基于移动医疗的妊娠期盆底肌训练对产后尿失禁发生的影响：一项基于随机对照试验设计的探索性研究

背景 孕产妇尿失禁（UI）发病率高，严重影响了女性生活质量。研究表明，盆底肌训练是UI有效的防治手段，本研究前期进行了一项随机对照试验（RCT），结果发现相比于常规宣教，基于移动医疗APP的盆底肌训练并未显现出预防优势，其原因需要进一步深入探讨。 目的 本研究拟对一项基于APP的妊娠期盆底肌训练的干预研究的阴性结果进行探索性分析，旨在探讨产后UI预防效果的影响因素以及获益的亚组人群。 方法 本研究数据来源于前期开展的一项RCT，采用方便抽样法，于2020年6—10月在南方医科大学深圳医院产科门诊招募了126例研究对象，采用随机数字表法分为干预组与对照组，每组各63例。对照组采用常规护理，干预组在此基础上使用"有爱屋"APP进行尿失禁自我管理，干预周期为2个月。产后42 d随访时收集两组产后相关资料，包括产后42 d UI发生情况。以产后是否发生UI为结局指标，将研究对象分为病例组和对照组，采用Logistic回归分析探讨混杂因素及其与干预方式之间的交互作用对产后UI发生的影响。针对Logistic回归分析的结果进行分层分析，探讨是否存在能从APP干预中获益的亚组人群。 结果 病例组和对照组阴道分娩史、入组时存在UI、Broome盆底肌自我效能量表（BPMSES）得分比较，差异均有统计学意义（P<0.05）。Logistic回归分析结果显示，入组时存在UI是产后发生UI的危险因素〔OR=15.897，95%CI（4.724，53.495），P<0.001〕；BPMSES得分与干预方式的交互作用可影响产后UI的发生〔OR=1.034，95%CI（1.017，1.051），P<0.001〕。分层分析结果显示，入组时存在UI症状的孕妇，干预组产后UI发生率低于对照组（χ2=4.18，P=0.041）；入组时不存在UI症状的孕妇，两组产后UI发生率比较，差异无统计学意义（χ2=1.89，P=0.284）。 结论 推荐有UI症状的孕妇使用"有爱屋"APP或许可预防产后UI的发生。而对于妊娠期没有UI症状的人群使用"有爱屋"APP预防产后UI发生的证据尚不充分。另外，不管有无UI症状，盆底肌训练自我效能高的孕妇有望从APP干预中获益。     

MRCS Performance by OMFS trainees: an update and call to action

Completion of the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a prerequisite for completion of specialty surgical training in UK. The aim of this study was to compare MRCS performance of OMFS trainees to trainees in other specialities over the past 13 years. Differential attainment (DA) was noted in MRCS Part A (MCQ) pass rates. There was no statistically significant difference in MRCS Part B pass rates. The reasons for this DA are currently unknown and require further investigation. It has been suggested that this may be due at least in part to competing time, family and financial obligations, which increase over time.     

Electromyographic comparison of vastus medialis obliquus facilitatory versus vastus lateralis inhibitory kinesio taping in athletes with patellofemoral pain: A randomized clinical trial

BackgroundPatellofemoral pain (PFP) is among the most common orthopedic complications afflicting active young people. Diminished coordination of the vastii, delayed activation of the vastus medialis obliquus (VMO), and decreased VMO-to-vastus lateralis (VL) activity ratio are well documented as underlying causes of PFP. This study compares the effects of VMO facilitatory kinesio tape (KT) versus VL inhibitory KT on electromyographic (EMG) activity of the vastii, balance, and pain in athletes with PFP.MethodsIn this single-blind randomized clinical trial, thirty-two female athletes with PFP (mean age 26.33 ± 5.93 years) were randomly assigned to VMO facilitatory KT (n = 16) or VL inhibitory KT (n = 16) groups. In the facilitatory group, a Y-shaped strip of KT at 25% of its available tension was attached from the origin of the VMO to its insertion and in the inhibitory group, an insertion-to-origin Y-shaped strip of KT at 15% of its available tension was applied on the VL. Pain intensity, dynamic balance, and EMG data were assessed respectively with a visual analogue scale, the modified Star Excursion Balance Test, and an EMG telemetry system, before and immediately after KT application.ResultsPain intensity decreased and dynamic balance improved significantly after taping in both groups, and VMO: VL activity ratio increased significantly in the VL group. However, none of the parameters differed significantly between groups.ConclusionsBoth VMO facilitatory and VL inhibitory KT can improve pain and balance, while the inhibitory technique might be more effective in regulating the VMO to VL activity ratio in athletes with PFP.     

U-turn speed is a valid and reliable smartphone-based measure of multiple sclerosis-related gait and balance impairment

BackgroundPeople living with multiple sclerosis (MS) experience impairments in gait and mobility, that are not fully captured with manually timed walking tests or rating scales administered during periodic clinical visits. We have developed a smartphone-based assessment of ambulation performance, the 5 U-Turn Test (5UTT), a quantitative self-administered test of U-turn ability while walking, for people with MS (PwMS).Research questionWhat is the test-retest reliability and concurrent validity of U-turn speed, an unsupervised self-assessment of gait and balance impairment, measured using a body-worn smartphone during the 5UTT?Methods76 PwMS and 25 healthy controls (HCs) participated in a cross-sectional non-randomised interventional feasibility study. The 5UTT was self-administered daily and the median U-turn speed, measured during a 14-day session, was compared against existing validated in-clinic measures of MS-related disability.ResultsU-turn speed, measured during a 14-day session from the 5UTT, demonstrated good-to-excellent test-retest reliability in PwMS alone and combined with HCs (intraclass correlation coefficient [ICC] = 0.87 [95 % CI: 0.80–0.92]) and moderate-to-excellent reliability in HCs alone (ICC = 0.88 [95 % CI: 0.69–0.96]). U-turn speed was significantly correlated with in-clinic measures of walking speed, physical fatigue, ambulation impairment, overall MS-related disability and patients’ self-perception of quality of life, at baseline, Week 12 and Week 24. The minimal detectable change of the U-turn speed from the 5UTT was low (19.42 %) in PwMS and indicates a good precision of this measurement tool when compared with conventional in-clinic measures of walking performance.SignificanceThe frequent self-assessment of turn speed, as an outcome measure from a smartphone-based U-turn test, may represent an ecologically valid digital solution to remotely and reliably monitor gait and balance impairment in a home environment during MS clinical trials and practice.     

Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis

PurposeThis systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community.ResultsA comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample’s results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high.ConclusionsIn older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.     

Compensatory postural responses to backward loss of balance in patients with cerebellar disease

BackgroundImpaired control of balance and coordinated reactions are a primary deficit of cerebellar dysfunction. As compared to other neurological patients with balance impairments, there has been little research assessing the characteristics of compensatory responses associated with falls in patients with cerebellar disease (CD).Research questionThe aim of this study was to examine the effects of cerebellar disease on compensatory balance control in response to postural perturbation. Do CD patients increase the number of steps when responding to instability because of inappropriate initial step reactions or poor control of trunk motion or both?MethodsIn this explorative study, 10 patients suffering from degenerative cerebellar ataxia and 10 age-matched healthy controls were examined. The balance recovery reactions were assessed using a lean-and-release postural perturbation method. Spatiotemporal characteristics of stepping movement and COM variables associated with torso motion were analyzed using 3D motion capture system.ResultsCD patients took multiple steps whereas matched controls generally took single steps to recover balance following perturbation. The characteristics of the initial step at the time of the fall revealed that foot reaction time, foot response time, and step distance of the initial step were similar between CD patients and matched controls. However, CD patients exhibited a shorter foot-to−COM distance, higher COM velocity, and less trunk flexion with which to attenuate their body momentum after the landing of the first step than did matched controls.SignificanceAlthough initial step responses were probably adequate, poor control of torso motion appears to be a particular problem that causes multiple-step reactions in CD patients. This observation would help to guide the development of tailored fall intervention strategies in CD patients aimed at promoting their recovery capacity in response to a pronounced balance challenge.     

The optimal exploitation of sensory electrical stimulation for regulating postural balance depends on participants’ intrinsic balance abilities

BackgroundThe sensory electrical stimulation applied to the postural muscles provides additional sensory information that improves postural balance but this improvement seems to be highly subject-dependent.Research questionThe first aim was to analyse the effects of sensory electrical stimulation on postural balance and the second aim was to analyse these effects depending on intrinsic postural balance abilities of subjects.MethodsTwenty healthy young male participants completed a monopedal postural task with sensory electrical stimulation (1 ms; 10 Hz; 7 ± 2 mA i.e., twice the intensity corresponding to the sensory threshold) and without sensory electrical stimulation. Pearson’s product-moment correlations were performed on centre of pressure parameters to assess whether the participant’s balance abilities at baseline were related to the beneficial effects of sensory electrical stimulation.ResultsThe results showed positive correlations for all the variables measured (i.e., with r² from 0.32 to 0.35). Evidence suggests that subjects’ abilities to take advantage from electrically induced additional afferents depended on participants’ intrinsic balance abilities. In fact, subjects who exhibited the worst postural balance at baseline (i.e. without stimulation) benefited more from the effects of sensory electrical stimulation than subjects who displayed the best postural balance at baseline.SignificanceIn physically impaired subjects, as part of functional rehabilitation, sensory electrical stimulation would be particularly interesting in order to limit their risk of falling.     

以就业为导向的脊柱相关疾病的推拿教学策略

目的培养脊柱及相关疾病推拿治疗的应用型人才。方法采用编写应用型教材、把教室转移到诊室和示教室、教材-案例“逼真”教学法、创造学生在临床真实环境下的动手操作机会和产-学-研相结合教学法等手段和方法,在内容改革上纳入目前医院和社会机构多使用的规划教材之外的手法技术、现代康复技术和世界各地的脊柱手法技术,拓宽知识面,与临床应用接轨;发挥考试的导向功能,通过改革考试和评价方法,切实培养应用型人才。结果教学效果良好,有效提升了学生临床适应能力和社会生存能力。结论以就业为导向的脊柱及相关疾病的推拿教学模式值得进一步探索。