Tag: statistics

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

JMIR Res Protoc. 2025 Feb 19;14:e54221. doi: 10.2196/54221.

ABSTRACT

BACKGROUND: Inhibitory deficits are common in psychopathology. Emotion-related impulsivity (ERI) and rumination are general risk factors for psychiatric distress that are similarly associated with dysfunctional inhibition-particularly in affective contexts. A number of cognitive remediation procedures have been developed to improve inhibitory control; however, most remediation programs focus on “cold” cognition independent of affective processing. This pilot trial will gather preliminary evidence for a new cognitive training intervention targeting “hot” affective control (ie, inhibitory functions during elevated emotional arousal) in a transdiagnostic sample of adults who report heightened emotion dysregulation.

OBJECTIVE: This manuscript describes a protocol for a pilot randomized waitlist-controlled trial to assess changes in ERI and rumination after neurobehavioral affective control training (N-ACT), an 8-week cognitive training intervention designed to improve emotional response inhibition and emotional working memory. Our primary aim is to evaluate the efficacy, feasibility, and acceptability of N-ACT in reducing rumination and ERI, which we respectively conceptualize as complementary cognitive and behavioral consequences of emotion dysregulation. Secondarily, we will examine whether N-ACT leads to improvements in inhibitory control and, more distally, psychopathology symptoms.

METHODS: The final sample will comprise 80 adults who report high ERI or rumination. Participants will be randomized to (1) begin the N-ACT program without delay or (2) join a waitlist condition and then complete N-ACT. Exclusion criteria include active alcohol or substance use disorders, psychosis, and suicide risk. At the baseline and postintervention time points, participants will complete measures of emotion dysregulation and psychiatric symptoms, as well as a neuropsychological assessment of inhibitory control. Individuals assigned to the control group will undergo an identical assessment before joining the waitlist, followed by parallel assessments before and after N-ACT.

RESULTS: This trial is funded by support from the University of California Board of Regents and the Peder Sather Foundation (funding period: October 2022-September 2025). Recruitment is scheduled to begin in spring 2025. We will begin data analysis once data collection is complete, which is planned to occur in fall 2025.

CONCLUSIONS: This pilot randomized waitlist-controlled trial is designed to assess the initial efficacy, feasibility, and acceptability of N-ACT, a novel cognitive remediation approach developed to address 2 key contributors to psychopathology: ERI and rumination. The N-ACT program uses computerized adaptive behavioral tasks to strengthen the affective control processes theoretically and empirically linked to ERI and rumination. We hope this work will help inform future studies with sufficient statistical power to ascertain whether enhancing affective control through cognitive training (N-ACT) produces downstream reductions in psychiatric symptoms via improved emotion regulation.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06226467; https://www.clinicaltrials.gov/study/NCT06226467; Open Science Framework Registry rak5z; https://osf.io/rak5z.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54221.

PMID:39970439 | DOI:10.2196/54221

JMIR Med Educ. 2025 Feb 19;11:e55861. doi: 10.2196/55861.

ABSTRACT

BACKGROUND: Student development is currently taking place in an environment governed by new technologies and social media. Some platforms, such as Instagram or X (previously known as “Twitter”), have been incorporated as additional tools for teaching and learning processes in higher education, especially in the framework of image-based applied disciplines, including radiology and pathology. Nevertheless, the role of social media in the teaching of core subjects such as histology has hardly been studied, and there are very few reports on this issue.

OBJECTIVE: The aim of this work was to investigate the impact of implementing social media on the ability to learn human histology. For this purpose, a set of voluntary e-learning activities was shared on Instagram as a complement to traditional face-to-face teaching.

METHODS: The proposal included questionnaires based on multiple-choice questions, descriptions of histological images, and schematic diagrams about the subject content. These activities were posted on an Instagram account only accessible by second-year medical students from the University of Malaga. In addition, students could share their own images taken during the laboratory practice and interact with their peers.

RESULTS: Of the students enrolled in Human Histology 2, 85.6% (143/167) agreed to participate in the platform. Most of the students valued the initiative positively and considered it an adequate instrument to improve their final marks. Specifically, 68.5% (98/143) of the student body regarded the multiple-choice questions and image-based questions as the most useful activities. Interestingly, there were statistically significant differences between the marks on the final exam (without considering other evaluation activities) for students who participated in the activity compared with those who did not or barely participated in the activity (P<.001). There were no significant differences by degree of participation between the more active groups.

CONCLUSIONS: These results provide evidence that incorporating social media may be considered a useful, easy, and accessible tool to improve the learning of human histology in the context of medical degrees.

PMID:39970433 | DOI:10.2196/55861

JMIR Form Res. 2025 Feb 19;9:e68840. doi: 10.2196/68840.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported.

OBJECTIVE: This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia.

METHODS: A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children’s Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models.

RESULTS: Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference -4.11, 95% CI -6.98 to -1.24; P=.005) and video game addiction (mean difference -1.62, 95% CI -2.83 to -0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI -0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention.

CONCLUSIONS: The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions.

PMID:39970430 | DOI:10.2196/68840