A new foot and ankle outcome score: Questionnaire based,subjective, Visual-Analogue-Scale,validated and computerized

Our purpose was to construct and validate a new score taking into consideration the flaws of existing scores.MethodsA new score named Visual-Analogue-Scale Foot and Ankle (VAS FA) with the following features was constructed: questionnaire based on 20 subjective questions, Visual-Analogue-Scale (VAS) based rating, computerized evaluation. The score was validated in 121 subjects. For validation, SF-36^® and Hannover Questionnaire (Q) were obtained and correlated with VAS FA.ResultsThe correlation VAS FA versus SF-36^® and Q (Pearson, all p-values <0.001, r ≥ 0.5) was sufficient for the total score and all score categories (pain, function, other complaints).The time needed for evaluating the scores was significantly lower for VAS FA than for SF-36^® and Q (Oneway-ANOVA, p < 0.001).ConclusionsThe introduced score is the first validated (on SF-36^®), subjective, VAS based outcome score for foot and ankle. The VAS FA is computerized which enables faster evaluation than SF-36^® or Q.     

Treadmill versus overground gait training in patients with lower limb burn injury: A matched control study

IntroductionGait impairment is commonly seen in patients with a lower limb burn injury (LLBI). Therefore, the aim of this study was to investigate the effects of two different gait training modes on gait symmetry, functional mobility and kinesiophobia in patients with LLBI.MethodsThis matched control study was conducted between January 2017 and August 2018. Patients with LLBI (n = 28) were allocated to 2 different groups by matching according to burn localization, age, and gender. Group 1 (overground group: n = 14) received overground gait training in addition to standard burn rehabilitation, and Group 2 (treadmill group: n = 14) received treadmill gait training in addition to standard burn rehabilitation. The rehabilitation program and gait training were started when the patient was admitted to the hospital and ended on discharge. These physical therapy interventions were performed 5 days per week. The gait training intensity, including walking speed and duration, was determined according to patient tolerance. Gait parameters, functional mobility, kinesiophobia and pain values were evaluated with GAITRite, the timed up-and-go test (TUG), Tampa Kinesiophobia Scale and Visual Analogue Scale, respectively. These evaluations were made twice; on admission and immediately prior to discharge. Gait symmetry was calculated using the Symmetry Index.ResultsThe baseline characteristics of the groups and initial outcome values were similar. In the comparison of the differences between the overground and treadmill groups, the change in kinesiophobia and TUG values were significantly higher in the treadmill group (p = 0.01, p = 0.02, respectively). The intragroup comparisons showed significant differences in SI in respect of step length (p = 0.004), swing (p = 0.006), stance (p = 0.008) and velocity (p = 0.001), cadence (p = 0.001), TUG (p = 0.001), kinesiophobia (p = 0.001) and pain (p = 0.001) in the overground group. Statistically significant differences were determined in step length (p = 0.01), swing (p = 0.01), stance (p = 0.02) and velocity (p = 0.001), cadence (p = 0.001), TUG (p = 0.001), kinesiophobia (p = 0.001) and pain (p = 0.001) in the treadmill group, when pre and post-training values were compared.ConclusionsThe results of this study have shown that treadmill gait training was more effective in the improvement of functional mobility and reduction in kinesiophobia levels of patients with LLBI compared to overground gait training. Both overground and treadmill gait training also provide greater improvements in the velocity and cadence, and gait symmetry for step length, swing and stance in patients with LLBI.Clinical trial registration numberNCT03217526.     

Factors associated with satisfaction with bunion surgery in women: A prospective study

BackgroundHallux valgus is a common indication for foot surgery. Over 25% of patients are dissatisfied with the outcome.ObjectiveTo examine women's pre- and post-surgical characteristics, regarding satisfaction with surgery for hallux valgus (‘bunions’).MethodProspective cohort of 95 consecutive female patients (132 ‘foot cases’) undergoing bunion surgery. Baseline interview and questionnaire asked about attitudes to fashion and footwear, plus SF-36 general health survey. At 12 months post-surgery, patients who were ‘very pleased’ with their surgery were compared with everyone else regarding their pre-, peri- and post-operative characteristics.ResultsBy 12 months, key SF-36 domains had significantly improved. The 75 foot operations (n = 75/116, 64.7%) were associated with respondents being ‘very pleased’ with their foot surgery. Following adjustment, the odds of being ‘very pleased’ were severely reduced where respondents were not ‘very pleased’ their foot's appearance (p < 0.001), or where foot pain was anything but absent (p = 0.018). There was significant interaction between pre-operative expectations of resumption of hiking/sports activities and range of footwear able to be worn post-operatively.ConclusionsThe perceived appearance of their foot and range of shoes that women can wear, are crucial to womens’ satisfaction with the outcome of bunion surgery. The (total) alleviation of pain is also important.     

Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years’ follow-up and effective volume of activated brain tissue

Chronic neuropathic pain affects 7%–10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years’ post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p = 0.0001), on UW-NPS of 35.2% (p = 0.3582), on BPI of 65.1% (p = 0.0505) and on SF-36 of 5% (p = 0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p = 0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p = 0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.     

Factors associated with patient satisfaction with foot and ankle surgery in a large prospective study

BackgroundThere is minimal published research on outcomes and satisfaction with foot and ankle surgery.ObjectiveTo investigate patient-reported outcomes and satisfaction, and investigate which factors influence satisfaction at 9 months following foot or ankle surgery.MethodsProspective study of 671 adult patients having foot or ankle surgery. Pre-and post-surgery, patients self-completed MOXFQ, SF-36 and EQ-5D questionnaires. Using ratings to a satisfaction item, patients who were ‘very pleased’ with the outcome were compared with everyone else, using multiple logistic regression, regarding their pre-, peri- and post-operative characteristics.ResultsOf 628 eligible patients, 491 (73%) completed pre-and post-operative questionnaires. Following adjustment, satisfaction with surgery was influenced by patients’ perceptions of their foot/ankle's appearance (OR 0.12, 95% CIs 0.06–0.23, p < 0.001); wearable range of shoes (OR 0.36, 95% CIs 0.17–0.79, p = 0.01); continued foot/ankle pain (OR 0.06, 95% CIs 0.03–0.14, p < 0.001); impairment in Social-Interaction (MOXFQ SI scale) (OR 0.98, 95% CIs 0.96–0.99, p = 0.009). The final explanatory model explained 67% of the variance in patient satisfaction.ConclusionsFoot appearance, wearable shoe range, the (full) alleviation of pain and the ability/confidence to interact socially are crucial to peoples’ satisfaction with their foot or ankle surgery.     

Effectiveness of therapeutic ultrasound in adhesive capsulitis

ObjectiveThere is a lack of evidence about the effectiveness of therapeutic ultrasound (US) compared with placebo US in the treatment of adhesive capsulitis. This study was performed to assess the effectiveness of therapeutic US in the treatment of adhesive capsulitis.MethodsForty-nine patients with adhesive capsulitis were randomized to US (n = 25) and sham US (n = 24) groups. Superficial heat and an exercise program were given to both groups. Ultrasound was applied to US group and imitative ultrasound was applied to sham US group for 2 weeks. Shoulder range of motion (ROM), pain and Shoulder Pain and Disability Index (SPADI) were assessed at the beginning, after treatment and after 3 months (control). Short Form-36 (SF-36) was applied for assessing general health status at the beginning and after 3 months. Compliance with the home exercise program was recorded daily on a chart for 3 months.ResultsShoulder ROM, pain with motion, two subscales and total score of SPADI and physical component summary score of SF-36 were improved significantly in both groups after the treatment and after 3 months (p < 0.0001). Improvements in flexion, inner and outer rotation values were significantly higher in the US group when we compared the differences between post- and pre-treatment values of shoulder ROM. The differences between control and pre-treatment values of inner and outer rotation were also significantly higher in the US group (p = 0.002 and p = 0.02 respectively). No significant difference was detected in pain, SPADI and SF-36 scores between groups. The exercise compliance was significantly higher in the sham US group (p = 0.04).ConclusionOur results suggest that US compared with sham US gives no relevant benefit in the treatment of adhesive capsulitis. Effectiveness of US might be masked by worse pre-treatment values of the US group and higher exercise compliance of the sham US group.     

Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC)

IntroductionYoung femoral neck fracture patients require surgical fixation to preserve the native hip joint and accommodate increased functional demands. Recent reports have identified a high incidence of fracture shortening and this may have negative functional consequences. We sought to determine if fracture shortening is associated with poor functional outcome in young femoral neck fracture patients.Patients and methodsOne hundred and forty-two patients with femoral neck fractures age 18–55 were recruited in this prospective cohort study across three Level 1 trauma hospitals in Mainland China. Patient-reported and objective functional outcomes were measured with the Harris Hip Score (HHS), Timed Up and Go (TUG), and SF-36 Physical Component Summary (SF-36 PCS) at 12 months. Radiographic fracture shortening was measured along the long axis of the femoral neck and corrected for magnification. Severe shortening was defined as ≥10 mm. The primary analysis measured associations between severe radiographic shortening and HHS at one-year post-fixation.ResultsOne hundred and two patients had complete radiographic and functional outcomes available for analysis at one year. The mean age of participants was 43.7 ± 10.8 years and 53% were male. Fifty-five percent of fractures were displaced and 37% were vertically orientated (Pauwels Type 3). The mean functional outcome scores were: HHS 90.0 ± 10.8, TUG 12.0 ± 5.1 s, and PCS 48.5 ± 8.6. Severe shortening occurred in 13% of patients and was associated with worse functional outcome scores: HHS mean difference 9.9 (p = 0.025), TUG mean difference 3.2 s (p = 0.082), and PCS mean difference 5.4 (p = 0.055).ConclusionsSevere shortening is associated with clinically important decreases in functional outcome as measured by HHS following fixation of young femoral neck fractures, occurring in 13% of patients in this population. The principle of fracture site compression utilized by modern constructs may promote healing; however, excessive shortening is associated with worse patient-reported outcomes and objective functional measures.     

Long-term outcome and quality of life in patients with Charcot foot

BackgroundThere is only sparse scientific data about the long-term effects of the Charcot foot on patients’ lives and the clinical outcome. This study evaluates the long-term effects of diabetic Charcot foot.MethodsA cross-sectional follow-up study of consecutive series of patients with Charcot foot referred to the University Hospital Diabetic Foot and Ankle Clinic between 1991 and 2002.ResultsForty-one patients were referred with Charcot foot between 1991 and 2002. After an average follow-up of 8 years their overall mortality rate was 29% (12/41) and 29 patients (30 Charcot feet) have been followed more than 5 years. Sixty-seven percent of Charcot feet suffered at least one episode of ulceration and 50% (15/30) of affected feet had surgical treatment resulting in 29 operations. Simple exostectomy was successful in 62% of cases. The need for surgical management increased markedly 4 years after the diagnosis. Correct diagnosis within 3 months resulted in better functional outcome (AOFAS) and walking distance (p = 0.006 and p = 0.008, respectively). Lower SF-36 component scores in physical functioning, social functioning and general health perceptions were found when the study population was compared to the general population and chronically ill control subjects.ConclusionsDiabetic Charcot foot decreases patient's physical functioning and general health but does not usually affect mental health. Surgical management is often required with an increase 4 years post-diagnosis. A delay of diagnosis of more than 3 months was found to adversely affect the quality of life and functional outcome.     

Kinematic analysis of ankle stiffness in subjects with and without flat foot

BackgroundAlthough the magnitude of ankle motion is influenced by joint congruence and ligament elasticity, there is a lack of understanding on ankle stiffness between subjects with and without flat foot.ObjectiveThis study investigated a quantified ankle stiffness difference between subjects with and without flat foot.MethodsThere were forty-five age- and gender-matched subjects who participated in the study. Each subject was seated upright with the tested foot held firmly onto a footplate that was attached to a torque sensor by the joint-driving device.ResultsThe flat foot group (mean ± standard deviation) demonstrated increased stiffness during ankle dorsiflexion (0.37 ± 0.16 for flat foot group, 0.28 ± 0.10 for control group; t = −2.11, p = 0.04). However, there was no significant group difference during plantar flexion (0.35 ± 0.15 for flat foot group, 0.33 ± 0.07 for control group; t = 0.64, p = 0.06).ConclusionThe results of this study indicated that the flat foot group demonstrated increased ankle stiffness during dorsiflexion regardless of demographic factors. This study highlights the need for kinematic analyses and joint stiffness measures during ankle dorsiflexion in subjects with flat foot.     

Alternate hot and cold application in the management of heel pain: A pilot study

BackgroundDespite a long-standing tradition of naturopathic physical therapy and hydrotherapy use in the treatment of musculoskeletal conditions, neither naturopathy, nor specific aspects of hydrotherapy have been tested for efficacy in the treatment of heel pain.MethodsPatients (n = 20) were assigned to standard naturopathic physiotherapy care (NPC) with two adjuvant therapy groups: a control group (therapeutic ultrasound, n = 10), or alternating compresses (n = 10). Pain scores were measured before and after treatment using Visual Analog Scale (VAS) and foot functionality was measured using the Foot Function Index (FFI).ResultsFFI reduced from 46.97 to 31.98 (p = 0.005) among normal protocol patients and from 49.72 to 21.35 (p = <0.001) among patients receiving the alternating compress protocol. Average VAS pain intensity in the seven days of treatment decreased from 3.53 to 2.53 cm (p = <0.001) among patients receiving NPC and from 4.09 to 2.61 cm (p = <0.001) amongst those receiving NPC plus alternating compresses. There was no significant difference in pain score reduction between the two groups (p = 0.206), but patients with alternating compresses as part of their treatment had significant improvements in foot functionality (p = 0.007).DiscussionNaturopathic physical therapy significantly improves foot functionality and pain scores in heel pain. Additionally, alternating compresses improve foot functionality scores.     

How are clinical outcomes related to the deviation severity of the tibiofemoral mechanical axis on coronal plane following knee arthroplasty?

ObjectiveTo analyze the effect of tibiofemoral mechanical axis (TFMA) deviation severity on clinical outcomes after total knee arthroplasty (TKA).MethodsWe retrospectively reviewed the patients who underwent primary TKA between January 2002 and December 2010. After applying inclusion/exclusion criteria, we evaluated 70 knees of 51 patients. The mean ± SD follow-up period was 7.08 ± 1.34 years. The knees were divided into 3 groups based on TFMAs. The first group, identified as “well aligned,” included the TFMAs that were neutral within 3° (0° ± 3°) of alignment. The second group, identified as “outliers 1,” included the slightly deviated TFMAs (−3° to −6° valgus and +3° to +6° varus). The third group, identified as “outliers 2,” included the severely deviated TFMAs of more than 6° from neutral alignment (<−6° valgus and > + 6° varus). The clinical outcomes of each group were compared by evaluating the Oxford Knee Score (OKS), visual analog scale (VAS), and Short Form-36 physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) scores.ResultsWe found that OKS, SF-36 PCS, and SF-36 MCS were nearly the same in the well-aligned and outliers 1 groups but worse in the outliers 2 group. VAS scores were nearly the same in all groups. (p > 0.05)ConclusionFunction scores were impaired when the TFMA deviated more than 6° from neutral. However, the differences in clinical outcomes between well-aligned knees and those of outliers were not found to be statistically significant in the medium term.     

The effect of aging on the hardness of foot sole skin: A preliminary study

BackgroundFoot problems are common in older people and altered biomechanical parameters under the foot sole has been proposed as a key risk factor for foot lesions. Therefore the aim of this study was to investigate the age-related differences in the hardness of foot sole skin.MethodsTwenty-six healthy volunteers without foot problems, aged from 26 to 65 years, were examined using shore meter. The hardness of the foot sole under the big toe (area 8), 1st metatarsal head (area 5), 3rd metatarsal head (area 6), 5th metatarsal head (area 7), mid foot (area 3, 4) and hind foot (area 1, 2) were measured. The correlation between age and hardness of foot sole was examined and comparisons were made between two age groups.ResultsFrom the result we observe statistical significant (p < 0.05; p < 0.01; p < 0.005) differences in hardness between age groups in hind foot, metatarsal heads (1st, 3rd & 5th) and big toe. Strong positive correlations between age and hardness of the foot sole were found at the big toe (r = 0.57; p < 0.005), 1st metatarsal head (r = 0.567; p < 0.00001), 3rd metatarsal head (r = 0.565; p < 0.00001), 5th metatarsal head (r = 0.55; p < 0.00001), and heel (r = 0.59; p < 0.0001).ConclusionThe loss of compliance in the foot sole may be one of the factors responsible for the higher incidence of foot problems in aged people. Routine foot examination and appropriate therapeutic intervention including the use of foot orthoses and optimal hardness of foot wear insole may help to prevent the serious foot injuries.     

Efficacy of Maitland joint mobilization technique on pain intensity,mouth opening,functional limitation,kinesiophobia, sleep quality and quality of life in temporomandibular joint dysfunction following bilateral cervicofacial burns

BackgroundBilateral cervicofacial burn contracture initially affects facial expressions and later affects tempero mandibular joint (TMJ) function of the patient. It further tightens the ligaments and capsules around the TMJ and leads to tempero mandibular dysfunction. The consequences of temporomandibular joint dysfunction will be pain, limitation of mouth opening, functional disability and poor quality of life (Qol). However, studies examining the efficacy of Maitland joint mobilization technique in this population are lacking.ObjectivesTo find the short term effects of Maitland joint mobilization technique on pain, mouth opening, functional limitation, kinesiophobia, sleep quality and Quality of life in tempero mandibular joint dysfunction following bilateral cervicofacial burns.MethodsThirty subjects with temporomandibular joint dysfunction following cervicofacial burn (N = 30) were allocated to Maitland joint mobilization group (n = 15) and home based training group (n = 15) randomly to receive Maitland joint mobilization technique and home based training for 4 weeks. All the participants received ultrasound therapy as common treatment. Primary (Numeric Pain Rating Scale – NPRS, maximal mouth opening – MMO & Tempero mandibular disability index – TDI) and secondary (Tampa Scale of Kinesiophobia – TSK-17, Sleep quality questionnaire – SSQ & Global Rating of Change – GRC) outcome measures were measured at baseline, after four weeks and three months follow up. Repeated measures of ANOVA and independent t test were performed for analyzing the dependent variables in both groups.ResultsBaseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following different training protocols Maitland joint mobilization group shows more significant changes in pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and Qol than home based training group (p ≤ 0.05). Also Maitland joint mobilization group show significant improvement in study variables than home based training group (p ≤ 0.05) at three months follow up.ConclusionBoth groups improved over time, however, differences between the groups were noticed small. However, physiotherapy management which includes Maitland joint mobilization technique and therapeutic exercise program has an effective strategy in the treatment of tempero mandibular joint dysfunction following cervicofacial burns.     

Assessment of foot posture: Correlation between different clinical techniques

BackgroundClinical evaluation of foot posture is necessary for assessing and treating patients with lower extremity dysfunction. Although several studies have explored the reliability and validity of different clinical techniques for the measurement of foot posture, there is limited research in studies investigating whether two or more such techniques correlate with each other.ObjectivesTo explore the correlations between the valgus and arch index measurements with the measurements of the navicular drop and drift in bipedal and single-leg stance.MethodsClinical measurements of the valgus index, the arch index, the navicular drop and drift were performed on the left foot of 26 healthy subjects in bipedal and in single-leg stance with 30° knee flexion.ResultsThe valgus index yielded moderate to strong correlations with the measurement of navicular drop (bipedal: r = 0.657, p < 0.001; single-leg stance: r = 0.613, p = 0.001) and small correlations with navicular drift (bipedal: r = 0.481, p = 0.13; single-leg stance: r = 0.335, p = 0.094). The arch index demonstrated small correlations with the navicular drop and drift in both bipedal and single-leg stance (r = 0.317-0.428, p = 0.115–0.029).ConclusionsAlthough strong associations were obtained between the valgus index and the navicular drop, all other correlations demonstrated low degrees of association. Further research should explore the association of these clinical measurements in patients with foot/lower limb impairments.     

Is there a learning curve in foot and ankle surgery?

BackgroundPrevious studies of orthopaedic learning curves have largely described the introduction of new techniques to experienced consultants. End points have usually involved technical considerations. A paucity of evidence surrounds foot and ankle surgery. This study investigates the learning curve during a foot and ankle surgeon's first year, defined by functional outcome.Methods150 patients underwent elective foot or ankle surgery during the whole period. Preoperative and 6 month postoperative functional scores were compared between the first and second 6 month groups.ResultsFunctional improvement was greater, approaching significance, in the second group (p = 0.0605). There was no difference for forefoot cases (p = 0.345). Functional improvement was significantly greater in the second group with forefoot cases removed (p = 0.0333).ConclusionsA learning curve exists in the first year of practice of foot and ankle surgery, demonstrated by functional outcome. This is confined to ankle, hindfoot and midfoot, but not forefoot surgery.     

Association between preoperative dynamic plantar pressures and clinical outcomes at 6 months after hallux valgus surgery

BackgroundThe influence of preoperative plantar pressures on clinical outcomes following hallux valgus surgery has not been yet established. This study aimed to assess the relationship between preoperative dynamic plantar pressure measurements and clinical outcomes following hallux valgus surgery.Material and methodsA prospective cohort study where patients attending the foot and ankle unit between 2016 and 2017, diagnosed of hallux valgus requesting surgical correction were recruited consecutively and preoperative plantar pressure were measured. At 6-months after surgery, the foot condition and foot pain were measured, through the American Orthopedic Foot and Ankle Society Score (AOFAS), and using Visual Analog Scale (VAS), respectively. A multivariate logistic model was used to estimate the magnitude of the associations between the explanatory variables and outcomes.Results114 patients were included in the study. Significant differences between patients with and without pain at 6-months after surgery were found in mean force on first toe, peak pressure on third and fourth metatarsal head, and maximum force on fourth and fifth metatarsal head (p < 0.05). The multivariate logistic model showed significant association between the preoperative peak pressure on fourth metatarsal head (OR:0.996, p = 0.003), walking (OR:7.430, p < 0.001), orthopedic shoe after surgery period (OR:0.754, p = 0.019) and preoperative AOFAS (OR:0.947, p = 0.006), and the appearance of pain at 6-months after surgery.ConclusionThe presence of pain at six months after surgery was significantly associated with the preoperative peak pressure under the fourth metatarsal head.     

Impact of the ankylosing spondylitis on the professional activity

Purpose of the studyAnkylosing spondylitis (AS) is a chronic inflammatory disease affecting axial skeleton, occurring in young and active patients and often condition their professional prospects.ObjectivesTo describe the social and occupational characteristics of patients affected by AS, to estimate the impact of the disease on their professional activity and to determine factors exposing to elevated risk of premature withdrawal from the labor force.MethodsWe had performed a cross-sectional study of 103 patients with AS recruited during 2 years (2005–2007) at the Department of Rheumatology, fulfilling the modified criteria of New York. Demographic, social and professional characteristics were determinated and some disease-specific instruments: BASDAI, BASFI, BASMI, BASG-s, BASRI, as well as an indicator of quality of life: the Short Form Survey-36 (SF-36).ResultsIt is about 88 man and 15 women, the average age is 37.6 years ± 11.7 (18–59 years). Seventy percent of patients live in urban zone and 17% have an educational level superior to 13 years. The disease duration is on average of 11.2 ± 9.6 years. The mean score of BASFI is 45.5 ± 27.5 (7–100), the mean score of BASDAI is 45.9 ± 22.4 (9–100), the mean score of BASG-s is 53.8 ± 21.2, the mean score of BASMI is of 4.4 ± 2.2 (3–10), the mean score of BASRI is 8.4 ± 3.5 (2–16). Among these patients 95 (92%) are eligible to a professional activity (aged between 18 and 65 years and having ended their studies or vocational training). The global unemployment rate is 25.3%, that's attributed to the disease is 20.6%. Some factors are associated with high risk of work withdrawal: female gender (p = 0.0005), low educational level (p = 0.02), living in rural zone (p = 0.028), manual labor (p = 0.038), cold exposing in work place (p = 0.006), high work time a week (p = 0.02) and the absence of colleague help (p = 0.001). For the specific disease indexes, high risk of withdrawal is correlated with high scores of BASFI (p = 0.00002), BASDAI (p = 0.044), BAS-Gs (p = 0.0005) and BASMI (0.0000). Concerning the SF-36, only the item of physical activity is more significantly altered in patient's having stopped their work.ConclusionSeveral factors are identified to be associated to a high risk of premature working withdrawal in patients affected by AS. Prevention of this risk needs an early diagnosis and treatment of the disease, a vocational guidance, work preliminary training and eventually professional redeployment.     

Extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized controlled trial

BackgroundThis study aimed at estimating the extent to which a combination therapy of extracorporeal shockwave therapy (ESWT) with usual care (exercise and orthotic support) improve functional ability in the patient with plantar fasciitis when compared to usual care alone.MethodsParticipants with plantar fasciitis were randomly allocated into two groups: ESWT (n = 23), and control (n = 21). All participants received home exercise program with orthotic support. In addition, ESWT group received 2000 shock waves with 0.02 mJ/mm² for three sessions. Functional outcomes were measured by function subscale of American orthopedic foot and ankle society (AOFAS-F) score and 12 minutes walking test including walking speed, cadence. The scores were recorded at baseline, third week and third month after the treatment. Analysis was performed using repeated measures ANOVA, and an intention to treat approach using multiple imputations.ResultsResults showed that there was a significant improvement in AOFAS-F total score and walking speed over three months in both groups (p < 0.001, p = 0.04 respectively); improvements in AOFAS-F were particularly in activity limitation (p = 0.001), walking distance (p = 0.02) and walking surface (p = 0.02). Groups were comparable with each other for both walking speed and AOFAS-F in any assessment time (p > 0.05). However, groups performed differently in cadence where there was an increase in cadence in ESWT group whereas a decline in control at the third month (p = 0.07).ConclusionThe results revealed that ESWT did not have an additive benefit over usual care to improve foot function and walking performance in patient with plantar fasciitis over three months post-treatment.     

Female patients display poorer burn-specific quality of life 12 months after a burn injury

IntroductionAlthough gender differences in morbidity and mortality have been measured in patients with moderate to severe burn injury, little attention has been directed at gender effects on health-related quality of life (HRQoL) following burn injury. The current study was therefore conducted to prospectively measure changes in HRQoL for males and females in a sample of burn patients.MethodsA total of 114 adults who received treatment at a statewide burns service for a sustained burns injury participated in this study. Instruments measuring generic health status (Short Form 36 Medical Outcomes Survey version 2), burn-specific HRQoL (Burns Specific Health Scale-Brief), psychological distress (Kessler Psychological Distress Scale) and alcohol use (Alcohol Use Disorders Identification Tool) were prospectively measured at 3, 6 and 12 months post-burn.ResultsIn the 12 months post-injury, female patients showed overall poorer physical (p = 0.01) and mental health status (p < 0.001), greater psychological distress (p < 0.001), and greater difficulty with aspects of burn-specific HRQoL: body image (p < 0.001), affect (p < 0.001), interpersonal functioning (p = 0.005), heat sensitivity (p = 0.01) and treatment regime (p = 0.01). While significant interaction effects suggested that female patients had more improvement in difficulties with treatment regime (p = 0.007), female patients continued to report greater difficulty with multiple aspects of physical and psychosocial health status 12 months post-injury.ConclusionEven though demographic variables, injury characteristics and burn care interventions were similar across genders, following burn injury female patients reported greater impairments in generic and burn-specific HRQoL along with psychological morbidity, when compared to male patients. Urgent clinical and research attention utilising an evidence-based research framework, which incorporates the use of larger sample sizes, the use of validated instruments to measure appropriate outcomes, and a commitment to monitoring long-term care, can only improve burn-care.     

Effect of extracorporeal shock wave therapy for burn scar regeneration: A prospective,randomized, double-blinded study

PurposeThis study aimed to investigate the regeneration effect of extracorporeal shock wave therapy (ESWT) on hypertrophic scar regeneration using objective measurements.MethodsThis was a double-blinded, randomized, controlled trial of 48 participants who had undergone autologous split-thickness skin grafting (STSG) with same artificial dermis. The ESWT group (n = 25) received shock waves with low-energy flux density (0.05–0.30 mJ/mm²). The interval between treatments is a 1-week. The ESWT group also received recommended treatment. The control group (n = 23) only received standard treatment. We measured skin characteristics before treatment and after 6 weeks for both groups.ResultsNo significant intergroup difference was noted at the initial evaluations (p > 0.05). The pre- to post-treatment change in the scar thickness (p = 0.03) and erythema (p = 0.03), greater reduction was found in the ESWT group than control group. The pre- to post-treatment change in the sebum level (p = 0.02), more increase was found in the ESWT group. We found no significant differences in the change measurements between the two groups for melanin levels (p = 0.62) and transepidermal water loss (TEWL) (p = 0.94). The changes (skin distensibility, biological skin elasticity, gross skin elasticity, and skin viscoelasticity) measured with the Cutometer showed no significant differences between the two groups (p = 0.87, p = 0.32, p = 0.37, and p = 0.29, respectively).ConclusionThis is the first report of ESWT on hypertrophic scar after burn using objective tools (melanin, erythema, sebum, TEWL, elasticity and thickness). ESWT has objective beneficial effects on burn-associated scar characteristics.