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Journal of Athletic Training 2010To (1) search the English-language literature for original research addressing the effect of cryotherapy on joint position sense (JPS) and (2) make recommendations... (Review)
Review
OBJECTIVE
To (1) search the English-language literature for original research addressing the effect of cryotherapy on joint position sense (JPS) and (2) make recommendations regarding how soon healthy athletes can safely return to participation after cryotherapy.
DATA SOURCES
We performed an exhaustive search for original research using the AMED, CINAHL, MEDLINE, and SportDiscus databases from 1973 to 2009 to gather information on cryotherapy and JPS. Key words used were cryotherapy and proprioception, cryotherapy and joint position sense, cryotherapy, and proprioception.
STUDY SELECTION
The inclusion criteria were (1) the literature was written in English, (2) participants were human, (3) an outcome measure included JPS, (4) participants were healthy, and (5) participants were tested immediately after a cryotherapy application to a joint.
DATA EXTRACTION
The means and SDs of the JPS outcome measures were extracted and used to estimate the effect size (Cohen d) and associated 95% confidence intervals for comparisons of JPS before and after a cryotherapy treatment. The numbers, ages, and sexes of participants in all 7 selected studies were also extracted.
DATA SYNTHESIS
The JPS was assessed in 3 joints: ankle (n = 2), knee (n = 3), and shoulder (n = 2). The average effect size for the 7 included studies was modest, with effect sizes ranging from -0.08 to 1.17, with a positive number representing an increase in JPS error. The average methodologic score of the included studies was 5.4/10 (range, 5-6) on the Physiotherapy Evidence Database scale.
CONCLUSIONS
Limited and equivocal evidence is available to address the effect of cryotherapy on proprioception in the form of JPS. Until further evidence is provided, clinicians should be cautious when returning individuals to tasks requiring components of proprioceptive input immediately after a cryotherapy treatment.
Topics: Ankle Joint; Biomechanical Phenomena; Confidence Intervals; Cryotherapy; Evoked Potentials, Somatosensory; Female; Health Status Indicators; Humans; Knee Joint; Male; Posture; Proprioception; Shoulder Joint; Somatosensory Disorders; Young Adult
PubMed: 20446845
DOI: 10.4085/1062-6050-45.3.306 -
Foot & Ankle International Dec 2023The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA.
METHODS
We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups).
RESULTS
Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group.
CONCLUSION
Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.
Topics: Humans; Ankle; Reoperation; Obesity; Joint Prosthesis; Arthroplasty, Replacement, Ankle; Ankle Joint; Treatment Outcome; Retrospective Studies
PubMed: 37902184
DOI: 10.1177/10711007231201158 -
The Bone & Joint Journal Nov 2013We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings... (Meta-Analysis)
Meta-Analysis Review
We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings and range of movement, in patients with end-stage osteoarthritis (OA) of the ankle who undergo this procedure. We used the methodology of the Cochrane Collaboration, which uses risk of bias profiling to assess the quality of papers in favour of a domain-based approach. Continuous outcome scores were pooled across studies using the generic inverse variance method and the random-effects model was used to incorporate clinical and methodological heterogeneity. We included 58 papers (7942 TARs) with an interobserver reliability (Kappa) for selection, performance, attrition, detection and reporting bias of between 0.83 and 0.98. The overall survivorship was 89% at ten years with an annual failure rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean American Orthopaedic Foot and Ankle Society score changed from 40 (95% CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The mean total range of movement improved from 23° (95% CI 19 to 26) to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients' lives, with benefits lasting ten years, as judged by improvement in pain and function, as well as improved gait and increased range of movement. However, the quality of evidence is weak and fraught with biases and high quality randomised controlled trials are required to compare TAR with other forms of treatment such as fusion.
Topics: Ankle Joint; Arthroplasty, Replacement, Ankle; Humans; Osteoarthritis; Quality of Life; Range of Motion, Articular; Survival Rate; Treatment Outcome
PubMed: 24151270
DOI: 10.1302/0301-620X.95B11.31633 -
International Orthopaedics Feb 2021To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus (OLT) to osteoarthritis (OA).
METHODS
A systematic review and a meta-analysis were performed on PubMed, Embase, and Cochrane Library in March 2020. Safety was evaluated through the reported side effects and effectiveness through the scores used. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool and the Downs and Black checklist. For each outcome, the quality of evidence was graded according to GRADE guidelines.
RESULTS
Twenty-four studies (21 for OA, 3 for OLT) were included on hyaluronic acid (HA), platelet-rich plasma (PRP), saline, methylprednisolone, botulinum toxin type A (BoNT-A), mesenchymal stem cells (MSCs), and prolotherapy. No severe adverse events were reported. For OLT, a comparison was possible between HA and PRP showing no significant difference. For ankle OA, a significant difference favouring HA versus saline was documented at six months (p < 0.001). The GRADE level of evidence was very low.
CONCLUSION
This meta-analysis supports the safety of intra-articular treatment for ankle OA and OLT, while only a very low evidence supports the efficacy of HA in terms of better results versus placebo for the treatment of ankle OA, and other conclusions are hindered by the scarcity of the available literature. This urges further and stronger trials to specifically investigate potential and limitations of these different injective approaches for the treatment of OLT and ankle OA.
Topics: Ankle; Ankle Joint; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Osteoarthritis, Knee; Platelet-Rich Plasma; Treatment Outcome
PubMed: 32647968
DOI: 10.1007/s00264-020-04689-5 -
Clinical Rehabilitation Oct 2013To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke.
DATA SOURCES
The following databases were searched; AMED, CINHAL, Cochrane Library (Stroke section), Medline, PubMed, Science Direct and Scopus. Previous reviews, reference lists and citation tracking of the selected articles were screened and the authors of selected trials contacted for any further unpublished data.
REVIEW METHODS
Controlled trials of an ankle-foot orthosis on gait biomechanics in stroke survivors were identified. A modified PEDro score evaluated trial quality; those scoring 4/8 or more were selected. Information on the trial design, population, intervention, outcomes, and mean and standard deviation values for the treatment and control groups were extracted. Continuous outcomes were pooled according to their mean difference and 95% confidence intervals in a fixed-effect model.
RESULTS
Twenty trials involving 314 participants were selected. An ankle-foot orthosis had a positive effect on ankle kinematics (P < 0.00001-0.0002); knee kinematics in stance phase (P < 0.0001-0.01); kinetics (P = 0.0001) and energy cost (P = 0.004), but not on knee kinematics in swing phase (P = 0.84), hip kinematics (P < 0.18-0.89) or energy expenditure (P = 0.43). There were insufficient data for pooled analysis of individual joint moments, muscle activity or spasticity. All trials, except one, evaluated immediate effects only.
CONCLUSIONS
An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.
Topics: Ankle Joint; Biomechanical Phenomena; Braces; Controlled Clinical Trials as Topic; Databases, Bibliographic; Foot Orthoses; Gait; Gait Disorders, Neurologic; Humans; Stroke; Stroke Rehabilitation; Walking
PubMed: 23798747
DOI: 10.1177/0269215513486497 -
Journal of Athletic Training Jul 2023To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks.
DATA SOURCES
A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021.
STUDY SELECTION
Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support.
DATA EXTRACTION
Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings.
DATA SYNTHESIS
A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = -1.83° [-2.97°, -0.69°], P = .002), plantar-flexion angle at initial contact (-3.86° [-6.18°, -1.54°], P = .001), and sagittal-plane excursion (-3.45° [-5.00°, -1.90°], P < .001) but not inversion angle at initial contact (-1.00° [-3.59°, 1.59°], P = .45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (-5.21° [-8.59°, -1.83°], P = .003) but not inversion angle at initial contact (0.32° [-2.11°, 1.47°], P = .73), frontal-plane excursion (-1.31° [-3.24°, 0.63°], P = .19), or plantar-flexion angle at initial contact (-0.12° [-3.54°, 3.29°], P = .94). Studies investigating changes of direction were insufficient.
CONCLUSIONS
Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined.
Topics: Humans; Ankle; Biomechanical Phenomena; Ankle Joint; Ankle Injuries; Running; Joint Instability; Sprains and Strains; Randomized Controlled Trials as Topic
PubMed: 36521172
DOI: 10.4085/1062-6050-0208.22 -
Spinal Cord Mar 2021Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries.
SETTING
Not applicable.
METHODS
A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial.
RESULTS
Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity.
CONCLUSIONS
There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.
Topics: Ankle Joint; Humans; Muscle Spasticity; Physical Therapy Modalities; Range of Motion, Articular; Spinal Cord Injuries
PubMed: 33564117
DOI: 10.1038/s41393-020-00610-4 -
Foot & Ankle Specialist Feb 2023Nonunion is a postoperative complication after ankle arthrodesis (AA), which leads to increased morbidity and revision rates. Previous studies have identified risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nonunion is a postoperative complication after ankle arthrodesis (AA), which leads to increased morbidity and revision rates. Previous studies have identified risk factors for nonunion following AA, but no meta-analysis has been performed to stratify risk factors based on strength of evidence.
METHODS
Abstracts and full-text articles were screened by 2 independent reviewers. Relevant data were extracted from the included studies. Random effects meta-analyses were summarized as forest plots of individual study and pooled random effect results.
RESULTS
Database search yielded 13 studies involving 987 patients were included, and 37 potential risk factors for nonunion. Meta-analysis found 5 significant risk factors for nonunion post-AA. Strong evidence supports male gender (OR: 1.96; 95% CI: 1.13-3.41), smoking (OR: 2.89; 95% CI: 1.23-6.76), and history of operative site infection prior to arthrodesis (OR: 2.40; 95% CI: 1.13-5.09) as predictors for nonunion following AA. There was moderate evidence supporting history of open injury (OR: 5.95; 95% CI: 2.31-15.38) and limited evidence for preoperative avascular necrosis (OR: 13.16; 95% CI: 2.17-79.61) as possible risk factors for nonunion.
CONCLUSION
The results of our meta-analysis suggest that male gender, smoking, and history of operative site infection have strong evidence and that history of open injury and avascular necrosis also have evidence as risk factors for nonunion. Surgeons should be cognizant of these risks when performing AA and closely follow up with patients with the aforementioned risk factors to ensure postoperative success.
LEVELS OF EVIDENCE
Level V: Systematic review of cohort and case-control studies.
Topics: Humans; Male; Ankle; Ankle Joint; Retrospective Studies; Risk Factors; Arthrodesis; Necrosis
PubMed: 33660542
DOI: 10.1177/1938640021998493 -
Diabetes/metabolism Research and Reviews Nov 2023To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance.
To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p = 0; I = 0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p = 0.21, I = 51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.
Topics: Humans; Ankle Joint; Diabetic Neuropathies; Ankle; Exercise Therapy; Range of Motion, Articular; Diabetes Mellitus
PubMed: 37431167
DOI: 10.1002/dmrr.3692 -
Georgian Medical News Oct 2022Epidemiological data suggest 9-15% of ankle joint osteoarthritis (AOA) in the general population. One of the methods of delaying radical intervention is ankle joint...
Epidemiological data suggest 9-15% of ankle joint osteoarthritis (AOA) in the general population. One of the methods of delaying radical intervention is ankle joint distraction arthroplasty of the ankle joint (ADA), including a combination of various techniques. The lack of publications summarizing the maximum possible clinical data on ADA for more than 50 years of the method's history justifies the need for a review. A systematic review of ankle distraction arthroplasty followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) protocol guidelines. The inclusion criteria were articles with clinical data in full text in English, available on the Internet for the maximum possible period, including the treatment of diseases of the ankle joint using distraction arthroplasty. At the search stage, 4640 publications from 3 sources were identified. 33 articles were selected for analysis of the full texts of the articles. Additionally, 1 article was excluded, as it contains duplicate information from an identical study. The analysis of the full texts of 32 publications was made, according to the parameters indicated earlier. A total of 927 patients underwent ADA. The mean age of the patients was 44.9 ± 12.7 years. Among the causes, post-traumatic AOA was indicated in 26 (81.3%) publications, osteochondral defects (n=2, 6.3%), consequences of poliomyelitis (n=4, 12.5%), congenital deformities (n=4, 12.5%), hemophilia (n= 2, 6.25%), idiopathic juvenile osteoarthritis (n=1, 3.1%), rheumatoid OA (n=1, 3.1%). Despite the more than 50-year history of ADA, there is still no sufficient understanding of this methodology. The goal of future research is to understand the exact indications for ADA depending on the stage, etiology, and type of AOA. ADA is a promising effective method of treatment that allows achieving an improvement in function and a reduction in pain in the medium and long term while preserving the patient's joint.
Topics: Humans; Adult; Middle Aged; Ankle; Treatment Outcome; Osteoarthritis; Ankle Joint; Arthroplasty
PubMed: 36539124
DOI: No ID Found