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O'Sullivan O, Houston A, Ladlow P, Barker-Davies RM, Chamley R, Bennett AN, Nicol ED, Holdsworth DA. Factors influencing medium- and long-term occupational impact following COVID-19. Occup Med (Lond) 2024; 74:53-62. [PMID: 37101240 DOI: 10.1093/occmed/kqad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG). AIMS To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months. METHODS Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG. RESULTS Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading. CONCLUSIONS Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
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Affiliation(s)
- O O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - A Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - R M Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - R Chamley
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
- Royal Centre for Defence Medicine, Birmingham B15 2GW, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - E D Nicol
- Academic Department of Military Medicine, Birmingham B15 2GW, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - D A Holdsworth
- Royal Centre for Defence Medicine, Birmingham B15 2GW, UK
- Academic Department of Military Medicine, Birmingham B15 2GW, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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Coppack RJ, Ladlow P, Cassidy RP, Egginton N, Barker-Davies R, Houston A, Lunt KM, O'Sullivan O, Bennett AN. Academic Department of Military Rehabilitation (ADMR): avoiding the pitfalls of ' the Walker Dip'. BMJ Mil Health 2024; 170:4-8. [PMID: 37495378 DOI: 10.1136/military-2023-002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
A key research theme identified during the 2021 Strategic Delivery Plan (SDP) for Defence Medical Services (DMS) Research was preventing and treating musculoskeletal injury (MSKI). MSKI is a significant burden to military populations globally, reducing both operational strength and force readiness. It is therefore essential that research is conducted to gain a greater understanding of the epidemiology, aetiology and risk factors associated with MSKI to develop targeted prevention strategies and rehabilitation interventions. The Academic Department of Military Rehabilitation (ADMR) and the recently established MSKI research-theme working group must use a combination of balance and flexibility when coordinating research priorities to ensure they align and reflect both higher level DMS and UK Defence Rehabilitation practitioner-driven priorities. This article describes the response ADMR have taken to meet and align with the requirements of the 2021 SDP.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - N Egginton
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - K M Lunt
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Barker-Davies RM, O'Sullivan O, Holdsworth DA, Ladlow P, Houston A, Chamley R, Greenhalgh A, Nicol ED, Bennett AN. How long is Long-COVID? Symptomatic improvement between 12 and 18 months in a prospective cohort study. BMJ Mil Health 2023:e002500. [PMID: 37788921 DOI: 10.1136/military-2023-002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION COVID-19 infection can precede, in a proportion of patients, a prolonged syndrome including fatigue, exercise intolerance, mood and cognitive problems. This study aimed to describe the profile of fatigue-related, exercise-related, mood-related and cognitive-related outcomes in a COVID-19-exposed group compared with controls. METHODS 113 serving UK Armed Forces participants were followed up at 5, 12 (n=88) and 18 months (n=70) following COVID-19. At 18 months, 56 were in the COVID-19-exposed group with 14 matched controls. Exposed participants included hospitalised (n=25) and community (n=31) managed participants. 43 described at least one of the six most frequent symptoms at 5 months: fatigue, shortness of breath, chest pain, joint pain, exercise intolerance and anosmia. Participants completed a symptom checklist, patient-reported outcome measures (PROMs), the National Institute for Health cognitive battery and a 6-minute walk test (6MWT). PROMs included the Fatigue Assessment Scale (FAS), Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Patient Checklist-5 (PCL-5) for post-traumatic stress. RESULTS At 5 and 12 months, exposed participants presented with higher PHQ-9, PCL-5 and FAS scores than controls (ES (effect size) ≥0.25, p≤0.04). By 12 months, GAD-7 was not significantly different to controls (ES <0.13, p=0.292). Remaining PROMs lost significant difference by 18 months (ES ≤0.11, p≥0.28). No significant differences in the cognitive scales were observed at any time point (F=1.96, p=0.167). At 5 and 12 months, exposed participants recorded significantly lower distances on the 6MWT (ηp 2≥0.126, p<0.01). 6MWT distance lost significant difference by 18 months (ηp 2<0.039, p>0.15). CONCLUSIONS This prospective cohort-controlled study observed adverse outcomes in depression, post-traumatic stress, fatigue and submaximal exercise performance up to 12 months but improved by 18-month follow-up, in participants exposed to COVID-19 compared with a matched control group.
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Affiliation(s)
- Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - D A Holdsworth
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - A Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R Chamley
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Greenhalgh
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - E D Nicol
- Department of Cardiology, Royal Brompton Hospital, Birmingham, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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O'Sullivan O, Behan FP, Coppack RJ, Stocks J, Kluzek S, Valdes AM, Bennett AN. Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research. BMJ Mil Health 2023:e002390. [PMID: 37491135 DOI: 10.1136/military-2023-002390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023]
Abstract
Within the UK Armed Forces, musculoskeletal injuries account for over half of all medical downgrades and discharges. Data from other Armed Forces show that osteoarthritis (OA), more common in military personnel, is likely to contribute to this, both in its primary form and following injury (post-traumatic OA, PTOA), which typically presents in the third or fourth decade. OA is not a progressive 'wear and tear' disease, as previously thought, but a heterogenous condition with multiple aetiologies and modulators, including joint damage, abnormal morphology, altered biomechanics, genetics, low-grade inflammation and dysregulated metabolism. Currently, clinical diagnosis, based on symptomatic or radiological criteria, is followed by supportive measures, including education, exercise, analgesia, potentially surgical intervention, with a particular focus on exercise rehabilitation within the UK military. Developments in OA have led to a new paradigm of organ failure, with an emphasis on early diagnosis and risk stratification, prevention strategies (primary, secondary and tertiary) and improved aetiological classification using genotypes and phenotypes to guide management, with the introduction of biological markers (biomarkers) potentially having a role in all these areas. In the UK Armed Forces, there are multiple research studies focused on OA risk factors, epidemiology, biomarkers and effectiveness of different interventions. This review aims to highlight OA, especially PTOA, as an important diagnosis to consider in serving personnel, outline current and future management options, and detail current research trends within the Defence Medical Services.
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Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - F P Behan
- Department of Bioengineering, Imperial College London, London, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
| | - J Stocks
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - S Kluzek
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
| | - A M Valdes
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Ladlow P, Suffield C, Greeves JP, Comfort P, Hughes J, Cassidy RP, Bennett AN, Coppack RJ. How 'STRONG' is the British Army? BMJ Mil Health 2023:e002508. [PMID: 37487657 DOI: 10.1136/military-2023-002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - C Suffield
- Physical Development Branch, Royal Army Physical Training Corps, Tidworth, UK
| | - J P Greeves
- Department of Army Health and Physical Performance Research, United Kingdom Ministry of Defence, Andover, UK
| | - P Comfort
- School of Health and Society, University of Salford, Salford, UK
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - J Hughes
- Headquarters, Royal Army Physical Training Corps, Aldershot, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Maqsood R, Schofield S, Bennett AN, Bull AM, Fear NT, Cullinan P, Khattab A, Boos CJ. Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study. BMJ Mil Health 2023:military-2022-002316. [PMID: 36990509 DOI: 10.1136/military-2022-002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/05/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)-a robust CVD risk marker-has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV. METHODS This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism. RESULTS Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD. CONCLUSION These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.
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Affiliation(s)
- Rabeea Maqsood
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - S Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - A N Bennett
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Mj Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
| | - P Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - A Khattab
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - C J Boos
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
- Department of Cardiology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
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O'Sullivan O, Ladlow P, Coppack RJ, Bennett AN. The BMJ Military Health Military Rehabilitation special issue. BMJ Mil Health 2022; 168:253-255. [PMID: 35868832 DOI: 10.1136/bmjmilitary-2022-002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- Headquarters Army Medical Services (HQ AMS), Camberley, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- Department of Health, University of Bath, Bath, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- Department of Health, University of Bath, Bath, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Allan R, Cassidy RP, Coppack RJ, Papadopoulou T, Bennett AN. Biomechanical and clinical outcomes in response to inpatient multidisciplinary hip and groin rehabilitation in UK military personnel. BMJ Mil Health 2021; 168:266-272. [PMID: 33619232 DOI: 10.1136/bmjmilitary-2020-001588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hip and groin related pain is a common complaint among the military population across UK Defence Rehabilitation and addressing associated biomechanical dysfunction is a key treatment goal. Personnel are exposed to complex occupational loads, therefore assessing movement during demanding tasks may expose biomechanical deficits. Observing biomechanical and clinical outcomes in response to treatment is therefore an important consideration. The aims were to examine clinical and biomechanical outcomes prior to (T1) and 12 weeks post (T2) inpatient rehabilitation and explore the influence of pathological subgroup. METHODS Prospective cohort study as part of a clinical service evaluation of 25 patients undergoing treatment for hip and groin related pain. Three-dimensional motion capture (3DM) during a single-leg squat, hip strength and patient-reported outcome measures were collected at T1 and T2. RESULTS Increased abductor and external rotator strength with reductions in contralateral pelvic drop (1.9°; p=0.041) at T2 on the injured side. Pain reduced by 9.6 mm (p=0.017) but no differences were found for Non-Arthritic Hip Score (NAHS). No statistically significant differences were found between pathological subgroups. Kinematic profiles display variation between diagnostic subgroups and response to treatment. CONCLUSION Strength and pain improved with treatment in this service evaluation although biomechanical adaptation and NAHS remain inconclusive. Small and uneven sample size prevents a firm conclusion regarding the effect of pathological subgroupings, however, the data can be considered hypothesis generating for future, larger studies to integrate 3DM for monitoring response to rehabilitation in pathological subgroups to support clinical decision making.
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Affiliation(s)
- Richard Allan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,British Association of Sport and Exercise Medicine, Doncaster, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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O'Sullivan O, Barker-Davies R, Chamley R, Sellon E, Jenkins D, Burley R, Holden L, Nicol AM, Phillip R, Bennett AN, Nicol E, Holdsworth DA. Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service. BMJ Mil Health 2021; 169:271-276. [PMID: 33547188 DOI: 10.1136/bmjmilitary-2020-001681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/04/2022]
Abstract
Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.
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Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,Headquarters Army Medical Services (HQ AMS), Camberley, Surrey, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - R Chamley
- Academic Department of Military Medicine, Birmingham, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - E Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Royal Centre for Defence Medicine, Birmingham, UK
| | - D Jenkins
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Royal Centre for Defence Medicine, Birmingham, UK
| | - R Burley
- Headquarters Defence Primary Healthcare, Lichfield, Staffordshire, UK
| | - L Holden
- Royal Centre for Defence Medicine, Birmingham, UK
| | - A M Nicol
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK
| | - R Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - E Nicol
- Royal Centre for Defence Medicine, Birmingham, UK.,Royal Brompton Hospital, London, UK
| | - D A Holdsworth
- Academic Department of Military Medicine, Birmingham, UK .,Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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Coppack RJ, Ladlow P, Bennett AN. Developing UK Defence Rehabilitation research priorities: a 2020 clinical practitioner engagement exercise. BMJ Mil Health 2020; 168:256-259. [PMID: 33243765 DOI: 10.1136/bmjmilitary-2020-001676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Establishing research priorities help to address knowledge gaps and exploit emerging opportunities to develop a clinical evidence base. The previous clinical engagement exercise to determine UK Defence Rehabilitation practitioner-based research priorities was conducted in 2014. The aim of this article is to (1) describe how research priorities are established for UK Defence Rehabilitation; (2) review, reassess and rate the priorities highlighted and set by rehabilitation practitioners following the 2014 survey and (3) identify new rehabilitation research themes and topics reflecting 2020 priorities. METHODS Stage 1: delegates (n=72) at the October 2019 Defence Medical Services Rehabilitation Conference participated in a series of focus group workshops. Stage 2: an online survey circulated through the military chain of command to all Defence Primary Health Care clinical rehabilitation staff. Stage 3: a thematic analysis of all survey submissions yielding a ranked order of priority by topic. RESULTS 165 clinical rehabilitation staff completed an online survey. 'Rehabilitation outcomes', 'Psychological factors in rehabilitation' and 'Residential/Inpatient treatment paradigm' emerged as three clear research priorities across all three tiers of UK Defence Rehabilitation. New research priorities emerging from the 2020 survey were 'lifestyle factors during rehabilitation', 'management of pain during rehabilitation' and 'anterior knee pain'. CONCLUSION It is essential that funding directed to musculoskeletal rehabilitation focuses on the highest research priorities in the field to ensure optimum health return on investment. The results of this survey will assist in guiding the clinical research being conducted within UK Defence Rehabilitation over the next five years.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Department for Health, University of Bath, Bath, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Department for Health, University of Bath, Bath, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK .,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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11
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Houston AD, Coppack RJ, Bennett AN. Effectiveness of virtual reality-based gait education in enhancing the rehabilitation outcomes of injured military personnel. BMJ Mil Health 2020; 168:308-313. [PMID: 33087538 DOI: 10.1136/bmjmilitary-2020-001581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Correcting adverse biomechanics is key in rehabilitating musculoskeletal injuries. Verbal instruction remains the primary method for correcting biomechanics and therefore a patient's understanding of these instructions is believed to directly influence treatment outcomes. The aim of this study was to establish the patients' perceptions of virtual reality-based gait education (VR-GEd) and to assess its influence on the standard military rehabilitation outcomes. METHODS A retrospective analysis using routinely collected data was performed. Twenty patients with lower-limb musculoskeletal injuries undertook a VR-GEd session on the commencement of a 3-week, multidisciplinary, inpatient course of rehabilitation. Patient outcomes were compared with a group of matched controls, completing the same standardised course of inpatient treatment. RESULTS The VR-GEd group exhibited greater reductions the interference pain had on their mood (p=0.022). Improvements in generalised anxiety (p=0.029) were greater in the VR-GEd group but were not large enough to be clinically meaningful. VR-GEd did not influence functional outcomes. Patients rated the sessions highly in terms of enjoyment and perceived value. Patient feedback highlighted that they understood their injury better and felt the session could positively influence their recovery. CONCLUSION VR-GEd was proven to be an enjoyable and valued means of educating military inpatients about their injury mechanics. This study found no contraindications for the inclusion of VR-GEd in current rehabilitation programmes. However, current evidence suggests a single VR-GEd session cannot act as a replacement for biofeedback interventions, due to the lack of enhanced improvement across rehabilitation outcomes.
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Affiliation(s)
- Andrew David Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, Somerset, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Coppack RJ, Bilzon JL, Wills AK, Papadopoulou T, Cassidy RP, Nicol AM, Bennett AN. The test-retest reliability of the Military Physical Loading Questionnaire (MPLQ). BMJ Mil Health 2020; 168:273-278. [PMID: 32234729 DOI: 10.1136/bmjmilitary-2020-001404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/25/2020] [Accepted: 03/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite the high prevalence of musculoskeletal injuries, there is a shortage of data quantifying the risk factors attributable to cumulative occupational demands among UK Military personnel. We developed a new comprehensive questionnaire that examines occupational and operational physical loading during military service. The aim of this study was to examine the test-retest reliability of the Military Physical Loading Questionnaire (MPLQ). METHODS Intraclass correlation coefficients (ICC) were used to evaluate the test-retest reliability (4-week interval) of the MPLQ on 18 occupational and 18 operational items in 50 male (mean age: 36 years; SD ±7.9) UK military personnel. A stratified analysis based on duration of Service (0-10 years, 11-20 years and ≥21 years) was conducted to assess whether stability of task items was dependent on participant length of recall. Internal consistency was assessed by Cronbach's alpha (α) coefficients. RESULTS Reliability of individual operational items ranged from fair to almost perfect agreement (ICC range: 0.37-0.89; α range: 0.53-0.94) with most items demonstrating moderate to substantial reliability. Overall scores related to occupational items showed substantial to almost perfect agreement between administrations (ICC range: 0.73-0.94; α range: 0.84-0.96). Stratifying by duration of Service showed similar within group reliability to the entire sample and no pattern of decreasing or increasing reliability with length of recall period was observed. CONCLUSIONS It is essential that data used in planning UK military policy and health services are as accurate as possible. This study provides preliminary support for the MPLQ as a reliable self-report instrument for assessing the cumulative lifelong effects of occupational loading in UK military personnel. Further validation studies using larger and more demographically diverse military populations will support its interpretation in future epidemiological research.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK .,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, UK
| | - J L Bilzon
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, UK.,Department for Health, University of Bath, Bath, UK
| | - A K Wills
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A M Nicol
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Conway D, Ladlow P, Ferreira J, Mani-Babu S, Bennett AN. Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain. BMJ Mil Health 2019; 166:336-341. [DOI: 10.1136/jramc-2018-001136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/03/2022]
Abstract
IntroductionLow back pain (LBP) has been reported as the most common reason for presentation to the Medical Centre in the British Military, and the most common re-referral for the same condition. In 2015, the UK Defence Medical Rehabilitation Centre (DMRC) adopted a cognitive functional therapy (CFT) approach to spinal rehabilitation in line with National Institute for Health and Care Excellence and military best practice guidelines. The aim of this study is to evaluate the functional and psychosocial outcomes of all patients with chronic LBP treated with CFT-based multidisciplinary rehabilitation at DMRC, Headley Court.MethodsA prospective observational service evaluation of British Military patients (n=238) with LBP who attended 3 weeks of inpatient multidisciplinary CFT-based programme from 2015 to the end of 2017 at DMRC was analysed. Functional outcomes include: multistage locomotion test (MSLT) and sit and reach test. Psychosocial outcomes include: Tampa Scale of Kinesiophobia, Oswestry Disability Index, Brief Pain Inventory (BPI), General Anxiety Disorder-7 and Patient Health Questionnaire-9.ResultsThere were significant improvements in endurance (MSLT), range of motion, kinesiophobia, pain-related lifestyle interference (BPI-Lifestyle), anxiety and depression (p≤0.001). However, no improvements in pain intensity (BPI-Intensity) were demonstrated (p>0.05).ConclusionAfter 3 weeks of CFT-based multidisciplinary rehabilitation, function and psychosocial health improved with symptoms of pain being less obtrusive to activities of daily activity. There were however no patient-reported reductions in pain intensity. The improvements demonstrated are indicative of outcomes that facilitate greater integration back to work or into society.
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Ladlow P, Bennett N, Phillip R, Dharm-Datta S, McMenemy L, Bennett AN. Passive-dynamic ankle-foot orthosis improves medium-term clinical outcomes after severe lower extremity trauma. J ROY ARMY MED CORPS 2018; 165:330-337. [PMID: 30415216 PMCID: PMC6839716 DOI: 10.1136/jramc-2018-001082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
Abstract
Introduction Individuals with delayed below-knee amputation have previously reported superior clinical outcomes compared with lower limb reconstruction. The UK military have since introduced a passive-dynamic ankle-foot orthosis (PDAFO) into its rehabilitation care pathway to improve limb salvage outcomes. The aims were to determine if wearing a PDAFO improves medium-term clinical outcomes and what influence does multidisciplinary team (MDT) rehabilitation have after PDAFO fitting? Also, what longitudinal changes in clinical outcomes occur with MDT rehabilitation and how do these results compare with patients with previous lower extremity trauma discharged prior to PDAFO availability? Methods We retrospectively evaluated levels of mobility, activities of daily living, anxiety, depression and pain in a heterogeneous group of 23 injured UK servicemen 34±11 months after PDAFO provision. We also retrospectively analysed 16 patients across four time points (pre-PDAFO provision, first, second and final inpatient admissions post-PDAFO provision) using identical outcome measures, plus the 6 min walk test. Results Outcomes were compared with previous below-knee limb salvage and amputees. Before PDAFO, 74% were able to walk and 4% were able to run independently. At follow-up, this increased to 91% and 57%, respectively. Mean depression and anxiety scores remained stable over time (p>0.05). After 3 weeks, all patients could walk independently (pre-PDAFO=31%). Mean 6 min walk distance significantly increased from 440±75 m (pre-PDAFO) to 533±68 m at last admission (p=0.003). The ability to run increased from 6% to 44% after one admission. Conclusions All functional and most psychosocial outcomes in PDAFO users were superior to previous limb salvage and comparable to previous below-knee amputees. The PDAFO facilitated favourable short-term and medium-term changes in all clinical outcome measurements.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK.,Blatchford, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - R Phillip
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - S Dharm-Datta
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - L McMenemy
- Centre for Blast Injury Studies (CBIS), Imperial College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Weinert-Aplin RA, Twiste M, Jarvis HL, Bennett AN, Baker RJ. Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking. Gait Posture 2017; 51:41-46. [PMID: 27697719 DOI: 10.1016/j.gaitpost.2016.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 02/02/2023]
Abstract
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual's net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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Affiliation(s)
| | - M Twiste
- School of Health Sciences, University of Salford, Salford, UK; United National Institute for Prosthetics & Orthotics Development, UK
| | - H L Jarvis
- School of Health Sciences, University of Salford, Salford, UK; Defence Medical Rehabilitation Centre Headley Court, Surrey, UK
| | - A N Bennett
- Defence Medical Rehabilitation Centre Headley Court, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, UK
| | - R J Baker
- School of Health Sciences, University of Salford, Salford, UK
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Bennett AN, Nixon J, Roberts A, Barker-Davies R, Villar R, Houghton JM. Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population. BMJ Open Sport Exerc Med 2016; 2:e000144. [PMID: 27900190 PMCID: PMC5117082 DOI: 10.1136/bmjsem-2016-000144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 01/22/2023] Open
Abstract
Background Femoroacetabular impingement (FAI) is common with an estimated prevalence of 10–15% among young active individuals. The natural history of the disorder is progression to early osteoarthritis. Hip arthroscopy is recommended if conservative treatments fail; however, outcomes are unclear, particularly in highly active populations. Aim To evaluate the functional and vocational outcome of hip arthroscopy, as part of an evidence-based rehabilitation hip pain pathway, for the treatment of FAI in an active military population. Methods All patients in the defence rehabilitation hip pain pathway, with a confirmed diagnosis of FAI who failed conservative treatment, were assessed prior to surgery and at 2, 6 and 12 months postsurgery. Outcome measures included the Visual Analogue Scale (VAS) for hip pain, Non-Arthritic Hip Score (NAHS) for function, and vocational assessments including functional activity assessment (FAA) and Joint Medical Employment Standard for military employability and deployability. Results 101 patients completed the study (mean age=33 years) (male:female:75:26) (Royal Navy/British Army/Royal Air Force: 13%/48%/39%). Outcomes demonstrated significant improvements with large effect size. Preoperative NAHS mean=62.9 (SD 16.4), 12-month postoperative NAHS mean=78.8 (18.3), mean improvement in NAHS=15.9 (95% CI 12.3 to 19.5, p<0.001). Preoperative VAS pain mean=51.3 (20.9), 12-month postoperative VAS pain=25.6 (24.5). Mean improvement 25.7 (95% CI 19.4 to 31.99, p<0.001). 73% of patients had a deployable medical category at 12 months postoperative. Conclusions These data confirm that hip arthroscopy as part of a structured evidence-based multidisciplinary care pathway produces significant and continued symptomatic, functional and vocational improvements over a 12-month period in a military population exposed to high intensity, weight-bearing exercise in uncontrolled and unforgiving environments.
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Affiliation(s)
- A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - J Nixon
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - A Roberts
- Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - R Barker-Davies
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - R Villar
- Department of Trauma and Orthopaedics , Wellington Hospital , London , UK
| | - J M Houghton
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
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Lucas PA, Page PRJ, Phillip RD, Bennett AN. The impact of genital trauma on wounded servicemen: qualitative study. Injury 2014; 45:825-9. [PMID: 24560873 DOI: 10.1016/j.injury.2013.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/27/2013] [Accepted: 12/13/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent military operations in Afghanistan have resulted in considerable lower limb trauma. Associated with this trauma have been serious injuries to the genitalia. No previous study has looked at the effect of traumatic genital injury on the individual. This study expresses the impact of these injuries. METHODS A qualitative evaluation, interviewing 13 male patients with extensive genital injuries, including 11 patients with orchidectomies. RESULTS Patients attach a very high importance to their genital injury, rating this injury as having more impact than lower limb amputations. They also have a high expectation for the recovery of sexual function. Psychological outcomes are better when an individual's future fertility is known at an early stage. CONCLUSION Better outcomes are achieved for the patient when psychological and surgical support if provided throughout the long treatment and recovery process It is important that every effort is made to preserve fertility right from the point of injury.
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Affiliation(s)
- P A Lucas
- Defence Medical Rehabilitation Centre, Headley Court, Surrey KT18 6JW, UK.
| | - P R J Page
- Defence Medical Rehabilitation Centre, Headley Court, Surrey KT18 6JW, UK
| | - R D Phillip
- Defence Medical Rehabilitation Centre, Headley Court, Surrey KT18 6JW, UK
| | - A N Bennett
- Defence Medical Rehabilitation Centre, Headley Court, Surrey KT18 6JW, UK; Leeds Institute of Molecular Medicine, University of Leeds, UK
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Rees JD, Bennett AN, Harris D, Jones T. Superior outcomes for military ankylosing spondylitis patients treated with anti-TNF. J ROY ARMY MED CORPS 2014; 160:310-3. [DOI: 10.1136/jramc-2013-000156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bennett AN, Gnjidic D, Hilmer SN. Medication Exposure May Confound the Association Between Dietary Intake and Frailty. J Gerontol A Biol Sci Med Sci 2013; 68:1440. [DOI: 10.1093/gerona/glt083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Isdale A, Keat A, Barkham N, Bennett AN, Gaffney K, Marzo-Ortega H, Sengupta R. Expanding the spectrum of inflammatory spinal disease: AS it was, as it is now. Rheumatology (Oxford) 2013; 52:2103-5. [DOI: 10.1093/rheumatology/ket244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bennett AN, Marzo-Ortega H, Tan AL, Hensor EMA, Green M, Emery P, McGonagle D. Ten-year follow-up of SpA-related oligoarthritis involving the knee: the presence of psoriasis but not HLA-B27 or baseline MRI bone oedema predicts outcome. Rheumatology (Oxford) 2012; 51:1099-106. [DOI: 10.1093/rheumatology/ker420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aydin SZ, Maksymowych WP, Bennett AN, McGonagle D, Emery P, Marzo-Ortega H. Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. Ann Rheum Dis 2011; 71:56-60. [DOI: 10.1136/ard.2011.153064] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe new Assessment of SpondyloArthritis international Society (ASAS) criteria classify axial spondyloarthritis (SpA) into human leucocyte antigen-B27 and/or imaging-based arms. To aid implementation, ASAS has proposed a definition of a positive MRI for active sacroiliitis.ObjectiveThe authors aimed to test the diagnostic and predictive value of the ASAS criteria and definition of a ‘positive’ MRI.MethodsBaseline MRI scans on 29 patients with early inflammatory back pain and 18 controls were read independently by four experienced rheumatologists. Both arms of the criteria were tested against a ‘gold standard’ of physician diagnosis of SpA. MRI abnormalities were assessed according to a global assessment of MRI and the ASAS definition. Sensitivity, specificity and likelihood ratios for individual and concordant reader data were calculated for axial SpA diagnosis at baseline and the development of radiographic sacroiliitis, fulfilling the modified New York criteria at 8 years.ResultsAll patients were classified as having axial SpA, with more patients fulfilling the imaging arm (83%, n=24/29) than the human leucocyte antigen B27 arm (62%, n=18/29). Concordant reader data showed that the baseline MRI had high diagnostic utility for SpA according to global assessment (sensitivity/specificity: 66%/94%, LR+ (positive likelihood ratio) 11.8, LR− (negative likelihood ratio) 0.4) and ASAS definition (sensitivity/specificity: 79%/89%, LR+ 7.1, LR− 0.2). Likewise, a positive baseline MRI had 100% sensitivity for subsequent radiographic sacroiliitis by either assessment, although specificity was lower (56% for global assessment and 33% for ASAS definition).ConclusionBoth arms of the ASAS criteria have good diagnostic utility in early SpA, although they are of limited value for the prediction of radiographic progression. This may be due to the definition of a positive MRI for sacroiliitis that lacks specificity at baseline.
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Haugeberg G, Bennett AN, McGonagle D, Emery P, Marzo-Ortega H. Bone loss in very early inflammatory back pain in undifferentiated spondyloarthropathy: a 1-year observational study. Ann Rheum Dis 2010; 69:1364-6. [PMID: 20448291 DOI: 10.1136/ard.2009.124982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Bone loss in patients with inflammatory back pain (IBP) suspicious of early undifferentiated spondyloarthropathy is poorly defined. The aim of this study was to examine changes in bone mineral density (BMD) at the hip, lumbar spine and hand in patients with early IBP and to look for possible biomarkers associated with this change. METHODS In 30 patients with early IBP, clinical data were collected and BMD assessed using dual energy x-ray absorptiometry at baseline, 6 and 12 months. Further imaging performed included MRI of the sacroiliac joints (SIJs) and spine at baseline and x-rays of the SIJs at baseline and after 8 years. RESULTS After 12 months no significant reduction in hip, spine and hand BMD was seen at the group level. However, hip bone loss was found to be associated with raised baseline C-reactive protein levels, baseline MRI bone marrow oedema of the SIJs and the presence of radiographic sacroiliitis after 8 years. No association was found with change in spine and hand BMD. CONCLUSION Systemic bone loss in the hip is an early feature of the inflammatory disease process in patients with IBP in undifferentiated spondyloarthropathy and is related to disease activity. These data highlight the importance of aggressive intervention in the early stages of disease in undifferentiated spondyloarthropathy.
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Affiliation(s)
- G Haugeberg
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
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Bennett AN, Marzo-Ortega H, Rehman A, Emery P, McGonagle D. The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy. Rheumatology (Oxford) 2010; 49:426-32. [DOI: 10.1093/rheumatology/kep427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Bennett AN, Rehman A, Hensor EMA, Marzo-Ortega H, Emery P, McGonagle D. The fatty Romanus lesion: a non-inflammatory spinal MRI lesion specific for axial spondyloarthropathy. Ann Rheum Dis 2009; 69:891-4. [DOI: 10.1136/ard.2009.112094] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bennett AN, Marzo-Ortega H, Emery P, McGonagle D. Diagnosing axial spondyloarthropathy. The new Assessment in SpondyloArthritis international Society criteria: MRI entering centre stage. Ann Rheum Dis 2009; 68:765-7. [DOI: 10.1136/ard.2009.111435] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bennett AN, Rehman A, Hensor EMA, Marzo-Ortega H, Emery P, McGonagle D. Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis. ACTA ACUST UNITED AC 2009; 60:1331-41. [DOI: 10.1002/art.24493] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bennett AN, McGonagle D, O'Connor P, Hensor EMA, Sivera F, Coates LC, Emery P, Marzo-Ortega H. Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. ACTA ACUST UNITED AC 2009; 58:3413-8. [PMID: 18975311 DOI: 10.1002/art.24024] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is increasingly used to detect sacroiliitis earlier. This study was undertaken to investigate what proportion of patients with MRI-evident sacroiliitis develop ankylosing spondylitis (AS) in the long term and whether there are predictors of outcome. METHODS Consecutive undiagnosed patients with early inflammatory back pain (IBP) (of <2 years' duration) were assessed clinically and radiologically. Baseline imaging assessments included fat-suppressed MRI sequences of the sacroiliac joints and lumbar spine that were scored for active bone marrow edema representative of acute inflammation, and anteroposterior radiographs of the pelvis and lateral radiographs of the lumbar spine, which were scored using the Stoke Ankylosing Spondylitis Spine Score. Patients were reassessed clinically and radiographically after 8 years. The primary outcome was the modified New York criteria for AS at followup. RESULTS Fifty patients were assessed at the beginning of the study, and 40 patients were followed up after a mean of 7.7 years. Of these 40 patients, 58% were HLA-B27 positive, and 98% met the European Spondylarthropathy Study Group criteria. At baseline, 33 (83%) of the 40 patients followed up had MRI-evident sacroiliitis, and 6 (12%) had unequivocal AS according to the modified New York criteria. At followup, despite significant improvements in clinical outcomes, 13 of 39 patients (33.3%) had AS according to the modified New York criteria. The combination of severe sacroiliitis seen on MRI with HLA-B27 positivity was an excellent predictor of future AS (likelihood ratio [LR] 8.0, specificity 92%), while mild or no sacroiliitis, regardless of HLA-B27 status, was a predictor of not having AS (LR 0.4, specificity 38%). CONCLUSION Our findings indicate that in patients with early IBP, a combination of severe sacroiliitis and HLA-B27 positivity has a high specificity for development of AS, compared with mild or no sacroiliitis, regardless of HLA-B27 status, which confers a low likelihood of developing AS. This has implications for the diagnosis of "early" AS and possibly for selection of more aggressive therapies.
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Affiliation(s)
- A N Bennett
- Leeds Institute of Molecular Medicine, and Chapel Allerton Hospital, Leeds, UK
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Marzo-Ortega H, McGonagle D, O'Connor P, Hensor EMA, Bennett AN, Green MJ, Emery P. Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Ann Rheum Dis 2008; 68:1721-7. [DOI: 10.1136/ard.2008.097931] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Coates LC, Cawkwell LS, Ng NWF, Bennett AN, Bryer DJ, Fraser AD, Emery P, Marzo-Ortega H. Real life experience confirms sustained response to long-term biologics and switching in ankylosing spondylitis. Rheumatology (Oxford) 2008; 47:897-900. [DOI: 10.1093/rheumatology/ken094] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bennett AN, Tan AL, Coates LC, Emery P, Marzo-Ortega H, McGonagle D. Sustained response to anakinra in ankylosing spondylitis. Rheumatology (Oxford) 2007; 47:223-4. [PMID: 18073250 DOI: 10.1093/rheumatology/kem302] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Coates LC, McGonagle DG, Bennett AN, Emery P, Marzo-Ortega H. Uveitis and tumour necrosis factor blockade in ankylosing spondylitis. Ann Rheum Dis 2007; 67:729-30. [DOI: 10.1136/ard.2007.077370] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Coates LC, Cawkwell LS, Ng NWF, Bennett AN, Bryer DJ, Fraser AD, Emery P, Marzo-Ortega H. Sustained response to long-term biologics and switching in psoriatic arthritis: results from real life experience. Ann Rheum Dis 2007; 67:717-9. [DOI: 10.1136/ard.2007.082925] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sangle SR, Jan W, Lau IS, Bennett AN, Hughes GRV, D'Cruz DP. Coeliac artery stenosis and antiphospholipid (Hughes) syndrome/antiphospholipid anti-bodies. Clin Exp Rheumatol 2006; 24:349. [PMID: 16870110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Paul SN, Sangle SR, Bennett AN, El-Hachmi M, Hangartner R, Hughes GR, D'Cruz DP. Vasculitis, antiphospholipid antibodies, and renal artery stenosis. Ann Rheum Dis 2006; 64:1800-2. [PMID: 16284352 PMCID: PMC1755325 DOI: 10.1136/ard.2005.040279] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bennett AN, Sangle SR, Jan W, Jenner M, Cavenagh J, Hughes G, D'Cruz DP. Hepatomegaly as a rare presentation of Churg–Strauss syndrome. Rheumatology (Oxford) 2005; 44:1458-9. [PMID: 16105912 DOI: 10.1093/rheumatology/kei021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Bennett AN, Peterson P, Zain A, Grumley J, Panayi G, Kirkham B. Adalimumab in clinical practice. Outcome in 70 rheumatoid arthritis patients, including comparison of patients with and without previous anti-TNF exposure. Rheumatology (Oxford) 2005; 44:1026-31. [PMID: 15870150 DOI: 10.1093/rheumatology/keh673] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of the fully human recombinant monoclonal anti-TNF antibody adalimumab in routine clinical practice, including comparison of patients with and without previous anti-TNF exposure. METHODS We prospectively studied the outcome of 70 rheumatoid arthritis patients treated with adalimumab in normal clinical practice. The primary outcome measures were Disease Activity Score 28 (DAS28), EULAR (European League Against Rheumatism) response and Health Assessment Questionaire (HAQ). RESULTS Seventy-seven per cent achieved a EULAR response (26% good, 51% moderate) and 19% were in remission. The mean decrease in DAS28 was 2.1 (6.3-4.2; P<0.001). The mean decrease in HAQ score was 0.34 (2.07-1.73; P<0.001), 66% achieving a clinically significant decrease of greater than 0.22. Twenty-three per cent stopped treatment because of side-effects (7%) or failure to respond (16%). Of the 26 patients who had previously tried 29 biologicals, 65% responded to adalimumab. There was no significant difference in the change in mean DAS (P = 0.69) or HAQ (P = 0.88) between groups with and without previous anti-TNF exposure. Of the 13 patients with previous secondary failure to infliximab, 77% responded to adalimumab. Patients with previous secondary failure had significantly better improvement in DAS (P = 0.023) than patients with previous primary failure. CONCLUSION Our clinical experience confirms that adalimumab is effective and safe in the treatment of RA. It also shows adalimumab is effective in patients with previous biological failures, particularly patients with secondary failure to infliximab.
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Affiliation(s)
- A N Bennett
- Department of Rheumatology, Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK
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Bennett AN, Peterson P, Sangle S, Hangartner R, Abbs IC, Hughes GRV, D'Cruz DP. Adult onset Still's disease and collapsing glomerulopathy: successful treatment with intravenous immunoglobulins and mycophenolate mofetil. Rheumatology (Oxford) 2004; 43:795-9. [PMID: 15039497 DOI: 10.1093/rheumatology/keh172] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this Grand Round we present a 32-yr-old African man who became severely ill after a 5-month history of weight loss, pyrexia, arthralgia, sweats and rash. He went on to develop pericarditis, pericardial effusion with tamponade, hepatomegaly with abnormal liver function tests, lymphadenopathy, massive proteinuria and required ventilatory, circulatory and renal support. The differential diagnosis was adult onset Still's disease, systemic lupus erythematosus (SLE), infection and lymphoma. Primary infection and lymphoma were excluded and he was treated, with dramatic success, with intravenous immunoglobulins (i.v.IG). Subsequent renal biopsy excluded SLE but confirmed collapsing glomerulopathy. The proteinuria improved dramatically following treatment with mycophenolate mofetil. We discuss some of the difficult diagnostic and management issues raised by this patient and the different uses and mechanisms of action of i.v.IG.
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Affiliation(s)
- A N Bennett
- The Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK
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Bennett AN, Sangle SR, Hughes GRV, D'Cruz DP. Dermatomyositis developing in a Duchenne muscular dystrophy carrier. Rheumatology (Oxford) 2004; 43:668-9. [PMID: 15103031 DOI: 10.1093/rheumatology/keh113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bennett AN. Impacted and inverted upper central incisor. Dent Surv 1969; 45:33. [PMID: 5258363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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