Highlights • E-coaching can be an effective tool to be used for cardiac rehabilitation. • At follow-up, complex e-coaching seems to be more effective than usual care. • However, it remains unclear ...which components of e-coaching are most effective. • The content of e-coaching programs should be described more clearly and precisely.
De Quervain disease is a common pathology resulting in pain caused by resisted gliding of the abductor pollicis longus and extensor pollicis brevis tendons in the fibro-osseous canal. In a situation ...of wavering assumptions and expanding medical knowledge, a treatment guideline is useful because it can aid in implementation of best practices, the education of health care professionals, and the identification of gaps in existing knowledge.
The aim of this study was to achieve consensus on a multidisciplinary treatment guideline for de Quervain disease.
A Delphi consensus strategy was used.
A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of surgical and nonsurgical interventions was conducted and published and was used as an evidence-based starting point for this study. In total, 35 experts (hand therapists and hand surgeons selected by the national member associations of their European federations and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report.
Consensus was achieved on the description, symptoms, and diagnosis of de Quervain disease. The experts agreed that patients with this disorder should always receive instructions and that these instructions should be combined with another form of treatment and should not be used as a sole treatment. Instructions combined with nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, NSAIDs plus splinting, corticosteroid injection, corticosteroid injections plus splinting, or surgery were considered suitable treatment options. Details on the use of instructions, NSAIDs, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of these treatment options (ie, severity and duration of the disorder, previous treatments given) were identified. A relationship between the severity and duration of the disorder and the choice of therapy was indicated by the experts and reported in the guideline.
One of the limitations of a Delphi method is its inability to forecast future developments. It investigated current opinions of the treatment of people with de Quervain disease.
This multidisciplinary treatment guideline may help in the treatment of and research on de Quervain disease.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
To describe the incidence, prevalence, and impact of running-related injuries (RRIs) and illness symptoms in half marathon and marathon runners during the 16-week period before the Utrecht Marathon.
...In this prospective cohort study, we used the Oslo Sports Trauma Research Center questionnaire to register RRIs and illness symptoms every 2 weeks during the 16-week study period. When an injury or illness occurred, questions were added regarding its nature. We calculated the incidence proportion (the number of new cases divided by the number of runners at risk) and the period prevalence (the number of existing and new cases within a 2-week period, divided by the total number of runners at risk during that period).
Of the 161 included runners, 9 out of 10 reported an RRI or illness symptom at some time during the study period. In any 2-week period, 5.6% to 14.8% of the runners reported a new RRI, and 6.3% to 13.8% of the runners reported a new illness symptom. The prevalence of RRIs ranged from 29.2% to 43.5%, and the prevalence of illness symptoms ranged from 28.3% to 71.2%. The most prevalent RRIs were in the lower leg (prevalence range, 5.4%-12.3%) and knee (prevalence range, 2.7%-9.3%). The most prevalent illness symptoms were rhinorrhea/sneezing (prevalence range, 3.9%-12.7%) and coughing (prevalence range, 3.9%-11.9%). The incidence and prevalence of illness symptoms peaked at the same time as the influenza-like illness epidemic of the winter of 2015-2016.
Nine out of every 10 runners reported an RRI or illness symptom in the lead-up to a half or full marathon. In any 2-week period, up to 1 in 7 runners reported a new RRI or illness symptom.
2b.
.
OBJECTIVETo study the prevalence of upper extremity disorders (UEDs) and neck as a total and complaints of the arm, neck and/or shoulder (CANS) not caused by acute trauma or any systemic disease as ...defined in the CANS model in the open population and to assess sociodemographic and health characteristics of chronic symptoms.
METHODSData were obtained from the DMC3-study, a Dutch questionnaire survey on musculoskeletal conditions (>25 y, n=3664). Data on four anatomic sites were assessedneck, shoulder, elbow, and wrist. Various health characteristics were measured including the Short Form-36. Rectangle diagrams were used to illustrate cooccurrence of pain in the four anatomic sites.
RESULTSThe 12-month prevalence of CANS was 36.8%, the point prevalence was 26.4%, and 19.0% patients reported chronic CANS. Women, aged 45 to 64 years, with the lowest education level and working were the most affected. Within those with UEDs, around 25% of cases were caused by an acute trauma or by some systemic disease. Of those with chronic CANS, 58% reported use of healthcare. Healthcare users scored worse on general health, limitations in daily living, pain, and sickness absence than nonhealthcare users; >43% reported symptoms in more than 1 anatomic site.
DISCUSSIONUEDs and CANS frequently occur in the open population. Excluding acute traumas and systemic diseases reduced the prevalence of CANS and resulted in a relatively healthier population. A compound definition of CANS seems indicated because of the large overlap of affected anatomic sites.
Abstract Objective To achieve consensus on a multidisciplinary treatment guideline for carpal tunnel syndrome (CTS). Design Delphi consensus strategy. Setting Systematic reviews reporting on the ...effectiveness of surgical and nonsurgical interventions were conducted and used as an evidence-based starting point for a European Delphi consensus strategy. Participants In total, 35 experts (hand surgeons selected from the Federation of European Societies for Surgery of the Hand, hand therapists selected from the European Federation of Societies for Hand Therapy, physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Interventions Not applicable. Main Outcome Measures Each Delphi round consisted of a questionnaire, analysis, and feedback report. Results After 3 Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of CTS. The experts agreed that patients with CTS should always be instructed, and instructions combined with splinting, corticosteroid injection, corticosteroid injections plus splinting, and surgery are suitable treatments for CTS. Relevant details for the use of instructions, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of the aforementioned treatment options were identified as follows: severity and duration of the disorder and previous treatments received. A relation between the severity/duration and choice of therapy was found by the experts and reported in the guideline. Conclusions This multidisciplinary treatment guideline may help physicians and allied health care professionals to provide patients with CTS with the most effective and efficient treatment available.
OBJECTIVE: CANS (complaints of arm, neck, and/or shoulder not caused by a systemic disease or acute trauma) are a recognized problem in specific occupational groups such as musicians. This study ...aimed to compare the prevalence, characteristics, and consequences of CANS between music
academy students and a control group of peer-age medical students. METHODS: A cross-sectional study among music academy students and medical students. Data were collected using a web-based questionnaire on musculoskeletal conditions of the upper extremity in the two cohorts. RESULTS: Students
of three music academies (n=345) and one medical university (n=2,870) received the questionnaire, of which 25% (n=87) and 18% (n=503) responded, respectively. The 12-month prevalence of CANS was nearly twice as high among music academy students as the control group (80.7% vs 41.5%, p<0.001).
Music academy students reported 2.6 times the point prevalence as medical students (47.0% vs 18.2%, p<0.001). Chronic CANS was present in 36.1% of the music students, compared to 10.3% of the medical students (p<0.001). Music academy students presented more complaints per anatomic localization
and a higher number of involved anatomic localizations. Music students rated the influence of CANS on daily functioning as more severe (5.0 vs 3.1, p<0.001). Of all subjects with CANS during the last year, more music academy students (46.3%) visited a healthcare professional compared to
medical students (29.8%, p=0.013). CONCLUSION: The prevalence of CANS is high in music academy students compared to medical students. This emphasizes the necessity of effective (preventive) interventions in these high-demanding professionals.
Summary Background Recurrence rates are important in the evaluation of the effectiveness of treatment for Dupuytren's disease (DD). In the literature, recurrence rates vary between 0% and 100%. The ...definition of recurrence of DD after treatment is inconsistently used. The aim of this study is to review all definitions of recurrence after treatment of DD and to evaluate the impact of using these definitions on a single cohort of patients treated for DD. Methods A literature search was performed in PubMed and Embase to identify studies. Titles and abstracts were analysed to collect all articles that described recurrence rates or definitions of recurrence. Two independent reviewers selected relevant studies and extracted data. The different definitions of recurrence were applied on our data set of 66 patients. Results Of the 113 articles reporting recurrent rates of DD, 56 (49%) presented a definition of recurrence. We could categorise the definitions into three groups. By applying the different definition on our data set of a randomised controlled trial, the recurrence rates ranged from 2% to 86%. Conclusions In the literature, different definitions of recurrence of DD are used and many authors failed to define recurrence. This study shows that the wide range of reported recurrence rates may largely be contributed by inconsistency in recurrence definitions. As a result, it is difficult or even impossible to compare recurrence rates between different treatments reported in the literature. The study indicates that consensus on a recurrence definition is needed.
Background
Midportion Achilles tendinopathy (AT) can cause long-term absence from sports participation, and shows high recurrence rates. It is important that the decision to return to sport (RTS) is ...made carefully, based on sharply delimited criteria. Lack of a well-defined definition and criteria hampers the decision to RTS among athletes with AT, and impedes comparison of RTS rates between different studies.
Objective
The aim of this study was to systematically review the literature for definitions of, and criteria for, RTS in AT research.
Study Design
Qualitative systematic review.
Methods
The PubMed, EMBASE, Cochrane, CINAHL, PEDro, and Scopus electronic databases were searched for articles that reported on the effect of a physiotherapeutic intervention for midportion AT. Article selection was independently performed by two researchers. Qualitative content analysis was used to analyze the included studies and extract definitions of, and criteria for, RTS.
Results
Thirty-five studies were included in the content analysis, showing large variety in both the definitions and criteria. Thirty-two studies reported a definition of RTS, but only 19 studies described the criteria for RTS. The content analysis revealed that ‘reaching pre-injury activity/sports level, with the ability to perform training and matches without limitations’, ‘absence of pain’, and ‘recovery’ were the main content categories used to define RTS. Regarding the criteria for RTS, eight different content categories were defined: (1) ‘level of pain’; (2) ‘level of functional recovery’; (3) ‘recovery of muscle strength’; (4) ‘recovery of range of motion’; (5) ‘level of endurance of the involved limb’; (6) ‘medical advice’; (7) ‘psychosocial factors’; and (8) ‘anatomical/physiological properties of the musculotendinous complex’. Many criteria were not clearly operationalized and lacked specific information.
Conclusions
This systematic review shows that RTS may be defined according to the pre-injury level of sports (including both training and matches), but also with terms related to the absence of pain and recovery. Multiple criteria for RTS were found, which were all related to level of pain, level of functional recovery, muscular strength, range of motion, endurance, medical advice, psychosocial factors, or anatomical/physiological properties of the Achilles tendon. For most of the criteria we identified, no clear operationalization was given, which limits their validity and practical usability. Further research on how RTS after midportion AT should be defined, and which criteria should be used, is warranted.
PROSPERO Registration Number
CRD42017062518.
Purpose: Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, ...but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I-III) was studied.
Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score ≤ −2.0. In addition, we focused on Z-score ≤ −1.0 because this may indicate a tendency towards low bone mineral density.
Results: We included 16 studies, comprising 465 patients aged 1-65 years. Moderate and conflicting evidence for low bone mineral density (Z-score ≤ −2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score ≤ −1.0) for several body parts.
Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy.
Implications for Rehabilitation
Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP.
Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view.
If indicated, medication and fall prevention training should be prescribed.
PDF
