Anti-citrullinated peptides antibodies in systemic sclerosis: Meta-analysis of frequency and meaning

Objectives

Diagnosis of systemic sclerosis (SSc) is partially determined by the presence of specific autoantibodies often associated with specific clinical features. Recent studies report the presence of ACPA in SSc. We aimed to evaluate the prevalence of ACPA in SSc and to assess their influence on clinical presentation of SSc.

The Effect of a Comprehensive Rehabilitation Program on Respiratory Function and Functional Capacity on Patients After 1 Month to Liver Transplantation

BackgroundPhysical exercise is prescribed in populations with chronic diseases, but data are scarce in the liver transplantation (LT) setting.ObjectiveThe aim of this study was to evaluate changes in forced expiratory volume in the first second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking test (6MWT), 6-minute step test (6MST), Duke Activity Status Index, VO₂ (mL/kg/min), and health-related quality of life (in patients submitted to a rehabilitation program, comprising physical exercise training, breathing techniques, and educational sessions after LT.MethodsThis cohort study enrolled patients to an 8-week period of thrice weekly comprehensive supervised rehabilitation program after 1 month of LT. A nonrandomized control cohort of LT patients were selected to match the rehabilitation group based on specific demographic data and severity of disease.ResultsThe rehabilitation group, compared with the control group, showed a significant improvement in respiratory parameters (forced vital capacity [0.33L vs 0.13L,P < .01]); exercise capacity (6MWT and 6MST 71.1 vs 34.1 meters; and 30.5 vs 7.5 steps; respectively P < .01); Duke Activity Status Index scores and VO₂ (21.3 vs 10.2 and 9 vs 4.3; respectively P < .01); respiratory muscle strength (maximal inspiratory pressure 21.1 vs 15.1 cmH₂O and maximal expiratory pressure 21.2 vs 10.2 cmH₂O; P < .01); and quality of life (SF-36 physical component summary 12.4 vs 2.9 P < .01).ConclusionThese data suggest that improvements in physical fitness, respiratory parameters, and quality of life are achieved with a comprehensive rehabilitation program initiated early after LT.     

Effect of Pilates mat exercise and home exercise programs on pain,functional level,and core muscle thickness in women with chronic low back pain

BackgroundTo investigate the effects of Pilates exercise in patients with chronic non-specific low back pain (CNLBP) by training core stabilization muscles in aspects such as: pain, functional level, depression, quality of life, and muscle thickness measured by Ultrasound Imaging (UI) and to compare it with home based exercise.MethodsA prospective, randomized-single blinded study included 60 female patients with CNLBP. Patients were randomized into Pilates (group 1) or home exercise group (group 2) three times/week for eight weeks. The evaluations were made at the beginning and end of the treatment. Outcome parameters were VAS, Oswestry Disability Index, Qubec Disability Scale, Short Form-36, Beck Depression Questionnaire, sit and reach, Modified Schöber and sit up tests. Multifidus and abdominal muscle thickness were measured by UI.ResultsSignificant improvement has been observed in all parameters in both groups. It was found that Group 1 was more effective in terms of all parameters (p < 0.05).ConclusionsBoth Pilates and home exercises are effective in treating patients with chronic low back pain. UI can be useful for evaluating the core muscle thickness progression of chronic low back pain patients who are undergoing exercise therapy.     

Effect of inspiratory muscle training (IMT) on aerobic capacity,respiratory muscle strength and rate of perceived exertion in paraplegics

Objectives: The purpose is to study the effect of inspiratory muscle training on aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics.

Study Design: Randomized controlled trial.

Settings: Rehabilitation department in Indian Spinal Injuries Centre, New Delhi.

Participants: A sample of 30 paraplegics (T1-T12) were randomly allocated into two groups: inspiratory muscle training (IMT) group and control group.

Interventions: The IMT group received inspiratory muscle training for 15 minutes 5 times a week for 4 weeks whereas the control group was given breathing exercises.

Outcome measures: Maximal inspiratory pressure(MIP), maximal expiratory pressure (MEP), modified Borg’s scale (MBS), 12 minute wheelchair aerobic test (12MWAT), multistage fitness test (MSFT), and 6 minutes push test (6MPT).

Results: Out of 30 participants, 27 completed the study. The results show that after four weeks of IMT training, there were significant improvements in mean change scores of IMT group as compared to control group. Participants in IMT group performed better on 12MWAT (P?=?0.001), MSFT (P?=?0.001) and 6MPT (P?=?0.001). Improvements in MIP scores (P?=?0.001), MEP scores (P?=?0.001) and MBS scores (P?=?0.004) were also seen in IMT group.

Conclusion: Both groups showed significant improvements, however inspiratory muscle training was seen to be more effective than deep breathing exercises for improving aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics.     

Accurately measuring the quality and effectiveness of lumbar surgery in registry efforts: determining the most valid and responsive instruments

Background contextProspective registries have emerged as a feasible way to capture real-world care across large patient populations. However, the proven validity of more robust and cumbersome patient-reported outcomes instruments (PROis) must be balanced with what is feasible to apply in large-scale registry efforts.PurposeTo determine the relative validity and responsiveness of common PROis in accurately determining effectiveness of lumbar fusion for degenerative lumbar spondylolisthesis in registry efforts.Study designProspective cohort study.Patient sampleFifty-eight patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spondylolisthesisOutcome measuresPatient-reported outcome measures for pain (numeric rating scale for back and leg pain [NRS-BP, NRS-LP]), disability (Oswestry Disability Index [ODI]), general health (Short Form [SF]-12), quality of life (QOL) (EuroQol five dimensions [EQ-5D]), and depression (Zung depression scale [ZDS]) were assessed.MethodsFifty-eight patients undergoing primary TLIF for lumbar spondylolisthesis were entered into an institutional registry and prospectively followed for 2 years. Baseline and 2-year patient-reported outcomes were assessed. To assess the validity of PROis to discriminate between effective and noneffective improvements, receiver operating characteristic curves were generated for each outcomes instrument. An area under the curve (AUC) of ≥0.80 was considered an accurate discriminator. The difference between standardized response means (SRMs) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each instrument.ResultsFor pain and disability, ODI had AUC=0.94, suggesting it as an accurate discriminator of meaningful improvement. Oswestry Disability Index was most responsive to postoperative improvement (SRM difference: 2.18), followed by NRS-BP and NRS-LP. For general health and QOL, SF-12 physical component score (AUC: 0.90), ZDS (AUC: 0.89), and SF-12 mental component score (AUC: 0.85) were all accurate discriminators of meaningful improvement, however, EQ-5D was most accurate (AUC: 0.97). EuroQol five dimensions was also most responsive (SRM difference: 2.83).ConclusionsFor pain and disability, ODI was the most valid and responsive measure of effectiveness of lumbar fusion. Numeric rating scale-BP and NRS-LP should not be used as substitutes for ODI in measuring effectiveness of care in registry efforts. For health-related QOL, EQ-5D was the most valid and responsive measure of improvement, however, SF-12 and ZDS are valid alternatives with less responsiveness.     

Incidence and risk of developing rheumatic diseases in 19,724 patients with palindromic rheumatism in South Korea: A nationwide population-based study

ObjectivesThe spectrum of progression of palindromic rheumatism (PR) to chronic diseases is quite variable. Hence, this study aimed to investigate the incidence and risk of developing rheumatic diseases in PR using nationwide, population-based medical claims data from Korea.MethodsWe assessed the incidence rate (IR) of PR in the population in the given year. After matching individuals with PR with those without PR (1:10) for age, gender, and the index year, we calculated the hazard ratios (HRs) with 95% confidence intervals (CIs) using the Cox proportional hazard model.ResultsA total of 19,724 newly diagnosed incident PR cases were identified from 2010 to 2016. The mean age was 50.2 ± 14.9 years. The incidence of PR was 7.02 (95% CI 6.92–7.12) per 100,000 person-years (6.22 and 7.80 in men and women, respectively). During observation, 8.79% patients with PR and 0.30% individuals without PR developed various outcome diseases. Patients with PR had an increased risk of seropositive rheumatoid arthritis (HR 46.51, 95% CI [41.05–52.69]), psoriatic arthritis (44.79 [15.16–132.35]), systemic lupus erythematosus (24.53 [16.15–37.24]), mixed connective tissue disease (22.01 [7.65–63.34]), Behçet's disease (21.04 [13.81–32.06]), Sjögren's syndrome (12.36 [8.54–17.88]), ankylosing spondylitis (9.00 [6.67–12.15]), dermatomyositis/polymyositis (6.14 [2.55–14.82]), and systemic sclerosis (3.75 [1.47–9.58]) compared with individuals without PR.ConclusionsThis nationwide, population-based cohort study demonstrated that about one-eleventh of patients with PR eventually develop systemic rheumatic diseases and that patients with PR have an increased risk of developing various rheumatic diseases including seropositive rheumatoid arthritis.     

Ventilation asymmetry,diaphragmatic mobility and exercise capacity in men with traumatic brachial plexus injury

ObjectiveTo investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic mobility and exercise capacity, compartmental volume changes, as well as volume contribution of each hemithorax and ventilation asymmetry during different respiratory maneuvers, and compare with healthy individuals. The velocity of shortening of the diaphragm, inspiratory, and expiratory muscles were also assessed.ParticipantsThe cross-sectional study was conducted with 40 male individuals (20 with TBPI who have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired by age and body mass index). Only patients with C8-T1 root avulsion were studied.Main outcomeCompartmental and hemithoracic volumes, as well as asymmetry between the affected and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute walking test was performed to evaluate exercise capacity, while diaphragm mobility was assessed during quiet breathing (QB) using an ultrasound device.ResultsTBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all p < .001) compared with healthy. The pulmonary ribcage compartment of the affected side was the main contributor to the reduction in volume during inspiratory capacity, vital capacity, and inspiratory load imposition (all p < .05). This compartment also exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory ribcage muscles.ConclusionCompared with healthy, TBPI patients who have not undergone nerve transfer surgery present low exercise capacity and diaphragmatic mobility, as well as reduced volume of the upper ribcage compartment on the affected side that leads to reduced shortening velocity and ventilation asymmetry.     

Physical Condition,Glycemia, Liver Function,and Quality of Life in Liver Transplant Recipients After a 12-Month Supervised Exercise Program

Background and aimsDespite the excellent long-term outcomes in liver transplant (LT) recipients, several medical complications related to lifestyle still represent an issue. This study examined the effects of a 12-month supervised aerobic and strength training program on the aerobic capacity, muscle strength, metabolic profile, liver function, and quality of life of a cohort of LT recipients.MethodsLT recipients with stable liver function were assigned to interventional exercise (group A) or usual care (group B). Aerobic capacity, muscle strength, metabolic profile, liver and kidney function, and health-related quality of life were assessed at baseline and after 6 and 12 months. Group A attended supervised training sessions 3 times per week for 12 months. Group B received general recommendations about home-based exercise.ResultsForty patients from 6 Italian LT centers were randomized. Twenty-nine (72.5%, men-to-women ratio 23:6, mean age, 52 ± 8 years) LT recipients completed the study. Baseline characteristics were similar between groups except for body mass index and time from LT. No episode of acute rejection nor increase of transaminases occurred. Maximum workload and body mass index increased in both groups over time, but fasting glucose significantly decreased in group A (94.0 ± 15.0 mg/dL vs 90.0 ± 17.0 mg/dL; P = .037) and increased in controls (95.0 ± 24.0 mg/dL vs 102.0 ± 34.0 mg/dL, P = .04). Upper limb muscle strength increased only in supervised LT recipients. Vitality and general and mental health domains significantly improved after physical exercise.ConclusionsSupervised combined training was safe and effective in increasing aerobic capacity, muscle strength, and quality of life and in improving glucose metabolism in stable LT recipients.     

Bouncing back after lumbar spine surgery: early postoperative resilience is associated with 12-month physical function,pain interference,social participation,and disability

BACKGROUND CONTEXTPositive psychosocial factors early after surgery, such as resilience and self-efficacy, may be important characteristics for informing individualized postoperative care.PURPOSETo examine the association of early postoperative resilience and self-efficacy on 12-month physical function, pain interference, social participation, disability, pain intensity, and physical activity after lumbar spine surgery.STUDY DESIGN/SETTINGPooled secondary analysis of prospectively collected trial data from two academic medical centers.PATIENT SAMPLETwo hundred and forty-eight patients who underwent laminectomy with or without fusion for a degenerative lumbar condition.OUTCOME MEASURESPhysical function, pain inference, and social participation (ability to participate in social roles and activities) were measured using the Patient Reported Outcomes Measurement Information System. The Oswestry Disability Index, Numeric Rating Scale, and accelerometer activity counts were used to measure disability, pain intensity, and physical activity, respectively.METHODSParticipants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Baseline positive psychosocial factors included resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). Multivariable linear regression analyses were used to assess the associations between early postoperative psychosocial factors and 12-month outcomes adjusting for age, sex, study site, randomized group, fusion status, fear of movement (Tampa Scale for Kinesiophobia), and outcome score at baseline. This study was funded by Patient-Centered Outcomes Research Institute and Foundation for Physical Therapy Research. There are no conflicts of interest.RESULTSResilience at 6 weeks after surgery was associated with 12-month physical function (unstandardized beta=1.85 [95% confidence interval [CI]: 0.29; 3.40]), pain interference (unstandardized beta=?1.80 [95% CI: ?3.48; ?0.12]), social participation (unstandardized beta=2.69 [95% CI: 0.97; 4.41]), and disability (unstandardized beta=?3.03 [95% CI: ?6.04; ?0.02]). Self-efficacy was associated with 12-month disability (unstandardized beta=?0.21 [95% CI: ?0.37; ?0.04].CONCLUSIONSPostoperative resilience and pain self-efficacy were associated with improved 12-month patient-reported outcomes after spine surgery. Future work should consider how early postoperative screening for positive psychosocial characteristics can enhance risk stratification and targeted rehabilitation management in patients undergoing spine surgery.     

Preoperative Zung depression scale predicts outcomes in older patients undergoing short-segment fusion surgery for degenerative lumbar spinal disease

Purpose

To identify the relationship between depression measured by Zung depression rating scale (ZDRS) and postoperative outcomes (including the patients reported outcomes [PRO] and clinical outcomes) two years after short-segment fusion surgery for degenerative lumbar spinal disease in older patients (aged 75 years and older).

Methods

We enrolled patients who underwent short-segment fusion surgery for lumbar degenerative disease from May 2018 to June 2020. All patients were assessed for depression using the ZDRS. Patients were included in the depression group and not-depressed group based on their scores. Preoperative baseline data were collected on characteristics, comorbidities, laboratory data, pain levels (visual analogue scale [VAS]), functional status (Oswestry Disability Index [ODI]), and surgery-related variables. The primary outcomes were PRO measures, including VAS, ODI and satisfaction two years after lumbar fusion surgery. Other outcomes included postoperative complications, the length of stay, and reoperation. Univariate and multivariate analyses were performed to identify the risk factors for poor satisfaction.

Results

A total of 231 patients (201 in not-depressed and 30 in depressed group) were enrolled in this study. There were no significant differences between the two groups for baseline data. Depressed group had higher rates of choices for dissatisfaction (36.7% vs. 14.0%, p = 0.015), higher VAS scores of low back pain (2.8 ± 2.3 vs. 1.6 ± 1.7, p = 0.012), and worse functional status (31.5 ± 22.5 vs 21.8 ± 19.9, p = 0.015) than the not-depressed group. Depressed patients reported significantly higher rates of postoperative complications and readmissions. Multivariate regression analysis revealed that depression (p = 0.001) was independently associated with postoperative dissatisfaction.

Conclusion

Preoperative depression was a risk factor for postoperative dissatisfaction, worse functional status, readmission, and complications in older patients undergoing lumbar fusion surgery. Preoperative screening using the Zung depression scale helps inform decision-making when considering fusion surgery for patients aged 75 and older.

     

No Sex Differences Exist in Posterior Condylar Offsets of the Knee

BackgroundRestoration of posterior condylar offset during TKA is believed to be important to improving knee kinematics, maximizing ROM, and minimizing flexion instability. However, controversy exists regarding whether there are important anatomic differences between sexes and whether a unisex knee prosthesis can restore the anatomy of knees in males and females.Questions/purposesThe purposes of our study were to determine if sex differences exist in (1) absolute posterior condylar offset size, (2) relative posterior condylar offset size in relation to total condylar height, and (3) posterior condylar articular cartilage thickness.MethodsWe identified 100 patients (50 men and 50 women) without a history of arthritis, deformity, dysplasia, osteochondral defect, fracture, or surgery about the knee who had MRI of the knee performed. All MR images were ordered by primary care medical physicians for evaluation of nonspecific knee pain. Using a previously described three-dimensional MRI protocol, we measured posterior condylar offset, total condylar height, and articular cartilage thickness at the medial and lateral femoral condyles and compared values to evaluate for potential sex differences. We performed an a priori power calculation using a 2-mm posterior condylar offset difference as the minimum clinically important difference; with 2n = 100, our power to detect such a difference was 99.8%.ResultsCompared with females, males had greater medial posterior condylar offset (30 mm [95% CI, 29.3–30.7 mm; SD, 2.5 mm] vs 28 mm [95% CI, 27.0–28.5 mm; SD, 2.7 mm]), lateral posterior condylar offset (27 mm [95% CI, 26.2–27.3 mm; SD, 2.0 mm] vs 25 mm [95% CI, 24.2–25.4 mm; SD, 2.0 mm]), medial condylar height (63 mm [SD, 3.2 mm] vs 57 mm [SD, 4.4 mm]), and lateral condylar height (71 mm [SD, 5.2 mm] vs 65 mm [SD: 4.0 mm]) (all p values < 0.001). However, the mean ratio of medial posterior condylar offset to medial condylar height (0.48 [SD, 0.04] vs 0.49 [SD, 0.05]) and the mean ratio of lateral posterior condylar offset to lateral condylar height (0.38 [SD, 0.05] vs 0.38 [SD, 0.03]) were not different between sexes (p = 0.08 and p = 0.8, respectively). There also was no sex difference in mean articular cartilage thickness at either condyle (medial condyle: 2.7 mm [SD, 0.5 mm] vs 2.5 mm [SD, 0.7 mm]; lateral condyle: 2.6 mm [SD, 0.6 mm] vs 2.5 mm [SD, 0.8 mm]) (both p values ≥ 0.1).ConclusionsResults of our study showed that knees in males exhibited greater posterior condylar offset and greater total condylar height at the medial and lateral femoral condyles, however, there were no sex differences in the ratio of posterior condylar offset to condylar height at either condyle.

Clinical Relevance

These findings suggest that a unisex knee prosthesis design is adequate to recreate the normal posterior condylar offsets for men and women.     

Serum level of endostatin and digital ulcers in systemic sclerosis patients

Patients with systemic sclerosis (SSc) are at a high risk of the development of ischaemic digital ulcers (DUs) that can be complicated with infections, gangrene, and osteomyelitis. The aim of this study is to evaluate the role of endostatin in scleroderma DUs.In total, 90 SSc patients were enrolled in this study. Serum endostatin levels and DU assessment were determined in all SSc patients. The serum levels of endostatin significantly increased with progression of capillaroscopic damage (P < .01). The serum levels of endostatin are significantly (P < .05) higher in SSc patients with new DUs than in SSc patients without new DUs (127 ± 31.1 ng/mL vs 116.3 ± 39.7 ng/mL). The Receiver Operating Characteristic (ROC) curves demonstrated good accuracy of new DU prediction for the serum level of endostatin (0.70, P < .01 [95% confidence interval (CI) 0.59‐0.81]). Using a cut‐off value of 116 ng/mL, the odds ratio was 2.609 (CI 1.075‐6.330, P < .05). The serum levels of endostatin are significantly (P < .01) higher in SSc patients with infected DUs than in SSc patients without infected DUs (139.2 [114.6‐340.91] ng/mL vs 117.5 [64.3‐163.9] ng/mL). Serum levels of endostatin are higher in patients with DUs, especially in those with infected DUs.     

Assessing the effects of 6 weeks of intermittent aerobic exercise on aerobic capacity,muscle fatigability,and quality of life in diabetic burned patients: Randomized control study

BackgroundBoth burn and diabetes mellitus (DM) cause functional and psychosocial disabilities. A low-cost and safe approach is greatly required to reduce these disabilities and the effects of aerobic exercise have generated varied evidence to date. The aim of the study was to explore the effects of 6 weeks of intermittent aerobic exercise (IAE) on aerobic capacity, muscle fatigability, and quality of life (QoL) in diabetic burned patients (DBPs).MethodsThe study design was a prospective, single-blind, randomized controlled trial. Between March 2018 and July 2019 thirty-six (22 males and 16 females) diabetic burned patients were included in the study, their age ranged 35–55 years. They were clinically diagnosed with type 2 DM and total body surface area (TBSA) was 15–30%. The participants were randomly assigned to the IAE group (n = 18) and controls (n = 18). Aerobic capacity, muscle fatigability, and QoL were assessed initially and repeated after 6 weeks of intervention.ResultsInitial data demonstrated non-significant differences between the IAE and control groups (p > 0.05). Comparing pre- and post-intervention outcomes showed significant improvement of VO₂max, muscle fatigability, QoL domains in the IAE group after 6 weeks intervention (p < 0.05) and non-significant changes in the control group (p > 0.05). The IAE group showed statistically significant improvement more than the control group in all outcome measures (p < 0.05).Conclusions6 weeks of intermittent aerobic exercise is an effective alternative modality to improve aerobic capacity, muscle fatigability, and QoL in DBPs. Adherence to intermittent aerobic exercise should be practicable into mainstream clinical intervention for those patients.     

Effect of Home-Based Well-Rounded Exercise in Community-Dwelling Older Adults

The purpose of this study was to assess the efficacy of a home-based well-rounded exercise program (WREP) in older adults. Forty sedentary community-dwelling older adults were randomly assigned to an exercise group (n = 23; aged 62-80 yr, average: 69.2 ± 5.2; 12 men and 11 women) or a control group (n = 17; aged 63-85 yr, average: 70.1 ± 6.6; 5 men and 12 women). The exercise group performed a 12-wk WREP which included aerobic exercise (walking) on about 3 days·wk^-1 for 37 min·day^-1; elastic band-based resistance exercises for the major muscle groups on about 3 days·wk^-1 for 26 min; and flexibility exercises (stretching) on about 4 days·wk^-1 for 19 min·day^-1. General physical characteristics, functional strength (Arm Curl [AC], Chair Stand [CS]), dynamic balance and agility (Up & Go [UG]), flexibility (Back Scratch [BS], Sit & Reach [SR]), and endurance (12-min walk [12-MW]) were measured. Following the 12-wk home-based WREP, improvements were observed in AC, CS, UG, BS, SR and 12-MW for the exercise group but not for the control group. These results suggest that the home-based WREP can improve overall fitness in older adults.

Key Points

• Walking, elastic band exercise and stretching were prescribed as a Well-Rounded Exercise Program for older adults.
• By combining aerobic, resistance and flexibility exercises, a Well-Rounded Exercise Program was effective for improving endurance, functional strength, dynamic balance and agility, and flexibility.
• Community-based exercise classes motivated older adults to perform home-based exercises.

Key words: Physical fitness, aerobic exercise, resistance exercise, flexibility exercise, adherence     

Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery

Background contextPatient satisfaction ratings are increasingly being used in health care as a proxy for quality and are becoming the focal point for several quality improvement initiatives. Affective disorders, such as depression, have been shown to influence patient-reported outcomes and self-interpretation of health status. We hypothesize that patient psychiatric profiles influence reported satisfaction with care, independent of surgical effectiveness.PurposeTo assess the predictive value of preoperative depression on patient satisfaction after revision surgery for same-level recurrent stenosis.Study designRetrospective cohort study.Patient sampleFifty-three patients undergoing a revision surgery for symptomatic same-level recurrent stenosis.Outcome measuresPatient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health state values (EuroQol-5D [EQ-5D]), disability (Oswestry Disability Index [ODI]), pain (visual analog scale [VAS]), depression (Zung self-rating depression scale), and Short Form 12 (SF-12) physical and mental component scores (PCS and MCS). Patient satisfaction was dichotomized as either “YES” or “NO” on whether they were satisfied with their surgical outcome 2 years after the surgery.MethodsA total of fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score (ZDS), education status, comorbidities, and postoperative satisfaction with surgical care and outcome was assessed for all patients. Baseline and 2-year VAS for leg pain (VAS-LP), VAS for low back pain (VAS-BP), ODI, SF-12 PCS and MCS, and health-state utility (EQ-5D) were assessed. Factors associated with patient satisfaction after surgery were assessed via multivariate logistic regression analysis.ResultsTwo years after surgery, a significant improvement was reported in all outcome measures: VAS-BP (5±2.94 vs. 9.28±1, p<.001), VAS-LP (3.43±2.95 vs. 9.5±0.93, p<.001), ODI (21.75±12.07 vs. 36.01±6, p<.001), SF-12 PCS (32.30±11.01 vs. 25.13±5.84, p<.001), SF-12 MCS (47.48±10.96 vs. 34.91±12.77, p<.001), EQ-5D (0.60±0.31 vs. 0.18±0.22, p<.001), and ZDS (37.52±11.98 vs. 49.90±10.88, p<.001). Independent of postoperative improvement in pain and disability (surgical effectiveness), increasing preoperative Zung depression score was significantly associated with patient dissatisfaction 2 years after revision lumbar surgery (Odds ratio=0.67 [confidence interval: 0.38, 0.87], p<.001).ConclusionsOur study suggests that independent of the surgical effectiveness, the extent of preoperative depression influences the reported patient satisfaction after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality should account for the patients' baseline depression as potential confounders.     

Impact of key manifestations of psoriatic arthritis on patient quality of life,functional status,and work productivity: Findings from a real-world study in the United States and Europe

ObjectivesTo determine the individual impact of key manifestations of psoriatic arthritis (PsA) on quality of life (QoL), physical function, and work disability.MethodsData from the Adelphi 2018 PsA Disease-Specific Programme, a multinational, cross-sectional study of PsA patients, were used. PsA manifestations included peripheral arthritis (number of joints affected), psoriasis (body surface area [BSA]), axial involvement (inflammatory back pain [IBP] and sacroiliitis) enthesitis, and dactylitis. General, and disease-specific QoL, physical function, and work disability were measured with EQ-5D-5L, PsAID-12, HAQ-DI, and WPAI, respectively. Multivariate regression adjusting for potential confounders evaluated the independent effect of PsA manifestations on each outcome.ResultsAmong the 2222 PsA patients analysed, 77.0% had active psoriasis and 64.4% had peripheral arthritis; 5.9%, 6.8%, 10.2%, and 3.6% had enthesitis, dactylitis, IBP, or sacroiliitis, respectively. Mean EQ VAS scores were significantly poorer in patients with vs. without enthesitis (59.9 vs. 75.6), dactylitis (63.6 vs. 75.4), and with greater peripheral joint involvement (none: 82.5; 1–2 affected joints: 74.1; 3–6 joints: 74.2; > 6 joints: 65.0). Significantly worse mean PsAID-12 scores were associated with vs. without enthesitis (4.39 vs. 2.34) or dactylitis (4.30 vs. 2.32), and with greater peripheral joint involvement (none: 1.21; 1–2 joints: 2.36; 3–6 joints: 2.74; > 6 joints: 3.92), and BSA (none: 1.49; > 3–10%: 2.96; > 10%: 3.43). Similar patterns were observed with HAQ-DI and WPAI scores.ConclusionMost PsA manifestations were independently associated with worse general, and PsA-specific QoL, physical function, and work disability, highlighting the need for treatments targeting the full spectrum of PsA symptoms to lower the burden of disease.     

Cartilage Oligomeric Matrix Protein (COMP) in systemic sclerosis (SSc): role in disease severity and subclinical rheumatoid arthritis overlap

ObjectiveThe aim of the present study was to compare the serum level of COMP in both subsets of Systemic sclerosis (SSc) as a marker of arthritis and reveal an associated subclinical RA overlap and a relation to clinical, laboratory and radiological findings in SSc.MethodsForty adult SSc patients were included in the study and grouped into the two subsets diffuse (dSSc) and limited (lSSc) SSc. Their mean age was 40 ± 9 years. Thorough history taking and clinical examination were performed to all patients. Skin thickness was scored according to the modified Rodnan skin score method (MRSS). The disease activity was assessed by measuring the Medsger severity score. The joints were extensively examined and the tenderness counted according to the Ritchie articular index (RAI). Relevant laboratory and radiological investigations were carried out. The serum COMP level was determined by ELISA.ResultsThe serum COMP was significantly higher in the SSc patients compared to the control and obviously higher in the dSSc compared to the lSSc patients. The level of COMP was higher in the females and significantly higher in the SSc patients with arthritis (56.5 ± 6.8 ug/ml) compared to those without (34 ± 8.3 ug/ml) (P 0.000).ConclusionThe COMP level may become a nonspecific but useful marker for joint involvement in SSc patients to identify patients at risk of joint damage and developing SSc-RA overlap syndrome even with mild arthritis.     

Hand impairment and activity limitations in four chronic diseases

Study designRetrospective cohort.IntroductionHand involvement in osteoarthritis (OA) and rheumatoid arthritis (RA) are well known to occupational and physical therapists; however, it is not known whether the impairments and activity limitations with diabetes (DMII) and systemic sclerosis (SSc) are as severe as those observed with OA and RA.PurposeTo compare the hand impairments and activity limitations in the 4 diseases.MethodsA convenience sample of 156 participants received evaluations of hand impairments: strength, joint motion, and dexterity and completed a hand activity limitations questionnaire.ResultsThe SSc and RA participants had weaker pinch, decreased joint motion and more activity limitations than the DMII and OA groups. There were no significant differences between the groups for right hand grip strength and pegboard dexterity, and applied dexterity.ConclusionsOA and DMII groups had significantly less impairments and activity limitations than the SSc and RA groups.Level of evidence2C.     

Indices of the Scleroderma Assessment Questionnaire (SAQ) can be used to demonstrate change in patients with systemic sclerosis over time

ObjectiveThis study aims to estimate the value of the Scleroderma Assessment Questionnaire (SAQ) to demonstrate change in patients (pts) with systemic sclerosis (SSc) over time.MethodsSixty pts with SSc were evaluated at two occasions, 12 months apart. Pts were divided into three subgroups according to criteria of improved, unchanged or deteriorated status of vascular, respiratory, gastrointestinal and musculosceletal system. All pts filled in the SAQ as part of both evaluations, and the Index of Vascular Status (IVS), Index of Respiratory Status (IRS), Index of Gastrointestinal status (IGS) and Index of Musculoskeletal Status (IMSS) were calculated. Average index scores for particular organ system at the beginning and after the follow-up period in all subgroups of pts were compared.ResultsThe mean value of IVS decreased significantly in pts with objectively improved vascular status (1.91 vs. 1.29, p = 0.01), but increased in pts with deteriorated status (1.54 vs. 2.13, p = 0.003). In the subgroup of pts with unchanged vascular morphology or function, the IVS did not change significantly either (1.84 vs. 1.77, p = 0.36). The mean value of IRS decreased significantly in pts with objectively improved lung function (1.08 vs. 0.62, p = 0.027), and increased in pts with deteriorated function (0.69 vs. 1.12, p = 0.012). In the subgroup of pts with unchanged pulmonary function, the IRS did not change significantly (0.13 vs. 0.14, p = 0.18). A statistically significant decrease in mean IGS value was found in pts who were treated with prokinetics (1.20 vs. 0.70, p < 0.001). In pts who were not treated with prokinetics, an increase of IGS was observed (0.58 vs. 0.76, p = 0.002). Differences between mean values of the IMSS were statistically significant in subgroups of pts with improved (1.28 vs. 0.90, p = 0.004) or deteriorated musculoskeletal status (0.98 vs. 1.44, p = 0.012), but not in pts with unchanged condition of this organ system (0.72 vs. 0.68, p = 0.498).ConclusionThe SAQ is a sensitive measurement to demonstrate change in patients with SSc over time.     

Interval training elicits higher enjoyment versus moderate exercise in persons with spinal cord injury

Background: High intensity interval training (HIIT) is a robust and time-efficient approach to improve multiple health indices including maximal oxygen uptake (VO₂max). Despite the intense nature of HIIT, data in untrained adults report greater enjoyment of HIIT versus continuous exercise (CEX). However, this has yet to be investigated in persons with spinal cord injury (SCI).

Objective: To examine differences in enjoyment in response to CEX and HIIT in persons with SCI.

Design: Repeated measures, within-subjects design.

Setting: University laboratory in San Diego, CA.

Participants: Nine habitually active men and women (age?=?33.3?±?10.5 years) with chronic SCI.

Intervention: Participants performed progressive arm ergometry to volitional exhaustion to determine VO₂peak. During subsequent sessions, they completed CEX, sprint interval training (SIT), or HIIT in randomized order.

Outcome Measures: Physical activity enjoyment (PACES), affect, rating of perceived exertion (RPE), VO₂, and blood lactate concentration (BLa) were measured.

Results: Despite a higher VO₂, RPE, and BLa consequent with HIIT and SIT (P?, PACES was significantly higher (P?=?0.03) in response to HIIT (107.4?±?13.4) and SIT (103.7?±?12.5) compared to CEX (81.6?±?25.4). Fifty-five percent of participants preferred HIIT and 45% preferred SIT, with none identifying CEX as their preferred exercise mode.

Conclusion: Compared to CEX, brief sessions of submaximal or supramaximal interval training elicit higher enjoyment despite higher metabolic strain. The long-term efficacy and feasibility of HIIT in this population should be explored considering that it is not viewed as more aversive than CEX.