Purpose The aim of the present study was to evaluate the efficacy and safety of non‐supervised home‐based exercise versus individualized and supervised programs delivered in clinic‐based settings for the functional recovery immediately after discharge from a primary TKA. Methods Medline, Embase, Cochrane, and PEDro databases were screened, from inception to April 2015, in search for randomized clinical trials (RCT) of home‐based exercise interventions versus individualized and supervised outpatient physical therapy after primary TKA. Target outcomes were: knee range of motion (ROM), patient‐reported pain and function, functional performance, and safety. Risk of bias was assessed with the PEDro scale. After assessing homogeneity, data were combined using random effects meta‐analysis and reported as standardized mean differences or mean differences. We set a non‐inferiority margin of four points in mean differences. Results The search and selection process identified 11 RCT of moderate quality and small sample sizes. ROM active extension data suitable for meta‐analysis was available from seven studies with 707 patients, and ROM active flexion from nine studies with 983 patients. Most studies showed no difference between groups. Pooled differences were within the non‐inferiority margin. Most meta‐analyses showed significant statistical heterogeneity. Conclusion Short‐term improvements in physical function and knee ROM do not clearly differ between outpatient physiotherapy and home‐based exercise regimes in patients after primary TKA; however, this conclusion is based on a meta‐analysis with high heterogeneity. Level of evidence I.
Negative affect appears frequently in rheumatic diseases, but studies about their importance and prevalence in systemic sclerosis patients are scarce, and the results are inconclusive separately. We conducted a comprehensive search on April 2013 of PubMed, Medline, and PsycINFO databases to identify original research studies published. A total of 48 studies were included in this systematic review. We found negative emotions have very high levels in these patients, compared to both healthy population other chronic rheumatic patients assessed with the same instruments and cutoffs. Depression has been, of the three negative emotions that we approach to in this review, the most widely studied in systemic sclerosis, followed by anxiety. Despite the fact that anger is a common emotion in these diseases is poorly studied. Methodologic issues limited the ability to draw strong conclusions from studies of predictors. Disease-specific symptoms (swollen joints, gastrointestinal and respiratory symptoms and digital ulcers) and factors related to physical appearance were associated with negative emotions. Interdisciplinary care and biopsychosocial approach would have a great benefit in the clinical management of these patients.
Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.
There are many misunderstandings about databases. Database is a commonly misused term in reference to any set of data entered into a computer. However, true databases serve a main purpose, organising data. They do so by establishing several layers of relationships; databases are hierarchical. Databases commonly organise data over different levels and over time, where time can be measured as the time between visits, or between treatments, or adverse events, etc. In this sense, medical databases are closely related to longitudinal observational studies, as databases allow the introduction of data on the same patient over time. Basically, we could establish four types of databases in medicine, depending on their purpose: (1) administrative databases, (2) clinical databases, (3) registers, and (4) study-oriented databases. But a database is a useful tool for a large variety of studies, not a type of study itself. Different types of databases serve very different purposes, and a clear understanding of the different research designs mentioned in this paper would prevent many of the databases we launch from being just a lot of work and very little science.
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BackgroundSpinal fractures occur more than expected in axial spondyloarthritis (Ax-Sp). However, it is not totally clear whether fracture risk depends solely on biomechanical problems of the spondyloarthritic spine or whether the prevalence of risk factors for fracture is larger than expected in these patients.ObjectivesTo describe the prevalence of risk factors for osteoporotic fractures (both axial and peripheral) in Ax-Sp.MethodsA systematic literature search was conducted. Medline, Embase and Cochrane Library databases were searched with a sensitive strategy including type of study and synonyms of Ax-Sp. All contemporary cross sectional studies or baseline results from representative cohorts of Ax-Sp published between January 2006 and 2016 were selected for detailed review. Only studies that fulfilled a minimum quality for survey data were included. Data on bone mineral density, prevalence of osteoporosis, and risk factor for fractures in Ax-Sp patients were collected.ResultsAfter screening 3597 titles and abstracts, only 43 studies (34 cross-sectional, 3 prospective and 6 retrospective) were reviewed in detail. Of these, 20 studies compared Ax-Sp patients with a control group, either healthy individuals (17 studies) or subjects with other diseases (6 studies). Reported prevalence of osteoporosis varied from 2% to 39.6%. Alcohol intake (58–61%), use of corticosteroids (11.7–67%), and 25-OH vitamin D deficit (26–76%) were unexpectedly high in Ax-Sp patients. All other factors were within expected frequencies for a not too old population.ConclusionsOur systematic review found that alcohol intake, steroid use and 25-OH-vitamin D deficit should be taken into account when assessing comorbidity in Ax-Sp in order to avoid excess fractures.Acknowledgementsthis project was funded by Merck Sharp & Dohme of Spain.Disclosure of InterestNone declared
BackgroundThe classical measures of spinal mobility for the assessment of patients with axial spondyloarthritis (SpA), such as BASMI, are subject to inter-observer variability.ObjectivesWe assessed the reproducibility of the UCOASMI index (University of Cόrdoba Ankylosing Spondylitis Metrology Index), a composite index of cervical and spinal mobility obtained with the UCOTrack© motion analysis system (an innovative 3D motion capture system based on video-images) [1], in patients with axial SpA.MethodsAn observational study of repeated measures was carried out in 3 Spanish centers with the technology available (H. Reina Sofía, Cόrdoba, H. Puerta de Hierro, Madrid and H. Fundaciόn Alcorcόn, Madrid). For the assessment of intra-observer reliability, 30 patients (10 per center) were evaluated twice, 3–5 days apart. For the inter-observer reliability, 9 patients were evaluated in the 3 centers by 3 observers (window 3–7 days). The Intraclass Correlation Coefficients (ICC) for UCOASMI and classical metrology measurements were calculated.ResultsWe included 30 patients (73% men, mean age 52 [SD 9], mean BASDAI 3.3 [SD 2]). The table shows the intra- and inter-observer reliability values. The reproducibility of UCOASMI was very high, with inter-observer ICC 0.99, and intra-observer ICC 0.97, 0.97 and 0.99, higher than most conventional measurements. The Schober test and cervical rotation showed lower reproducibility (inter-observer ICC between 0.58 and 0.68) and variable intra-observer ICC.Table 1Inter-observer reliabilityIntra-observer reliability Observer 1Observer 2Observer 3 ICC (95% CI)ICC (95% CI)ICC (95% CI)ICC (95% CI) UCOASMI0.99 (0.98–1.00)0.99 (0.98–1.00)0.97 (0.94–1.00)0.97 (0.93–1.00)Conventional Metrology BASMI0.50 (0.11–0.89)0.78 (0.54–1.00)0.61 (0.21–1.00)0.99 (0.97–1.00) Right lateral flexion0.83 (0.64–1.00)0.94 (0.87–1.00)0.91 (0.80–1.00)0.96 (0.91–1.00) Left lateral flexion0.88 (0.75–1.00)0.96 (0.92–1.00)0.93 (0.85–1.00)0.97 (0.94–1.00) Right tragus-wall distance0.97 (0.95–1.00)0.96 (0.91–1.00)0.91 (0.81–1.00)0.99 (0.98–1.00) Left tragus-wall distance0.97 (0.95–1.00)0.96 (0.91–1.00)0.90 (0.78–1.00)0.98 (0.97–1.00) Schöber test0.68 (0.39–0.97)0.64 (0.27–1.00)0.98 (0.97–1.00)0.95 (0.89–1.00) Intermaleolar distance0.87 (0.73–1.00)0.93 (0.85–1.00)0.82 (0.61–1.00)0.98 (0.97–1.00) Right cervical rotation0.65 (0.33–0.96)0.82 (0.61–1.00)0.94 (0.87–1.00)0.98 (0.97–1.00) Left cervical rotation0.58 (0.22–0.94)0.91 (0.81–1.00)0.75 (0.47–1.00)0.98 (0.97–1.00)ConclusionsThe reproducibility of the UCOASMI, obtained through the UCOTrack© motion analysis system in the 3 centers, was very high, in contrast to the lower reproducibility of the Schobert test and other measures of classical metrology. The reliability of this system opens the door to using this technology to monitor SpA patients and in future research studies.References Garrido-Castro JL, Escudero A, Medina-Carnicer R, et al. Validation of a new objective index to measure spinal mobility: the University of Cordoba Ankylosing Spondylitis Metrology Index (UCO...
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