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Global statements to produce and implement evidence in the post-COVID-era provide a path forward for rehabilitation - A joint initiative of Cochrane Rehabilitation and the leading journals in the field

This article is a simultaneous joint publication in Journal of Rehabilitation Medicine, Annals of Physical and Rehabilitation Medicine, American Journal of Physical Medicine & Rehabilitation, Developmental Neurorehabilitation, European Journal of Physical and Rehabilitation Medicine, Journal of Occupational Rehabilitation, Musculoskeletal Science & Practice and Neurorehabilitation and Neural Repair. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article.

Pros and Cons of Randomized Controlled Trials and Benchmarking Controlled Trials in Rehabilitation: An Academic Debate within the European Academy of Rehabilitation Medicine

The European Academy of Rehabilitation Medicine (EARM) held a debate in Hannover, Germany, on 1^st of September 2016 on the pros and cons of randomized controlled trials (RCTs) and observational effectiveness studies (benchmarking controlled trials; BCTs). The debate involved a chairperson, a person presenting the substance of the debate, an opponent, and a rapporteur. The academicians participated in the discussion. Eight propositions and proposed statements formed the substance of the debate. There was agreement that a study question should be the starting point of an effectiveness study, and not the study method, i.e. RCT or BCT. The term “benchmarking” was questioned: does it mean market-oriented medicine? It was clarified that benchmarking refers to the methodological features of this study design: there must always be a comparison between peers. It was agreed that BCTs might be better than RCTs for use in rehabilitation studies, in which one often needs multi-centred studies, such as in the assessment of the effectiveness of pathways when there is complexity of processes, health systems, organizational issues, structures and facilities; or where interactions between therapists, doctors and patients differ between centres; and when assessing the implementation of rehabilitation. In addition, BCTs may deal with ethical issues, e.g. the acceptability of interventions, more easily than RCTs. Recommendations regarding the different approaches (RCTs or BCTs) should be provided by the scientific rehabilitation societies. Concern over the validity of BCTs was considered justified, as the validity criteria of BCTs cover all those related to RCTs and include the risk of selection bias between treatment arms. Appropriate description of the essentials of the study object, including adequate description of how the interventions were actualized in comparison to the study plan, are essential features for a valid and generalizable study for both RCTs and BCTs. BCTs are necessary to widen the evidence-base of effectiveness in rehabilitation. It was suggested that the rehabilitation field should support the concept of BCTs. It was proposed that education regarding BCTs is indicated, and stakeholders need to be convinced that BCTs are a valid alternative to RCTs. EARM and other physical and rehabilitation medicine (PRM) bodies could advance the use of BCTs for clinical and health policy decision-making.

Advancing Academic Capacity in Physical and Rehabilitation Medicine to Strengthen Rehabilitation in Health Systems Worldwide: A Joint Effort by the European Academy of Rehabilitation Medicine, the Association of Academic Physiatrists, and the International Society of Physical and Rehabilitation Medicine

Not available.

Autonomy in participation in cerebral palsy from childhood to adulthood

AIM

To determine the long-term development of autonomy in participation of individuals with cerebral palsy (CP) without intellectual disability.

METHOD

Individuals with CP (n=189, 117 males, 72 females; mean age [SD] 21y 11mo [4y 11mo], range 12-34y); were assessed cross-sectionally (46%) or up to four times (54%), between the ages of 12 and 34 years. Autonomy in participation was classified using phase 3 of the Rotterdam Transition Profile. A logistic generalized estimating equation regression model was used to analyse autonomy in six domains (independent variables: age, Gross Motor Function Classification System [GMFCS] level, and interaction between age and GMFCS level). Proportions of autonomy were compared to references using binomial tests (p<0.05).

RESULTS

In most domains, over 90% of participants (n=189, 400 observations, 80% in GMFCS levels I and II) reached autonomy in participation in their late twenties, except for intimate/sexual relationships. Those in GMFCS levels III to V compared to those in GMFCS levels I and II had less favourable development of autonomy in the transportation, intimate relationships, employment, and housing domains, and more favourable development in the finances domain. Compared to references, fewer individuals with CP were autonomous in participation.

INTERPRETATION

This knowledge of autonomy may guide the expectations of young people with CP and their caregivers. Furthermore, rehabilitation professionals should address autonomy development in intimate relationships, employment, and housing, especially in individuals with lower gross motor function.

WHAT THIS PAPER ADDS

Individuals with cerebral palsy without intellectual disability achieved autonomy in most participation domains. Regarding intimate relationships, they continued to have less experience compared to age-matched references. Development of autonomy was less favourable for individuals in Gross Motor Function Classification System levels III to V.

Fifty years of the Journal of Rehabilitation Medicine

Missing (Editorial).

Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury

Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury.Methods: This cross-sectional study included 268 individuals (aged 28-65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders.Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04-0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity.Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitationPre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury.Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury.When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.

The Real Impact Factor of Journal of Rehabilitation Medicine (JRM) and JRM Clinical Communications (JRM-CC)

Missing (Editorial)

Restructuring Routinely Collected Patient Data: ORCA Applied to Andrology

Hospital information systems do not always cover all required detail per specialty. This may lead to scattering of data over disparate systems and the paper record. The ORCA (Open Record for CAre) CPR offers a generic structure for record sharing, and record keeping tailored to specific needs. We studied whether a semantic integration of existing and new data was possible, using the ORCA structure. Existing andrology data, originating from separate sources, were utilized for this purpose. During normalization, validation and explication steps, latent problems in the source data were exposed and removed, followed by a merge with new data items. By conversion of source data to ORCA, a unique representation of medical concepts in the database was attained, facilitating retrieval of univocal data for multiple purposes. We conclude that the expansion to the andrology domain, including transparent integration of existing data, provides support for the generality of ORCA.

ORCA: The Versatile CPR

The introduction of computer-based patient records (CPRs) that fully replace paper records proves especially difficult in specialized care, despite the potential advantages of CPRs for patient care and research. Improved data legibility, availability, sharing of records, and decision support may directly benefit patient care. Barriers to the introduction of CPR applications at institutions may be caused by lack of infrastructure, or by financial or organizational issues. To have clinicians interactively enter data at the point of care is still a big challenge. This paper presents an overview of ORCA (Open Record of CAre): a generic CPR, designed for integration with existing systems, presentation of multi-media patient data, and the collection of structured data, directly by clinicians. ORCA can easily be tailored to the needs of a variety of medical specialists without the need for changes to its data model, functionality, or interface. The paper describes the essence of the architecture of ORCA and the user benefits with emphasis on the support of structured data entry.

Health-related physical fitness of ambulatory adolescents and young adults with spastic cerebral palsy

OBJECTIVE

To describe in detail the health-related physical fitness of adolescents and young adults with cerebral palsy, compared with able-bodied references, and to assess differences related to Gross Motor Functioning Classification System (GMFCS) level and distribution of cerebral palsy.

DESIGN

Cross-sectional.

SUBJECTS

Fifty ambulatory persons with spastic cerebral palsy, GMFCS level I or II, aged 16-24 years.

METHODS

Physical fitness measures were: (i) cardiopulmonary fitness by maximal cycle ergometry, (ii) muscle strength, (iii) body mass index and waist circumference, (iv) skin-folds, and (v) lipid profile.

RESULTS

Regression analyses, corrected for age and gender, showed that persons with bilateral cerebral palsy had lower cardiopulmonary fitness and lower hip abduction muscle strength than those with unilateral cerebral palsy. Comparisons between persons with GMFCS levels I and II showed a difference only in peak power during cycle ergometry. Cardiopulmonary fitness, hip flexion and knee extension strength were considerably lower (< 75%) in persons with cerebral palsy than reference values.

CONCLUSION

The distribution of cerebral palsy affects fitness more than GMFCS level does. Furthermore, adolescents and young adults with cerebral palsy have reduced health-related physical fitness compared with able-bodied persons. This stage of life has a strong influence on adult lifestyle, thus it is an important period for intervention.

Cost-utility of a lifestyle intervention in adolescents and young adults with spastic cerebral palsy

OBJECTIVE

To evaluate the cost-utility of a lifestyle intervention among adolescents and young adults with cerebral palsy.

DESIGN

Single-blind, randomized controlled trial.

SETTING

Six university hospital/clinics in the Netherlands.

PARTICIPANTS

Fifty-seven adolescents and young adults with spastic cerebral palsy classified as Gross Motor Functioning Classification System (GMFCS) level I-IV.

INTERVENTION

A 6-month lifestyle intervention consisting of physical fitness training combined with counselling sessions focusing on physical behaviour and sports participation.

MAIN OUTCOME MEASURES

Data on quality of life, direct medical costs and productivity costs were collected using standardized questionnaires. Quality adjusted life years (QALYs) were derived from the Short-Form 36 questionnaire using the Short-Form 6D.

RESULTS

Quality of life remained stable over time for both groups. No significant differences between groups were found for direct medical costs or productivity costs. A cost-utility ratio of -€23,664 per QALY was found for the lifestyle intervention compared with no treatment.

CONCLUSION

The results of this study are exploratory, but indicate that implementing a lifestyle intervention for the cerebral palsy population might be cost-effective or cost-saving compared with offering no intervention to improve physical behaviour and fitness. However, the large range of uncertainty for the cost-utility ratio should be taken into account and the results interpreted with caution.

Accelerometric assessment of different dimensions of natural walking during the first year after stroke: Recovery of amount, distribution, quality and speed of walking

OBJECTIVES

To describe the course of walking behaviour over a period of 1 year after stroke, using accelerometry, and to compare 1-year data with those from a healthy group.

DESIGN

One-year follow-up cohort study.

SUBJECTS

Twenty-three stroke patients and 20 age-matched healthy subjects.

METHODS

Accelerometer assessments were made in the participants' daily environment for 8 h/day during the 1st (T1), 12th (T2) and 48th (T3) weeks after stroke, and at one time-point in healthy subjects. Primary outcomes were: percentage of time walking and upright (amount); mean duration and number of walking periods (distribution); step regularity and gait symmetry (quality); and walking speed.

RESULTS

Time walking, time upright, and number of walking bouts increased during T1 and T2 (p < 0.01) and then levelled off (p > 0.30). Mean duration of walking periods showed no significant improvements (p > 0.30) during all phases. Step regularity, gait symmetry and gait speed showed a tendency to increase consistently from T1 to T3. At T3, amount and distribution variables reached the level of the healthy group, but significant differences remained (p < 0.02) in step regularity and gait speed.

CONCLUSION

In this cohort, different outcomes of walking behaviour showed different patterns and levels of recovery, which supports the multi-dimensional character of gait.

Can a lifestyle intervention programme improve physical behaviour among adolescents and young adults with spastic cerebral palsy? A randomized controlled trial

AIM

Optimal physical behaviour is important, as physical inactivity contributes to functional deterioration and reduced social participation. Nevertheless, research showed that persons with cerebral palsy (CP) have low physical activity levels. The objective of this study is to evaluate the effectiveness of a lifestyle intervention programme on physical behaviour.

METHOD

Fifty-seven persons (36 completed the total study) with spastic CP (age range 16 to 25y; 27 males, 30 females), classified as Gross Motor Function Classification System levels I-IV were included in this randomized controlled trial. Twenty-nine participants had a unilateral CP and 27 had a bilateral CP. A 6-month lifestyle intervention consisting of fitness training and counselling on physical behaviour and sports participation was evaluated. Physical behaviour was objectively measured using ambulatory activity monitors. Self-reported physical activity was determined using the Physical Activity Scale for Individuals with Physical Disabilities.

RESULTS

The intervention did not affect the objectively measured physical activity during the intervention (beta=0.34, CI=-1.70 to 2.37) or at follow-up (beta=0.30, CI=-1.99 to 2.59). Self-reported physical activity was positively affected during the intervention period (beta=7.61, CI=0.17-15.05); however, this effect was not present at follow-up (beta=3.65, CI=-3.05 to 10.36).

INTERPRETATION

The lifestyle intervention was ineffective in eliciting a behavioural change towards more favourable physical behaviour in adolescents and young adults with spastic CP.

Can a lifestyle intervention improve physical fitness in adolescents and young adults with spastic cerebral palsy? A randomized controlled trial

OBJECTIVE

To evaluate both the short- and long-term effectiveness of a lifestyle intervention on physical fitness in adolescents and young adults with cerebral palsy (CP).

DESIGN

Single-blind, randomized controlled trial.

SETTING

University hospitals and rehabilitation clinics.

PARTICIPANTS

Adolescents and young adults (N=57) with spastic CP classified in Gross Motor Function Classification System levels I through IV; of these, 42 completed the study.

INTERVENTION

A 6-month lifestyle intervention consisting of physical fitness training combined with counseling sessions focused on physical behavior and sports participation.

MAIN OUTCOME MEASURES

Physical fitness, including measures of cardiopulmonary fitness, muscle strength, and body composition.

RESULTS

Favorable short- and medium-term effects were found for peak oxygen consumption, oxygen consumption, and load on the anaerobic threshold and waist circumference. Favorable long-term effects were found for sum of skinfolds, systolic blood pressure, and total cholesterol.

CONCLUSIONS

This exploratory study showed that the lifestyle intervention was effective in improving cardiopulmonary fitness and body composition. Effects of body composition were maintained in the long term. However, the intervention needs to be optimized to increase muscle strength and for long-term retention of effects on aerobic capacity.

[Contemporary interpretation of lung function test results]

OBJECTIVE

To determine which changes take place in the interpretation of spirometric examination results when the transition is made from reference values for children (Zapletal) and adults (European Community for Steel and Coal (ECSC)) to those from the Global Lung Function Initiative (GLI).

DESIGN

Retrospective study.

METHOD

We analysed spirometric data (forced expiratory volume in 1 s, FEV1 and forced vital capacity, FVC) obtained pre- and post-bronchodilation in patients: 1012 children (aged 6-17 years, 47.1% girls) and 4653 adults (aged 18-91 years, 48.6% females). Prevalence rates of airway obstruction based on the lower limit of predicted values (FEV1/FVC < 5th percentile) and an abnormally low FVC (FEV1/FVC > 0.85, FVC < 5th percentile) were calculated in 9 groups of patients. Airway obstruction was also classified based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion: FEV1/FVC < 0.70.

RESULTS

Predicted values for FEV1 and FVC according to ECSC and Zapletal were too low. The prevalence rates of spirometrically determined airway obstruction using the three prediction equations varied little; an abnormally low FVC occurred more frequently, especially in young adults. GOLD-defined airway obstruction led to 13.5% underdiagnosis in those aged < 45 years, and about 33% overdiagnosis in elderly subjects, being markedly age-dependent.

CONCLUSION

The prevalence rate of spirometrically determined airway obstruction is little affected by adopting the GLI reference values. The GOLD criterion for airway obstruction leads to underdiagnosis in adults aged < 45 years, and appreciable overdiagnosis in those aged > 45 years. Using z-scores to interpret test results removes biases related to age, height and sex and ethnic group and is clinically valid.

Germination of conidia of Aspergillus niger is accompanied by major changes in RNA profiles

The transcriptome of conidia of Aspergillus niger was analysed during the first 8 h of germination. Dormant conidia started to grow isotropically two h after inoculation in liquid medium. Isotropic growth changed to polarised growth after 6 h, which coincided with one round of mitosis. Dormant conidia contained transcripts from 4 626 genes. The number of genes with transcripts decreased to 3 557 after 2 h of germination, after which an increase was observed with 4 780 expressed genes 8 h after inoculation. The RNA composition of dormant conidia was substantially different than all the subsequent stages of germination. The correlation coefficient between the RNA profiles of 0 h and 8 h was 0.46. They were between 0.76-0.93 when profiles of 2, 4 and 6 h were compared with that of 8 h. Dormant conidia were characterised by high levels of transcripts of genes involved in the formation of protecting components such as trehalose, mannitol, protective proteins (e.g. heat shock proteins and catalase). Transcripts belonging to the Functional Gene Categories (FunCat) protein synthesis, cell cycle and DNA processing and respiration were over-represented in the up-regulated genes at 2 h, whereas metabolism and cell cycle and DNA processing were over-represented in the up-regulated genes at 4 h. At 6 h and 8 h no functional gene classes were over- or under-represented in the differentially expressed genes. Taken together, it is concluded that the transcriptome of conidia changes dramatically during the first two h and that initiation of protein synthesis and respiration are important during early stages of germination.

The effect of natamycin on the transcriptome of conidia of Aspergillus niger

The impact of natamycin on Aspergillus niger was analysed during the first 8 h of germination of conidia. Polarisation, germ tube formation, and mitosis were inhibited in the presence of 3 and 10 μM of the anti-fungal compound, while at 10 μM also isotropic growth was affected. Natamycin did not have an effect on the decrease of microviscosity during germination and the concomitant reduction in mannitol and trehalose levels. However, it did abolish the increase of intracellular levels of glycerol and glucose during the 8 h period of germination.

Natamycin hardly affected the changes that occur in the RNA profile during the first 2 h of germination. During this time period, genes related to transcription, protein synthesis, energy and cell cycle and DNA processing were particularly up-regulated. Differential expression of 280 and 2586 genes was observed when 8 h old germlings were compared with conidia that had been exposed to 3 μM and 10 μM natamycin, respectively. For instance, genes involved in ergosterol biosynthesis were down-regulated. On the other hand, genes involved in endocytosis and the metabolism of compatible solutes, and genes encoding protective proteins were up-regulated in natamycin treated conidia.

Rate of progression and predictive factors for pulmonary outcome in children and adults with Pompe disease

Respiratory insufficiency is a serious threat to patients with Pompe disease, a neuromuscular disorder caused by lysosomal acid alpha-glucosidase deficiency. Innovative therapeutic options which may stabilize pulmonary function have recently become available. We therefore determined proportion and severity of pulmonary involvement in patients with Pompe disease, the rate of progression of pulmonary dysfunction, and predictive factors for poor respiratory outcome. In a single-center, prospective, cohort study, we measured vital capacity (VC) in sitting and supine positions, as well as maximum inspiratory (MIP) and expiratory (MEP) mouth pressures, and end expiratory CO(2) in 17 children and 75 adults with Pompe disease (mean age 42.7 years, range 5-76 years). Seventy-four percent of all patients, including 53% of the children, had some degree of respiratory dysfunction. Thirty-eight percent had obvious diaphragmatic weakness. Males appeared to have more severe pulmonary involvement than females: at a group level, their mean VC was significantly lower than that of females (p<0.001), they used mechanical ventilation more often than females (p=0.042) and the decline over the course of the disease was significantly different between males and females (p=0.003). Apart from male gender, severe skeletal muscle weakness and long disease duration were the most important predictors of poor respiratory status. During follow-up (average 1.6 years, range 0.5-4.2 years), three patients became ventilator dependent. Annually, there were average decreases in VC in upright position of 0.9% points (p=0.09), VC in supine position of 1.2% points (p=0.049), MIP of 3.2% points (p=0.018) and MEP of 3.8% points (p<0.01). We conclude that pulmonary dysfunction in Pompe disease is much more common than generally thought. Males, patients with severe muscle weakness, and those with advanced disease duration seem most at risk.

Sexuality of Young Adults with Cerebral Palsy: Experienced Limitations and Needs

Objective of this study is to describe the problems young adults with Cerebral Palsy (CP) experience in the various stages of the sexual response cycle, and the physical and emotional obstacles they experience with sexuality. In this prospective cohort study 74 young adults (46 men; 28 women) with CP and average intelligence participated, aged 20–24 years. Twenty percent of these young adults with CP experienced anorgasmia, 80% reported physical problems with sex related to CP and 45% emotional inhibition to initiate sexual contact. In 90% of the participants, sexuality had not been discussed during the rehabilitation treatment. Many adolescents reported wanting information about the impact of CP on sexuality and reproduction (35%), about interventions (26%), tools and medicines (16%) and about problems with their partner (14%). Young adults with CP can experience various problems or challenges with sexuality. For preventing sexual difficulties and treating sexual problems, health care professionals need to proactively take the initiative to inform young people with CP about sexuality.

Recovery of the Sit-to-Stand Movement After Stroke: A Longitudinal Cohort Study

Background and Objective . To present quantitative data on sit-to-stand (STS)-related functioning and recovery during the first year after stroke. STS-related functioning was used to evaluate independent STS movement, rising speed, and actual STS performance during normal daily life. Methods. This was a prospective cohort study of 50 patients poststroke. Assessments were made at 0, 3, 6, 9, 12, 24, and 48 weeks poststroke. Actual STS performance was assessed at 0, 12, and 48 weeks. The main outcome measures were the following: ability to rise independently, rising speed (power chair stand up), number of STS movements, percentage of time walking and standing during daily life (using an activity monitor), and clinical outcomes, measured among others by the Barthel index (BI). Results. During year 1, the percentage of patients able to rise increased from 54% to 83%. Most improvements occurred during weeks 0 to 12, whereas no significant changes were observed during weeks 12 to 24. Rising speed similarly increased from 0.15 to 0.26 s− 1 during weeks 0 to 12 and to 0.30 s−1 at week 48. Gait speed and BI also significantly increased. The number of STS movements increased significantly during weeks 0 to 12 (from 10.6 to 17.7) but not during weeks 12 to 48. Conclusions. STS-related functioning improved significantly in the first year after stroke, with the most improvement occurring during the first 12 weeks. After 12 weeks, rising speed, gait speed, and BI continue to improve.

Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: a case series

OBJECTIVE

To evaluate short and mid-term results of active physical therapy in athletes with longstanding groin pain.

DESIGN

Case series.

SETTING

Primary care physical therapy practice.

PARTICIPANTS

A total of 44 athletes suffering longstanding adductor-related groin pain.

INTERVENTION

A combination of passive (joint mobilization) and active (exercises) physical therapy interventions.

MAIN OUTCOME MEASUREMENTS

Return to (the same level of) sports, restriction in sports, and recurrence.

RESULTS

Directly after treatment, return to the same level and type of sport was successful in 38 athletes (86%), and without symptoms in 34 athletes (77%). At 6.5-51 months follow up, 10/38 (26%) of those that returned to sports had experienced a relapse; 22 (50%) athletes were able to participate in sports without any restrictions at the mid-term follow-up.

CONCLUSIONS

For athletes with longstanding groin pain, short term results of physical therapy seem positive, whereas mid-term results are moderately positive. The risk for recurrence is high.

Resting thickness of transversus abdominis is decreased in athletes with longstanding adduction-related groin pain

The purpose of the study was to compare thickness of the transversus abdominis (TA) and obliquus internus (OI) muscles between athletes with and without longstanding adduction-related groin pain (LAGP). Forty two athletes with LAGP and 23 controls were included. Thickness of TA and OI were measured with ultrasound imaging on the right side of the body during rest. Relative muscle thickness (compared to rest) was measured during the active straight leg raise (ASLR) left and right, and during isometric hip adduction. TA resting thickness was significantly smaller in injured subjects with left-sided (4.0+/-0.82mm; P<0.001) or right-sided (4.3+/-0.64mm; P=0.015) groin complaints compared with controls (4.9+/-0.90mm). No significant differences between patients and controls in TA or OI relative thickness during the ASLR and isometric hip adduction were found (all cases P>/=0.15). In conclusion, TA resting thickness is smaller in athletes with LAGP and may thus be a risk factor for (recurrent) groin injury. This may have implications for therapy and prevention of LAGP.

Pre-operative pulmonary evaluation of lung cancer patients: a review of the literature

Complete anatomical resection of the primary tumour is still the standard of care in patients with early stage lung cancer. Because these patients are usually smokers who also suffer from chronic obstructive pulmonary disease, regional differences in pulmonary function due to lung tissue destruction exist. The purpose of the present article is to evaluate the currently available guidelines and to discuss novel methods for the pre-operative functional and anatomical pulmonary evaluation in lung cancer patients. Despite the fact that knowledge on the pre-operative evaluation of the pulmonary function has substantially increased during the past decade, the majority of the studies are small, underpowered and, with exception of a proposed algorithm, not prospectively validated in independent cohorts. The future harmonisation of guidelines is required and novel imaging techniques should be incorporated in the pre-operative evaluation in chronic obstructive pulmonary disease patients with borderline pulmonary function.