Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence

2015 ◽  
Vol 24 (4) ◽  
pp. 413-418 ◽  
Author(s):  
Scott W. Cheatham ◽  
Keelan R. Enseki ◽  
Morey J. Kolber
Keyword(s):  
Systematic Reviews ◽  
Hip Arthroscopy ◽  
Evidence Synthesis ◽  
Initial Period ◽  
Weight Bearing ◽  
Case Series ◽  
The Body ◽  
Future Research ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Programs

Context:Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation.Objective:To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint.Evidence Acquisition:A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.Evidence Synthesis:Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials.Conclusion:This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.

Postoperative Rehabilitation After Hip Resurfacing: A Systematic Review

2016 ◽  
Vol 25 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Scott Cheatham ◽  
Monique Mokha ◽  
Matt Lee
Keyword(s):  
Systematic Review ◽  
Evidence Synthesis ◽  
Case Series ◽  
Hip Resurfacing ◽  
The Body ◽  
Harris Hip Score ◽  
Postoperative Rehabilitation ◽  
Hip Resurfacing Arthroplasty ◽  
Resurfacing Arthroplasty ◽  
Rehabilitation Programs

Context:Hip-resurfacing arthroplasty (HRA) has become a popular procedure in the treatment of hip-joint arthritis in individuals under the age of 65 y. Although the body of literature examining operative procedures has grown, there is a lack of consistent reporting of the effectiveness of an HRA postoperative rehabilitation program. To date, no systematic reviews have evaluated the available evidence on postoperative rehabilitation programs.Objective:To evaluate the available evidence on postoperative rehabilitation programs after HRA.Evidence Acquisition:A systematic review was conducted according to the PRISMA guidelines. A search of PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar was conducted in April 2014 using the following keywords alone and in combination: postoperative, postsurgical, rehabilitation, physical therapy, programs, hip resurfacing, arthroplasty, and metal-on-metal. The grading of studies was conducted using the PEDro and Oxford Centre for Evidence-Based Medicine scales.Evidence Synthesis:The authors identified 648 citations, 4 of which met the inclusion criteria. The qualifying studies yielded 1 randomized control trial, 2 case reports, and 1 case series, for a total of 90 patients. Patients were mostly male (n = 86), had a mean age of 48 ± 5.47 y, and had been physically active before HRA. Postoperative rehabilitation programs varied in length (range 8–24 wk) and consisted of at least 3 phases. The methodology to assess program effects varied, but all 4 studies did measure a combination of function, pain, and quality of life using written questionnaires, with follow-up ranging from 9 mo to 1 y. The most common questionnaire was the Harris Hip Score.Conclusion:This review found postoperative rehabilitation programs after HRA to be underinvestigated. Limited results indicate that postoperative rehabilitation programs may be effective in improving gait (stride length, velocity, and cadence), hip range of motion, and pain and function, as measured by questionnaires, but not hip strength.

Dysregulation of the Hypothalamic-Pituitary-Testicular Axis due to Energy Deficit

2021 ◽  
Author(s):  
Mathis Grossmann ◽  
Gary A Wittert
Keyword(s):  
Evidence Synthesis ◽  
Case Series ◽  
Serum Testosterone ◽  
Energy Deficit ◽  
Future Research ◽  
Clinical Consequences ◽  
Thyroid Axis ◽  
Healthy Body Weight ◽  
Gonadotrophin Releasing Hormone ◽  
Hpt Axis

Abstract Context While gonadal axis dysregulation due to energy deficit is well recognised in women, the effects of energy deficit on the male gonadal axis have received much less attention. Evidence acquisition To identify relevant articles, we conducted PubMed searches from inception to May 2021. Evidence synthesis Case series and mechanistic studies demonstrate that energy deficit (both acutely over days or chronically over months) either due to inadequate energy intake and/or excessive energy expenditure can lower serum testosterone concentration as a result of hypothalamic-pituitary-testicular (HPT) axis dysregulation in men. The extent to which this has clinical consequences that can be disentangled from the effects of nutritional insufficiency, concomitant endocrine dysregulation (e.g., adrenal and thyroid axis), and co-existing comorbidities (e.g., depression and substance abuse) is uncertain. HPT axis dysfunction is primarily due to the loss of Gonadotrophin Releasing Hormone (GnRH) pulsatility resulting from a failure of leptin to induce kisspeptin signaling. The roles of neuroendocrine consequences of depression, hypothalamic-pituitary-adrenal axis activation, proinflammatory cytokines, Ghrelin and genetic susceptibility remain unclear. In contrast to hypogonadism due to organic pathology of the HPT axis, energy deficit-associated HPT dysregulation is functional, and generally reversible by restoring energy balance. Conclusions The clinical management of such men should aim to restore adequate nutrition and achieve and maintain a healthy body weight. Psychosocial co-morbidities must be identified and addressed. There is no evidence that testosterone treatment is beneficial. Many knowledge gaps regarding epidemiology, pathophysiology, and treatment remain and we highlight several areas that require future research.

A Stepwise Approach to Systematic Reviews and Meta-analyses of Endovascular Interventions

2020 ◽  
Vol 27 (5) ◽  
pp. 805-817
Author(s):  
George A. Antoniou ◽  
Giuseppe Biondi-Zoccai ◽  
Francesco Versaci ◽  
Stavros A. Antoniou
Keyword(s):  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Evidence Base ◽  
Future Research ◽  
Specific Topic ◽  
Stepwise Approach ◽  
Endovascular Interventions ◽  
Statistical Precision ◽  
Meta Analyses

The accrual of clinical studies poses important challenges to researchers and practitioners, especially in the field of endovascular therapy, where patient, lesion, technique, and device subtleties abound. Systematic reviews and meta-analyses may prove particularly fruitful in such settings by increasing statistical precision and bolstering external validity if the evidence base on a specific topic is consistent or by highlighting important discrepancies in the opposite scenario. However, mastering the correct approach to systematic review and meta-analysis is challenging for careful readers or for those interested in conducting such an evidence synthesis exercise. The present article highlights a stepwise approach to systematic reviews and meta-analyses, focusing on endovascular interventions, which will prove useful to anyone reading or wishing to synthesize the evidence base on endovascular topics to optimize decision making or shape future research efforts.

scholarly journals Do manual therapies have a specific autonomic effect? An overview of systematic reviews

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260642
Author(s):  
Sonia Roura ◽  
Gerard Álvarez ◽  
Ivan Solà ◽  
Francesco Cerritelli
Keyword(s):  
Manual Therapy ◽  
Systematic Reviews ◽  
Risk Of Bias ◽  
The Body ◽  
Manual Therapies ◽  
Body Region ◽  
Future Research ◽  
Overview Of Systematic Reviews ◽  
Therapy Interventions ◽  
The Impact

Background The impact of manual therapy interventions on the autonomic nervous system have been largely assessed, but with heterogeneous findings regarding the direction of these effects. We conducted an overview of systematic reviews to describe if there is a specific autonomic effect elicited by manual therapy interventions, its relation with the type of technique used and the body region where the intervention was applied. Methods We conducted an overview according to a publicly registered protocol. We searched the Cochrane Database of Systematic Reviews, MEDLINE, EPISTEMONIKOS and SCOPUS, from their inception to march 2021. We included systematic reviews for which the primary aim of the intervention was to assess the autonomic effect elicited by a manual therapy intervention in either healthy or symptomatic individuals. Two authors independently applied the selection criteria, assessed risk of bias from the included reviews and extracted data. An established model of generalisation guided the data analysis and interpretation. Results We included 12 reviews (5 rated as low risk of bias according the ROBIS tool). The findings showed that manual therapies may have an effect on both sympathetic and parasympathetic systems. However, the results from included reviews were inconsistent due to differences in their methodological rigour and how the effects were measured. The reviews with a lower risk of bias could not discriminate the effects depending on the body region to which the technique was applied. Conclusion The magnitude of the specific autonomic effect elicited by manual therapies and its clinical relevance is uncertain. We point out some specific recommendations in order to improve the quality and relevance of future research in this field.

scholarly journals Charcot knee — presentation, diagnosis, management — a scoping review

2021 ◽  
Author(s):  
Victor Lu ◽  
James Zhang ◽  
Azeem Thahir ◽  
Andrew Zhou ◽  
Matija Krkovic
Keyword(s):  
Scoping Review ◽  
Animal Studies ◽  
Case Reports ◽  
Weight Bearing ◽  
Case Series ◽  
Joint Effusion ◽  
Future Research ◽  
Charcot Arthropathy ◽  
Qualitative Synthesis ◽  
Entry Site

Abstract Background Charcot arthropathy is a progressive, non-infectious, destructive inflammatory process. Charcot arthropathy of the knee (CK) is rare and diagnosis is often delayed, resulting in detrimental outcomes. This scoping review aims to investigate the literature on CK, present the pathognomonic features of CK to aid early diagnosis, and suggest gaps in the literature for future research. Methods A systematic search of PubMed, EMBASE, Web of Science for literature relevant to CK was performed. Primary studies such as case reports, case series, retrospective studies were included. Review articles and animal studies were excluded. Results Of the 513 results, 58 were included in qualitative synthesis. Average time from symptom onset to CK diagnosis was 50.5 months. Eighteen and twenty-one studies included patients who had diabetes mellitus and syphilis, respectively. Twenty-one studies reported pain as a presenting complaint, but the degree of pain didn’t correspond with the level of destruction. Oedema and joint effusion were noticed in 34 studies. Twenty-nine studies reported lower limb hypoesthesia and 17 studies reported decreased tendon reflex. Twenty-eight studies reported initial conservative treatment, often in a knee brace with minimal weight bearing, 9 of which needed subsequent surgical management. Twelve studies utilised arthrodesis, with fracture at the intramedullary nail entry site being the most common complication. Twenty-four studies utilised TKA. Conclusion The literature on CK remains sparse, with most publications being case reports. Given that CK dramatically reduces quality of life, increases morbidity of patients, there is need for more literature on evidence-based options for early diagnoses and management.

Force Plate Analysis of Dogs with Bilateral Hip Dysplasia Treated with a Unilateral Triple Pelvic Osteotomy: A Long-term Review of Cases

1998 ◽  
Vol 11 (02) ◽  
pp. 85-93 ◽  
Author(s):  
Joanne R. Cockshutt ◽  
H. Dobson ◽  
C. W. Miller ◽  
D. L. Holmberg ◽  
Connie L. Taves ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Hip Dysplasia ◽  
Weight Bearing ◽  
Force Plate ◽  
Case Series ◽  
Pelvic Osteotomy ◽  
Vertical Force ◽  
Long Term Outcome ◽  
Case Series Study

SummaryA retrospective case series study was done to determine the long-term outcome of operations upon dogs treated for canine hip dysplasia by means of a triple pelvic osteotomy (TPO). Twentyfour dogs with bilateral hip dysplasia, that received a unilateral TPO between January 1988 and June 1995, were re-examined at the Ontario Veterinary College. The assessment included physical, orthopedic and lameness examinations, standard blood work, pelvic radiographs and force plate gait analysis. They were compared to bilaterally dysplastic dogs that had not been treated, and also to normal dogs. Force plate data analysis demonstrated a significant increase in peak vertical force (PVF) and mean vertical force over stance (MVF) in the limb that underwent surgical correction by means of a TPO, when compared to the unoperated hip. It was determined that performing a unilateral TPO on a young dysplastic dog resulted in greater forces and weight bearing being projected through the TPO corrected limb when compared to the unoperated limb.Dogs with bilateral hip dysplasia treated with a unilateral triple pelvic osteotomy (TPO) were assessed by force plate gait analysis, radiographs and orthopedic examination. There was a significant increase in hip Norberg angles over time, although degenerative changes did progress. Limbs that had been operated upon had significantly greater peak and mean ground reaction forces than limbs that had not received an operation.

scholarly journals Molecular Mechanisms of Insulin Resistance in Polycystic Ovary Syndrome: Unraveling the Conundrum in Skeletal Muscle?

2019 ◽  
Vol 104 (11) ◽  
pp. 5372-5381 ◽  
Author(s):  
Nigel K Stepto ◽  
Alba Moreno-Asso ◽  
Luke C McIlvenna ◽  
Kirsty A Walters ◽  
Raymond J Rodgers
Keyword(s):  
Insulin Resistance ◽  
Skeletal Muscle ◽  
Polycystic Ovary Syndrome ◽  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Polycystic Ovary ◽  
Evidence Synthesis ◽  
Basic Research ◽  
Future Research ◽  
Ovary Syndrome

Abstract Context Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting 8% to 13% of women across the lifespan. PCOS affects reproductive, metabolic, and mental health, generating a considerable health burden. Advances in treatment of women with PCOS has been hampered by evolving diagnostic criteria and poor recognition by clinicians. This has resulted in limited clinical and basic research. In this study, we provide insights into the current and future research on the metabolic features of PCOS, specifically as they relate to PCOS-specific insulin resistance (IR), that may affect the most metabolically active tissue, skeletal muscle. Current Knowledge PCOS is a highly heritable condition, yet it is phenotypically heterogeneous in both reproductive and metabolic features. Human studies thus far have not identified molecular mechanisms of PCOS-specific IR in skeletal muscle. However, recent research has provided new insights that implicate energy-sensing pathways regulated via epigenomic and resultant transcriptomic changes. Animal models, while in existence, have been underused in exploring molecular mechanisms of IR in PCOS and specifically in skeletal muscle. Future Directions Based on the latest evidence synthesis and technologies, researchers exploring molecular mechanisms of IR in PCOS, specifically in muscle, will likely need to generate new hypothesis to be tested in human and animal studies. Conclusion Investigations to elucidate the molecular mechanisms driving IR in PCOS are in their early stages, yet remarkable advances have been made in skeletal muscle. Overall, investigations have thus far created more questions than answers, which provide new opportunities to study complex endocrine conditions.

scholarly journals Music, Politics, and History: An Introduction

2021 ◽  
Vol 60 (2) ◽  
pp. 362-374
Author(s):  
David Kennerley
Keyword(s):  
Sound Studies ◽  
The Body ◽  
Future Research ◽  
Short Article ◽  
Distinctive Features ◽  
Music And Politics ◽  
Introductory Article ◽  
History Of ◽  
Eighteenth And Nineteenth Centuries ◽  
The Relationship

AbstractMusic has been steadily rising up the historical agenda, a product of the emergence of sound studies, the history of the senses, and a mood of interdisciplinary curiosity. This introductory article offers a critical review of how the relationship between music and politics has featured in extant historical writing, from classic works of political history to the most recent scholarship. It begins by evaluating different approaches that historians have taken to music, summarizes the important shifts in method that have recently taken place, and advocates for a performance-centered, contextualized framework that is attentive to the distinctive features of music as a medium. The second half examines avenues for future research into the historical connections between music and politics, focusing on four thematic areas—the body, emotions, space, and memory—and closes with some overarching reflections on music's use as a tool of power, as well as a challenge to it. Although for reasons of cohesion, this short article focuses primarily on scholarship on Britain and Ireland in the eighteenth and nineteenth centuries, its discussion of theory and methods is intended to be applicable to the study of music and political culture across a broad range of periods and geographies.

scholarly journals A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

2021 ◽  
pp. 1-22
Author(s):  
Sebastian Jugl ◽  
Aimalohi Okpeku ◽  
Brianna Costales ◽  
Earl J. Morris ◽  
Golnoosh Alipour-Haris ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
The Body ◽  
Medical Cannabis ◽  
High Quality ◽  
Chronic Noncancer Pain ◽  
High Quality Evidence ◽  
Improved Outcomes ◽  
Noncancer Pain ◽  
Study Setting

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016–2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn’s disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

scholarly journals Involvement of Probiotics and Postbiotics in the Immune System Modulation

Biologics ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 89-110
Author(s):  
Neslihan Yeşilyurt ◽  
Birsen Yılmaz ◽  
Duygu Ağagündüz ◽  
Raffaele Capasso
Keyword(s):  
Immune System ◽  
Pharmaceutical Industry ◽  
Intestinal Microbiota ◽  
Health Benefits ◽  
The Body ◽  
Future Research ◽  
Immune Systems ◽  
Advantages And Disadvantages ◽  
Immune System Modulation ◽  
Molecular Patterns

Intestinal microbiota interacts with other systems, especially the immune system, which is responsible for protecting the body by recognizing “stranger” (pathogen associated molecular patterns-PAMPs) and “danger” (damage-associated molecular patterns-DAMPs) molecular motifs. In this manner, it plays an important role in the pathogenesis of various diseases and health. Despite the use of probiotics that modulate the intestinal microbiota in providing health benefits and in the treatment of diseases, there are some possible concerns about the possibility of developing adverse effects, especially in people with suppressed immune systems. Since probiotics provide health benefits with bioactive compounds, studies are carried out on the use of products containing non-living probiotic microorganisms (paraprobiotics) and/or their metabolites (postbiotics) instead of probiotic products. It is even reported that these microbial compounds have more immunomodulatory activities than living microorganisms via some possible mechanism and eliminates some disadvantages of probiotics. Considering the increasing use of functional foods in health and disease, further studies are needed with respect to the benefits and advantages of parabiotic and/or postbiotic use in the food and pharmaceutical industry as well as immune system modulation. Although probiotics have been extensive studied for a long time, it seems that postbiotics are promising tools for future research and applications according to the recent literature. This review aimed to evaluate the interaction of probiotics and postbiotics with the immune systems and also their advantages and disadvantages in the area of food-pharmaceutical industry and immune system modulation.

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