Impact of a Palliative Care Consultation Team on Cancer-Related Symptoms in Advanced Cancer Patients Referred to an Outpatient Supportive Care Clinic

ContextPatients with advanced cancer may develop severe physical and psychosocial symptoms. There are limited data on the impact of an outpatient palliative consultation (PC) team on cancer-related symptoms.ObjectivesTo study the impact of the PC on symptoms in patients with advanced cancer receiving outpatient palliative care.MethodsFour hundred six consecutive patients referred to a supportive care outpatient center (OPC) from January 2006 to June 2007 with complete Edmonton Symptom Assessment Scale (0–10 scale) at the initial and follow-up visits were reviewed. Patient characteristics, change of symptoms at follow-up visit, and response rate were analyzed. Using logistic regression models, the predictors of improvement of pain and fatigue were assessed.ResultsMedian age was 59 years; 53% were female. Median interval between visits was 15 days. Mean scores at baseline and follow-up visits were fatigue 6.8 and 5.3 (P < 0.0001), pain 5.3 and 4.1 (P < 0.0001), depression 3.2 and 2.5 (P < 0.0001), anxiety 3.7 and 2.8 (P < 0.0001), dyspnea 2.7 and 2.5 (P = 0.05), sleep 5 and 4 (P < 0.0001), and well-being 5.2 and 4.4 (P < 0.0001). Dyspnea (odds ratio and P-value, 0.90, 0.03), nausea (0.92, 0.06), and depression (0.91, 0.04) were associated with improvement in fatigue; drowsiness (1.10, 0.04), and feeling of well-being (0.87, 0.02) were associated with improvement in pain.ConclusionThe initial consult by PC achieved significant symptom improvement in patients receiving treatment in the OPC. Further prospective studies are needed.     

Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash

BackgroundHealth-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash.ObjectiveWe assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL.MethodsIn this inception cohort study, injured participants (≥ 17 years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12 months. HRQoL was measured by the European Quality of Life–5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses.ResultsAmong 2019 individuals identified, 1201 (59.5%) were followed up after 12 months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12 months, HRQoL score was lower for people claiming compensation than others (P < 0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P = 0.02) or head or face (P = 0.01), being a driver or passenger at the time of the crash (P < 0.0001), hospital admission (P < 0.0001) and pain severity (P < 0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P = 0.02), pre-injury health (P = 0.04), pre-injury psychological conditions (P = 0.04), trauma-related distress (P = 0.0002) and general psychological distress (P < 0.0001).ConclusionsA wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.     

New factors that affect quality of life in patients with aphasia

BackgroundAphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population.ObjectiveWe aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke.MethodsPatients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors.ResultsWe included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P = 0.008) and at follow-up (P = 0.01); increased communication activity limitations at follow-up (P < 0.001); increased limitations on activities of daily life at baseline (P = 0.008) and follow-up (P < 0.001); increased fatigue at follow-up (P = 0.001); and increased depression symptoms at follow-up (P = 0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R² = 0.756, P < 0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations.ConclusionAphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies.     

Characteristics of Advanced Cancer Patients With Cancer-Related Fatigue Enrolled in Clinical Trials and Patients Referred to Outpatient Palliative Care Clinics

ContextLimited published data exist on whether characteristics of patients with advanced cancer enrolled in cancer-related fatigue clinical trials (CCTs) differ from patients in outpatient palliative care clinics (OPCs).ObjectivesThe primary aim of this study was to compare the characteristics of two groups of patients with advanced cancer and moderate-to-severe fatigue: patients in CCTs and patients at an OPC.MethodsWe retrospectively reviewed the records of 337 patients who were enrolled in one of five CCTs for advanced cancer patients at The University of Texas M. D. Anderson Cancer Center as well as the records of 1896 consecutive patients who were referred to our OPC from January 2003 through December 2010. Patients with fatigue scores of ≥4/10 (measured by the Edmonton Symptom Assessment System [ESAS]) were eligible (1252 OPC patients and 337 CCT patients). Patient characteristics, ESAS scores, and survival times were compared using Chi-square tests, Wilcoxon rank sum tests, and the Kaplan-Meier method.ResultsCompared with the CCT patients, OPC patients were more likely to be older (58 vs. 59 years; P = 0.009) and male (38% vs. 52%; P < 0.001). The most common primary cancer type was breast cancer (22%) in the CCT patients and lung cancer (23%) in the OPC patients (P < 0.001). The median ESAS scores in the OPC and CCT groups, respectively, were 6 and 4 for pain (P < 0.001), 7 and 7 for fatigue (P = 0.525), 3 and 2 for depression (P = 0.004), 3 and 2 for anxiety (P < 0.001), 3 and 2 for dyspnea (P < 0.001), and 43 and 32 for the symptom distress score (P < 0.001). The median overall survival times were 17.9 months (95% CI 13.5–22.3 months) in the CCT group and 3.8 months (95% CI 3.5–4.1 months) in the OPC group (P < 0.001).ConclusionBaseline characteristics and overall survival times significantly differed between patients enrolled in the CCT and OPC groups. Therefore, we conclude that the results of CCTs cannot be generalized to patients being treated in OPCs.     

Frequency,Indications, Outcomes,and Predictive Factors of Opioid Switching in an Acute Palliative Care Unit

The aim of this study was to prospectively evaluate the frequency, indications, outcomes, and predictive factors associated with opioid switching, using a protocol that had been clinically applied and viewed as effective for many years. A prospective study was carried out on a cohort of consecutive cancer patients who were receiving opioids but had an unacceptable balance between analgesia and adverse effects, despite symptomatic treatment of side effects. The initial conversion ratio between opioids and routes was as follows (mg/day): oral morphine 100 = intravenous morphine 33 = transdermal fentanyl 1 = intravenous fentanyl 1 = oral methadone 20 = intravenous methadone 16 = oral oxycodone 70 = transdermal buprenorphine 1.3. The switch was assisted by opioids used as needed, and doses were changed after the initial conversion according to clinical response in an acute care setting. Intensity of pain and symptoms associated with opioid therapy were recorded. A distress score (DS) was calculated as a sum of symptom intensity. A switch was considered successful when the intensity of pain and/or DS, or the principal symptom necessitating the switch, decreased to at least 33% of the value recorded before switching. One hundred eighteen patients underwent opioid substitutions. The indications for opioid switching were uncontrolled pain and adverse effects (50.8%), adverse effects (28.8%), uncontrolled pain (15.2%), and convenience (4.2%). Overall, 103 substitutions were successful. Ninety-six substitutions were successful after the first switching, and a further substitution was successful in seven patients who did not respond to the first switch. The mean time to achieve dose stabilization after switching was 3.2 days. The presence of both poor pain control and adverse effects was related to unsuccessful switching (P < 0.004). No relationship was identified between unsuccessful switching and the opioid dose, opioid sequence, pain mechanism, or use of adjuvant medications. Opioid switching was an effective method to improve the balance between analgesia and adverse effects in more than 80% of cancer patients with a poor response to an opioid. The presence of both poor pain relief and adverse effects is a negative factor for switching prognosis, whereas renal failure is not.     

Effects of a Full-Body Massage on Pain Intensity,Anxiety, and Physiological Relaxation in Taiwanese Patients with Metastatic Bone Pain: A Pilot Study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%–45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29) = 16.5, P = 0.000; t(29) = 8.9, P = 0.000], short-term (20–30 minutes) [t(29) = 9.3, P = 0.000; t(29) = 10.1, P = 0.000], intermediate (1–2.5 hours) [t(29) = 7.9, P = 0.000; t(29) = 8.9, P = 0.000], and long-term benefits (16–18 hours) [t(29) = 4.0, P = 0.000; t(29) = 5.7, P = 0.000] on PPI and anxiety. The most significant impact occurred 15 [F = 11.5(1,29), P < 0.002] or 20 [F = 20.4(1,29), P < 0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.     

Cancer-Related Symptom Clusters,Eosinophils, and Survival in Hepatobiliary Cancer: An Exploratory Study

ContextThe study of symptom clusters is gaining increased attention in the field of oncology in an attempt to improve the quality of life of patients diagnosed with cancer.ObjectivesThe aims of the present study were to 1) determine the prevalence and distribution of pain, fatigue, and symptoms of depression and their covariation as a cluster in people with hepatobiliary carcinoma (HBC), 2) characterize how variation in each individual symptom and/or their covariation as a cluster are associated with changes in immunity, and 3) determine if the symptom clusters, and associated biomarkers, are related to survival in people diagnosed with HBC.MethodsTwo hundred six participants diagnosed with HBC completed a battery of standardized questionnaires measuring cancer-related symptoms. Peripheral blood leukocytes were measured at diagnosis and at three- and six-month follow-ups. Survival was measured from the date of diagnosis to death.ResultsCancer-related symptoms were prevalent and two-step hierarchical cluster analyses yielded three symptom clusters. High levels of pain, fatigue, and depression were found to be associated with elevated eosinophil percentages (F[1,78] = 3.1, P = 0.05) at three- and six-month follow-up using repeated-measures analysis of variance. Using multivariate latent growth curve modeling, pain was the primary symptom associated with elevated eosinophil percentages between diagnosis and six months (z = 2.24, P = 0.05). Using Cox regression, vascular invasion and age were negatively associated with survival (Chi-square = 21.6, P = 0.03). While stratifying for vascular invasion, Kaplan-Meier survival analysis was performed, and eosinophil levels above the median for the sample were found to be related to increased survival in patients with and without vascular invasion (Breslow Chi-square = 4.9, P = 0.03). Symptom clusters did not mediate the relationship between eosinophils and survival.ConclusionCancer-related symptoms, particularly pain and depression, were associated with increased percentages of eosinophils. The presence of symptoms may reflect tumor cell death and be indicative of response to treatment, or other processes, in patients with HBC.     

The prognostic value of serum pregnancy-associated plasma protein A,S100 and high sensitivity C-reactive protein in acute ischemic stroke patients without heparin administration

ObjectivesThe concerns regarding the pre-analytical bias caused by medicine treatments have been raised in the diagnosis and prognosis of ischemic stroke recently. The aim of this study was to examine the prognostic value of serum pregnancy-associated plasma protein A (PAPP-A), S100 and high sensitivity C-reactive protein (hs-CRP) in heparin-naïve patients of acute ischemic stroke.Design and methodsSerum levels of PAPP-A, S100 and hs-CRP were determined in 205 heparin-naïve patients of acute ischemic stroke and 50 healthy controls. Clinical information and radiological information were collected. Unfavorable outcomes (stroke recurrence, myocardial infarction or death) were also recorded after six months. The associations between serum biomarker levels and stroke severity/outcome were assessed.ResultsSerum PAPP-A, S100 and hs-CRP levels increased in patients compared with controls (P < 0.05). S100 and hs-CRP levels were significantly higher in patients with larger cerebral infarction sizes (P < 0.05) and more severe neurological impairment (P < 0.05). Serum PAPP-A level showed a progressive increase with the increase of stroke severity (P < 0.05). Serum hs-CRP and National Institutes of Health Stroke Scale (NIHSS) scores were identified as independent predictors for unfavorable outcomes with odds ratios of 2.884 (1.154 to 7.210, P = 0.023) and 2.887 (1.146 to 7.273, P = 0.024), respectively.ConclusionSerum PAPP-A, S100 and hs-CRP were associated with stroke severity or outcome after ischemic stroke and may offer complementary information, essential for clinical decision making. Serum PAPP-A showed a potential value for the evaluation of stroke clinically.     

Sensory hypoaesthesia is a feature of chronic whiplash but not chronic idiopathic neck pain

Both sensory hypersensitivity and hypoaesthesia are features of chronic whiplash associated disorders (WAD). Sensory hypersensitivity is not a consistent feature of chronic idiopathic (non-traumatic) neck pain but the presence of hypoaesthesia has not been investigated. This study compared the somatosensory phenotype of whiplash and idiopathic neck pain. Comprehensive Quantitative Sensory Testing (QST) including both detection and pain thresholds as well as psychological distress were measured in 50 participants with chronic WAD, 28 participants with chronic idiopathic neck pain and 31 healthy controls. The whiplash group demonstrated lowered pressure pain thresholds (PPTs) at all sites compared to the controls (p < 0.01) but there was no difference between the two neck pain groups (p > 0.05) except at the tibialis anterior site (p = 0.02). The whiplash group demonstrated lowered cold pain thresholds compared to idiopathic and control groups (p < 0.03). For detection thresholds, the whiplash group showed elevated vibration (p < 0.04), heat (p < 0.02) and electrical (p < 0.04) thresholds at all upper limb sites compared to the idiopathic neck pain group and the controls (p < 0.04). Sensory hypoesthesia whilst present in chronic whiplash is not a feature of chronic idiopathic neck pain. These findings indicate that different pain processing mechanisms underlie these two neck pain conditions and may have implications for their management.     

Evaluating the effect of Matricaria recutita and Mentha piperita herbal mouthwash on management of oral mucositis in patients undergoing hematopoietic stem cell transplantation: A randomized,double blind,placebo controlled clinical trial

ObjectivesTo investigate the effects of Matricaria recutita and Mentha piperita on oral mucositis (OM) in patients undergoing hematopoietic stem cell transplantation (HSCT).DesignRandomized double blind placebo controlled clinical trial.SettingFaculty of Pharmacy, Shahid Beheshti University of Medical Sciences, and Bone Marrow Transplantation Center at Taleghani Teaching Hospital, Tehran, Iran.ParticipantsSixty patients undergoing HSCT were randomly assigned to two groups: placebo (n = 33), and herbal mouthwash group (n = 27).InterventionsAll patients received the mouthwash one week before HSCT and were instructed to use it three times daily for at least 30 s.Main outcome measuresOM was graded using National Cancer Institute Common Toxicity Criteria (NCI-CTC) scale (grade 0–5). The Numerical Rating Scale (NRS: 0–10 scale) measured the severity of OM symptoms.ResultsThe duration, maximum and average daily grade of OM were significantly reduced in the treatment group (P < 0.05). The use of herbal mouthwash led to significant improvements in pain intensity (P = 0.009), dryness (P = 0.04) and dysphagia (P = 0.009). Other significant results included: reduced need for complementary medications (P = 0.03), narcotic analgesics (P = 0.047), total parenteral nutrition (TPN) (P = 0.02) and the duration of TPN (P = 0.03).ConclusionThis study shows that patients receiving the herbal mouthwash experienced less complications and symptoms associated with OM. In summary, it seems that the use of our prepared herbal mouthwash is beneficial for patients undergoing HSCT.     

Plasma and synovial fluid sclerostin are inversely associated with radiographic severity of knee osteoarthritis

ObjectiveThe purpose of this study was to analyze sclerostin in plasma and synovial fluid of knee osteoarthritis (OA) patients and to investigate the association between sclerostin levels and radiographic severity.Design and methodsA total of 190 subjects (95 knee OA patients and 95 healthy controls) were recruited in the present study. Sclerostin levels in plasma and synovial fluid were assessed using an enzyme-linked immunosorbent assay. OA grading was performed using the Kellgren–Lawrence classification.ResultsPlasma sclerostin levels were significantly lower in OA patients than in healthy controls (P = 0.004). Additionally, sclerostin levels in plasma were significantly higher with respect to paired synovial fluid (P < 0.001). Moreover, sclerostin levels in plasma and synovial fluid demonstrated a significant inverse correlation with the radiographic severity of knee OA (r = − 0.464, P < 0.001 and r = − 0.592, P < 0.001, respectively). Subsequent analysis revealed that there was a positive correlation between plasma and synovial sclerostin levels (r = 0.657, P < 0.001).ConclusionsSclerostin was significantly lower in OA plasma samples when compared with healthy controls. Plasma and synovial fluid sclerostin levels were inversely associated with the radiographic severity of knee OA. Therefore, sclerostin may be utilized as a biochemical marker for reflecting disease severity in primary knee OA.     

Consistent and Breakthrough Pain in Diverse Advanced Cancer Patients: A Longitudinal Examination

Although cancer pain, both consistent and breakthrough pain ([BTP]; pain flares interrupting well-controlled baseline pain), is common among cancer patients, its prevalence, characteristics, etiology, and impact on health-related quality of life (HRQOL) are poorly understood. This longitudinal study examined the experience and treatment of cancer-related pain over six months, including an evaluation of ethnic differences. Patients with Stage III or IV breast, prostate, colorectal, or lung cancer, or Stage II–IV multiple myeloma with BTP completed surveys on initial assessment and at three and six months. Each survey assessed consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Among the respondents (n = 96), 70% were white, 66% were female, and had a mean age of 56 ± 10 years. Nonwhites reported significantly greater severity for consistent pain at its worst (P = 0.009), least (P ≤ 0.001), on average (P = 0.004), and upon initial assessment (P = 0.04), and greater severity for BTP at its worst (P = 0.03), least (P = 0.02), and at initial assessment (P = 0.008). Women also had higher levels of some BTP measures. Ethnic disparities persisted when data estimation techniques were used. Examined longitudinally, consistent pain on average and several BTP measures reduced over time, although not greatly, indicating the persistence of pain in the cancer experience. These data provide evidence for the significant toll of cancer pain, while demonstrating further health care disparities in the cancer pain experience.     

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis

BackgroundThe association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis.MethodsSixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n = 18), mild pain (n = 27), or moderate/severe pain (n = 22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified.FindingsThe moderate/severe pain group demonstrated worse global pain (P < 0.01) and physical function scores (P < 0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P = 0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P = 0.009), which was associated with higher weight acceptance peak knee adduction moments (P = 0.003) and worse global pain (P = 0.003) and physical function scores (P = 0.006).InterpretationGreater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.     

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years

ObjectivesThe usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.MethodsThis was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.ResultsWe reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P < 0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P < 0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P < 0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P < 0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P < 0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P < 0.05).ConclusionsDisabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.     

The effects of gait retraining in runners with patellofemoral pain: A randomized trial

BackgroundRunning popularity has increased resulting in a concomitant increase in running-related injuries with patellofemoral pain most commonly reported. The purpose of this study was to determine whether gait retraining by modifying footstrike patterns from rearfoot strike to forefoot strike reduces patellofemoral pain and improves associated biomechanical measures, and whether the modification influences risk of ankle injuries.MethodsSixteen subjects (n = 16) were randomly placed in the control (n = 8) or experimental (n = 8) group. The experimental group performed eight gait retraining running sessions over two weeks where footstrike pattern was switched from rearfoot strike to forefoot strike, while the control group performed running sessions with no intervention. Variables were recorded pre-, post-, and one-month post-running trials.FindingsKnee pain was significantly reduced post-retraining (P < 0.05; effect size = 0.294) and one-month follow-up (P < 0.05; effect size = 0.294). Knee abduction was significantly improved post-retraining (P < 0.05; effect size = 0.291) and one-month follow-up (P < 0.05; effect size = 0.291). Ankle flexion was significantly different post-retraining (P < 0.05; effect size = 0.547), as well as ankle range of motion post-retraining (P < 0.05; effect size = 0.425) and one-month follow-up (P < 0.05; effect size = 0.425).InterpretationFindings suggest running with a forefoot strike pattern leads to reduced knee pain, and should be considered a possible strategy for management of patellofemoral pain in recreational runners.This trial is registered at the US National Institutes of Health (clinicaltrials.gov) #NCT02567123.     

Paravertebral spinal injection for the treatment of patients with degenerative facet osteoarthropathy: Evidence of motor performance improvements based on objective assessments

BackgroundThis study examined short- and long-term improvements in motor performance, quantified using wearable sensors, in response to facet spine injection in degenerative facet osteoarthropathy patients.MethodsAdults with confirmed degenerative facet osteoarthropathy were recruited and were treated with medial or intermediate branch block injection. Self-report pain, health condition, and disability (Oswestry), as well as objective motor performance measures (gait, balance, and timed-up-and-go) were obtained in five sessions: pre-surgery (baseline), immediately after the injection, one-month, three-month, and 12-month follow-ups. Baseline motor performance parameters were compared with 10 healthy controls.FindingsThirty patients (age = 50 (14) years) and 10 controls (age = 46 (15) years) were recruited. All motor performance parameters were significantly different between groups. Results showed that average pain and Oswestry scores improved by 51% and 24%, respectively among patients, only one month after injection. Similarly, improvement in motor performance was most noticeable in one-month post-injection measurements; most improvements were observed in gait speed (14% normal walking, P < 0.02), hip sway within balance tests (63% eyes-open P < 0.01), and turning velocity within the timed-up-and-go test (28%, P < 0.02). Better baseline motor performance led to better outcomes in terms of pain relief; baseline turning velocity was 18% faster among the responsive compared to the non-responsive patients.InterpretationsSpinal injection can temporarily (one to three months) improve motor performance in degenerative facet osteoarthropathy patients. Successful pain relief in response to treatment is independent of demographic characteristics and initial pain but dependent on baseline motor performance. Immediate self-reported pain relief is unrelated to magnitude of gradual improvement in motor performance.