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Purpose To describe the clinical course and develop prognostic models for poor recovery in patients with cervical radiculopathy who are managed conservatively. Methods Sixty-one consecutive adults with cervical radiculopathy who were referred for conservative management were included in a prospective cohort study, with 6-and 12-month follow-up assessments. Exclusion criteria were the presence of known serious pathology or spinal surgery in the past. Outcome measures were perceived recovery, neck pain intensity and disability level. Multiple imputation analyses were performed for missing values. Prognostic models were developed using multivariable logistic regression analyses, with bootstrapping techniques for internal validation. Results About 55% of participants reported to be recovered at 6 and 12 months. All multivariable models contained 2 baseline predictors. Longer symptoms duration increased the risk of poor perceived recovery, whereas the presence of paresthesia decreased this risk. A higher neck pain intensity and a longer duration of symptoms increased the risk of poor relief of neck pain. A higher disability score increased the risk of poor relief of disability, and larger active range of rotation toward the affected side decreased this risk. Following bootstrapping, the explained variance of the models varied between 0.22 and 0.30, and the median area under the curve varied between 0.75 and 0.79. Conclusions The clinical course of cervical radiculopathy appears to be long, with most of the reduction in symptoms occurring within the first 6 months. All prognostic models showed an adequate predictive performance with modest diagnostic accuracy and explained variance. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.
Inflammatory processes have been implicated in the pathogenesis of
traumatic brain damage. We analyzed the spatiotemporal expression
pattern of the proinflammatory key molecules: interleukin-1β,
interleukin-6, tumor necrosis factor-α, and inducible nitric
oxide synthase in a rat closed head injury (CHI) paradigm. 51 rats
were used for RT-PCR analysis after CHI, and 18 for
immunocytochemistry. We found an early upregulation of
IL-1β, IL-6, and TNF-α mRNA between 1 h and
7 h after injury; the expression of iNOS mRNA only revealed a
significant increase at 4 h. After 24 h, the expression
decreased towards baseline levels, and remained low until 7 d
after injury. Immunocytochemically, IL-1β induction was localized to ramified
microglia in areas surrounding the primary
impact place as well as deeper brain structures. Our study shows
rapid induction of inflammatory gene expression that exceeds by
far the primary impact site and might therefore contribute to
tissue damage at remote sites.
Background
Mobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps.
Objective
The primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences.
Methods
A web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses.
Results
Of the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users’ confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians.
Conclusions
The Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app.
Supplemental Digital Content is available in the text
Prognostic models for recovery, pain, and disability following lumbar microdiscectomy and postoperative physiotherapy were developed and internally validated. The models performed poorly. Currently gathered data do not enable surgeons and clinicians to predict the outcome.
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