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Acta Medica Okayama Jun 2024Fracture liaison services (FLS) have been introduced in Japan and several other countries to reduce medical complications and secondary fractures. We aimed to evaluate...
Fracture liaison services (FLS) have been introduced in Japan and several other countries to reduce medical complications and secondary fractures. We aimed to evaluate the effects of the implementation of an FLS approach on patient outcomes during hospitalization at our hospital and over a 2-year follow-up post-injury. This retrospective cohort study included patients ≥ 60 years admitted to our hospital for hip fragility fractures between October 1, 2016, and July 31, 2020. Patient groups were defined as those treated before (control group, n=238) and after (FLS group, n=196) establishment of the FLS protocol at our institution. The two groups were compared in terms of time to surgery, length of hospital stay, and the incidence of complications after admission, including secondary hip fracture and mortality rates. The follow-up period was 24 months. FLS focuses on early surgery within 48 h of injury and assessing osteoporosis treatment before injury to guide post-discharge anti-osteoporosis medication. FLS reduced the length of hospital stay (p<0.001) and the prevalence of complications after admission (p<0.001), particularly cardiovascular disease, and it increased adherence to anti-osteoporosis medication. These FLS effects resulted in lower secondary hip fracture and mortality rates at 12 and 24 months post-injury. FLS for fragility hip fractures can improve patient outcomes during hospitalization and over a 2-year follow-up period.
Topics: Humans; Hip Fractures; Female; Male; Aged; Retrospective Studies; Aged, 80 and over; Middle Aged; Length of Stay; Japan
PubMed: 38902211
DOI: 10.18926/AMO/67198 -
Archives of Osteoporosis Jun 2024Interviews and focus groups with patients, FLS clinicians, and GPs identified challenges relating to clinical and shared decision-making about bone health and...
UNLABELLED
Interviews and focus groups with patients, FLS clinicians, and GPs identified challenges relating to clinical and shared decision-making about bone health and osteoporosis medicines. Findings will inform the development of the multicomponent iFraP intervention to address identified training needs and barriers to implementation to facilitate SDM about osteoporosis medicines.
PURPOSE
The iFraP (improving uptake of Fracture Prevention treatments) study aimed to develop a multicomponent intervention, including an osteoporosis decision support tool (DST), to support shared decision-making (SDM) about osteoporosis medicines. To inform iFraP intervention development, this qualitative study explored current practice in relation to communication about bone health and osteoporosis medicines, anticipated barriers to, and facilitators of, an osteoporosis DST, and perceived training needs.
METHODS
Patients attending an FLS consultation (n = 8), FLS clinicians (n = 9), and general practitioners (GPs; n = 7) were purposively sampled to participate in a focus group and/or telephone interview. Data were transcribed, inductively coded, and then mapped to the Theoretical Domains Framework (TDF) as a deductive framework to systematically identify possible barriers to, and facilitators of, implementing a DST.
RESULTS
Inductive codes were deductively mapped to 12 TDF domains. FLS clinicians were perceived to have specialist expertise (knowledge). However, clinicians described aspects of clinical decision-making and risk communication as difficult (cognitive skills). Patients reflected on decisional uncertainty about medicines (decision processes). Discussions about current practice and the proposed DST indicated opportunities to facilitate SDM, if identified training needs are met. Potential individual and system-level barriers to implementation were identified, such as differences in FLS configuration and a move to remote consulting (environmental context and resources).
CONCLUSIONS
Understanding of current practice revealed unmet training needs, indicating that using a DST in isolation would be unlikely to produce a sustained shift to SDM. Findings will shape iFraP intervention development to address unmet needs.
Topics: Humans; Qualitative Research; Osteoporosis; Female; Male; Focus Groups; Bone Density Conservation Agents; Decision Making, Shared; Middle Aged; Aged; Osteoporotic Fractures
PubMed: 38898212
DOI: 10.1007/s11657-024-01410-6 -
Science Advances Jun 2024Satisfactory healing following acute tendon injury is marred by fibrosis. Despite the high frequency of tendon injuries and poor outcomes, there are no pharmacological...
Satisfactory healing following acute tendon injury is marred by fibrosis. Despite the high frequency of tendon injuries and poor outcomes, there are no pharmacological therapies in use to enhance the healing process. Moreover, systemic treatments demonstrate poor tendon homing, limiting the beneficial effects of potential tendon therapeutics. To address this unmet need, we leveraged our existing tendon healing spatial transcriptomics dataset and identified an area enriched for expression of (TRAP) and subsequently demonstrated robust TRAP activity in the healing tendon. This unexpected finding allowed us to refine and apply our existing TRAP binding peptide (TBP) functionalized nanoparticle (NP) drug delivery system (DDS) to facilitate improved delivery of systemic treatments to the healing tendon. To demonstrate the translational potential of this DDS, we delivered niclosamide (NEN), an inhibitor. While systemic delivery of free NEN did not alter healing, TBP-NP enhanced both functional and mechanical recovery, demonstrating the translational potential of this approach to enhance the tendon healing process.
Topics: Animals; Wound Healing; Tendon Injuries; Tendons; Drug Delivery Systems; Nanoparticles; Mice; Nanoparticle Drug Delivery System; Disease Models, Animal; Calcium-Binding Proteins; Humans
PubMed: 38896625
DOI: 10.1126/sciadv.adn2332 -
BMJ Open Sport & Exercise Medicine 2024The primary purpose of the study was to assess the one-factor and two-factor structure of the Injury Psychological Readiness to Return to Sport Scale (IPRRS) in an...
OBJECTIVES
The primary purpose of the study was to assess the one-factor and two-factor structure of the Injury Psychological Readiness to Return to Sport Scale (IPRRS) in an injured physically active population using confirmatory factor analysis (CFA) procedures and assess group (ie, sex, age, injury type, athlete status) and longitudinal differences using structural equation modelling (eg, invariance testing).
METHODS
The non-experimental study included a sample of 629 physically active individuals who suffered a musculoskeletal injury who sought treatment at an outpatient integrated sport medicine and rehabilitation therapy clinic. Participants filled out a questionnaire packet at three time points. Data analysis included a CFA and multigroup and longitudinal invariance.
RESULTS
Sample mean age was 26.3 years, with females comprising 49.5%. Chronic injuries represented 29.6% of the sample and 35.0% were classified as competitive athletes. A six-item, one-factor model was confirmed in the sample with factor loadings ranging from 0.67 to 0.86. Multigroup and longitudinal invariance were established. Multigroup invariance demonstrated null differences between sex and injury type, and statistical differences between age and athlete status subgroups. Longitudinal invariance demonstrated a statistically significant increase in psychological readiness over time.
CONCLUSIONS
The findings support the use of the IPRRS as a tool to measure aspects of psychological readiness. Clinicians and researchers can use the IPRRS to assess interventions in future research.
PubMed: 38895645
DOI: 10.1136/bmjsem-2023-001869 -
Frontiers in Human Neuroscience 2024As a therapeutic tool, kinesiology taping (KT) has become increasingly popular for musculoskeletal injuries utilized by physiotherapists. KT has been found to have...
BACKGROUND
As a therapeutic tool, kinesiology taping (KT) has become increasingly popular for musculoskeletal injuries utilized by physiotherapists. KT has been found to have effects on facilitating muscle strength by generating a concentric pull on the fascia. However, little is known about KT in the improvement of dynamic and static balance. This study aims to explore whether KT on the quadriceps muscle has any immediate effects on static and dynamic balance.
METHODOLOGY
Twenty-seven healthy individuals (13 males and 14 females, aged 22 to 29) were recruited in a crossover study with two conditions: KT and no taping. KT was applied to the quadriceps muscle for the taping group, with the control receiving no taping. Pre- and post-test measurements were taken to give an indication of the effect of the tape on balance performance. Center of Pressure Excursion (COPE) and Time to Stabilization (TTS) when landing from a hop test and Y Balance test combined score (YBTCS) were used to assess a stabilizing balance activity and a dynamic balance. The pre- and post-intervention were collected, with differences explored using repeated measures ANOVA with time and condition (tape) factor analysis.
RESULTS
We found a significant improvement ( ≤ 0.05) with a moderate to large effect size in YBTCS between KT and no taping, indicating enhanced balance performance in the KT group. However, no significant difference ( ≥ 0.05) with small to moderate effect size was found in COPE or TTS between the two conditions during landing tests, suggesting similar balance capabilities in these specific measures.
CONCLUSION
The use of KT shows no significant immediate effect on static balance in healthy individuals when applied to the quadriceps muscles; however, it demonstrates a positive immediate effect on dynamic balance.
PubMed: 38895169
DOI: 10.3389/fnhum.2024.1397881 -
Iranian Journal of Public Health Feb 2024Youth is undeniably the most important resource of any country. This study aimed to determine the trend of mortality rate and the cause of death, based on the ICD-10,...
BACKGROUND
Youth is undeniably the most important resource of any country. This study aimed to determine the trend of mortality rate and the cause of death, based on the ICD-10, among young people in Iran and examines significance of the changes in any cause during the last three decades.
METHODS
The present study is a secondary analysis of data, which examines the trend of death rate and its causes among young adult, aged 15-24 yr, longitudinally during 1990-2019. The data source was the GBD web-site. Linear Regression analysis was used to measure the slope of changes in mortality rates and causes of death during the period, where "time" was the independent variable and "mortality rate" and "causes of mortality" were dependent variables.
RESULTS
The death rate of young people declined by 56% during the period, equal to an average of 2.17 units per year. The most common cause of death has been injuries (69%), then NCDs (25%), and finally communicable diseases (6%). However, death due to injuries (except SUD), communicable diseases (except HIV), and NCDs (except musculoskeletal disorders) declined significantly by 1.43, 0.3, and 0.09 units per year, over 30 yr respectively.
CONCLUSION
Examining past trends in death rates and causes strengthens insights into the state and future trends in health and death-related indicators, which are crucial for policy-making, especially in developing countries with limited resources.
PubMed: 38894834
DOI: 10.18502/ijph.v53i2.14932 -
Cureus May 2024Muscle tears/strains are among the most common musculoskeletal injuries, posing a serious challenge for sports medicine. Aiming to reduce the time to return to play and... (Review)
Review
Muscle tears/strains are among the most common musculoskeletal injuries, posing a serious challenge for sports medicine. Aiming to reduce the time to return to play and the rate of reinjuries, apart from the traditional conservative treatments and rehabilitation protocols, new and innovative therapeutic options have emerged, particularly platelet-rich plasma (PRP). This study aims to present the available evidence regarding PRP injection for the treatment of muscle strains in athletes. Two databases were searched for articles published between January 2012 and December 2022 in Portuguese or English. The query used for the PubMed database was ("Muscles/injuries"[Mesh]) AND ("Athletes"[Mesh] OR "Athletic Injuries"[Mesh]) AND "Platelet-Rich Plasma"[Mesh], while for the Web of Science database the search was performed for "Platelet-rich plasma" AND "Muscle injuries" AND ("Athletes" OR "Athletic injuries"). Eleven studies involving athletes diagnosed with muscle injuries who received treatment with PRP injection alone, or in combination with traditional conservative treatment, compared to a control group, were included. Four randomized controlled trials, four systematic reviews/meta-analyses, two retrospective studies, and one comparative study were included. Current evidence from the highest-quality studies does not support the hypothesis of reduction of time to return to play and the rate of reinjuries after PRP injection, even though some studies reported positive results. However, the available evidence suggests that PRP might have a beneficial effect on the pain perceived by athletes following an acute muscle strain. It is challenging to arrive at definitive conclusions and translate these findings into a clinical context for treating muscle strains in athletes. The existing trials present several inconsistencies and limitations, with a heterogeneous set of patients and injuries, as well as the use of different and inconsistent methods for preparing, administering, and measuring the effects of PRP. To achieve consistent outcomes, standardizing PRP administration procedures is essential.
PubMed: 38894806
DOI: 10.7759/cureus.60585 -
Journal of Athletic Training Jun 2024Musculoskeletal injuries (MSK-I) are a well-documented problem in military populations and a leading contributor to disability across military services. However, only a...
CONTEXT
Musculoskeletal injuries (MSK-I) are a well-documented problem in military populations and a leading contributor to disability across military services. However, only a portion of Service members who sustain MSK-I report it to medical providers. Although several studies have identified barriers to seeking medical care in military populations, less is known about what motivates Service members to seek care for MSK-I.
OBJECTIVE
To describe determinants of medical care-seeking behavior for MSK-I and/or musculoskeletal pain (MSK-P) in recently-enlisted Marines during military training.
DESIGN
Qualitative Study.
SETTING
School of Infantry-West (SOI-W), US Marine Corps Base XXX, XXX.
PATIENTS OR OTHER PARTICIPANTS
1,097 US Marines entering Infantry Training Battalion or Marine Combat Training at SOI-W.
DATA COLLECTION AND ANALYSIS
Participants completed written surveys at entry to (baseline) and graduation from SOI-W. Closed-ended question responses were used to calculate MSK-I/MSK-P and care-seeking frequencies. Open-ended responses describing determinants of care-seeking behavior were analyzed using inductive thematic analysis.
RESULTS
Ten percent of participants self-reported sustaining MSK-I during basic training, while 14% self-reported sustaining MSK-I in SOI-W training. A greater proportion reported seeking medical care for their MSK-I/MSK-P during basic training compared to SOI-W training. The thematic analysis resulted in three main themes that describe drivers and barriers for seeking medical care: 1) Self-perceived need for medical care; 2) Prioritizing military training; and 3) Training-specific influences.
CONCLUSION
Understanding determinants of care-seeking behavior is valuable when designing intervention strategies to promote early MSK-I treatment. Our findings add to previous research to elucidate reasons underlying the decisions about care-seeking for MSK-I/MSK-P. Interventions, including educational strategies and direct approaches, like embedding medical providers within units, to minimize barriers to seeking medical care in the military may reduce the burden of MSK-I/MSK-P on Service members throughout their military careers.
PubMed: 38894683
DOI: 10.4085/1062-6050-0707.23 -
Sensors (Basel, Switzerland) May 2024The use of crutches is a common method of assisting people during recovery from musculoskeletal injuries in the lower limbs. There are several different ways to walk...
The use of crutches is a common method of assisting people during recovery from musculoskeletal injuries in the lower limbs. There are several different ways to walk with crutches depending on the patient's needs. The structure of crutch gaits or crutch gait patterns varies based on the delay between the aid and foot placement, the number of concurrent points of contact, and laterality. In a rehabilitation process, the prescribed pattern may differ according to the injury, the treatment and the individual's condition. Clinicians may improve diagnosis, assessment, training, and treatment by monitoring and analyzing gait patterns. This study aimed to assess and characterize four crutch walking patterns using spatial and temporal parameters obtained from the instrumented crutches. For this purpose, 27 healthy users performed four different gait patterns over multiple trials. Each trial was recorded using a portable system integrated into the crutches, which measured force, position, and acceleration. Based on the data angle, an algorithm was developed to segment the trials into gait cycles and identify gait phases. The next step was to determine the most appropriate metrics to describe each gait pattern. Several metrics were used to analyze the collected data, including force, acceleration, angle, and stride time. Among 27 participants, significant differences were found between crutch gait patterns. Through the use of these spatial and temporal parameters, promising results were obtained for monitoring assisted gait with crutches. Furthermore, the results demonstrated the possibility of using instrumented crutches as a clinical tool.
Topics: Humans; Gait; Crutches; Male; Female; Adult; Walking; Spatio-Temporal Analysis; Algorithms; Biomechanical Phenomena; Young Adult; Gait Analysis
PubMed: 38894346
DOI: 10.3390/s24113555 -
Journal of Clinical Medicine May 2024: There is limited knowledge regarding the comparative patient-reported outcomes (PROMs) and effect sizes (ESs) across orthopedic elective surgery. : All patient data...
: There is limited knowledge regarding the comparative patient-reported outcomes (PROMs) and effect sizes (ESs) across orthopedic elective surgery. : All patient data between January 2020 and December 2022 were collected, and treatment outcomes assessed as a PROM difference between baseline and one-year follow-up. The cohort was divided into subgroups (hand, elbow, shoulder, spine, hip, knee, and foot/ankle). The PROM ESs were calculated for each patient separately, and patients with ES > 0.5 were considered responders. : In total, 7695 patients were operated on. The mean ES across all patient groups was 1.81 (SD 1.41), and the largest ES was observed in shoulder patients and the smallest in hand patients. Overall, shoulder, hip, and knee patients had a larger ES compared to hand, spine, and foot/ankle patients ( < 0.0001). The proportion of positive responders ranged between 91-94% in the knee, shoulder, and hip, and 69-70% in the hand, spine, and foot/ankle subgroups. : The ESs are generally high throughout elective orthopedic surgery. However, based on our institutional observations, shoulder, hip, and knee patients experience larger treatment effects compared to hand, spine, and foot/ankle patients, among whom there are also more non-responders. The expected treatment outcomes should be clearly communicated to patients when considering elective surgery. Because of the study limitations, the results should be approached with some caution.
PubMed: 38892784
DOI: 10.3390/jcm13113073