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PubMed1993

Problems related to the interpretation of autoradiographic data on gene expression using common constitutive transcripts as controls.

The 28S rRNA, a ribosomal RNA, and the ACTB and GAPD mRNAs, coding respectively for beta-actin and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), are frequently presented as controls of modulated gene expression. These transcripts were quantified by replicate slot-blot autoradiography and image analysis in mammary epithelial cells and fibroblasts from breast tissues. Each cell-type group comprised strains with different pathological backgrounds, growth rates, antigenic phenotypes and culture histories. The effects of a differentiating agent (cholera toxin) and/or a tumor promoter (12-O-tetradecanoyl-phorbol-13-acetate) were also examined. Despite the impression that visual examination of autoradiographs might create, image analysis suggests that 28S rRNA, ACTB and GAPD are substantially and independently influenced by the above biological factors and by the drugs. Therefore, these transcripts represent specifically regulated cellular activities and may not be taken as alternative indicators of the overall transcription rate or of the amount of material being examined. Instead, such nonspecific variation may be accurately measured and removed from quantitative data using a principal component function. A methodology that allows comparison of expression (or amplification) patterns between genes, between experiments or, even, between laboratories is presented with an example of quantification of transcripts related to cell-growth, differentiation, signaling and cancer.

Actins↗

PubMed2001

What is the role of stimulant laxatives in the management of childhood constipation and soiling?.

BACKGROUND: Constipation is extremely common in childhood and may lead to overflow soiling/encopresis. Standard treatment of the more severe case is to empty the bowels of impacted faeces by the use of oral or rectal laxatives and then maintain regular bowel movements by the continuation of osmotic and stimulant laxatives. OBJECTIVES: The objective of the review was to determine the effect of stimulant laxative treatment in children with chronic constipation who may also suffer from soiling / encopresis. SEARCH STRATEGY: The Cochrane database of randomised controlled trials was searched. Additional citations were sought by hand searching of paediatric journals and from contact with known professionals in the field. SELECTION CRITERIA: All identified randomised controlled trials (RCTs) which compare the administering of stimulant laxatives to children with either placebo or alternative treatment. DATA COLLECTION AND ANALYSIS: No trials were found that met the selection criteria. MAIN RESULTS: No trials were found that adequately met the selection criteria. REVIEWER'S CONCLUSIONS: The need exists to establish a secure footing for treatment decisions and adequately sized trials are required to provide comparative data on commonly used drugs.

Cathartics↗

PubMed1997

Common and idiosyncratic patterns of cytokine gene expression by Epstein-Barr virus transformed human B cell lines.

Epstein-Barr virus (EBV) transformed human B cells proliferate indefinitely in vitro, and it has been proposed that cytokine-mediated autocrine loops contribute to the maintenance of the lymphoblastoid phenotype. We used a novel multiprobe RNase protection assay to quantify cytokine mRNA species expressed by EBV-transformed lymphoblastoid cell lines (LCL), derived either by the transformation of B cells with B95-8 or wild-type EBV or by the in vitro outgrowth of EBV-associated B cell lymphomas to identify cytokines that are commonly expressed in all LCL and thus more likely to be essential for immortalization of B cells. All 16 LCL expressed high levels of tumor necrosis factor (TNF)alpha, TNFbeta, and transforming growth factor (TGF)beta1 mRNA, while interleukin (IL)-10 transcripts were detected in most LCL but at a lower level. Expression of IL-1alpha, IL-1beta, IL-6, IL-12p35, IL-12p40, IL-13 and IFNgamma mRNA was variable among the LCL tested. Granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-2, IL-4, and IL-5 mRNA were undetectable in all LCL. Furthermore, we found that IL-10, TNFalpha, and TNFbeta mRNA were induced in EBV-negative B cell lines after infection with EBV. These data define common versus idiosyncratic patterns of cytokine expression by LCL and, in the former case, such cytokines as TNFalpha, TNFbeta, and IL-10 emerge as strong candidates that are essential for the autocrine regulation of EBV-immortalized B cells.

Animals↗

PubMed2000

Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database.

PURPOSE: To report the results of the first 2 years of experience with an American Academy of Ophthalmology (AAO) cataract surgery registry; to compare patient characteristics, operative procedures, and patient outcomes observed in the registry to those observed in the Cataract PORT study; and to discuss the current shortcomings and potential benefits of a national cataract surgery registry. DESIGN: Observational study of episodes of cataract surgery reported by a self-selected sample of 249 ophthalmologists. PARTICIPANTS: Seven thousand six hundred twenty-six patients undergoing cataract surgery during 1996 and 1997. METHODS: Beginning in January 1996, participation in the AAO cataract surgery registry was offered to all ophthalmologists. Participants could use software or paper data collection forms to submit a common set of data regarding patients' demographics, preoperative ophthalmologic history, physical examination and test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery. Data were transmitted to a central database, where they were aggregated and analyzed. Findings were compared with those observed in the Cataract PORT study, which was conducted in 1991 and 1992. RESULTS: Between January 1, 1996, and February 28, 1998, 249 ophthalmologists submitted data on at least one patient who underwent cataract surgery. A total of 7626 patients undergoing first or second eye surgery were enrolled, with all preoperative, intraoperative, and postoperative data forms submitted for 3342 patients (44%). The preoperative characteristics of patients reported to National Eyecare Outcomes Network (NEON) were similar to those of patients enrolled in the Cataract PORT study except for a higher reported prevalence of ocular comorbidity in NEON patients. Use of retrobulbar anesthesia was reported far less commonly, and use of topical anesthesia, phacoemulsification, and foldable intraocular lenses was reported far more often for NEON than for Cataract PORT study patients. Patient outcomes reported to NEON were similar to those observed in the Cataract PORT study. MAIN OUTCOME MEASURES: Visual acuity, VF-14, Cataract Symptom Score, surgical complications. CONCLUSIONS: During the first 2 years of NEON, ophthalmologist participation in the NEON cataract surgery database was low and consisted of a self-selected and likely nonrepresentative sample of ophthalmologists. The representativeness of patients for whom data were reported is unknown. In addition, complete data were submitted on only a minority of patients who were enrolled. Even so, the preoperative characteristics of patients on whom data were submitted to NEON were similar to those of patients enrolled in the Cataract PORT study. The initial experience with NEON demonstrates that it is technically possible to collect clinical data from, and report aggregated results to, practicing clinicians' offices. In addition, at least some practicing clinicians are willing to spend the time required to participate in the NEON registry. The NEON cataract surgery database thus has the potential to provide a practical means for tracking practice patterns and patient outcomes in real time. If a representative sample of physicians was willing to contribute data systematically and accurately over time, initiatives such as NEON could provide a means for professional societies and physicians to play a leadership role in defining and monitoring quality of care.

Aged↗

PubMed1994

Ecotoxicology of selenium in freshwater systems.

The toxicology, environmental impacts and risk assessment of Se in freshwater systems are a high priority for research and regulatory agencies. However, understanding Se in freshwater systems is a challenging endeavor. The accurate risk assessment and determination of a water-quality criterion for any freshwater ecosystem are difficult for many reasons. First, the understanding of the structure and energy dynamics in ecosystems is limited. Second, knowledge of Se cycling and transformations in aquatic ecosystems is rudimentary. Third, the role of various environmental factors affecting its bioaccumulation, biotransformation, and toxicology in aquatic ecosystems is largely unknown. Fourth, the extrapolation and use of existing data in commonly used formulas for risk assessment and calculations of water quality criteria is difficult because of the demonstrated species differences in the bioaccumulation, metabolism, and tolerance of Se. There are many aspects of Se ecotoxicology that need to be addressed to develop more accurate environmental risk assessments and determine appropriate water-quality criteria to protect aquatic ecosystems. Studies evaluating the biochemical speciation of Se in aquatic ecosystems, and determination of the role of microbial communities in its cycling, bioaccumulation, transformation, transfer, and toxicity in aquatic systems, appear to be priorities for future research. These would include a broad exploration of Se effects on ecosystems, e.g., exposure regime, direct and indirect biologic effects, and ecosystem level effects. There are, however, ecological uncertainties that tend to confound such endeavors, e.g., insufficient data, extrapolation issues, and environmental stochasticity (Harwell and Harwell 1989). There are several concepts concerning the ecotoxicology of Se that can be stated. Elevated concentrations have degraded many freshwater ecosystems throughout the United States, and additional systems are expected to be affected as anthropogenic activities increasingly mobilize Se into aquatic systems. Se is a very toxic essential trace element. Toxic threshold concentrations in water, dietary items, and tissues are only 2-5 times normal background concentrations. Toxicity in freshwater ecosystems is the result of bioaccumulation, biotransformation, and cycling of Se in aquatic food chains. Thus, environmental risk assessment and development of effective water-quality criteria to protect freshwater ecosystems become formidable tasks.

Animals↗

PubMed2006

Osmolyte-induced protein folding free energy changes.

Upon addition of protecting osmolyte to an aqueous solution of an intrinsically unstructured protein, spectral observables are often seen to change in a sigmoid fashion as a function of increasing osmolyte concentration. Commonly, such data are analyzed using the linear extrapolation model (LEM), a method that defines a scale from 0%-100% folded species at each osmolyte concentration by means of extending pre- and post-folding baselines into the transition region. Defining the 0%-100% folding scale correctly for each osmolyte is an important part of the analysis, leading to evaluation of the fraction of folded protein existing in the absence of osmolytes. In this study, we used reduced and carboxyamidated RNase T1 (RCAM-T1) as an intrinsically unstructured protein, and determined the thermodynamic stability of RCAM-T1 induced by naturally occurring osmolytes. Because the folded fraction of the protein population determined by experiments of thermal and urea-induced denaturation is nonzero in the absence of osmolytes at 15 degrees C, the commonly used LEM can lead to false values of DeltaG[stackD-->N0] for protein folding due to the arbitrary assumption that the protein is 100% unfolded in the presence of buffer alone. To correct this problem, titration of the protein solution with urea and extrapolating back to zero urea concentration gives the spectral value for 100% denatured protein. With fluorescence as the observable we redefine F/F0 to F/F0extrap = 1.0 and require that the denatured-state baseline have this value as its intercept. By so doing, the 0%-100% scale-corrected DeltaG[D-->N0] values of RCAM-T1 folding in the presence of various osmolytes are then found to be identical, with small error, demonstrating that DeltaG[D-->N0] is independent of the osmolytes used. Such a finding is an important step in validating this quantity derived from the LEM as having the properties expected of an authentic thermodynamic parameter. The rank order of osmolyte efficacies in stabilizing RCAM-T1 is sarcosine > sucrose > sorbitol > proline > betaine > glycerol.

Circular Dichroism↗

PubMed2000

[Prevalence and morbidity of hip excentration in cerebral palsy: review of the literature].

PURPOSE OF THE STUDY: Excentration of the hip is one of the main orthopedic complications of ante and perinatal cerebral palsy. Excentration can progress to dislocation even if tenotomy is performed. What is the prevalence and morbidity of hip excentration? METHODS: We reviewed the pertinent literature on the prevalence and morbidity of hip excentration in patients with cerebral palsy based on the Medline and Reedoc databases. RESULTS: Data presented in the literature vary greatly. Populations are representative of the referral network of the teams reporting the study rather than the cerebral palsy population in general. Signs reported were pain, difficult nursing procedures, difficult sitting position, pressure sores and fractures, but only one sign can be taken fully into account: 50 p. cent of the dislocated hip joints were painful. DISCUSSION: No one study gives a precise assessment of the prevalence of hip excentration and displacement and its consequences in patients with cerebral palsy. In a population of quadriplegic patients who do not walk, the question is whether complementary tenotomy should be performed, knowking the difficult operative and postoperative situation of such procedures. In this population, walking is an exceptional goal of bone surgery, pain relief and patient comfort are more common goals. Data in this literature (50 p. 100 of the dislocated hips are painful) suggest a prudent approach. However, there is no known marker which can be used to distinguish hips which will become painful from those which will remain pain free. In addition, irreversible cartilage degeneration can cause pain contraindicating reconstructive surgery.

Cerebral Palsy↗

PubMed1998

Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus.

OBJECTIVE: To investigate the pathophysiologic mechanisms that lead to ileus after abdominal surgery. SUMMARY BACKGROUND DATA: The common supposition is that more invasive operations are associated with a more extensive ileus. The cellular mechanisms of postsurgical ileus remain elusive, and few studies have addressed the mechanisms. METHODS: Rats were subjected to incremental degrees of surgical manipulation: laparotomy, eventration, "running," and compression of the bowel. On postsurgical days 1 and 7, muscularis infiltrates were characterized immunohistochemically. Circular muscle activity was assessed using mechanical and intracellular recording techniques in vitro. RESULTS: Surgical manipulation caused an increase in resident phagocytes that stained for the activation marker lymphocyte function-associated antigen (LFA-1). Incremental degrees of manipulation also caused a progressive increase in neutrophil infiltration and a decrease in bethanechol-stimulated contractions. Compression also caused an increase in other leukocytes: macrophages, monocytes, dendritic cells, T cells, natural killer cells, and mast cells. CONCLUSION: The data support the hypothesis that the degree of gut paralysis to cholinergic stimulation is directly proportional to the degree of trauma, the activation of resident gut muscularis phagocytes, and the extent of cellular infiltration. Therefore, postsurgical ileus may be a result of an inflammatory response to minimal trauma in which the resident macrophages, activated by physical forces, set an inflammatory response into motion, leading to muscle dysfunction.

Animals↗

PubMed2001

A framework for cost-effectiveness analysis from clinical trial data.

We present a general Bayesian framework for cost-effectiveness analysis (CEA) from clinical trial data. This framework allows for very flexible modelling of both cost and efficacy related trial data. A common CEA technique is established for this wide class of models through linking mean efficacy and mean cost to the parameters of any given model. Examples are given in which efficacy may be measured as a continuous, binary, ordinal or time-to-event outcome, and in which costs are modelled as distributed normally, log-normally, as a mixture or non-parametrically. A case study is presented, illustrating the methodology and illuminating the role of prior information.

Bayes Theorem↗

PubMed2003

PACRAT: a database and analysis system for archaeal and bacterial intergenic sequence features.

Analysis of intergenic sequences for purposes such as the investigation of transcriptional signals or the identification of small RNA genes is frequently complicated by traditional biological database structures. Genome data is commonly treated as chromosome-length sequence records, detailed by gene calls demarcating subsequences of the chromosomes. Given this model, the determination of non-called subsequences between any gene and its nearest neighbors requires an exhaustive search of all gene calls associated with the chromosome. Further compounding the issue, the location of intergenic regions for many called genes cannot be resolved unambiguously due to uncertainties in gene boundaries, as well as the presence of other conflicting gene calls. To address these difficulties we have constructed the PACRAT (http://www.biosci.ohio-state.edu/~pacrat/) database system. PACRAT preprocesses GenBank genome submissions, evaluates for every gene the character of its relationship to those genes nearest to it, and produces a relationally linked model of the gene ordering for the genome. Using this information, the interface allows the researcher to query gene data as well as intergenic sequence data based on a number of criteria. These include the ability to filter searches based on the status of start and stop positions, or upstream/downstream sequences as conflicting with called genes and automated extension of upstream or downstream searches to find probable operon promoters or terminators. The database is also indexed by KEGG classification, allowing, for example, functionally-related groups of high-quality promoter-containing regions to be easily retrieved as a group.

DNA, Archaeal↗

PubMed1989

Further explorations of common-sense representations of common illnesses.

A simple method is presented for measuring people's illness cognitions--their common-sense representations of common illnesses. Data were collected from 1,628 different respondents who described a recent illness form 1 to 3 separate times over a 17-month period. A free-clustering task performed by a set of naive participants confirmed that these cognitions fall into the five components that have been previously noted: identity, time line, consequences, cause, and cure. These five components are found to be reasonably stable over time and across different illness episodes. Several consequences of these illness cognitions, in terms of changes in health-locus-of-control beliefs and different propensities to visit a doctor, are also noted. Specifically, controllable attributions for getting sick and personal responsibility attributions for getting better are associated with increased beliefs in Self-Control Over Health and decreased beliefs in Chance Health Outcomes; people with strong Identity and Cure components in their common-sense representations of common illnesses have a greater propensity to visit a doctor when feeling ill.

Adolescent↗

PubMed2000

A study of in-shoe plantar shear in normals.

OBJECTIVE: To quantify features of in-shoe plantar shear in asymptomatic adult gait. DESIGN: In order to standardize footwear conditions and facilitate later comparison to patient groups, measurement is made in a group of adults walking freely in stock orthopaedic footwear. BACKGROUND: Better data on plantar shear is required to complement well-documented pressure data for an overall picture of plantar stress. METHODS: Measurements were made locally beneath the medial four metatarsal heads and heel using biaxial transducers mounted flush into an inlay. Pressure distribution was also measured. RESULTS: The shear data revealed common features in the shear pattern occurring at defined phases of gait, with good inter-step reliability. For the five sites of interest, these values ranged from 24 kPa to 70.4 kPa, and 31 kPa to 86.5 kPa for individuals wearing nylon hose or hose-free respectively. Maximum shear occurred more laterally than maximum pressure. CONCLUSIONS: Features of plantar shear were not always as expected; for example the forward thrust at push-off was not reflected in the anteroposterior shear stress. Because of the inter-subject variability, study of a larger group is indicated. RELEVANCE: Mechanical stress at the plantar interface between foot and shoe is of particular clinical relevance to the formation and management of ulcers in diabetic neuropathy. It is also of relevance to shoe and orthotic design for various foot pathologies. This study provides reliable data on the shear component of plantar stress for which, unlike the well-documented pressure component, there is only sparse data so far available.

Adult↗

PubMedDate not supplied

Rotodynamic pump scaling.

Despite extensive theoretical knowledge of fluid dynamics, the design process for rotodynamic pumps still relies heavily on experimental data. One common technique is to model the design of a new pump based on the design of existing pumps, using the laws of similarity. Another, similar approach frequently used for atypically large or small pumps is to scale a final product design from conveniently sized laboratory prototypes that have been refined to the desired performance in extensive experiments. Both approaches to pump design are usually considered highly reliable. However, for blood pumps, this approach has been questioned. Due to the extremely small size of these pumps and the relatively low Reynolds Numbers, extraneous effects may overwhelm the assumptions made for similarity calculations that are satisfactory for significantly larger models. Three geometrically similar pumps with related scaling factors of 1, 3.2, and 6.4 were tested for the same range of nondimensional flow and pressure. The quality of similitude was determined by comparing the nondimensionalized pump data of the three pumps. It was found that the effects of large linear dimension scaling factors had only a small influence on the quality of similitude (maximum 5.8% error), whereas Reynolds Number effects, especially at high pump flows, had a strong impact on the quality of similitude (maximum 45.4% error). Because Reynolds Number similarity cannot always be achieved simultaneously with geometric similarity, a correction factor for Reynolds Number related departure from similarity was developed. It is based on the Reynolds Number, the Flow Coefficient, the specific speed, and the pump's relative surface roughness. Use of this correction factor reduces the error due to Reynolds Number effects to a maximum of 7.5%. We conclude that the use of scaling techniques in rotodynamic blood pump design is a valid approach, if Reynolds Number similarity is maintained or suitable correction factors are used.

Equipment Design↗

PubMed2004

Gene ontology application to genomic functional annotation, statistical analysis and knowledge mining.

While a massive amount of biomolecular information is increasingly accumulating in different databanks, on the other hand high-throughput technologies are generating a great quantity of data that need to be annotated with the genomic information available, and interpreted. To this aim, the use of specific ontologies can greatly help either in integrating different information stored within heterogeneous databanks, or in identifying and clustering sequence data sharing common characteristics. In the molecular biology domain, the Gene Ontology (GO) is the most developed and widely used ontology. To demonstrate its great utility in the annotation and biological interpretation of gene sets obtained by means of high-throughput experiments, we implemented the web application here described. It enables functional annotations of a given gene set on a genomic scale and across different species. Within our application the annotations provided by the GO vocabulary allow either to easily bind several information from different resources, or to cluster annotated genes according to their biological characteristics. Through the GO structure it is also possible to represent biological concepts with different specificity levels, from very general to very precise concepts. Furthermore, the statistical evaluation of the categorizations provided by the GO annotations enables to highlight the most significant biological characteristics of a gene set, and therefore to mine knowledge from data. Our created tool meets the need to manage a vast quantity of biological data with a simple user interface adapt also for users with limited informatics knowledge, leading them to evaluate the functional significance of experiment's results with graphical views and statistical indexes in a well-known web browser user interface.

Genomics↗

PubMed1998

Surgical management of impacted third molars.

Teeth may become impacted when they fail to erupt or develop into the proper functional location. As such, impacted teeth are considered nonfunctional, abnormal, and pathological. The mandibular third molar is the most common tooth to become impacted. The cause of impacted third molars is thought to be inadequate space. Several studies indicate that a change from a coarse, attritive diet to a modern, refined diet has lead to an increased incidence of impacted teeth. Interproximal attrition allows for greater mesial migration of teeth and space for third molar teeth. Teeth that fail to attain a functional position may be pathological and should be considered for removal. The indications for removing impacted teeth can be divided into those of acute or chronic pathology. Impacted third molars are often associated with pain, infection, cyst formation, benign tumors, root resorption, bone loss, periodontal disease, and caries. The decision to surgically remove impacted third molars is often unclear. There are no absolute treatment protocols established. The dentist must consider a variety of factors and make an informed decision with the patient. Most experienced clinicians combine objective data and common sense to arrive at a logical treatment plan. The purpose of this article is to discuss factors related to impacted teeth and help the orthodontist understand the general management of impacted third molars. The decision for surgery will be assisted by an understanding of all of the risk factors associated with impacted teeth and presenting the options to the patient.

Decision Trees↗

PubMed2001

Patient outcomes after Harrington instrumentation for idiopathic scoliosis: a 15- to 28-year evaluation.

STUDY DESIGN: A retrospective study was performed, using the Short Form-36 Health Survey and the Roland and Morris Disability Questionnaire, to investigate patient outcomes after fusion for adolescent idiopathic scoliosis using Harrington rod instrumentation. OBJECTIVE: To evaluate health-related quality of life and low back pain in a long-term follow-up study of surgery for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The commonly accepted surgical treatment for idiopathic evolutive scoliosis is vertebral fusion. It has been suggested that this procedure may cause low back pain and a poor quality of life over the long term. Outcome measures after surgery for adolescent idiopathic scoliosis have focused mainly on objective parameters such as radiographic measures. However, this information has proved to be correlated only weakly with outcomes that are more relevant to patients, such as functional status and symptoms. Until recently, only a few long-term outcome studies have used standardized and validated patient-oriented tools to evaluate surgically treated patients with scoliosis. METHODS: In this study, 70 patients treated with a standard Harrington technique were recontacted and evaluated by means of self-administered questionnaires (Short Form-36 Health Survey and Roland and Morris Disability, clinical examination, and radiographic analysis. Preoperative and follow-up radiographic findings were registered. Relations between radiographic and patient-oriented data were evaluated. RESULTS: A comparison between the current sample and the Italian age-matched normative data for the Short Form-36 Health Survey showed them to have a similar pattern. Findings showed the patient-oriented outcome to be correlated inversely with the extension of vertebral fusion and the preoperative Cobb angle. CONCLUSION: Long-term follow-up evaluation of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life, as measured by patient-oriented evaluation.

Adult↗

PubMed1977

Application of nonparametric procedure for bioassay data to the evaluation of analgesics in man.

Parametric tests for bioassay data are commonly applied to scores of pain intensity and relief for the assessment of potency ratios of analgesic drugs. It has been demonstrated, however, that scores derived from semiquantitative scales often deviate from normal distribution. In addition, when scores decrease as a consequence of analgesic treatment, the variances may be nonhomogenous. Both parametric and nonparametric procedures have been employed in this study for the evaluation of results of a double-blind multicenter trial of the analgesic effect of indoprofen and ASA (both drugs at three dose levels) and placebo in episiotomy pain. There was a good agreement between potency ratios obtained with the two assays. Peak PID appeared a less efficient means of estimating potency ratio than other measurements such as SPID and TOTPAR. The nonparametric test for quantitative bioassay appears to be a valid statistical procedure for evaluating results of clinical trials, and it does not imply any assumptions as to the type of distribution of the data.

Adolescent↗

PubMed2006

Chronic tendinopathy: effectiveness of eccentric exercise.

OBJECTIVES: To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies. DATA SOURCES: Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966-Jan 2006), CINAHL (1982-Jan 2006), AMED (1985-Jan 2006), EMBASE (1988-Jan 2006), and all EBM reviews--Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric. REVIEW METHODS: The PEDro and van Tulder scales were employed to assess methodological quality. Levels of evidence were then obtained according to predefined thresholds: Strong--consistent findings among multiple high-quality RCTs. Moderate--consistent findings among multiple low-quality RCTs and/or clinically controlled trials (CCTs) and/or one high-quality RCT. Limited--one low-quality RCT and/or CCT. Conflicting--inconsistent findings among multiple trials (RCTs and/or CCTs). No evidence-no RCTs or CCTs. RESULTS: Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included studies of Achilles tendinopathy (AT), patella tendinopathy (PT) and tendinopathy of the common wrist extensor tendon of the lateral elbow (LET). Limited levels of evidence exist to suggest that EE has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound. Levels of evidence were found to be variable across the tendinopathies investigated. CONCLUSIONS: This review demonstrates the dearth of high-quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies. Further adequately powered studies that include appropriate randomisation procedures, standardised outcome measures and long-term follow-up are required.

Chronic Disease↗