scholarly journals Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12203
Author(s):  
Rudi Hansen ◽  
Mathilde Lundgaard-Nielsen ◽  
Marius Henriksen
Keyword(s):  
Knee Joint ◽  
Video Recording ◽  
Visual Assessment ◽  
Patellofemoral Pain ◽  
Interrater Agreement ◽  
Kappa Statistics ◽  
Clinical Tool ◽  
Easy Method ◽  
Cross Sectional ◽  
Agreement Study

Background Assessment of knee kinematics plays an important role in the clinical examination of patients with patellofemoral pain (PFP). There is evidence that visual assessments are reliable in healthy subjects, but there is a lack of evidence in injured populations. The purpose of this study was to examine the intra- and interrater agreement in the visual assessment of dynamic knee joint alignment in patients with PFP. Methods The study was a cross-sectional agreement study. Sixty participants (42 females) were included. We assessed the intra- and interrater agreement of two functional tests: The single leg squat (SLS) and the forward lunge (FL). One investigator scored the movement according to preset criteria while video recording the movement for retest. Moreover, the performance was scored by another investigator using the video recording. Agreement was assessed using weighted kappa statistics. Results The intrarater agreement ranged from moderate to good (Kappa 0.58 (FL) to 0.70 (SLS)) whereas the interrater agreement ranged from fair to moderate (Kappa 0.22 (SLS) to 0.50 (FL)). Conclusion The agreement within raters was better than between raters, which suggests that assessments should preferably be performed by the same tester in research and in a clinical setting, e.g., to evaluate any treatment effect. We promote FL as a reliable clinical tool for evaluating dynamic knee alignment, since it shows equally good intra- and interrater agreement, and it is an inexpensive and easy method to use.

Patellofemoral Pain Syndrome: Sensitivity Analysis of Muscle Parameters for Expedited Recovery Utilizing an OpenSim Model for Lower Extremities

2018 ◽  
Author(s):  
Adam Novotny ◽  
Manish Paliwal
Keyword(s):  
Knee Joint ◽  
Treatment Plan ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Cross Sectional ◽  
Joint Reaction Forces ◽  
Reaction Forces ◽  
Gastrocnemius Muscles ◽  
Joint Reaction

Patellofemoral pain syndrome (PFPS) is a musculoskeletal condition characterized by anterior knee pain. The symptoms associated with PFPS can be further aggravated through activities that increase patellofemoral compressive forces. Despite the number of mechanisms that are considered to contribute to this disorder, there is no consensus about its etiology, causing difficulty in prescribing the appropriate treatment or physical therapy. To properly evaluate PFPS, the influences of various muscles and their geometries on knee joint reaction forces for a human subject during a normal gait cycle were observed by conducting parametric analysis using OpenSim. The muscles that were seen to be most critical and have a potential effect in reducing the pain experienced at the knee joint are the soleus, iliopsoas, and gastrocnemius muscles. It was observed that individually increasing the length of the soleus and iliopsoas muscles from 75% to 125% of their default lengths resulted in decrease in knee joint reaction forces of up to 400 N (57%) in the x-direction and 600 N (40%) in the y-direction for the soleus and 550 N (38%) in the x-direction and 1000 N (29%) in the y-direction for the iliopsoas. It was also seen that by indirectly reducing the cross-sectional area of the gastrocnemius muscles from 125% to 75% of their default value resulted in decreases in knee joint reaction forces of up to 250 N (50%) in the x-direction and 500 N (42%) in the y-direction. Therefore, exercises should be advised to specifically stretch or strengthen the soleus and iliopsoas, and the gastrocnemius muscles should be rested. Pain and recovery time may be substantially reduced with the utilization of a targeted physiotherapy treatment plan. It can be coupled with longterm physiotherapy program for improving muscle fitness.

Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

2020 ◽  
Vol 18 (6) ◽  
pp. 658-661
Author(s):  
Mafalda Lemos Caldas ◽  
Miguel Julião ◽  
Ana João Santos ◽  
Harvey Max Chochinov
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Sectional Study ◽  
Clinical Tool ◽  
Cross Sectional ◽  
Old Patients ◽  
Promising Tool ◽  
Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

scholarly journals Neurophysiological changes of brain and spinal cord in individuals with patellofemoral pain: a systematic review and meta-analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049882
Author(s):  
Jing Nong Liang ◽  
Savanna Budge ◽  
Austin Madriaga ◽  
Kara Meske ◽  
Derrick Nguyenton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Quality Assessment ◽  
Meta Analysis ◽  
Neuromuscular Control ◽  
Patellofemoral Pain ◽  
Randomised Control Trial ◽  
Cross Sectional ◽  
Prospective Longitudinal ◽  
Brain And Spinal Cord

IntroductionReduced neuromuscular control due to altered neurophysiological functions of the central nervous system has been suggested to cause movement deficits in individuals with patellofemoral pain (PFP). However, the underlying neurophysiological measures of brain and spinal cord in this population remain to be poorly understood. The purpose of this systematic review is to evaluate the evidence for altered cortical and spinal cord functions in individuals with PFP.Methods and analysisThe protocol for conducting the review was prepared using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will systematically search the literature that examines cortical and spinal cord functions in individuals with PFP, aged 18–45 years. The studies for cross-sectional, prospective, longitudinal, case–control and randomised control trial designs will be included from the following databases: PubMed (MEDLINE), EMBASE and Web of Science. Only studies published in English prior to 1 February 2021 will be included. The risk of bias and quality assessment will be performed using National Institutes of Health’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We will conduct meta-analysis of the data where appropriate. Narrative synthesis will be taken if a meta-analysis is not possible.Ethics and disseminationThis is a systematic review from the existing literature and does not require ethical approval. The results of this study will be published in a peer-reviewed journal in the field of rehabilitation medicine, sports/orthopaedic medicine or neurology, regardless of the outcome.PROSPERO registration numberCRD42020212128.

scholarly journals Automated quantitative MRI volumetry reports support diagnostic interpretation in dementia: a multi-rater, clinical accuracy study

2021 ◽  
Author(s):  
Hugh G. Pemberton ◽  
◽  
Olivia Goodkin ◽  
Ferran Prados ◽  
Ravi K. Das ◽  
...  
Keyword(s):  
Visual Assessment ◽  
Quantitative Mri ◽  
Interrater Agreement ◽  
Clinical Image ◽  
Single Subject ◽  
Volume Loss ◽  
Brain Volumes ◽  
Additional Information ◽  
Clinical Accuracy ◽  
Accuracy Study

Abstract Objectives We examined whether providing a quantitative report (QReport) of regional brain volumes improves radiologists’ accuracy and confidence in detecting volume loss, and in differentiating Alzheimer’s disease (AD) and frontotemporal dementia (FTD), compared with visual assessment alone. Methods Our forced-choice multi-rater clinical accuracy study used MRI from 16 AD patients, 14 FTD patients, and 15 healthy controls; age range 52–81. Our QReport was presented to raters with regional grey matter volumes plotted as percentiles against data from a normative population (n = 461). Nine raters with varying radiological experience (3 each: consultants, registrars, ‘non-clinical image analysts’) assessed each case twice (with and without the QReport). Raters were blinded to clinical and demographic information; they classified scans as ‘normal’ or ‘abnormal’ and if ‘abnormal’ as ‘AD’ or ‘FTD’. Results The QReport improved sensitivity for detecting volume loss and AD across all raters combined (p = 0.015* and p = 0.002*, respectively). Only the consultant group’s accuracy increased significantly when using the QReport (p = 0.02*). Overall, raters’ agreement (Cohen’s κ) with the ‘gold standard’ was not significantly affected by the QReport; only the consultant group improved significantly (κs 0.41➔0.55, p = 0.04*). Cronbach’s alpha for interrater agreement improved from 0.886 to 0.925, corresponding to an improvement from ‘good’ to ‘excellent’. Conclusion Our QReport referencing single-subject results to normative data alongside visual assessment improved sensitivity, accuracy, and interrater agreement for detecting volume loss. The QReport was most effective in the consultants, suggesting that experience is needed to fully benefit from the additional information provided by quantitative analyses. Key Points • The use of quantitative report alongside routine visual MRI assessment improves sensitivity and accuracy for detecting volume loss and AD vs visual assessment alone. • Consultant neuroradiologists’ assessment accuracy and agreement (kappa scores) significantly improved with the use of quantitative atrophy reports. • First multi-rater radiological clinical evaluation of visual quantitative MRI atrophy report for use as a diagnostic aid in dementia.

scholarly journals AB0709 CHARACTERIZATION OF NAILFOLD CAPILLAROSCOPY IN COVID-19: A CASE CONTROL STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1386.2-1387
Author(s):  
P. E. Bermudez Bermejo ◽  
R. Jimenez-Soto ◽  
A. Sanchez Rodríguez ◽  
A. Turrent ◽  
D. Mercado Velasco ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Medical Center ◽  
Microvascular Complications ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Nailfold Capillaroscopy ◽  
Healthy Population ◽  
Healthy Controls ◽  
Clinical Tool ◽  
Cross Sectional

Background:Nailfold capillaroscopy is a relatively easy-to-access, low-cost clinical tool that could help identify early coagulopathy in subjects with SARS-CoV-2, but specific findings vs. controls and its possible prognostic role has not been studied.Objectives:To describe capillaroscopic findings and their usefulness in patients with COVID-19 compared to healthy controls.Methods:We designed a cross-sectional study, carried out in a single care center for critical patients with SARS-CoV-2 pneumonia at the ABC Medical Center, Mexico City, which included patients from an intensive care unit (ICU) and internal medicine ward from March to April 2020. Demographic, biochemical and clinical features were collected. All patients signed the informed consent and the study was approved by the hospital ethics committee. All patients underwent nail capillary imaging of the 3 central fingers of each hand with a portable microscope with 60-100x magnification coupled to a smartphone with 7 megapixel images in an immersion medium. Capillaroscopy was performed in patients who did not have fever or hypothermia, or need vasopressors at the time of evaluation. Control subjects are healthy subjects matched on age and sex from a database of healthy controls without rheumatic diseases. Image evaluation of COVID-19 patients was performed in a blinded way for their characteristics. Prior to the analysis of the images, a pilot test was obtained with 4 rheumatologists in random cases, obtaining an acceptable global agreement in the visualization of capillaries and specific alterations of the nail bed. (Kappa = 0.58, p = 0.0019). Obtained data from capillaroscopies were used to be compared between severe and moderate cases of SARS-CoV-2 pneumonia. Additionally, we compared the findings against a healthy population in order to establish a reference.Results:We included data from 27 patients and 32 controls with similar demographic features. Patients with COVID-19 patients had a mean age of 43 +/- 13.8 years, 63% female. Comorbidities were present in 44.4% with: type II Diabetes Mellitus 18.5%, systemic arterial hypertension 18.5%, and rheumatoid arthritis 3.7%. The mean length of stay time was 13 +/- 7.1 days, 48.1% were admitted to the ICU, and 40.7% required invasive mechanical ventilation. In the capillaroscopic review remarkable findings of patients vs. controls were hemosiderin deposits (33 vs 12.5%, p=0.05), less frequently observable capillaries (77 vs 100%, p=0.005), any abnormality in capillaries (25.9 vs. 6.3%, p=0.03). Of notice, specific findings in COVID-19 patients were capillary tortuosities in 19%, dilatation in 9.5%, serpentine pattern in 4.8%, bush pattern in 9.5% and decreased density in only 4.8% of the cases. No avascular areas or capillaries of neoformation were observed. Finally, the presence of hemosiderin was associated with worse presentation and risk factors for severe COVID-19: Male sex 66.7 vs. 27.8%, (p = 0.024); Admission to ICU 77% vs 33% (p = 0.029); BMI > 30 kg/m2 66.7 vs. 27.8% (p = 0.053). And risk for ICU admission OR = 7.0 (95% CI 1.098 - 44.6). No significant associations were found for abnormalities in capillary morphology.Conclusion:We present one of the first reports of nailfold capillaroscopic findings in patients with COVID-19 and the first to compare to healthy controls. Previous data on this regard suggests the presence of endothelial dysfunction and microvascular complications such as micro hemorrhage or micro thrombosis. Further studies may confirm these findings and prognostic value for worse outcomes in COVID-19 patients.References:[1]Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.[2]Cutolo M, Cortes S. capillaroscopic patterns in rheumatic diseases. Acta Reumatol Port. 2007 Jan-Mar;32(1):29-36.[3]Natalello G, De Luca G, Gigante L, et al. Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement. Microvasc Res. 2021;133:104071.Disclosure of Interests:None declared

scholarly journals Vacuum Dynamics as an Alternative Method for Detection of Bimodal Milk Ejection in Dairy Cows

Animals ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1860
Author(s):  
Matthias Wieland ◽  
Christina Marie Geary ◽  
Gloria Gioia ◽  
Kerry Lynn Case ◽  
Paolo Moroni ◽  
...  
Keyword(s):  
Dairy Cows ◽  
Predictive Value ◽  
Primary Objective ◽  
Cow Milk ◽  
Kappa Statistics ◽  
Flow Meter ◽  
Flow Curves ◽  
Cross Sectional ◽  
Gold Standard Method ◽  
Milk Flow

The primary objective of our study was to assess the ability of a vacuum recorder to detect the presence of bimodal milk flow curves in dairy cows compared with a portable milk flow meter. In a cross-sectional study, 241 individual cow milking observations were analyzed. We simultaneously collected (1) individual cow vacuum events during milking using portable vacuum recorders, and (2) individual cow milk flow curves by attaching a portable milk flow meter to the same milking unit. Presence of bimodality was assessed with the vacuum recorder visually (BIMVA) and with the gold standard method of a milk flow meter through automatic detection (BIMLA). Kappa statistics revealed moderate agreement between BIMVA and BIMLA [κ, 95% confidence intervals (95% CI) = 0.59 (0.46–0.71)]. Diagnostic test statistics for BIMVA for detection of bimodality indicated moderate performance for sensitivity [0.65 (0.52–0.76)] and positive predictive value [0.71 (0.58–0.82)] and high values for specificity [0.92 (0.87–0.95)] and negative predictive value [0.93 (0.84–0.93)]. We conclude that milking vacuum dynamics are a suitable measure to assess bimodal milk flow curves in dairy cows.

scholarly journals Medial knee joint contact force in the intact limb during walking in recently ambulatory service members with unilateral limb loss: a cross-sectional study

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e2960 ◽  
Author(s):  
Ross H. Miller ◽  
Rebecca L. Krupenevich ◽  
Alison L. Pruziner ◽  
Erik J. Wolf ◽  
Barri L. Schnall
Keyword(s):  
Knee Joint ◽  
Limb Loss ◽  
Service Members ◽  
Model Parameters ◽  
Joint Loading ◽  
Cross Sectional ◽  
Medial Knee ◽  
Knee Oa ◽  
Joint Contact ◽  
Intact Limb

BackgroundIndividuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading during walking would be greater in the intact limb of young US military service members with limb loss than in controls with no limb loss.MethodsCross-sectional instrumented gait analysis at self-selected walking speeds with a limb loss group (N = 10, age 27 ± 5 years, 170 ± 36 days since last surgery) including five service members with transtibial limb loss and five with transfemoral limb loss, all walking independently with their first prosthesis for approximately two months. Controls (N = 10, age 30 ± 4 years) were service members with no overt demographical risk factors for knee OA. 3D inverse dynamics modeling was performed to calculate joint moments and medial knee joint contact forces (JCF) were calculated using a reduction-based musculoskeletal modeling method and expressed relative to body weight (BW).ResultsPeak JCF and maximum JCF loading rate were significantly greater in limb loss (184% BW, 2,469% BW/s) vs. controls (157% BW, 1,985% BW/s), with large effect sizes. Results were robust to probabilistic perturbations to the knee model parameters.DiscussionAssuming these data are reflective of joint loading experienced in daily life, they support a “mechanical overloading” hypothesis for the risk of developing knee OA in the intact limb of limb loss subjects. Examination of the evolution of gait mechanics, joint loading, and joint health over time, as well as interventions to reduce load or strengthen the ability of the joint to withstand loads, is warranted.

scholarly journals VASTUS LATERALIS OBLIQUE ACTIVITY DURING GAIT OF SUBJECTS WITH PATELLOFEMORAL PAIN

2017 ◽  
Vol 23 (2) ◽  
pp. 88-92
Author(s):  
Gilmar Moraes Santos ◽  
Karina Gramani Say ◽  
Flávio Pulzatto ◽  
Thiele de Cássia Libardoni ◽  
Larissa Milani Brognoli Sinhorim ◽  
...  
Keyword(s):  
Knee Joint ◽  
Vastus Lateralis ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Flexion Angle ◽  
Oblique Muscle ◽  
Electromyographic Activity ◽  
Healthy Controls ◽  
Patellar Stability

ABSTRACT Introduction: So far, little is known about the behavior of electromyographic activity of vastus lateralis oblique muscle during treadmill gait in subjects with and without patellofemoral pain syndrome. Objective: The purpose of this study was to investigate the electromyographic activity of the patellar stabilizers muscles and the angle of the knee joint flexion in subjects with and without patellofemoral pain syndrome. Method: Fifteen subjects without (21 ± 3 years) and 12 with patellofemoral pain syndrome (20 ± 2 years) were evaluated. The electromyographic activity and flexion angle of the knee joint were obtained during gait on the treadmill with a 5 degree inclination. Results: The knee flexion angle was significantly lower in the subjects with patellofemoral pain syndrome when compared with the healthy controls. The electromyographic activity of vastus lateralis longus was significantly greater during gait on the treadmill with inclination in subjects with patellofemoral pain syndrome. The results also showed that the electromyographic activity of vastus lateralis oblique and vastus medialis oblique were similar in both groups, regardless of the condition (with/without inclination). Conclusion: We have shown that knee kinematics during gait differs among patients with and without patellofemoral pain syndrome and healthy controls and that a different motor strategy persists even when the pain is no longer present. In addition, the findings suggested that the vastus lateralis oblique has a minor role in patellar stability during gait.

To Determine the Degree of Agreement between Ki67 and Histopathology to Differentiate between Hydatidiform Mole

2021 ◽  
Vol 15 (10) ◽  
pp. 2619-2621
Author(s):  
Mariya Manzoor ◽  
Haseeb Ahmed Khan ◽  
Sabiha Riaz ◽  
Imrana Tanvir ◽  
Atiya Batool Gardezi ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
P Value ◽  
Kappa Statistics ◽  
Cross Sectional Survey ◽  
Ki 67 ◽  
Cross Sectional ◽  
Histopathologic Diagnosis ◽  
Hematoxylin And Eosin ◽  
High Degree ◽  
Gross Examination

Aim: To determine the degree of agreement between Ki67 and histopathology to differentiate between hydatidiform mole and hydropic abortus. Methods: Descriptive, Cross Sectional Survey was conducted in the Department of Pathology, Fatima Memorial Hospital, Lahore during 6 months (May 11, 2016 to Nov 11, 2016). Using non-probability consecutive sampling, 105 cases were included in this study as per the inclusion and exclusion criteria. 10% buffered formalin was used to fix the sepecimens. Gross examination and staining with Hematoxylin and Eosin was done. The cases were diagnosed by a histopathologist. IHC staining Ki67 was performed, assessed by histopathologist and the data was recorded on the proforma. Results: The mean age was 27.79±5.81 years with minimum and maximum ages of 18 years and 42 years respectively. The histopathological findings showed hydatidiform mole in 41 (39%) women and hydropic abortus in 64(61%) women. The Ki67 was reported to be >25 in 41(39%) patients and less than or equal to 25 in 64(61%) patients. The agreement of differentiation in the two types for histopathology and Ki67 was found in 101(96.2%) patients. Kappa statistics showed 92% (p-value= 0.000) strength of agreement between histopathology and Ki67. Conclusion: There is high degree of agreement between Ki67 and histopathology for differentiation of hydatidiform mole and hydropic abortus. So Ki67 can be used as an adjacent in histopathologic diagnosis of hydatidiform mole in difficult cases. MeSh words: Hydatidiform Mole, Immunohistochemistry, Ki-67 Antigen

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