Roser Boza

Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial.

OBJECTIVE To determine the efficacy of botulinum toxin type A for the treatment of spastic shoulder pain in patients after stroke. DESIGN Double-blind randomized clinical trial. PATIENTS Of 31 patients enrolled from an acute-care hospital in Spain, 2 cases dropped out (drop-out rate 6.5%). Fourteen subjects were treated with infiltration of 500 units of botulinum toxin type A in the pectoralis major muscle of the paretic side, and 15 with a placebo. METHODS After infiltration, both groups received transcutaneous electrical nerve stimulation for 6 weeks. Patients were assessed by the use of the Visual Analogue Scale for pain. A good result concerning pain was considered when the Visual Analogue Scale score was below 33.3 mm or less than half the initial score. The patients were followed-up for 6 months. RESULTS The patients treated with botulinum toxin type A showed a significantly greater pain improvement from the first week post-infiltration. Persistent shoulder pain was observed more frequently in the placebo group, with relative risks in the range 0.32-0.41 during the follow-up period. CONCLUSION Patients with spastic shoulder pain treated with a botulinum toxin type A infiltration in the pectoralis major muscle of the paretic side have a higher likelihood of pain relief (between 2.43- and 3.11-fold).

Analysis of the expectations of elderly patients before undergoing total knee replacement

The opinion of patients expressed in terms of satisfaction is extremely important in any evaluation of total knee arthroplasty (TKA) results. The primary endpoint of this study was to determine the quantitative and qualitative expectations of elderly patients before undergoing TKA. Cross-sectional study of 497 patients over 65 years was performed before TKA. Main variables collected: demographic, functioning, pain, comorbidity, depression and expectations assessed with the Hospital for Special Knee Replacement Expectation Survey. Statistical tests used were: Students t-test, analysis of variance, Spearmans ρ and multivariate regression analysis. The means of the total and maximum expectations were 12.3±1.63 and 9.5±1.78 (±S.D.), respectively. Between 90 and 100% of patients referred expectations to improvement regarding pain, basic functional activities (walking, climbing stairs, knee mobility, general mobility) and general well being. There were statistically significant correlations with age (r=-0.321), pain before operation (r=-0.206), expected pain at 6 months (r=-0.206), depressive symptoms (r=-0.180) and the Barthel index (BI) (r=0.154). One can conclude, that the expectations of improvement among patients before TKA are high and may be classified as expectations of improvement of pain, basic functional activities and general well being. Age, pain intensity and presence of depression correlate inversely with the amount of expectations.

Balance 1 year after TKA: correlation with clinical variables.

Knee osteoarthritis results in changes that affect balance. It has been reported that osteoarthritis worsens proprioception and increases the risk of falling. The objective of this study was to assess changes in balance among patients with knee osteoarthritis at 1 year after total knee arthroplasty (TKA) surgery and its relationship with clinical variables. This prospective, observational study evaluated 44 patients before and 1 year after TKA. Variables analyzed included age, body mass index, pain, range of motion for both knees, bilateral quadriceps and hamstrings muscle strength, gait velocity, and Knee Society score. Balance and posture control were assessed using the following computerized posturography tests: the weight bearing test, modified Clinical Test of Sensory Interaction on Balance (mCTSIB) test, and sit-to-stand test. Pre- and postoperative differences were analyzed using Wilcoxon and chi-square tests, and effect size was measured using standardized response mean. Correlations were assessed by the Spearman test. One year after TKA, some improvement in balance tests was observed. Significant differences were observed in the mCTSIB test: foam surface with open eyes (P≤.001), foam surface with closed eyes (P≤.001), and composite value (P≤.001). Effect size was moderate to high. Age showed significant correlation with mCTSIB composite value changes (-0.369; P=.037). No significant correlations were found between posturographic tests and other analyzed variables. Balance measured by computerized posturography improved 1 year after TKA. Significant changes were observed between open and closed eyes using a foam surface for the mCTSIB test. A mild negative correlation was found between age and posturographic changes.

Assessment of angle velocity in girls with adolescent idiopathic scoliosis

BackgroundAlthough it has been demonstrated that the peak height velocity (PHV) is a predictive factor of progression in adolescent idiopathic scoliosis (AIS), little is known about the usefulness of angle progression in clinical practice. The purpose of this study was to establish a relationship between height and angle velocities, as well as to determine if peak angle velocity (PAV) occurs at the same time than PHV.MethodsA retrospective study of a cohort of girls with idiopathic scoliotic curves greater than 10°. Data of 132 girls who participated in a previous retrospective study about growth in AIS were used to calculate height and angle velocities. Relationship between height and angle velocities was estimated by the use of a Linear Mixed Model.ResultsPHV and PAV take place simultaneously 1 year before menarche in progressive curves managed with a brace in AIS. Changes in angle velocity are influenced by changes in height growth velocity, in such a way that as from 6 months post-menarche, height growth velocity in this group of girls estimates curve progression velocity (β-coefficient -0.88, p = 0.04).ConclusionAs from 6 months post-menarche, there is an inverse relationship between height velocity and curve progression in the group of AIS girls with progressive curves managed with a brace. Because height velocity is decreasing from 1 year before menarche, this finding corroborates that at the end of puberty, there is still a risk of progression in this group of girls despite bracing. The assessment of both height and angle velocity might be useful in clinical practice at the time of assessing brace effectiveness and how long bracing has to be indicated.

CROSS-VALIDATION OF A MODEL FOR PREDICTING FUNCTIONAL STATUS AND LENGTH OF STAY IN PATIENTS WITH STROKE

OBJECTIVE In a study published in 2002, it was observed that a variable composed by the Functional Independence Measure (FIM) and the trunk control test at admission predicted 66.5% of the FIM at discharge in stroke patients. The objective was to confirm the reproducibility of this predictive model. METHODS Retrospective study of 245 hemiparetic stroke inpatients of the rehabilitation department. The main variables studied were: trunk control test FIM at admission and compound variable (FIM+trunk control test) as independent variables and FIM at discharge and inpatient rehabilitation length of stay as dependent variables. RESULTS Correlation between the compound variable and the length of stay was statistically significant (r=0.59), as was its correlation with the total FIM at discharge (r=0.82). The regression analysis predicted 34.3% of the length of stay variability and 66.4% of the total FIM at discharge variability. CONCLUSION The compound variable is a reliable tool because of its reproducibility in predicting the functional level at hospital discharge in hemiparetic patients.

Correlation of dorsiflexion angle and plantar pressure following arthrodesis of the first metatarsophalangeal joint.

Background: The correlation between angle of fusion of the first metatarsophalangeal (1MTTP) joint and pressures under metatarsal heads and hallux has not been well characterized. The main purpose was to investigate the correlation between fusion dorsiflexion angle of the 1MTTP joint and plantar pressures under the first metatarsal head and hallux during gait. Methods: Patients who underwent arthrodesis of the 1MTTP joint from 2005 to 2010 were seen for a follow-up examination. Of 27 patients, 15 (22 feet) with a mean follow-up of 26.2 months were evaluated in the study. Main outcomes included the fusion clinical and radiological dorsiflexion angles and the mean and maximum dynamic plantar pressures under all 5 metatarsal heads and under the hallux. Plantar pressures were measured through an in-shoe system while patients walked normally along a corridor. Results: The dorsiflexion angle was positively correlated with mean dynamic plantar pressures under the first metatarsal head: P = .02 (r = 0.5) for clinical angle, and P = .01 (r = 0.58) for radiological angle. Patients with 15 degrees or more of clinical dorsiflexion angle demonstrated higher mean dynamic plantar pressure under the first metatarsal head (P = .05) and higher maximum dynamic plantar pressure under the second metatarsal head (P = .04) compared with patients with less than 15 degrees. In contrast, the latter patients demonstrated higher mean dynamic plantar pressure beneath the hallux (P = .04). Patients with 30 degrees or more of radiological dorsiflexion angle demonstrated significantly higher mean dynamic plantar pressure under the first metatarsal head (P = .04) compared with patients with less than 30 degrees. Conclusion: Higher dorsiflexion angles correlate with higher plantar pressures under the first metatarsal head. Lower dorsiflexion angles increase plantar pressures beneath the hallux during gait. Clinical Relevance: Significant increase in plantar pressure under the first metatarsal head may be avoided by performing the arthrodesis of the 1MTTP joint below 30° and 15° for the radiological and clinical dorsiflexion angles, respectively.

Crecimiento, madurez y pronóstico de la escoliosis. Métodos de valoración de la madurez

Resumen Objetivos Actualizar los conocimientos existentes respecto a la relacion entre el crecimiento y la evolucion de la escoliosis idiopatica del adolescente (EIA). Determinar la utilidad de los diferentes metodos de valoracion del final del crecimiento. Estrategia de busqueda Se hicieron busquedas en el Cochrane Controlled Trials Register , MEDLINE (2000 hasta marzo 2009), Trip Database y en las listas de referencias de los articulos. Tambien se consulto a expertos. Seleccion de estudios Estudios de revision y pronosticos sobre la historia natural y pronostico de las EIA, asi como estudios diagnosticos sobre metodos de evaluacion de la madurez osea en las EIA. Sintesis de resultados y Conclusiones Las curvas toracicas, un angulo de Cobb mayor de 25° en el momento del diagnostico y la velocidad de progresion de la curva son los factores que han demostrado tener mas utilidad en el pronostico de las EIA. A pesar de que existen metodos de mayor fiabilidad para la estimacion de la madurez osea, en la practica clinica, el signo de Risser y la menarquia siguen siendo los parametros mas utilizados para valorar el estado puberal de las pacientes con EIA.

Correction: Assessment of angle velocity in girls with adolescent idiopathic scoliosis

Correction to Escalada F, Marco E, Duarte E, Muniesa JM, Boza R, Tejero M, Cáceres E. Assessment of angle velocity in girls with adolescent idiopathic scoliosis. Scoliosis 2009; 4:20.

Calidad de vida en pacientes con amputación de extremidad inferior

Resumen Objetivos Averiguar la calidad de vida percibida (CV) de los pacientes con amputacion del miembro inferior. Conocer la relacion entre factores funcionales, clinicos y sociales con la percepcion de calidad de vida. Metodologia >Se realiza estudio transversal en pacientes afectos de amputacion de miembro inferior y que realizan controles periodicos en nuestro servicio. Las variables recogidas fueron: demograficas; sociales (convivencia, ingresos economicos, caracteristicas del domicilio); clinicas: causas de amputacion, lateralidad, tiempo medio de deambulacion al dia (TMD). Escalas de valoracion funcional (Barthel y Houghton), escala de depresion de Yesavage (GDS), indice de comorbilidad de Charlson, escala cognitiva de Pfeiffer, escala de calidad de vida percibida Short Form-36 (SF-36) y valoracion de estado de salud global medido con escala visual analogica (EVAsalud). Resultados >Se reclutaron un total 56 pacientes, con una edad media de 67 anos. Sexo: 49 hombres y 7 mujeres. 41 unilaterales y 15 bilaterales. El 90 % de los pacientes estaban protetizados. La mediana de Houghton fue 8; Barthel 90, GDS 2, Charslon 3, Pfiffer 0, EVAsalud 63,5. Los resultados del cuestionario SF-36 fueron inferiores a la media observada en la poblacion general, agrupados por edad. La media del componente resumen fisico SF-36 fue 36,7 y del componente resumen mental 45. Se establecieron correlaciones moderadas pero significativas del SF-36 con Barthel; TMD; GDS; Charlson; Pfeiffer y caracteristicas del domicilio. Conclusiones >La calidad de vida percibida de nuestra muestra es inferior a la de la poblacion no amputada y se ve influida por factores demograficos, clinicos y sociales.