scholarly journals Effectiveness of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: study protocol for a randomized controlled trial

2020 ◽  
Author(s):  
Shaikh Nabi Bukhsh Nazir ◽  
Syed Shahzad Ali ◽  
Saeed Akhtar
Keyword(s):  
Knee Osteoarthritis ◽  
Study Protocol ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Controlled Trial ◽  
Movement Control ◽  
Clinical Decision ◽  
The Body ◽  
Study Objective ◽  
Trunk Stabilization

AbstractKnee Osteoarthritis (KOA) patients have a huge negative impact on gait parameters and altered biomechanics in many components, including impairments of dynamic lower limb alignment and lumbopelvic movement control. The understanding of these components seems to be very crucial and there is need to add these unfocused components in treatment regimens in the research setting to see its effects; before using as a routine treatment regime in Clinical practice for patients with KOA. This study protocol focuses on whether Mulligan joint mobilization with movement provides evident effects on decreasing pain and restoring the joint biomechanics. Trunk stabilization exercises improve the stability of the trunk which distributes the weight of the body evenly on both feet biomechanically. The treatment effects of both treatments are inconclusive. Accordingly, the study aims to determine the efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening for KOA. It is a study protocol of a three-arm randomized control trial. Initial screening of the subjects will be carried out by a referring consultant. Subjects who fulfill the study criteria will be randomly allocated into three groups After an explanation of study objective and obtaining informed consent. Group 1 will receive mulligan mobilization with kinesiotaping and knee strengthening. Group 2 will receive trunk stabilization exercise, knee strengthening, and Kinesiotaping. Group 3 will receive knee strengthening along with kinesiotaping. All participants will be evaluated using visual analogue scale, Knee injury and Osteoarthritis Outcome Score, stair climb test and 6-minute walk test at 1st, 3rd and 6th week. The results of this study will answer a clearly focused question investigated in KOA patients. Finding of this study will serve as a guide to inform clinical decision making for healthcare professionals, researcher, and patients.Trial registrationNCT04099017

scholarly journals Effectiveness of Mulligan Joint Mobilizations and Trunk Stabilization Exercises Versus Isometric Knee Strengthening in the Management of Knee Osteoarthritis: Study Protocol for a Randomized Controlled Trial.

2020 ◽  
Author(s):  
SHAIKH NABI BUKHSH NAZIR ◽  
Syed Shahzad Ali ◽  
Saeed Akhtar
Keyword(s):  
Randomized Controlled Trial ◽  
Study Protocol ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Controlled Trial ◽  
Clinical Decision ◽  
The Body ◽  
Study Objective ◽  
Randomized Controlled ◽  
Trunk Stabilization

Abstract BackgroundKnee Osteoarthritis (KOA) has a huge negative impact on gait parameters and on many components of biomechanics, including impairment of dynamic lower limb alignment and control of lumbopelvic movement. Specifically addressing these problems in treatment regimens is therefore critical but they must first be studied in detail before they can be used clinically to treat patients with KOA. This study protocol focuses on whether Mulligan joint mobilization with movement demonstrably decreases pain and restores healthy joint biomechanics and whether trunk stabilization exercises improve stability of the trunk, thereby distributing the weight of the body evenly on both feet. Because the treatment effects of neither treatment are conclusive, this study aims to determine their efficacy versus isometric knee strengthening.Method:The study protocol is a three-arm randomized controlled trial. After initial screening by a referring consultant, subjects who fulfil the study criteria will be randomly assigned to one of three groups. They will then be given an explanation of study objective and asked for their informed consent to participate in the study. Group 1 will receive Mulligan mobilization with kinesiotaping and knee strengthening. Group 2 will receive trunk stabilization exercises, knee strengthening, and kinesiotaping. Group 3 will receive knee strengthening along with kinesiotaping. All participants will be evaluated using a visual analogue scale, Knee injury and Osteoarthritis Outcome Score, stair climb test and 6-minute walk test at the baseline, 3rd and end of 6th week.DiscussionThe results of this study will answer focused questions concerning the relative efficacy of each treatment in KOA patients. The findings of this study will inform clinical decision-making by healthcare professionals and researchers.Trial registration: NCT04099017

scholarly journals Ovarian tissue freezing and activation after thawing: an update

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Li-fan Peng
Keyword(s):  
Granulosa Cells ◽  
Clinical Decision Making ◽  
Ovarian Function ◽  
Ovarian Tissue ◽  
Clinical Decision ◽  
The Body ◽  
Endocrine Function ◽  
Ovarian Tissue Cryopreservation ◽  
Main Body ◽  
Tissue Cryopreservation

Abstract Background With the growth of women’s age, ovarian failure can be caused by various factors. For the women who need chemotherapy because of cancer factors, the preservation of fertility is more urgent. The treatment of cancer is also a process in which all tissues and organs of the body are severely damaged, especially in the reproductive system. Main body As a new fertility preservation technology, autologous ovarian tissue cryopreservation and transplantation is developing rapidly and showing great potentiality in preserving ovarian endocrine function of young cervical cancer patients. Vitrification and slow freezing are two common techniques applied for ovarian tissue cryopreservation. Thus, cryopreserved/thawed ovarian tissue and transplantation act as an important method to preserve ovarian function during radiotherapy and chemotherapy, and ovarian cryopreservation by vitrification is a very effective and extensively used method to cryopreserve ovaries. The morphology of oocytes and granulosa cells and the structure of organelles were observed under the microscope of histology; the hormone content in the stratified culture medium of granulosa cells with the diameter of follicle was used to evaluate the development potential of ovarian tissue, and finally the ovarian tissue stimulation was determined by the technique of ovarian tissue transplantation. Conclusions Although there are some limitations, the team members still carry out this review to provide some references and suggestions for clinical decision-making and further clinical research.

scholarly journals Golden plaster for pain therapy in patients with knee osteoarthritis: study protocol for a multicenter randomized, double-blind, placebo-controlled trial

Trials ◽  
2013 ◽  
Vol 14 (1) ◽  
pp. 383 ◽  
Author(s):  
Jin-Tao Liu ◽  
De-Zhi Tang ◽  
Xiao-Feng Li ◽  
Zhi-Gang Zhang ◽  
Wan-Bo Ji ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Study Protocol ◽  
Pain Therapy ◽  
Controlled Trial ◽  
Double Blind ◽  
Double Blind Placebo

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals Sinew acupuncture for knee osteoarthritis: study protocol for a randomized sham-controlled trial

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Kwok Yin Au ◽  
Haiyong Chen ◽  
Wing Chung Lam ◽  
Chiu On Chong ◽  
Andrew Lau ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Study Protocol ◽  
Controlled Trial ◽  
Sinew Acupuncture

scholarly journals From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Sara Söling ◽  
◽  
Juliane Köberlein-Neu ◽  
Beate Sigrid Müller ◽  
Truc Sophia Dinh ◽  
...  
Keyword(s):  
Decision Making ◽  
Formative Evaluation ◽  
Clinical Decision Making ◽  
Code Of Ethics ◽  
Controlled Trial ◽  
Implementation Process ◽  
Clinical Decision ◽  
Group Behavior ◽  
Control Group ◽  
Implementation Barriers

Abstract Objective Formative evaluation of the implementation process for a digitally supported intervention in polypharmacy in Germany. Qualitative research was conducted within a cluster randomized controlled trial (C-RCT). It focused on understanding how the intervention influences behavior-related outcomes in the prescription and medication review process. Methods/setting Twenty-seven general practitioners (GPs) were included in the study in the two groups of the C-RCT, the intervention, and the wait list control group. Behavior-related outcomes were investigated using three-step data analysis (content analytic approach, documentary method, and design of a model of implementation pathways). Results Content analysis showed that physicians were more intensely aware of polypharmacy-related risks, described positive learning effects of the digital technology on their prescribing behavior, and perceived a change in communication with patients and pharmacists. Conversely, they felt uncertain about their own responsibility when prescribing. Three main dimensions were discovered which influenced adoption behavior: (1) the physicians’ interpretation of the relevance of pharmaceutical knowledge provided by the intervention in changing decision-making situations in polypharmacy; (2) their medical code of ethics for clinical decision making in the context of progressing digitalization; and (3) their concepts of evidence-based medicine on the basis of professional experiences with polypharmacy in primary care settings. In our sample, both simple and complex pathways from sensitization to adoption were observed. The resulting model on adoption behavior includes a paradigmatic description of different pathways and a visualization of different observed levels and applied methodological approaches. We assumed that the GP habitus can weaken or strengthen interventional effects towards intervention uptake. This formative evaluation strategy is beneficial for the identification of behavior-related implementation barriers and facilitators. Conclusion Our analyses of the adoption behavior of a digitally supported intervention in polypharmacy revealed both simple and complex pathways from awareness to adoption, which may impact the implementation of the intervention and therefore, its effectiveness. Future consideration of adoption behavior in the planning and evaluation of digitally supported interventions may enhance uptake and support the interpretation of effects. Trial registration NCT03430336, 12 February 2018.

scholarly journals Value-impregnated factual claims may undermine medical decision-making

2018 ◽  
Vol 13 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Niels Lynøe ◽  
Gert Helgesson ◽  
Niklas Juth
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Personal Values ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Medical Decision ◽  
Clinical Decisions ◽  
Soft Laws

Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor–patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients’ influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff’s personal values influence clinical decision-making.

scholarly journals Nortriptyline in knee osteoarthritis (NortIKA Study): study protocol for a randomised controlled trial

Trials ◽  
2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Ben Hudson ◽  
Jonathan A. Williman ◽  
Lisa K. Stamp ◽  
John S. Alchin ◽  
Gary J. Hooper ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Knee Osteoarthritis ◽  
Study Protocol ◽  
Controlled Trial ◽  
Randomised Controlled
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