatherapy as a Complementary Approach in Palliative Care: A Systematic Review.

Background: Palliative care, a cornerstone of comprehensive healthcare, prioritizes quality of life for individuals with life-threatening illnesses. Aromatherapy, with its holistic approach and patient-reported benefits, emerges as a promising complementary therapy for managing symptoms and enhancing well-being in palliative care. Objective: The objective of this systematic review is to assess the efficacy of aromatherapy interventions in symptom management, with a focus on pain, anxiety, nausea, and sleep disturbances among palliative care patients. Design: A comprehensive search was conducted across various databases to identify relevant studies. Eligibility criteria were applied, resulting in the inclusion of eight studies for analysis. The review assessed the efficacy of aromatherapy interventions, primarily through massage, in symptom management. Variations in intervention procedures and outcome measures were noted, necessitating a critical examination of the findings. Results: The review's findings suggest promising outcomes associated with aromatherapy in palliative care. Aromatherapy interventions demonstrated significant efficacy in reducing pain, anxiety, nausea, and improving sleep quality among patients. However, considerable heterogeneity was observed across studies, highlighting the need for standardized methodologies and larger-scale trials. Conclusion: This systematic review underscores the potential of aromatherapy as a complementary intervention in palliative care. While the findings support its efficacy in symptom management, methodological inconsistencies across studies warrant further research. Standardized approaches and larger trials are essential to validate the tailored effectiveness of aromatherapy for different symptoms encountered in palliative care, ultimately enhancing its clinical utility and integration into therapeutic practices.

Differential effects of sertraline and cognitive behavioural therapy on behavioural inhibition in patients with obsessive compulsive disorder.

Patients with obsessive compulsive disorder (OCD) randomised to sertraline, manualised cognitive behavioural therapy (CBT), or combination (sertraline + CBT), underwent cognitive assessment. Cognitive testing was conducted at baseline and at week 16. The stop signal reaction time task (SSRT) was used to evaluate motor impulsivity and attentional flexibility was evaluated using the intra/extra-dimensional set shifting task. Paired-samples t -tests or nonparametric variants were used to compare baseline and posttreatment scores within each treatment group. Forty-five patients were tested at baseline (sertraline n = 14; CBT n = 14; sertraline + CBT n = 17) and 23 patients at week 16 (sertraline n = 6; CBT n = 7; sertraline + CBT n = 10). The mean dosage of sertraline was numerically higher in those taking sertraline as a monotherapy (166.67 mg) compared with those taking sertraline in combination with CBT (100 mg). Analysis of pre-post treatment scores using an intent-to-treat-analysis found a significant reduction in the SSRT in those treated with sertraline, whilst there was no significant change on this task for those treated with CBT or the combination. This study found that motor inhibition improved significantly following sertraline monotherapy. Suboptimal sertraline dosing might explain the failure to detect an effect on motor inhibition in the group receiving combination of sertraline + CBT. Higher dose sertraline may have broader cognitive effects than CBT for OCD, motor impulsivity may have value as a measure of treatment outcome and, by extension, the SSRT could serve as a biomarker for personalising care.

Revisiting Eye Movement Desensitization and Reprocessing Therapy for Post-traumatic Stress Disorder: A Systematic Review and Discussion of the American Psychological Association's 2017 Recommendations.

This literature review evaluates the efficacy and clinical applications of eye movement desensitization and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD). The review highlights the effectiveness of EMDR in reducing PTSD symptoms and explores variations in treatment protocols, populations studied, and outcome measures. We conducted systematic searches of multiple databases, supplemented with manual searches and reference list exploration. The inclusion criteria focused on English-language studies published between January 2000 and June 2023, with a specific emphasis on adult psychiatric patients with PTSD receiving EMDR treatment. The review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for narrative literature reviews. Out of 867 identified studies, 16 met the eligibility criteria. Most studies found that EMDR was superior in relieving PTSD when compared to controls. Eleven of the 16 selected studies demonstrated improvement in PTSD symptoms. An additional three studies noted an improvement in PTSD symptoms when compared to their waitlist control counterparts. One study found EMDR superior in combating depressive symptoms when compared to rapid eye movement desensitization. EMDR therapy is an appropriate treatment for PTSD. Although some studies compared to waitlist controls, and others have a small number of participants, the data supports the use of EMDR for PTSD. Future studies are needed to continue to better understand the mechanism and application in different populations.

Efficacy of arm crank ergometry on individuals with spinal cord injury: A systematic review of randomized controlled trials.

To investigate the efficacy of arm crank ergometry (ACE) on physical, psychological, and quality of life outcomes in individuals with spinal cord injury (SCI). A comprehensive search was conducted on PubMed, Scopus, MEDLINE, Physiotherapy Evidence Database (PEDro), Web of Science, REHABDATA, and Embase from inception until July 2023. Studies were included if the sample was composed of individuals with SCI, the intervention followed an ACE intervention, and the study was a randomized controlled trial including at least one outcome measure evaluating physical, psychological, or quality of life. The PEDro scale was used to assess the methodological quality of the included studies. The meta-analysis was not feasible due to the heterogeneity in the treatment protocols and outcome measures among the selected studies. Of 1013 articles, seven studies (n = 200), with 16% of participants being female, were included in this review. The scores on the PEDro scale ranged from 6 to 8, with a median score of 7. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The effects of the ACE interventions on physical, psychological, and quality of life outcomes showed inconsistency. ACE training proves to be a suitable and safe intervention for individuals with traumatic SCI. Nevertheless, the existing evidence concerning its effects on physical, psychological, and quality of life outcomes in individuals with SCI is limited. Further trials are required to investigate the effects of various ACE training protocols on SCI populations.

Maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: A one-year single-blinded randomized controlled trial.

The objective was to assess the one year implant treatment outcome and patient-related outcome measures (PROMs) following maxillary sinus floor augmentation (MSFA) with autogenous bone graft (ABG) from the zygomatic buttress (control) compared with 1:1 mixture of ABG and anorganic porcine bone mineral (APBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients (34 females, 26 males) were randomly allocated to either control or test groups. Outcome measures included survival of suprastructures and implants, implant stability quotient, health status of peri-implant tissue, peri-implant marginal bone loss, frequency of complications, and PROMs using Oral Health Impact Profile-14 combined with questionnaire assessing patient perception of peri-implant soft tissue, prosthetic solution, implant function, and implant treatment outcome using visual analogue scale. Mean differences were expressed with standard deviation and 95% confidence interval. Level of significance was .05. All suprastructures and implants were well-functioning after one year of functional implant loading. There was no significant difference between control and test groups in any of the applied outcome measures. The implant stability significantly increased from implant placement to abutment connection within all groups (p < .001). High patient satisfaction and significant improvement in oral health-related quality of life was also reported within all groups. This study demonstrates that MSFA with composite grafts containing minimal amounts of ABG reveals comparable implant treatment outcomes as compared with ABG alone, after one year of functional implant loading. Extensive ABG harvesting in conjunction with MSFA therefore seems not to be needed.

The mediating role of neuroimaging-derived biological brain age in the association between risk factors for dementia and cognitive decline in middle-aged and older individuals without cognitive impairment: a cohort study

Neuroimaging-based brain-age delta has been shown to be a mediator linking cardiovascular risk factors to cognitive function. We aimed to assess the mediating role of brain-age delta in the association between modifiable risk factors of dementia and longitudinal cognitive decline in middle-aged and older individuals who are asymptomatic, stratified by Alzheimer's disease pathology. We also explored whether the mediation effect is specific to cognitive domain. In this cohort study, we included participants from the ALFA+ cohort aged between 45 years and 65 years who were cognitively unimpaired and who had available structural MRI, cerebrospinal fluid β-amyloid (Aβ)42 and Aβ40 measurements obtained within 1 year of each other, modifiable risk factors assessment, and cognitive evaluation over 3 years. Participants were recruited from the Barcelonaβeta Brain Research Center (Barcelona, Spain). Included individuals underwent a first assessment between Oct 25, 2016, and Jan 28, 2020, and a follow-up cognitive assessment 3·28 (SD 0·27) years later. We computed brain-age delta and composites of different cognitive function domains (preclinical Alzheimer's cognitive composite [PACC], attention, executive function, episodic memory, visual processing, and language). We used partial least squares path modelling to explore mediation effects in the associations between modifiable risk factors (including cardiovascular, mental health, mood, metabolic or endocrine history, and alcohol use) and changes in cognitive composites. To assess the role of Alzheimer's disease pathology, we computed separate models for Aβ-negative and Aβ-positive individuals. Of the 419 participants enrolled in ALFA+, 302 met our inclusion criteria, of which 108 participants were classified as Aβ-positive and 194 as Aβ-negative. In Aβ-positive individuals, brain-age delta partially mediated (percent mediation proportion 15·73% [95% CI 14·22-16·66]) the association between modifiable risk factors and decline in overall cognition (across cognitive domains). Brain-age delta fully mediated (mediation proportion 28·03% [26·25-29·21]) the effect of modifiable risk factors on the PACC, wherein increased values for risk factors correlated with an older brain-age delta, and, consequently, an older brain-age delta was linked to greater PACC decline. This effect appears to be primarily driven by memory decline. Mediation was not significant in Aβ-negative individuals (3·52% [0·072-4·17]) on PACC, although path coefficients were not significantly different from those in the Aβ-positive group. Our findings suggest that brain-age delta captures the association between modifiable risk factors and longitudinal cognitive decline in middle-aged and older people. In asymptomatic middle-aged and older individuals who are Aβ-positive, the pathology might be the strongest driver of cognitive decline, whereas the effect of risk factors is smaller. Our results highlight the potential of brain-age delta as an objective outcome measure for preventive lifestyle interventions targeting cognitive decline. La Caixa Foundation, the TriBEKa Imaging Platform, and the Universities and Research Secretariat of the Catalan Government. For the Spanish translation of the abstract see Supplementary Materials section.

Quality of Life Assessment in Female Rheumatoid Arthritis Patients

IntroductionRheumatoid arthritis (RA) is a chronic inflammatory disease that significantly impacts patients’ quality of life (QOL), affecting both physical and mental well-being. QOL is predictive of morbidity and mortality, making its consideration increasingly important in treatment decisions.ObjectivesThis study aims to assess the Quality of Life in Female Rheumatoid Arthritis patients.Methods The study included 87 female patients with confirmed RA, diagnosed by an experienced rheumatologist based on the ACR 1987 or ACR/EULAR 2010 criteria. Quality of life was assessed using the World Health Organization Quality of Life assessment, short form (WHOQOL-BREF scale). The scoring ranged from 0 to 100 for each domain. Disease activity was assessed using the Disease Activity Score (DAS28), and functional disability was evaluated using the Health Assessment Questionnaire (HAQ).Results The study included 87 patients with a mean age of 54.7 ± 12.2 years and a mean disease duration of 12 ± 9.1 years. The majority of patients had a medium socioeconomic level (81.6%), and a low cultural level with 31% being illiterate, 6% attending university, and 76.9% unemployed. Regarding marital status, 74.7% were married. RA was erosive in 77% of patients, deforming in 68%, and 40% were seropositive (FR and/or anti-CCP). Extra-articular manifestations were present in 34.5% of patients. Sixty-seven patients (77%) were on disease-modifying antirheumatic drugs (DMARDs), with 67.8% on methotrexate. Eighteen percent were treated with biological agents. Corticosteroids were used by 47.1% of patients, while 12.6% used non-steroidal anti-inflammatory drugs, and 6.9% used both. Disease activity varied, with 9.2% having low activity, 43.7% moderate activity, and 24.1% high activity based on DAS28. The mean HAQ index was 1.1 ± 0.8, indicating moderate to severe disability for more than 60% of patients. The mean WHOQOL scores were substantially reduced in the physical health (43 ± 16.2), psychological health (50.3 ± 14.4), social relationships (51.5 ± 18.6), and environment domains (46.8 ± 15). There was a significant inverse correlation between HAQ and the physical health (r = −0.52, p &lt; 0.001), psychological (r = −0.57, p &lt; 0.001), social relationships (r = −0.37, p = 0.001), and environmental domains (r = −0.45, p &lt; 0.001) of QOL. There was no correlation between any domain of QOL and DAS28.ConclusionsPatients with RA experience reduced QOL across multiple domains, including physical function, mental health, and social relationships. Functional disability, as reflected by HAQ, is the most significant factor affecting QOL in RA. The WHOQOL-BREF should be considered a valid outcome measure for interventions aimed at improving the quality of life for people with rheumatoid arthritis.Disclosure of InterestNone Declared

Management of Persistent Postnasal Drip Without Sinus Affection

Persistent postnasal drip (PPND), characterized by chronic mucus sensation in the throat without evident sinus involvement, poses challenges in otolaryngology. This study aimed to evaluate low dose, long duration Clarithromycin’s efficacy in managing PPND symptoms, addressing the limitations of existing therapies. A prospective, randomized, controlled trial was conducted with 50 participants (18-65 years) diagnosed with PPND but without sinus pathology (proved by sinus clear CT Paranasal sinus scans). They received either Clarithromycin (250 mg daily) or a placebo for 12 weeks. Validated assessment tools, such as the nasal symptom score (NSS), visual analog scale (VAS), and Sino-nasal outcome test-22 (SNOT-22), measured treatment outcomes. Current therapies addressing associated symptoms exhibit limited efficacy, prompting the need for novel treatment strategies. The study revealed a significant improvement in PPND symptoms with low-dose, long-duration Clarithromycin treatment. Participants exhibited reduced throat-clearing frequency, cough episodes, and subjective mucus sensation. Objective assessments showed enhanced nasal pathology and mucociliary clearance post-treatment. Low-dose, long-duration Clarithromycin treatment demonstrated promising efficacy in ameliorating PPND symptoms and improving quality of life without sinus involvement. These findings emphasize the potential therapeutic role of macrolides in addressing PPND’s underlying pathophysiology. Further research, including larger trials, is essential to validate these outcomes and establish effective clinical guidelines for managing PPND.

A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research.

It is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians' and researchers' desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation. To use scoping review methodology to identify transcription-less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: 'What transcription-less tools and analysis procedures are available to assess discourse in people with aphasia?' and included several sub-questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties. The scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer-reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. 'Transcription-less' analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review. An overview of the state of transcription-less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings. Transcription-less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings. What is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech-language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription-less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients' desired outcomes. However, little is known about the current state of transcription-less discourse analysis, blocking progress. What this paper adds to existing knowledge This study provides an overview of currently available transcription-less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription-less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro-structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription-less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription-less procedures are lacking psychometric data including information about validity and reliability. What are the potential or actual clinical implications of this work? Transcription-less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription-less discourse analysis to better monitor clients' desired treatment outcomes.