Validity and Reliability of an Inertial Measurement Unit–based 3-Dimensional Angular Measurement of Cervical Range of Motion

ObjectiveThis study aimed to assess the reliability and validity of an inertial measurement unit (IMU)–based 3-dimensional (3D) angular measurement system for evaluating cervical range of motion.MethodsThirty-three healthy participants (21.9 ± 2.1 years; 162.0 ± 6.0 cm; 55.8 ± 9.0 kg; 21.2 ± 2.4 kg/m²) were evaluated. Kinematic data of the cervical joints were simultaneously obtained using the IMU 3D angular, goniometer, and photographic measurements during cervical flexion (0°, 30°, and 50°), extension (30°, 50°), side-bending (0°, 20°, 40°), and rotation (45°). Test–retest reliability was investigated in each measurement method. Concurrent validity was assessed with the direct comparison between the IMU 3D angular measurement and other methods.ResultsThe IMU 3D angular measurement showed mostly good to high test–retest reliability with relatively small standard error of measurement and the minimal detectable change values. The concurrent validity of IMU 3D angular measurements in the cervical range of motion was mostly reasonable. However, the measurement bias between the 2 methods tended to be larger at the end range of each plane.ConclusionUsing the IMU 3D angular measurement in cervical spine is recommended because of its mostly good to high reliability and reasonable validity. However, using the IMU 3D angular measurement at the end range of each plane should be carefully considered owing to the poorer validity.     

Can Ultrasound Propagate in the Joint Space of a Human Knee?

A large body of evidence supports the principle that the use of low-intensity pulsed ultrasound with a frequency of 1.5 MHz can reduce fracture healing time. It is hypothesized that similar therapeutic benefits may be achieved in damaged articular cartilage. This study looks specifically at a 22-mm circular ultrasound transducer delivering ultrasound with a frequency of 1.5 MHz. A human cadaver knee was imaged using CT, the resulting images were used to help map a number of hydrophone positions in the joint from which measurements were taken. The experimental results suggest that at best there is a 30-mm window in which to place the ultrasound transducer for ultrasound to propagate through the joint space. In terms of a clinical device delivering an I(SATA) of 30 mW cm(-2) to anterior regions of the joint, the I(SATA) in posterior regions will at best be in the region of 10 mW cm(-2). The clinical implications of this are not known and require further investigation.     

When does a difference make a difference? Interpretation of number needed to treat,number needed to harm,and likelihood to be helped or harmed

Although great effort is made in clinical trials to demonstrate statistical superiority of one intervention vs. another, insufficient attention is paid regarding the clinical relevance or clinical significance of the observed outcomes. Effect sizes are not always reported. Available absolute effect size measures include Cohen's d, area under the curve, success rate difference, attributable risk and number needed to treat (NNT). Of all of these measures, NNT is arguably the most clinically intuitive and helps relate effect size difference back to real‐world concerns of clinical practice. This commentary reviews the formula for NNT, and proposes acceptable values for NNT and its analogue, number needed to harm (NNH), using examples from the medical literature. The concept of likelihood to be helped or harmed (LHH), calculated as the ratio of NNH to NNT, is used to illustrate trade‐offs between benefits and harms. Additional considerations in interpreting NNT are discussed, including the importance of defining acceptable response, adverse outcomes of interest, the effect of time, and the importance of individual baseline characteristics.     

Anorexia: a taste of things to come?

Anorexia, the loss of the desire to eat, is common in patients with cancer. Studies report a prevalence of up to 66% and clinical practice suggests that it is an almost universal experience as the cancer progresses. It generally leads to a reduction in food intake that contributes to the development of malnutrition and cachexia, impairing quality of life and increasing morbidity and mortality. Successful curative or palliative treatment of the underlying cancer is an effective approach. When this is not possible, there are limited treatment options, which generally have not been shown to be practicable, tolerable, effective or safe in the long-term management of the cachexia-anorexia syndrome. Recent increases in the understanding of the physiology of energy intake and of the pathophysiology of anorexia are helping to guide the development of rational approaches. This journal club provides an outline of the pathophysiology of anorexia and highlights a paper that may provide an exciting glimpse of the future.     

What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial

Background

Recent healthcare policies have encouraged increasing interest in the concept of patient self-referral, specifically with regard to physiotherapy. However, what has not been known until recently is the efficacy of this mode of access within the National Health Service (NHS), including the cost implications on which to reliably base the provision of future service models.

Aim

To establish the costs to National Health Service (NHS) Scotland of differing modes of access to physiotherapy in primary care.

Design

Cost-minimisation analysis, multi-centred national trial.

Setting

Twenty-six general practices throughout Scotland.

Participants

Three-thousand and ten patients.

Method

Self-referral was introduced in each site in parallel with referral by a general practitioner (GP). NHS-associated cost data were collated over a full year by referral type, i.e. self-referral, GP-suggested and GP-referral groups. A cost-minimisation analysis was performed and the main outcome measures were the number of GP and physiotherapy contacts, prescribing of non-steroidal anti-inflammatory drugs and analgesics, and referral for X-ray, magnetic resonance imaging and/or secondary care. Costs were established for 2004.

Results

The data from 3010 patients identified significant associations between referral group and prescribing, referral for X-ray and to secondary care, and GP and physiotherapy contacts (P < 0.001). The average cost of an episode of care was established as £66.31 for a self-referral, £79.50 for a GP-suggested referral and £88.99 for a GP referral. Extrapolated to identify national implications, the average cost benefit to NHS Scotland was identified as being approximately £2 million per annum.

Conclusion

There are significant positive implications associated with self-referral to physiotherapy that represent added value for NHS Scotland. These implications are also of relevance to the rest of the NHS in the UK.     

Are we close to a theory of energy medicine?

Critical phenomena offer an attractive new theoretical resource for biophysics. Physical instabilities result in fluctuations, the quantum properties of which can be applied to regulatory control mechanisms in living organisms with promising results. Many aspects of energy medicine can be scientifically modeled, in agreement with previous theoretical ideas and speculation, such as the existence of macroscopic quantum coherence in living systems. Light is shed on areas of complementary and alternative medicine (CAM) such as Ayurveda, naturopathy, and the nature and action of potentized medicines in homeopathy and other aspects of vibrational medicine.     

In vitro susceptibility to a new antimalarial organometallic analogue,ferroquine, of Plasmodium falciparum isolates from the Haut-Ogooué region of Gabon

OBJECTIVES: To assess the activity of a new organometallic chloroquine analogue, ferroquine, against numerous Plasmodium falciparum isolates from Gabon. METHODS: The in vitro susceptibility of 116 P. falciparum isolates to chloroquine and ferroquine was assessed using the isotopic microtest. All isolates were from outpatients in the Franceville and Bakoumba medical centres in the province of Haut-Ogooué, south-east Gabon. RESULTS: The in vitro resistance to chloroquine was 51.8% in Franceville and 96.7% in Bakoumba. The IC50 geometric mean (95% CI) of ferroquine against isolates in Franceville was 16.0 (14.4-17.8) nM, with individual values ranging from 1.0 to 47.0 nM; in Bakoumba it was 27.9 (23.4-33.2) nM, with individual values ranging from 1.0 to 62.0 nM. Compared with chloroquine, ferroquine was 5.3 times more active on isolates susceptible to chloroquine, and 13.3 times more active on isolates resistant to chloroquine. A weak positive correlation was observed between responses of these two drugs, but too low to demonstrate cross-resistance. CONCLUSIONS: Ferroquine may be useful as an alternative drug for treating chloroquine-resistant malaria.     

Treatment of mild to moderate psoriasis with Reliéva, a Mahonia aquifolium extract--a double-blind, placebo-controlled study

Psoriasis is usually treated with local and systemic medications that have varying degrees of efficacy and safety profiles. We investigated the efficacy and safety of an alternative treatment from natural sources, Mahonia aquifolium, for the management of mild to moderate psoriasis. Two hundred subjects participated in a randomized, double-blind, placebo-controlled study using either the topical cream Reliéva (a homeopathic product containing a proprietary M. aquifolium extract) or control (placebo) twice a day for 12 weeks. Efficacy and safety were assessed using the Psoriasis Area Severity Index (PASI) and the Quality of Life Index (QLI) questionnaires at different times throughout the 12-week study. The PASI was evaluated by the physician at the beginning (week 0) and end (week 12) of the study. The QLI was assessed by patients at weeks 0, 4, 8, and 12. The results indicate statistically significant (P < 0.05) improvements in PASI and QLI in the Mahonia-treated group, compared with the control group. The side effects reported were infrequent, < 1% and minor; the most frequent side effects were rash, a burning sensation when applying the cream, and clothing stain. These data indicate that Reliéva, a proprietary form of M. aquifolium, is effective and well tolerated in patients with mild to moderate psoriasis.     

Is There a Dose Response for Valgus Unloader Brace Usage on Knee Pain,Function, and Muscle Strength?

Hurley ST, Hatfield Murdock GL, Stanish WD, Hubley-Kozey CL. Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength?ObjectiveTo examine whether there was a dose response for valgus unloader brace wear on knee pain, function, and muscle strength in participants with medial compartment knee osteoarthritis.DesignIn this single-group study, participants with medial compartment knee osteoarthritis were followed for approximately 6 months.SettingRecruitment was conducted in the general community, and testing was performed at a university laboratory.ParticipantsA convenience sample of patients (N=32) who were prescribed a valgus unloader brace agreed to participate, met the inclusion criteria, and completed the baseline data collection. Twenty-four participants (20 men, 4 women) completed baseline and follow-up collections.InterventionParticipants wore their valgus unloader brace as needed.Main Outcome MeasuresKnee extensor, flexor, and plantar flexor strength was tested at baseline and follow-up. Participants filled out Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Medical Outcomes Study 36-Item Short-Form Health Survey questionnaires to assess pain and function. Self-selected walking velocity and stride length were objective measures of function. Brace usage (dose) and activity (step count) were recorded at least 4 days/week for the study duration.ResultsPositive relationships existed between brace wear usage and percent change in step count (r=.59, P=.006) and percent change in hamstrings strength (r=.37, P=.072). At follow-up, there was significant improvement in hamstrings strength (P=.013), and trends toward improvements in WOMAC pain (P=.059) and WOMAC function (P=.089).ConclusionsOur results indicate that greater brace use may positively affect physical activity level, but there was minimal effect of brace wear dosage on lower-limb muscle strength. Only knee flexion showed a positive relationship. Our finding of no decreased muscle strength indicates that increased brace use over a 6-month period does not result in muscle impairment.