The aim of this study was to evaluate body composition, handgrip strength, quality of life, disease duration and activity and lifestyle habits in patients with rheumatoid arthritis (RA) and to ...evaluate possible associations between all of the abovementioned factors. Seventy-five stable RA patients were included. Data on sociodemographic data, disease activity, quality of life, nutritional risk, body mass composition, anthropometric parameters, and clinical and laboratory parameters were collected for each study participant. The results showed that the mean score of the disease activity score (DAS28) was 5.4, the mean score of the health assessment questionnaire-disability index (HAQ-DI) was 1.19, and the mean disease duration in our population was 13.9 years. Our studied population had a long disease duration and high disease activity. Positive predictors of muscle mass in RA patients were daily caloric intake, fat-free mass, bone mass, basal metabolic rate, total body water, weight, body mass index (BMI), height, and muscle strength. There were no significant negative predictors. Positive predictors of muscle strength in RA patients were daily caloric intake, basal metabolic rate, predicted muscle mass, fat-free mass, bone mass, weight, total body water, metabolic age, hemoglobin, BMI, and number of exercises per week. In contrast, negative predictors of muscle strength were number of comorbidities, number of swollen joints, DAS, number of tender joints, erythrocyte sedimentation rate (ESR), and duration of RA. An association was also found between bone mineral density and both muscle mass and muscle strength. A structured nutritional approach in terms of multidisciplinary collaboration between rheumatologist, dietitian and physical medicine specialist is needed in the Dalmatian RA population.
Background: Painfully decreased cervical range of motion accompanied by muscle spasm is a common presentation of whiplash injury of the neck. Stiffness of the cervical muscles can be assessed by ...ultrasound shear wave elastography (SWE), expressed in kilopascals (kPa). The hypothesis: SWE of the trapezius muscle is an objective measurement suitable for the initial screening and follow-up of patients who report whiplash injury. Methods and results: A total of 99 patients after whiplash injury were compared to 75 control participants. Mean trapezius stiffness was 82.24 ± 21.11 vs. 57.47 ± 13.82 for whiplash patients and controls, respectively. The cut-off value of SWE of 75.8 kPa showed 77% accuracy in correctly assigning patients to the whiplash or control group. To evaluate whether SWE can be used as a follow-up method of recovery after a whiplash injury, initial and endpoint SWE (after six months, n = 24) was carried out. Patients reporting no recovery showed similar SWE values as completely recovered patients. This finding refutes the second part of our hypothesis. Conclusions: SWE is a method that can be used for the initial screening of patients with whiplash injury, but we are still searching for an objective measurement that can be used in the follow-up of recovery.
Nefarmakološko liječenje (NFL) osteoporoze (OP) sastavni je dio svih algoritama liječenja ove kompleksne metaboličke bolesti koštanog sustava, čiji je učinak često teško mjerljiv kod primjene istog. ...Za razliku od farmakološkog liječenja koje ima strogo definirane principe liječenja, ovdje postoji dosta neformalnih postupaka i slobodnijeg tumačenja njihovih učinaka na ishode liječenja. Zato smo uvidom u dvije značajne baze podataka (Cochrane, PEDro) i pretraživanjem istih željeli utvrditi što medicina utemeljena na dokazima (EBM) nudi u svojim zaključcima na temu nefarmakološkog liječenja osteoporoze. Najveće značenje daje se različitim modelima vježbanja nudeći (ne)uvjerljive podatke o njihovom učinku na (re)modeliranje osteoporotične kosti i prevenciju novih prijeloma. Kod postmenopauzalne osteoporoze najbolji učinak su pokazale kombinacije vježbi koje su uključivale vježbe snaženja, aerobik, vježbe s utezima i vježbe visokog intenziteta. Od tih vježbi statističko značajno povećanje mineralne gustoće kostiju pokazale su samo vježbe protiv otpora, na spravama u teretani, i to samo za gustoću kosti vrata bedrene kosti, dok su vježbe koordinacije i ravnoteže smanjile broj padova i posljedični broj osteoporotičnih prijeloma. Ostaje potreba za daljnjim istraživanjima i traženjem novih kvalitetnijih dokaza da nefarmakološko liječenje osteoporoze doista ima značajno mjesto u svim postupnicima liječenja.
A prospective observational study comparing shear wave elastography (SWE) of trapezius muscle with Neck Disability Index (NDI) in a prediction model of health status six months after a whiplash ...injury. Both SWE values, measured by two radiologists, and NDI scores were obtained at baseline and after physical therapy (PT) (6-month period). Those values were compared with a 3-point Likert scale (no, partial or full recovery). Twenty-two subjects completed the study. A decrease in trapezius stiffness was detected by both radiologists, statistically significant for one (Δ10.1 kPa; p = 0.04) but not for the second radiologist (Δ8.63 kPa; p = 0.07). The measurements showed excellent intra-observer (ICC 0.75–0.94) and inter-observer (ICC 0.78–0.88) reliability. After six months, fully recovered patients showed lower NDI scores than partially recovered patients (Δ22.98; p < 0.001). SWE values did not differ with the recovery status (55.6 ± 9.7 vs. 57 ± 15.8, Δ1.45; p = 0.82). The single most accurate variable in classifying health status six months after whiplash injury was the relative change of NDI, and it showed the highest accuracy (73.9%) and low Akaike information criterion (AIC = 39.2). Overall, the most accurate classification was obtained when combining NDI and SWE after physical therapy with an accuracy of 77.3% and a decrease in AIC (32.8).
Purpose
The health related quality of life (HRQoL) outcomes of total hip arthroplasty (THA) present a pertinent and clinically important problem in modern orthopaedics. Our goal was to report and ...compare the health-related outcomes after THA in respect to type of fixation in patients with hip osteoarthritis (H-OA) one year after operation.
Methods
A total of 145 patients with H-OA who received THA were evaluated. Uncemented and cemented subjects were evaluated using generic measures, i.e. the EQ-5D questionnaire, and the disease-specific measures designed by the authors, i.e. the Total Hip Arthroplasty Questionnaire (THAQ). Obtained data was statistically processed at the level of pain, functionality and general health perception. Patient-reported outcomes were measured differences between pre-operative measures and those at one-year follow-up visit.
Results
Significant improvement in health outcomes was reached in both groups regardless of the type of fixation (p < 0.001). Uncemented fixation exhibited better results for EQ-5D
INDEX
, pain (p = 0.004) and self-care on EQ-5D (p = 0.043), as well as increased magnitude of change for functionality on THAQ (p = 0.002). However, additional analysis of the subset did not reveal a significant difference between cemented vs. uncemented groups with regard to function on THAQ, but the significant difference on self-care and pain dimensions of EQ-5D remained.
Conclusions
Uncemented endoprosthesis generally achieved better short-term outcomes in some dimensions. However, painless mobility has been restored in most of the patients, regardless of the fixation type. Both methods reached good clinical outcomes in their respective domains; therefore, we would emphasise prevention of osteoarthritis and the quality of care as the more important predictors of good clinical outcomes.
Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive stiffness and rigidity of truncal muscles accompanied with co-contraction of agonist-antagonist ...muscles. Our 51-year-old female patient was presented for the first time to physiatrists in 2006 and diagnosed with axial-spondyloarthropathy (SpA) HLA-B27 positive. SPS was diagnosed 7 years after initial symptoms. SPS should be taken into consideration in HLA-B27 positive patients if stiffness of paravertebral and abdominal muscles progresses during SpA therapy.
Background and Objectives: Rheumatoid arthritis (RA) patients experience sarcopenia and decreased muscle mass and handgrip strength, leading to decreased quality of life and disability. The ...prevalence of RA varies across regions. This study aimed to evaluate the factors associated with RA in Croatian regional centres and explore correlations between clinical parameters and muscle strength. Materials and Methods: Included in this study were 267 stable RA patients from four Croatian clinical centres. The patients’ mean age was 60.4 ± 12.0 years, with 12.7% of them being male. For each study participant, information was gathered on their anthropometric characteristics, clinical and laboratory indicators, quality of life, disease activity, and sociodemographics. Results: The main results showed that in the female RA participants, the significant positive predictors are weight, height, exercise, VAS, and haemoglobin level. The negative predictors are the use of conventional synthetic disease-modifying anti-rheumatic drugs, the use of biological disease-modifying anti-rheumatic drugs, the number of tender joints, the number of swollen joints, the estimated sedimentation rate, the C-reactive protein, the disease activity score, the parameters of the EQ5D, and being prescribed with three or more medications. In the male RA participants, significant predictors of muscle strength are only weight, height, and anxiety/depression difficulties, according to the EQ5D. Conclusions: This study showed correlations between muscle strength and the parameters of disease activity, inflammation parameters, health-related quality of life, therapy, and exercise in the female RA participants in Croatia.
Kompleksnost uzroka, patofiziologije i kliničke slike osteoporoze (OP) razlog je i posljedično kompleksnog liječenja bolesti. Stoga, osim farmakoterapije, u procesu liječenja OP-a veliku ulogu ima i ...prevencija i nefarmakološko liječenje. Pri tome najviše mislimo na liječenje najteže posljedice bolesti – prijeloma. U tu svrhu koriste se različiti oblici fizikalne terapije i različiti rehabilitacijski modeli usmjereni na smanjenje bola i povećanje funkcijskih mogućnosti bolesnica. Spomenutim metodama treba pridodati i korištenje različitih funkcijskih pomagala, koja značajno olakšavaju aktivnosti dnevnog življenja.
Summary
Objective
Longitudinal study to test the validity and reliability of the Croatian version of the neck disability index (NDI-CRO) for use in patients.
Methods
Three groups were given NDI-CRO ...on two occasions, 48 h apart: acute whiplash neck injury group (
n
= 30), hospital physiotherapists—professional chronic neck pain group (
n
= 56) and control group (
n
= 65). To test validity, correlation between NDI-CRO and the pain VAS and PHQ‑9 questionnaire for depression was analyzed. Reliability testing was done using the test-retest experiment and item-total score correlation.
Results
Test-retest showed excellent correlation in all groups: whiplash 0.86, control 0.95 and physiotherapist 0.89 (Spearman r). Item-total score in the 3 analyzed groups showed positive correlation in all 10 categories, varying from 0.43–0.85. The NDI-CRO score showed significant difference between groups (median whiplash 38%, physiotherapist 12% and control 6%,
p
< 0.05). Validity testing showed positive correlation between NDI and pain VAS (control r = 0.63, physiotherapist r = 0.68 and whiplash r = 0.83,
p
< 0.05) and PHQ‑9 (control r = 0.49, physiotherapist r = 0.71 and whiplash r = 0.69,
p
< 0.05). No correlation was found between NDI-CRO and age, gender or radiographic findings. In the whiplash injury group 75% of patients showed moderate to severe disability. The majority of physiotherapists showed mild to moderate disability due to neck pain while 40% showed no disability. In the control group two out of three people reported no disability.
Conclusion
The NDI-CRO is a valid index for measuring the degree of neck disability in people with acute and chronic neck pain and in control group. It is strongly correlated with pain VAS and PHQ‑9 index.
Liječenje upalnih reumatskih bolesti vrlo je kompleksno i zahtjevno. Holistički i individualni pristup takvim bolesnicima obvezuje nas na korištenje svih raspoloživih resursa, kako farmakoloških tako ...i nefarmakoloških na putu postizanja remisije bolesti, bez obzira o kojoj se upalnoj reumatskoj bolesti radi. U ovom preglednom radu, zasnovanom na proučavanju medicine utemeljene na dokazima, osvrnuo sam se na značaj nefarmakološkog liječenja (NFL)
koje je postalo sastavni dio svih algoritama liječenja ovih bolesnika, pri čemu medicinske vježbe imaju najvažniju ulogu među takvim metodama liječenja. Čitav niz dokaza koji su pokazali da je mišić sekretorni organ dokazuju kako se svakim ciklusom vježbanja u mišićima oslobađaju proteini nazvani miokinima, među kojima je najznačajniji u mišiću sintetizirani IL-6, koji onda inhibira proizvodnju TNF-a, stimulira i inducira proizvodnju protuupalnih citokina: IL1-Ra (receptor antagonist) i IL-10 u mononuklearnim krvnim stanicama, čime se ostvaruje značajan protuupalni učinak. Stoga, suprotno ranijim strahovima kako tjelesna aktivnost može pogoršati upalu, sada se smatra kako bi se terapijske vježbe mogle koristiti kao potencijalno potentni lijek za bolesnike s upalnim reumatskim bolestima zbog sinergističkog djelovanja s biološkom terapijom. Pritom ne treba zaboraviti niti ostale metode NFL koje imaju simptomatski učinak, kao što su različiti oblici fizikalne terapije i nutritivna potpora.
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