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PubMed1998

A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients.

OBJECTIVE: To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus (HIV). DESIGN: Randomized controlled trial. SUBJECTS: HIV-infected men (n=118) who were less than 90% of usual weight for height or who had lost more than 10% of body weight. INTERVENTION: Nutrition counseling alone (control group) vs nutrition counseling plus enteral supplementation (supplement group) for 6 weeks. All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day. MAIN OUTCOME MEASURES: Weight, skinfold thickness, fat-free mass, grip strength, quality of life, and cognitive function (Buschke test). STATISTICAL ANALYSES: Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test. RESULTS: Ninety-nine men completed at least 4 weeks of treatment, 49 in the supplement group and 50 in the control group. Half the patients in each treatment group achieved at least 80% of their energy target. No differences in weight, skinfold thickness measurements, or quality of life were observed. Compared with the control group, the supplement group had larger increases in fat-free mass and grip strength, although the differences did not reach statistical significance. APPLICATIONS: In the short term, nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50% of malnourished HIV-infected patients. Although further study is needed to evaluate long-term effects, these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients.

Adult↗

PubMed2006

Sham device v inert pill: randomised controlled trial of two placebo treatments.

OBJECTIVE: To investigate whether a sham device (a validated sham acupuncture needle) has a greater placebo effect than an inert pill in patients with persistent arm pain. DESIGN: A single blind randomised controlled trial created from the two week placebo run-in periods for two nested trials that compared acupuncture and amitriptyline with their respective placebo controls. Comparison of participants who remained on placebo continued beyond the run-in period to the end of the study. SETTING: Academic medical centre. PARTICIPANTS: 270 adults with arm pain due to repetitive use that had lasted at least three months despite treatment and who scored > or =3 on a 10 point pain scale. INTERVENTIONS: Acupuncture with sham device twice a week for six weeks or placebo pill once a day for eight weeks. MAIN OUTCOME MEASURES: Arm pain measured on a 10 point pain scale. Secondary outcomes were symptoms measured by the Levine symptom severity scale, function measured by Pransky's upper extremity function scale, and grip strength. RESULTS: Pain decreased during the two week placebo run-in period in both the sham device and placebo pill groups, but changes were not different between the groups (-0.14, 95% confidence interval -0.52 to 0.25, P = 0.49). Changes in severity scores for arm symptoms and grip strength were similar between groups, but arm function improved more in the placebo pill group (2.0, 0.06 to 3.92, P = 0.04). Longitudinal regression analyses that followed participants throughout the treatment period showed significantly greater downward slopes per week on the 10 point arm pain scale in the sham device group than in the placebo pill group (-0.33 (-0.40 to -0.26) v -0.15 (-0.21 to -0.09), P = 0.0001) and on the symptom severity scale (-0.07 (-0.09 to -0.05) v -0.05 (-0.06 to -0.03), P = 0.02). Differences were not significant, however, on the function scale or for grip strength. Reported adverse effects were different in the two groups. CONCLUSIONS: The sham device had greater effects than the placebo pill on self reported pain and severity of symptoms over the entire course of treatment but not during the two week placebo run in. Placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals.

Acupuncture Analgesia↗

PubMed2005

Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomised, controlled trial.

A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups. During the period of two years, patients who underwent indirect reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised.

Adolescent↗

PubMed1999

Evaluation of the lower motor neuron integrity of upper extremity muscles in high level spinal cord injury.

PURPOSE: To evaluate the lower motor neuron (LMN) integrity of upper extremity muscles of persons with high tetraplegia (C1-C4) in order to determine muscles available for stimulation. METHODS: Fourteen subjects (23 arms) were evaluated for LMN integrity. Muscles that elicited a functional response (grade 3 or better) to surface electrical stimulation were considered to have intact LMN and good candidates for FES. Strength-duration (S-D) curves were generated on muscles that showed weak (less than grade 3) or no response to surface stimulation. Muscles were considered denervated if S-D curves were discontinuous or depicted steep, increasing amplitude for pulse durations greater than 1 m. RESULTS: Muscles for grasp and release had intact LMN in 19 of 23 (83%) arms. The wrist extensors and flexors and pronator were excitable in 17 (74%), 20 (87%) and 19 (83%) arms, respectively. The supinator demonstrated LMN lesion in 80% of the arms. Over 90% of the biceps muscles were unresponsive to electrical stimulation and 85% and 87% of the deltoid and supraspinatus muscles, respectively, were not electrically excitable. The latissimus dorsi and triceps muscles were typically innervated (78% and 91%, respectively) and slightly more than half (52%) of the pectoralis major muscles were excitable. CONCLUSION: These data suggest that application of FES in high tetraplegia for hand and arm function would require augmentation because of the inability to stimulate the elbow flexors, deltoid and rotator cuff muscles. These data also show that several paralyzed proximal muscles with intact LMN that have been historically transferred to address shoulder paralysis in other patient populations are available for transfer and stimulation in the population with high level spinal injuries.

Adolescent↗

PubMed2006

The new Geriatric Nutritional Risk Index is a good predictor of muscle dysfunction in institutionalized older patients.

BACKGROUND & AIMS: The validity of Geriatric Nutritional Risk Index (GNRI), in predicting nutrition-related risk of complications in the elderly, has been recently underscored. Malnutrition may results also in muscle function impairment. Thus, the present study aims to investigate if GNRI might be a reliable detector of muscle dysfunction in institutionalized older people. METHODS: In total, 153 institutionalized elderly (71 males, 82 females; mean age+/-SD: 75.2+/-8.4; range: 65-96) were studied in anthropometric parameters, serum albumin concentration and total score on GNRI. Muscle function was assessed by handgrip strength (HG). RESULTS: Women were significantly older than men and presented lower values of HG and arm muscle area (AMA). In overall population, GNRI was significantly correlated with AMA, HG and strength for centimeter of muscle area (HG/AMA); however, in gender-separated analysis, men presented higher degrees of correlation. After dividing patients in four categories according to GNRI, a more significant difference was detected in HG and HG/AMA rather than the other clinical and anthropometric parameters. Moreover, ANOVA analysis between HG quartiles was highly significant for GNRI, AMA and HG/AMA. CONCLUSIONS: GNRI is a good predictor of muscle dysfunction, particularly in men, and useful in identifying patients suitable for nutritional support and physical activity.

Age Factors↗

PubMed2006

Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer.

BACKGROUND: In a prospective study, long term upper-limb morbidity, perceived disabilities in activities of daily life (ADL) and quality of life (QOL) were assessed before and 2 years after sentinel lymph node biopsy (SLNB) or axillary lymph node dissections (ALND) for breast cancer. METHODS: Two hundred and four patients with stage I/II breast cancer, mean age 55.6 years (SD: 11.6) entered the study and 181 patients (89%) could be evaluated after 2 years. Fifty-seven patients underwent SLNB (31%) and 124 patients underwent an ALND (69%). Assessments included pain, shoulder range of motion, muscle strength, arm volume, perceived shoulder disability in ADL and QOL. RESULTS: Significant (P<0.05) changes between before and 2 years after surgery were found in almost all assessments of shoulder function, ADL and several QOL subscales. Patients in the ALND group showed significant more changes in range of motion (ROM), grip strength, arm volume, ADL and QOL physical- and role functioning, pain and sleeplessness and arm symptoms compared to the SLNB group. Multivariate linear regression analysis showed that ALND could predict decrease of ROM, grip strength, ADL and physical functioning (QOL) and increase of arm volume, pain and arm symptoms score (QOL). Radiation on the axilla predicts an additional decrease in shoulder ROM and increase of arm volume. CONCLUSION: Two years after surgery for breast cancer, patients show significantly less treatment related upper limb morbidity, perceived disability in ADL and worsening of QOL after SLNB compared with ALND.

Activities of Daily Living↗

PubMed2006

Combined nerve transfers for C5 and C6 brachial plexus avulsion injury.

PURPOSE: To report the results of combined nerve transfer in C5 and C6 brachial plexus avulsion injury. METHODS: Fifteen patients had nerve transfers: spinal accessory nerve to the suprascapular nerve, a part of the ulnar nerve to the biceps motor branch, and the nerve to the long head of the triceps to the anterior branch of the axillary nerve. Patients were evaluated with regard to elbow flexion, shoulder abduction, and shoulder external rotation. RESULTS: All patients had recovered full elbow flexion: 13 scored M4 and 2 scored M3. Thirteen of the 15 patients obtained good results. The weight the patients could lift ranged from 0 to 7 kg. All patients had recovery of the deltoid function: 13 scored M4 and 2 scored M3. All 15 patients achieved useful functional recovery. Ten patients experienced excellent recoveries and 5 were classified as having good results. The mean shoulder abduction was 115 degrees . Shoulder external rotation strength was scored as M4 in 9 patients, M3 in 4 patients, and M2 in 2 patients. The range of motion of external rotation that was measured from full internal rotation averaged 97 degrees . No clinical donor nerve deficits were observed. CONCLUSIONS: We recommend combined nerve transfers for C5 and C6 avulsion root injuries. These nerve transfers have the advantage of a quick recovery time as a result of the short regeneration distance without nerve graft. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Accessory Nerve↗

PubMed2004

Scaphotrapeziotrapezoid (STT)-arthrodesis in Kienbock's disease.

This study reviews the results of 59 of 84 patients with severe Kienbock's disease who were treated with STT fusion. The average follow-up period was 4 (ranges: 2-8 years). The average arc of wrist extension and flexion was 67 degrees (60% of the contralateral side, 81% of pre-operative range) and that of ulnar and radial deviation was 31 degrees (52% of the contralateral side, 56% of pre-operative range). Pre-operative pain values (VAS) were 56 (non-stress) and 87 (stress) and were significantly higher than the postoperative values of 12 (non-stress) and 41 (stress). Grip strength improved from 45kPa pre-operatively to 52kPa postoperatively. The mean modified Mayo wrist score was 63 points. The patients reported low disability in the DASH scores, with an average of 28 points. Our data show that STT fusion is a reliable and effective treatment for pain relief and offers a good functional result in advanced stages of Kienbock's disease. However the long-term effect of this procedure on radioscaphoid and other intercarpal joints is yet to be determined.

Adolescent↗

PubMed2004

Long interpositional nerve graft consistently induces incomplete motor and sensory recovery in the rat. An experimental model to test nerve repair.

Motor and sensory regeneration was studied in a 40 mm long graft interposed between the sectioned stumps of the rat median nerve. Animals were behaviorally assessed from 1 to 720 days after surgery by the grasping and modified Randall-Sellito tests. Rats recovered grasping function 43.7 (S.D. +/- 2.6) days after surgery. Grasping strength attained 50 and 65% of the normal control group, 280 and 360 days after surgery, respectively. From 90 to 360 days after surgery, sensory nociceptive recovery was only 30% of the normal control group. The results indicate that motor and sensory neurons were capable of regenerating additional axonal length, but functional return was clearly better in the motor system. This model of deficient reinnervation might prove to be of interest in testing of new strategies for the enhancement of nerve recovery.

Animals↗

PubMed1995

Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis.

Seventeen patients were treated with scaphoid excision and four-corner arthrodesis (lunate, capitate, hamate, triquetrum) for scapholunate advanced collapse wrist and followed for a mean of 27 months. Eleven wrists in 10 patients had a proximal row carpectomy for scapholunate advanced collapse wrist and were followed for a mean of 37 months. The total arc of motion averaged 95 degrees in the four-corner arthrodesis patients and 115 degrees in the proximal row carpectomy patients, which was 47% and 64%, respectively, of the range of motion of the opposite wrist. Grip strength averaged 74% of the opposite wrist in the four-corner arthrodesis group and 94% in the proximal row carpectomy group. Three wrists in the four-corner arthrodesis group failed and were successfully converted to a total wrist fusion; two additional patients were awaiting arthrodesis. There were no failures in the proximal row carpectomy group. Proximal row carpectomy showed a high degree of patient satisfaction and is our motion-preserving procedure of choice except in those wrists with advanced capitolunate arthritis.

Adult↗

PubMed1998

Wide excision of the distal ulna: a multicenter case study.

Excision of the distal ulna to treat degenerative disease or instability has fallen into disfavor following reports of radioulnar impingement, carpal instability, and distal ulnar instability. Alternative procedures for reconstruction of the painful distal ulna have been developed to address these problems; the results have been generally favorable. When faced with distal ulnar reconstruction that has failed after multiple surgical procedures, or a distal ulnar neoplasm, the surgeon is left with few treatment options. Creation of a one-bone forearm, free fibular transfer, and allograft replacement have been attempted, with mixed outcomes. We report the results of 5 men and 7 women who underwent wide excision of the distal ulna, defined as surgical excision of 25% to 50% of the ulnar length. The diagnosis was failed distal radioulnar reconstruction or excision in 8 patients, osteomyelitis in 1, congenital pseudoarthrosis of the radius in 1, and neoplasm in 2. No soft tissue reconstruction was performed. Patients were examined at an average of 22 months after surgery for radiocarpal and radioulnar instability, functional outcome, pain relief, grip strength, and range of motion. Nine of the 12 procedures resulted in good or excellent results; 1 patient had a fair result after resection for osteosarcoma, and the procedure in 2 patients failed, requiring conversion to a one-bone forearm. Grip strength was restored to 75% of the normal side and range of motion was restored to 86% of the normal side. Wide excision of the distal ulna without soft tissue reconstruction is a simple and durable treatment of neoplasms of the distal ulna or salvage of the failed reconstruction of the distal radioulnar joint. We do not recommend its use in patients with incompetency or disruption of the interosseous membrane.

Adult↗

PubMed2000

Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women.

UNLABELLED: Creatine monohydrate (CrM) administration may enhance high intensity exercise performance and increase body mass, yet few studies have examined for potential adverse effects, and no studies have directly considered potential gender differences. PURPOSE: The purpose of this study was to examine the effect of acute creatine supplementation upon total and lean mass and to determine potential side effects in both men and women. METHODS: The effect of acute CrM (20 g x d(-1) x 5 d) administration upon systolic, diastolic, and mean BP, plasma creatinine, plasma CK activity, and body composition was examined in 15 men and 15 women in a randomized, double-blind experiment. Additionally, ischemic isometric handgrip strength was measured before and after CrM or placebo (PL). RESULTS: CrM did not affect blood pressure, plasma creatinine, estimated creatinine clearance, plasma CK activity, or handgrip strength (P > 0.05). In contrast, CrM significantly increased fat-free mass (FFM) and total body mass (P < 0.05) as compared with PL, with no changes in body fat. The observed mass changes were greater for men versus women. CONCLUSIONS: These findings suggest that acute CrM administration does not affect blood pressure, renal function, or plasma CK activity, but increases FFM. The effect of CrM upon FFM may be greater in men as compared with that in women.

Adult↗

PubMed1996

Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction.

OBJECTIVE: To evaluate an exercise protocol designed to improve strength and mobility, and to decrease injury risk factors in physically restrained nursing home residents. DESIGN: A randomized controlled trial. PARTICIPANTS: Ninety-seven residents were randomized into either exercise or control groups. Thirty-five exercise and 37 control group residents completed all post-assessments after a 9-week trial. INTERVENTION: Walking or wheelchair movement training was supplemented by rowing exercise three times per week. Practice in behaviors related to safe movement was provided incidental to the exercise. MEASUREMENT: Endurance, speed, and injury risk measures relevant to walking, wheelchair propulsion, and standing were assessed by standardized protocols. Rowing endurance, rowing range of motion, and handgrip strength measures were collected to assess the effect of the rowing component of the exercise protocol. RESULTS: Fifty-four percent of the subjects who provided consent did not complete the protocol because of health status changes, lack of cooperation, or physical limitations that precluded exercise. The subjects who completed the exercise program showed significant improvement on injury risk and measures related to upper body strength (handgrip strength, rowing endurance, wheelchair endurance, and speed). Measures related to lower body strength did not significantly improve. CONCLUSION: Physically restrained residents are very frail, and it is difficult to implement a long-term exercise program with many residents because of the frailty. However, a substantial proportion of residents did cooperate well with the exercise program and showed improvement on measures correlated with decreased injury risk. The exercise program could be easily modified to include more lower body exercise, and the resultant protocol would be an important adjunct to restraint reduction programs.

Aged↗

PubMed2026

Multidisciplinary mHealth Rehabilitation for Patients With Abdominal Cancer Who Are Receiving Chemoradiotherapy: Randomized Phase II Trial.

BACKGROUND: Concurrent chemoradiotherapy (CCRT) for abdominal cancer frequently induces muscle loss, weight loss, and malnutrition. OBJECTIVE: This exploratory randomized phase II trial evaluated whether a multidisciplinary, mobile health (mHealth)-based multimodal rehabilitation program could preserve handgrip strength and muscle mass in patients with abdominal cancer undergoing CCRT. METHODS: In this prospective, multicenter, randomized, open-label phase II trial (NCT05325554), 111 eligible patients with abdominal malignancies scheduled for CCRT were randomly assigned (1:1) to receive either multidisciplinary mHealth rehabilitation care (MRC; n=57) or standard care (SC; n=54). The MRC program was delivered by a dedicated multidisciplinary team using the AiNST mHealth platform and wearable heart rate monitors. The primary end point was handgrip strength at the end of CCRT (analyzed with analysis of covariance adjusting for baseline). Secondary end points were exploratory and analyzed without multiplicity adjustment; sensitivity analysis using false discovery rate (FDR) correction was performed. RESULTS: Between February 2022 and April 2023, 111 patients were enrolled. Adherence was high (n=93, 83.9% achieved exercise targets). After adjusting for baseline handgrip strength, the MRC group had significantly higher handgrip strength at the end of CCRT than the SC group (adjusted mean difference 4.87 kg, 95% CI 3.36-6.38; P<.001). Exploratory analyses of secondary end points (without multiplicity adjustment) showed that the MRC group also had better preservation of body weight (P=.005), skeletal muscle mass (P<.001), serum albumin (P=.009), prealbumin (P=.02), and lower rates of hematological toxicity (P<.05), as well as improved psychological status (distress thermometer [DT] and Hospital Anxiety and Depression Scale [HADS]) and nutritional scores (Nutritional Risk Screening 2002 [NRS-2002] and Patient-Generated Subjective Global Assessment [PG-SGA]) at the end of CCRT (all P<.05). All nominally significant secondary end points remained significant after FDR correction (q<.05). These findings are preliminary and should be interpreted with caution due to the open-label design, population heterogeneity, and exploratory secondary analyses. CONCLUSIONS: In this exploratory phase II trial, a multidisciplinary, mHealth-based multimodal rehabilitation program was associated with better preservation of handgrip strength, muscle mass, and nutritional status, as well as lower rates of certain treatment toxicities, compared with SC. However, definitive conclusions are limited by the open-label design, heterogeneity of tumor types, and short follow-up. Larger, blinded phase III trials are needed to confirm these findings.

Humans↗

PubMed2001

Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids.

OBJECTIVE: To evaluate compliance and the change in serum albumin associated with essential amino acid (EAA) therapy in hypoalbuminemic hemodialysis subjects. DESIGN AND SETTING: Open label, single intervention, pilot study conducted at 2 outpatient hemodialysis centers located in Baltimore, Maryland. SUBJECTS: Eighteen patients with a mean 3-month prestudy serum albumin of <3.8 g/dL and a mean Kt/V of > or =1.0, without any recent hospitalizations or infections, who provided informed consent, and who demonstrated > or =90% compliance rate during a 2 week run-in period, were enrolled in the study. The mean age was 61.3 years, 44% were male, 78% were black, and 50% were diabetic. INTERVENTION: Subjects were instructed to take 3 Aminess N tablets (Recip AB, Stockholm, Sweden) 3 times each day with meals (total of 6.8 g of EAA per day) for 4 months. MAIN OUTCOME MEASURE: Median 4-month compliance and the change in mean follow-up serum albumin levels (mean of the serum albumin levels at day 30, day 60, day 90, and day 120 after the start of therapy) compared with mean baseline serum albumin levels (mean of the serum albumin levels at day -90, day -60, day -30, and day 0 before therapy). Secondary outcomes included changes in grip strength and body weight. Data was also collected on C-reactive protein levels, dialysis adequacy (Kt/V), and serum bicarbonate. A 2-day dietary recall was obtained at both the start and finish of the study. RESULTS: Monthly compliance with EAA tablets remained relatively stable over the study period, with median compliance rates of 86%, 88%, 82%, and 82% at months 1 through 4, and an overall median compliance of 82%. Seventy-eight percent of patients had an overall compliance rate of 70% or greater. Serum albumin improved from baseline to follow-up by a mean (95% confidence interval) of 0.20 g/dL (95% confidence interval, 0.04 to 0.30; P =.001). Lowest postdialysis weight increased from a mean of 74.5 kg to 77.1 kg (P =.05), and there was a nonsignificant increase in grip strength. C-reactive protein levels increased in 33%, remained constant in 11%, and decreased in 56% of subjects, and there was no significant correlation between change in C-reactive protein levels and improvement in serum albumin. Dietary recalls did not show any significant change in the spontaneous protein or caloric intakes in association with the use of the EAA tablets. CONCLUSION: Although uncontrolled, these results support the feasibility and benefits of moderate dose oral EAA supplementation in hypoalbuminemic hemodialysis subjects.

Administration, Oral↗

PubMed2003

Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for Stage I or II breast carcinoma.

BACKGROUND: The goals of sentinel lymph node biopsy (SLNB) are to improve axillary staging and reduce unnecessary axillary lymph node dissections (ALND), thereby reducing treatment-related upper-limb morbidity. In the current prospective study, short-term upper-limb morbidity was assessed after SLNB and/or ALND. METHODS: The study comprised 204 patients with Stage I/II breast carcinoma. Mean patient age was 55.6 years (standard deviation, 11.6). Sixty-six patients (32%) underwent SLNB only, and 138 (68%) underwent a Level I-II ALND. Assessment (preoperative [t0] and 6 weeks postoperative [t1]) included evaluation of shoulder range of motion, muscle strength, grip strength, pain, upper/forearm circumference, shoulder disability, and activities of daily life (ADL). RESULTS: Considerable treatment-related upper-limb morbidity was observed. Significant (P < 0.001) changes were found for pain, range of motion in forward flexion, abduction and abduction/external rotation, strength of shoulder abductors and elbow flexors, and in perceived disability in ADL. However, no significant difference in change of upper-limb function and ADL was found between the SLNB and ALND groups. CONCLUSIONS: Significant short-term treatment-related upper-limb morbidity exists after SLNB or ALND. There is no significant difference in short-term treatment-related morbidity between SLNB and ALND.

Activities of Daily Living↗

PubMed2003

Endoscopic versus open carpal tunnel release: a randomized trial.

PURPOSE: This study compared the outcomes in patients assigned to either endoscopic carpal tunnel release (ECTR) or traditional open carpal tunnel release (OCTR). METHODS: An unbalanced randomized clinical trial (91 endoscopic, 32 open) was conducted. Short-term and long-term outcomes were evaluated by a blinded assessor. The primary outcome measures were symptom severity measured on a self-report scale and nerve/vascular complications. Secondary outcomes included the McGill pain questionnaire, grip strength, pinch strength, sensory threshold (NK PSSD device, NK Biotechnical Corp, Minneapolis, MN), and time to return to work. RESULTS: Both groups improved on all outcomes. No differences were observed in primary outcomes between the groups at either baseline or follow-up at 1 week, 6 weeks, or 12 weeks after surgery. No significant complications occurred in either group. Grip strength and pain were significantly better at 1 and 6 weeks in the endoscopic group although differences dissipated by 12 weeks. No significant differences occurred in other secondary outcomes. Long-term satisfaction was lower in the endoscopic group, attributable to a 5% rate of re-operation. Lower rates of endoscopic release have occurred at our center once these results were available to surgeons and patients. CONCLUSIONS: No substantive difference in benefit was shown for these 2 methods of carpal tunnel release.

Carpal Tunnel Syndrome↗

PubMed2004

Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury.

The primary objective was to determine the effect of an aquatic exercise programme on the physical fitness of people with a brain injury. A pre-test-post-test randomized-groups design was conducted. Sixteen outpatients with a brain injury were included in the study. Eight participants were assigned to an aquatic exercise group and eight to a control group. The components of physical fitness measured included cardiovascular endurance, body composition, muscular strength and endurance and flexibility. Measurements were taken pre- and post-programme. Results indicated an increase in components of physical fitness for the experimental group but not the control group. Increases in fitness were reported as having a positive impact on the functional capacity of individuals in the exercise group as well as enhancing the individual's ability to complete activities of daily living successfully. Results indicate that aquatic exercise may positively impact the primary and secondary physical injuries caused by a brain injury.

Adult↗