Objectives: Increasing attention has been paid to pelvic incidence (PI) as a potential parameter related to low back pain. However, little knowledge exists regarding potential anthropometric landmarks specialized for the estimation of PI. This study aimed to examine the inter-and intra-examiner reliability of potential anthropometric landmarks applicable to estimate PI. Methods: Twenty healthcare workers were recruited as participants. Three were experienced physiotherapists for more than 5 years in clinical practice. Eight anatomical landmarks were selected: (1) the acromion, (2) the upper edge of the iliac crest, (3) the posterior superior iliac spine (PSIS), ( 4) the anterior superior iliac spine (ASIS), ( 5) the upper edge of the greater trochanter, (6) the coccyx, (7) the lateral joint space of the knee, and (8) the lateral malleolus. Photographs of the right-side view of the subjects were used to determine the twodimensional (x, y) coordinates of the landmarks. Results: Most landmark measurements reached acceptable levels for intra-examiner (ICC 1 , 0.64 to 0.98) and inter-examiner reliability (ICC 3 , 0.71 to 0.97). However, as possible anatomical landmarks, the PSIS (ICC 1 0.65, ICC 3 0.48), acromion (ICC 3 0.66), and coccyx (ICC 1 0.64) tended to have relatively low ICCs. Conclusions: Our study suggests that potential anthropometric landmarks on the body surface examined on palpation have acceptable intra-and inter-examiner reliability; however, identifying the acromion, PSIS, and coccyx as anatomical landmarks using the measurement method in this study remain difficult to be considered reliable.
Introduction: Cervical isometric muscle strengthening and cervical range of motion (ROM) training are recommended after laminoplasty (LP). However, their preventive effects on axial pain are unclear. We examined whether neck extension muscle strengthening and cervical ROM training from the early postoperative period effectively suppress postoperative axial pain.Methods: Sixty-one patients undergoing a muscle-preserving LP attached to C2 and C7 for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament were randomly allocated to the cervical exercise (33 patients) or nonexercize (28 patients) groups.Postoperative cervical collars were not worn in any cases. The cervical exercise group underwent neck extension isometric muscle strengthening and cervical ROM exercises for 3 months starting on postoperative day 2. Changes in axial pain (visual analog scale [VAS]) from baseline at 2 weeks and 3 months after surgery were evaluated as the primary outcome. Cervical muscle strength, cervical ROM, and Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores were evaluated as secondary outcomes.Results: Axial pain was significantly exacerbated at 2 weeks after LP compared with before surgery, and then, a significant improvement was observed at 3 months after surgery. No
univariate analysis, Cox proportional hazards regression for multivariate analysis. Results: Since 2014, 127 patients were identified who met the inclusion criteria, 44% female, 56% male, median age 62. 70 received SBRT, 57 SRS. 80% of patients were treated for lung cancer, 20% other primary sites. 53% of patients received nivolumab, 29% pembrolizumab, 13% atezolizumab, 5% other. 20% received immunotherapy before SBRT/SRS, 39% during SBRT/SRS, 41% after. 86 patients had died by the time of analysis, the median OS for the whole cohort was 9.7 months. Patients who had completed immunotherapy prior to SBRT/SRS had worse OS than those who received concurrent therapy or immunotherapy after SBRT/ SRS, with a difference in median OS of 3.6 months versus 13.0 months (p Z 0.010), this was retained on multivariate analysis (p Z 0.011). There was no significant difference in OS between patients receiving SRS versus SBRT (p Z 0.30, 0.21), gender (p Z 0.43, 0.60), age >62 (p Z 0.73, 0.84), or lung primary vs. others (p Z 0.89, 0.41) on univariate or multivariate analysis. Conclusion: Overall survival appears to be worse in patients who complete immunotherapy prior to SBRT/SRS compared to those receiving it concurrently or after. The design of this retrospective review may be prone to lead-time bias, although the difference in median survival is longer than the 6-month window before SBRT/SRS and could only account for part of this difference. Further analysis into causes of death and toxicity as well as prospective studies are needed to confirm the results of this analysis.
This study aimed to explore effective measurement angles for pelvic incidence (PI) classification and to develop a quick, noninvasive assessment tool for PI classification. We defined five variation types of hip–knee line (HKL) angles and tested the discrimination ability of the receiver operating characteristic (ROC) analysis using 125 photographs of upright standing posture from the right lateral side. ROC analysis revealed an applicable HKL angle defined by the line connecting the most raised part of the buttock and the central point of the knee and the midthigh line. The acceptable cut-off points for discriminating small or large PIs in terms of HKL angle were 18.5° for small PI (sensitivity, 0.91; specificity, 0.79) and 21.5° for large PI discrimination (sensitivity, 0.74; specificity, 0.72). In addition, we devised a quick noninvasive assessment tool for PI classification using the cut-offs of the HKL angle with a view to practical application. The results of intra- and inter-rater reliability ensured a substantial/moderate level of the tool (Cohen’s kappa coefficient, 0.79; Fleiss’s kappa coefficient, 0.50–0.54). These results revealed that the HKL angle can distinguish the size of the PI with a high/moderate discrimination ability. Furthermore, the tool indicated acceptable inter-/intra-rater reliability for practical applications.
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