OBJECTIVE:To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in ...participants with patellar tendinopathy (PT) after 24 weeks.
DESIGN:Randomized controlled trial.
SETTING:Sports medicine departments of a university hospital and a general hospital in the Netherlands.
PARTICIPANTS:Fifty-two physically active male and female participants with a clinical diagnosis of PT (mean age28.6 years; range, 18-45) were randomly allocated to the ESWT (n = 22) or sham shockwave (n = 30).
INTERVENTIONS:Extracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants were instructed to perform eccentric exercises (3 sets of 15 repetitions twice a day) for 3 months on a decline board at home.
MAIN OUTCOME MEASURES:The Victorian Institute of Sport Assessment-Patella (VISA-P) scores (primary), pain scores during functional knee loading tests, and Likert score (secondary) were registered at baseline and at 6, 12, and 24 weeks after the start with the ESWT or sham-shockwave treatment.
RESULTS:No significant differences for the primary and secondary outcome measures were found between the groups. In the ESWT/eccentric group, the VISA-P increased from 54.5 ± 15.4 to 70.9 ± 17.8, whereas the VISA-P in the sham-shockwave/eccentric group increased from 58.9 ± 14.6 to 78.2 ± 15.8 (between-group change in VISA-P at 24 weeks −4.8; 95% confidence interval, −12.7 to 3.0, P = 0.150).
CONCLUSIONS:This study showed no additional effect of 3 sessions ESWT in participants with PT treated with eccentric exercises. The results should be interpreted with caution because of small sample size and considerable loss to follow-up, particularly in the ESWT group.
The COVID-19 pandemic increases healthcare worker (HCW) absenteeism. The bacillus Calmette-Guérin (BCG) vaccine may provide non-specific protection against respiratory infections through enhancement ...of trained immunity. We investigated the impact of BCG vaccination on HCW absenteeism during the COVID-19 pandemic.
HCWs exposed to COVID-19 patients in nine Dutch hospitals were randomized to BCG vaccine or placebo in a 1:1 ratio, and followed for one year using a mobile phone application. The primary endpoint was the self-reported number of days of unplanned absenteeism for any reason. Secondary endpoints included documented COVID-19, acute respiratory symptoms or fever. This was an investigator-funded study, registered at ClinicalTrials.gov (NCT03987919).
In March/April 2020, 1511 HCWs were enrolled. The median duration of follow-up was 357 person-days (interquartile range IQR, 351 to 361). Unplanned absenteeism for any reason was observed in 2.8% of planned working days in the BCG group and 2.7% in the placebo group (adjusted relative risk 0.94; 95% credible interval, 0.78–1.15). Cumulative incidences of documented COVID-19 were 14.2% in the BCG and 15.2% in the placebo group (adjusted hazard ratio (aHR) 0.94; 95% confidence interval (CI), 0.72–1.24). First episodes of self-reported acute respiratory symptoms or fever occurred in 490 (66.2%) and 443 (60.2%) participants, respectively (aHR: 1.13; 95% CI, 0.99–1.28). Thirty-one serious adverse events were reported (13 after BCG, 18 after placebo), none considered related to study medication.
During the COVID-19 pandemic, BCG-vaccination of HCW exposed to COVID-19 patients did not reduce unplanned absenteeism nor documented COVID-19.
Background
Costs associated with extracorporeal membrane oxygenation (ECMO) are an important factor in establishing cost effectiveness. In this systematic review, we aimed to determine the total ...hospital costs of ECMO for adults.
Methods
The literature was retrieved from the PubMed/MEDLINE, EMBASE, and Web of Science databases from inception to 4 March 2020 using the search terms ‘extracorporeal membrane oxygenation’ combined with ‘costs’; similar terms or phrases were then added to the search, i.e. ‘Extracorporeal Life Support’ or ‘ECMO’ or ‘ECLS’ combined with ‘costs’. We included any type of study (e.g. randomized trial or observational cohort) evaluating hospital costs of ECMO in adults (age ≥18 years).
Results
A total of 1768 unique articles were retrieved during our search. We assessed 74 full-text articles for eligibility, of which 14 articles were selected for inclusion in this review; six papers were from the US, five were from Europe, and one each from Japan, Australia, and Taiwan. The sample sizes ranged from 16 to 18,684 patients. One paper exclusively used prospective cost data collection, while all other papers used retrospective data collection. Five papers reported charges instead of costs. There was large variation in hospital costs, ranging from US$22,305 to US$334,608 (2019 values), largely depending on the indication for ECMO support and location. The highest reported costs were for lung transplant recipients who were receiving ECMO support in the US, and the lowest reported costs were for extracorporeal cardiopulmonary resuscitation patients presenting with non-shockable rhythm in Japan. The additional costs of ECMO patients compared with non-ECMO patients varied between US$2518 and US$200,658. Personnel costs varied between 11 and 52% of the total amount.
Conclusions
ECMO therapy is an advanced and expensive technology, although reported costs differ considerably depending on ECMO indication and whether charges or costs are measured. Combined with the ongoing gathering of outcome data, cost effectiveness per ECMO indication could be determined in the future.
Background:
Although it has been suggested that generalized joint hypermobility (GJH) is a risk factor for injury in soccer players, it remains unclear whether this applies to elite female soccer ...players.
Purpose:
To investigate whether GJH is a risk factor for injury in elite female soccer players.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Elite female soccer players in the Netherlands were screened at the start of the 2014-2015 competitive season. GJH was assessed using the Beighton score. Soccer injuries and soccer exposure were registered throughout the entire season. Poisson regression was performed to calculate incidence risk ratios (IRRs) using different cutoff points of the Beighton score (≥3, ≥4, and ≥5) to indicate GJH.
Results:
Of the 114 players included in the study, 20 were classified as hypermobile (Beighton score ≥4). The mean (±SD) injury incidence per player was 8.40 ± 9.17 injuries/1000 hours of soccer, with no significant difference between hypermobile and nonhypermobile players. GJH was not a risk factor for injuries when using Beighton score cutoff points of ≥3 (IRR = 1.06 95% CI, 0.74-1.50; P = .762), ≥4 (IRR = 1.10 95% CI, 0.72-1.68; P = .662), or ≥5 (IRR = 1.15 95% CI, 0.68-1.95; P = .602). Similarly, GJH was not a significant risk factor for thigh, knee, or ankle injuries evaluated separately.
Conclusion:
This study indicates that GJH is not a risk factor for injuries in elite female soccer players, irrespective of Beighton score cutoff point. Hypermobile players at this elite level might have improved their active stability and/or used braces to compensate for joint laxity.
Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional ...treatment are scarce.
To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms.
Retrospective cohort study.
Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital.
Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury.
Functional treatment of the initial ALALS.
Acute lateral ankle ligamentous sprain recurrences and residual symptoms.
A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them.
A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints.
Introduction
Due to large and increasing numbers of cancer survivors, long-term cancer-related health issues have become a major focus of attention. This study examined the relation between a ...high-intensity physical rehabilitation program and return-to-work in cancer survivors who had received chemotherapy.
Methods
The intervention group, consisting of 72 cancer survivors from one hospital (8 men and 64 women, mean age 49 years), followed an 18-weeks rehabilitation program including strength and interval training, and home-based activities. An age-matched control group, consisting of 38 cancer survivors (9 men and 29 women), was recruited from two other hospitals. They received only standard medical care. All subjects were evaluated during a telephone interview on employment issues, conducted at ±3 years after diagnosis. The main outcomes were change in working hours per week and time until return-to-work.
Results
Patients in the intervention group showed significant less reduction in working hours per week −5.0 h/week vs. −10.8 h/week (
P
= .03). Multivariate analyses showed that the training intervention, the age of patients, and the number of working hours pre-diagnosis could explain the improvement in long-term participation at work. Time until (partial) return-to-work was 11.5 weeks for the intervention group versus 13.2 weeks for the control group (
P
= .40). On long-term follow-up, 78% of the participants from the intervention group versus 66% from the control group had returned to work on the pre-diagnosis level of working hours (
P
= .18).
Conclusion
Rehabilitation using high-intensity physical training is useful for working patients to minimize the decreased ability to work resulting from cancer and its treatment.
Purpose: This study reports on survival and health related quality of life (HRQOL) after extracorporeal membrane oxygenation (ECMO) treatment and the associated costs in the first year.
Materials and ...Methods: Prospective observational cohort study patients receiving ECMO in the intensive care unit during August 2017 and July 2019. We analyzed all healthcare costs in the first year after index admission. Follow-up included a HRQOL analysis using the EQ-5D-5L at 6 and 12 months.
Results: The study enrolled 428 patients with an ECMO run during their critical care admission. The one-year mortality was 50%. Follow up was available for 124 patients at 12 months. Survivors reported a favorable mean HRQOL (utility) of 0.71 (scale 0–1) at 12 months of 0.77. The overall health status (VAS, scale 0–100) was reported as 73.6 at 12 months. Mean total costs during the first year were $204,513 ± 211,590 with hospital costs as the major factor contributing to the total costs. Follow up costs were $53,752 ± 65,051 and costs of absenteeism were $7317 ± 17,036.
Conclusions: At one year after hospital admission requiring ECMO the health-related quality of life is favorable with substantial costs but considering the survival might be acceptable. However, our results are limited by loss of follow up. So it may be possible that only the best-recovered patients returned their questionnaires. This potential bias might lead to higher costs and worse HRQOL in a real-life scenario.
•One year costs after ICU admission with extracorporeal membrane oxygenation are high.•Hospital costs are the major factor contributing to the total costs.•Health related quality of life is favorable and comparable to the general population.
Objectives
Although muscle flexibility is considered to be a risk factor for hamstring‐and‐lower back injuries (HLB‐injuries) in male soccer players, it is unclear whether this is true for elite ...female soccer players.
Design
Prospective observational cohort study.
Method
One hundred fourteen elite female soccer players were monitored during the 2014‐2015 soccer season. Hamstring‐and‐lower‐back flexibility (HLB‐flexibility) was assessed using the sit‐and‐reach test (SRT) and soccer exposure and soccer‐related injuries were registered. Poisson regression was used to study the association between HLB‐flexibility and HLB‐injuries with adjustment for possible confounders.
Results
Of the 114 players, 46 (40%) reported an HLB‐injury (60 hamstring injuries and 20 lower back injuries) during the season, accounting for 22% of all injuries reported. No significant association was found between HLB‐flexibility and HLB‐injuries (P = .534). Also, after correction for potential confounders (age, weight, height, match exposure, and training exposure), HLB‐flexibility was not found to be associated with HLB‐injuries ((1.027 (0.989‐1.066) (RR 95% CI)), P = .164 unadjusted, and 1.022 (0.987‐1.059), P = .217 adjusted). Match exposure was significantly associated with HLB‐injuries. When the number of match hours increased by 1, the number of HLB‐injuries increased by a factor 1.051.
Conclusion
HLB‐flexibility does not influence the occurrence of HLB‐injuries in elite female soccer players.
PDF
