Tag: pubmed

Proc Inst Mech Eng H. 2021 Feb 23:954411921994937. doi: 10.1177/0954411921994937. Online ahead of print.

ABSTRACT

The present study examined trends in occupant dynamics during side impact testing in vehicle models over the past decade. “Moderate-to-high” speed side impacts (delta-V ≥15 km/h) were analyzed. The Insurance Institute for Highway Safety (IIHS) side impact crash data was examined (N = 126). The test procedure involved a moving deformable barrier (MDB) impacting the sides of stationary vehicles at 50.0 km/h. Instrumented 5th-percentile female SID IIs dummies were positioned in the driver and left rear passenger seats. Occupant head, neck, shoulder, torso, spine, and pelvis/femur responses (times histories, peaks, and time-to-peak values) were evaluated and compared to injury assessment reference values (IARVs). The effects of delta-V, vehicle model year, vehicle body type, and occupant seating position on dynamic responses were examined. The vehicle lateral delta-Vs ranged from 15.9 to 34.5 km/h. The MY2018-2020 demonstrated lower peak dynamics than MY2010-2013, for the driver head acceleration (53.7 ± 11.3g vs 46.4 ± 11.6g), shoulder lateral forces (1.7 ± 0.7 kN vs 1.5 ± 0.2 kN), average rib deflection (29.8 ± 8.3 mm vs 28.4 ± 6.2 mm), spine accelerations at T4 (51.4 ± 23.4g vs 39.6 ± 5.9g) and T12 (56.3 ± 18.5g vs 45.2 ± 9.6g), iliac forces (1.9 ± 1.0 kN vs 1.2 ± 0.9 kN), and acetabular forces (1.9 ± 0.8 kN vs 1.3 ± 0.5 kN). The driver indicated statistically higher dynamic responses than the left rear passenger. Higher wheelbase vehicles generally showed lower occupant loading than the smaller vehicles. In conclusion, a reduction in occupant loading and risks for injury was observed in vehicle models over the past decade. This provides further insight into injury mechanisms, occupant dynamics simulations, and seat/restraint design.

PMID:33619979 | DOI:10.1177/0954411921994937

J Neurotrauma. 2021 Feb 23. doi: 10.1089/neu.2020.7407. Online ahead of print.

ABSTRACT

Neurological disorders usually present very heterogeneous recovery patterns. Nonetheless, accurate prediction of future clinical endpoints and robust definition of homogeneous cohorts are necessary for scientific investigation and targeted care. For this, unbiased recursive partitioning with conditional inference trees (URP-CTREE) has received increasing attention in medical research, especially, but not limited to traumatic spinal cord injuries (SCI). URP-CTREE was introduced to SCI as a clinical guidance tool to explore and define homogeneous outcome groups by clinical means, while providing high accuracy in predicting future clinical outcomes. The validity and predictive value of URP-CTREE to provide improvements compared to other more common approaches applied by clinicians has recently come under critical scrutiny. Therefore, a comprehensive simulation study based on traumatic, cervical complete spinal cord injuries provides a framework to investigate and quantify the issues raised. Firstly, we assessed the replicability and robustness of URP-CTREE to identify homogeneous subgroups. Secondly, we implemented a prediction performance comparison of URP-CTREE with traditional statistical techniques, such as linear or logistic regression, and a novel machine learning method. URP-CTREE’s ability to identify homogeneous subgroups proved to be replicable and robust. In terms of prediction, URP-CTREE yielded a high prognostic performance comparable to a machine learning algorithm. The simulation study provides strong evidence for the robustness of URP-CTREE, which is achieved without compromising prediction accuracy. The slightly lower prediction performance is offset by URP-CTREE’s straightforward interpretation and application in clinical settings based on simple, data-driven decision rules.

PMID:33619988 | DOI:10.1089/neu.2020.7407

Med Glas (Zenica). 2021 Feb 1;18(1). doi: 10.17392/1282-21. Online ahead of print.

ABSTRACT

Aim To evaluate if the sinus tarsi approach treated with open reduction and internal fixation (ORIF), without using plate fixation, provided good functional results in active adult population. The hypothesis was that the sinus tarsi approach with limited incision provided good results comparable to other approaches. Methods A total of 78 patients (81 feet) surgically treated for articular calcaneus fracture were reviewed according to inclusion criteria: Sanders fracture type II-III, minimum follow-up of 2 years, patients aged 18-65 years. Exclusion criteria were smokers, diabetics, non-collaborative patients and patients with Sanders fracture type I and IV. A mean follow-up was 52.6 months. Radiographic changes of the Bohler’s angle were reported. For the clinical evaluation, Visual Analogue Scale (VAS) for calcaneal fractures, American Orthopaedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score (MFS) were used. Results A statistically significant restitution of Böhler’s angle from preoperative to postoperative (13.5°-27°; p<.001) was found. The AOFAS and MFS showed pain relief and good/excellent functional activities at the final follow-up in 65 of 78 (83.3%) patients. In eight (out of 81; 10%) feet a superficial wound infection was observed. In three (3.8%) patients a subtalar arthrodesis was performed. Conclusion The mini-invasive sinus tarsi approach for active adult population is a valid and reproducible technique with a low rate of major complications, but it is mandatory advice to patients regarding the expectation of the results.

PMID:33619940 | DOI:10.17392/1282-21

Eur J Phys Rehabil Med. 2021 Feb 23. doi: 10.23736/S1973-9087.21.06566-7. Online ahead of print.

ABSTRACT

BACKGROUND: Children with cerebral palsy (CP) often present a loss of effectiveness of the plantarflexors/knee-extensors couple that leads to crouch gait. When treating a child with crouch gait by means of ankle foot orthoses, preserving or restoring push off power is a key issue.

AIM: To compare carbon-fiber spring (Carbon Ankle Seven® = CAFO) and hinged anklefoot orthoses (HAFO) effectiveness in improving functionality and walking ability in children with diplegic CP and crouch gait.

DESIGN: Randomized crossover trial.

SETTING: Hospital center.

POPULATION: Ten children with diplegic CP and crouch gait, 5 males and 5 females, aged 11 (4) years.

METHODS: The gait of each child was evaluated by means of instrumental gait analysis with both CAFO and HAFO, in a randomized order and after a 4-week adaptation period. The primary outcome measure was the change in ankle power generation. As secondary outcome measures, knee joint kinematics, stride length, walking speed, Observational Gait Scale, and preferred orthosis were considered.

RESULTS: The median of the energy produced in stance was superior with CAFO (+2.2 J/kg, IQR 4.7, p=0.006), and the energy absorbed inferior (-3.3 J/kg, IQR 4.3, p=0.011). No statistically significant difference was found for any other parameter. Preference of the children was equally distributed between the two orthoses.

CONCLUSIONS: No evident superiority of CAFO with respect to HAFO was found in improving gait performance of children with CP and crouch gait. Nevertheless, the results suggest the possibility that CAFO permits an energy saving and reduction of the more compromising deficits.

CLINICAL REHABILITATION IMPACT: The final choice of the participants indicates that CAFOs are preferred by older and heavier children, but the preference does not correlate with the performance of the orthoses during gait.

PMID:33619943 | DOI:10.23736/S1973-9087.21.06566-7

Eur J Phys Rehabil Med. 2021 Feb 23. doi: 10.23736/S1973-9087.21.06653-3. Online ahead of print.

ABSTRACT

BACKGROUND: Home-based cardiac telerehabilitation (HBCT) is a feasible and effective alternative to traditional center-based cardiac rehabilitation (CBCR). Currently, there are only limited studies focusing on a long-term effect of HBCT, which means it is essential to do more research in this study field.

AIM: This study aimed at investigating a 1-year effect of a randomized controlled study using Cardiac Rehabilitation through the Global Position System (CR-GPS) compared to outpatient cardiac rehabilitation. Study focused on cardiorespiratory fitness (CRF) and health-related quality of life (HRQL) in patients with coronary heart disease (CAD).

DESIGN: A long-term follow-up of a randomized study.

SETTING: Patients were enrolled, and the intervention was performed in an outpatient or homebased model. The results were obtained and evaluated in a hospital.

POPULATION: Patients who participated in the CR-GPS study were diagnosed with CAD with low to moderate cardiovascular risk.

METHODS: Patients enrolled in the study were eligible participants who had previously completed a 12-week HBCT program using a wrist heart rate (HR) monitor or attended a traditional CBCR. Primary outcome was the change in CRF expressed in peak oxygen uptake (pVO2), and the secondary outcomes were self-reported HRQL, objectively measured anthropometric characteristics, and mortality and hospitalization rates.

RESULTS: 44 patients (76%) completed the long-term follow-up. The average peak of pVO2 was higher after 1-year follow-up in the telerehabilitation group (HBCT 25.5 ml / kg / min compared to the active control group CBCR 23.6 ml / kg / min p = 0.047). No statistically significant difference between the two groups was found after long-term follow-up for the parameter HRQL. For both groups, there was a significant improvement in the range of perceptions of general health. There was no death case and no difference in hospitalization rate between the groups.

CONCLUSIONS: This study supports the HBCT model. It has been demonstrated that it induces satisfactory long-term effects in pVO2, exercise performance, and perceived general health in CAD patients with low to moderate cardiovascular risk.

CLINICAL REHABILITATION IMPACT: Cardiovascular telerehabilitation using wrist HR monitors is a feasible and effective rehabilitation method that can help patients eliminate barriers that prevent them from using CBCR programs. Especially in the current global situation with the COVID-19 pandemic, this topic is becoming increasingly important.

PMID:33619944 | DOI:10.23736/S1973-9087.21.06653-3

J Sports Med Phys Fitness. 2021 Feb 23. doi: 10.23736/S0022-4707.21.11920-6. Online ahead of print.

ABSTRACT

BACKGROUND: Improving dynamic postural stability after lateral ankle sprain due to chronic ankle instability helps prevent recurrence, and changes in dynamic postural stability can be assessed with the Star Excursion Balance Test. To date, no studies have examined the change in Star Excursion Balance Test score after the end of a balance training program or whether chronic ankle instability affects the rate of change. To examine the effect of chronic ankle instability on changes in Star Excursion Balance Test. score over time after a balance training program.

METHODS: Fifteen collegiate soccer players with chronic ankle instability selected with the Cumberland Ankle Instability Tool and ultrasonography. Participants completed a 6-week balance training program. We assessed the Star Excursion Balance Test 5 times (before and immediately after the program and 2, 4, and 6 weeks later) and examined differences in the duration of training effects by a 2-way analysis of variance, with Bonferroni correction for post hoc comparisons to explain any significant interactions. The significance level for all analyses was set at P < .05. We performed statistical analyses with SPSS version 25.

RESULTS: Analysis of the posterolateral and posteromedial scores in Star Excursion Balance Test showed a significant effect of time. Post hoc analysis of the posterolateral score showed that for each leg, participants reached significantly farther after the program than before (P = .012). The posterolateral scores at 2, 4, and 6 weeks after the training program did not differ from before the program, but the posteromedial score was significantly improved immediately after the program (P = .008) and also 2 (P = .004) and 4 weeks later (P = .006).

CONCLUSIONS: A 6-week balance training program to improve dynamic postural control can improve posterolateral and posteromedial scores in people with chronic ankle instability, and the improvements in posteromedial are still present 4 weeks after program completion.

PMID:33619951 | DOI:10.23736/S0022-4707.21.11920-6

Int J Health Policy Manag. 2021 Jan 16. doi: 10.34172/ijhpm.2020.252. Online ahead of print.

ABSTRACT

BACKGROUND: The most recent emerging infectious disease, coronavirus disease 2019 (COVID-19), is pandemic now. Iran is a country with community transmission of the disease. Telehealth tools have been proved to be useful in controlling public health disasters. We developed an online self-screening platform to offer a population-wide strategy to control the massive influx to medical centers.

METHODS: We developed a platform operating based on given history by participants, including sex, age, weight, height, location, primary symptoms and signs, and high risk past medical histories. Based on a decision-making algorithm, participants were categorized into four levels of suspected cases, requiring diagnostic tests, supportive care, not suspected cases. We made comparisons with Iran STEPs (STEPwise approach to Surveillance) 2016 study and data from the Statistical Centre of Iran to assess population representativeness of data. Also, we made a comparison with officially confirmed cases to investigate the effectiveness of the platform. A multilevel mixed-effects Poisson regression was used to check the association of visiting platform and deaths caused by COVID-19.

RESULTS: About 310 000 individuals participated in the online self-screening platform in 33 days. The majority of participants were in younger age groups, and males involved more. A significant number of participants were screened not to be suspected or needing supportive care, and only 10.4% of males and 12.0% of females had suspected results of COVID-19. The penetration of the platform was assessed to be acceptable. A correlation coefficient of 0.51 was calculated between suspected results and confirmed cases of the disease, expressing the platform’s effectiveness.

CONCLUSION: Implementation of a proper online self-screening tool can mitigate population panic during wide-spread epidemics and relieve massive influx to medical centers. Also, an evidence-based education platform can help fighting infodemic. Noticeable utilization and verified effectiveness of such platform validate the potency of telehealth tools in controlling epidemics and pandemics.

PMID:33619926 | DOI:10.34172/ijhpm.2020.252