Nevin Manimala

Neurol Res Pract. 2025 Feb 20;7(1):8. doi: 10.1186/s42466-025-00365-4.

ABSTRACT

BACKGROUND: Several publications have raised concerns that female stroke patients may be at a disadvantage when accessing stroke treatment services. These publications have found significant regional differences in the provision of stroke treatment to male and female patients. In this study, we provide current nationwide data on stroke management differences between men and women in Germany.

METHODS: This large retrospective cohort study used national datasets from the German Federal Statistical Office for 2017-2022. We examined differences between female and male stroke patients in terms of case volume, intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), stroke unit (SU) treatment, intrahospital mortality, and prevalence of atrial fibrillation (AF).

RESULTS: Data from more than 1.3 million hospitalised stroke patients were included. Forty-seven percent of the patients were female. Female patients were older and more frequently ≥ 80 years old (50.3% versus 29.4%). Rates of IVT (16.3% versus 16.3%) were similar for both sexes but higher in females when adjusted for age. MTE rates (8.2% versus 6.3%) were consistently higher in female patients across all age groups. Female patients had higher rates of intrahospital mortality (9.1% versus 6.2%), and admission to SUs (73.6% versus 76.0%) was less common. Treatment rates in intensive care units were similar (10.6% versus 10.5%). AF, a surrogate for embolic (and more severe) strokes, was more prevalent in females (32.6% versus 25.4%).

CONCLUSIONS: We found no evidence that female stroke patients in Germany face any disadvantage in accessing stroke treatment services. Acute stroke treatment rates were generally similar or higher when compared to males. Higher intrahospital mortality and lower SU rates were attributed to greater age, comorbidities, and stroke severity. However, the differences were not fully explained when adjusting for AF and age. Further research is needed on sex differences in stroke mechanisms and outcomes.

PMID:39972395 | DOI:10.1186/s42466-025-00365-4

Glob Health Res Policy. 2025 Feb 19;10(1):5. doi: 10.1186/s41256-024-00398-3.

ABSTRACT

BACKGROUND: Although the implementation of a hierarchical medical system (HMS) has been shown to improve the allocation of medical resources and patient health-seeking behaviour, its role in patient’s perceived quality of primary care remains unexplored. This study aimed to assess the impact of HMS implementation on rural and urban residents’ perceived quality of primary care.

METHODS: Data were obtained from the China Family Panel Study for 2012, 2014, 2016, and 2018. A total of 40,011 rural and 22,482 urban residents were included in the research participants for analysis. This study adopted a quasi-natural experimental design, and the multiple-period difference-in-differences method was used to capture changes in patient’s perceived quality of primary care before and after the introduction of HMS.

RESULTS: We found that HMS implementation declined the perceived quality of primary care by an average of 18% among rural residents (OR: 0.82, 95% CI 0.68-0.99), while there was no significant change among urban residents (OR: 1.13, 95% CI 0.87-1.46). There was a 24% reduction in the perceived quality of primary care (OR: 0.76, 95% CI 0.61-0.96) one year after HMS among rural residents, and there was no statistically significant difference two years after HMS. After HMS implementation, the level of perceived quality of primary care by rural patients with chronic diseases decreased by 72% (OR: 0.28, 95% CI 0.11-0.78).

CONCLUSIONS: HMS has a limited effect on improving residents’ perceived quality of primary care, especially for those living in rural areas. Policymakers are suggested to establish a quality monitoring system that incorporates patient experience as an essential standard to systematically evaluate the impacts of the HMS, with more efforts being put into helping vulnerable groups such as residents under 60 years old and patients with chronic diseases.

PMID:39972386 | DOI:10.1186/s41256-024-00398-3

J Intellect Disabil Res. 2025 Feb 19. doi: 10.1111/jir.13223. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with PWS need constant support and/or supervision, which creates a high caregiver burden on their parents and siblings. Previous research has identified adverse stress outcomes in relatively small and country-specific samples. This study’s aims were to examine stress outcomes in a large multi-country sample of parents and siblings and to expand upon previous research by incorporating data on psychosocial factors that may mitigate stress outcomes.

METHODS: The sample comprised 135 parents of a child with PWS, with additional data for 45 siblings as reported by parents. Participants were recruited from 31 countries, spanning Europe, North and South America, Africa, Asia and Australasia, who participated by completing an online questionnaire that included standardised psychometric measures of depression and anxiety (HADS), life stress (PSS), PTSD symptoms (CATS-C) and family cohesion (FACES II). Outcomes were compared to published population norms, and multiple regression was used to investigate the role of potential exacerbating and mitigating factors.

RESULTS: Findings revealed high rates of mental pathologies in both parents and siblings. Parents’ scores for depression and anxiety indicated high rates of caseness: 67.4% of parents exhibited ‘abnormal’ levels of anxiety, while 15.6% exhibited ‘borderline abnormal’ levels; 34.8% exhibited ‘abnormal’ levels of depression, with 22.2% exhibiting ‘borderline abnormal’ levels. Younger parents exhibited higher anxiety than older parents (p = 0.007); younger male parents reported higher depression than older male parents (p = 0.029). Parents whose child with PWS lived in the family home exhibited higher depression scores than parents whose child with PWS lived away from home (p = 0.035). Family cohesion was inversely associated with parental depression (p < 0.001) and parental anxiety (p = 0.012), even when statistically controlling for age of parent, age of child with PWS and parental education level. Scores for life stress were markedly higher than population norms, with 88.7% of parents exhibiting ‘high’ or ‘moderate’ life stress. Parental life stress was significantly correlated with temper outburst severity in their child with PWS (p < 0.001) and with food problem severity (p < 0.001). All siblings exhibited at least one symptom of PTSD, with 28.9% of siblings exhibiting ‘clinically relevant’ levels of PTSD symptoms. Sibling PTSD symptom levels were significantly associated with temper outburst severity in the child with PWS (p = 0.025) but not with ratings of food problem severity (p = 0.114). Family cohesion was inversely associated with PTSD symptoms in siblings (p = 0.022).

CONCLUSIONS: PWS impacts families negatively, and relatives suffer as a result. The findings of this study confirm that parents and siblings of persons with PWS exhibit clinically notable levels of mental pathology. Strategies to enhance family cohesion should be employed to help diminish adverse outcomes among PWS families.

PMID:39970479 | DOI:10.1111/jir.13223

J Back Musculoskelet Rehabil. 2025 Jan;38(1):71-82. doi: 10.1177/10538127241296340. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: In recent years, the femoral neck system (FNS) has become increasingly widely used for Pauwels type III femoral neck fractures.

OBJECTIVE: We performed a meta-analysis to investigate the safety and efficacy of FNS and the mainstream internal fixation method, cannulated screw (CS), in the treatment of Pauwels type III femoral neck fractures.

METHODS: We systematically searched all research studies from PubMed, Embase, Web of Science, Cochrane, WANFANG, and the Chinese Academic Journal Full-Text Database (CNKI) from 2018 to July 2024 and conducted data extraction. The study was conducted on July 26, 2024. We used the PRISMA guidelines to assess the quality of the results of all included studies. In addition, we searched for references to relevant articles. After completing the literature search, we performed a manual literature screening to obtain studies that met the inclusion criteria. The outcomes were Harris Hip Score, operation duration, intraoperative blood loss, hospital stay, healing time, and postoperative complications.

RESULTS: This meta-analysis ultimately included nine studies (n = 524) and conducted quality evaluations. All nine articles were retrospective cohort studies. The study exhibited statistically significant variations between the FNS and CS groups in relation to total complications (95% confidence interval (CI)= [0.11, 0.40], odds ratio (OR) = 0.21, P < 0.001), Harris Hip Score (95%CI = [2.14, 3.65], mean difference (MD) = 2.89, P < 0.001), Femoral head necrosis (95%CI = [0.17, 0.86], OR = 0.38, P = 0.02), Internal fixation failure (95%CI = [0.06, 0.50], OR = 0.17, P = 0.001), Medium femoral neck shortening (95%CI = [0.17, 0.53], OR = 0.30, P < 0.001), intraoperative blood loss (95%CI = [11.57, 26.80], MD = 19.19, P < 0.001), Operation duration (95%CI = [-15.20, -2.17], MD = -8.69, P = 0.009), and healing time (95%CI = [-1.30, -0.32], MD = -0.81, P = 0.001).

CONCLUSION: This meta-analysis showed that in Pauwels type III femoral neck fractures, the femoral neck system has a shorter operative time, a lower rate of postoperative complications, a shorter healing time, less shortening of the femoral neck, and a higher Harris Hip Score compared with cannulated screws, but increases intraoperative blood loss. However, more clinical studies are needed to confirm our conclusions due to our small sample size and lack of randomized controlled trials.

PMID:39970468 | DOI:10.1177/10538127241296340

J Back Musculoskelet Rehabil. 2025 Jan;38(1):83-92. doi: 10.1177/10538127241296342. Epub 2024 Dec 19.

ABSTRACT

BACKGROUND: Forward head posture (FHP) is a common malalignment affecting the cervicothoracic spine. This deviation is associated with neck disability and muscle imbalance.

OBJECTIVE: This study aimed to investigate the efficacy of FHP correction using regional versus comprehensive spinal programs on the craniovertebral (CV) angle, neck disability, and spinal muscle activity.

METHODS: Sixty participants with FHP were randomly assigned to receive either a cervicothoracic correction program (control group) or a cervicothoracic plus lumbopelvic program (experimental group). The CV angle, neck disability index (NDI), and normalized electromyography as a percentage of maximum voluntary isometric contraction (%MVIC) from spinal muscles were measured before and after the intervention.

RESULTS: Post-intervention, both groups showed significant improvement across time in CV angle and NDI (p < 0.001, p = 0.002). However, the between-group comparison was not statistically significant. The NDI showed significant improvement only in the experimental group (p = 0.005). The minimal clinical important difference (MCID) obtained was 6.44 for the NDI. A reduction in %MVIC over time was observed in both groups for cervical erector spinae (Right, p = 0.006, Left, p = 0.001). The between-group comparison of spinal muscle activation was not significantly different.

CONCLUSION: The study suggested that FHP management using a cervicothoracic or cervicothoracic plus lumbopelvic protocol could improve cervical posture and lower cervical muscle demand. Incorporating a lumbopelvic into the cervicothoracic protocol was more effective in reducing short-term neck pain and disability than a cervicothoracic protocol alone. A comprehensive spine program may be a clinically beneficial rehabilitation protocol for FHP to improve neck pain and disability.

PMID:39970467 | DOI:10.1177/10538127241296342

J Back Musculoskelet Rehabil. 2025 Jan;38(1):121-131. doi: 10.1177/10538127241291665. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: Prior studies showing the effectiveness of extracorporeal shock wave therapy (ESWT) in patients with plantar fasciitis are mostly based on patient-reported measurements.

OBJECTIVE: The aim of this study was to demonstrate the effectiveness of ESWT with ultrasonographic and pedobarographic measurements.

METHODS: A total of 50 patients were included in the study. All patients were evaluated before and six weeks after ESWT treatment. Pain was evaluated with the Visual Analogue Scale (VAS), functional status with Foot Function Index (FFI), and quality of life with Short Form-36 (SF-36). Plantar pressure measurements were made with a pedobarography device, and plantar fascia thickness was measured with ultrasonography.

RESULTS: After treatment, VAS-Pain decreased significantly. There was a statistically significant improvement in FFI scores after treatment. Similarly, a statistically significant improvement was seen in SF-36 scores. There was a significant decrease in ultrasonographic measurements of the plantar fascia thickness in the origo and midsection regions. There was a statistically significant decrease only in medial heel pressure measurements.

CONCLUSION: The results of this study showed that ESWT provides symptomatic and functional improvements in patients with plantar fasciitis as well as ultrasonographic plantar fascia thickness and pedobarographic medial heel pressure measurements.

PMID:39970462 | DOI:10.1177/10538127241291665

J Back Musculoskelet Rehabil. 2025 Jan;38(1):158-164. doi: 10.1177/10538127241296344. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: Quality of life in patients receiving knee arthroplasty is crucial for rehabilitation. Even if the validity of the 36-Item Short Form (SF-36) was already confirmed, the Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom Score (PASS) values of this score remain unknown for both Total Knee Arthroplasty (TKA) and Unicompartmental Knee Arthroplasty (UKA).

OBJECTIVE: The purpose of this research was to compute the Minimal Clinically Important Difference (MCID) of the SF-36 after UKA, and the SCB and PASS of SF-36 after TKA and UKA, in order to assess post-surgery quality of life in knee osteoarthritis.

METHODS: Overall, 59 patients (40 women and 19 men, mean age 60.3 ± 13.1 years) completed the questionnaire until six months follow-up. Of these patients, 22 underwent the TKA procedure, while 37 patients underwent the UKA procedure. The anchor question for computing the MCID and SCB thresholds was “How would you describe your health condition in relation to your previous state?”. The PASS scores were determined using the ROC curve and the 75th percentile of the cumulative percentage curve of respondents who believe their symptoms are under control.

RESULTS: The MCID values of global SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS) after UKA were 11.3, 14.5 and 11.4, respectively. The SCB values of global SF-36, PCS and MCS after UKA were 23.5, 23.1 and 15, respectively. The PASS values of global SF-36, PCS and MCS after TKA were 71.2, 75 and 69.3, respectively. The PASS values of global SF-36, PCS and MCS after UKA were 70.4, 72.1 and 67.5, respectively.

CONCLUSION: The SF-36 score represents a valid score for quality of life in patients with knee osteoarthritis. Taken together, the results showed a statistically significant improvement between inception and latest follow-up after TKA and UKA.

PMID:39970460 | DOI:10.1177/10538127241296344

J Back Musculoskelet Rehabil. 2025 Jan;38(1):63-70. doi: 10.1177/10538127241296345. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: Randomized controlled trials (RCTs) represent the highest level of evidence in guiding the management of clavicle fractures. They are conducted to ensure that evidence drives the basis of treatment algorithms. Relying solely on P values to assess orthopedic RCTs may be deceptive and challenge the validity of the studies.

OBJECTIVE: To evaluate the degree of statistical fragility in the clavicle fracture literature using the fragility index (FI) and fragility quotient (FQ).

METHODS: A systematic search strategy using the Medline, PubMed, and Embase databases was used to find all dichotomous data for randomized controlled trials (RCTs) in clavicle fracture research from 2000 to 2024. The FI of each outcome was calculated by reversing a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ.

RESULTS: Of the 3646 articles screened, 81 met the search criteria, with 30 RCTs evaluating clavicle fractures included for analysis. There were 250 total outcomes, where 62 significant and 188 nonsignificant outcomes were identified. The overall FI and FQ were 4 (IQR 3-5) and 0.045 (IQR 0.024-0.080). Statistically significant and nonsignificant outcomes had an FI of 3.5 (IQR 2-7) and 4 (IQR 3-5), respectively. Regarding loss to follow-up (LTF), 63.3% (19) reported LTF greater or equal to the overall FI of 4.

CONCLUSION: When scrutinizing management algorithms relying on statistical analysis, we recommend including the FI and FQ alongside the P value.

PMID:39970459 | DOI:10.1177/10538127241296345

J Back Musculoskelet Rehabil. 2025 Jan;38(1):171-183. doi: 10.1177/10538127241289351. Epub 2024 Dec 11.

ABSTRACT

BACKGROUND: The pathogenesis of adolescent idiopathic scoliosis (AIS) remains unclear, with muscle imbalance being a widely discussed hypothesis.

OBJECTIVE: This study examined the impact of muscle imbalance on AIS by injecting botulinum toxin A (BTX) into patients’ unilateral muscles and investigating altered back muscle synergies.

METHODS: Three AIS patients received BTX injections in the concave-side paraspinal muscles. High-density electromyogram arrays placed from T8 to L4 recorded signals during five spinal motions at four timepoints (one pre-BTX and three post-BTX). Muscle synergies were extracted using non-negative matrix factorization and compared with data from ten healthy and ten AIS subjects from our previous studies.

RESULTS: Post-BTX, muscle activity maps during flexion/extension, sitting, and standing exhibited reduced symmetry, with concave/convex ratios decreasing and being statistically lower than those of healthy subjects at post-2 and post-3 follow-ups (p < 0.01). Muscles on the dominant side during lateral bending or axial rotation demonstrated decreased activation and differently distributed center of gravity positions on synergy maps compared to healthy subjects at all timepoints (p < 0.05). Post-BTX changes were particularly notable for the patient with mild deformity.

CONCLUSIONS: BTX affected the activation of paraspinal muscles, providing insights into the role of muscle imbalance in AIS and informing future therapeutic strategies.

PMID:39970455 | DOI:10.1177/10538127241289351

J Back Musculoskelet Rehabil. 2025 Jan;38(1):101-112. doi: 10.1177/10538127241289343. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: Chronic low back pain (cLBP) is a global health complaint. Acupuncture is an effective therapy for cLBP; however, evidence for an optimal acupuncture practice scheme is limited.

OBJECTIVE: This study aimed to determine the feasibility of conducting a randomized controlled trial (RCT) to assess the effectiveness of two acupuncture regimes (sensitized-points acupuncture and routine integrative acupuncture package) for cLBP.

METHODS: This was a two-arm, assessor-blind, randomized-controlled feasibility study. Thirty adult participants with cLBP were randomly assigned into two groups. Each group received 8 sessions of either sensitized-points acupuncture or routine integrative acupuncture package, respectively. Treatments were conducted twice per week. Outcomes were assessed at baseline (week 0), on a weekly basis for four weeks (week 1, 2, 3, 4), and follow-up (week 12). Student’s t-tests, Mann-Whitney U tests, Fisher’s exact tests, descriptive analyses, and power analyses were used for statistics.

RESULTS: Participants were recruited over 10 weeks with a recruitment rate of 12 participants per month. The treatment plan in both groups was well accepted and tolerated. Besides, the study was characterized by low adverse event rates (8.0% in Group A, 11.7% in Group B), high completion of the outcome measures (97.8% in Group A, 94.3% in Group B), and high participant retention rate (100% in Group A, 93.8% in Group B). Furthermore, preliminary analyses showed that both regimes of acupuncture were potentially efficacious and safe.

CONCLUSIONS: Conducting a fully powered RCT to evaluate efficacy and safety of two acupuncture regimes in the management of cLBP is feasible.

PMID:39970453 | DOI:10.1177/10538127241289343