Functional Recovery in Hip Fracture Patients: a Real-practice Pilot Study Comparing Different Rehabilitation Settings

Abstract Background: Hip fractures are a major source of disability in the elderly and rehabilitation is mandatory to recover pre-fracture functioning. To date, there is a big heterogeneity not only in terms of frequency and timing but also of choosing the most appropriate setting for hip fracture rehabilitation. In this real-practice pilot study we aimed at evaluating the long-term effects of rehabilitative intervention on disability status and functional outcomes in post-hip fracture elderly people.Methods: We included patients aged 65 years or older who had undergone surgical stabilization of a hip fracture. Exclusion criteria: pathological fractures or whose comorbidities could have an impact on motor, cognitive or sensory function. The sample was divided into 3 groups according to their destination after hospital discharge: Group 1, outpatient rehabilitation; Group 2, inpatient rehabilitation; Group 3, home-based rehabilitation. All three groups underwent a specific rehabilitation protocol for 3 times/week for 2 months. At the baseline (T0), at 3 months (T1), and at 6 months after fracture (T2), we assessed as outcome measures: Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, Medical Research Council scale (MRC) to assess muscle strength in hip flexion, hip abduction, and knee extension.Results: All three groups showed an average statistically significant improvement (p<0.05) in all the outcome measures compared to baseline, except for MRC of knee extension in group 3 at T1. Considering the between-group analysis, BI was significantly higher in Group 1 than in Group 2 at T2 (p=0.018).Conclusions: Taken together, our findings show that rehabilitation could lead to a significant improvement in functional recovery, independently from the settings, albeit outpatient rehabilitation seems to be the best option for hip fracture patients.

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MON-594 The Peculiarity of the Gut Microbiota in Patients with Different Phenotypes of Obesity (Pilot Study)

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1200 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Natalia Volkova ◽

Julia Naboka ◽

Lilia Ganenko ◽

Oksana Oksenuk ◽

Ilia Davidenko ◽

...

Keyword(s):

Pilot Study ◽

Gut Microbiota ◽

Nutrition Education ◽

Control Group ◽

Metabolically Healthy Obesity ◽

Detection Frequency ◽

Group 3 ◽

Metabolically Healthy ◽

Group 2 ◽

Group 1

Abstract Recent studies have shown that obesity is not a homogeneous condition and that there is a subgroup of people with obesity, but without metabolic disturbance. This phenotype of obesity is called “metabolically healthy obesity” (MHO) [1]. More and more data are appearing in the scientific literature, indicating that quantitative and qualitative changes in the gut microbiota (GM) can be a trigger in the development of obesity and metabolic disorders [2]. In order to study the role of GM in the development of various types of obesity, 37 patients were examined, divided into 3 groups: group 1 (n = 11) - healthy people without obesity and overweight (control), group 2 (n = 13) - patients with MHO, group 3 (n = 13) - patients with metabolically unhealthy obesity (MUHO). The basic metabolic parameters were determined for all of them and a quantitative assessment of the condition of the GM was performed using the Real-time PCR method. Results: 1. In people from the control group (group 1) in the GM, compared with formal normative indicators, the number of Lactobacillus spp., Bifidobacterium spp., B. thetaiotaomicron was reduced (p<0.05) and indicators of the total bacterial mass and Enterobacter spp./Citrobacter spp. were increased (p<0.05). 2. In subjects with MHO (group 2), GM changes similar to group 1 were observed. However, in comparison to group 1, Klebsiella spp. and Proteus spp. were recorded in feces in quantities exceeding the formal regulatory. In patients with MUHO (group 3), in addition to changes detected in group 2, C. difficile was found in feces, as well as a significant (p <0.05) decrease in F. prausnitzii and an increase (p <0.05) in the detection frequency of banal E.coli, as well as the more diverse composition of the microbiota. Thus, the data obtained as a result of a pilot study certainly indicate changes in the GM in people with different phenotypes of obesity and in healthy ones. Further study of the GM in patients with various types of obesity, but in a larger groups, is required. Reference: 1) Phillips C.M. Metabolically healthy obesity across the life course: epidemiology, determinants and implications. Ann N.Y. Acad Sci 2017 Mar;139(1):85-100.doi:10.1111/nyas.13230. 2). Giovanna Muscogiuri, Elena Cantone, Sara Cassarano, Dario Tuccinardi, Luigi Barrea, Silvia Savastano, Annamaria Colao & on behalf of the Obesity Programs of nutrition, Education, Research and Assessment (OPERA) group. Gut microbiota: a new path to treat obesity. International Journal of Obesity Supplements 2019 Apr;9(1):10-19. doi: 10.1038/s41367-019-0011-7

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An exploratory pilot study evaluating the supplementation of standard antibiotic therapy with probiotic lactobacilli in south African women with bacterial vaginosis

BMC Infectious Diseases ◽

10.1186/s12879-019-4425-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Harold Marcotte ◽

Per Göran Larsson ◽

Kasper Krogh Andersen ◽

Fanglei Zuo ◽

Lasse Sommer Mikkelsen ◽

...

Keyword(s):

Pilot Study ◽

Bacterial Vaginosis ◽

South African ◽

Oral Antibiotic ◽

Once Daily ◽

Group 3 ◽

Group 2 ◽

Probiotic Lactobacilli ◽

Cure Rates ◽

Group 1

Abstract Background To reduce acquisition and relapse of bacterial vaginosis (BV), lactobacilli must be maintained in the vaginal microbiome. Probiotic lactobacilli may aid this purpose. We investigated whether vaginal probiotics (containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869) would result in vaginal colonisation with lactobacilli in women with and without BV. Methods This prospective, partially randomised, exploratory pilot study was conducted in Soweto, South Africa. Thirty-nine sexually-active, HIV negative women were enrolled from October 2014 to May 2016 into three arms. Women who did not have BV (Group 1, n = 13) self-administered probiotic capsules vaginally once daily for 30 days, then once a week until Day 190. Women diagnosed with BV were randomized into Group 2 (n = 12) or Group 3 (n = 14) and treated with the triple oral antibiotic combination for vaginal discharge syndrome per South African guidelines (cefixime 400 mg stat, doxycycline 100 mg BD for 7 days and metronidazole 2 g stat). Immediately after antibiotic treatment, women in Group 2 self-administered probiotic capsules vaginally once daily for 30 days then vaginally once a week until Day 190. Women in Group 3 were not given lactobacilli. Results During the study, L. rhamnosus DSM 14870 or L. gasseri DSM 14869, were isolated in 5/13 (38.5%) women in Group 1 compared to 10/12 (83.3%) women in Group 2 (p = 0.041). The 1-month and 6-month BV cure rates were similar (P > 0.05) between Group 2 (42 and 25%) compared to Group 3 (36 and 25%). In Group 2, no correlation was observed between the frequency of isolation of the two Lactobacillus strains and the 1-month or 6-month cure rate. Conclusions Supplementation with vaginal probiotic capsules resulted in colonisation of the vagina by the Lactobacillus strains (L. rhamnosus DSM 14870 and L. gasseri DSM 14869) contained in the capsules. We observed low initial cure rates of BV after a stat dose of metronidazole and that the probiotic did not improve BV cure rates or alleviate recurrence which could be due to treatment failure or very limited power of the study. Trial registration Registered at the Pan African Clinical Trial Registry (www.pactr.org) on April 13, 2018 (retrospectively registered). Trial identification number: PACTR201804003327269.

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Cognitive training for robotic surgery: a chance to optimize surgical training? A pilot study

Journal of Robotic Surgery ◽

10.1007/s11701-020-01167-3 ◽

2020 ◽

Author(s):

Sandra Schönburg ◽

Petra Anheuser ◽

Jennifer Kranz ◽

Paolo Fornara ◽

Viktor Oubaid

Keyword(s):

Pilot Study ◽

Cognitive Training ◽

Training Session ◽

Cost Effective ◽

Control Group ◽

Training Simulator ◽

Neo Personality Inventory ◽

Group 3 ◽

Group 2 ◽

Group 1

AbstractThe rapid rise of robotic-assisted surgery (RAS) has necessitated an efficient and standardized training curriculum. Cognitive training (CT) can significantly improve skills, such as attention, working memory and problem solving, and can enhance surgical capacity and support RAS training. This pilot study was carried out between 02/2019 and 04/2019. The participants included 33 student volunteers, randomized into 3 groups: group 1 received training using the da Vinci training simulator, group 2 received computer-based cognitive training, and group 3 was the control group without training. Before (T1) and after-training (T2), performance was measured. Additionally, expert ratings and self-evaluations were collected. Subjective evaluations of performance were supplemented by evaluations based on three scales from the revised NEO Personality Inventory (NEO PI-R). In total, 25 probands remained with complete data for further analyses: n = 8 (group 1), n = 7 (group 2) and n = 10 (group 3). There were no significant differences in T1 and T2 among all three groups. The average training gain of group 1 and 2 was 15.87% and 24.6%, respectively, (a restricting condition is the loss of the last training session in group 2). Analyses of semi-structured psychological interviews (SPIs) revealed no significant differences for T1, but in T2, significance occurred at ‘self-reflection’ for group 2 (F(2.22) = 8.56; p < .005). The efficacy of CT in training highly complex and difficult procedures, such as RAS, is a proven and accepted fact. Further investigation involving higher numbers of training trials (while also being cost effective) should be performed.

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The clinical and histological effects of Dermagraft® in the healing of chronic venous leg ulcers

Phlebology The Journal of Venous Disease ◽

10.1258/026835503321236858 ◽

2003 ◽

Vol 18 (1) ◽

pp. 12-22 ◽

Cited By ~ 13

Author(s):

Latha Krishnamoorthy ◽

Keith Harding ◽

David Griffiths ◽

Keith Moore ◽

David Leaper ◽

...

Keyword(s):

Pilot Study ◽

Control Group ◽

Venous Disease ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Compression Bandaging ◽

Group 4 ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: Pilot study to assess the safety and effectiveness of Dermagraft® when used in conjunction with multi-layer compression bandage therapy (Profore™) compared with multilayer compression only in the treatment of chronic venous leg ulcers. Design: Open-label, prospective, multicentre, randomized, controlled clinical trial. Methods: Patients aged at least 18 years with leg ulceration of venous aetiology were screened for inclusion in the trial. Patients with arterial disease (ankle brachial pressure index <0.7) and causes of ulceration other than venous disease were excluded. Patients were randomized into four groups. Three active treatment groups received Dermagraft® in combination with compression bandaging, Profore™: Group 1, 12 pieces of Dermagraft (one per week for 12 weeks); Group 2, four pieces of Dermagraft (Weeks 0, 1, 4, 8); Group 3, one piece of Dermagraft (Week 0). The control group was treated with compression bandaging alone (Group 4). The study was not powered to detect statistical differences in healing rates. Adverse events were reported according to national guidelines. There was no statistical analysis of adverse event data. Results: In all 53 patients were randomized, of whom 47 completed the study per protocol. At 12 weeks complete healing of the ulcer, analysed by 'intention-to-treat' (ITT) was 15% using Profore alone, 7% using single application Dermagraft and Profore (Group 3), compared with 38% using multiple applications of Dermagraft and Profore (Groups 1 and 2). At study discontinuation, the median percentage reduction in wound area was 81.4% for Group 1, 88.6% for Group 2, 59.4% for Group 3 and 78.1% for Group 4. No major safety issues were identified during the course of the study. Conclusions: The results of the pilot study indicate that four pieces of Dermagraft are the optimal application frequency to take forward to further clinical trials. Further studies are required to confirm these data, and these should be powered to detect whether there are statistical differences in healing rates and safety between different regimens.

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The fibromyalgia patients would present higher levels of magnification that controls pain: A pilot study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.492 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S205-S206

Author(s):

K. Cabas-Hoyos ◽

J.L. Muñoz-Salgado ◽

I. Cadavid-Perez ◽

L. De Hoyos ◽

G. Gonzalez-Gamero ◽

...

Keyword(s):

Pilot Study ◽

Clinical Population ◽

Healthy Group ◽

Dsm 5 ◽

American College Of Rheumatology ◽

Group 3 ◽

Mental Perception ◽

Group 2 ◽

Competing Interest ◽

Group 1

Catastrophism is a variable of great importance in the study of pain. Catastrophism refers to a negative and exaggerated compared to the experience of pain, both real and anticipated mental perception (Sullivan, Bishop and Pivik, 1995; Sullivan et al., 2001). The current study to compare the levels of catastrophism in patients with and without fibromialgia. This study is cross-cutting and comparative. Twenty participants (M: 47.20; SD: 12.11) distributed as the following way:– group 1: patients with fibromyalgia previously diagnosed through the American College of Rheumatology criteria (n = 10);– group 2: Clinical depression, defined according to the DSM-5 (n = 5);– group 3: healthy patients (n = 5) paired by age with the group of Fibromyalgia.The PCS, a self-administered, was used to measure Catastrophism. Responses were summed to yield three different subscales: Rumination, Magnification and Helplessness. This instrument is validated in both experimental and clinical population (Van Damme, Crombez, Bijttebier, Gouber and Van Houdenhove, 2002; Edwards et al., 2006). A comparison among the three groups was established using one-way factor ANOVA. The results point out that patients with fibromyalgia have higher levels of magnification controls with depression and healthy group (P < 0.05). In contrast, although the average level of Catastrophism total presented a greater tendency in fibromyalgia patients no statistically significant differences were found. This is discussed in relation to the literature, a higher level of magnification to explain pain and maintaining the chronicity of the disease. It is important to consider the component catastrophism to have a multidimensional view of pain.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients

Geriatrics ◽

10.3390/geriatrics6030083 ◽

2021 ◽

Vol 6 (3) ◽

pp. 83

Author(s):

Margarida Mota Freitas ◽

Sara Antunes ◽

Diana Ascenso ◽

Alda Silveira

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Outcome Measures ◽

Group Analysis ◽

Inpatient Rehabilitation ◽

The Elderly ◽

Knee Extension ◽

Outpatient Rehabilitation ◽

Home Based ◽

Hip Flexion

Femoral neck fractures are a major source of disability in the elderly. Rehabilitation is fundamental to recover pre-fracture functionality. We conducted an observational cohort study with the aim of comparing the efficacy of rehabilitation programs in different therapeutic settings. We included elderly patients who had undergone surgical stabilization of a hip fracture. The participants were divided into 3 groups: group 1, outpatient rehabilitation; group 2, inpatient rehabilitation; group 3, home-based rehabilitation. Patients were evaluated at baseline, at three months, and at six months after fracture. Our outcome measures were the Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, and muscle strength in hip flexion, abduction, and knee extension. At six months, all three groups showed an average statistically significant improvement (p < 0.05) in all outcome measures compared to the baseline. Considering the between-group analysis, final BI was significantly higher in outpatient than inpatient-treated patients (p = 0.018), but no statistical difference was found between outpatient and home-based patients. Our findings suggest that rehabilitation leads to significant functional recovery after hip fracture in elderly patients. Both outpatient and home-based rehabilitation seem to be reasonable options for hip fracture rehabilitation.

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The relationship between obesity, cardiometabolic disorders and disease activity in psoriatic arthritis patients: data from the Russian register

Terapevticheskii arkhiv ◽

10.26442/00403660.2021.05.200789 ◽

2021 ◽

Vol 93 (5) ◽

Author(s):

Yuliia L. Korsakova ◽

Tatiana V. Korotaeva ◽

Elena I. Loginova ◽

Elena E. Gubar ◽

Elizaveta A. Vasilenko ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Lower Treatment ◽

Cardiometabolic Disorders ◽

High Incidence ◽

Group 3 ◽

Group 2 ◽

Real Practice ◽

The Relationship ◽

Group 1

Aim. To study the relationship between obesity, cardiometabolic disorders and disease activity in patients with psoriatic arthritis (PsA) in real practice. Materials and methods. The Russian register included 614 PsA patients [female 331 (54%)/283 (46%)]. Average age 45.20.52 years, PsA duration 5.70.27 years, psoriasis 15.710.56 years. Patients underwent examination, body mass index (BMI), PsA activity according to DAPSA, cDAPSA, analysis of concomitant diseases were assessed. The patients were divided into 3 groups depending on BMI (kg/m2): normal 25 (group 1), increased 2530 (group 2), obesity 30 (group 3). Results. The average BMI was 27.70.23 kg/m2, normal BMI in 213 (34.7%), increased in 214 (34.8%) and obesity in 187 (30.5%). Concomitant diseases in 297 (48%). In group 3, arterial hypertension was observed significantly more often than in groups 1 and 2 (p0.0001); more often than in group 2 diabetes mellitus (p0.0001), metabolic syndrome (p0.0001); more often than in group 1 ischemic heart disease (p=0.026). PsA activity at Baseline, after 6/12 months was significantly higher in group 3 (p0.031). In obese patients, the chance of a decrease in disease activity to a moderate/low level and remission during therapy for 6/12 months is 2.484 times lower than in group 1, and 2.346 times lower than in group 2: odds ratio 2.346 (95% сonfidence interval 1.075.143) and 2.484 (95% сonfidence interval 1.1355.439), respectively. Conclusion. In the majority (65.3%) of PsA patients, BMI exceeded the norm. Obesity is associated with a high incidence of cardiometabolic disorders, with higher PsA activity and lower treatment efficacy.

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Transition to Telehealth Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement: A Pilot Study With Retrospective Matched-Cohort Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121997469 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199746

Author(s):

Brandy S. Horton ◽

Jennifer D. Marland ◽

Hugh S. West ◽

James D. Wylie

Keyword(s):

Pilot Study ◽

Physical Therapy ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Cohort Analysis ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Therapy Team ◽

Group 1

Background: Telehealth use has increased significantly of late. However, outside of total hip and knee arthroplasty, there is minimal evidence regarding its efficacy in orthopaedics and postoperative rehabilitation. Purpose: To determine the efficacy and cost-effectiveness of a transition to postoperative telehealth physical therapy in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients undergoing postoperative physical therapy after hip arthroscopy for FAI. The intervention group consisted of patients undergoing initial in-person visits followed by a transition to telehealth physical therapy for 3 months postoperatively (group 1; n = 17). Comparison groups included patients undergoing in-person physical therapy with the same physical therapy team as the telehealth group (group 2; n = 17) and patients undergoing in-person therapy with a different therapy team at the same facility (group 3; n = 17). All groups were matched 1-to-1 by patient age and sex. All patients completed the short version of the International Hip Outcome Tool (iHOT-12) both preoperatively and at 3 months postoperatively. At 3 months postoperatively, it was determined whether patients met the minimally clinically important difference (MCID; ≥13 points) or substantial clinical benefit (SCB; ≥28 points) or whether they reached a Patient Acceptable Symptomatic State (PASS; ≥64 points). Billed charges were recorded as a measure of cost. Results: The overall mean age of the study patients ranged from 33 to 34 years. Among the 3 groups, there was no significant difference in the preoperative, postoperative, or pre- to postoperative change in iHOT-12 scores or in the percentage of patients meeting MCID, SCB, or PASS at 3 months. Group 1 had significantly lower mean costs ($1015.67) compared with group 2 ($1555.62; P = .011) or group 3 ($1896.38; P < .001). Conclusion: In this pilot study, telehealth physical therapy after hip arthroscopy was found to lead to similar short-term outcomes and was cost-effective compared with in-person physical therapy.

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Computer Kinesiology: New Diagnostic and Therapeutic Tool for Lower Back Pain Treatment (Pilot Study)

BioMed Research International ◽

10.1155/2020/2987696 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Pavla Honcu ◽

Petr Zach ◽

Jana Mrzilkova ◽

Dobroslava Jandova ◽

Vladimir Musil ◽

...

Keyword(s):

Back Pain ◽

Pilot Study ◽

Chronic Back Pain ◽

Pain Treatment ◽

Medical Information System ◽

Control Group ◽

Pain Group ◽

Group 3 ◽

Group 2 ◽

Group 1

The aim of this study was to demonstrate the effectiveness of the diagnostic and therapeutic medical information system Computer Kinesiology in physiotherapy in patients with low back pain who were not responding to conventional therapy. Computer Kinesiology is primarily intended for the diagnostics and therapy of functional disorders of the locomotor system. This pilot study population included 55 patients (Group 1) with acute and chronic back pain and 51 persons (Group 2) without back pain. The third group was a control group of 67 healthy volunteers with no evidence of musculoskeletal pathologies and no back pain. All 173 subjects were examined three times by the diagnostic part of the Computer Kinesiology method. Groups 1 and 2 were treated after every diagnostics. Group 3 was not treated. The effect was evaluated by H score. Improvements after therapy were defined by reducing the H score by at least 1 point. In Group 1, the H score decreased by at least 1 point in 87.3% (95% CI: 75.5-94.7) and in Group 2 in 78.4% (95% CI: 64.7-88.7). There was no change of distribution of H Score grade in Group 3. The improvement neither depended on gender, age, and BMI nor was it influenced by the length of the therapy. This study demonstrated a high therapeutic efficacy of the Computer Kinesiology system in patients with back pain (Group 1) and in persons without back pain (Group 2) who used the Computer Kinesiology system for primary and secondary prevention of back pain.

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Use of SMS and tablet computer improves the electronic collection of elective orthopaedic patient reported outcome measures

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184900769 ◽

2014 ◽

Vol 96 (5) ◽

pp. 348-351 ◽

Cited By ~ 19

Author(s):

N Roberts ◽

B Bradley ◽

D Williams

Keyword(s):

Pilot Study ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Tablet Computer ◽

Web Based ◽

Patient Reported ◽

Group 3 ◽

Group 2 ◽

Group 1

Introduction Electronic patient reported outcome measures (PROMs) enable real time reporting back to the patient and medical team, comparison between similar patient cohorts and long-term cost effective outcome measurement. The primary objective of this three-phase pilot study was to measure uptake using a web-based PROM system following the introduction of two separate process improvements. Methods Eighty consecutive new elective orthopaedic patients in a single surgeon’s practice were recruited for the study. Patients in Group 1 (n=26) received only a letter reminding them to complete a symptom score. Those in Group 2 (n=31) also received a reminder SMS (short message service) message via their mobile or home telephone and those in Group 3 (n=23) also had access to a tablet computer in clinic. Results The mean patient age in Group 1 was 55 years (range: 24–80 years), in Group 2 it was 60 years (range: 23–85 years) and in Group 3 it was 58 years (range: 37–78 years) (p>0.05). Overall, 79% of patients had internet access, and 35% of Group 1, 55% of Group 2 and 74% of Group 3 recorded an electronic PROM score (p=0.02). In Group 3, 94% of patients listed for an operation completed an electronic PROM score (p=0.006). Conclusions Collecting PROM data effectively in everyday clinical practice is challenging. Electronic collection should meet that challenge and improve healthcare delivery but it is in its infancy. This pilot study shows that the combination of an SMS reminder and access to a Wi-Fi enabled tablet computer in the clinic setting enabled 94% of patients listed for an operation to complete a score on a web-based clinical outcomes system. Additional staff training and telephone call reminders may further improve uptake.

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