Quality of life, function and disability in individuals with chronic ankle symptoms: a cross-sectional online survey

BACKGROUND

Chronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL.

METHOD

Individuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history.

RESULTS

A total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm- 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001).

CONCLUSION

Individuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.

Stimulation of the local femoral inflammatory response to fracture and intramedullary reaming

We have undertaken a prospective study in patients with a fracture of the femoral shaft requiring intramedullary nailing to test the hypothesis that the femoral canal could be a potential source of the second hit phenomenon. We determined the local femoral intramedullary and peripheral release of interleukin-6 (IL-6) after fracture and subsequent intramedullary reaming.

In all patients, the fracture caused a significant increase in the local femoral concentrations of IL-6 compared to a femoral control group. The concentration of IL-6 in the local femoral environment was significantly higher than in the patients own matched blood samples from their peripheral circulation. The magnitude of the local femoral release of IL-6 after femoral fracture was independent of the injury severity score and whether the fracture was closed or open.

In patients who underwent intramedullary reaming of the femoral canal a further significant local release of IL-6 was demonstrated, providing evidence that intramedullary reaming can cause a significant local inflammatory reaction.

Incidence and causes of mortality following acute orthopaedic and trauma admissions

PURPOSE

To analyse the incidence and causes of mortality of orthopaedic and trauma patients.

METHODS

Between March 1995 and October 2000, there were 594 (404 females) in-patient deaths (2.8%) with a mean age of 82.14 years (range, 21-102 years) out of 21,122 acute admissions. The cause of death and details of the acute episode were collected from the hospital records, death certificates and postmortem examinations. Data collected were computerised and analysed using the Astute statistical package, University of Leeds.

RESULTS

The most common primary diagnosis on admission was fracture neck of femur 392 (69.1%; P = 0.001). In total, 443 (78.1%) patients underwent surgical intervention of their injuries prior to mortality with 21 patients (4.7%) dying on the same day of the operation. The mean number of days between the initial surgical intervention and death was 22.3 days (range, 0-154 days). Of the patients who were treated non-operatively, 124 died due to poor medical condition (4 [3.2%] died within 24 h, 66 [51.6%] died within the first week and the rest died thereafter). In the death certificate, the most common primary cause of death recorded in the group of patients of 64 years of age and below was cancer followed by multi-organ failure. In the age group of 65 years and above, the most common primary cause of mortality was pneumonia followed by heart failure and myocardial infarction.

CONCLUSIONS

In orthopaedic and trauma patients below the age of 65 years, the most common cause of death appears to be cancer followed by multiple system organ failure; in the elderly, pneumonia predominates followed by heart failure and myocardial infarction. Proximal femoral fractures accounted for 70% of the deaths.

Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs

We assessed factors which may affect union in 32 patients with nonunion of a fracture of the diaphysis of the femur and 67 comparable patients whose fracture had united. These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open or closed), the type of nail, the mode of locking, reaming nu non-reaming, infection, failure of the implant, distraction at the fracture site, and the time to full weight-bearing. Patients with severe head injuries were excluded. Both groups were comparable with regard to gender, Injury Severity Score and soft-tissue injury. There was no relationship between the rate of union and the type of implant, mode of locking, reaming, distraction or smoking. There were fewer cases of nonunion in more comminuted fractures (type C) and in patients who were able to bear weight early. There was a marked association between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing was noted in patients who took NSAIDs and whose fractures had united.

Nonunion of the femoral diaphysis

We assessed factors which may affect union in 32 patients with nonunion of a fracture of the diaphysis of the femur and 67 comparable patients whose fracture had united. These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open or closed), the type of nail, the mode of locking, reaming v non-reaming, infection, failure of the implant, distraction at the fracture site, and the time to full weight-bearing. Patients with severe head injuries were excluded. Both groups were comparable with regard to gender, Injury Severity Score and soft-tissue injury.

There was no relationship between the rate of union and the type of implant, mode of locking, reaming, distraction or smoking. There were fewer cases of nonunion in more comminuted fractures (type C) and in patients who were able to bear weight early. There was a marked association between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing was noted in patients who took NSAIDs and whose fractures had united.

The Self-Expansiveness Level Form: examination of its validity and relation to the Neo Personality Inventory--Revised

This study examined the validity of the Self-expansiveness Level Form of Friedman with particular emphasis on the Transpersonal subscale, a measure of transpersonal self-concept, in terms of its basic psychometric properties and its relation to the NEO Personality Inventory--Revised. Support for the basic psychometric properties of the scale in terms of reliability, factorial validity, and concurrent validity was obtained; however, support was limited for convergent validity as correlations between scores on the Transpersonal subscale and measures of theoretically related constructs were low. Correlational analyses involving the Self-expansiveness Level Form and NEO Personality Inventory--Revised indicated that Transpersonal scores were not appreciably associated with the NEO Personality Inventory--Revised domains. Moreover, factor analysis of NEO Personality Inventory--Revised facets and Self-expansiveness Level Form items generated a solution in which the two measures contributed to separate factors. Discussion of the implications and limitations of the findings is included.

Spirituality: description, measurement, and relation to the five factor model of personality

The present article focused on the development and measurement of a factor model of the expressions of spirituality. Study 1 (N = 534) involved the use of factor analysis to examine the latent factor structure in a sample of 11 measures of spiritual constructs. Study 2 (N = 938) focused on the replication of Study 1 results and on the construction and initial validation of an instrument to operationalize the factor model of spirituality. Results indicate that at least 5 robust dimensions of spirituality underlie the spirituality test domain. These dimensions were labeled Cognitive Orientation Towards Spirituality (COS), Experiential/Phenomenological Dimension (EPD), Existential Well-Being (EW-B), Paranormal Beliefs (PAR), and Religiousness (REL). The measure developed, named the Expressions of Spirituality Inventory (ESI), takes the form of a 98-item instrument that generated scores demonstrating satisfactory reliability and adequate initial validity. Examination of the relation of spirituality to the Five Factor Model (FFM) as measured by the NEO Personality Inventory-Revised revealed that the dimensions of the FFM appear to differentially relate to the major elements of spirituality but are nevertheless conceptually unique, pointing to the possible existence of major aspects of personality not represented in the FFM.

Exchange nailing for femoral shaft aseptic non-union

Although rare, non-union of femoral shaft fractures is a cause of significant morbidity. In aseptic non-union, excellent union rates have historically been reported following reamed exchange femoral nailing. However, recently, a high incidence of failure requiring additional procedures has been reported. In light of these concerns and a recent change in our practice to the use of thin solid nails we undertook a retrospective study to determine the efficacy of exchange nailing with these modern nails in our hands. We reviewed records and radiographs of 25 patients who had a reamed exchange femoral nailing for established aseptic non-union. 24 patients (96%) united after exchange without the need for an additional procedure. The mean time to union was 29.75 weeks. Patients who had open bone grafting performed at the same procedure tended to unite quicker, but this did not achieve statistical significance (p = 0.14). Union times were not affected by smoking habits or nail type. This study demonstrates that reamed exchange nailing for aseptic femoral non-union remains an effective treatment. We believe that the nail type is less important than the biological effects of reaming, bone grafting and dynamization.

A confirmatory study of the relation between self-reported complex partial epileptic signs, peak experiences and paranormal beliefs

Data obtained from a sample of 102 university students were used to calculate Pearson product moment correlations between measures of complex partial epileptic signs, peak experiences and paranormal beliefs. Significant correlations ranging from .35 to .42 (p < .001) were found between all three measures. Moreover, notable relations were obtained between complex partial epileptic signs and a number of subscales of the paranormal measure including precognition (r = .43), psi beliefs (r = .40), spiritualism (r = .40), extraordinary life forms (r = .26) and superstition (r = .22). The results are consistent with previous research linking temporal lobe signs to paranormal and peak experiences.

Correlations between the Myers-Briggs Type Indicator and the Neo Personality Inventory facets

Using data obtained from 48 male and 161 female undergraduate students in psychology, correlations between scores on the scales of the Myers-Briggs Type Indicator and the facets of the Neuroticism, Extraversion, and Openness domains of the NEO Personality Inventory were low to moderate.

The relationship between psychometric intelligence and the five-factor model of personality in a rehabilitation sample

WAIS-R and NEO Personality Inventory (NEO-PI) scores obtained from 85 rehabilitation clients of the Evaluation and Development Center of Southern Illinois University's Rehabilitation Institute were utilized to examine the relationship between psychometric intelligence and personality. Correlational analyses revealed that the NEO-PI Openness domain and its six facets significantly correlated with WAIS-R FSIQ, VIQ, PIQ, and 9 of the 11 subtests. Multiple regression analyses showed that the five NEO-PI domains accounted for significant proportions of WAIS-R, FSIQ, VIQ, and PIQ score variance. The NEO-PI Openness domain was found to be the best predictor of WAIS-R FSIQ, VIQ, and PIQ scores. The study concludes with a discussion of the meaning and implications of the findings and suggestions for future research.

Styrene migration from general-purpose and high-impact polystyrene into food-simulating solvents

General-purpose and high-impact polystyrenes (GPPS and HIPS, respectively) are used in many food-contact applications for the packaging of aqueous-based, fatty and dry foods. The correlation of residual styrene concentrations in polystyrene with styrene migration into food-stimulating solvents is of interest in order to predict the potential exposure of consumers to styrene from food-packaging applications. Studies of the migration of styrene into 8% ethanol and cooking oil from a GPPS and a HIPS polymer, each containing three different residual styrene levels, have been completed at temperatures ranging from 70 to 180 degrees F (21 to 82 degrees C). The results showed that the amount of styrene migrating from both polymers into cooking oil was proportional to the square root of the time of exposure, and the total amount of styrene migrating was proportional to the residual levels of styrene in the polymers. The calculated diffusion coefficients were found to be independent of the residual levels of styrene in a given polymer at a given temperature. While the partition equilibrium was not approached when the polymers were exposed to cooking oil, it was observed in the 8%-ethanol exposure studies. The calculated partition coefficients between the polymers and 8% ethanol appeared to be independent of the residual levels of styrene in the polymers at a given temperature. Linear relationships were observed between the logs of the diffusion and partition coefficients and the inverse of the absolute temperature of exposure.

Pulsatile flow in a catheterised artery

A model is presented for the physiological problem of a catheter which is inserted in a femoral artery to measure the pressure gradient. As the catheter will modify the pressure distribution in the artery, the pressure gradient which would be recorded by a perfect pressure transducer attached to it would differ from that in the uncatheterised artery. To estimate the magnitude of this error, it is assumed that the rates of flow of blood through the catheterised and the uncatheterised artery are described by the same known periodic function of time.