The effect of pain severity on balance,postural stability and fall risk in patients with shoulder pathologies

IntroductionThe study aimed to investigate how pain severity in the shoulder region affects balance ability, postural stability and fall risk.Material and methodsSixty participants with shoulder pain, aged 42.45 ±6.51 years, were assessed using a Visual Analog Scale (VAS); they were divided into 2 subgroups as a mild pain group (group 1) and a moderate/severe pain group (group 2). According to VAS-at rest the mild-pain group included 39 and the moderate/severe-pain group included 21 subjects. According to VAS-during movement, the mild-pain group included 19 and the moderate/severe-pain group included 41 subjects. Balance ability-postural stability, fall risk and fear of falling were assessed by the Sportkat System, Berg Balance Scale (BBS), and Fall Efficacy scale (FES) respectively. Differences of variables between mild pain and moderate/severe pain groups were analyzed by the independent groups t-test in groups conforming to a normal distribution and the Mann-Whitney U test for the variables that did not fit a normal distribution.ResultsA positive relationship was found between VAS-at rest and double-foot static balance test score right-left (RL) ratio, while a negative relationship was found between VAS-at rest and BBS score (p < 0.05). Significant differences were found between right foot static balance left score and RL ratio according to pain at rest (p < 0.05).ConclusionsThe results indicated that shoulder pain severity affects balance parameters. As pain level at rest increases, postural sway increases in a medio-lateral direction, and towards the left while standing on the right foot. Approaches regarding increasing balance and postural instability should be included in physiotherapy and rehabilitation programs of patients with shoulder pain at an early phase to protect patients from balance problems and fall risk.     

Cone-beam computed tomography evaluation of impacted and transmigrated mandibular canines: a retrospective study

Oral Radiology - The purpose of this study is to evaluate CBCT images of impacted mandibular canines in detail and to discuss implications for diagnosis and treatment. CBCT images of dental...     

Methodological considerations on the design and analysis of an equivalence stratified cluster randomization trial

The World Health Organization and collaborating institutions in four developing countries have conducted a multi-centre randomized controlled trial, in which clinics were allocated at random to two antenatal care (ANC) models. These were the standard 'Western' ANC model and a 'new' ANC model consisting of tests, clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes. The two models were compared using the equivalence approach. This paper discusses the implications of the equivalence approach in the sample size calculation, analysis and interpretation of results of this cluster randomized trial. It reviews the ethical aspects regarding informed consent, concluding that the Zelen design has a place in cluster randomization trials. It describes the estimation of the intracluster correlation coefficient (ICC) in a stratified cluster randomized trial using two methods and reports estimates of the ICC obtained for many maternal, newborn and perinatal outcomes. Finally, it discusses analytical problems that arose: issues encountered using a composite index, heterogeneity of the intervention effect across sites, the choice of the method of analysis and the importance of efficacy analyses. The choice of the clustered Woolf estimator and the generalized estimating equations (GEE) as the methods of analysis applied is discussed.     

Cigarette smoking during pregnancy and risk of preeclampsia: a systematic review.

In this systematic review of the existing evidence regarding the relationship between cigarette smoking during pregnancy and preeclampsia, studies were found through searches of MEDLINE (1966-October 31, 1998), Embase, Popline, CINAHL, Lilacs, bibliographies of identified studies, and proceedings of meetings on preeclampsia, and also through contact with relevant researchers. No language restrictions were imposed. Only cohort and case-control studies dealing with the relationship between cigarette smoking and preeclampsia were considered. Assessment of methodologic quality and data extraction of each study were carried out by 2 authors working independently. Typical relative risks and odds ratios with 95% confidence intervals were calculated for cohort and case-control studies, respectively, with both fixed and random effects models. Twenty-eight cohort studies and 7 case-control studies including a total of 833,714 women were included. All cohort studies reported an inverse association between cigarette smoking during pregnancy and incidence of preeclampsia (typical relative risk, 0.68; 95% confidence interval, 0.67-0.69). The findings were similar for case-control studies (typical odds ratio, 0.68; 95% confidence interval, 0.57-0.81). An inverse dose-response relationship was also found. Pooled data from cohort and case-control studies showed a lower risk of preeclampsia associated with cigarette smoking during pregnancy.