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Rickert C, Ahlich S, Gosheger G, Kalisch T, Liem D, Schneider KN, Klingebiel S. How shoulder immobilization after surgery influences daily activity - a prospective pedometer-based study. INTERNATIONAL ORTHOPAEDICS 2024; 48:793-799. [PMID: 37950086 PMCID: PMC10902083 DOI: 10.1007/s00264-023-06033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Immobilization, especially of the lower extremity, after orthopaedic surgery has been associated with reduced physical activity. Previous interventions from our study group showed even in young, healthy people reduced activity levels after immobilization of the shoulder. Therefore, this study investigates the change in physical activity due to shoulder immobilization after a reconstructive surgery. METHODS This prospective study includes 40 patients undergoing surgery from May 2019 to December 2020. Daily activity was measured before surgery, after discharge and three weeks postoperatively each time for six days. Activity including step counts and active time were measured by Fitbit™ inspire. Range of motion before and after surgery as well as Pain (VAS) were documented. RESULTS Steps became significantly less immediately postoperatively with an immobilized shoulder joint than before surgery (9728.8 vs. 6022.6, p < 0.05). At follow-up, the number of steps increased again, but still showed a significantly lower number of steps (mean 8833.2) compared to preoperative. Patients preoperatively showed mostly an "active" activity pattern, whereas postoperatively a "low active" behaviour predominated. The proportion of sedentary behaviour ("basal activity" and "limited activity") was almost three times higher postoperatively (12.5% vs. 30%). CONCLUSION General physical activity is restricted during upper limb immobilization in adults. Therefore, activity-enhancing measures should be implemented in the early phase of rehabilitation after upper extremity surgery.
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Affiliation(s)
- Carolin Rickert
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1 BuildingA1, Muenster, Germany.
| | - Stefanie Ahlich
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1 BuildingA1, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1 BuildingA1, Muenster, Germany
| | - Tobias Kalisch
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1 BuildingA1, Muenster, Germany
| | | | - Kristian Nikolaus Schneider
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1 BuildingA1, Muenster, Germany
| | - Sebastian Klingebiel
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1 BuildingA1, Muenster, Germany
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Pitt JB, Zeineddin S, Carter M, Figueroa A, Park E, Kwon S, Ghomrawi H, Abdullah F. Using Consumer Wearable Devices to Profile Postoperative Complications After Pediatric Appendectomy. J Surg Res 2024; 295:853-861. [PMID: 38052697 DOI: 10.1016/j.jss.2023.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Markers of postoperative recovery in pediatric patients are difficult for parents to evaluate after hospital discharge, who use subjective proxies to assess recovery and the onset of complications. Consumer-grade wearable devices (e.g., Fitbit) generate objective recovery data in near real time and thus may provide an opportunity to remotely monitor postoperative patients and identify complications beyond the initial hospitalization. The aim of this study was to use daily step counts from a Fitbit to compare recovery in patients with complications to those without complications after undergoing appendectomy for complicated appendicitis. METHODS Children ages 3-17 years old undergoing laparoscopic appendectomy for complicated appendicitis were recruited. Patients wore a Fitbit device for 21 d after operation. After collection, patient data were included in the analysis if minimum wear-time criteria were achieved. Postoperative complications were identified through chart review, and step count trajectories for patients recovering with and without complications were compared. Additionally, to account for the patients experiencing a complication on different postoperative days, median daily step count for pre- and post-complication were analyzed. RESULTS Eighty-six patients with complicated appendicitis were enrolled in the study, and fourteen children developed a postoperative complication. Three patients were excluded because they did not meet the minimum wear time requirements. Complications were divided into abscesses (n = 7, 64%), surgical site infections (n = 2, 18%), and other, which included small bowel obstruction and Clostridioides difficile infection (n = 2, 18%). Patients presented with a complication on mean postoperative day 8, while deviation from the normative recovery trajectory was evident 4 d prior. When compared to children with normative recovery, the patients with surgical complications experienced a slower increase in step count postoperatively, but the recovery trajectory was specific to each complication type. When corrected for day of presentation with complication, step count remained low prior to the discovery of the complication and increased after treatment resembling the normative recovery trajectory. CONCLUSIONS This study profiled variations from the normative recovery trajectory in patients with complication after appendectomy for complicated appendicitis, with distinct trajectory patterns by complication type. Our findings have potentially profound clinical implications for monitoring pediatric patients postoperatively, particularly in the outpatient setting, thus providing objective data for potentially earlier identification of complications after hospital discharge.
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Affiliation(s)
- J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Angie Figueroa
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erica Park
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Soyang Kwon
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hassan Ghomrawi
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Rheumatology Division, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Manojlovic M, Roklicer R, Trivic T, Carraro A, Gojkovic Z, Maksimovic N, Bianco A, Drid P. Objectively evaluated physical activity among individuals following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2024; 10:e001682. [PMID: 38347861 PMCID: PMC10860114 DOI: 10.1136/bmjsem-2023-001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 02/15/2024] Open
Abstract
Objective To compare time spent in moderate-to-vigorous physical activity (MVPA) per week, MVPA per day, and steps per day between individuals that were subjected to the anterior cruciate ligament reconstruction (ACLR) and healthy control group. Design Systematic review and meta-analysis of observational studies. Data sources Web of Science, Scopus, and PubMed have been comprehensively searched to identify relevant investigations. Eligibility criteria for selecting studies An observational research that objectively evaluated physical activity among respondents with a history of ACLR. Results Of 302 records, a total of 12 studies fulfilled the eligibility criteria. Four hundred and forty-three participants underwent the ACLR, 153 men and 290 women. The mean time between anterior cruciate ligament (ACL) surgery and evaluation of analysed outcomes was 34.8 months. The main findings demonstrated that the ACLR group spent less time in weekly MVPA (standardised mean differences (SMD)=-0.43 (95% CI -0.66 to -0.20); mean = -55.86 min (95% CI -86.45 to -25.27); p=0.0003; τ2=0.00), in daily MVPA (SMD=-0.51 95% CI -0.76 to -0.26]; mean = -15.59 min (95% CI -22.93 to -8.25); p<0.0001; τ2=0.00), and they had fewer daily steps (SMD=-0.60 95% CI -0.90 to -0.30); mean = -1724.39 steps (95% CI -2552.27 to -896.50); p<0.0001; τ2=0.00) relative to their non-injured counterparts. Additionally, available investigations indicated that individuals with a history of ACLR participated in 316.8 min of MVPA per week, 67 min in MVPA per day, and 8337 steps per day. Conclusion Long-term after ACLR, participants undergoing ACL surgery were less physically active compared with their non-injured peers, and they did not satisfy recommendations regarding steps per day. PROSPERO registration number CRD42023431991.
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Affiliation(s)
- Marko Manojlovic
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Roberto Roklicer
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Tatjana Trivic
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Attilio Carraro
- Faculty of Education Free University of Bozen-Bolzano, Brixen-Bressanone, Italy
| | - Zoran Gojkovic
- University of Novi Sad Faculty of Medicine, Novi Sad, Serbia
| | - Nemanja Maksimovic
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Patrik Drid
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
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Flinck M, Riad J. Recovery of Gait in Children and Adolescents After Pediatric Femoral Shaft Fracture Treated With Intramedullary Nail Fixation: A Longitudinal Prospective Study. J Pediatr Orthop 2024; 44:1-6. [PMID: 37791633 DOI: 10.1097/bpo.0000000000002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Femoral shaft fractures in school-aged children are commonly treated with intramedullary nail fixation. Outcomes such as time to healing, alignment and non-union, leg length discrepancy, and refractures, and other complications are often reported based on radiographic findings. There are limited reports on physical function, including objective quantitative measures. The aim was to study the progress and recovery of gait after femoral shaft fracture in children and adolescents. METHODS Inclusion criteria were individuals 6 to 16 years of age with a femoral shaft fracture treated with intramedullary nails. Exclusion criteria were pathologic fractures and other physical impairments or injuries that influenced gait.At 6 and 12 weeks, assessments of mobilization and weight bearing were performed at clinical hospital follow-ups.At 3, 6, 9, and 12 months, physical examinations of passive range of motion, stair walking, and three-dimensional gait analysis, including temporospatial, movement (kinematics), and force (kinetics) data, were performed. RESULTS Seventeen participants, with a median of 9.2 (interquartile range 6.5 to 11.3) years of age were included. At 6 weeks, 14 of 16 (88%) used walking aids and at twelve weeks, 25% did. Sixty-nine percent could walk up and down stairs at 6 weeks and 100% at 12 weeks. At 3 months, 3 participants walked with a speed below 100 cm/second and had clear deviations in gait pattern compared with the control group. Three participants had no deviations in gait patterns at 3 months. Gait patterns had normalized in most participants at 6 months. Hip and knee extension moments were decreased up to 6 months compared with the control group. Hip extensor muscle work was increased on the fractured side compared with the control group. CONCLUSIONS Early recovery, between 6 and 12 weeks postoperatively, was noted in basic performance tests after femoral shaft fractures in children and adolescents. Three-dimensional gait analysis revealed normalization of gait patterns at 6 months. Information on the expected time and degree of recovery of physical function could guide the rehabilitation process. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marianne Flinck
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg
| | - Jacques Riad
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
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Gait Analysis to Monitor Fracture Healing of the Lower Leg. Bioengineering (Basel) 2023; 10:bioengineering10020255. [PMID: 36829749 PMCID: PMC9952799 DOI: 10.3390/bioengineering10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.
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Lopas LA, Shen H, Zhang N, Jang Y, Tawfik VL, Goodman SB, Natoli RM. Clinical Assessments of Fracture Healing and Basic Science Correlates: Is There Room for Convergence? Curr Osteoporos Rep 2022; 21:216-227. [PMID: 36534307 DOI: 10.1007/s11914-022-00770-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the clinical and basic science methods used to assess fracture healing and propose a framework to improve the translational possibilities. RECENT FINDINGS Mainstays of fracture healing assessment include clinical examination, various imaging modalities, and assessment of function. Pre-clinical studies have yielded insight into biomechanical progression as well as the genetic, molecular, and cellular processes of fracture healing. Efforts are emerging to identify early markers to predict impaired healing and possibly early intervention to alter these processes. Despite of the differences in clinical and preclinical research, opportunities exist to unify and improve the translational efforts between these arenas to develop and optimize our ability to assess and predict fracture healing, thereby improving the clinical care of these patients.
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Affiliation(s)
- Luke A Lopas
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd Suite 535, Indianapolis, IN, USA.
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yohan Jang
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd Suite 535, Indianapolis, IN, USA
| | - Vivianne L Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd Suite 535, Indianapolis, IN, USA
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Choi YH, Park D, Park D. A novel technique of tibial tuberosity fracture fixation with two knotless suture anchors in an adult: A case report and literature review. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2022; 56:416-420. [PMID: 36567547 PMCID: PMC9885693 DOI: 10.5152/j.aott.2022.22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tibial tuberosity fractures are uncommon in adults. Surgery for these types of fractures is performed similarly to that of tibial tuberosity avulsion fractures in adolescents. The most commonly introduced method is to fix the displaced bone fragments using screws or wires and, if necessary, use tension band wiring for augmentation. However, if the bone fragments are too small or severely comminuted, it may be challenging to fix them using the conventional method. In this study, we introduced a fixation method using two knotless suture anchors that could be attempted in such cases. Since this surgical method fixes the bone fragments without direct damage to the bone fragments, it can be used even when the fragments are small or comminuted. This technique achieved a nearly full active range of knee motion without an extension lag at four weeks postoperatively. In addition, there were no complications related to surgery, and a complete bone union was achieved without additional dislocation. Therefore, this surgical method may be a good alternative if a fixation of the fracture is considered problematic by the conventional method.
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Braun BJ, Grimm B, Hanflik AM, Richter PH, Sivananthan S, Yarboro SR, Marmor MT. Wearable technology in orthopedic trauma surgery - An AO trauma survey and review of current and future applications. Injury 2022; 53:1961-1965. [PMID: 35307166 DOI: 10.1016/j.injury.2022.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/02/2023]
Abstract
The use of wearable sensors to track activity is increasing. Therefore, a survey among AO Trauma members was conducted to provide an overview of their current utilization and determine future needs and directions. A cross sectional expert opinion survey was administered to members of AO Trauma. Respondents were surveyed concerning their experience, subspeciality, current use characteristics, as well as future needs concerning wearable technology. Three hundred and thirty-three survey sets were available for analysis (Response Rate 16.2%). 20.7% of respondents already use wearable technology as part of their clinical treatment. The most prevalent technology was accelerometry combined with smartphones (75.4%) to measure general patient activity. To facilitate the use of wearable technology in the future, the most pressing issues were cost, patient compliance and validity of results. Wearable activity monitors are currently being used in trauma surgery. Surgeons employing these technologies mostly measure simple activity or activity associated parameters. Cost was the greatest perceived barrier to implementation. Further research, especially concerning the interpretation of the outcome values obtained, is required to facilitate wearable activity monitoring as an objective patient outcome measurement tool.
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Affiliation(s)
- Benedikt J Braun
- University Hospital Tuebingen on Behalf of the Eberhard-Karls-University Tuebingen, BG Hospital, Schnarrenbergstr. 95, Tuebingen 72076, Germany.
| | - Bernd Grimm
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods Group, Luxembourg, Institute of Health, Transversal activities, Luxembourg, Luxembourg
| | - Andrew M Hanflik
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Downey Medical Center, Kaiser Permanente Downey, CA, United States
| | - Peter H Richter
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | | | | | - Meir T Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
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Beeckman M, Hughes S, Van der Kaap-Deeder J, Plasschaert F, Michielsen J, Moens P, Schelfaut S, Goubert L. Risk and Resilience Predictors of Recovery After Spinal Fusion Surgery in Adolescents. Clin J Pain 2021; 37:789-802. [PMID: 34419974 DOI: 10.1097/ajp.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This prospective study examined risk and resilience predictors of pain and functional recovery in the first 6 months after spinal fusion surgery in adolescents. METHODS Adolescents with adolescent idiopathic scoliosis undergoing spinal fusion surgery (n=100, aged 12 to 18 y, 77% girls) completed assessments before surgery and at 3 weeks, 6 weeks, and 6 months after surgery. Recovery trajectories in pain, health-related quality of life (HRQOL), and objectively registered physical activity were identified. Presurgical pain catastrophizing and pain intensity (risk), and psychological flexibility, and postsurgical pain acceptance (resilience) were examined as predictors of recovery. RESULTS Latent growth class analyses revealed 4 distinct pain recovery trajectories (ie, Severe-Moderate [11%, n=9], Mild-No [58%, n=49], Moderate-Mild [24%, n=20], and Moderate-Severe [7%, n=6] pain trajectory), 2 HRQOL recovery trajectories; 2 trajectories characterizing recovery in average daily physical activity at moderate-to-vigorous intensity (MVPA); and 3 trajectories characterizing recovery in total physical activity volume characterized by the average daily number of steps. Subsequent multivariate analyses of variance revealed that presurgical pain intensity (partial η2=0.21, P<0.001) and pain catastrophizing (partial η2=0.13, P<0.01) were both predictive of poorer recovery in HRQOL, and pain catastrophizing additionally predicted poorer pain recovery (partial η2=0.15, P<0.05). Psychological flexibility (partial η2=0.25, P<0.001) and postsurgical pain acceptance (partial η2=0.07, P<0.05) were predictive of more favorable recovery trajectories in HRQOL, and psychological flexibility additionally predicted more favorable recovery trajectories in postsurgical pain (partial η2=0.15, P<0.05). Daily MVPA trajectories were not significantly predicted by any of the hypothesized factors, while presurgical pain catastrophizing levels were predictive of a delayed recovery trajectory in the daily amount of steps (partial η2=0.17 P<0.01). CONCLUSIONS Presurgical screening could include assessment of pain intensity, pain catastrophizing, psychological flexibility, and pain acceptance to identify adolescents who are at risk for poorer recovery. These are potentially modifiable factors that can be targeted in presurgical interventions to prevent poor and foster adaptive outcomes after major surgery in adolescents.
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Affiliation(s)
| | - Sean Hughes
- Experimental-Clinical and Health Psychology, Ghent University
| | | | - Frank Plasschaert
- Department of Orthopedics and Traumatology, Ghent University Hospital, Ghent
| | | | - Pierre Moens
- Department of Orthopedics, Leuven University Hospital, Leuven, Belgium
| | | | - Liesbet Goubert
- Experimental-Clinical and Health Psychology, Ghent University
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Effect of Severe Distal Tibia, Ankle, and Mid- to Hindfoot Trauma on Meeting Physical Activity Guidelines 18 Months After Injury. Arch Phys Med Rehabil 2021; 103:409-417.e2. [PMID: 34425087 DOI: 10.1016/j.apmr.2021.07.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine the effect of severe lower extremity trauma on meeting Physical Activity Guidelines for Americans (PAGA) 18 months after injury and perform an exploratory analysis to identify demographic, clinical, and psychosocial factors associated with meeting PAGA. DESIGN Secondary analysis of observational cohort study. SETTING A total of 34 United States trauma centers PARTICIPANTS: A total of 328 adults with severe distal tibia, ankle and mid- to hindfoot injuries treated with limb reconstruction (N=328). INTERVENTIONS None. MAIN OUTCOME MEASURES The Paffenbarger Physical Activity Questionnaire was used to assess physical activity levels 18 months after injury. Meeting PAGA was defined as combined moderate- and vigorous-intensity activity ≥150 minutes per week or vigorous-intensity activity ≥75 minutes per week. RESULTS Fewer patients engaged in moderate- or vigorous-intensity activity after injury compared with before injury (moderate: 44% vs 66%, P<.001; vigorous: 18% vs 29%; P<.001). Patients spent 404±565 minutes per week in combined moderate- to vigorous-intensity activity before injury compared with 224±453 minutes postinjury (difference: 180min per week; 95% confidence interval [CI], 103-256). The adjusted odds of meeting PAGA were lower for patients with depression (adjusted odds ratio [AOR], 0.45; 95% CI, 0.28-0.73), women (AOR, 0.59; 95% CI, 0.35-1.00), and Black or Hispanic patients (AOR, 0.49; 95% CI, 0.28-0.85). Patients meeting PAGA prior to injury were more likely to meet PAGA after injury (odds ratio, 2.0; 95% CI, 1.20-3.31). CONCLUSIONS Patients spend significantly less time in moderate- to vigorous-intensity physical activity after injury. Patients with depression are less likely to meet PAGA. Although the causal relationship is unclear, results highlight the importance of screening for depression.
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Belete Y, Belay GJ, Dugo T, Gashaw M. Assessment of Functional Limitation and Associated Factors in Adults with Following Lower Limb Fractures, Gondar, Ethiopia in 2020: Prospective Cross-Sectional Study. Orthop Res Rev 2021; 13:35-45. [PMID: 33727867 PMCID: PMC7955725 DOI: 10.2147/orr.s300459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Lower limb fractures account for approximately one-third of all fractures. Lower limb fracture complications are one of the major reasons for hospital stays and have high impact on rehabilitation services. Functional limitations with lower extremities fractures are related to decreased functional mobility, the need for long term use of assistive devices, lack of independence, and the long term need for assistive care. This study aimed to assess the functional limitation and identify the possible predictors among lower limb fracture patients by using the Lower Extremity Functional Scale (LEFS). Methods A prospective institutional-based cross-sectional study was conducted from July to October 30/2020, at University of Gondar, comprehensive specialized hospital. The data of 226 participants were collected through face-to-face interviews, patient record review and by physical examination with simple random sampling techniques. Binary logistic regression was used to identify predictors of functional limitation among lower limb fracture with SPSS 25. The strength of the association was present by adjusted odds ratios (OR). Results One hundred and eighty-two (n = 182 (80.5%): 95% CI (74.8 to 85.8) patients with following lower limb fracture have functional limitation. Level of education (AOR =5.50; 95% CI: 1.707–17.742), presence of hospitalized complication AOR=3.26; 95% CI (1.147–9.294), severity of pain AOR=3.19; 95% CI (1.399–7.259), duration of onset AOR=9.512; 95% CI (3.585–25.237), knee flexion limitation AOR=7.13; 95% CI (1.926–26.368) were the independent risk factors for functional limitation. Conclusion The magnitude of functional limitation in following lower limb fracture individual was considerably high in study setup. Level of education, presence of hospitalized complication, severity of pain, duration of onset, knee flexion limitation were the independent risk factors for functional limitation.
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Affiliation(s)
- Yihalem Belete
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Gashaw Jember Belay
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Tamiru Dugo
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
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Lu P, Liao Z, Zeng Q, Chen H, Huang W, Liu Z, Chen Y, Zhong J, Huang G. Customized Three-Dimensional-Printed Orthopedic Close Contact Casts for the Treatment of Stable Ankle Fractures: Finite Element Analysis and a Pilot Study. ACS OMEGA 2021; 6:3418-3426. [PMID: 33553960 PMCID: PMC7860236 DOI: 10.1021/acsomega.0c06031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Ankle fracture is one of the most common traumatic fractures among the elderly population. The majority of ankle fractures are stable types with the typically conservative strategy of close contact casting treatment. The continuous use of unventilated standard cast immobilization severely affects patient's satisfaction and compliance and markedly increases the rates of various complications. Three-dimensional (3D) printing for casts has advantages of lightweight, ventilated, proper-fit, and esthetic improvements. In this work, this novel 3D-printed cast has been applied to individuals with stable ankle fractures, and its effectiveness can be successfully validated with finite element analysis and a pilot study. A 30% reduction of the volume was chosen as the optimal result in topology optimization. Both 3D-printed casts and conventional casts showed significant ankle function improvement after immobilization for 6 weeks (p = 0.000). The 3D-printed casts were superior to the traditional casts in Olerud-Molander Ankle Scores (OMAS), with the mean difference of 8.3 ± 8.57 OMAS points (95% CI -10.8 to 27.5; p = 0.354) for 6 weeks, implying that the 3D-printed casts possibly maintain the equal clinical efficacy as the traditional casts. The statistically significant difference between groups from the 3D-printed cast and the traditional one observed in C-QUEST 2.0 was 11.3 ± 1.5 points (95% CI 8.0-14.6; p = 0.000), indicating that the 3D-printed cast possesses outperforming satisfaction and compliance and has great potential in practical applications. There were no severe complications in the 3D-printed casts, but more moderate complications were observed in the traditional casts.
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Affiliation(s)
- Pengcheng Lu
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Zhengwen Liao
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Qing Zeng
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Huan Chen
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Weichun Huang
- School
of Chemistry and Chemical Engineering, Nantong
University, Nantong 226019, China
| | - Zhen Liu
- Department
of Rehabilitation Medicine, The First People’s
Hospital of Foshan, Foshan 528000, China
| | - Yanjun Chen
- Guangdong
Medical Innovation Platform for Translation of 3D Printing Application,
Department of Medical Radiology, The Third
Affiliated Hospital of Southern Medical University, Guangzhou 510515, China
| | - Jing Zhong
- Guangdong
Engineering Research Center for Translation of Medical 3D Printing
Application, Guangdong Provincial Key Laboratory of Medical Biomechanics,
School of Basic Medical Sciences, Southern
Medical University, Guangzhou 510515, China
| | - Guozhi Huang
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
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13
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Veitch WG, Climie RE, Gabbe BJ, Dunstan DW, Owen N, Ekegren CL. Agreement between the International Physical Activity Questionnaire and Accelerometry in Adults with Orthopaedic Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176139. [PMID: 32846977 PMCID: PMC7504024 DOI: 10.3390/ijerph17176139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/21/2022]
Abstract
Orthopaedic injury can lead to decreased physical activity. Valid measures for assessing physical activity are therefore needed in this population. The aim of this study was to determine the agreement and concordance between the International Physical Activity Questionnaire-Short Form (IPAQ) and device-measured physical activity and sitting time in orthopaedic injury patients. Adults with isolated upper or lower limb fracture (n = 46; mean age of 40.5 years) wore two activity monitors (ActiGraph wGT3X-BT and activPAL) for 10 days, from 2 weeks post-discharge. The IPAQ was also completed for a concurrent 7-day period. Lin's concordance correlation coefficients and Bland-Altman plots were calculated to compare walking/stepping time, total METmins, and sitting time. The IPAQ overestimated device-derived walking time (mean difference = 2.34 ± 7.33 h/week) and total METmins (mean difference = 767 ± 1659 METmins/week) and underestimated sitting time (mean difference = -2.26 ± 3.87 h/day). There was fair concordance between IPAQ-reported and device-measured walking (ρ = 0.34) and sitting time (ρ = 0.38) and moderate concordance between IPAQ-reported and device-measured METmins (ρ = 0.43). In patients with orthopaedic injury, the IPAQ overestimates physical activity and underestimates sitting time. Higher agreement was observed in the forms of activity (walking, total PA and sitting) commonly performed by this patient group.
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Affiliation(s)
- William G. Veitch
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; (W.G.V.); (B.J.G.)
| | - Rachel E. Climie
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; (W.G.V.); (B.J.G.)
- Health Data Research UK, Swansea University Medical School, Swansea SA2 8QA, UK
| | - David W. Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
| | - Neville Owen
- Behavioural Epidemiology, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
- Swinburne Centre for Urban Transitions, Swinburne University of Technology, Melbourne 3122, Australia
| | - Christina L. Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; (W.G.V.); (B.J.G.)
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
- Emergency and Trauma Centre, The Alfred, Melbourne 3004, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston 3199, Australia
- Correspondence: ; Tel.: +61-3-9903-0939
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14
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Ekegren CL, Climie RE, Simpson PM, Owen N, Dunstan DW, Veitch W, Gabbe BJ. Physical Activity and Sedentary Behavior 6 Months After Musculoskeletal Trauma: What Factors Predict Recovery? Phys Ther 2020; 100:332-345. [PMID: 31588514 DOI: 10.1093/ptj/pzz151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/25/2019] [Accepted: 06/27/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Physical activity is increasingly recognized as an important marker of functional recovery following fracture. OBJECTIVE The objectives of this study were to measure sedentary behavior and physical activity 2 weeks and 6 months following fracture and to determine associated demographic and injury factors. DESIGN This was an observational study. METHODS Two weeks and 6 months following fracture, 83 adults who were 18 to 69 years old and had upper limb (UL) or lower limb (LL) fractures wore an accelerometer and an inclinometer for 10 days. We calculated sitting time, steps, moderate-intensity physical activity (MPA), and vigorous-intensity physical activity and conducted linear mixed-effects multivariable regression analyses to determine factors associated with temporal changes in activity. RESULTS At 6 months versus 2 weeks after fracture, participants sat less, took more steps, and engaged in more MPA. Participants with LL fractures sat 2 hours more, took 66% fewer steps, and engaged in 77% less MPA than participants with UL fractures. Greater reductions in sitting time were observed for participants in the youngest age group and with LL fractures, participants with high preinjury activity, and participants who were overweight or obese. For steps, greater improvement was observed for participants in the youngest and middle-aged groups and those with LL fractures. For MPA, greater improvement was observed for middle-aged participants and those with LL fractures. LIMITATIONS Although this study was sufficiently powered for the analysis of major categories, a convenience sample that may not be representative of all people with musculoskeletal trauma was used. CONCLUSIONS Working-age adults with LL fractures had lower levels of physical activity 6 months after fracture than those with UL fractures. Older adults showed less improvement over time, suggesting that they are an important target group for interventions aimed at regaining preinjury activity levels.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; and The Alfred, Melbourne, Victoria, Australia
| | - Rachel E Climie
- Baker Heart and Diabetes Institute; and Paris Centre de Recherche Cardiovasculaire, Paris, France
| | - Pamela M Simpson
- BSc (Hons), Grad Dip Biostats, Department of Epidemiology and Preventive Medicine, Monash University
| | - Neville Owen
- Baker Heart and Diabetes Institute; and Swinburne University of Technology, Melbourne, Victoria, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute; and Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - William Veitch
- BBiomedSci (Hons), Department of Epidemiology and Preventive Medicine, Monash University
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University; and Health Data Research UK, Swansea University, Swansea, United Kingdom
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15
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Maggio ABR, Martin X, Steiger C, Tabard-Fougère A, Dayer R, Delhumeau C, Ceroni D. Do teenagers return to normal physical activity levels after limb fractures? A longitudinal, accelerometry-based, activity monitoring study. J Child Orthop 2019; 13:575-581. [PMID: 31908674 PMCID: PMC6924123 DOI: 10.1302/1863-2548.13.190082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study aimed to elucidate whether levels of physical activity (PA) return to normal after bone healing or whether long-term behavioural changes in PA are to be expected in children and teenagers who have sustained limb fractures. METHODS In all, 100 children and teenagers with a first episode of limb fracture and 100 sex- and age-matched healthy controls (CTRL) were recruited for a prospective study. PA in limb fracture patients was assessed at 18-month follow-up using accelerometer measurements, and values were compared with those of CTRL. Time spent in PA at different levels of intensity was determined for each participant and expressed in minutes and as a percentage of total validly measured time. RESULTS Mean levels of PA at different levels of intensity by previously injured children and teenagers were similar than CTRL (42 sets of paired data). However, time spent in moderate-to-vigorous PA (MVPA) was lower than 60 minutes among limb-fracture patients at 18-month follow-up. CONCLUSION The amount of skeletal loading in children and teenagers returns to normal values by 18 months after limb fracture. Even if time spent in MVPA is not significantly lower in children and teenagers with limb fractures, it no longer reached the international recommendations for school-aged children (MVPA > 60 minutes), which may be interpreted as a lifestyle modification or a behavioural change to avoid new trauma. LEVEL OF EVIDENCE II.
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Affiliation(s)
- A. B. R. Maggio
- Health and movement consultation, Pediatric Cardiology Unit, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - X. Martin
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland,Clinical Epidemiology Service, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - C. Steiger
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - A. Tabard-Fougère
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland,Correspondence should be sent to A. Tabard-Fougère, Pediatric Orthopedic Unit, Department of Child and Adolescent, Children’s Hospital, 6 Rue Willy Donzé, 1211 Geneva 14 / Switzerland. E-mail:
| | - R. Dayer
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - C. Delhumeau
- Clinical Epidemiology Service, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - D. Ceroni
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
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16
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L. Ekegren C, E. Climie R, G. Veitch W, Owen N, W. Dunstan D, A. Kimmel L, J. Gabbe B. Sedentary behaviour and physical activity patterns in adults with traumatic limb fracture. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Maggio ABR, Martin XE, Tabard-Fougère A, Delhumeau C, Ceroni D. What is the real impact of upper limb cast immobilisation on activity-related energy expenditure in children? BMJ Open Sport Exerc Med 2018; 4:e000359. [PMID: 30364617 PMCID: PMC6196977 DOI: 10.1136/bmjsem-2018-000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background Upper limb fractures and subsequent cast immobilisation constitute a potential cause of reduction in childhood levels of physical activity (PA), with subsequent decrease of energy consumption. The main objective of this study was thus to quantify the decrease of activity-related energy expenditure (AEE) due to upper limb cast immobilisation. Methods We conducted a longitudinal matched case-control study that included 35 children and teenagers with a first episode of upper limb fracture and 35 healthy cases. PA was assessed during cast immobilisation by accelerometer. AEE was the calculated using an equation based on the total counts per day measured by accelerometers. Results AEE in children and teenagers with upper limb fractures was estimated to be 7.4 % lower than healthy controls. The mean difference corresponded to 1.35 kcal/kg per mean valid recorded time (750 min), that is, the waking hours. When converted in kcal per mean subjects’ weight, the difference in AEE amounted 63.5 kcal/day, which corresponds approximately to 26 min of walking at a speed of 4 km/hours. In comparison with the mean AEE in healthy controls (18.2 kcal/kg), the noted decrease (1.35 kcal/kg) represents only 7.4 % of AEE. Conclusion Reduction of AEE in children and teenagers with upper limb fractures may lead to a slight positive energy balance, as there is usually no compensatory reduction of energy intake. An increase of light PA has to be counselled in this situation or patients should be advised to reduce their energy intake during the immobilisation period. Level of evidence Level I: high-quality prospective study (all patients were enrolled at the same point in their disease with ≥80 % follow-up of enrolled patients).
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Affiliation(s)
- Albane B R Maggio
- Santé et Mouvement Consultation, Service of Paediatric Specialties, Department of Child and Adolescent, UniversityHospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Xavier Eric Martin
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals, Geneva, Switzerland.,Clinical Epidemiology Service, Department of Child and Adolescent, University of Geneva Hospitals, Geneva, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals, Geneva, Switzerland
| | - Cécile Delhumeau
- Clinical Epidemiology Service, Department of Child and Adolescent, University of Geneva Hospitals, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Hospitals, Geneva, Switzerland
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18
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Ghomrawi HM, Baumann LM, Kwon S, Hebal F, Hsiung G, Williams K, Reimann M, Stake C, Johnson EK, Abdullah F. Using accelerometers to characterize recovery after surgery in children. J Pediatr Surg 2018; 53:1600-1605. [PMID: 29092769 DOI: 10.1016/j.jpedsurg.2017.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessment of recovery after surgery in children remains highly subjective. However, advances in wearable technology present an opportunity for clinicians to have an objective assessment of postoperative recovery. The aims of this pilot study are to: (1) evaluate acceptability of accelerometer use in pediatric surgical patients, (2) use accelerometer data to characterize the recovery trajectory of physical activity, and (3) determine if postoperative adverse events are associated with a decrease in physical activity. STUDY DESIGN Children aged 3-18-years-old undergoing elective inpatient and outpatient surgical procedures were invited to participate. Physical activity was measured using an Actigraph GT3X wristworn accelerometer for ≥2days preoperatively and 5-14days postoperatively. Time spent performing light (LPA) and moderate-to-vigorous physical activity (MVPA) was expressed in minutes/day. Physical activity for each postoperative day was calculated as a percentage of preoperative activity, and recovery trajectories were produced. Adverse events were reported and mapped against recovery trajectories. RESULTS Of 60 patients enrolled, 25 (10 inpatients, 15 outpatients) completed the study procedures and were included in the analysis. For outpatient procedures, LPA recovered to preoperative level on postoperative day (POD) 7 and MVPA peaked at 90% on POD 8. For inpatient procedures, LPA peaked at 70% on POD 11, and MVPA peaked at 53% on POD 10. Adverse events in 2 patients were associated with a decline in activity. CONCLUSIONS This study demonstrates that objective monitoring of postoperative physical activity using accelerometers is feasible in the pediatric surgical population. Recovery trajectories for inpatient and outpatient procedures differ. Accelerometer technology presents clinicians with a new potential tool for assessing and managing surgical recovery, and for determining if children are not recovering as expected. TYPE OF STUDY Diagnostic Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hassan Mk Ghomrawi
- Departments of Surgery and Pediatrics, Feinberg School of Medicine; Center for Healthcare Studies, Northwestern University.
| | - Lauren M Baumann
- Center for Healthcare Studies, Northwestern University; Division of Pediatric Surgery, Department of Surgery
| | - Soyang Kwon
- The Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago
| | | | - Grace Hsiung
- Department of Surgery University of Texas Health Science Center at San Antonio
| | - Kibileri Williams
- Center for Healthcare Studies, Northwestern University; Division of Pediatric Surgery, Department of Surgery
| | - Molly Reimann
- Division of Pediatric Surgery, Department of Surgery
| | | | - Emilie K Johnson
- Center for Healthcare Studies, Northwestern University; Department of Urology, Northwestern University; Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Fizan Abdullah
- Departments of Surgery and Pediatrics, Feinberg School of Medicine; Center for Healthcare Studies, Northwestern University; Division of Pediatric Surgery, Department of Surgery
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19
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Perry B, Herrington W, Goldsack JC, Grandinetti CA, Vasisht KP, Landray MJ, Bataille L, DiCicco RA, Bradley C, Narayan A, Papadopoulos EJ, Sheth N, Skodacek K, Stem K, Strong TV, Walton MK, Corneli A. Use of Mobile Devices to Measure Outcomes in Clinical Research, 2010-2016: A Systematic Literature Review. Digit Biomark 2018; 2:11-30. [PMID: 29938250 PMCID: PMC6008882 DOI: 10.1159/000486347] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/13/2017] [Indexed: 01/08/2023] Open
Abstract
Background The use of mobile devices in clinical research has advanced substantially in recent years due to the rapid pace of technology development. With an overall aim of informing the future use of mobile devices in interventional clinical research to measure primary outcomes, we conducted a systematic review of the use of and clinical outcomes measured by mobile devices (mobile outcomes) in observational and interventional clinical research. Method We conducted a PubMed search using a range of search terms to retrieve peer-reviewed articles on clinical research published between January 2010 and May 2016 in which mobile devices were used to measure study outcomes. We screened each publication for specific inclusion and exclusion criteria. We then identified and qualitatively summarized the use of mobile outcome assessments in clinical research, including the type and design of the study, therapeutic focus, type of mobile device(s) used, and specific mobile outcomes reported. Results The search retrieved 2,530 potential articles of interest. After screening, 88 publications remained. Twenty-five percent of the publications (n = 22) described mobile outcomes used in interventional research, and the rest (n = 66) described observational clinical research. Thirteen therapeutic areas were represented. Five categories of mobile devices were identified: (1) inertial sensors, (2) biosensors, (3) pressure sensors and walkways, (4) medication adherence monitors, and (5) location monitors; inertial sensors/accelerometers were most common (reported in 86% of the publications). Among the variety of mobile outcomes, various assessments of physical activity were most common (reported in 74% of the publications). Other mobile outcomes included assessments of sleep, mobility, and pill adherence, as well as biomarkers assessed using a mobile device, including cardiac measures, glucose, gastric reflux, respiratory measures, and intensity of head-related injury. Conclusion Mobile devices are being widely used in clinical research to assess outcomes, although their use in interventional research to assess therapeutic effectiveness is limited. For mobile devices to be used more frequently in pivotal interventional research – such as trials informing regulatory decision-making – more focus should be placed on: (1) consolidating the evidence supporting the clinical meaningfulness of specific mobile outcomes, and (2) standardizing the use of mobile devices in clinical research to measure specific mobile outcomes (e.g., data capture frequencies, placement of device). To that aim, this manuscript offers a broad overview of the various mobile outcome assessments currently used in observational and interventional research, and categorizes and consolidates this information for researchers interested in using mobile devices to assess outcomes in interventional research.
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Affiliation(s)
- Brian Perry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
| | - Will Herrington
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer C Goldsack
- Clinical Trials Transformation Initiative, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Cheryl A Grandinetti
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kaveeta P Vasisht
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Martin J Landray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Corey Bradley
- Duke University Hospital, Durham, North Carolina, USA
| | | | - Elektra J Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nirav Sheth
- MicroMedicine, Watertown, Massachusetts, USA
| | - Ken Skodacek
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Marc K Walton
- Janssen Research and Development, Titusville, New Jersey, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
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20
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Zdziarski-Horodyski L, Horodyski M, Sadasivan KK, Hagen J, Vasilopoulos T, Patrick M, Guenther R, Vincent HK. An integrated-delivery-of-care approach to improve patient reported physical function and mental wellbeing after orthopedic trauma: study protocol for a randomized controlled trial. Trials 2018; 19:32. [PMID: 29325583 PMCID: PMC5765655 DOI: 10.1186/s13063-017-2430-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthopedic trauma injury impacts nearly 2.8 million people each year. Despite surgical improvements and excellent survivorship rates, many patients experience poor quality of life (QOL) outcomes years later. Psychological distress commonly occurs after injury. Distressed patients more frequently experience rehospitalizations, pain medication dependence, and low QOL. This study was developed to test whether an integrative care approach (IntCare; ten-step program of emotional support, education, customized resources, and medical care) was superior to usual care (UsCare). The primary aim was to assess patient functional QOL (objective and patient-reported outcomes) with secondary objectives encompassing emotional wellbeing and hospital outcomes. The primary outcome was the Lower Extremity Gain Scale score. METHODS/DESIGN A single-blinded, single-center, repeated measures, randomized controlled study is being conducted with 112 orthopedic trauma patients aged 18-85 years. Patients randomized to the IntCare group have completed or are receiving a guided ten-step support program during acute care and at follow-up outpatient visits. The UsCare group is being provided the standard of care. Patient-reported outcomes and objective functional measures are collected at the hospital and at weeks 2, 6, and 12 and months 6 and 12 post surgery. The main study outcomes are changes in Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires of Physical Function quality of life, Satisfaction with Social Roles, and Positive-Illness Impact, Post-Traumatic Stress Disorder Check List, and the Tampa Scale of Kinesiophobia-11 from baseline to month 12. Secondary outcomes are changes in objective functional measures of the Lower Extremity Gain Scale, handgrip strength, and range of motion of major joints from week 2 to month 12 post surgery. Clinical outcomes include hospital length of stay, medical complications, rehospitalizations, psychological measures, and use of pain medications. A mixed model repeated measures approach assesses the main effects of treatment and time on outcomes, as well as their interaction (treatment × time). DISCUSSION The results from this study will help determine whether an integrative care approach during recovery from traumatic orthopedic injury can improve the patient perceptions of physical function and emotional wellbeing compared to usual trauma care. Additionally, this study will assess the ability to reduce the incidence or severity of psychological distress and mitigate medical complications, readmissions, and reduction of QOL after injury. TRIAL REGISTRATION ClinicalTrials.gov, NCT02591472 . Registered on 28 October 2015.
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Affiliation(s)
| | - MaryBeth Horodyski
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Kalia K Sadasivan
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Jennifer Hagen
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Terrie Vasilopoulos
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA.,Departments of Anesthesia, University of Florida, Gainesville, FL, 32608, USA
| | - Matthew Patrick
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Robert Guenther
- Departments of Clinical Psychology, University of Florida, Gainesville, FL, 32608, USA
| | - Heather K Vincent
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA.
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21
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Physical Activity and Sedentary Behavior Subsequent to Serious Orthopedic Injury: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2017.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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Conrad N, Karlik J, Lewandowski Holley A, Wilson AC, Koh J. A Narrative Review: Actigraphy as an Objective Assessment of Perioperative Sleep and Activity in Pediatric Patients. CHILDREN-BASEL 2017; 4:children4040026. [PMID: 28420221 PMCID: PMC5406685 DOI: 10.3390/children4040026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
Sleep is an important component of pediatric health and is crucial for cognitive development. Actigraphy is a validated, objective tool to capture sleep and movement data that is increasingly being used in the perioperative context. The aim of this review is to present recent pediatric studies that utilized actigraphy in the perioperative period, highlight gaps in the literature, and provide recommendations for future research. A literature search was completed using OVID and PubMed databases and articles were selected for inclusion based on relevance to the topic. The literature search resulted in 13 papers that utilized actigraphic measures. Results of the review demonstrated that actigraphy has been used to identify predictors and risk factors for poor postoperative sleep, examine associations among perioperative pain and sleep patterns, and assess activity and energy expenditure in both inpatient and outpatient settings. We propose expansion of actigraphy research to include assessment of sleep via actigraphy to: predict functional recovery in pediatric populations, to study postoperative sleep in high-risk pediatric patients, to test the efficacy of perioperative interventions, and to assess outcomes in special populations for which self-report data on sleep and activity is difficult to obtain.
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Affiliation(s)
- Nicole Conrad
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
| | - Joelle Karlik
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
| | - Amy Lewandowski Holley
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR 97329, USA.
| | - Anna C Wilson
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR 97329, USA.
| | - Jeffrey Koh
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
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Biber R, Stedtfeld HW, Bail HJ. The Targon PH(®) nail for distal femoral fracture fixation in disabled children. A report of three cases. Orthop Traumatol Surg Res 2014; 100:699-702. [PMID: 24970711 DOI: 10.1016/j.otsr.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 03/06/2014] [Accepted: 05/07/2014] [Indexed: 02/02/2023]
Abstract
UNLABELLED Recommendations for distal femoral fracture treatment in children with neuromuscular disease are various, including conservative, plating, nailing, and ESIN. All methods have disadvantages. Retrograde femoral intramedullary nailing using a statically interlocked Targon PH nail was performed in three cases. A right nail was used for a right femur (and vice versa). A short nail was used for supracondylar fractures, a long nail for distal femoral shaft fractures. Closed reduction was performed in all cases. Despite osteopenia, small bone dimensions and muscle dystrophy, no intraoperative or postoperative complications occurred. All cases achieved primary stability, allowing immediate rehabilitation. Bone healing occurred uneventfully within four months. No deterioration of functional status or range of motion was seen. There were no peri-implant fractures or hardware removal need over a two-year-period. Retrograde femoral nailing with the Targon PH nail seems to be a reasonable treatment concept for these rare and demanding cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- R Biber
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg Sued, Breslauer Strasse 201, 90471 Nuernberg, Germany.
| | - H-W Stedtfeld
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg Sued, Breslauer Strasse 201, 90471 Nuernberg, Germany.
| | - H J Bail
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg Sued, Breslauer Strasse 201, 90471 Nuernberg, Germany.
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Kamada M, Kitayuguchi J, Lee IM, Hamano T, Imamura F, Inoue S, Miyachi M, Shiwaku K. Relationship between physical activity and chronic musculoskeletal pain among community-dwelling Japanese adults. J Epidemiol 2014; 24:474-83. [PMID: 25070208 PMCID: PMC4213222 DOI: 10.2188/jea.je20140025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/22/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Both little and excessive physical activity (PA) may relate to chronic musculoskeletal pain. The primary objective of this study was to characterize the relationship of PA levels with chronic low back pain (CLBP) and chronic knee pain (CKP). METHODS We evaluated 4559 adults aged 40-79 years in a community-based cross-sectional survey conducted in 2009 in Shimane, Japan. We used self-administered questionnaires to assess sociodemographics and health status: PA was assessed by the International Physical Activity Questionnaire, and CLBP and CKP were assessed by a modified version of the Knee Pain Screening Tool. We examined relationships of PA with prevalence of CLBP and CKP using Poisson regression, controlling for potential confounders. RESULTS CLBP and CKP were both prevalent (14.1% and 10.7%, respectively) and associated with history of injury, medication use, and consultation with physicians. PA was not significantly related to CLBP or CKP (P > 0.05) before or after adjustment for potential confounders. For example, compared with adults reporting moderate PA (8.25-23.0 MET-hours/week), prevalence ratios for CKP adjusted for sex, age, education years, self-rated health, depressive symptom, smoking, chronic disease history, and body-mass index were 1.12 (95% confidential interval [CI] 0.84-1.50) among those with the lowest PA and 1.26 (95% CI 0.93-1.70) among those with the highest PA (P quadratic = 0.08). The prevalence ratios were further attenuated toward the null after additional adjustment for history of injury, medication use, and consultation (P quadratic = 0.17). CONCLUSIONS This cross-sectional study showed that there were no significant linear or quadratic relationships of self-reported PA with CLBP and CKP. Future longitudinal study with objective measurements is needed.
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Sabatini CS, Curtis TA, Mahan ST. Patient-based outcomes after tibia fracture in children and adolescents. Open Orthop J 2014; 8:41-8. [PMID: 24627732 PMCID: PMC3952204 DOI: 10.2174/1874325001408010041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction : Tibia fractures are common in pediatric patients and time necessary to return to normal function may be underappreciated. The purpose of this study was to assess functional recovery in pediatric patients who sustain tibia fractures, utilizing the Pediatrics Outcome Data Collection Instrument (PODCI), in order to provide evidence-based information on post-injury functional limitations and anticipated recovery times. Methods : 84patients (out of 264 eligible patients, response rate 32%) age 1.5-18 years treated for a tibia fracture at a large children's hospital between 1/07 and 4/08 completed a PODCI questionnaire at 6 and 12 months post-injury. PODCI questionnaires were compared to previously reportednormal controls using Student's t-test in six categories. Results : At 6 months after injury, the Sports functioning PODCI score was significantly less than healthy controls in both the parent reports for adolescent (mean 88.71 versus 95.4) and adolescent self-report (mean 90.44 versus 97.1); these showed no difference at 12 months. Discussion : For adolescents who sustain fractures of the tibia, there remains a negative impact on their sports functioning after 6 months that resolves by 12 months. Physicians can counsel their patients that although they may be limited in their sports function for some time after injury, it is anticipated that this will resolve by one year from the time of injury. Level of Evidence : Level II.
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Affiliation(s)
- Coleen S Sabatini
- Department of Orthopaedic Surgery, University of California at San Francisco, USA
| | - Tracy A Curtis
- Department of Orthopaedic Surgery, University of California at San Francisco, Benioff Children's Hospital, USA
| | - Susan T Mahan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Orthopaedic Surgery, Harvard Medical School, USA
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Ceroni D, Martin XE, Delhumeau C, Farpour-Lambert NJ, De Coulon G, Dubois-Ferrière V, Rizzoli R. Recovery of decreased bone mineral mass after lower-limb fractures in adolescents. J Bone Joint Surg Am 2013; 95:1037-43. [PMID: 23780542 DOI: 10.2106/jbjs.l.00809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Loss of bone mineral mass, muscle atrophy, and functional limitations are predictable consequences of immobilization and subsequent weight-bearing restriction due to leg or ankle fractures. The aim of this study was to prospectively determine whether decreased bone mineral mass following lower-limb fractures recovers at follow-up durations of six and eighteen months in adolescents. METHODS In the present study, we included fifty adolescents who underwent cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of four different sites (total hip, femoral neck, entire lower limb, and calcaneus) were performed at the time of the fracture, at cast removal, and at follow-ups of six and eighteen months. Patients with fractures were paired with healthy controls according to sex, age, and ethnicity. Dual x-ray absorptiometry values were compared between groups and between injured and non-injured legs in adolescents with fractures. RESULTS Among those with fractures, lower-limb bone mineral variables were significantly lower at the injured side compared with the non-injured side at cast removal, with differences ranging from 6.2% to 31.7% (p < 0.0001). Similarly, injured adolescents had significantly lower bone mineral values at the level of the injured lower limb compared with healthy controls (p < 0.0001). At the six-month follow-up, there were still significant residual differences between injured and non-injured legs in adolescents with fractures (p < 0.0001). However, a significant residual difference between healthy controls and injured adolescents was present only for femoral neck bone mineral density (p = 0.011). At the eighteen-month follow-up, no significant difference was observed at any lower-limb site. CONCLUSIONS Bone mineral loss following a fracture of the lower limb in adolescents is highly significant and affects the lower limb both proximal to and distal to the fracture site. In contrast to observations in adults, a rapid bone mass reversal occurs with full bone recovery by eighteen months. LEVEL OF EVIDENCE Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dimitri Ceroni
- Pediatric Cardiology Unit, Department of Child and Adolescent, University Hospitals of Geneva, 6 Rue Willy Donzé, 1211 Geneva 14, Switzerland.
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