Feasibility of the physiological cost index as an outcome measure for the assessment of energy expenditure during walking

Objective: To determine if the Physiological Cost Index (PCI) can be recommended as an outcome measure in clinical trials. Design: Three assessments were performed, 2 with shoes, 1 without. The difference between walking with shoes and walking barefoot was used to study the ability of the PCI to detect a change in the criterion standard. Setting: A research department affiliated with a rehabilitation hospital in the Netherlands. Participants: Twelve children with cerebral palsy. Interventions: During the first and third assessments, the children walked with shoes. During the intermediate assessment, the children walked without shoes. Main Outcome Measures: Breath-by-breath oxygen uptake, heart rate (HR), and walking speed were measured at a self-selected comfortable speed. Oxygen cost (EO2) and the PCI were subsequently calculated offline. Feasibility judgments were made regarding the ability of the PCI to detect changes in a criterion standard and the statistical power of the outcome measure. Results: Pearson correlation coefficients were .66 and .62 for HRwalking-HRbaseline and HRwalking, respectively. The smallest detectable difference of the PCI and EO2 were 69% and 32%, respectively. A difference of at least 69% or 32% should be found before one can conclude a difference with a certainty of 95%. Conclusions: The reproducibility of the PCI and the ability to show small differences in EO2 were moderate. Subtracting HRbaseline when calculating the PCI is probably not useful because it only increased within-subject variability. With respect to statistical power of a new clinical trial, we recommend using EO2 instead of the PCI

Flexor Hallucis Longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

<p>Abstract</p> <p>Background</p> <p>To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL) tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints.</p> <p>Methods</p> <p>Thirty RA patients with painful feet were analysed, their feet were examined clinically for the presence of pes planus and range of motion (ROM), radiographs were scored looking for the presence of forefoot damage, and ultrasound examination was performed, examining the presence of tenosyovitis or rupture of the FHL at the level of the medial malleolus. The correlation between the presence or absence of the FHL and ROM, forefoot damage and pes planus was calculated.</p> <p>Results</p> <p>In 11/60(18%) of the feet, a rupture of the FHL was found. This was associated with a limited motion of the MTP1-joint, measured on the JAM (χ²= 10.4, p = 0.034), a higher prevalence of pes planus (χ²= 5.77, p = 0.016) and a higher prevalence of erosions proximal at the MTP-1 joint (χ²= 12.3, p = 0.016), and joint space narrowing of the MTP1 joint (χ²= 12.7, p = 0.013).</p> <p>Conclusion</p> <p>Rupture of the flexor hallucis longus tendon in RA-patients is associated with limited range of hallux motion, more erosions and joint space narrowing of the MTP-1-joint, as well as with pes planus.</p

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Assessment of rectus femoris function during initial swing phase

The normal human gait cycle is divided into two phases, namely, stance and swing. The objective of stance is to provide support, stability and propulsion and that of swing is to provide ground clearance and limb advancement. Knee flexion is essential during swing to lift the foot off the ground for limb advancement. The complex mechanisms involved in producing limb advancement can produce excessive knee flexion at faster walking speeds. Under these circumstances the shank needs to be decelerated to reduce the amount of knee flexion. It is assumed that rectus femoris (RF) is active for a very short period at the beginning of the swing phase (Perry J. Gait Analysis—Normal and Pathological Gait. Slack Incorporated, USA, 1992; Scott L, Ringwelsky D, Carroll N. Transfer of rectus femoris: effects of transfer site on moment arms about the knee and hip. J Biomech 27;1994:1201–1211) and the amount of this activation is proportional to the walking speed and thus to the generated knee moment and the angular acceleration of the lower limb segments. However, there is very little evidence to support these assumptions. The objective of this study was to study this relationship. Quantified electromyogram of RF and vastus lateralis (VL), using surface electrodes, were examined, body mounted kinematic sensors such as seismic accelerometers and gyroscopes were used to measure segments' angular accelerations and the net muscular knee torque calculated from the kinematics of the segments at various speeds. The results showed that RF and VL work independent of each other during the initial swing phase. The amount of RF activity is clearly related to walking speed. The muscle activity increases with increasing walking speed. The relationship between the angular acceleration of the shank and the amount of RF activity is linear. The active knee moment, as a function of the shank's angular acceleration, shows the same high correlation to the EMG signal of RF

Accelerometer and rate gyroscope measurement of kinematics : an inexpensive alternative to optical motion analysis systems

Développement d'un systeme portable pour obtenir des données de la cinématique de la marche dans le plan sagittal ; ce système est constitué de 4 accéléromètres uniaxe et d'un gyroscope par segment corporel