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Hurley ET, Danilkowicz RM, Paul AV, Myers H, Anakwenze OA, Klifto CS, Lau BC, Taylor DC, Dickens JF. Author Reply to "Can We Conclude That the Arthroscopic Bankart Repair and Open Latarjet Procedure Show Similar Rates of Return to Play and How Should This Conclusion Be Interpreted?". Arthroscopy 2024; 40:657-658. [PMID: 38206248 DOI: 10.1016/j.arthro.2023.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Eoghan T Hurley
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | | | - Alexandra V Paul
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Heather Myers
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Oke A Anakwenze
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Jonathan F Dickens
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
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Hurley ET, Danilkowicz RM, Paul AV, Myers H, Anakwenze OA, Klifto CS, Lau BC, Taylor DC, Dickens JF. Majority of Studies Show Similar Rates of Return to Play After Arthroscopic Bankart Repair or Latarjet Procedure: A Systematic Review. Arthroscopy 2024; 40:515-522. [PMID: 37146663 DOI: 10.1016/j.arthro.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To systematically review the current evidence in the literature to compare return to play following arthroscopic Bankart repair versus open Latarjet procedure for the treatment of anterior shoulder instability. METHODS A literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative studies reporting return to play following arthroscopic Bankart repair versus open Latarjet procedure were included. Return to play was compared, with all statistical analysis performed using Review Manager, Version 5.3. RESULTS Nine studies with 1,242 patients (mean age: 15-30 years) were included. The rate of return to play was 61% to 94.1% among those undergoing arthroscopic Bankart repair and 72% to 96.8% in those undergoing an open Latarjet procedure. Two studies (Bessiere et al. and Zimmerman et al.) found a significant difference in favor of the Latarjet procedure (P < .05 for both, I2 = 37%). The rate of return to play at preinjury level was 9% to 83.8% among those undergoing arthroscopic Bankart repair and 19.4% to 80.6% in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I2 = 0%). The mean time of return to play was 5.4 to 7.3 months among those undergoing arthroscopic Bankart repair and 5.5 to 6.2 months in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I2 = 39%). CONCLUSIONS Overall, the majority of studies showed no significant difference in rates of return to play or timing following arthroscopic Bankart repair or open Latarjet procedure. Furthermore, no study has found a significant difference in rate of return to play at pre-injury level, or rate of return to play among collision athletes. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A..
| | | | - Alexandra V Paul
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Heather Myers
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Kennedy J, Otley T, Hendren S, Myers H, Tate A. Sink or Swim? Clinical Objective Tests and Measures Associated with Shoulder Pain in Swimmers of Varied Age Levels of Competition: A Systematic Review. Int J Sports Phys Ther 2024; 19:1381-1397. [PMID: 38179580 PMCID: PMC10761606 DOI: 10.26603/001c.90282] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level. PURPOSE The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests. DESIGN Systematic review. METHODS PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified. RESULTS Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies. CONCLUSION Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures. Key level of evidence 3, Systematic review of mostly Level 3 studies.
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Affiliation(s)
- June Kennedy
- Rehabilitation Services Duke University Health System
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Myers H, Keefe FJ, George SZ, Kennedy J, Lake AD, Martinez C, Cook CE. Effect of a Patient Engagement, Education, and Restructuring of Cognitions (PEERC) approach on conservative care in rotator cuff related shoulder pain treatment: a randomized control trial. BMC Musculoskelet Disord 2023; 24:930. [PMID: 38041042 PMCID: PMC10691016 DOI: 10.1186/s12891-023-07044-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Despite similar outcomes for surgery and physical therapy (PT), the number of surgeries to treat rotator cuff related shoulder pain (RCRSP) is increasing. Interventions designed to enhance treatment expectations for PT have been shown to improve patient expectations, but no studies have explored whether such interventions influence patient reports of having had surgery, or being scheduled for surgery. The purpose of this randomized clinical trial was to examine the effect of a cognitive behavioral intervention aimed at changing expectations for PT on patient-report of having had or being scheduled for surgery and on the outcomes of PT. METHODS The Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention, was designed to change expectations regarding PT. PEERC was evaluated in a randomized, pragmatic "add-on" trial in by randomizing patients with RCRSP to receive either PT intervention alone (PT) or PT + PEERC. Fifty-four (54) individuals, recruited from an outpatient hospital-based orthopedic clinic, were enrolled in the trial (25 randomized to PT, 29 randomized to PT + PEERC). Outcomes assessed at enrollment, 6 weeks, discharge, and six months after discharge included the patient report of having had surgery, or being scheduled for surgery (primary) and satisfaction with PT outcome, pain, and function (secondary outcomes). RESULTS The average age of the 54 participants was 51.81; SD = 12.54, and 63% were female. Chronicity of shoulder pain averaged 174.61 days; SD = 179.58. Study results showed that at the time of six months follow up, three (12%) of the participants in the PT alone group and one (3.4%) in the PT + PEERC group reported have had surgery or being scheduled for surgery (p = .32). There were no significant differences between groups on measures of satisfaction with the outcome of PT (p = .08), pain (p = .58) or function (p = .82). CONCLUSIONS In patients with RCRSP, PT plus the cognitive behavioral intervention aimed at changing expectations for PT provided no additional benefit compared to PT alone with regard to patient report of having had surgery, or being scheduled to have surgery, patient reported treatment satisfaction with the outcome of PT, or improvements in pain, or function. TRIAL REGISTRATION The trial is registered on ClinicalTrials.gov: NCT03353272 (27/11/2017).
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Affiliation(s)
- Heather Myers
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences; Psychology and Neuroscience, Medicine, and Anesthesiology, Duke University School of Medicine, 2200 W Main St, Suite 340, Durham, NC, 27705, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27701, USA
| | - June Kennedy
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Ashley Davis Lake
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Corina Martinez
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Chad E Cook
- Department of Orthopaedics, Duke University School of Medicine, 311 Trent Drive, Durham, NC, 27705, USA
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Abdoo O, Martinez C, Forshey T, Myers H, Hendren S, Pietrosimone LS. Do Climate and Environmental Characteristics Influence Concussion Incidence in Outdoor Contact Sports? A Systematic Review. J Athl Train 2023; 58:987-997. [PMID: 37115014 PMCID: PMC10784884 DOI: 10.4085/1062-6050-0655.22] [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] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To obtain a comprehensive understanding of the implications of environmental and climate factors on sport-related concussion incidence in outdoor contact sports. DATA SOURCES MEDLINE (via Ovid), Embase (via Elsevier), CINAHL Complete (via EBSCOhost), SPORTDiscus (via EBSCOhost), and Scopus (via Elsevier). STUDY SELECTION Studies that report incidence of sport-related concussion, assess data from athletes participating in outdoor contact sports, report on 1 or more climate or environmental factors, and report a diagnosis of concussion performed by a licensed medical professional were included. Reasons for exclusion included no report on extrinsic or environmental factors, no data on sport-related concussion incidence, and self-report of concussion diagnosis. DATA EXTRACTION This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 2 reviewers at each phase and a third reviewer for conflict resolution. DATA SYNTHESIS A total of 7558 articles were reviewed, and 20 met the inclusion criteria. There was moderate to strong strength of evidence concluding no difference between surface type (grass versus artificial) on sport-related concussion risk. Moderate to strong strength of evidence was found supporting no difference in sport-related concussion incidence based on game location (home versus away). There was no consensus on the effects of altitude or temperature on sport-related concussion incidence. One high-quality study found a decreased risk of sport-related concussion when playing in wet versus dry conditions. Heterogenous populations and data collection methods prevented extraction and meta-analysis. CONCLUSIONS Although a consensus on specific environmental and climate factors that influence sport-related concussion incidence was limited, the majority of studies were of high quality and gave insight into opportunities for future investigation. Administrators of large injury surveillance databases should consider including specific environmental and climate factors to provide investigators with robust data sets to better understand potential associations with sport-related concussion.
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Saunders B, Burton C, van der Windt DA, Myers H, Chester R, Pincus T, Wynne-Jones G. Patients' and clinicians' perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme. BMC Musculoskelet Disord 2023; 24:1. [PMID: 36588148 PMCID: PMC9805906 DOI: 10.1186/s12891-022-06059-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/13/2022] [Accepted: 12/06/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Clinical management of musculoskeletal shoulder pain can be challenging due to diagnostic uncertainty, variable prognosis and limited evidence for long-term treatment benefits. The UK-based PANDA-S programme (Prognostic And Diagnostic Assessment of the Shoulder) is investigating short and long-term shoulder pain outcomes. This paper reports linked qualitative research exploring patients' and clinicians' views towards primary care consultations for shoulder pain. METHODS Semi-structured interviews were conducted with 24 patients and 15 primary care clinicians. Twenty-two interviews (11 patients, 11 clinicians) were conducted as matched patient-clinician 'dyads'. Data were analysed thematically. RESULTS Clinicians reported attempts to involve patients in management decisions; however, there was variation in whether patients preferred treatment choice, or for decisions to be clinician-led. Some patients felt uncertain about the decisions made, due to a lack of discussion about available management options. Many General Practitioners expressed a lack of confidence in diagnosing the underlying cause of shoulder pain. Patients reported either not being given a diagnosis, or receiving different diagnoses from different professionals, resulting in confusion. Whilst clinicians reported routinely discussing prognosis of shoulder pain, patients reported that prognosis was not raised. Patients also expressed concern that their shoulder pain could be caused by serious pathology; however, clinicians felt that this was not a common concern for patients. CONCLUSIONS Findings showed disparities between patients' and clinicians' views towards shoulder pain consultations, indicating a need for improved patient-clinician communication. Findings will inform the design of an intervention to support treatment and referral decisions for shoulder pain that will be tested in a randomised controlled trial.
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Affiliation(s)
- B. Saunders
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
| | - C. Burton
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
| | - D. A. van der Windt
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
| | - H. Myers
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK ,grid.9757.c0000 0004 0415 6205Clinical Trials Unit, Keele University, Keele, UK
| | - R. Chester
- grid.8273.e0000 0001 1092 7967School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norwich, UK
| | - T. Pincus
- grid.5491.90000 0004 1936 9297Faculty of Environmental and Life Sciences (FELS), University of Southampton, Southampton, UK
| | - G. Wynne-Jones
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
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Otley T, Myers H, Lau BC, Taylor DC. Return to Sport After Shoulder Stabilization Procedures: A Criteria-Based Testing Continuum to Guide Rehabilitation and Inform Return-to-Play Decision Making. Arthrosc Sports Med Rehabil 2022; 4:e237-e246. [PMID: 35141557 PMCID: PMC8811525 DOI: 10.1016/j.asmr.2021.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
The athlete with shoulder instability poses a unique challenge to the sports medicine team. Clinical studies support surgical intervention followed by a phased approach to rehabilitation. In the latter phases, it is important to tailor this program to the individual’s specific athletic needs, which requires ongoing qualitative assessment and objective measurement. Passing a return-to-sport testing battery has been shown to decrease the risk of recurrent instability. What is lacking in the literature is a consensus for how to best measure shoulder performance when the required athletic demands are widely varied by hand dominance, sport played, and playing position. Multiple upper-extremity tests have been described in the literature, but there is no consensus on which tests should be used to direct rehabilitation and to safely return the athlete to unrestricted athletic exposure. Using available evidence, we suggest a framework for return-to-play testing that integrates traditional rehabilitation phases with performance testing and graduated sports exposure. Level of Evidence Level V, expert opinion.
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Affiliation(s)
- Thomas Otley
- Duke Sports Sciences Institute, Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, U.S.A
| | - Heather Myers
- Duke Sports Sciences Institute, Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Duke Sports Sciences Institute, Department of Orthopedic Surgery, Duke University Health System, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Duke Sports Sciences Institute, Department of Orthopedic Surgery, Duke University Health System, Durham, North Carolina, U.S.A
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Harris E, Myers H, Saxena K, Mitchell-Heggs R, Kind P, Chattarji S, Morris R. Experiential modulation of social dominance in a SYNGAP1 rat model of Autism Spectrum Disorders. Eur J Neurosci 2021; 54:7733-7748. [PMID: 34672048 PMCID: PMC7614819 DOI: 10.1111/ejn.15500] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Advances in the understanding of developmental brain disorders such as autism spectrum disorders (ASDs) are being achieved through human neurogenetics such as, for example, identifying de novo mutations in SYNGAP1 as one relatively common cause of ASD. A recently developed rat line lacking the calcium/lipid binding (C2) and GTPase activation protein (GAP) domain may further help uncover the neurobiological basis of deficits in children with ASD. This study focused on social dominance in the tube test using Syngap+/Δ-GAP (rats heterozygous for the C2/GAP domain deletion) as alterations in social behaviour are a key facet of the human phenotype. Male animals of this line living together formed a stable intra-cage hierarchy, but they were submissive when living with wild-type (WT) cage-mates, thereby modelling the social withdrawal seen in ASD. The study includes a detailed analysis of specific behaviours expressed in social interactions by WT and mutant animals, including the observation that when the Syngap+/Δ-GAP mutants that had been living together had separate dominance encounters with WT animals from other cages, the two higher ranking Syngap+/Δ-GAP rats remained dominant whereas the two lower ranking mutants were still submissive. Although only observed in a small subset of animals, these findings support earlier observations with a rat model of Fragile X, indicating that their experience of winning or losing dominance encounters has a lasting influence on subsequent encounters with others. Our results highlight and model that even with single-gene mutations, dominance phenotypes reflect an interaction between genotypic and environmental factors.
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Affiliation(s)
- E. Harris
- Edinburgh Neuroscience, Centre for Discovery Brain Sciences, 1 George Square, The University of Edinburgh, Edinburgh, EH8 9JZ, U.K
| | - H. Myers
- Edinburgh Neuroscience, Centre for Discovery Brain Sciences, 1 George Square, The University of Edinburgh, Edinburgh, EH8 9JZ, U.K
| | - K. Saxena
- Edinburgh Neuroscience, Centre for Discovery Brain Sciences, 1 George Square, The University of Edinburgh, Edinburgh, EH8 9JZ, U.K
- Simons Initiative for the Developing Brain, The University of Edinburgh, Edinburgh, EH8 9XD, U.K
| | - R. Mitchell-Heggs
- Edinburgh Neuroscience, Centre for Discovery Brain Sciences, 1 George Square, The University of Edinburgh, Edinburgh, EH8 9JZ, U.K
| | - P. Kind
- Edinburgh Neuroscience, Centre for Discovery Brain Sciences, 1 George Square, The University of Edinburgh, Edinburgh, EH8 9JZ, U.K
- Simons Initiative for the Developing Brain, The University of Edinburgh, Edinburgh, EH8 9XD, U.K
| | - S Chattarji
- Simons Initiative for the Developing Brain, The University of Edinburgh, Edinburgh, EH8 9XD, U.K
- Centre for Brain Development and Repair, National Centre for Biological Sciences and Institute for Stem Cell Science & Regenerative Medicine, Bangalore 560065, India
| | - R.G.M. Morris
- Edinburgh Neuroscience, Centre for Discovery Brain Sciences, 1 George Square, The University of Edinburgh, Edinburgh, EH8 9JZ, U.K
- Simons Initiative for the Developing Brain, The University of Edinburgh, Edinburgh, EH8 9XD, U.K
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Myers H, Keefe F, George SZ, Kennedy J, Lake AD, Martinez C, Cook C. The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2021; 22:727. [PMID: 34429074 PMCID: PMC8386126 DOI: 10.1186/s12891-021-04588-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite similar outcomes for surgery and conservative care, the number of surgeries to treat rotator cuff related shoulder pain has increased. Interventions designed to enhance treatment expectations for conservative care have been shown to improve patient expectations, but no studies have yet explored whether such interventions influence patient decisions to pursue surgery. The purpose of this randomized clinical trial is to examine the effect of an intervention designed to improve expectations of conservative care on the decision to have surgery. METHODS We will test the effectiveness of the Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention which is intended to change expectations regarding conservative care. The PEERC intervention will be evaluated in a randomized, pragmatic "add-on" trial, to better understand the effect the intervention has on outcomes. Ninety-four (94) participants with rotator cuff related shoulder pain referred for physical therapy will be randomized to receive either impairment-based care or impairment-based care plus PEERC. Both groups will receive impairment-based conservative treatment created by compiling the evidence associated with established, effective interventions. Participants assigned to the impairment-based care plus PEERC condition will also receive the PEERC intervention. This intervention, informed by principles of cognitive behavioral therapy, involves three components: (1) strategies to enhance engagement, (2) education and (3) cognitive restructuring and behavioral activation. Outcomes will be assessed at multiple points between enrolment and six months after discharge. The primary outcome is patient reported decision to have surgery and the secondary outcomes are pain, function, expectations and satisfaction with conservative care. DISCUSSION Rotator cuff related shoulder pain is highly prevalent, and because conservative and surgical treatments have similar outcomes, an intervention that changes expectations about conservative care could alter patient reports of their decision to have surgery and ultimately could lead to lower healthcare costs and decreased risk of surgical complications. TRIAL REGISTRATION This study is registered as NCT03353272 at ClincialTrials.gov.
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Affiliation(s)
- Heather Myers
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Francis Keefe
- Professor in Psychiatry and Behavioral Sciences, Psychology and Neuroscience, Medicine, and Anesthesiology, 2200 W Main St, Suite 340, Durham, NC, 27705, USA
| | - Steven Z George
- Laszlo Ormandy Distinguished Professor, Department of Orthopaedic Surgery, Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA
| | - June Kennedy
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Ashley Davis Lake
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Corina Martinez
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Chad Cook
- Professor, Director of Clinical Research Facilitation, Duke Doctor of Physical Therapy Division, Duke Clinical Research Institute, 311 Trent Drive, Durham, NC, 27705, USA
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Lindsay T, Myers H, Tham S. 146 Ligamentization and Remnant Integration: Implications for Scapholunate Reconstruction. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Scapholunate interosseous ligament (SLIL) injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date, no reconstructive technique has been described that discusses the potential benefit of the preservation of the scapholunate ligament remnant. Little is known about the ‘ligamentization’ of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices.
Method
We conducted a systematic review of the literature using Pubmed, Embase and Medline. Keywords were ‘Ligament’ AND ‘Reconstruction’ AND ‘Remnant’. We identified 366 original studies for title and abstract review. A total of 5 studies were included in the final analysis.
Results
In 5 animal studies, remnant stump integration resulted in enhanced ligamentization of grafted tissue as measured by vascularity, biomechanics, and proprioception.
Conclusions
Our review demonstrates a trend towards enhanced early ligamentization in grafts that incorporate the remnant stump. Remnant preservation is not currently performed in SLIL reconstruction and may provide an avenue for enhanced therapies. As such, it is a promising area for further, wrist specific, research.
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Affiliation(s)
- T Lindsay
- St Catharine's College, University of Cambridge, Cambridge, United Kingdom
| | - H Myers
- Plastic Surgery Unit, Austin Hospital, Melbourne, Australia
| | - S Tham
- Hand Surgery Unit, Department of Plastic Surgery, St Vincent's Hospital, Melbourne, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St Vincent Institute, Melbourne, Australia
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Lentz TA, Magill J, Myers H, Pietrosimone LS, Reinke EK, Messer M, Riboh JC. Development of Concise Physical Performance Test Batteries in Young Athletes. Med Sci Sports Exerc 2020; 52:2581-2589. [PMID: 32555020 DOI: 10.1249/mss.0000000000002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed 1) to define the principal components of physical function assessed by 10 common lower extremity physical performance tests and 2) to derive a reduced-item set of physical performance tests that efficiently and accurately measures raw performance and limb symmetry on each underlying component in pediatric and adolescent athletes. METHODS This study included healthy, uninjured volunteers (n = 100) between the ages 6 and 18 yr (mean age = 11.7 ± 3.6 yr; 52 females). Subjects performed the stork balance, stork balance on BOSU® Balance Trainer, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, triple crossover SLH, and lower quarter Y-Balance Test™. Item reduction was performed using principal components analysis (PCA). We developed separate principal components analysis for average raw performance and side-to-side limb symmetry, with secondary analyses to evaluate consistency of results by age and sex. RESULTS We identified two components for average raw performance (accounting for 65.2% of the variance in total test battery) with a reduced-item set composed of five tests, and four components for limb symmetry (accounting for 62.9% of the variance in total test battery) with a reduced-item set of seven tests. The most parsimonious test suitable for screening both average raw performance and limb symmetry would consist of five tests (stork balance on BOSU, SLS on BOSU, forward SLH, timed SLH, and lower quarter Y-Balance Test™). Age- and sex-specific test batteries may be warranted. CONCLUSION Comprehensive screening for lower extremity average raw performance and limb symmetry is possible with short physical performance test batteries.
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Affiliation(s)
- Trevor A Lentz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC
| | - John Magill
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, NC
| | - Heather Myers
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, NC
| | - Laura S Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Emily K Reinke
- Duke Sports Science Institute, Duke University, Durham, NC
| | - Michael Messer
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, NC
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Martinez C, Christopherson Z, Lake A, Myers H, Bytomski JR, Butler RJ, Cook CE. Clinical examination factors that predict delayed recovery in individuals with concussion. Arch Physiother 2020; 10:10. [PMID: 32514379 PMCID: PMC7251896 DOI: 10.1186/s40945-020-00081-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A secondary aim explored the influence of early examination on individual prognosis. Methods The study was a retrospective, observational cohort design that included 163 individuals seen at a concussion clinic who were followed longitudinally until cleared for sports activity. Cognitive, visual, balance, vestibular, and cervical clinical testing and symptom assessment were performed at initial evaluation. DR was calculated by taking the median value associated with time to clearance for activity. Bivariate logistic regression analysis was calculated to determine odds ratios (and 95% confidence intervals) for the odds of DR with presence or absence of each clinical finding. Multivariate analyses were used to define the best predictors of DR. Results 80 of 163 individuals were considered delayed in their clearance to activity. Cognitive impairments (OR = 2.72; 95%CI = 1.40, 5.28), visual exam findings (OR = 2.98; 95%CI = 1.31, 6.80), and vestibular exam findings (OR = 4.28; 95%CI = 2.18, 8.43) all increased the odds of a DR. Multivariate modeling retained cognitive symptoms and clinical examination-vestibular testing as predictors of delayed recovery. Time to examination after injury was a mediator for DR. Conclusions The clinical examination provides value in identifying individuals who are likely to exhibit a delayed clearance. In particular, vestibular impairments identified clinically at initial evaluation and cognitive symptoms were associated with increased odds of a DR to return to activity. Our data support that early implementation of a standardized clinical examination can help to identify individuals who may be more at risk of prolonged recovery from concussion.
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Affiliation(s)
- Corina Martinez
- Department of Physical Therapy and Occupational Therapy, Duke University, DUMC 3965, Durham, NC 27705 USA
| | - Zachary Christopherson
- Department of Physical Therapy and Occupational Therapy, Duke University, DUMC 3965, Durham, NC 27705 USA
| | - Ashley Lake
- Department of Physical Therapy and Occupational Therapy, Duke University, DUMC 3965, Durham, NC 27705 USA
| | - Heather Myers
- Department of Physical Therapy and Occupational Therapy, Duke University, DUMC 3965, Durham, NC 27705 USA
| | | | - Robert J Butler
- St Louis Cardinals, St. Louis, MO USA.,Division of Physical Therapy, Department of Orthopedics, Duke University, 2200 W. Main Street, Durham, NC 27708 USA
| | - Chad E Cook
- Division of Physical Therapy, Department of Orthopedics, Duke University, 2200 W. Main Street, Durham, NC 27708 USA
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Roskin D, Keyser K, Alperi C, Myers H. Improving Shoulder Internal Rotation Motion of In-season Throwing Athletes: A Randomized Controlled Trial. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563385.19060.48] [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: 11/21/2022]
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Garcia AN, Thigpen CA, Lake AD, Martinez C, Myers H, Cook C. Do older adults with shoulder disorders who meet the minimal clinically important difference also present low disability at discharge? An observational study. Braz J Phys Ther 2019; 24:152-160. [PMID: 30885628 DOI: 10.1016/j.bjpt.2019.02.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The choice of outcome success thresholds may influence clinical management, pay-for-performance, and assessment of value-based care. OBJECTIVE To evaluate outcomes success thresholds in older adults using two different methods: 1) Minimal clinically important differences (MCIDs) of the Quick-DASH and 2) Dichotomization of the Quick-DASH based on low disability rating at discharge DESIGN: An observational design (retrospective database study). SETTING Dataset of 1109 patients with shoulder disorders. PARTICIPANTS 297 older adults patients who were diagnosed with rotator cuff related shoulder disorders and were managed through physical therapy treatment. MAIN OUTCOME MEASURES We categorized and calculated how many patients met 8.0 and 16.0 point changes on the Quick-DASH. To evaluate outcomes success thresholds using dichotomization, patients who discharge score of ≤20 on the Quick-DASH were considered positive responders with successful outcomes. RESULTS The percentage of positive responders who met the MCID thresholds for the Quick-DASH were 63.3% using MCID of 8.0 points, 39.7% using the MCID of 16.0 points, and 46.12% who met discharge score of ≤ 20 on the Quick-DASH. 39.0% met both MCID of 8.0 points and discharge score of ≤ 20 on the Quick-DASH. Only 28% met both MCID of 16.0 points and discharge score of = 20 on the Quick-DASH. CONCLUSION Three different success threshold derivations classified patients into three very different assessments of success. Quick-DASH scores of ≤ 20 represent low levels of self-report disability at discharge and can be a stable clinical option for a measure of success to capture whether a treatment results in meaningful improvement.
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Affiliation(s)
- Alessandra Narciso Garcia
- Post-Doctorate, Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, 2200 W. Main St. Durham, NC, USA 27708.
| | - Charles A Thigpen
- Sr. Director of Practice Innovation & Analytics, ATI Physical Therapy; Director, Program in Observational Clinical Research in Orthopedics, Center for Effectiveness in Orthopedic Research, Arnold School of Public Health, University of South Carolina, Greenville SC USA 29681
| | - Ashley Davis Lake
- Senior Physical Therapist, Department of Physical Therapy and Occupational Therapy, Duke University Health System, 3475 Erwin Road, Durham, NC 27710
| | - Corina Martinez
- Senior Physical Therapist, Department of Physical Therapy and Occupational Therapy, Duke University Health System, 3475 Erwin Road, Durham, NC 27710
| | - Heather Myers
- Senior Physical Therapist, Department of Physical Therapy and Occupational Therapy, Duke University Health System, 3475 Erwin Road, Durham, NC 27710
| | - Chad Cook
- Professor and program director, Doctor of Physical Therapy Division, Duke Clinical Research Institute, Duke University, 2200 W. Main St. Durham, NC, USA 27708
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Myers H, Christopherson Z, Butler RJ. RELATIONSHIP BETWEEN THE LOWER QUARTER Y-BALANCE TEST SCORES AND ISOKINETIC STRENGTH TESTING IN PATIENTS STATUS POST ACL RECONSTRUCTION. Int J Sports Phys Ther 2018; 13:152-159. [PMID: 30090673 PMCID: PMC6063058] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND ACL injuries are common among sports populations and achieving adequate lower extremity strength is important prior to return to play. Access to isokinetic testing equipment that measures lower extremity strength is limited. Screening tools that measure functional criteria are accessible to clinicians, however the tools' relationship to strength constructs have not been investigated in an ACL reconstructed (ACLR) population. PURPOSE The primary objective was to determine if relationships exist between isokinetic peak knee extension torque (PKET), peak knee flexion torque (PKFT), hamstring to quadriceps (HQ) ratios, and YBT-LQ performance following ACLR. The secondary objective was to observe differences in isokinetic strength ability between high and low performers on the YBT-LQ. STUDY DESIGN Retrospective Chart Review. METHODS Medical records of forty-five ACL-reconstructed subjects, between five-12 months post-surgery were queried for functional assessment data collected during the institution's standard outcome testing battery. Variables of interest included: demographic and anthropomorphic measures, YBT-LQ performance, and involved limb isokinetic PKET, PKFT, and HQ ratios. Performance on each measure, as well as asymmetry between sides, was analyzed using a correlation matrix. RESULTS Statistically significant (p<0.01) relationships were identified between YBT-LQ anterior reach asymmetry and the PKET deficit (r=0.264). PKET and PKFT on the involved limb correlated to performance of anterior reach (r=0.591, p<0.01)(r=0.493, p<0.01), posteromedial reach (r=0.498, p<0.01)(r=0.577, p<0.01), and posterolateral reach (r=0.294, p<0.05)(r=0.445, p<0.01) respectively. Similar relationships existed on the uninvolved side, but to a lesser extent. High and low performers on the YBT-LQ demonstrated lower and higher extension torque deficits, respectively. CONCLUSION While each test measures unique constructs, there are associations between components of the tests. In the ACLR population, both the YBT-LQ and isokinetic strength testing can expose asymmetries and impact return to play decision making. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Heather Myers
- Department of Physical Therapy and Occupational Therapy, Sports Medicine Division, Duke University Health System, Durham, NC, USA
| | - Zachary Christopherson
- Department of Physical Therapy and Occupational Therapy, Sports Medicine Division, Duke University Health System, Durham, NC, USA
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Lake AD, Myers H, Aefsky B, Butler R. IMMEDIATE AND SHORT TERM EFFECT OF DRY NEEDLING ON TRICEPS SURAE RANGE OF MOTION AND FUNCTIONAL MOVEMENT: A RANDOMIZED TRIAL. Int J Sports Phys Ther 2018; 13:185-195. [PMID: 30090677 PMCID: PMC6063060] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Dry needling (DN) has been established as an effective treatment for myofascial pain, however, there are no studies thus far investigating the benefit to movement and motor control. PURPOSE The primary purpose of this study was to compare differences in a series of outcomes between dry needling, dry needling and stretching, and stretching only in a sample of healthy males. A secondary purpose was to compare change over time. DESIGN Blinded, randomized controlled trial. METHODS Thirty healthy male subjects were randomly assigned to one of three intervention groups: DN, stretching, or combination DN +stretching. Subjects in the DN group and DN+stretch group received DN to a palpated trigger point (TrP) in the triceps surae to elicit local twitch response. Subjects in the stretch group and DN+stretch group were instructed in a home stretching program for gastrocnemius and soleus muscles. All groups were tested for dorsiflexion range of motion and performed functional tasks (overhead deep squat, and Y-Balance test, Lower Quarter) prior to intervention, directly after intervention, and four days post intervention. Group comparisons were performed using a repeated measure Analysis of Variance and a partial eta squared calculation for effect size. For all measures a p-value of < 0.05 was used to determine significance. Cohen's criteria were used to categorize strength of effect size. RESULTS There were no statistically significant differences among groups for range of motion nor functional measures, with the exception of the deep squat. Proportionally, the DN group improved significantly in deep squat performance (p<0.01) compared to the other groups. Time oriented improvements were seen for the YBT posterior-lateral reach (p = 0.02) only. Between groups effect sizes ranged from 0.02 (small) to 0.17 (large). CONCLUSIONS Including DN did not markedly influence range of motion nor functional assessment measures, excluding those seen during the overhead deep squat. Effect measures suggest the lack of significant findings may be an issue of statistical power. LEVEL OF EVIDENCE 1b.
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Menz H, Roddy E, Marshall M, Thomas M, Rathod T, Myers H, Thomas E, Peat G. Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Osteoarthritis Cartilage 2015; 23:77-82. [PMID: 25450852 PMCID: PMC4291455 DOI: 10.1016/j.joca.2014.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 05/09/2014] [Revised: 07/30/2014] [Accepted: 10/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). DESIGN Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. RESULTS Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. CONCLUSIONS This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice.
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Affiliation(s)
- H.B. Menz
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom,Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia,Address correspondence and reprint requests to: H.B. Menz, Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia. Tel: 61-(3)-9479-5801; Fax: 61-(3)-9479-5415.
| | - E. Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - M. Marshall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - M.J. Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - T. Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - H. Myers
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - E. Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - G.M. Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
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Martinez C, Davis A, Myers H, Butler RJ. Interaction of gender and body composition on rectus femoris morphology as measured with musculoskeletal ultrasound imaging. Sports Health 2014; 6:451-6. [PMID: 25177424 PMCID: PMC4137677 DOI: 10.1177/1941738114539450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Quadriceps function is an important measure in patients recovering postoperatively. Traditionally, strength measures that require high levels of resistance are contraindicated during the early postoperative phase. Thus it may be helpful to evaluate the utilization of other tools, such as ultrasound imaging, that allow for assessment during a position of low resistance. Hypothesis: The rectus femoris cross-sectional area (CSA) is affected by sex and body composition in healthy subjects. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Thirty-two healthy subjects (16 women, 16 men), selected from a previously larger study, were chosen for analysis. All subjects underwent a maximal volitional isometric contraction protocol from 0° to 90° of knee motion controlled by an isokinetic dynamometer. In the contracted and resting positions, the rectus femoris CSA was measured at each angle using ultrasound imaging. The contractile index (contracted − resting CSA) was calculated at each position. Subjects were separated into 1 of 4 groups based on sex and fat percentage (low or high). These data were analyzed using mixed-factor analysis of variance (group × angle) for each variable, with a critical α level of 0.05. Results: A significant interaction was noted for the CSA of the rectus femoris at rest (P < 0.03) and during contraction (P < 0.02). For both variables, all groups performed similarly, with the exception of women with high body fat percentage. No statistically significant interaction existed for the contractile index; however, a main effect for angle (P < 0.01) was observed. Conclusion: Rectus femoris CSA appears to depend on sex as well as the body composition of individuals. Clinical Relevance: Traditional subjective assessment measures of quadriceps strength and function have low reliability and functional validity. With the improved feasibility of ultrasound imaging in the clinical setting, quadriceps size may be more accurately measured during the early postoperative stages.
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Affiliation(s)
- Corina Martinez
- Department of Physical and Occupational Therapy, Sports Medicine Division, Duke University Health System, Durham, North Carolina
| | - Ashley Davis
- Department of Physical and Occupational Therapy, Sports Medicine Division, Duke University Health System, Durham, North Carolina
| | - Heather Myers
- Department of Physical and Occupational Therapy, Sports Medicine Division, Duke University Health System, Durham, North Carolina
| | - Robert J Butler
- Department of Physical and Occupational Therapy, Sports Medicine Division, Duke University Health System, Durham, North Carolina ; Division of Physical Therapy, Department of Community Health and Family Medicine, Duke University, Durham, North Carolina
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Marshall M, Peat G, Nicholls E, van der Windt D, Myers H, Dziedzic K. Subsets of symptomatic hand osteoarthritis in community-dwelling older adults in the United Kingdom: prevalence, inter-relationships, risk factor profiles and clinical characteristics at baseline and 3-years. Osteoarthritis Cartilage 2013; 21:1674-84. [PMID: 23954700 PMCID: PMC3819994 DOI: 10.1016/j.joca.2013.08.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/04/2013] [Accepted: 08/03/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the population prevalence, inter-relationships, risk factor profiles and clinical characteristics of subsets of symptomatic hand osteoarthritis (OA) with a view to understanding their relative frequency and distinctiveness. METHOD 1076 community-dwelling adults with hand symptoms (60% women, mean age 64.7 years) were recruited and classified into pre-defined subsets using physical examination and standardised hand radiographs, scored with the Kellgren & Lawrence (K&L) and Verbruggen-Veys grading systems. Detailed information on selected risk factors was obtained from direct measurement (Body Mass Index (BMI)), self-complete questionnaires (excessive use of hands, previous hand injury) and medical record review (hypertension, dyslipidaemia, type 2 diabetes). Hand pain and disability were self-reported at baseline and 3-year follow-up using Australian/Canadian Osteoarthritis Hand Index (AUSCAN). RESULTS Crude population prevalence estimates for symptomatic hand OA subsets in the adult population aged 50 years and over were: thumb base OA (22.4%), nodal interphalangeal joint (IPJ) OA (15.5%), generalised hand OA (10.4%), non-nodal IPJ OA (4.9%), erosive OA (1.0%). Apart from thumb base OA, there was considerable overlap between the subsets. Erosive OA appeared the most distinctive with the highest female: male ratio, and the most disability at baseline and 3-years. A higher frequency of obesity, hypertension, dyslipidaemia, and metabolic syndrome was observed in this subset. CONCLUSION Overlap in the occurrence of hand OA subsets poses conceptual and practical challenges to the pursuit of distinct phenotypes. Erosive OA may nevertheless provide particular insight into the role of metabolic and cardiovascular risk factors in the pathogenesis of OA.
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Affiliation(s)
- M. Marshall
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - G. Peat
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - E. Nicholls
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - D. van der Windt
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - H. Myers
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - K. Dziedzic
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
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Roddy E, Thomas M, Marshall M, Rathod T, Myers H, Menz H, Thomas E, Peat G. OP0032 Population Prevalence of Symptomatic Radiographic Foot Osteoarthritis in Community-Dwelling Older Adults: The Clinical Assessment Study of the Foot (CASF). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.237] [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: 11/04/2022]
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Myers H, Davis A, Lazicki R, Martinez C, Black D, Butler RJ. Sex differences in rectus femoris morphology across different knee flexion positions. Int J Sports Phys Ther 2013; 8:84-90. [PMID: 23593545 PMCID: PMC3625786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
UNLABELLED PURPOSEBACKGROUND: Quadriceps function is an important outcome following lower extremity injury and surgery. Measurements of quadriceps function are particularly helpful initially post surgery, however traditional quadriceps strength measures like isokinetic testing are contraindicated during this time period. Inclusion of dynamic musculoskeletal ultrasound imaging in the clinical setting has been beneficial in understanding quadriceps activation specifically rectus femoris (RF) contraction; however, there is a paucity of literature in this area. The purpose of the current study was to describe the cross-sectional area (CSA) of the RF across varying knee flexion angles. METHODS Forty-five adult recreational athletes were recruited for the study (21 males, 24 females). All subjects underwent tests of maximal volitional isometric contractions of the knee extensors at 0, 30, 60 and 90 degrees of knee flexion. During the trials, musculoskeletal ultrasound images of the RF at 15 cm from the superior pole of the patella were taken at rest and during contraction for each of the angular positions. Mixed model ANOVAs (angle x sex) were utilized to examine the differences between males and females for different angular positions. These analyses were conducted for the resting CSA, active CSA, and the contractile index (resting - active). RESULTS RF cross-sectional area increased with increasing angles of knee flexion for both the resting and active conditions. The contractile index consistently decreased as knee flexion angle increased. No statistically significant interactions or main effects for sex were observed, although differences were observed in the trajectories of the data sets for males and females. CONCLUSIONS RF CSA is dependent on knee flexion angle in both males and females. As a result, the assessment of RF CSA should be conducted in a standardized position if this variable is to be utilized as a meaningful measure of muscle size during rehabilitation. Additional research should seek out which factors are associated with clinically relevant factors that effect RF CSA across the range of knee flexion. LEVEL OF EVIDENCE 3b.
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Norton S, Done J, Sacker A, Young A, Cox N, Treharne GJ, McGavock ZC, Tonks A, Kafka SA, Hale ED, Kitas GD, Fletcher D, Sanderson T, Baker G, Street P, Hewlett S, Stynes S, Peat G, Myers H, Croft P, Bosworth AM, Crake D, Hurley M, Patel A, Walsh N, Mitchell H, Kumar K, Gordhan C, Situnayake D, Raza K, Bacon P, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Stevenson K, Roddy E, Jordan K, Waldron N, Brown S, McCabe C, McHugh N, Hewlett S, Shelmerdine J, Ferenkeh-Koroma A, Breslin A, Sawyer S, Haas M, Elliott B, Law RJ, Breslin A, Oliver E, Mawn L, Markland D, Peter M, Thom J, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Cliss A, Morris M, Ambler N, Knops B, Hammond A, Almeida C, Hewlett S. BHPR: Research [278-290]: 278. What does the Hospital Anxiety and Depression Scale Measure? Evidence of a Bifactor Structure and Item Bias. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq731] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Marshall M, van der Windt D, Nicholls E, Myers H, Hay E, Dziedzic K. Radiographic hand osteoarthritis: patterns and associations with hand pain and function in a community-dwelling sample. Osteoarthritis Cartilage 2009; 17:1440-7. [PMID: 19500560 DOI: 10.1016/j.joca.2009.05.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 04/16/2009] [Accepted: 05/11/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patterns of radiographic osteoarthritis (ROA) of the hand are often examined by row, with the four joints of the thumb studied inconsistently. The objectives of this study were to determine relationships of ROA at different hand joints, use the findings to define radiographic sub-groups and investigate their associations with pain and function. METHODS Sixteen joints in each hand were scored for the presence of ROA in a community-dwelling cohort of adults, 50-years-and-over, with self-reported hand pain or problems. Principal components analysis (PCA) with varimax rotation was used to study patterns of ROA in the hand joints and identify distinct sub-groups. Differences in pain and function between these sub-groups were assessed using Australian/Canadian Osteoarthritis Index (AUSCAN), Grip Ability Test (GAT) and grip and pinch strength. RESULTS PCA was undertaken on data from 592 participants and identified four components: distal interphalangeal joints (DIPs), proximal interphalangeal joints (PIPs), metacarpophalangeal joints (MCPs), thumb joints. However, the left thumb interphalangeal (IP) joint cross-loaded with the PIP and thumb groups. On this basis, participants were categorised into four radiographic sub-groups: no osteoarthritis (OA), finger only OA, thumb only OA and combined thumb and finger OA. Statistically significant differences were found between the sub-groups for AUSCAN function, and in women alone for grip and pinch strength. Participants with combined thumb and finger OA had the worst scores. CONCLUSION Individual thumb joints can be clustered together as a joint group in ROA. Four radiographic sub-groups of hand OA can be distinguished. Pain and functional difficulties were highest in participants with both thumb and finger OA.
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Affiliation(s)
- M Marshall
- Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
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Reinhard MJ, Hinkin CH, Barclay TR, Levine AJ, Marion S, Castellon SA, Longshore D, Newton T, Durvasula RS, Lam MN, Myers H. Discrepancies between self-report and objective measures for stimulant drug use in HIV: cognitive, medication adherence and psychological correlates. Addict Behav 2007; 32:2727-36. [PMID: 17499443 PMCID: PMC2679746 DOI: 10.1016/j.addbeh.2007.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/08/2007] [Accepted: 04/09/2007] [Indexed: 10/23/2022]
Abstract
While it has long been recognized that self-reported drug use may be at variance with objectively obtained evidence such as urine toxicology assays, few studies have explored the behavioral correlates of such discrepancies. Here we compared self-reported and objective measures of stimulant drug use for 162 HIV infected individuals and identified a sub-group with discrepancies between data obtained via the two methods. Results showed poorer neurocognitive performance (attention, learning/memory) and lower medication adherence rates for the discrepant group as compared to those who either acknowledged their drug use or accurately denied recent stimulant use. Using the Millon Clinical Multiaxial Inventory-III, it was also found that those in the discrepant group were more hesitant to reveal psychopathology. Comparisons of self-reported and objectively measured medication adherence data are also discussed.
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Galloway DA, Gewin LC, Myers H, Luo W, Grandori C, Katzenellenbogen RA, McDougall JK. Regulation of telomerase by human papillomaviruses. Cold Spring Harb Symp Quant Biol 2006; 70:209-15. [PMID: 16869756 DOI: 10.1101/sqb.2005.70.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The E6 oncoprotein of human papillomaviruses (HPVs) induces telomerase activity in primary human epithelial cells. This activity is dependent on association of E6 with E6AP, a cellular ubiquitin ligase. E6 activates the transcription of hTERT, the catalytic subunit of telomerase. E boxes near the start of hTERT transcription are required for E6; however, acetylated histones are only present in the E6 cells. We identified two isoforms of NFX1, a new binding partner of E6/E6AP. The NFX1- 91 isoform binds to an X-box motif located adjacent to the proximal E box, binds Sin3A and HDACs, repressing hTERT transcription. It preferentially binds E6/E6AP and is targeted for ubiquitin-mediated degradation. The NFX1-123 isoform has the opposite activity, increasing hTERT transcription or translation. This is the first example of viral oncoproteins disrupting regulation of telomerase, a critical event in tumorigenesis.
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Affiliation(s)
- D A Galloway
- Program in Cancer Biology, Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA
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Abstract
College students (122 males and 88 females) completed the Group Embedded Figures Test measure of field-dependence, and Sensation-Seeking Scale, and performed preference ratings on 40 slides of paintings. Factor analysis revealed six hypothesized and one unhypothesized preference dimensions that underlay preference ratings of paintings. It was hypothesized that the cognitive structuring ability associated with field-dependence would result in certain relationships between field-dependence and preference for paintings. Further, it was hypothesized that preference for novel, complex, and dynamic experiences, associated with sensation-seeking, would result in certain relationships between sensation-seeking and preference for paintings. For the full sample, three of five hypothesized relationships between field-dependence and preference for paintings were obtained, while three of four hypothesized relationships were found between sensation-seeking and preference for paintings.
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Affiliation(s)
- J J Tobacyk
- Louisiana Tech University, Area of Behavioral Sciences, Ruston 71272, USA
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Schneider RH, Castillo-Richmond A, Alexander CN, Myers H, Kaushik V, Aranguri C, Norris K, Haney C, Rainforth M, Calderon R, Nidich S. Behavioral treatment of hypertensive heart disease in African Americans: rationale and design of a randomized controlled trial. Behav Med 2002; 27:83-95. [PMID: 11763829 DOI: 10.1080/08964280109595775] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
African Americans experience higher morbidity and mortality than Whites do as a result of hypertension and associated cardiovascular disease. Chronic psychosocial stress has been considered an important contributing factor to these high rates. The authors describe the rationale and design for a planned randomized controlled trial comparing Transcendental Meditation, a stress-reduction technique, with lifestyle education in the treatment of hypertension and hypertensive heart disease in urban African Americans. They pretested 170 men and women aged 20 to 70 years over a 3-session baseline period, with posttests at 6 months. Outcomes included clinic and ambulatory blood pressure, quality of life, left ventricular mass measured by M-mode echocardiography, left ventricular diastolic function measured by Doppler, and carotid atherosclerosis measured by beta-mode ultrasound. This trial was designed to evaluate the hypothesis that a selected stress reduction technique is effective in reducing hypertension and hypertensive heart disease in African Americans.
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Abstract
Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest-post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.
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Affiliation(s)
- B O'Connell
- School of Nursing, Deakin University, Geelong, Victoria, Australia.
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Abstract
A descriptive correlation study was conducted in an acute-care hospital to explore the relationship between nurses' use of restraints and their attitudes toward restraint use and the elderly. A total of 201 nurses returned a questionnaire that collected demographic information and included two research instruments: (i) Perceptions of Restraint Use Questionnaire and (ii) Attitudes toward the Aged Semantic Differential. Results showed slightly positive attitudes towards the elderly and toward the use of restraints, although there was no correlation between scores on the two scales. Furthermore, nurses' attitudes did not predict their self-reported use of restraints.
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Affiliation(s)
- H Myers
- Nursing Practice Research Network, Sir Charles Gairdner Hospital University Department of Nursing Research and Development, Perth, Western Australia.
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Castillo-Richmond A, Schneider RH, Alexander CN, Cook R, Myers H, Nidich S, Haney C, Rainforth M, Salerno J. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000; 31:568-73. [PMID: 10700487 PMCID: PMC9341385 DOI: 10.1161/01.str.31.3.568] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE African Americans suffer disproportionately higher cardiovascular disease mortality rates than do whites. Psychosocial stress influences the development and progression of atherosclerosis. Carotid intima-media thickness (IMT) is a valid surrogate measure for coronary atherosclerosis, is a predictor of coronary outcomes and stroke, and is associated with psychosocial stress factors. Stress reduction with the Transcendental Meditation (TM) program decreases coronary heart disease risk factors and cardiovascular mortality in African Americans. B-mode ultrasound is useful for the noninvasive evaluation of carotid atherosclerosis. METHODS This randomized controlled clinical trial evaluated the effects of the TM program on carotid IMT in hypertensive African American men and women, aged >20 years, over a 6- to 9-month period. From the initially enrolled 138 volunteers, 60 subjects completed pretest and posttest carotid IMT data. The assigned interventions were either the TM program or a health education group. By use of B-mode ultrasound, mean maximum IMT from 6 carotid segments was used to determine pretest and posttest IMT values. Regression analysis and ANCOVA were performed. RESULTS Age and pretest IMT were found to be predictors of posttest IMT values and were used as covariates. The TM group showed a significant decrease of -0.098 mm (95% CI -0. 198 to 0.003 mm) compared with an increase of 0.054 mm (95% CI -0.05 to 0.158 mm) in the control group (P=0.038, 2-tailed). CONCLUSIONS Stress reduction with the TM program is associated with reduced carotid atherosclerosis compared with health education in hypertensive African Americans. Further research with this stress-reduction technique is warranted to confirm these preliminary findings.
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Affiliation(s)
- A Castillo-Richmond
- Center for Natural Medicine and Prevention, Maharishi University of Management, College of Maharishi Vedic Medicine, Fairfield, Iowa 52557, USA.
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Bowles J, Brooks T, Hayes-Reams P, Butts T, Myers H, Allen W, Kington RS. Frailty, family, and church support among urban African American elderly. J Health Care Poor Underserved 2000; 11:87-99. [PMID: 10778045 DOI: 10.1353/hpu.2010.0533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A community-based survey of 507 African Americans aged 60 and older from South Central Los Angeles was conducted to estimate the prevalence of frailty and describe the correlation between frailty, social support from family and church, and use of community services. Persons were considered frail if they met criteria for any of four conditions: functional impairment, depression, urinary incontinence, falls. Sixty-seven percent met criteria for frailty. Analyses revealed that frail elderly were significantly less likely to report feeling very close to family. Family contact, feeling that church was important, and receiving church support were similar for the frail and nonfrail. Frail elderly were more likely to use community services. These findings suggest that frail elderly in this population may not receive more support from family and church than nonfrail elderly. There is a need for caution when assuming families and churches in urban African American communities are able to support the most vulnerable elderly.
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Swanson JT, Cox EO, France FL, Teets Grimm KC, Herbert JW, Hodgson ES, Lieberthal AS, Yasuda K, Davis T, Chessin RD, Sayers R, Eugenio EE, Berger JE, Buckley JM, Craft WH, Deitschel CH, Evans G, Fraser JJ, Myers H, Combs L, Heland K. American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine and Committee on Medical Liability. Pediatric physician profiling. Pediatrics 1999; 104:970-2. [PMID: 10506244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.
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Meier DE, Myers H, Muskin PR. When a patient requests help committing suicide. Generations 1999; 23:61-8. [PMID: 17144040] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- D E Meier
- Division of Geriatrics, Palliative Care Initiative, Mt. Sinai Medical Center, New York, NY, USA
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Abstract
This study describes patterns of functional status among older blacks and whites by their history of birth in and migration out of the South. We used multivariate regression to analyze data on functional status of US-born non-Hispanic blacks (N = 1868) and whites (N = 13469) age 60 years or above. In general, the functional status of blacks who were born in the South and migrated was similar to that of blacks born outside the South and better than those born in the South who did not migrate. Whites who migrated from the South had functional status similar to those who did not migrate and worse than those born outside of the South. Socioeconomic status did not explain differences by race and migration history. These results differ sharply from mortality studies, which have found a consistent pattern of high mortality among black migrants from the South. Differences among race groups by migration history vary across health measures. Selective migration and selective survival may account for the complex patterns of racial differences in geographic distributions of function and health.
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Chang L, Mehringer CM, Ernst T, Melchor R, Myers H, Forney D, Satz P. Neurochemical alterations in asymptomatic abstinent cocaine users: a proton magnetic resonance spectroscopy study. Biol Psychiatry 1997; 42:1105-14. [PMID: 9426880 DOI: 10.1016/s0006-3223(97)00135-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cocaine can cause a variety of neuropsychiatric and neurobehavioral complications; however, it is uncertain whether cocaine causes persistent cerebral structural and neurochemical abnormalities in asymptomatic users. We studied 52 African-American men (26 human immunodeficiency virus-negative asymptomatic heavy cocaine users and 26 normal subjects). Ventricle-to-brain ratio (VBR) and white matter lesions (WML) were quantified on magnetic resonance imaging. N-acetyl-containing compounds (NA), total creatine, choline-containing compounds, myo-inositol, and glutamate + glutamine were measured with in vivo proton magnetic resonance spectroscopy, VBR and WML were not significantly different in the cocaine users compared to the normal controls. Elevated creatine (+7%; p = .05) and myo-inositol (+18%; p = .01) in the white matter were associated with cocaine use. NA, primarily a measure of N-acetyl aspartate and neuronal content, was normal. Normal NA suggest no neuronal loss or damage in the brain regions examined in these cocaine users. Therefore, we conclude that neurochemical abnormalities observed might result from alterations in nonneuronal brain tissue.
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Affiliation(s)
- L Chang
- Department of Neurology, Harbor-UCLA Medical Center, Torrance, California 90509, USA
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Strickland TL, James R, Myers H, Lawson W, Bean X, Mapps J. Psychological characteristics related to cocaine use during pregnancy: a postpartum assessment. J Natl Med Assoc 1993; 85:758-60. [PMID: 8254692 PMCID: PMC2568218] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study assessed four psychological factors that have been suggested by previous research to be highly correlated with drug use. Twenty-one postpartum urban African-American women served as the research participants. At parturition, 10 infants tested positive for cocaine and 11 did not. Measures of depression (Beck Depression Index), anxiety (Spielberger Trait Anxiety Inventory), anger/self-control (Self-Analysis Questionnaire), and sociopathy (California Personality Inventory subscale) were obtained from the mothers within 6 weeks of delivery. Women who gave birth to cocaine-positive infants were significantly more depressed and had significantly higher sociopathy scores than their cocaine-negative counterparts. No differences with respect to anxiety and anger were obtained. The implications of these findings, as well as the potential adverse effects of cocaine use during pregnancy, are discussed.
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Affiliation(s)
- T L Strickland
- Department of Psychiatry, Drew University of Medicine and Science, Los Angeles, CA 90059
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Strickland TL, Mena I, Villanueva-Meyer J, Miller BL, Cummings J, Mehringer CM, Satz P, Myers H. Cerebral perfusion and neuropsychological consequences of chronic cocaine use. J Neuropsychiatry Clin Neurosci 1993; 5:419-27. [PMID: 8286941 DOI: 10.1176/jnp.5.4.419] [Citation(s) in RCA: 180] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Research indicates that cocaine significantly constricts the cerebral vasculature and can lead to ischemic brain infarction. Long-term effects of intermittent or casual cocaine use in patients without symptoms of stroke or transient ischemic attack were investigated. Single-photon emission computed tomography with xenon-133 and [99mTc]hexamethylpropyleneamine oxime, magnetic resonance imaging, and selected neuropsychological measures were used to study cerebral perfusion, brain morphology, and cognitive functioning. Patients were drug free for at least 6 months before evaluation. All showed regions of significant cerebral hypoperfusion in the frontal, periventricular, and/or temporal-parietal areas. Deficits in attention, concentration, new learning, visual and verbal memory, word production, and visuomotor integration were observed. This study indicates that long-term cocaine use may produce sustained brain perfusion deficits and persistent neuropsychological compromise in some subgroups of cocaine-abusing patients.
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Affiliation(s)
- T L Strickland
- Department of Psychiatry, Drew University of Medicine and Science, Los Angeles, CA 90059
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Krantz DS, DeQuattro V, Blackburn HW, Eaker E, Haynes S, James SA, Manuck SB, Myers H, Shekelle RB, Syme SL. Psychosocial factors in hypertension. Circulation 1987; 76:I84-8. [PMID: 3297413] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Finkelstein H, Barnett P, Myers H. Safeguarding the residents. Contemp Adm Long Term Care 1984; 7:47-9. [PMID: 10271761] [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: 02/12/2023]
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Caldwell J, Cooper R, Eaker E, Edozien J, Harburg E, Hayden G, Hedeger M, Hullett S, James S, Kasl S, Keil J, Maloy J, McDonald R, McLarin W, Myers H, Pierce C, Schoenberger J, Shapiro A, Thomson G, Wallace J, Wellons R, Wright J. Summary of workshop III: Working Group on Socieconomic and Sociocultural Influences. Am Heart J 1984. [DOI: 10.1016/0002-8703(84)90660-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Myers H. Fluorides vs. caries--molecular mechanisms. Symp Pharmacol Ther Toxicol Group 1974:17-25. [PMID: 4534346] [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: 01/11/2023]
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