Francis Fatoye

Proprioception and muscle torque deficits in children with hypermobility syndrome

OBJECTIVES Sensorimotor deficits such as impaired joint proprioception and muscle weakness have been found in association with hypermobility syndrome (HMS) in adults. HMS is more common in children than adults, yet such deficits have not been adequately investigated in paediatric populations. It is therefore uncertain as to what sensorimotor deficits are present in children with HMS. This study investigated knee joint proprioception and muscle torque in healthy children and those with HMS. METHODS Thirty-seven healthy children (mean age +/- s.d. = 11.5 +/- 2.6 yrs) and 29 children with HMS (mean age +/- s.d. = 11.9 +/- 1.8 yrs) participated in this study. Knee joint kinaesthesia (JK) and joint position sense (JPS) were measured, with the absolute angular error (AAE) calculated as the absolute difference between the target and perceived angles. Knee extensor and flexor muscle torque was assessed and normalized to body mass. Mann-Whitney U-tests were performed to compare JK, JPS and muscle torque between the two groups. RESULTS Children with HMS had significantly poorer JK and JPS compared with the controls (both P < 0.001). Knee extensor and flexor muscle torque was also significantly reduced (both P < 0.001) in children with HMS compared with their healthy counterparts. CONCLUSIONS The findings of this study demonstrated that knee joint proprioception was impaired in children with HMS. They also had weaker knee extensor and flexor muscles than healthy controls. Clinicians should be aware of these identified deficits in children with HMS, and a programme of proprioceptive training and muscle strengthening may be indicated.

Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice

BACKGROUND Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but may be different for mirabegron, a β3-adrenoceptor agonist with a different adverse event profile. OBJECTIVE To compare persistence and adherence with mirabegron versus tolterodine extended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period. DESIGN, SETTING, AND PARTICIPANTS Retrospective, longitudinal, observational study of anonymised data from the UK Clinical Practice Research Datalink GOLD database. Eligibility: age ≥18 yr, ≥1 prescription for target OAB drug (between May 1, 2013 and June 29, 2014), and 12-mo continuous enrolment before and after the index prescription date. INTERVENTIONS Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was persistence (time to discontinuation). Secondary endpoints included 12-mo persistence rates and adherence (assessed using medication possession ratio, MPR). Cox proportional-hazards regression models and logistic regression models adjusted for potential confounding factors were used to compare cohorts. Analyses were repeated after 1:1 matching. RESULTS AND LIMITATIONS The study population included 21996 eligible patients. In the unmatched analysis, the median time-to-discontinuation was significantly longer for mirabegron (169 d, interquartile range [IQR] 41-not reached) compared to tolterodine ER (56 d, IQR 28-254; adjusted hazard ratio [HR] 1.55, 95% confidence interval 1.41-1.71; p<0.0001) and other antimuscarinics (range 30-78 d; adjusted HR range 1.24-2.26, p<0.0001 for all comparisons). The 12-mo persistence rates and MPR were also significantly greater with mirabegron than with all the antimuscarinics. Limitations include the retrospective design, use of prescription records to estimate outcomes, and inability to capture reasons for discontinuation. CONCLUSIONS Persistence and adherence were statistically significantly greater with mirabegron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK. PATIENT SUMMARY This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.

Relationship Between Anxiety, Depression, and Quality of Life in Adult Patients With Cystic Fibrosis

BACKGROUND: The impact of anxiety and depression on quality of life (QOL) in adult patients with cystic fibrosis (CF) is fully unknown. We investigated the prevalence and factors associated with anxiety and depression, including QOL, in adult CF patients. METHODS: One hundred twenty-one adult CF subjects, age ≥ 18 years were recruited from our out-patient clinic. Participants self-completed the Hospital Anxiety Depression Scale and the Cystic Fibrosis Quality of Life Questionnaire (CF-QOL). Socio-demographic data and values for lung function were extracted from the medical notes. RESULTS: Mean ± SD age was 30 ± 8.8 years, and age ranged 18–70 years. Forty (33%) were identified with anxiety symptoms, 20 (17%) with depressive symptoms. Factors related with depression were impaired QOL and low lung function. Anxiety was associated with difficulty in interpersonal relationships and severity of chest symptoms. The CF-QOL sub-domains (physical functioning, social functioning, treatment issues, chest symptoms, emotional functioning, concerns for the future, interpersonal relationships, body image, future/career concerns, and total CF-QOL) were all significantly correlated with anxiety (P < .001) and with depression (P < .001), respectively. CONCLUSIONS: Anxiety and depressive symptoms are common in adult CF patients. They are associated with poorer QOL, low lung function, reduced physical functioning, and severity of chest symptoms. Therefore, routine screening for symptoms of anxiety and depression is a worthy endeavor, and those identified with elevated clinical symptoms should be referred to receive appropriate treatment.

Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome

Hypermobility syndrome (HMS) is characterised by generalised joint laxity and musculoskeletal complaints. Gait abnormalities have been reported in children with HMS but have not been empirically investigated. The extent of passive knee joint range of motion (ROM) has also not been well reported in children with HMS. This study evaluated gait kinematics and passive knee joint ROM in children diagnosed with HMS and healthy controls. Thirty-seven healthy children (mean age±SD=11.5±2.6 years) and 29 children with HMS (mean age±SD=11.9±1.8 years) participated. Sagittal knee motion and gait speed were evaluated using a VICON 3D motion analysis system. Passive knee ROM was measured with a manual goniometer. Independent t-tests compared the values of sagittal knee motion and gait speed between the two groups. Mann-Whitney U tests compared passive knee ROM between groups. Passive ROM (extension and flexion) was significantly higher (both p<0.001) in children with HMS than the healthy controls. Peak knee flexion (during loading response and swing phase) during walking was significantly lower (both p<0.001) in children with HMS. Knee extension in mid stance during walking was significantly increased (p<0.001) in children with HMS. However, gait speed was not statistically (p=0.496) different between the two groups. Children with HMS had higher passive knee ROM than healthy children and also demonstrated abnormal knee motion during gait. Gait re-education and joint stability exercise programmes may be of value to children with HMS.

“Everything was spiraling out of control”: Experiences of anxiety in people with chronic obstructive pulmonary disease

OBJECTIVE This study sought to elicit and describe the first-hand experiences of anxiety in community patients with stable chronic obstructive pulmonary disease (COPD). Anxiety is common among patients with COPD. Clinical anxiety affects up to two thirds of patients, leading to reduced quality of life and physical functioning. There has been little research exploring the experiences of anxiety in patients with COPD, particularly in individuals with stable respiratory symptoms. METHODS We interviewed 14 community patients with stable COPD and self-reported symptoms of anxiety. Data were analyzed using thematic network analysis to develop basic, organizing, and global themes. RESULTS Patients reported intense thoughts of fear, hopelessness, and confusion that were associated with the anxiety and panic attacks. Self-management was important, particularly self-talk coping strategies. CONCLUSIONS Unmanaged anxiety seems to be particularly distressing for patients with COPD. Self-management strategies can be highly effective in preventing and managing anxiety.

The changing face of newspaper representations of the mentally ill

Background Negative stereotypes presented in the media may contribute to the stigma associated with mental illness. Peoples attitudes towards the mentally ill are initially influenced and subsequently maintained in part by the frequent media presentation of negative stereotypes of mental illness. This could result in social rejection of individuals with mental illnesses. Aim To explore how four main UK national newspapers reported on mental health/mental illness stories over a 10-year period. Method This study utilised content analysis to identify words, themes and trends of representation related to the mentally ill in articles from the four newspapers. Results The findings indicated that there was an increase in the number of articles related to mental health/illness over the time of the study. The rate of increase was far greater than that for the increase in the total number of articles carried in the press over this time period. It was also identified that pejorative terms were used, in a number of the articles, to describe the mentally ill person. Conclusion Many of the newspaper reports highlighted the need for protection of the general public from the mentally ill, and that the mentally ill were in some way different to the general public. In particular, both the words “violence” and “drugs” were linked to mental health/mental illness in these articles.

The Development and Validation of the Anxiety Inventory for Respiratory Disease

BACKGROUND Anxiety is a common comorbidity in patients with COPD, yet it remains underrecognized. Existing anxiety measures contain somatic items that can overlap with symptoms of COPD and side effects of medications. There is a need for a disease-specific nonsomatic anxiety scale to screen and measure anxiety in patients with COPD. METHODS In phase 1, 88 patients with COPD (mean age 71 years, 36% men) completed a 16-item scale developed with patients and clinicians. Six items were removed using item and factor analysis. In phase 2, 56 patients with COPD (mean age 70 years, 48% men) completed the 10-item scale and other self-report measures of anxiety, quality of life, and functional limitations. Of these, 41 patients completed the scale on a second occasion, 14 days later. Construct validity (using confirmatory factor analysis [CFA]), discriminant validity, convergent validity, and anxiety screening accuracy were explored. RESULTS The Anxiety Inventory for Respiratory Disease (AIR) had high internal consistency (Cronbach α = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.81) and excellent convergent validity, correlating with the Hospital Anxiety and Depression-Anxiety subscale (r = 0.91, P < .001). The scale also discriminated between patients with clinical anxiety (measured using the Patient Health Questionnaire) and those without (U = 9, P < .001). A cutoff score of 14.5 yielded a sensitivity of 0.93 and specificity of 0.98 for detection of clinical anxiety. A two-factor model of general anxiety and panic symptoms had the best fit according to CFA. CONCLUSIONS The AIR is a short, user-friendly, reliable, and valid scale for measuring and screening anxiety in patients with COPD.

Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome

BACKGROUND Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS. AIM To investigate the between-days repeatability of joint proprioception and muscle torque in these groups. METHODS Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight. RESULTS Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque were excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error. CONCLUSIONS Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution.

Analysis of asymmetry of the forces applied on the lower limb in subjects with nonspecific chronic low back pain.

Objective. Several studies have investigated asymmetry and loading patterns in different spine pathologies, motor disorders, and other conditions; there is a lack of knowledge on these aspects in chronic low back pain (CLBP). The aim of this study was to analyse asymmetry and loading patterns in patients with nonspecific chronic low back pain (NCLBP) compared to normal individuals, during walking. Method. Forty participants (20 healthy subjects and 20 patients with NCLBP) participated in the study. Asymmetry of the force was measured based on the Asymmetry Index (ASI). The difference in the mean values of all data between the two groups was examined using the independent t-test. Results. The mean value of the first peak of ground reaction force of normal subjects was 1.02 ± 0.0354 N/BW compared to 1.038 ± 0.099 N/BW in NCLBP patients (P = 0.25) and 0.1004 ± 0.036 N/BW mediolateral force applied on the leg in normal subjects compared to 0.089 ± 0.022 N/BW in NCLBP patients (P = 0.214). The Asymmetry Index (ASI) of the first peak of vertical force was 2.59% ± 1.89% and 3.88% ± 2.94% for NCLBP and normal subjects, respectively, P = 0.2. Conclusion. Therefore, it can be concluded that NCLBP subjects follow avoidance-endurance model without any limitation during walking.

Gait analysis of anterior cruciate ligament reconstructed subjects with a combined tendon obtained from hamstring and peroneus longus

BACKGROUND Stability of the knee joint is achieved by a complex process in which the anterior cruciate ligament (ACL) plays an important role. The rupture of this ligament is quite frequent especially in athletic young subjects. Various methods have been used to reconstruct the ACL. One of the new methods is to use a graft combined from peroneus longus and hamstring. As there is no evidence regarding this method, it was aimed to evaluate the efficiency of this method. METHOD Two groups of normal and those with ACL injury, in whom their ACLs were reconstructed with the new method, participated in this study. The kinematic and kinetic parameters during walking on level surface were evaluated by a motion analysis system (Qualysis) and a Kistler force plate. The difference between the parameters of operated and non-operated sides and also between patients and normal subjects was evaluated by use of a two sample t test (p-value was 0.05). RESULTS The results of this study showed that the pattern and magnitude of the loads transmitted by lower extrimity joints differed between normal and ACL reconstructed subjects. The sound side pattern and magnitude of motion were also influenced by ACL insufficiency. CONCLUSIONS The results of the current study showed that the reconstructed ACL by use of this method did not have enough performance to restore the function of the leg. As the knee joint is unstable following the use of this method, it is recommended to find a new method of ACL reconstruction to improve the function of this ligament after reconstruction.