This study evaluated three splint designs for a patient with radial nerve palsy using a single-subject experimental design. The patient underwent assessments at baseline and after 3 weeks wearing each splint. Only the dynamic tenodesis suspension splint and dorsal wrist cock-up with dynamic finger extension splint resulted in statistically significant improvements compared to baseline based on standardized measures. Clinically, the patient completed all tasks while using these two splints but not the static volar wrist cock-up splint. The patient also preferred the dorsal wrist cock-up splint based on a questionnaire.
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving sw...Veera Bagu
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving swallowing ability among Cerebrovascular Accident patients with dysphagia at selected Hospital, Erode
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
No effect on functional outcome after repair pronator quadratus Sufindc
This randomized clinical trial compared functional outcomes of repairing vs not repairing the pronator quadratus muscle during volar plating surgery for distal radial fractures. 72 patients were randomly assigned to have the muscle either repaired or not repaired. The primary outcome of Patient Rated Wrist Evaluation scores at 12 months showed no clinically significant difference between the groups. Secondary outcomes including other patient reported scores and range of motion measures also showed no significant differences between groups. Thus repair of the pronator quadratus muscle provides no additional benefit to functional outcomes compared to non-repair.
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
This study reviewed 232 patients with low-grade (Spetzler-Martin Grade I-II) brain arteriovenous malformations (AVMs) who underwent surgical resection. The key findings were:
1) AVM resection was successful in all patients and confirmed angiographically in 94% with no residual AVMs found.
2) Overall good functional outcomes (mRS 0-1) were found in 78% at last follow-up, with 97% improved or unchanged from their preoperative status.
3) Patients with unruptured AVMs had better functional outcomes (91% good) than those with ruptured AVMs (65% good), but equivalent relative outcomes (96-98% improved
Austin Journal of Musculoskeletal Disorders is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system. The Journal focuses upon all the related aspects of musculoskeletal system disorders and the new advancements in the related treatments including Complex issues and injuries involving the musculoskeletal system and surgeries.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Musculoskeletal Disorders accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system.
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving sw...Veera Bagu
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving swallowing ability among Cerebrovascular Accident patients with dysphagia at selected Hospital, Erode
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
No effect on functional outcome after repair pronator quadratus Sufindc
This randomized clinical trial compared functional outcomes of repairing vs not repairing the pronator quadratus muscle during volar plating surgery for distal radial fractures. 72 patients were randomly assigned to have the muscle either repaired or not repaired. The primary outcome of Patient Rated Wrist Evaluation scores at 12 months showed no clinically significant difference between the groups. Secondary outcomes including other patient reported scores and range of motion measures also showed no significant differences between groups. Thus repair of the pronator quadratus muscle provides no additional benefit to functional outcomes compared to non-repair.
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
This study reviewed 232 patients with low-grade (Spetzler-Martin Grade I-II) brain arteriovenous malformations (AVMs) who underwent surgical resection. The key findings were:
1) AVM resection was successful in all patients and confirmed angiographically in 94% with no residual AVMs found.
2) Overall good functional outcomes (mRS 0-1) were found in 78% at last follow-up, with 97% improved or unchanged from their preoperative status.
3) Patients with unruptured AVMs had better functional outcomes (91% good) than those with ruptured AVMs (65% good), but equivalent relative outcomes (96-98% improved
Austin Journal of Musculoskeletal Disorders is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system. The Journal focuses upon all the related aspects of musculoskeletal system disorders and the new advancements in the related treatments including Complex issues and injuries involving the musculoskeletal system and surgeries.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Musculoskeletal Disorders accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system.
This document contains abstracts from multiple conference presentations on various chiropractic case studies and research:
- The first case study found that implementing functional medicine protocols as part of chiropractic care resulted in improved health outcomes for a patient with various chronic conditions over 15 years.
- The second case study found that a 9-week-old infant with retrocollis saw resolution of their posture issues with 6 chiropractic adjustments to the upper cervical spine.
- A third case study presented a successful total ankle replacement in a 51-year-old patient with end-stage ankle osteoarthritis.
- Multiple additional abstracts summarized chiropractic case studies and research on various topics.
Artificial tiger bone powder for improving the quality of life in elderly pat...LucyPi1
The document describes a study that investigated the effects of artificial tiger bone powder on fracture healing time, wrist function recovery, and quality of life in elderly patients with distal radius fractures. 76 elderly patients with distal radius fractures were randomly assigned to either a treatment group that received artificial tiger bone powder or a control group that received a placebo. Outcomes including fracture healing time, wrist range of motion, and quality of life scores were measured before and 6 and 12 months after treatment. The study found that the treatment group had significantly shorter fracture healing times and better wrist function and quality of life scores compared to the control group after 6 and 12 months.
This study evaluated the early rehabilitation effects of percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniations. 91 patients underwent PTED and were followed for 6 months. Results showed significantly reduced low back and leg pain based on VAS and ODI scores after surgery compared to before. No significant differences in low back pain scores at 3 days, 3 months, and 6 months post-op were found. PTED resulted in less trauma, fewer complications, and markedly shortened postoperative rehabilitation time, demonstrating it is a safe and effective treatment for lumbar disc herniations.
Pro disc l replacement vs circumferential arthrodesis of spineQueen Mary Hospital
This study compared results of the ProDisc-L total disc replacement to circumferential spinal fusion for treating two-level lumbar degenerative disc disease. 256 patients were randomized to the two procedures. At 24 months, 143 patients received total disc replacement while 60 received spinal fusion. The total disc replacement group had significantly less operative time, blood loss, and shorter hospital stays. Clinical outcomes including ODI, SF-36, and pain/satisfaction scales were measured at multiple points up to 24 months. Radiographic outcomes were also assessed to analyze device success and fusion rates between the two procedures.
31 title pagewithauthordetails-724-1-10-20210129buatdownload6
This document discusses the use of a pins and rubber traction frame technique to treat comminuted fractures of the proximal interphalangeal (PIP) joint in 8 patients. The technique involves inserting K-wires above and below the fracture site and connecting them with rubber bands to provide traction. All patients achieved bone union without complications. Postoperative range of motion of the PIP joint averaged 4.88-86.25 degrees and of the DIP joint averaged 4.38-86.25 degrees. The pins and rubber traction frame provides a simple, effective method for stabilizing complex PIP fractures to allow early motion and prevent joint stiffness.
Surgical Treatment of Haglund Triad by Using Complete Detachment and Reattach...skisnfeet
This study evaluated the surgical outcome of treating the Haglund triad, which includes retrocalcaneal exostosis, insertional Achilles tendinosis, and retrocalcaneal bursitis, using a standardized approach of complete detachment and reattachment of the Achilles tendon. Seventeen patients underwent this surgery and reported significant pain reduction, high satisfaction rates, and good functional outcomes post-operatively based on questionnaires and clinical scoring systems. Complications were few and minor in most cases.
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
This document summarizes topics presented at recent hand surgery conferences and articles published in hand surgery journals. It discusses declines in finger replantation rates, factors associated with loss of reduction in distal radius fractures involving the volar ulnar corner, higher complication rates but similar outcomes for surgical versus nonsurgical treatment of distal radius fractures in older patients, the need for caution in hand transplantation, ongoing debates around flexor tendon rehabilitation protocols, advances in extensor tendon rehabilitation using relative motion splinting, and a study showing the efficacy and safety of treating two joints rather than one with collagenase injections for Dupuytren contracture.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study examines 10 cases of acromioclavicular (AC) joint injuries in military personnel treated either conservatively or surgically. For conservatively treated grade I-II injuries, full function was regained within 6 months, while grade III-V injuries took 6-12 months. Surgically treated grade III injuries took 6 months to regain function and grade IV-V took 12-15 months. Functional outcomes were assessed at 3, 6, and 12 months, with UCLA shoulder scores improving significantly over time for both groups. The study concludes that precontoured clavicular hook plates provide good fixation for type III dislocations without additional ligament repair.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
This research article compares the health-related quality of life of knee osteoarthritis patients in two cities in Pakistan - Lahore and Sialkot. The study involved 158 patients (105 female, 53 male) aged 40-80 years old who were given the SF-12 questionnaire to assess their physical and mental health. The results found no significant difference in health-related quality of life between patients in Lahore, a major urban center, and Sialkot, a smaller city. This suggests that levels of disability and health awareness were effectively the same between the two cities for knee osteoarthritis patients.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
A prospective observational study on comparing the outcome of patellar resurf...Dr.Avinash Rao Gundavarapu
Introduction: Total Knee Arthroplasty (TKA) has been a very successful surgery in relieving pain and restoring function in osteoarthritis. Conflicting evidence in literature exists regarding the merits of patellar resurfacing during TKA over non-resurfacing. Our aim is to evaluate and compare the difference between patellar resurfaced group and non-resurfaced group in primary TKA.
Materials and Methods: This prospective obsevational study was initiated in May 2016 conducted till April 2008 (2 years) in Yashoda Superspeciality Hospital, Hyderabad. At least 14 mm of patella was ensured to be retained after patellar cut. A total of 40 patients were allocated to receive (n=20) or not to receive patellar resurfacing (n=20) during primary TKA. The data was analyzed statistically using the Student t test. Overall patient satisfaction was recorded using the SF-36 score.
Results: Of the 40 patients, 67.5% females and 32.5 % males underwent TKA. Among those who underwent resurfacement, 40% were males. 75% among the non-resurfaced group were females. Right knee was operated on 37.5% of cases. Mean operative time being 103.9 and 122.5 minutes in nonresurfaced and resurfaced cases respectively. Mean patellar thickness was 22.1mm in nonresurfaced and 23.6mm in resurfaced group. The difference in VAS score, modified HSS score, KSS scores between the two groups were statistically insignificant with p-values of 0.230, 0.0214, 0.2513 respectively at the end of two year,
but there was significant reduction of anterior knee pain in the resurfaced with p-value < 0> Conclusion: The functional outcome was not affected by whether the patella was resurfaced or nonresurfaced. There was no significant difference between the two groups with respect to the prevalence of knee-related readmission, or of subsequent patella-related surgery or patients overall satisfaction. We recommend selective patellar resurfacing at the time of primary total knee replacement.
Keywords: TKA, Patellar resurfacement, Non-resurfacement, HSS score, KSS score.
2000 anti pronation tape_before_and_after_exercisepainfree888
1) The study evaluated the effects of antipronation tape and temporary orthotics on vertical navicular height before and after exercise compared to a control condition.
2) Both the tape and orthotic treatments significantly increased vertical navicular height after application compared to the control condition, but the effect diminished with exercise.
3) While diminished after exercise, the tape and orthotic conditions still performed better than the control at maintaining vertical navicular height, suggesting they provide some control of excessive foot pronation.
This study aimed to assess the long-term outcomes of lumbar fusion versus non-specific physiotherapy for chronic low back pain. 294 patients were randomized to fusion or physiotherapy and followed for an average of 12.8 years.
Using various analytic approaches, success rates based on patient's global assessment of improvement were in the 65% range for fusion patients, compared to 31-37% for physiotherapy patients. However, secondary outcomes like disability and pain scales showed similar levels of improvement between groups. The discrepancies between primary and secondary outcomes means the study provides only Level II evidence regarding recommending fusion for non-specific low back pain.
This document summarizes several studies related to foot and ankle research. It highlights studies on muscle strength in patients with gout, muscle and joint factors associated with foot deformities in diabetics, the effectiveness of extracorporeal shock wave therapy for lower limb tendinopathies, and multidisciplinary management of diabetic foot disease. It also reviews evidence on treatments for plantar heel pain and vascular assessment techniques used by podiatrists. The introduction provides an overview of various foot and ankle conditions and clinical factors considered by clinicians in lower limb rehabilitation.
The study evaluated the efficacy of paraffin bath therapy for hand osteoarthritis. 56 patients were randomly assigned to either a treatment group receiving paraffin baths or a control group. Outcome measures including pain, hand function, range of motion and strength were assessed at baseline, 3 weeks and 12 weeks. At 12 weeks, the treatment group showed significantly greater improvements in pain, range of motion and strength compared to the control group. Paraffin bath therapy appeared effective in reducing pain and maintaining strength for hand osteoarthritis over 12 weeks.
The document summarizes a randomized controlled trial that assessed the effectiveness of arm ergometer training for improving spasticity, range of motion, and motor control in patients with sub-acute and chronic stroke. 40 patients were divided into two groups - one that received conventional therapy alone and one that received conventional therapy plus arm ergometer training. The results showed that the group receiving arm ergometer training in addition to conventional therapy had significantly greater reductions in spasticity, as well as greater improvements in range of motion and gross motor function compared to the conventional therapy alone group. The study concluded that conventional therapy combined with arm ergometer treatment was effective for reducing spasticity and improving motor outcomes in sub-acute and chronic stroke
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
This document contains abstracts from multiple conference presentations on various chiropractic case studies and research:
- The first case study found that implementing functional medicine protocols as part of chiropractic care resulted in improved health outcomes for a patient with various chronic conditions over 15 years.
- The second case study found that a 9-week-old infant with retrocollis saw resolution of their posture issues with 6 chiropractic adjustments to the upper cervical spine.
- A third case study presented a successful total ankle replacement in a 51-year-old patient with end-stage ankle osteoarthritis.
- Multiple additional abstracts summarized chiropractic case studies and research on various topics.
Artificial tiger bone powder for improving the quality of life in elderly pat...LucyPi1
The document describes a study that investigated the effects of artificial tiger bone powder on fracture healing time, wrist function recovery, and quality of life in elderly patients with distal radius fractures. 76 elderly patients with distal radius fractures were randomly assigned to either a treatment group that received artificial tiger bone powder or a control group that received a placebo. Outcomes including fracture healing time, wrist range of motion, and quality of life scores were measured before and 6 and 12 months after treatment. The study found that the treatment group had significantly shorter fracture healing times and better wrist function and quality of life scores compared to the control group after 6 and 12 months.
This study evaluated the early rehabilitation effects of percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniations. 91 patients underwent PTED and were followed for 6 months. Results showed significantly reduced low back and leg pain based on VAS and ODI scores after surgery compared to before. No significant differences in low back pain scores at 3 days, 3 months, and 6 months post-op were found. PTED resulted in less trauma, fewer complications, and markedly shortened postoperative rehabilitation time, demonstrating it is a safe and effective treatment for lumbar disc herniations.
Pro disc l replacement vs circumferential arthrodesis of spineQueen Mary Hospital
This study compared results of the ProDisc-L total disc replacement to circumferential spinal fusion for treating two-level lumbar degenerative disc disease. 256 patients were randomized to the two procedures. At 24 months, 143 patients received total disc replacement while 60 received spinal fusion. The total disc replacement group had significantly less operative time, blood loss, and shorter hospital stays. Clinical outcomes including ODI, SF-36, and pain/satisfaction scales were measured at multiple points up to 24 months. Radiographic outcomes were also assessed to analyze device success and fusion rates between the two procedures.
31 title pagewithauthordetails-724-1-10-20210129buatdownload6
This document discusses the use of a pins and rubber traction frame technique to treat comminuted fractures of the proximal interphalangeal (PIP) joint in 8 patients. The technique involves inserting K-wires above and below the fracture site and connecting them with rubber bands to provide traction. All patients achieved bone union without complications. Postoperative range of motion of the PIP joint averaged 4.88-86.25 degrees and of the DIP joint averaged 4.38-86.25 degrees. The pins and rubber traction frame provides a simple, effective method for stabilizing complex PIP fractures to allow early motion and prevent joint stiffness.
Surgical Treatment of Haglund Triad by Using Complete Detachment and Reattach...skisnfeet
This study evaluated the surgical outcome of treating the Haglund triad, which includes retrocalcaneal exostosis, insertional Achilles tendinosis, and retrocalcaneal bursitis, using a standardized approach of complete detachment and reattachment of the Achilles tendon. Seventeen patients underwent this surgery and reported significant pain reduction, high satisfaction rates, and good functional outcomes post-operatively based on questionnaires and clinical scoring systems. Complications were few and minor in most cases.
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
This document summarizes topics presented at recent hand surgery conferences and articles published in hand surgery journals. It discusses declines in finger replantation rates, factors associated with loss of reduction in distal radius fractures involving the volar ulnar corner, higher complication rates but similar outcomes for surgical versus nonsurgical treatment of distal radius fractures in older patients, the need for caution in hand transplantation, ongoing debates around flexor tendon rehabilitation protocols, advances in extensor tendon rehabilitation using relative motion splinting, and a study showing the efficacy and safety of treating two joints rather than one with collagenase injections for Dupuytren contracture.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study examines 10 cases of acromioclavicular (AC) joint injuries in military personnel treated either conservatively or surgically. For conservatively treated grade I-II injuries, full function was regained within 6 months, while grade III-V injuries took 6-12 months. Surgically treated grade III injuries took 6 months to regain function and grade IV-V took 12-15 months. Functional outcomes were assessed at 3, 6, and 12 months, with UCLA shoulder scores improving significantly over time for both groups. The study concludes that precontoured clavicular hook plates provide good fixation for type III dislocations without additional ligament repair.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
This research article compares the health-related quality of life of knee osteoarthritis patients in two cities in Pakistan - Lahore and Sialkot. The study involved 158 patients (105 female, 53 male) aged 40-80 years old who were given the SF-12 questionnaire to assess their physical and mental health. The results found no significant difference in health-related quality of life between patients in Lahore, a major urban center, and Sialkot, a smaller city. This suggests that levels of disability and health awareness were effectively the same between the two cities for knee osteoarthritis patients.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
A prospective observational study on comparing the outcome of patellar resurf...Dr.Avinash Rao Gundavarapu
Introduction: Total Knee Arthroplasty (TKA) has been a very successful surgery in relieving pain and restoring function in osteoarthritis. Conflicting evidence in literature exists regarding the merits of patellar resurfacing during TKA over non-resurfacing. Our aim is to evaluate and compare the difference between patellar resurfaced group and non-resurfaced group in primary TKA.
Materials and Methods: This prospective obsevational study was initiated in May 2016 conducted till April 2008 (2 years) in Yashoda Superspeciality Hospital, Hyderabad. At least 14 mm of patella was ensured to be retained after patellar cut. A total of 40 patients were allocated to receive (n=20) or not to receive patellar resurfacing (n=20) during primary TKA. The data was analyzed statistically using the Student t test. Overall patient satisfaction was recorded using the SF-36 score.
Results: Of the 40 patients, 67.5% females and 32.5 % males underwent TKA. Among those who underwent resurfacement, 40% were males. 75% among the non-resurfaced group were females. Right knee was operated on 37.5% of cases. Mean operative time being 103.9 and 122.5 minutes in nonresurfaced and resurfaced cases respectively. Mean patellar thickness was 22.1mm in nonresurfaced and 23.6mm in resurfaced group. The difference in VAS score, modified HSS score, KSS scores between the two groups were statistically insignificant with p-values of 0.230, 0.0214, 0.2513 respectively at the end of two year,
but there was significant reduction of anterior knee pain in the resurfaced with p-value < 0> Conclusion: The functional outcome was not affected by whether the patella was resurfaced or nonresurfaced. There was no significant difference between the two groups with respect to the prevalence of knee-related readmission, or of subsequent patella-related surgery or patients overall satisfaction. We recommend selective patellar resurfacing at the time of primary total knee replacement.
Keywords: TKA, Patellar resurfacement, Non-resurfacement, HSS score, KSS score.
2000 anti pronation tape_before_and_after_exercisepainfree888
1) The study evaluated the effects of antipronation tape and temporary orthotics on vertical navicular height before and after exercise compared to a control condition.
2) Both the tape and orthotic treatments significantly increased vertical navicular height after application compared to the control condition, but the effect diminished with exercise.
3) While diminished after exercise, the tape and orthotic conditions still performed better than the control at maintaining vertical navicular height, suggesting they provide some control of excessive foot pronation.
This study aimed to assess the long-term outcomes of lumbar fusion versus non-specific physiotherapy for chronic low back pain. 294 patients were randomized to fusion or physiotherapy and followed for an average of 12.8 years.
Using various analytic approaches, success rates based on patient's global assessment of improvement were in the 65% range for fusion patients, compared to 31-37% for physiotherapy patients. However, secondary outcomes like disability and pain scales showed similar levels of improvement between groups. The discrepancies between primary and secondary outcomes means the study provides only Level II evidence regarding recommending fusion for non-specific low back pain.
This document summarizes several studies related to foot and ankle research. It highlights studies on muscle strength in patients with gout, muscle and joint factors associated with foot deformities in diabetics, the effectiveness of extracorporeal shock wave therapy for lower limb tendinopathies, and multidisciplinary management of diabetic foot disease. It also reviews evidence on treatments for plantar heel pain and vascular assessment techniques used by podiatrists. The introduction provides an overview of various foot and ankle conditions and clinical factors considered by clinicians in lower limb rehabilitation.
The study evaluated the efficacy of paraffin bath therapy for hand osteoarthritis. 56 patients were randomly assigned to either a treatment group receiving paraffin baths or a control group. Outcome measures including pain, hand function, range of motion and strength were assessed at baseline, 3 weeks and 12 weeks. At 12 weeks, the treatment group showed significantly greater improvements in pain, range of motion and strength compared to the control group. Paraffin bath therapy appeared effective in reducing pain and maintaining strength for hand osteoarthritis over 12 weeks.
The document summarizes a randomized controlled trial that assessed the effectiveness of arm ergometer training for improving spasticity, range of motion, and motor control in patients with sub-acute and chronic stroke. 40 patients were divided into two groups - one that received conventional therapy alone and one that received conventional therapy plus arm ergometer training. The results showed that the group receiving arm ergometer training in addition to conventional therapy had significantly greater reductions in spasticity, as well as greater improvements in range of motion and gross motor function compared to the conventional therapy alone group. The study concluded that conventional therapy combined with arm ergometer treatment was effective for reducing spasticity and improving motor outcomes in sub-acute and chronic stroke
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Artigo - Acupuncture and physiotherapy for painful shoulderRenato Almeida
This randomized controlled trial evaluated the efficacy of single-point acupuncture combined with physiotherapy compared to physiotherapy alone for the treatment of painful shoulder. 425 patients with subacromial syndrome received 15 sessions of physiotherapy over 3 weeks along with either weekly acupuncture at point ST38 or sham TENS. Patients receiving acupuncture showed significantly greater improvement in shoulder function scores and reported less analgesic use compared to the control group receiving only physiotherapy. The study demonstrates that adding acupuncture to physiotherapy can more effectively treat painful shoulder conditions.
Pilot Study of Massage in Veterans with Knee OsteoarthritisMichael Juberg
This pilot study assessed the feasibility and preliminary efficacy of Swedish massage therapy for 25 veterans with knee osteoarthritis. The study found high retention and adherence rates, suggesting massage was feasible and acceptable for veterans. Veterans receiving 8 weekly one-hour massage sessions experienced statistically significant improvements in self-reported knee pain, stiffness, function, and quality of life, as well as trends toward improved range of motion. The results support further study of massage as a treatment approach for knee osteoarthritis in veterans.
This case report summarizes the physical therapy management of a 62-year-old female patient following a right medial unicompartmental knee arthroplasty (UKA). The patient presented with impairments including decreased range of motion, strength, and functional ability. Physical therapy focused on improving range of motion, strength, and dynamic balance through interventions like stretching, strengthening, and balance exercises. Outcomes included clinically meaningful improvements in knee range of motion and function, though some deficits remained at discharge. The report discusses rehabilitation after UKA compared to accelerated protocols for total knee arthroplasty, noting generally faster recovery times but some lingering functional weakness in this case.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
This systematic review analyzed 15 studies on the use of physical modalities for the conservative treatment of three common hand and wrist tenosynovitis conditions: De Quervain disease, Dupuytren disease, and trigger finger. For De Quervain disease, laser therapy and therapeutic ultrasound were found to be the most effective physical therapies based on 7 randomized controlled trials involving 320 patients. For Dupuytren disease, extracorporeal shock wave therapy was identified as the most efficient and safe therapy based on 3 studies involving 131 patients. For trigger finger, extracorporeal shock wave therapy was found to be the most frequent physical modality used for functional improvement and pain control based on 5 studies involving 209 patients. However,
This randomized clinical trial compared the effectiveness of anterior versus posterior glide joint mobilization techniques for improving shoulder external rotation range of motion in patients with adhesive capsulitis. Twenty subjects with primary adhesive capsulitis and external rotation deficits were randomly assigned to receive either anterior or posterior glide mobilization plus therapeutic ultrasound and exercise over six sessions. Shoulder external rotation range of motion was measured initially and after each session. The group receiving posterior glide mobilization showed significantly greater improvement in external rotation range of motion compared to the group receiving anterior glide mobilization. Both groups had significant decreases in pain.
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons.
Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.
Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system.
Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P< 0.001).
Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000518.php
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Please click on link: https://crimsonpublishers.com/
For more Articles on Open Access Peer Reviewed High Impact Factor journals
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Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and ...ijtsrd
Background and Objective: According to world Health Organization (WHO) stroke is defined as œrapidly developing clinical sign of focal (or global) disturbance of cerebral function lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin.1 Focal neurological deficits must persists for at least 24 hours, motor deficits are characterized by paralysis (hemiplegia) or weakness (hemiparesis), typically on the side of the body opposite site of lesion.Materials and Methods: The study was performed among 30 patients of both genders, aged 45-60 years. Subjects were selected on the basis of inclusion criteria and randomly divided into two groups by convenience sampling and allocating alternate patient group A and group B, 15 in each group. Group A was treated with Repetitive Facilitation Exercises (RFE), Group B was treated with Hand Arm Bimanual Intensive Training (HABIT). Baseline assessments were taken using WMFT and FMA and data was analyzed.Results: The groups showed significant differences in WMFT and FMA variables. But on comparing the mean of both the groups: there was no significant difference between both the groups. Conclusion: This study concluded that RFE and HABIT both are effective in treatment of patients with hemiparesis. Dr. Shilpy Jetly | Sukhwinder Kaur | Dr. Jaspinder Kaur"Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and Repetitive Facilitation Exercises on Upper Limb Functions In Post Stroke Hemiparetic Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-1 | Issue-5 , August 2017, URL: http://www.ijtsrd.com/papers/ijtsrd2375.pdf http://www.ijtsrd.com/medicine/other/2375/comparison-between-effectiveness-of-hand-arm-bimanual-intensive-training-and-repetitive-facilitation-exercises-on-upper-limb-functions-in-post-stroke-hemiparetic-patients/dr-shilpy-jetly
This study analyzed the long-term effectiveness of corticosteroid injections for treating trigger finger. The study observed 71 patients over 8 years on average who received injections for their first diagnosis of trigger finger. It found that 69% of patients experienced complete remission of symptoms without needing surgery. Thumbs responded better to treatment, with an 81% success rate, compared to 56% for other fingers. While injections provided relief for most, diabetes reduced their effectiveness. The study concludes that corticosteroid injections provide an effective first-line treatment for trigger finger.
Out comes of lower level laser vs ultrasonicDR.SUNIL KUMAR
De Quervain's tenosynovitis is a painful condition of the wrist caused by overuse of the thumb. This study compared the effectiveness of low-level laser therapy (LLLT) and ultrasound therapy (UST) in treating De Quervain's tenosynovitis. 30 patients were randomly assigned to receive either LLLT or UST daily for 7 sessions. Outcome measures including pain, tenderness, grip strength and tendon thickness were assessed before and after treatment. The study found that grip strength and pain improved more in the UST group compared to the LLT group. However, differences in tendon thickness changes between the groups were not statistically significant. In conclusion, UST seemed to
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
This study compared the success rates of traditional intraoral versus a new extraoral technique for reducing temporomandibular joint dislocations. 58 dislocation reduction attempts were randomly allocated to the two methods. The traditional intraoral method was successful in 86.2% of cases, while the new external method was only successful in 55.2% of cases, a statistically significant difference. While the external method has benefits of avoiding hand bites, the study found it had a lower success rate than the traditional intraoral approach and often required additional techniques for reduction. More research is needed to better evaluate the potential advantages and disadvantages of the new external reduction method.
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
This document discusses the use of ligamentotaxis and external fixation in the treatment of intra-articular and juxta-articular fractures of the wrist. It presents a study of 116 patients treated for these fractures. 100 patients underwent external fixation using ligamentotaxis to achieve and maintain fracture reduction. Results found good to excellent clinical and radiological outcomes in most of these patients. Complications like pin tract infection and loosening occurred in a small percentage of cases. The study concludes that external fixation with ligamentotaxis is an effective treatment that allows for wound management and mobility while maintaining fracture reduction in intra-articular and juxta-articular wrist fractures.
Alt PDFThe Journal of the CanadianChiropractic Associati.docxdaniahendric
Alt PDF
The Journal of the Canadian
Chiropractic Association
The Canadian Chiropractic Association
What is your research question?
An introduction to the PICOT
format for clinicians
John J. Riva, BA, DC, Keshena M.P. Malik, BSc,
DC, [...], and Jason W. Busse, DC, PhD
Additional article information
Introduction
Clinicians often witness impressive treatment
results in practice and may wish to pursue
research to formally explore their anecdotal
experiences. The potential to further new
knowledge both within the profession and to the
greater healthcare system is compelling. An
obvious next step for a practitioner considering
research is to connect with experienced
researchers to convey their idea for a study, who
may in turn ask, “What is your research
question?” With limited understanding of how to
respond, this interaction may result in the first
and last experience these clinicians will have with
the research community.
It has been estimated that between 1% and 7% of
the chiropractic profession in Canada is engaged
in research. Arguably, this low engagement
could be the result of practitioners’ perceived
importance of research and levels of research
literacy and capacity. However, increasing
demands for evidence-based approaches across
the health system puts pressure on all clinicians to
base their decisions on the best available
scientific evidence. Lack of clinician
representation in research has the probable effect
of limiting growth and new developments for the
profession. Furthermore, lack of clinician
involvement in research complicates the transfer
of study findings into practical settings.
The Canadian Institutes of Health Research
describes integrated knowledge translation as a
process that involves collaboration between
researchers and knowledge users at all stages of a
research project. This necessitates involvement
of clinicians to help in forming a research
question, interpreting the results, and moving
research findings into practice. This shared effort
between clinicians and researchers increases the
likelihood that research initiatives will be relevant
to practice. Conversely, it has been reported that
there is a growing communication gap between
clinicians and academics in chiropractic.
Clinicians have important practice-related
questions to ask, but many may lack the ability to
map out their research strategy, specifically in
communicating their question in a manner
required to develop a research protocol.
David L. Sackett, Officer of the Order of Canada
and the founding Chair of Canada’s first
Department of Clinical Epidemiology &
Biostatistics at McMaster University, highlights
the importance of mapping one’s research
strategy in exploration of the research question:
“one-third of a trial’s time between the germ of
your idea and its publication in the New England
Journal of Medicine should be spent fighting
about the research question.” (personal
communicat ...
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. Splinting and Radial Nerve Palsy:
A Single-subject Experiment
Susan D. Hannah, BScOT (Reg), OTR, CHT
The Toronto Western Hospital Hand Program
The University Health Network '
399 Bathurst Street
Toronto, Ontario, Canada
Pamela 1. Hudak, MSc, BScPT
Doctoral candidate, Institute for Medical Sciences,
The University of Toronto;
The Toronto Western Hospital Hand Program;
The Toronto Western Hospital and Hospital
for Sick Children
Toronto, Ontario
The radial nerve is a commonly injured upper
extremity peripheral nerve. Although its superficial
position in the spiral groove makes the nerve most
vulnerable to injury at the mid-humeral level, injury to
the radial nerve can also occur at the neck of the
humerus and brachial plexus.1
Common causes of
radial nerve palsy are humeral fractures, elbow dis-
locations, and Monteggia fracture-dislocations.1
Although trauma is the most common cause of radial
nerve palsy, other conditions such as diabetes mellitus
and polyarteritis may cause radial nerve dysfunction.1
Radial nerve palsy causes significant impairment
of hand function, presenting clinically as the classic
drop wrist. The inability to extend the wrist results in
loss of tenodesis action1
and diminished use of the
fingers for power grip and grasp-and-release
actions.1
-
3
On a positive note, the loss of sensation
associated with radial nerve palsy is not functionally
significant, because palmar sensation remains intact.3
Various authors1
have reported that the radial
nerve recovers spontaneously, and estimates of this
recovery period range from 5 weeks to 24 months.
One of the challenges for hand therapists during this
period of nerve regeneration is to fabricate a splint
that prevents over-stretching of denervated extensor
musculature while maximizing hand function.3
A
Correspondence and reprint requests to Susan D. Hannah, BScOT
(Reg), OTR, CHT, The University Health Network Hand
Program, The Toronto Western Hospital, 399 Bathurst Street,
Toronto, Canada, M5T 2S8
ABSTRACT: This study examines which of three splint designs
most effectively improved hand function in a patient with radial
nerve palsy, and demonstrates the application of a single-subject
experimental design. The static volar wrist cock-up splint
(splint 1), dynamic tenodesis suspension splint (splint 2), and dor-
sal wrist cock-up with dynamic finger extension splint (splint 3)
were evaluated. Each splint was worn for 3 weeks, and hand func-
tion was assessed by means of standardized measures of function
and disability. Statistical significance was calculated using the
minimal level of detectable change (MDC) at the 95% confidence
level. Only with splints 2 and 3 did a true change in function
occur, compared with baseline scores (no splint). In addition, the
patient completed all tasks while using splints 2 and 3 but did not
complete three tasks while using splint 1.The hand therapists'
goal is to fabricate a splint that improves function and that the
patient will wear. Only splint 3 met these criteria. This experiment
highlights the need to evaluate both the statistical and the clinical
significance of treatment interventions.
JHAND THER. 2001;14:195-201.
variety of splinting options have been described-a
static wrist extension splint,4 a light-weight spring
splint that allows wrist movement,S a modified
spring splint, or "lively splint,,,6 a dorsal slab splint
with loop suspension for digits} and a splint that
"harnesses" the tenodesis pattern of the hand using
static lines to support the digits.1
McKee and
MorganS summarized static and dynamic splinting
options used following radial nerve palsy at the mid-
humeral level but did not report on splint efficacy.
Although splinting options are described in the liter-
ature, we were unable to locate (in the CINAHL and
MEDLINE databases, 1980-99) published work report-
ing evidence of splint efficacy for improving the
hand function of patients with radial nerve palsy.
Hand therapists practice in a continually changing
health care environment in which policy makers,
health care providers, and consumers expect docu-
mentation of clinical change and accountability.9
From a professional as well as a clinical perspective,
hand therapists are required to justify treatment
interventions such as splinting.
We often refer to the published literature for
research evidence to support our treatment choices.
One of the more rigorous research designs is the dou-
ble-blind randomized controlled trial. Although the
radial nerve is a commonly injured peripheral nerve,
the incidence of this condition is relatively low. Thus,
even multicenter randomized controlled trials are
infeasible because of small sample sizes.1O
-
12
In addi-
tion to the issue of sample size, a randomized con-
July-September 200 I 195
2. FIGURE 1. Static volar wrist cock-up splint. This splint stati-
cally holds the wrist in extension.
FIGURE 2. Dynamic tenodesis suspension splint. Through
the use ofa tenodesis action, this splint provides adynamic, pas-
sive assist to substitute for weak or absent wrist and finger
extensors.
FIGURE 3. Dorsal wrist cock-up with dynamic finger exten-
sion splint. This splint provides adynamic, passive assist to sub-
stitute for weak or absent finger extensors. The wrist is held stat-
ically in extension.
196 JOURNAL OF HAND THERAPY
trolled trial is not the best way to determine the treat-
ment of choice for a specific patient, since results are
based on the average improvement scores for all sub-
jects and therefore do not provide information on the
performance of individual subjects.9
Since the focus and accountability of therapists are
at the level of the individual patient, we need an alter-
native research method that allows for the evaluation
of individual treatment interventions. Single-subject
experimental designs have been proposed as one alter-
native to the randomized controlled trial.9
-
14
These
designs are advantageous for a number of reasons:
results can indicate whether treatment benefits a par-
ticular patient, the patient is his or her own control,
and results can be used to fine-tune clinical hypothe-
ses.12
,14 In addition, a single-subject experimental
design is a natural extension of therapists' systematic
evaluation of patients and can therefore be easily
incorporated into clinical practice. If this approach is
used to study enough patients with the same condi-
tion over time, results may be generalizable.14
This study was designed to evaluate which of three
splint designs was most effective in improving hand
function in an 83-year-old woman with radial nerve
palsy, and to demonstrate the application of a single-
subject experimental design to a clinical problem.
METHODS
Subject Profile
The patient was an active, cooperative 83-year-old
woman who had sustained a subglenoid dislocation
of her left shoulder after slipping and falling at home.
She experienced full recovery of the biceps, triceps,
supinator, and pronator teres muscles following a left
brachial plexopathy. Residual impairments included
lack of wrist, finger, and thumb extension and short-
ening of the flexor pollicis longus musculotendinous
unit. Six months after the injury, she was referred to
hand therapy for fabrication of a splint to improve
performance of activities of daily living. At the time
of referral, the treating therapist reported that the
patient's physical status had stabilized.
Evaluators
The three evaluators were hand therapists working
in a university-affiliated program specialized in the
care of upper extremity and hand conditions. This pro-
gram is located in a major tertiary-care hospital in a
large urban center in Canada. Each therapist had at
least five years' experience working in hand therapy.
Research Design
A single-subject experimental design was used to
compare the patient's responses to four treatment
interventions-no splint (baseline), static volar wrist
3. cock-up splint (Figure I), dynamic tenodesis suspen-
sion splint (Figure 2), and dorsal wrist cock-up with
dynamic finger extension splint (Figure 3). These
three splint designs were selected becal,lse of their
common use clinically and frequent description in
the literature. The order of splint design was ran-
domly allocated. Each splint was fabricated by the
same therapist, and standard instructions for wear
and care of each splint were provided. Because of
shortening of the patient's flexor pollicis longus mus-
culotendinous unit, thumb abduction components
were added to the dynamic tenodesis suspension
splint and the dorsal wrist colck-up with dynamic fin-
ger extension splint to improve thumb abduction.
On the basis of the treating therapist's clinical judg-
ment and manual muscle testing results collected at
3-week intervals during the study, the patient's con-
dition was assumed to be stable. Although the
patient was blinded to the weekly assessment results,
it was not possible to blind the patient and therapists
to which splint was being evaluated, since the splints
were worn during evaluation of the patient's physi-
cal function.
Approval of the hospital's ethics review committee
and informed consent of the patient were obtained
prior to initiation of the study.
Outcome Measures
Four established outcome measures were chosen to
assess the following variables-performance of the
upper extremity during activities of daily Living (Test
Evaluant Les Membres Superieurs des Personnes
Agees, TEMPA), self-reported level of disability
(Disabilities of the Arm, Shoulder and Hand ques-
tionnaire, DASH), self-perceived performance in
activities of daily living (Canadian Occupational
Performance Measure, COPM), and strength of spe-
cific muscle groups to monitor stability of physical
status (manual muscle testing). Two nonstandard-
ized questionnaires designed specifically for this
study were also used-a splint-wearing schedule and
a splint-preference questionnaire. .
The TEMPA is an upper extremity function test
designed for geriatric populations. High reliability as
well as content, face, and preliminary construct
validity in this population have been reported.1S
,16
The TEMPA consists of five bilateral and four unilat-
eral tasks related to daily activities (Figure 4). Both
the right and left hands are evaluated in the perform-
ance of unilateral tasks. Scoring is based on speed of
performance, a functional rating score (independence
in performing each task), and task analysis (range of
motion, strength, prehension, and precision of gross
and fine movement). A combined total score is calcu-
lated by adding the functional rating and task analy-
sis scores for both unilateral and bilateral tasks.
Speed of execution is examined independently of the
Pick up and move a jar Unilateral
2 Open a jar and remove a spoonful of coffee Bilateral
3 Pick up a pitcher and pour water into a glass Unilateral
4 Unlock a lock and open a pill container Bilateral
5 Write on an envelope and stick a stamp on it Bilateral
6 Tie a scarf around one's neck Bilateral
7 Shuffle and deal playing cards Bilateral
8 Handle coins Unilateral
9 Pick up and move small objects Unilateral
FIGURE 4. TEMPA Tasks
combined total score. We report the functional rating
score in this study, since it provides the most global
indication of functional independence.
The DASH self-completed questionnaire measures
disability and symptoms related to upper extremity
musculoskeletal disordersY The patient is asked to
rate his or her ability to perform certain activities dur-
ing the previous week. Because this measure is intend-
ed to capture disability, patients are asked to describe
their ability to do different tasks regardless of which
hand or arm is used to complete the activity. The 30-
item questionnaire includes 21 physical function items
(e.g., prepare a meal, garden or do yard work, and par-
ticipate in recreational activities), 6 symptom items
(e.g., pain, tingling, weakness, stiffness) and 3
social!role function items (extent to which arm, shoul-
der, or hand problem interferes with normal social
activities). Two optional modules address the effects
of the arm, shoulder, or hand problem on sports, per-
forming arts, and work. Initial results suggest the
DASH is sensitive to upper limb disability and is able
to discriminate across severity of condition.18
,19
Preliminary results provide evidence of the reliability
and convergent validity of the DASH, although sup-
port for its divergent validity is poor.18
,19 The original
DASH score out of 30 is transformed to a score out of
lOa, where 0 corresponds to "no disability" and 100
corresponds to "considerable disability."
The COPM is an individualized measure designed
to detect change over time in a patient's self-percep-
tion of occupational performance?O The patient is
asked to generate a list of occupational performance
issues in the areas of self-care (hygiene, feeding,
finances), productivity (paid/unpaid work,cleaning,
play, homework), and leisure (hobbies, sports, social-
ization). Each issue is rated by the patient on a ten-
point scale, in terms of importance, performance, and
patient satisfaction with performance. We report on
performance in this study because it is most reflective
of function. Preliminary results provide evidence of
July-September 200 I 197
4. I· I I+t---_ I+t - - -_
3 Weeks 3 Weeks 3 Weeks
Stallc Volar Wrisl
Cock-Up Spllnl
Dynamic Tenodesis Dorsal Wrlsl Cock-up
Suspension Splinl wilh Dynamic Finger
Extension Spllnl
FIGURE 5. Method: single-subject experimental design. Data
were collected at baseline (no splint) and after each 3-week splint
trial.
test-retest reliability of the COPM as well as of con-
tent validity and responsiveness to clinical change;
results with respect to construct validity are mixed.21
The TEMPA, DASH, COPM, and muscle strength
test were assessed at baseline (no splint) and after the
patient wore each splint (Figure 5).
For each 3-week period of splint intervention, the
patient completed a splint-wearing schedule on
which she documented, daily, the total number of
hours that the splint was worn, the. activities per-
formed while the splint was worn, and the length of
time the splint was worn during each activity. At the
end of the study, the patient was asked to complete a
final 3-week splint-wearing schedule. During this
time, she chose the splint design she preferred to use
for each activity and documented the splint chosen,
the length of wearing time, and the activity per-
formed. Finally, at the end of the study, she complet-
ed a splint preference questionnaire outlining her
splint preferences and rationale for selection.
Data Analysis
Results were examined from a statistical as well as
a clinical perspective. For change to be statistically
significant, it is important to determine that the
change is real and not due to chance or measurement
error.22
One method for assessing statistical change is
called the minimal level of detectable change
(MDC).9,22,23 The MDC is based on the standard error
of measurement of each outcome measure and pro-
vides a confidence interval around a point estimate.
Clinicians can be confident that any value greater
than the MDC represents a true change,z2 The MDC
at the 95% confidence level was calculated for the
TEMPA, DASH, and COPM using published values
(see Appendix). The following MDC values were cal-
culated-TEMPA, 3.13; DASH, 17.23; and COPM,
2.815. This means, for example, we can be 95% confi-
dent that a true change in score on the DASH has
occurred if the difference between the baseline and
post-splint score is greater than 17.23 points.
Statistical analysis of single-subject experiments is
still relatively new, and there are controversies
regarding appropriate methods of analyzing such
data,z4 After the literature was reviewed, the MDC
method was chosen, because the patient's physical
status was stable at baseline and throughout the
study as assessed by manual muscle testing. It was
198 JOURNAL OF HAND THERAPY
reasonable to assume that the patient was clinically
stable, because she did not report changes in strength
or function over the course of the study. Methods
based on trend estimation are more appropriate if a
patient's baseline data are not stable or are fluctuat-
ing, since this may reveal a trend that continues dur-
ing the treatment intervention.25
To assess clinical significance, the number of
TEMPA tasks completed during the use of each
splint, trends identified in the splint-wearing sched-
ule, and information gathered in the splint prefer-
ence questionnaire were considered.
RESULTS
Statistical Findings
Scores on the TEMPA, DASH, and COPM at base-
line and while wearing each splint are summarized
in graph form. Figure 6 shows results for the TEMPA
functional rating scores, where a reduction in score
reflects improvement in upper extremity function.
Scores at baseline and with the static volar wrist
cock-up splint (splint I), dynamic tenodesis suspen-
sion splint (splint 2), and dorsal wrist cock-up with
dynamic finger extension splint (splint 3) were 13, 12,
7, and 3, respectively. The 95% confidence interval
around the baseline TEMPA score is shown in black.
Scores obtained during use of the dynamic tenodesis
suspension splint and the dorsal wrist cock-up with
dynamic finger extension splint fall outside the 95%
confidence interval, indicating improved hand func-
tion. Hand function did not improve during use of
the static volar wrist cock-up splint.
Figure 7 illustrates results for the DASH, in which
a reduction in score reflects improvement in the
patient's upper extremity disability and symptoms.
Scores at baseline and with the static volar wrist
cock-up splint (splint 1), dynamic tenodesis suspen-
sion splint (splint 2), and dorsal wrist cock-up with
20
16. 1
15
X = 13
X = 12
10 9.8
X =3
Sa line 3
Slatlc Volar Oyn.mlc Dorsal Wrist
Wrlsl Tenod••is Cock-up with
Cock-Up Su pension OyNmlc Flng r
Solint Splint ExtoMlon Splinl
FIGURE 6. Statistical results for the Test Evaluant Les Membres
Superieurs des Personnes Agees functional rating scores.
5. dynamic finger extension splint (splint 3) were 62.5,
51.6,36.25, and 26 respectively. The 95% confidence
interval around the baseline DASH score is shown in
black. DASH scores obtained during use of the
dynamic tenodesis suspension splint and the dorsal
wrist cock-up with dynamic finger extension splint
fall outside this confidence interval, indicating with
95% confidence that these splints improved the
patient's disability and symptoms, whereas the static
volar wrist cock-up splint did not.
Finally, the COPM performance rating scores are
shown in Figure 8. These numbers reflect the
patient's perception of performance while wearing
each of the three splints; improvement on this meas-
ure is indicated by an increase in score. Scores at
baseline and with the static volar wrist cock-up splint
(splint 1), dynamic tenodesis suspension splint
(splint 2), and dorsal wrist cock-up with dynamic fin-
ger extension splint (splint 3) were 3, 4.8, 7.2, and 7.6,
respectively. The 95% confidence interval is shown in
black. Again, scores with the dynamic tenodesis sus-
pension splint and the dorsal wrist cock-up with
dynamic finger extension splint fall outside of the
95% confidence interval, indicating improvement in
hand function. Hand function did not improve when
the patient used the static volar wrist cock-up splint.
Clinical Findings
Functionally, the patient was unable to complete
three TEMPA tasks both at baseline and with the stat-
ic volar wrist cock-up splint. However, with the
dynamic tenodesis suspension splint and the dorsal
wrist cock-up with dynamic finger extension splint,
she was able to complete all nine TEMPA tasks.
The total number of hours that each splint was
worn while the patient performed daily tasks and the
average number of hours that the splint was used
each day were calculated from the splint-wearing
schedule. The static volar wrist cock-up splint was
100
90
80
70
60
50
40
30
20
10
X= 62.5
--
Baseline
X = 51.6
Static Volar
Wrist
Cock·Up
Splint
1- - - - 1- 79. 7
45.3
x =36.25
X =26
3
Dynamic Dorsal Wrist
Tenodesis Cock·up with
Susponslon Dynamic Finger
Splint Extension Splint
FIGURE 7. Statistical results for the Disabilities of the
Shoulder, Arm and Hand questionnaire scores.
.0
6 ;-_ __
a....".
X-4.8
StaUcVolar
Wrll!
Cock-tJp
Splint
X =7.2
2
DyNlm1c
T.nod....
Suspension
SpUnt
X =7.&
Ooru. Wrlst
Cock-upwlth
DyNlm1c Finger
Ext.nslon Spin!
5.8
.2
FIGURE 8. Statistical results for the Canadian Occupational
Performance Measure performance rating score.
worn 4.5 hours a day, compared with the dynamic
tenodesis suspension splint and the dorsal wrist
cock-up with dynamic finger extension splint, which
were both worn 6.8 hours a day. Although these data
were not analyzed statistically, the cumulative time
that each of the two dynamic splints was worn, when
compared with the time the static volar wrist cock-up
splint was worn, appears to be longer. A list of activ-
ities performed while each splint was worn and the
length of time the splint was worn during each activ-
ity were also collected. No obvious trends in these
data were apparent.
The patient was asked to complete the splint-wear-
ing schedule one more time over a 3-week post-study
period. During this time, the patient was allowed to
choose whichever of the three splints she preferred
for performing activities of daily living. She chose the
static volar wrist cock-up splint (2.4 hours per day)
and the dorsal wrist cock-up with dynamic finger
extension splint (1.8 hours per day). She did not use
the dynamic tenodesis suspension splint at any time
during this 3-week period.
The splint preference questionnaire showed that the
patient believed that her hand function improved with
both dynamic splints, more with the dorsal wrist cock-
up with dynamic finger extension splint than with the
dynamic tenodesis suspension splint. Interestingly,
however, despite the improvement in function, she
preferred the static volar wrist cock-up splint because
it offered support, was easy to put on, and was less
conspicuous to wear than the other two splints.
DISCUSSION
The importance of demonstrating treatment effec-
tiveness is acknowledged and accepted by clinicians.
Splinting is an intervention used frequently by hand
therapists to treat patients with radial nerve palsy.
Although splinting options for radial nerve palsy are
described in the literature, published works compar-
ing designs could not be located.
July-September 200 I 199
6. This study shows that the dynamic tenodesis sus-
pension splint and the dorsal wrist cock-up with
dynamic finger extension splint statistically im-
proved (in comparison with baseline scores on the
TEMPA, DASH, and COPM) the hand function of
this 83-year-old female patient with radial nerve
palsy, whereas the static volar wrist cock-up splint
did not. In addition, the patient was able to complete
all TEMPA tasks while using the two dynamic splints
but was unable to complete three tasks while using
the static volar wrist cock-up splint.
Regardless of evaluation scores, our clinical goal is
to fabricate a splint that improves function and that
the patient will wear. In this single-subject experi-
ment, only the dorsal wrist cock-up with dynamic
finger extension splint met these criteria. According
to our statistical analyses, this splint improved the
patient's hand function, and, as documented in the
post-study diary, the patient used it for daily activi-
ties. In the splint preference questionnaire, she
reported better hand function while wearing the dor-
sal wrist cock-up with dynamic finger extension
splint than with the dynamic tenodesis suspension
and static volar wrist cock-up splints. Although the
static volar wrist cock-up splint did not statistically
improve her hand function, she preferred to wear
this splint because it was supportive, easy to apply,
and less noticeable. This reinforces the importance of
ensuring that dynamic splints are comfortable, light-
weight, and inconspicuous.
The study has three limitations. First, we were
unable to blind testers to the intervention being eval-
uated because the patient was required to wear each
splint when completing the TEMPA assessment.
However, the use of standardized assessment proce-
dures should help minimize any potential bias this
may have introduced. Second, re-administration of
the TEMPA without splint at the end of each 3-week
interval may have further supported our clinical
impression that no change in physical status had
occurred over the 12-week period of this study.
Finally, the two dynamic splints had an added com-
ponent to facilitate thumb abduction for grasp-and-
release activities (e.g., picking up small objects such
as coins or a lipstick, picking up a glass or container,
turning a key, opening a tight jar), whereas the static
volar wrist cock-up splint did not. The addition of
this component may have magnified the functional
differences identified statistically and clinically
between the two dynamic splints and the static volar
wrist cock-up splint.
CONCLUSION
This paper describes a process for the systematic
evaluation of treatment interventions using a single-
subject experimental design. This approach should
encourage experimentation by clinicians, because it is
200 JOURNAL OF HAND THERAPY
easier than a randomized controlled trial to conduct
in clinical settings, particularly with relatively rare
conditions like radial nerve palsy.
In this experiment, the patient's hand function
improved statistically and clinically during use of the
dorsal wrist cock-up with dynamic finger extension
splint and the dynamic tenodesis suspension splint.
However, when given the choice of wearing one of
these two dynamic splints, the patient wore only the
dorsal wrist cock-up with dynamic finger extension
splint during activities of daily living.
Although results of this study cannot be general-
ized to all patients with radial nerve palsy, a series of
Single-subject experiments comparing splint effec-
tiveness in patients in this group could make gener-
alization possible in the future.
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ApPENDIX
Calculation of Minimal Level of Detectable Change22
The minimal level of detectable change (MDC) is calculat-
ed as follows:
MDC = SEM x1.96 x,j2.
where SEM is the standard error of measurement.
The SEM is calculated as:
SEM=utb-R
where u t is the total variance for the test.
Test Evaluant Les Membres Superieurs des
Personnes Agees (TEMPA)16
One hundred and four men and women who had various
upper limb impairments participated in this study. Their
ages ranged from 60 to 94 years. Concurrent validity was
tested by examining the agreement of TEMPA scores with
scores for the Action Research Arm Test and the Box and
Block Test. Construct validity was explored by testing two
hypotheses relating upper limb performance with func-
tional independence.
ICC (test-retest for total functional rating score) = 0.98
SD (total functional rating score) = -8.0
MDC = (~-82 xb -0.98) x1.96 x,j2.
MDC = 3.13
Disabilities of the Arm, Shoulder and Hand
(DASH) Questionnaire19
Sixty-nine patients were treated at one of two tertiary refer-
ral clinics for problems related to the elbow-either non-
surgical management or postoperative reassessment.
ICC (test-retest) = 0.92
SD=22
MDC = (,J-22z x~1-0.92) x1.96 x,j2.
MDC = 17.23
Canadian Occupational Performance
Measure (COPM)20
Twenty-seven patients over the age of 65 years were receiv-
ing rehabilitation services for a variety of neurologic and
musculoskeletal disorders.
ICC (test-retest for performance component) = 0.63
SD (performance component) = 1.67
MDC = (~1.672 xb -0.63) x1.96 x,j2.
MDC =2.815
July-September 200 I 20 I