Montserrat Girabent-Farrés

Methodological Quality and Reporting of Generalized Linear Mixed Models in Clinical Medicine (2000–2012): A Systematic Review

Background Modeling count and binary data collected in hierarchical designs have increased the use of Generalized Linear Mixed Models (GLMMs) in medicine. This article presents a systematic review of the application and quality of results and information reported from GLMMs in the field of clinical medicine. Methods A search using the Web of Science database was performed for published original articles in medical journals from 2000 to 2012. The search strategy included the topic “generalized linear mixed models”,“hierarchical generalized linear models”, “multilevel generalized linear model” and as a research domain we refined by science technology. Papers reporting methodological considerations without application, and those that were not involved in clinical medicine or written in English were excluded. Results A total of 443 articles were detected, with an increase over time in the number of articles. In total, 108 articles fit the inclusion criteria. Of these, 54.6% were declared to be longitudinal studies, whereas 58.3% and 26.9% were defined as repeated measurements and multilevel design, respectively. Twenty-two articles belonged to environmental and occupational public health, 10 articles to clinical neurology, 8 to oncology, and 7 to infectious diseases and pediatrics. The distribution of the response variable was reported in 88% of the articles, predominantly Binomial (n = 64) or Poisson (n = 22). Most of the useful information about GLMMs was not reported in most cases. Variance estimates of random effects were described in only 8 articles (9.2%). The model validation, the method of covariate selection and the method of goodness of fit were only reported in 8.0%, 36.8% and 14.9% of the articles, respectively. Conclusions During recent years, the use of GLMMs in medical literature has increased to take into account the correlation of data when modeling qualitative data or counts. According to the current recommendations, the quality of reporting has room for improvement regarding the characteristics of the analysis, estimation method, validation, and selection of the model.

The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial

Objective: To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients. Design: A randomized controlled trial. Setting: Inpatient rehabilitation hospital in two centres. Subjects: Eighty patients (mean of 23.25 (±16.7) days post-stroke) were randomly assigned to an experimental group and a control group. Interventions: Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention. Main measures: The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index. Results: The experimental group showed statistically significant differences for all of the total scale scores (P<0.05), except for the sitting section of the Brunel Balance Assessment. The mean (SD) difference between groups in Trunk Impairment Scale total score was 3.40 (±4.12) points, and its subscale dynamic sitting balance was 2.28 (±3.29). The Berg Balance Scale was 14.54 (±18.19) points, and the Barthel Index was 13.17 (±25.27) points. Collectively, these results were in favour of the experimental group. Conclusions: Core stability exercises in addition to conventional therapy improves trunk control, dynamic sitting balance, standing balance, gait and activities of daily living in subacute post-stroke patients.

A simple method for measuring thickness of gingiva and labial bone of mandibular incisors

OBJECTIVE Thin supporting tissues may cause gingival recessions and esthetic problems in the anterior area. The objectives of this study were to present a simple and reliable radiographic technique to measure thickness of alveolar bone labial to mandibular incisors, and to establish a possible correlation of bone thickness with its tissue biotype. METHOD AND MATERIALS A metal strip was placed over the gingiva of the mandibular incisor axis, and a perpendicular occlusal radiograph was taken of 51 patients. Patients in routine orthodontic practice before any orthodontic treatment was started were distributed into three groups according to their periodontal biotype (A1, thin with < 2 mm keratinized gingiva; A2, thin with > 2 mm; and B, thick with wide zone of keratinized gingiva), as described by Müller and Eger.1 Radiographs were scanned and thickness of gingival tissue and of bone at two levels (at the bone crest and at 3 mm below the bone crest) was measured to the nearest 0.1 mm. Measurements of soft tissue and bone thickness were compared and correlated. RESULTS Groups A2 and B showed a significant difference in bone thickness at the bone crest. Correlation of bone and gingival thickness was only found in gingival biotype B at 3 mm below the bone crest level only (R = 0.290; P < .001). No other correlation between bone and gingival thickness was observed in any group. CONCLUSIONS The radiographic technique proposed in this study is a simple and reliable method for calibrating the amount of buccal bone in the mandibular anterior area. It is a cheap and fast diagnostic tool that may help determine the amount of buccal bone and gingival thickness, and therefore avoid excessive radiation to patients. Groups A2 and B showed a significant difference in bone thickness at the bone crest. Although not significant, group A1 showed the lowest values of bone and gingival thickness, whereas group B showed the highest bone and gingival thickness. A clear correlation between thickness of bone and gingiva 3 mm below the cementoenamel junction was found in group B.

Effects of the standing program with hip abduction on hip acetabular development in children with spastic diplegia cerebral palsy.

Abstract Purpose: Early identification and intervention with conservative measures is important to help manage hip dysplasia in children with a high adductor and iliopsoas tone and delay in weight bearing. The effect of a daily standing program with hip abduction on hip acetabular development in ambulatory children with cerebral palsy was studied. Method: The participants were 26 children with spastic diplegia cerebral palsy (CP), classified at Level III according to the Gross Motor Function Classification System (GMFCS). Thirteen children stood with hip abduction at least 1 h daily from 12 to 14 months of age to 5 years with an individually fabricated standing frame with hip abduction. Results: At the age of 5 years, radiologic results of the study group were compared with a comparison group of 13 children with spastic diplegia CP who had not taken part in a standing program. The migration percentage in all children who stood with abduction remained within stable limits (13–23%) at 5 years of age, in comparison to children who did not stand in abduction (12–47%) (p < 0.01). Conclusions: The results indicate that a daily standing program with hip abduction in the first 5 years may enhance acetabular development in ambulatory children with spastic diplegia CP. Implications for Rehabilitation Abnormal acetabular development is a problem related to mobility problems and spasticity muscles around the hip. The literature suggests that postural management and standing programs could reduce levels of hip subluxation and increase function in children with cerebral palsy. A standing program with hip abduction can be a beneficial to develop more stable hips in children with spastic diplegic GMFCS level III.

Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy.

Purpose: To investigate the effects of a standing program on the range of motion (ROM) of hip abduction in children with spastic diplegic cerebral palsy. Methods: The participants were 13 children, Gross Motor Functional Classification System level III, who received physical therapy and a daily standing program using a custom-fabricated stander from 12 to 14 months of age to the age of 5 years. Hip abduction ROM was goniometrically assessed at baseline and at 5 years. Results: Baseline hip abduction was 42° at baseline and 43° at 5 years. Conclusions: This small difference was not clinically significant, but did demonstrate that it was possible to maintain hip abduction ROM in the spastic adductor muscles of children with cerebral palsy with a daily standing program during the childrens first 5 years of development.

Validation of the Spanish version of the Trunk Impairment Scale Version 2.0 (TIS 2.0) to assess dynamic sitting balance and coordination in post-stroke adult patients

Background: In recent years the Trunk Impairment Scale version 2.0 (TIS 2.0) has been a frequently used scale to assess dynamic sitting balance and trunk control for stroke patients. Objective: To translate the TIS 2.0 into Spanish and validate it as an instrument to evaluate dynamic sitting balance and trunk control and coordination for post-stroke adult patients. Methods: The original version was translated into Spanish and was agreed by a team of experts. A back-translation into English was subsequently performed and sent to the original author, who approved this version. 58 post-stroke patients’ performance was recorded on a videotape. These videos were then used to carry out four measurements to assess the intra-rater and inter-rater reliability, two of these were performed by the same rater and the third and fourth by a second and third rater. Results: The reliability was calculated by the Kappa index, and was superior to 0.80 for intra-rater reliability, while inter-rater reliability varied from 0.487 to 1. Cronbach’s alpha for internal consistency was 0.896 and to subscales dynamic sitting balance and coordination were 0.899 and 0.613 respectively. Intra-class correlations (ICC) for the summed scores of the different subscales were above 0.90 for all of them. Conclusion: The Spanish version of the TIS 2.0 is valid and reliable, and can be recommended for use in the evaluation of dynamic sitting balance and trunk control and coordination in future research on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

Intrauterine growth restriction (IUGR) is the failure of the fetus to achieve its inherent growth potential, and it has frequently been associated with neurodevelopmental problems in childhood. Neurological disorders are mostly associated with IUGR babies with an abnormally high cephalization index (CI) and a brain sparing effect. However, a similar correlation has never been demonstrated in an animal model. The aim of this study was to determine the correlations between CI, functional deficits in learning and memory and alterations in synaptic proteins in a rat model of IUGR.

Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños

INTRODUCTION Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for childrens obstructive Sleep Apnea The aim is to show the experience of an ENT department with Drug-induced sedation endoscopy in children selected for sleep apnea surgery METHODS Includes 56 cases between 2 and 12 years old (mean age: 59,13±27,29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6,32±8,71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%) and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. RESULTS In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. CONCLUSION Drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy.

Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients:

Objective: Analyse the effect of core stability exercises in addition to conventional physiotherapy training three months after the intervention ended. Design: A randomized controlled trial. Setting: Outpatient services. Subjects: Seventy-nine stroke survivors. Interventions: In the intervention period, both groups underwent conventional physiotherapy performed five days/week for five weeks, and in addition the experimental group performed core stability exercises for 15 minutes/day. Afterwards, during a three-month follow-up period, both groups underwent usual care that could eventually include conventional physiotherapy or physical exercise but not in a controlled condition. Main measures: Primary outcome was trunk control and dynamic sitting balance assessed by the Spanish-Version of Trunk Impairment Scale 2.0 and Function in Sitting Test. Secondary outcomes were standing balance and gait evaluated by the Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Spanish-Version of Postural Assessment Scale for Stroke and activities of daily living using the Barthel Index. Results: A total of 68 subjects out of 79 completed the three-month follow-up period. The mean difference (SD) between groups was 0.78 (1.51) points (p = 0.003) for total score on the Spanish-Version of Trunk Impairment Scale 2.0, 2.52 (6.46) points (p = 0.009) for Function in Sitting Test, dynamic standing balance was 3.30 (9.21) points (p= 0.009) on the Berg Balance Scale, gait was 0.82 (1.88) points (p = 0.002) by Brunel Balance Assessment (stepping), and 1.11 (2.94) points (p = 0.044) by Tinetti Test (gait), all in favour of core stability exercises. Conclusions: Core stability exercises plus conventional physiotherapy have a positive long-term effect on improving dynamic sitting and standing balance and gait in post-stroke patients.

The Spanish version of the Alberta Infant Motor Scale: Validity and reliability analysis

Abstract Objectives: Validity and reliability of the cross-cultural adaptive translation of the Alberta Infant Motor Scale (AIMS), to monitor gross motor development in infants from 0 to 18 months of age, were evaluated. Methods: A cross-cultural translation was used to generate a Spanish version of the AIMS. Fifty infants at risk or with diagnosis of motor delay, 0–18 months of age, participated in this study. Two independent physical therapists scored infants on the AIMS. Concurrent validity was tested using the AIMS and the Bayley Scales of Infant and Toddler Development – III (Bayley – III). Results: Reliability and the internal consistency were high (ICCs ranged from 0.94 to 1.00 and KR-20 ranged from 0.90 to 0.98, respectively). AIMS and Bayley – III scores correlated strongly (r = 0.97). Conclusion: The Spanish version of the AIMS presented excellent validity and reliability. Further studies are suggested in order to assess the AIMS in preterm babies.