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Journal articleHancock M, Smith A, O'Sullivan P, et al., 2024, , Journal of Physiotherapy, Vol: 70, Pages: 294-301, ISSN: 1836-9553
QuestionDo five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?DesignSecondary analysis of the RESTORE randomised controlled trial.ParticipantsA total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.InterventionParticipants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care.Outcome measuresThe outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising.ResultsBaseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks.ConclusionThe finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients.RegistrationACTRN12618001396213.
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Journal articleJohnson M-C, McGregor AH, A'Hern R, et al., 2024, , European Journal of Surgical Oncology, Vol: 50, ISSN: 0748-7983
PURPOSE: Sixty percent of breast cancer patients develop persistent upper limb pain and dysfunction, but only limited knowledge exists about how these symptoms relate to rehabilitation access. METHODS: A postal survey was sent to patients treated at a London University Teaching Hospital (2018-2020). Data were collected on pain (Pain Detect), shoulder function (Disability of Shoulder Arm and Hand (DASH)), quality-of-life (QoL) (EQ-5D-5L), and clinical characteristics, including treatment and access to rehabilitation. The free-text section invited patients' comments on upper limb symptoms and management strategies, which were analysed thematically. Quantitative data were analysed descriptively, and the medians were examined with Mann-Whitley U-Tests or Kruskal-Wallis Test. RESULTS: Of 511 patients surveyed, 162 (32 %) questionnaires were returned and analysed. Respondents' mean age was 62 years (SD 11.3). The majority had Sentinel Node Biopsy 71 % (116/162) and mastectomy 61 % (99/162). 73 % (119/162) reported pain. Mean (SD) Pain Detect and DASH Score were respectively 11.07 (7) and 21.7 (21.5), with 51 % recording significant shoulder dysfunction, and only 28 % reporting access to rehabilitation. Individuals with neuropathic pain had significantly higher median (range) DASH score 60.8 (35.8, 75.0) p = 0.000. Median DASH score for sedentary individuals was significantly higher 22.9 (7.9, 31.8) p = 0.0009. Free-text analysis revealed persistent, progressive symptoms, mixed attitudes towards exercise and variations in access to rehabilitation and support. CONCLUSION: Two years following surgery many patients reported significant upper limb symptoms which adversely impact on QoL. However, approximately two thirds did not access potentially beneficial rehabilitation treatments. There is a need to improve pathways of care.
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Journal articleKhan AM, Gupte CM, 2024, , BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 85, ISSN: 1750-8460
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Conference paperSgambato BG, Hakami H, Yang X, et al., 2024, , 2024 IEEE Ultrasonics, Ferroelectrics, and Frequency Control Joint Symposium (UFFC-JS), Publisher: IEEE, Pages: 1-6
Powered hand prostheses are essential to support limb-difference users living independently. However, prosthesis abandonment rates are high due to a mismatch between the user’s needs and the performance of current surface electromyography-powered prostheses. Ultrasound has been proposed as an alternative modality of interfacing, but current work has mainly investigated offline scenarios or virtual benchtop validations. To advance in this area, we designed a custom socket and prosthesis solution with 32 distributed single-element transducers to record line-scanning ultrasound across the stump of one participant. A machine learning model was trained, allowing the participant to voluntarily control simultaneous wrist rotation and hand aperture. Offline cross-validation showed a high performance with an r-square of 0.69 ± 0.26. An Online experiment demonstrated that the participant was able to complete the virtual target achievement control task, the box and blocks test, and the clothespin relocation test in an accurate way. This marks the first functional demonstration of A-mode ultrasound-based simultaneous and proportional control, demonstrating its potential for natural and flexible control of prosthetic hands.
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Journal articleAllen J, Clunie G, Newman H, et al., 2024, , Journal of Clinical Medicine, Vol: 13, ISSN: 2077-0383
We read with interest the paper published by Chatwin et al. [1], Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders in the April 2024 edition of the Journal of Clinical Medicine. The ways in which the respiratory (physio)therapy profession is embracing new tools to refine the efficacy of mechanical in-exsufflation (MI-E) are both innovative and fascinating, and we would like to congratulate the authors for establishing such an informative review. We do, however, have a couple of issues to query. As members of a speech and language therapy (SLT) group with a special interest and expertise in upper airway assessment using ultrasound and other adjuvant tools, we believe that this review is missing reference to contemporary literature specific to two key upper airway assessment methods: (1) cervical auscultation and (2) ultrasound. We write this letter in the interest of drawing the reader’s attention to this work. In the absence of empirical evidence, expert opinion plays an important role in clinical decision-making and the development of practice guidelines [2]. However, where evidence does exist, a balanced critique of current literature is necessary. This includes recognising the limitations of emerging assessment tools to ensure that readers are well-informed and that risks of misapplication are mitigated [2,3,4]. We hope our contribution will encourage appropriate use of cervical auscultation and ultrasound in clinical practice and facilitate a well-balanced understanding of their potential and, more importantly, constraints as tools to evaluate the upper airway.
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Journal articleAbel R, 2024, , Scientific Reports, Vol: 14, ISSN: 2045-2322
Gestational growth and development of bone is an understudied process compared to soft tissues and has implications for lifelong health. This study investigated growth and development of human fetal limb bone trabecular architecture using 3D digital histomorphometry of microcomputed tomography data from the femora and humeri of 35 skeletons (17 female and 18 male) with gestational ages between 4 and 9 months. Ontogenetic data revealed: (i) fetal trabecular architecture is similar between sexes; (ii) the proximal femoral metaphysis is physically larger, with thicker trabeculae and greater bone volume fraction relative to the humerus, but other aspects of trabecular architecture are similar between the bones; (iii) between 4 and 9 months gestation there is no apparent sexual or limb dimorphism in patterns of growth, but the size of the humerus and femur diverges early in development. Additionally, both bones exhibit significant increases in mean trabecular thickness (and for the femur alone, bone volume fraction) but minimal trabecular reorganisation (i.e., no significant changes in degree of anisotropy, connectivity density, or fractal dimension). Overall, these data suggest that in contrast to data from the axial skeleton, prenatal growth of long bones in the limbs is characterised by size increase, without major reorganizational changes in trabecular architecture.
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Conference paperSoteriou I, Hadjixenophontos S, Musbahi O, et al., 2024, , 48th Annual Conference of the Association-of-Surgeons-in-Training (ASiT), Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
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Journal articleKuder I, Rock M, Jones G, et al., 2024, , Ultrasound in Medicine and Biology, Vol: 50, Pages: 1108-1121, ISSN: 0301-5629
Objective:Ultrasound speckle tracking enables in vivo measurement of soft tissue deformation or strain, providing a non-invasive diagnostic tool to quantify tissue health. However, adoption into new fields is challenging since algorithms need to be tuned with gold-standard reference data that are expensive or impractical to acquire. Here, we present a novel optimization approach that only requires repeated measurements, which can be acquired for new applications where reference data might not be readily available or difficult to get hold of.Methods:Soft tissue motion was captured using ultrasound for the medial collateral ligament (MCL) of three quasi-statically loaded porcine stifle joints, and medial ligamentous structures of a dynamically loaded human cadaveric knee joint. Using a training subset, custom speckle tracking algorithms were created for the porcine and human ligaments using surrogate optimization, which aimed to maximize repeatability by minimizing the normalized standard deviation of calculated strain maps for repeat measurements. An unseen test subset was then used to validate the tuned algorithms by comparing the ultrasound strains to digital image correlation (DIC) surface strains (porcine specimens) and length change values of the optically tracked ligament attachments (human specimens).Results:After 1500 iterations, the optimization routine based on the porcine and human training data converged to similar values of normalized standard deviations of repeat strain maps (porcine: 0.19, human: 0.26). Ultrasound strains calculated for the independent test sets using the tuned algorithms closely matched the DIC measurements for the porcine quasi-static measurements (R > 0.99, RMSE < 0.59%) and the length change between the tracked ligament attachments for the dynamic human dataset (RMSE < 6.28%). Furthermore, strains in the medial ligamentous structures of the human specimen during flexion showed a strong correlation with anterior/posterior p
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Journal articleNair A, Alagha MA, Cobb J, et al., 2024, , Bioengineering, Vol: 11, ISSN: 2306-5354
Knee osteoarthritis (OA) affects over 650 million patients worldwide. Total knee replacement is aimed at end-stage OA to relieve symptoms of pain, stiffness and reduced mobility. However, the role of imaging modalities in monitoring symptomatic disease progression remains unclear. This study aimed to compare machine learning (ML) models, with and without imaging features, in predicting the two-year Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for knee OA patients. We included 2408 patients from the Osteoarthritis Initiative (OAI) database, with 629 patients from the Multicenter Osteoarthritis Study (MOST) database. The clinical dataset included 18 clinical features, while the imaging dataset contained an additional 10 imaging features. Minimal Clinically Important Difference (MCID) was set to 24, reflecting meaningful physical impairment. Clinical and imaging dataset models produced similar area under curve (AUC) scores, highlighting low differences in performance AUC < 0.025). For both clinical and imaging datasets, Gradient Boosting Machine (GBM) models performed the best in the external validation, with a clinically acceptable AUC of 0.734 (95% CI 0.687–0.781) and 0.747 (95% CI 0.701–0.792), respectively. The five features identified included educational background, family history of osteoarthritis, co-morbidities, use of osteoporosis medications and previous knee procedures. This is the first study to demonstrate that ML models achieve comparable performance with and without imaging features.
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Journal articleBartolo MK, Newman S, Dandridge O, et al., 2024, , Frontiers in Bioengineering and Biotechnology, Vol: 12, ISSN: 2296-4185
Aims: The ovine stifle is an established model for evaluation of knee treatments, such as meniscus replacement. This study introduces a novel ovine gait simulator for pre-testing of surgical treatments prior to in vivo animal trials. Furthermore, we describe a pilot study that assessed gait kinematics and contact pressures of native ovine stifle joints and those implanted with a novel fiber-matrix reinforced polyvinyl alcohol-polyethylene glycol (PVA-PEG) hydrogel meniscus to illustrate the efficacy of the simulator.Methods: The gait simulator controlled femoral flexion-extension and applied a 980N axial contact force to the distal tibia, whose movement was guided by the natural ligaments. Five right ovine stifle joints were implanted with a PVA-PEG total medial meniscus replacement, fixed to the tibia via transosseous tunnels and interference screws. Six intact and five implanted right ovine stifle joints were tested for 500 k gait cycles at 1.55 Hz. Implanted stifle joint contact pressures and kinematics in the simulator were compared to the intact group. Contact pressures were measured at 55° flexion using pressure sensitive film inserted sub-meniscally. 3D kinematics were measured optically across two 30-s captures.Results: Peak contact pressures in intact stifles were 3.6 ± 1.0 MPa and 6.0 ± 2.1 MPa in the medial and lateral condyles (p < 0.05) and did not differ significantly from previous studies (p > 0.4). Medial peak implanted pressures were 4.3 ± 2.2 MPa (p > 0.4 versus intact), while lateral peak pressures (9.4 ± 0.8 MPa) were raised post medial compartment implantation (p < 0.01). The range of motion for intact joints was flexion/extension 37° ± 1°, varus/valgus 1° ± 1°, external/internal rotation 5° ± 3°, lateral/medial translation 2 ± 1 mm, anterior/posterior translation 3 ± 1 mm and distraction/compression 1 ± 1 mm. Ovine joint kinematics in t
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Journal articleGoh EL, Boughton OR, Donnelly T, et al., 2024, , SICOT-J, Vol: 10, ISSN: 2426-8887
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Journal articleDavies A, Sabharwal S, Liddle AD, et al., 2024, , Bone Joint J, Vol: 106-B
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Journal articleDavies A, Liddle AD, Talaya MBZ, et al., 2024, , BONE & JOINT JOURNAL, Vol: 106B, Pages: 1-1, ISSN: 2049-4394
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Journal articleZHOU T, Salman D, McGregor A, 2024, , BMC Musculoskeletal Disorders, Vol: 25, ISSN: 1471-2474
BackgroundLow back pain (LBP) is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population. To rationalise the management of LBP, clinical practice guidelines (CPGs) have been issued in various countries around the world. This study aims to identify and compare the recommendations of recent CPGs for the management of LBP across the world.MethodsMEDLINE, EMBASE, CINAHL, PEDro, and major guideline databases were searched from 2017 to 2022 to identify CPGs. CPGs focusing on information regarding the management and/or treatment of non-specific LBP were considered eligible. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.ResultsOur analysis identified a total of 22 CPGs that met the inclusion criteria, and were of middle and high methodological quality as assessed by the AGREE II tool. The guidelines exhibited heterogeneity in their recommendations, particularly in the approach to different stages of LBP. For acute LBP, the guidelines recommended the use of non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation. For subacute LBP, the guidelines recommended the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation. For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture.ConclusionsCurrent CPGs provide recommendations for almost all major aspects of the management of LBP, but there is marked heterogeneity between them. Some recommendations lack clarity and overlap with other treatments within the guidelines.
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Journal articleDavies A, Sabharwal S, Liddle AD, et al., 2024, , The Bone & Joint Journal, Vol: 106-B, Pages: 482-491, ISSN: 2049-4408
AimsMetal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the National Joint Registry (NJR), which collects data from England, Wales, Northern Ireland, Isle of Man and the States of Guernsey.MethodsNJR shoulder arthroplasty records were linked to Hospital Episode Statistics and the National Mortality Register. TSA and HA performed for osteoarthritis (OA) in patients with an intact rotator cuff were included. Metal and ceramic humeral head prostheses were matched within separate TSA and HA groups using propensity scores based on 12 and 11 characteristics, respectively. The primary outcome was time to first revision and the secondary outcome was non-revision reoperation.ResultsA total of 4,799 TSAs (3,578 metal, 1,221 ceramic) and 1,363 HAs (1,020 metal, 343 ceramic) were included. The rate of revision was higher for metal compared with ceramic TSA, hazard ratio (HR) 3.31 (95% confidence interval (CI) 1.67 to 6.58). At eight years, prosthesis survival for ceramic TSA was 98.7% (95% CI 97.3 to 99.4) compared with 96.4% (95% CI 95.2 to 97.3) for metal TSA. The majority of revision TSAs were for cuff insufficiency or instability/dislocation. There was no significant difference in the revision rate for ceramic compared with metal head HA (HR 1.33 (95% CI 0.76 to 2.34)). For ceramic HA, eight-year prosthetic survival was 92.8% (95% CI 86.9 to 96.1), compared with 91.6% (95% CI 89.3 to 93.5) for metal HA. The majority of revision HAs were for cuff failure.ConclusionThe rate of all-cause revision was higher following metal compared with ceramic humeral head TSA in patients with OA and a
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Journal articleHashim S, Jones G, 2024, , Journal of Orthopaedic Case Reports, Vol: 14, Pages: 121-125, ISSN: 2250-0685
Failure of anterior cruciate ligament (ACL) reconstructive surgery often presents alongside progressive mono-compartment tibiofemoral arthrosis. A total knee arthroplasty (TKA) is the conventional treatment option for this scenario but is associated with high levels of dissatisfaction amongst this younger cohort. This case report outlines a 39-year-old male patient, who underwent revision anterior cruciate ligament reconstruction plus a medial unicompartmental knee replacement (UKA) as a single stage procedure. This is the first reported ACL revision with a simultaneous medial UKA and provides an alternative solution to a total knee arthroplasty in this younger cohort of patients.
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Journal articleDavies A, Sabharwal S, Liddle AD, et al., 2024,
Revision rate in metal compared to ceramic humeral head total shoulder arthroplasty and hemiarthroplasty AN ANALYSIS OF DATA FROM THE NATIONAL JOINT REGISTRY
, BONE & JOINT JOURNAL, Vol: 106B, Pages: 482-491, ISSN: 2049-4394 -
Journal articleScott JW, Ng KCG, Liddle AD, et al., 2024, , CLINICAL BIOMECHANICS, Vol: 115, ISSN: 0268-0033
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Journal articleClunie G, Roe J, Al-Yaghchi C, et al., 2024, , Clinical Otolaryngology, Vol: 49, Pages: 324-330, ISSN: 1749-4478
Objectives:Airway reconstruction for laryngo tracheal stenosis (LTS) improves dyspnoea. There is little evidence relating to impact upon voice and swallowing. We explored voice and swallowing outcomes in adults with LTS before and after reconstructive surgery.Design:Outcome measures were collected pre-reconstructive surgery, two-weeks post-surgery and up to 4-6 months post-surgery.Setting:Tertiary referral centre.Participants:With ethical approval, twenty consecutive adult (≥18 years) LTS patients undergoing airway reconstruction were prospectively recruited.Main outcome measures:These included physiological values (maximum phonation time (MPT) and fundamental frequency; penetration aspiration score, residue score), clinician-reported (GRBAS, functional oral intake score, 100ml Water Swallow Test) and patient-reported outcomes (Voice Handicap Index-10, Reflux Symptoms Index, Eating Assessment Tool, Dysphagia Handicap Index).Results:The observational study identified patient-reported and clinician-reported voice and swallow difficulties pre- and post-surgery; median and interquartile range are reported at each time point: Voice Handicap Index-10 23 (8-31); 20.5 (9-33.5), 24.5 (12.5-29); Dysphagia Handicap Index 9 (0-37); 13 (7-44); 15 (4-34); GRBAS grade 1(1-2); 2 (1-2.5); 2(1-2); 100ml Water Swallow Test volume score 16.7 (11.1-20); 14.3 (12.5-16.7); 16.7 (14.3-20.0); 100ml Water Swallow Test capacity score 16.3 ± 9.0; 11.0 ± 4.1; 12.5 ± 2.6.Conclusions:We present the first prospective data on voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. The variability of the outcomes was higher than expected but importantly, for many the voice and swallow outcomes were not within normal limits before surgery. The clinical value of the study demonstrates the need for individual assessment and management of LTS patients’ voice and swallowing.
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Journal articleWoodbridge H, McCarthy C, Jones M, et al., 2024, , Critical Care (UK), Vol: 28, ISSN: 1364-8535
BackgroundPhysical rehabilitation of critically ill patients is implemented to improve physical outcomes from an intensive care stay. However, before rehabilitation is implemented, a risk assessment is essential, based on robust safety data. To develop this information, a uniform definition of relevant adverse events is required. The assessment of cardiovascular stability is particularly relevant before physical activity as there is uncertainty over when it is safe to start rehabilitation with patients receiving vasoactive drugs.MethodsA three-stage Delphi study was carried out to (a) define adverse events for a general ICU cohort, and (b) to define which risks should be assessed before physical rehabilitation of patients receiving vasoactive drugs. An international group of intensive care clinicians and clinician researchers took part. Former ICU patients and their family members/carers were involved in generating consensus for the definition of adverse events. Round one was an open round where participants gave their suggestions of what to include. In round two, participants rated their agreements with these suggestions using a five-point Likert scale; a 70% consensus agreement threshold was used. Round three was used to re-rate suggestions that had not reached consensus, whilst viewing anonymous feedback of participant ratings from round two.ResultsTwenty-four multi-professional ICU clinicians and clinician researchers from 10 countries across five continents were recruited. Average duration of ICU experience was 18 years (standard deviation 8) and 61% had publications related to ICU rehabilitation. For the adverse event definition, five former ICU patients and one patient relative were recruited. The Delphi process had a 97% response rate. Firstly, 54 adverse events reached consensus; an adverse event tool was created and informed by these events. Secondly, 50 risk factors requiring assessment before physical rehabilitation of patients receiving vasoactive drugs
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