To elucidate and attempt to dissociate the two mechanisms, neuromuscular and mechanical, underlying patellofemoral pain syndrome, 18 subjects, divided into two groups based on a diagnosis of patellofemoral pain syndrome and the knee Q angle, were studied. The control group was asymptomatic and exhibited a normal Q angle (mean, 8.25 degrees), whereas the other group, diagnosed as patellofemoral pain syndrome patients, reported knee pain and had an above-normal Q angle (mean, 21.05 degrees). All subjects were tested for isometric maximum knee extension at 90 degrees, 30 degrees, and 15 degrees of knee flexion while they were seated in a special restraining chair. During testing, surface electromyography at the oblique and long fibers of the vastus medialis, and at the vastus lateralis were recorded along with the knee moment of force. The integrated electromyographic signals associated with the peak torque for all of the vastus muscles, along with the vastus medialis obliquus:vastus lateralis and vastus medialis longus:vastus lateralis activity ratios showed no significant differences between groups nor between the three angles, suggesting that all vasti measured were consistently active throughout the studied range of motion. This suggests that the neural drive was not affected in the patellofemoral pain syndrome patients. However, when the five patients showing the largest Q angles were isolated, they revealed a significantly smaller vastus medialis obliquus:vastus lateralis ratio when compared to the other group. The same ratio was also significantly smaller at 15 degrees compared to 90 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Individuals respond differently to nutrients and foods. This is reflected in different levels of benefits and risks at the same intake of a nutrient and, consequently, different ‘windows of benefit’ in terms of nutrient intake. This has led recently to the concept of ‘personalised nutrition’. Genetic factors such as single nucleotide polymorphisms may be one source of this inter-individual variation in benefit–risk response to nutrients. In 2004 a European Union-funded network of excellence in the area of nutrigenomics (European Nutrigenomics Organisation; NuGO) organised a workshop on the role of nutrient–gene interactions in determining benefit–risk of nutrients and diet. The major issues discussed at theworkshop are presented in the present paper and highlighted with examples from the presentations. The overall consensus was that although genetics provides a new vision where genetic information could in the future be used to provide knowledge on disease predisposition and nutritionalrequirements, such a goal is still far off and much more research is required before we can reliably include genetic factors in the risk–benefit assessment of nutrients and diets.

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Editorial ase studies are a critical link between the best available research evidence and clinical practice. 1 As we have described in previous editorials, case studies are underappreciated and their value diminished in the light of large-scale clinical trials and systematic reviews. As we have previously highlighted, a major factor for this lack of appreciation is that it remains unclear what evidence a case study can provide. Is all case study evidence equal? We proposed a new model in which we can break down the purpose of case studies into two main classifications: validation and exploration. 1Validation case studies are used to describe clinical decision outcomes which were guided by the best available research evidence. These are considered evidence-based practice reports.2 By contrast, exploration case studies are descriptions of clinical decision outcomes that were based predominantly on clinical expertise and the professional body of knowledge. These clinical decisions rely more heavily of internal evidence and, therefore, are considered practice-based evidence reports.2 Both evidence-based practice reports and practice-based evidence reports can contribute to a profession's body of knowledge in meaningful ways. 2,3 By testing the best available research evidence with a validation case study, we can determine which elements should be incorporated into professional education, 1 and truly close the circle of evidence-based practice. In turn, practice-based evidence reports highlight the value of internal evidence derived from professional training and clinical experience. The published practice-based evidence reports become a source of external evidence for other practicing clinicians and researchers, and can guide clinical research by revealing where there are gaps in our knowledge base. Thus a symbiotic relationship between validation and exploration case studies is created.The purpose of this editorial is to provide a logical blueprint to describe the value of these reports in shaping our professional body of knowledge. In this editorial, we present a model for defining four levels of evidence for case studies in the context of evidence-based practice (validation) and practice-based evidence (exploration). We provide a description of the hallmarks of each level and the value as it relates to using external and internal evidence for making clinical decisions.In the following section, we present these levels of evidence from lowest (level 4) to highest (level 1) to help readers develop an appreciation for the logical progression from practice-based evidence to evidence-based practice. The rare events (level 4) and exploration case studies (level 3) have been previously described in an editorial. 4 Synopses of these, in conjunction with higher levels of case study evidence, are presented below. Please see the Table for details pertaining to the levels of case study evidence and the logical flow from one level to the next. Level 4: Rare Events (The Zebras)Rare events are reports of cases that are both hig...

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Motor-skill retention is more critical than a single skill performance. Rehabilitation programs can be enhanced in effectiveness and variety by considering task characteristics, practice scheduling, distribution, and feedback techniques.