Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins

Rectus femoris muscle proximal injuries are not rare conditions. The proximal rectus femoris tendinous anatomy is complex and may be affected by traumatic, microtraumatic, or nontraumatic disorders. A good knowledge of the proximal rectus femoris anatomy allows a better understanding of injury and disorder patterns. A new sonographic lateral approach was recently described to assess the indirect head of the proximal rectus femoris, hence allowing for a complete sonographic assessment of the proximal rectus femoris tendons. This article will review sonographic features of direct, indirect, and conjoined rectus femoris tendon disorders.     

Effect of Chemodenervation of the Rectus Femoris Muscle in Adults With a Stiff Knee Gait Due to Spastic Paresis: A Systematic Review With a Meta-Analysis in Patients With Stroke

Objective

To determine the effect of motor branch block (MBB) or neuromuscular block (NMB) of the rectus femoris on knee kinematics during swing, functional outcome, and energy cost in adults with spastic paresis presenting a stiff knee gait.

Data Sources

PubMed, Embase, CINAHL, and Cochrane Library were searched. Studies were collected up to February 26, 2013. Reference lists were additionally scrutinized.

Study Selection

No restrictions were applied regarding study design. Patients were adults suffering from a central neurological disorder. Interventions had to include MBB or NMB. Outcome measures had to include knee kinematics during the swing phase. Study selection was independently performed by 2 reviewers.

Data Extraction

Two reviewers independently assessed the methodological quality of included studies. Data on kinematics, functional outcome, and energy cost from patients with stroke were extracted from the total population and when possible pooled.

Data Synthesis

A total of 9 articles describing 12 different studies were included. Knee kinematics (peak knee flexion or knee range) during swing improved significantly in all the included studies. The average increase in peak knee flexion varied from 1.9° to 15.4°. Data pooling of peak knee flexion in patients with stroke showed a significant improvement of 7.37° (P=.000) in NMB studies and of 9.35° (P=.002) in MBB studies. Data pooling of knee velocity at toe-off showed a significant improvement of 53.01°/s in NMB studies. In MBB studies, this improvement was not significant. Data pooling of knee range of motion, functional outcomes, and energy cost showed no significant difference.

Conclusions

According to this review, chemodenervation of the rectus femoris shows a significant improvement in peak knee flexion during swing. The effect on functional outcomes and energy cost is still unclear.     

Program of therapeutic exercises associated with electrotherapy in patients with chronic neck pain: Protocol for a randomized controlled trial

Conservative treatment is the most common clinical management for the proper rehabilitation of patients with chronic neck pain, and there is a trend towards the use of therapeutic exercise. However, some uncertainty about the efficacy of therapeutic exercises remains, and it is necessary to conduct more studies with high methodological rigor, especially in regard to multimodal treatment, as in the combination of therapeutic exercises with electrotherapy. Thus, the objective of this study will be to evaluate the clinical effects of adding high- and low-frequency transcutaneous electrical nerve stimulation (TENS) in a program of specific therapeutic exercises for the treatment of patients with chronic neck pain. Sixty participants will be randomized into three groups: therapeutic exercise + placebo TENS group (n = 20), therapeutic exercise + high-frequency TENS group (n = 20), and therapeutic exercise + low-frequency TENS group (n = 20). Eight treatment sessions will be performed, and participants will be evaluated before and after the eight sessions and four weeks after the end of treatment. The Numerical Rating Pain Scale, Neck Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Tampa Scale for Kinesiophobia will be used for participant evaluations. In the statistical analysis, a linear mixed model will be applied considering interaction between time and group factors. The addition of this electrotherapeutic modality to a therapeutic exercise program is expected to generate clinical improvements for patients with chronic neck pain, and if the results demonstrate benefits in the treatment group, this form of care could be used.     

Rates and Predictors of Manual and Powered Wheelchair Use for Persons With Stroke: A Retrospective Study in a Canadian Rehabilitation Center

Mountain AD, Kirby RL, MacLeod DA, Thompson K. Rates and predictors of manual and powered wheelchair use for persons with stroke: a retrospective study in a Canadian rehabilitation center.

Objectives

To determine the rates of manual and powered wheelchair use at discharge for people with stroke admitted to a rehabilitation center and to determine whether any predictors of wheelchair use at discharge could be identified.

Design

Retrospective cohort study.

Setting

Rehabilitation center.

Participants

Consecutive former inpatients (N=100) with a primary diagnosis of stroke, a sample of convenience.

Interventions

None.

Main Outcome Measures

We reviewed the inpatient health records to determine the rates of wheelchair use at discharge and to record some readily available demographic and clinical data that might serve as predictors of wheelchair use.

Results

At discharge, 40 people (40%) were using manual wheelchairs, 1 person (1%) was using a powered wheelchair, and 59 (59%) were not using a wheelchair. Of the patients who were walkers on admission (ie, walking FIM scores of 6 or 7), none (0%) used wheelchairs at discharge. Of those with nonwalking FIM scores (1-5) on admission, 56% were using wheelchairs at discharge. Multivariate analyses revealed that the adjusted odds ratios of using a wheelchair (manual or powered) were 3.33 (95% confidence interval [CI], 1.33-8.33) for those with left-hemisphere versus right-hemisphere strokes (P=.010), .94 (CI, .91-.96) for each point rise in the total raw FIM score on admission (P<.0001), and 19.46 (CI, 6.33-59.81) if the total admission FIM score was less than 80 versus greater than or equal to 80 (P<.0001).

Conclusions

On discharge from our rehabilitation center, 40% of people with stroke were using manual wheelchairs and 1% powered wheelchairs. People who were not walking on admission, those with left-hemisphere strokes, and those with lower total admission FIM scores were more likely to use a wheelchair. These findings may permit clinicians to predict wheelchair use better early in the rehabilitation process, when it can affect rehabilitation planning.     

The Use of a Nurse-Initiated Pain Protocol in the Emergency Department for Patients with Musculoskeletal Injury: A Pre-Post Intervention Study

Background and Aim: As a common complaint of patients with traumatic injuries, pain remains undermanaged in emergency departments (EDs). Our aim was to evaluate the effects of a nurse-initiated pain management protocol in patients with musculoskeletal injuries in an ED in Iran.Material and MethodsThis pre-post intervention design study was conducted on 240 patients with orthopedic injuries selected through sequential sampling over two phases. The intervention consisted of case study sessions and the implementation of the nurse-initiated pain management protocol. The outcomes were assessed based on the Numeric Rating Scale (NRS) pain scores, the pain management satisfaction questionnaire, the nursing performance checklist and the waiting time evaluation form.ResultsThe mean pain intensity 30 and 60 min after triage and at discharge decreased significantly in the post-intervention group (p < .001). The patients' satisfaction with pain management (p < .01) and the nurses’ performance (p < .001) improved in the post-intervention group. Waiting time: there was a significant reduction in the post-intervention group from the end of triage by the nurse to the visit by the physician, and from patient’s arrival in ED to discharge or transferring, and also the time to initial analgesic.ConclusionsEducation based on case study and the implementation of the nurse-initiated pain management protocol resulted in a significant increase in multimodal analgesia administration and a reduction in pain intensity, an increase in patient satisfaction, an improvement in the triage nurses’ performance and the reduction of potential delays in pain management while maintaining the safety of patients with musculoskeletal trauma.     

The Safety of Reusing Ablation Catheters with Temperature Control and the Need for a Validation Protocol and Guidelines for Reprocessing

The objective of this study was to evaluate the safety of reusing ablation catheters with temperature control, which has not previously been reported. A review of previously conducted studies on the feasibility of reusing electrode catheters is also presented. From September 1994 to December 1997, 74 deflectable ablation catheters with temperature control (Cordis-Websters and Osypkas) were used during mean 7.6 ± 8.0 ablation sessions. The catheter tests included visual inspection for surface defects using a magnification glass, impedance measurements, evaluation of the catheter deflection capability, and the integrity of the thermistor and thermocouple. The catheters were sterilized by Sterrad(tm) after each use. A total of 41 catheters were rejected after an average 9.1 ± 8.8 uses (range 1–31). The main reasons for rejection were inaccurate temperature measurements by the thermistor or thermocouple (19 %), breakage of or defect in the internal pulling wire (12%), loss or disturbance of electrogram (9%), and loss of deflection capability (8%). The reuse of the catheters has not resulted in any major catheter failures or any major adverse clinical complications. There were no local or systemic infections. It can be concluded that these types of ablation catheters will sustain repeated uses and resterilizations without untoward harm to the patient provided that a thorough validation protocol and guidelines for quality control and rejection of catheters are used. There seems to be no rational for setting a limit for the number of reuses, since most failures occurred at any time of reuse.     

Low Vitamin D as a Risk Factor for the Development of Myalgia in Patients Taking High-Dose Simvastatin: A Retrospective Review

Background

Statins are the treatment of choice for dyslipidemia, primarily lowering elevated LDL-C levels and reducing the occurrence of major cardiovascular events. In June 2011, the Food and Drug Administration issued a warning regarding the use of high-dose simvastatin 80 mg and its risk of myopathy.

Objective

The incidence of myalgia, myopathy, and rhabdomyolysis was analyzed in a veteran population prescribed simvastatin 80 mg. Risk factors for myalgia were examined and compared with the results of recently published studies.

Methods

This was a retrospective medical record review of 450 patients who were prescribed simvastatin 80 mg at the Veterans Affairs Western New York Healthcare System between August 1, 2006, and July 31, 2011. Records were examined for evidence of myalgia, myopathy (incipient or definite), and rhabdomyolysis. Variables that may have contributed to the development of myalgia were also collected and analyzed.

Results

Myalgia was reported by 50 patients (11.1%), whereas rhabdomyolysis developed in 1 patient (0.22%). No patient fit the criteria for myopathy (incipient or definite). Myalgia was statistically more likely to occur in younger patients, patients with a history of myalgia, and patients with low vitamin D levels. The mean (SD) vitamin D level in patients experiencing myalgia was 26.2 (12.9) versus 36.3 (11.8) ng/mL. The 25-hydroxyvitamin D level in those who reported myalgia was approximately 10 ng/mL lower compared with those who tolerated simvastatin 80 mg (P = 0.0003). There was no statistically significant association between length of therapy and development of myalgia.

Conclusion

A lower incidence of adverse muscle events with high-dose simvastatin 80 mg was found in patients with higher vitamin D levels, suggesting that correction of 25-hydroxyvitamin D levels before statin therapy initiation may mitigate one risk factor in the development of statin-related myalgia. Vitamin D insufficiency appears to be a risk factor for the development of myalgia.     

Development and content validation of the Wheelchair Use Confidence Scale: a mixed-methods study

Background.?Confidence in one's ability to perform a given task can be a stronger predictor of performance than skill itself. There are currently no measures to assess confidence with manual wheelchair use. The objective of this study was to develop and assess the content validity of the Wheelchair Use Confidence Scale (WheelCon-M).

Method.?A two-phase mixed-methods design was used. Semi-structured interviews were conducted to generate items, followed by a Delphi survey for item selection. Persons who use a wheelchair, health care professionals, and researchers participated in both phases of the study.

Results.?An 84-item WheelCon-M was developed based on the qualitative data. After the Delphi survey, a final 62-item WheelCon-M was composed of the following six areas (number of items per area): Negotiating the Physical Environment (33 items), Activities Performed using a Manual Wheelchair (11 items), Knowledge and Problem Solving (6 items), Advocacy (4 items), Managing Social Situations (5 items) and Managing Emotions (3 items).

Conclusion.?This article reports the development and content validation of the WheelCon-M. As a scale to measure confidence with wheelchair use was not available prior to this work, clinicians now have a method of identifying individuals who have low confidence with wheelchair use.     

Hipocrates: a Robust System for the Control of Neuromuscular Blockade

Objective. Development of an automatic system (software package Hipocrates) for the control of neuromuscular blockade by continuous infusion of the non-depolarising types of muscle relaxant drugs presently used in anaesthesia, namely atracurium, cisatracurium, vecuronium and rocuronium. Methods. Hipocrates incorporates control strategies based upon classical, adaptive and robust control, as well as a wide range of noise reduction techniques and on-line adaptation to patient-specific characteristics. Therefore, the system provides strong robustness to inter- and intra-individual variability of the patients responses or unexpected circumstances and adaptation to the individual requirements. Results. The control system is easy to set up and to use in a clinical environment. It consists of a portable PC computer, a Datex AS/3 NMT sensor and a B|Braun compact perfusion pump. In the simulation mode the software package incorporates sophisticated generation of pharmacokinetic/pharmacodynamic models driven by simulated drug administration regimes (bolus, continuous infusion and a combination of both). Conclusions. Hipocrates is an advanced stand-alone application for the control of neuromuscular blockade with a friendly graphic interface. It has been extensively validated, and it can be used on patients undergoing surgery as well as for simulation studies. Therefore Hipocrates also provides an excellent environment for education and training purposes.     

长期固定使用一试剂"船"对均相法测定血清高密度脂蛋白胆固醇影响的研究

目的探讨长期固定使用一试剂“船”对均相法测定血清高密度脂蛋白胆固醇(HDL-C)时所出现问题的原因,并寻找解决问题的办法。方法用出现问题的试剂“船”,装入一套新开启的HDL-C测定试剂,用出现问题的试剂和新开启试剂交叉组成两套试剂,模拟日常实际工作,分别用这些试剂测定质控血清和病人血清的HDL-C值。结果将测定结果经配对t检验,发现装入出现问题的试剂“船”中新开启的HDL-C试剂,前两天测定结果无明显变化(P>0.05);第三天开始发生明显变化,第四天变化最显著(P<0.01)。出现问题的试剂中试剂2的变化要比试剂1大(P<0.01)。结论要定期更换试剂“船”。     

Dynamic training of the lumbar musculature to prevent recurrence of acute low back pain: a randomized controlled trial using a daily pain recall for 1 year

Purpose: The purpose of this experiment was to quantify lumbar muscle endurance training for individuals with a recent episode of acute low back pain (LBP) (≥ moderate pain for ≥ 2 days) and to observe whether the training would reduce the rate and severity of recurrent LBP episodes. Method: Twenty-six participants who were pain-free at the time of the study were randomly divided into a high intensity back endurance (HIBE)-trained or a low intensity abdominal (LOAB)-trained (control) group. The HIBE-trained group performed preloaded maximum isokinetic exertions of the back extensors (five sets of 10 repetitions, 3 days a week for 4 weeks, totaling 12 sessions). The LOAB-trained group performed low intensity isometric contractions on their abdominals that had minimal effect on their back musculature. The two groups reported daily pain logs on a weekly basis on an interactive voice response telephone system for 1 year. Results: The HIBE-trained group experienced more pain days (p = 0.038) in the minor and moderate categories and more episodes of acute LBP than the LOAB-trained group. However, there was a trend of less pain in the severe, intense and excruciating categories in the HIBE-trained group. Conclusions: The results of this experiment did not provide evidence that short-term intense training of the low back musculature provides protection against future episodes of LBP.

Implications for Rehabilitation

• Short-term high intensity back endurance (HIBE) training of the back musculature did not provide protection against future episodes of acute low back pain compared to the low intensity abdominal (LOAB) – trained group.

• HIBE training may have sensitized the subjects to report significantly more minor and moderate pain and less pain-free days compared to the LOAB-trained group.

• There was a strong trend that the HIBE-trained group experienced less pain in the severe, intense and excruciating categories compared to the LOAB-trained group.

• Future studies in rehabilitation must require daily recall of pain and quick reporting in order to capture the subtle effects training can elicit from pain reporting.