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Journal of Shoulder and Elbow Surgery Aug 2022Distal biceps tendon rupture is a rare injury associated with decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high-demand... (Review)
Review
BACKGROUND
Distal biceps tendon rupture is a rare injury associated with decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high-demand patients like athletes.
PURPOSE
To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports.
METHODS
MEDLINE, Cochrane, Web of Science, and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until June 30, 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made.
RESULTS
Ten articles were identified, including 157 athletes. Mean age was 40.5 years, and the dominant arm was injured in 103 cases (66%). Rupture was acute in 121 athletes (77%), and the mean follow-up was 25.7 months. A hundred and fifty-three athletes (97.5%) successfully returned to sport within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 115 (73%) and suture anchor fixation in 52 (33%) cases. No postsurgical immobilization was reported in 38 (24%) and immobilization for 2 weeks in 124 (79%) athletes. Decreased supination-pronation and flexion-extension arc was found in 63 (40%) and 27 (17%) cases, respectively. Earlier return to sport was associated with nondominant-side (P = .007) and acute (P < .001) injuries, participation in weightlifting (P = .001), double-incision approach (P = .005), cortical button fixation (P < .001), and absence of supination-pronation restriction (P = .032). Time of return to sport activity was independent of rehabilitation, including immobilization (P = .539) and strengthening (P = .155), and decreased flexion-extension arc (P = .059).
CONCLUSION
Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport.
Topics: Adult; Arm Injuries; Athletes; Elbow; Humans; Range of Motion, Articular; Rupture; Tendon Injuries; Tendons; Treatment Outcome
PubMed: 35367620
DOI: 10.1016/j.jse.2022.02.027 -
Materials (Basel, Switzerland) Jan 2022This systematic review aims to highlight the differences between different clear aligner therapies that differ in the presence of attachments or in attachment... (Review)
Review
This systematic review aims to highlight the differences between different clear aligner therapies that differ in the presence of attachments or in attachment configuration. Eight electronic databases were searched up to March 2020. Two authors independently proceeded to study selection, data extraction, and risk of bias assessment. The analysis of the results was carried out examining six groups of movements (mesio-distal tipping/bodily movement; anterior bucco-lingual tipping/root torque; posterior bucco-lingual tipping/expansion; intrusion; extrusion; rotation). Five clinical trials were selected and all of them showed a medium risk of bias. Literature showed that attachments mostly increase the effectiveness of orthodontic treatment with clear aligners, improving anterior root torque, rotation, and mesio-distal (M-D) movement; they are also important to increase posterior anchorage. However, some articles showed contradictory or not statistically significant results. Attachments also seem to improve intrusion, but the evidence about this movement, as well as extrusion, is lacking. No studies evaluated posterior bucco-lingual tipping/expansion. Further clinical trials are strongly suggested to clarify the influence of attachments and their number, size, shape, and position on each orthodontic movement.
PubMed: 35057250
DOI: 10.3390/ma15020533 -
The Journal of Manual & Manipulative... Feb 2022To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF).
METHODS
An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF.
RESULTS
Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was -10.2 points (p = 0.02), the DASH was -9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3-7 days was -14.58 ml (p = 0.03), at 17-21 days -17.96 ml (p = 0.009), at 33-42 days -15.34 ml (p = 0.003), and at 63-68 days -13.97 ml (p = 0.002).
CONCLUSION
There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.
Topics: Exercise Therapy; Humans; Musculoskeletal Manipulations; Physical Therapy Modalities; Radius Fractures; Range of Motion, Articular
PubMed: 34668847
DOI: 10.1080/10669817.2021.1992090 -
Current Pain and Headache Reports Aug 2022Painful diabetic neuropathy (PDN) manifests with pain typically in the distal lower extremities and can be challenging to treat. The authors appraised the literature for... (Review)
Review
PURPOSE OF REVIEW
Painful diabetic neuropathy (PDN) manifests with pain typically in the distal lower extremities and can be challenging to treat. The authors appraised the literature for evidence on conservative, pharmacological, and neuromodulation treatment options for PDN.
RECENT FINDINGS
Intensive glycemic control with insulin in patients with type 1 diabetes may be associated with lower odds of distal symmetric polyneuropathy compared to patients who receive conventional insulin therapy. First-line pharmacologic therapy for PDN includes gabapentinoids (pregabalin and gabapentin) and duloxetine. Additional pharmacologic modalities that are approved by the Food and Drug Administration (FDA) but are considered second-line agents include tapentadol and 8% capsaicin patch, although studies have revealed modest treatment effects from these modalities. There is level I evidence on the use of dorsal column spinal cord stimulation (SCS) for treatment of PDN, delivering either a 10-kHz waveform or tonic waveform. In summary, this review provides an overview of treatment options for PDN. Furthermore, it provides updates on the level of evidence for SCS therapy in cases of PDN refractory to conventional medical therapy.
Topics: Diabetes Mellitus; Diabetic Neuropathies; Gabapentin; Humans; Insulins; Pregabalin; Spinal Cord Stimulation
PubMed: 35716275
DOI: 10.1007/s11916-022-01061-7 -
Revista Brasileira de Psiquiatria (Sao... 2021Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing...
OBJECTIVE
Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior.
METHODS
A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched.
RESULTS
Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors.
CONCLUSION
Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.
Topics: Adolescent; Adolescent Behavior; Child; Humans; Risk Factors; Risk-Taking; Sexual Behavior; Substance-Related Disorders; Suicidal Ideation
PubMed: 32756805
DOI: 10.1590/1516-4446-2019-0835 -
JAMA Network Open Apr 2020No consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing,... (Comparative Study)
Comparative Study Meta-Analysis
IMPORTANCE
No consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift.
OBJECTIVES
To compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults.
DATA SOURCES
The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures.
STUDY SELECTION
Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded.
DATA EXTRACTION AND SYNTHESIS
Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019.
MAIN OUTCOMES AND MEASURES
The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment.
RESULTS
A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (≤1 year) DASH score after operative treatment compared with nonoperative treatment (MD, -5.22 [95% CI, -8.87 to -1.57]; P = .005; I2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI, 0.15-5.32]; P = .04; I2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI, 2.26-14.15]; P = .007; I2 = 76%). No improvement in medium-term DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, -0.98 [95% CI, -3.52 to 1.57]; P = .45; I2 = 34%]), compared with a larger improvement in medium-term DASH score after operative treatment in the other studies that included patients 18 years or older (MD, -7.50 [95% CI, -12.40 to -2.60]; P = .003; I2 = 77%); the difference between these subgroups was statically significant (test for subgroup differences, P = .02).
CONCLUSIONS AND RELEVANCE
This meta-analysis suggests that operative treatment of distal radius fractures improves the medium-term DASH score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate. The findings suggest that operative treatment might be more effective and have a greater effect on the health and well-being of younger, nonelderly patients.
Topics: Adult; Female; Fracture Fixation; Hand Strength; Humans; Male; Observational Studies as Topic; Radius Fractures; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 32324239
DOI: 10.1001/jamanetworkopen.2020.3497 -
International Journal of Implant... Nov 2021Implant-assisted removable partial dentures (IARPDs) have recently become popular, but little information is available on the treatment outcomes based on the Kennedy... (Review)
Review
BACKGROUND
Implant-assisted removable partial dentures (IARPDs) have recently become popular, but little information is available on the treatment outcomes based on the Kennedy classification and attachment types.
OBJECTIVE
The objective of this review was to evaluate the treatment outcomes of IARPD delivered for distal extension edentulous areas based on the differences in the Kennedy classification and attachment type.
MATERIALS AND METHODS
English-language clinical studies on IARPD published between January 1980 and February 2020 were collected from MEDLINE (via PubMed), the Cochrane Library (via the Cochrane Central Register of Controlled Trials), Scopus online database, and manual searching. Two reviewers selected the articles based on pre-determined inclusion and exclusion criteria, followed by data extraction and analysis.
RESULTS
Eighty-one studies were selected after evaluating the titles and abstracts of 2410 papers. Nineteen studies were finally included after the perusal of the full text. Fourteen studies focused on Class I, 4 studies investigated both Class I and II, and only 1 study was conducted on Kennedy's class II. Eight types of attachments were reported. The ball attachment was the most frequently used attachment, which was employed in 8 of the included studies. The implant survival rate ranged from 91 to 100%. The reported marginal bone loss ranged from 0.3 mm to 2.30 mm. The patient satisfaction was higher with IARPD than with conventional RPDs or that before treatment. The results of prosthetic complications were heterogeneous and inconclusive.
CONCLUSION
IARPD exhibited favorable clinical outcomes when used as a replacement for distal extension edentulous areas. The comparison between the clinical outcomes of Kennedy's class I and II was inconclusive owing to the lack of studies focusing on Kennedy Class II alone. The stud attachment was the most commonly used type in IARPDs. Overall, the different attachment systems did not influence the implant survival rate and patient satisfaction. Further high-quality studies are needed to investigate the attachment systems used in IARPD.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Partial, Removable; Humans; Patient Satisfaction; Treatment Outcome
PubMed: 34773513
DOI: 10.1186/s40729-021-00394-z -
The Saudi Dental Journal Feb 2022The aim of this systematic review was to address the clinical effectiveness of space maintainers and space regainers in the prevention and correction of dental arch... (Review)
Review
BACKGROUND
The aim of this systematic review was to address the clinical effectiveness of space maintainers and space regainers in the prevention and correction of dental arch decreases in mixed dentition.
METHODS
An electronic search was conducted using five databases: the Cochrane Database for Systematic Reviews, EBSCO Host, ScienceDirect, PubMed, and Scopus (until February 2021) and 6 relevant journals. Inclusion criteria were: Randomized Controlled Clinical Trials (RCTs), Controlled Clinical Trials (CCTs), cohort studies and case-control studies of children in the mixed dentition requiring a space maintainer or a space regainer, children with mild to moderate crowding, and with Class I and mild Class II or Class III skeletal pattern. All articles included in this review were examined independently by three teams of investigators to assess the level of bias using the Cochrane risk of bias tools RoB 2.0 (for RCTs) and ROBINS-I (for non-RCTs).
RESULTS
Following the three phases of a systematic search, 11 studies were included for the final analysis, of which nine used space maintainers (a lower lingual arch) and two used space regainers (one lip bumper and one transpalatal arch) with contradicting results. Four of the former and one of the latter devices showed a significant increase in arch length. Out of the 11 articles, one was found to be of critical risk, two of serious risk and eight of moderate risk of bias.
CONCLUSIONS
There is very low evidence to suggest that space maintainers and regainers are effective in preserving arch length and preventing mild to moderate crowding in children during the mixed dentition stage at the expense of lower incisor proclination. However, considering the low evidence provided by this systematic review, high-quality studies are needed.
PubMed: 35241896
DOI: 10.1016/j.sdentj.2021.09.025 -
Psychotherapy Research : Journal of the... Sep 2023Emotion regulation (ER) refers to the process of modulating an affective experience or response. Objectives: This is a systematic review of the research on therapist... (Meta-Analysis)
Meta-Analysis
Emotion regulation (ER) refers to the process of modulating an affective experience or response. Objectives: This is a systematic review of the research on therapist methods to facilitate patient ER, including affect-focused, experiential methods that aim to enhance immediate patient emotion regulation, and structured psychoeducation, skills training in ER. A total of 10 studies of immediate and intermediate outcomes of emotion regulation methods were examined. A total of 38 studies were included in the meta-analysis of distal treatment effects on emotion regulation. In eight studies with 84 clients and 33 therapists, we found evidence of positive intermediate outcomes for affect-focused therapist methods and interpretations. A meta-analysis of 26 studies showed that the average effect size of ER methods from pre- to post-treatment was large ( = 0.82). Both affect-focused and structured skill training are associated with distal improvements in emotion regulation. When working with ER in psychotherapy, therapists must consider how patients' cultural backgrounds inform display rules, as well as what might be considered adaptive or maladaptive. The article concludes with training implications and therapeutic practices based on the research evidence.
Topics: Humans; Emotional Regulation; Psychotherapy; Emotions
PubMed: 36943017
DOI: 10.1080/10503307.2023.2183155 -
International Orthodontics Sep 2022To evaluate the treatment effects and post-treatment stability of the maxillary total arch distalization using TADs during the non-extraction treatment of class II... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the treatment effects and post-treatment stability of the maxillary total arch distalization using TADs during the non-extraction treatment of class II malocclusions.
MATERIALS AND METHODS
Study involved an electronic search followed by hand searching for randomized and non-randomized clinical studies about maxillary total arch distalization using TADs. After data extraction and risk of bias assessment, meta-analysis was performed for dental, skeletal and soft tissue changes using the Generic-inverse variance approach by use of the mean difference and random-effect model.
RESULTS
In total, 1788 articles were identified, 88 full texts were screened and 22 studies were found eligible; 17 of them were included in the quantitative analysis. The means of distalization/distal tipping of the maxillary first molar were 4mm/3.17° in adults, 3.95mm/1.61° in adolescents after treatment with the Modified C-Palatal plate (MCPP), while they were 2.44mm/2.91° with the inter-radicular mini-screws. Both MCPP's treatment in adults and inter-radicular mini-screws resulted in significant intrusion of U6 (1.64 and 0.75mm, respectively), while insignificant extrusion of U6 was resulted in adolescents treated by MCPP. MCPP appliances resulted in palatal inclination/extrusion of maxillary incisors U1 (6.77°/2mm in adults, 7.46°/3.14mm in adolescents). In contrast, inter-radicular mini-screws resulted in less palatal less amount of palatal inclination/insignificant intrusion of U1 (2.42°/0.14mm). MCPP treatment also resulted in significant changes in the skeletal measurements (SNA, ANB, occlusal and mandibular planes). Insignificant differences were found between subgroups in the retraction amount of maxillary incisors, as well as the upper and lower lips. In the follow-up of adolescents treated with MCPP, a significant amount of mesial movement, mesial tipping, and extrusion (2.94mm, 2.84°, and 3.94mm, respectively) was found. However, skeletal and occlusal corrections of the Class II relationship were maintained.
CONCLUSIONS
Maxillary total arch distalization using TADs can be an effective and stable treatment procedure. However, RCTs or prospective cohort studies are highly recommended to establish a clinical evidence regarding their efficiency.
Topics: Adolescent; Adult; Humans; Cephalometry; Malocclusion, Angle Class II; Maxilla; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Prospective Studies; Tooth Movement Techniques; Clinical Trials as Topic
PubMed: 35871982
DOI: 10.1016/j.ortho.2022.100666