Background Rehabilitation is crucial for postoperative patients with low back pain (LBP). However, the implementation of traditional clinic-based programs is limited in developing countries, such as China, because of the maldistribution of medical resources. Mobile phone–based programs may be a potential substitute for those who have no access to traditional rehabilitation. Objective The aim of this study was to examine the efficacy of mobile phone–based rehabilitation systems in patients who underwent lumbar spinal surgery. Methods Patients who accepted spinal surgeries were recruited and randomized into 2 groups of rehabilitation treatments: (1) a mobile phone–based eHealth (electronic health) program (EH) or (2) usual care treatment (UC). The primary outcomes were (1) function and pain status assessed by the Oswestry Disability Index (ODI) and (2) the visual analog scale (VAS). Secondary outcomes were (1) general mental health and (2) quality of life (Likert scales, EuroQol-5 Dimension health questionnaire, and 36-item Short-Form Health Survey). All the patients were assessed preoperatively and then at 3, 6, 12, and 24 months postoperatively. Results A total of 168 of the 863 eligible patients were included and randomized in this study. Our analysis showed that the improvement of primary outcomes in the EH group was superior to the UC group at 24 months postoperatively (ODI mean 7.02, SD 3.10, P <.05; VAS mean 7.59, SD 3.42, P <.05). No significant difference of primary outcomes was found at other time points. A subgroup analysis showed that the improvements of the primary outcomes were more significant in those who completed 6 or more training sessions each week throughout the trial (the highest compliance group) compared with the UC group at 6 months (ODI mean 17.94, SD 5.24, P <.05; VAS mean 19.56, SD 5.27, P <.05), 12 months (ODI mean 13.39, SD 5.32, P <.05; VAS mean 14.35, SD 5.23, P <.05), and 24 months (ODI mean 18.80, SD 5.22, P <.05; VAS mean 21.56, SD 5.28, P <.05). Conclusions This research demonstrated that a mobile phone–based telerehabilitation system is effective in self-managed rehabilitation for postoperative patients with LBP. The effectiveness of eHealth was more evident in participants with higher compliance. Future research should focus on improving patients’ compliance. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-13003314; http://www.chictr.org.cn/showproj.aspx?proj=6245 (Archived by WebCite at http://www.webcitation.org/766RAIDNc)

The purpose of this study was to evaluate the effect of salmon calcitonin (sCT) on improving fibrosis‐related indicators in frozen shoulder synovial/capsular fibroblasts (SCFs) and detect the potential downstream pathway. Quantitative real‐time polymerase chain reaction and cell‐substrate adhesion assays were used to measure alterations in fibrosis‐related molecule expression and the cell adhesion ability of frozen shoulder SCFs after treatment with range concentrations of sCT. The presence of calcitonin receptors (CTRs) in shoulder joint synovial/capsular tissue samples was detected by immunohistochemistry (IHC). The downstream pathways of sCT in SCFs were further explored by utilizing three classical pathway inhibitors. With the addition of sCT to the culture medium of frozen shoulder SCFs, the messenger RNA (mRNA) expression of collagen type I (COL1A1), COL3A1, fibronectin 1, laminin 1, transforming growth factor‐β1 (TGF‐β1), and interleukin‐1α (IL‐1α) showed a descending trend as the sCT concentration increased. Treatment with sCT increased the expression of vascular endothelial growth factor and IL‐6 in a dose‐dependent manner. The enhanced adhesion ability of frozen shoulder SCFs gradually diminished with increasing concentrations of sCT. By using IHC, the CTR was detected extensively in the frozen shoulder joint synovium and capsule. Blocking the protein kinase C (PKC) pathway reversed the sCT‐mediated suppression of COL1A1 production. Blocking the PKC or protein kinase A (PKA) pathway eliminated the sCT‐induced inhibition of TGF‐β1 production. This study demonstrated that sCT effectively improved the mRNA expression of fibrosis‐related molecules and decreased the enhanced cell‐substrate adhesion ability of frozen shoulder SCFs. sCT might achieve these effects by interacting with the CTR that is expressed on the SCF surface and by activating the downstream PKC or PKA pathway.

This study compared knee stability and alterations in the composition of synovial fluid among patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction with either a hamstring autograft or a hamstring allograft. This prospective cohort study enrolled 175 patients. Of these patients, 90 underwent hamstring tendon autograft ACL reconstruction. The remaining patients (n=85) underwent hamstring tendon allograft ACL reconstruction. All of the patients had a minimum of 1 year of follow-up (mean, 2.5 years). Side-to-side differences and the proportion of mononuclear cells in knee joint synovial fluid were measured at 5 time points (preoperatively and at postoperative weeks 1, 3, 6, and 12). During the early postoperative phase, side-to-side knee laxity was greater among the allograft group compared with the autograft group (P<.001). Additionally, among the allograft group, the proportion of mononuclear cells remained high at weeks 6 and 12 (mean, 90.0% and 88.9%, respectively) compared with a normal level in the autograft group (mean, 45.1% and 65.7%, separately). However, no significant difference was found between the 2 groups at final follow-up for range of motion, results of the Lachman test, results of the anterior drawer test, results of the pivot shift test, Lysholm score, bone tunnel enlargement, and graft failure rate (P>.05). These findings showed that, in the early postoperative phase, ACL reconstruction with a hamstring allograft resulted in greater knee laxity and immunologic response compared with the hamstring autograft group. However, at relatively long-term follow-up, both grafts achieved similar objective and subjective outcomes. [Orthopedics. 2017; 40(5):e892-e897.].

Background:Rehabilitation is very important for postoperative patients with low back pain. However, the promotion of traditional clinic-based program is limited in developing countries like China, due to the maldistribution of medical resources. Smartphones may be a potential substitute for those who have no access to traditional rehabilitation. Objective:The aim of this study was to examine the efficacy of a smartphone based rehabilitation system in patients accepted lumbar spinal operation. Methods:Postoperative patients with low back pain were recruited and randomized to rehabilitation treatment provide by smartphone based e-health program (EH) or usual care treatment (UC) as control group. Primary outcomes were function and pain status assessed by Oswestry Disability Index (ODI) and visual analogue scale (VAS). Secondary outcomes were general mental health and life status (Likert scales, EQ-5D and SF-36). All the patients were assessed pre-operatively and then at 3, 6, 12 and 24 months post-operatively. ResultsA total of 168 of the 863 eligible patients were included and randomized in this study. The analysis showed that the improvement in EH group was superior to UC group at 24 months postoperatively (mean difference: ODI 7.02, SD 3.1, P<0.05; VAS 7.59, SD 3.42, P<0.05). No significant difference of primary outcomes was found at the other time points. Subgroup analysis showed that the improvements of the primary outcomes were more significant in those considered as high compliance in the EH group throughout the trial, compared with the UC group at 6, 12 and 24 months. Conclusion:This research demonstrated that E-health, a smart phone based tele-rehabilitation system can be an effective rehabilitation tool in self-management for postoperative patient with low back pain.The effectiveness of E-health was more evident in high adherent participants. Still, more researches are needed to understand factors associated with patients' adherence.Trial Registration: Chinese clinical trial registry, ChiCTR-TRC-13003314,