Studies that used social cognitive or learning theory principles to improve self-efficacy in patients with orthopedic or musculoskeletal conditions generally displayed moderate to large effect sizes supporting this intervention. Sound research methodological quality and low risk of intervention-related injury or other adverse events were also generally observed. Findings suggest that these interventions may also benefit individuals with conditions that have not progressed to end-stage salvage surgery such as younger, more athletically active individuals for knee OA prevention.
The study evaluated the incidence of and complications associated with the use of an intramedullary nail vs open reduction and internal fixation (ORIF) with a sliding compression hip screw and plate in treating intertrochanteric fractures. The authors hypothesized that the biomechanically stronger and less invasive intramedullary nail would have superior results and fewer complications compared with ORIF. Patients followed for up to 1 year postoperatively were identified from the 5% nationwide sample of Medicare administrative claims data (1998-2007) using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes 820.21 and 820.31. There were 9157 patients treated with intramedullary nails and 27,687 treated with compression screw and plate fixation. Intertrochanteric hip fractures treated with an intramedullary nail during this period increased from 3.3% to 63.1% compared with ORIF. Patients treated with an intramedullary nail had a higher adjusted risk of pulmonary embolism at 90 days (P=.003) and a higher risk of mortality at 1 year (P<.001) compared with those treated with ORIF. Patients who underwent intramedullary nailing during 2006 to 2007 had a lower adjusted risk of conversion to total hip replacement at 1 year (P=.037) compared with those who had ORIF. Over the decade of the study, intramedullary nail usage increased 59.8% compared with ORIF. Increased use of intramedullary nails compared with ORIF has not shown improved outcomes or decreased complications in patients with intertrochanteric hip fractures. The increased use of intramedullary nails for intertrochanteric hip fractures appears to be multifactorial, including the less invasive nature of the surgery and increased experience with the closed surgical technique.
Stroke is one of the most devastating and prevalent diseases. However, efforts to limit tissue damage in acute stroke have met with only minimal success. Therefore, it is of paramount importance to establish effective therapies for use during long-term stages of recovery. Such therapy can capitalize on neuroplastic change (brain reorganization), which has been associated with recovery of function after brain lesions. Intensive, repetitive motor training is a therapeutic intervention that has been shown to support neuroplastic change and improve motor performance after stroke. Likewise, sensory input in the form of peripheral nerve stimulation (PNS) has been shown to upregulate neuroplasticity and improve motor performance after stroke. However, no studies have evaluated how pairing intensive motor training with various PNS intensities and times may affect motor performance, particularly for subjects with severe upper extremity (UE) hemiparesis after stroke. Here, we describe our ongoing study of whether various intensities and times of delivery of PNS relative to motor training will yield differential effects on UE motor function in subjects with chronic, severe motor deficit after stroke. Our results will facilitate development of a dose-response model for PNS paired with intensive, repetitive motor training, which will help optimize this combinatory intervention for stroke survivors with highest need.
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