Published in 2015

Need for strengthened focus on cancer rehabilitation in Danish municipalities

Kristiansen, M., Adamsen, L., Brinkmann, F. K., Krasnik, A. & Hendriksen, C., apr. 2015, I: Danish Medical Bulletin (Online). 62, 4, 5 s., A5045.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

INTRODUCTION: Danish municipalities have recently been given a mandate to organise cancer rehabilitation services. Knowledge is therefore needed about the services provided and their utilisation. The aim of this national Danish baseline survey was to explore the availability, utilisation, content and organisation of municipal cancer rehabilitation services.

METHODS: Electronic questionnaires were sent to all 98 Danish municipalities in January 2013. The questionnaire consisted of closed-ended and open-ended questions. Descriptive statistics and contents analysis were used.

RESULTS: A total of 91 municipalities responded (93% response rate). Of these, 75% reported that they provided cancer rehabilitation services. The number of patients enrolled was below the estimated proportion of patients needing rehabilitation services. Services consisted predominantly of physical training in groups, followed by "stop smoking" courses, dietary advice, physical training guidance, patient education and individual physical training. Inequality in referral by ethnicity, age and gender was reported. Challenges encountered included low patient numbers, inadequate collaboration within and across sectors and lack of evidence-based models for cancer rehabilitation.

CONCLUSION: There is a need for increased capacity and improved alignment between patients' rehabilitation needs and the available services.

FUNDING: This study was funded by grants from The Centre for Integrated Rehabilitation of Cancer Patients (CIRE), and received support from The Danish Cancer Society and The Novo Nordisk Foundation.

TRIAL REGISTRATION: not relevant.

Originalsprog Engelsk
Artikelnummer A5045
Tidsskrift Danish Medical Bulletin (Online)
Vol/bind 62
Udgave nummer 4
Antal sider 5
ISSN 1603-9629
Status Udgivet - apr. 2015

No evidence of seasonality of birth in adult type 2 diabetes in Denmark

Jensen, C. B., Zimmermann, E., Gamborg, M., Heitmann, B. L., Baker, J. L., Vaag, A. & Sørensen, T. I. A., sep. 2015, I: Diabetologia. 58, 9, s. 2045-50 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

AIMS/HYPOTHESIS: The season of birth might influence prenatal circumstances, which may influence the risk of developing type 2 diabetes. The aim of this study was to determine whether the diagnosis of type 2 diabetes in Denmark changed with the season of birth.

METHODS: This study used data from the population-based Copenhagen School Health Records Register (CSHRR) that includes schoolchildren born between 1930 and 1989. Via a personal identification number, the CSHRR was linked to the National Patient Register containing hospital discharge diagnoses since 1977. The effect of seasonal variation in birth on the risk of type 2 diabetes was assessed using Cox regression, with month or season of birth as the predictor. The underlying time variable was age, and follow-up started in 1977 or at age 30 years.

RESULTS: The study population consisted of 223,099 people, of whom 12,486 developed adult type 2 diabetes. Using January as the reference month, the risk of type 2 diabetes by month of birth was not statistically different for any of the 11 comparative birth months. Grouping month of birth into seasons (spring was the reference) gave essentially similar results, showing no difference in the risk of type 2 diabetes for any season. Repeating the analysis by sex, birth cohort and birthweight categories revealed no associations.

CONCLUSIONS/INTERPRETATION: The risk of adult type 2 diabetes was not associated with month of birth in a large Danish population-based study. The results suggest that the causes of seasonality in birthweight are not causes of type 2 diabetes.

Originalsprog Engelsk
Tidsskrift Diabetologia
Vol/bind 58
Udgave nummer 9
Sider (fra-til) 2045-50
Antal sider 6
ISSN 0012-186X
DOI
Status Udgivet - sep. 2015

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review

Holler, J. G., Bech, C. N., Henriksen, D. P., Mikkelsen, S., Pedersen, C. & Lassen, A. T., 2015, I: PLoS One. 10, 3, s. e0119331

Publikation: Bidrag til tidsskriftReviewpeer review

Nutrient and food intakes in early life and risk of childhood fractures: a systematic review and meta-analysis

Händel, M. N., Heitmann, B. L. & Abrahamsen, B., nov. 2015, I: The American journal of clinical nutrition. 102, 5, s. 1182-95 14 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The identification of detrimental dietary patterns early in life may contribute to reducing the high incidence of fracture among healthy children. However, information based on a systematic review of the effect of various dietary foods and nutrients on fracture risk is lacking.

OBJECTIVE: We conducted a systematic review and meta-analysis of observational studies that examined the association between dietary intake or serum nutritional concentrations and childhood fractures.

DESIGN: Studies published up until June 2015 were identified on the basis of a literature search in Medline, Web of Science, and Scopus databases and by hand searching references by first author based on predefined inclusion criteria. A meta-analysis was carried out for case-control studies that examined differences in mean calcium intake in the case compared with the control group. Random-effects analysis was performed on the basis of the effect estimates derived as the differences in mean calcium intakes between cases and controls.

RESULTS: From a total of 1960 articles, we identified 18 observational studies, which were primarily case-control in design. Randomized controlled trials were absent, potentially because of unethical aspects related to the enrollment of children randomly assigned to certain dietary exposures and later fracture rates. Overall, fracture risk seemed to be associated with milk avoidance, high energy intake, high cheese intake, high intake of sugar-sweetened beverages, and no breastfeeding. The pooled effect size of the 9 case-control studies that examined mean calcium intake, which had appropriate data for the meta-analysis, showed no association (P = 0.99) with fair heterogeneity (I(2) = 69.3%, P = 0.001) with the use of the random-effects model.

CONCLUSIONS: On the basis of a systematic review of studies that were judged to be of high or medium quality, there is an indication that some nutritional factors seem to be associated with an increased fracture risk among children. The results may be inflated by selection bias, bias in diet reporting, or residual confounding. More high-quality longitudinal observational or intervention studies are needed on the subject.

Originalsprog Engelsk
Tidsskrift The American journal of clinical nutrition
Vol/bind 102
Udgave nummer 5
Sider (fra-til) 1182-95
Antal sider 14
ISSN 0002-9165
DOI
Status Udgivet - nov. 2015

Occupational therapy evaluation: use of self-report and/or observation?

Nielsen, K. T. & Wæhrens, E. E., jan. 2015, I: Scandinavian Journal of Occupational Therapy. 22, 1, s. 13-23 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The Occupational Therapy Intervention Process Model (OTIPM) serves to guide occupational therapists in their professional reasoning. The OTIPM prescribes evaluation of task performance based on both self-report and observation. Although this approach seems ideal, many clinicians raise the issue that time to perform evaluations is limited. It is, therefore, relevant to examine whether similar information concerning task performance can be obtained using self-report or observation.

OBJECTIVE: The aims were to investigate what information can be obtained regarding the quality of ADL task performance based on self-report and observation, respectively, and to examine the relationship between measures of self-reported and observed quality of ADL task performance.

METHODS: The quality of ADL task performance among 20 adults with depression was evaluated using the ADL Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS).

RESULTS AND CONCLUSIONS: Results indicated that participants both reported and demonstrated increased effort and/or fatigue, increased use of time, need for assistance, and safety problems. However, little relationship was found between measures of self-reported and observed quality of ADL task performance, supporting the use of both self-report and observation as part of the evaluation phase outlined in the OTIPM.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 22
Udgave nummer 1
Sider (fra-til) 13-23
Antal sider 11
ISSN 1103-8128
DOI
Status Udgivet - jan. 2015

P2x7 receptors: Role in bone cell formation and function

Agrawal, A. & Gartland, A., 15 jan. 2015, I: Journal of Molecular Endocrinology. 54, 2, s. R75-R88

Publikation: Bidrag til tidsskriftReviewpeer review

PAIN MECHANISMS IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A NATIONWIDE CROSS-SECTIONAL DANBIO REGISTRY SURVEY

Rifbjerg-Madsen, S., Christensen, A. W., Christensen, R., Hetland, M. L., Bliddal, H., Kristensen, L. E., Danneskiold-Samsøe, B. & Amris, K., 2015, I: Annals of the Rheumatic Diseases. 74, Suppl. 2, s. 313 1 s.

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 74
Udgave nummer Suppl. 2
Sider (fra-til) 313
Antal sider 1
ISSN 0003-4967
Status Udgivet - 2015

Pain Sensitisation in Women with Active Rheumatoid Arthritis: A Comparative Cross-Sectional Study

Vladimirova, N., Jespersen, A., Bartels, E. M., Christensen, A. W., Bliddal, H. & Danneskiold-Samsøe, B., 2015, I: Arthritis. 2015, s. 434109

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA (DAS28 > 2.6) and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p < 0.01) and pain tolerance (p < 0.01) than HC. The mean temporal summation- (TS-) index in RA patients was 0.98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (p < 0.01). Conclusion. Patients with active RA showed decreased pressure-pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup of patients may be of importance when considering treatment strategies.

Originalsprog Engelsk
Tidsskrift Arthritis
Vol/bind 2015
Sider (fra-til) 434109
ISSN 2090-1984
DOI
Status Udgivet - 2015

Participants and Non-participants in the Scand-Ankle study - An alcohol cessation intervention at the time of fracture surgery

Aalykke, M., Wernheden, E., Pedersen, B., Egholm, J., Madsen, B., Lauritzen, J. B. & Tønnesen, H., okt. 2015, I: Clinical Health Promotion. 5, 2

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Originalsprog Engelsk
Tidsskrift Clinical Health Promotion
Vol/bind 5
Udgave nummer 2
Status Udgivet - okt. 2015

BACKGROUND: Patients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery. This protocol describes a randomised clinical trial that aims to evaluate the effect of a new gold standard programme for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness.

METHODS/DESIGN: Patients with hazardous alcohol intake undergoing ankle fracture surgery will be recruited into the trial from multiple orthopaedic wards at university hospitals in Denmark, Sweden and Norway. Included patients will be randomly allocated to either standard care or the gold standard programme aimed at complete alcohol abstinence before, during and 6 weeks after surgery. It includes a structured patient education programme and weekly interventions meetings at the orthopaedic outpatient clinic. Furthermore, patients are provided with thiamine and B-vitamins, alcohol withdrawal prophylaxis and treatment, and disulfiram to support abstinence. Alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly intervention meetings and follow-up visits. Follow-up assessments will be conducted 6 weeks and 3, 6, 9 and 12 months after surgery for all patients. The effect of the gold standard programme will be assessed comparing the outcome measures between the intervention and control group at each follow-up point.

DISCUSSION: The study will provide new knowledge about how to prevent alcohol-related postoperative complications at the time of acute fracture surgery. If effective, the results will be a benefit for the clinical course, patients and society alike.

TRIAL REGISTRATION: The protocol is registered in ClinicalTrials.gov (Id: NCT00986791 ).

Originalsprog Engelsk
Tidsskrift B M C Surgery
Vol/bind 15
Sider (fra-til) 52
ISSN 1471-2482
DOI
Status Udgivet - 1 maj 2015

Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence

Thorborg, K., Tijssen, M., Habets, B., Bartels, E. M., Roos, E. M., Kemp, J., Crossley, K. M. & Hölmich, P., jun. 2015, I: British Journal of Sports Medicine. 49, 12, s. 812

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND/AIM: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults.

METHODS: A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO.

RESULTS: Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were identified. Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 were the most thoroughly investigated PROs and studies including these PROs reported key aspects of the COSMIN checklist. HAGOS and IHOT-12 were based on studies with the least ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present.

CONCLUSIONS: HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip arthroscopy. At present, HAGOS is the only PRO also aimed for young-aged to middle-aged adults presenting with groin pain and is recommended for use in this population.

TRIAL REGISTRATION NUMBER: CRD42014009995.

Originalsprog Engelsk
Tidsskrift British Journal of Sports Medicine
Vol/bind 49
Udgave nummer 12
Sider (fra-til) 812
ISSN 0306-3674
DOI
Status Udgivet - jun. 2015

Patients with hidradenitis suppurativa carry a higher systemic inflammatory load than other dermatological patients

Riis, P. T., Søeby, K., Saunte, D. M. & Jemec, G. B. E., dec. 2015, I: Archives of Dermatological Research. 307, 10, s. 885-9 5 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Performance of activities of daily living among hospitalized cancer patients

Lindahl-Jacobsen, L., Hansen, D. G., Wæhrens, E. E., la Cour, K. & Søndergaard, J., mar. 2015, I: Scandinavian Journal of Occupational Therapy. 22, 2, s. 137-46 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data.

METHODS: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55).

RESULTS: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. RESULTS from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments.

CONCLUSION: Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 22
Udgave nummer 2
Sider (fra-til) 137-46
Antal sider 10
ISSN 1103-8128
DOI
Status Udgivet - mar. 2015

Perioperative smoking cessation in vascular surgery: challenges with a randomized controlled trial

Kehlet, M., Heeseman, S., Tønnesen, H. & Schroeder, T. V., 2015, I: Trials. 16, 1, s. 441

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery.

METHODS: A single-blinded randomized clinical trial conducted at two vascular surgery departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According to the power calculation a total of 144 patients were needed in the trial.

RESULTS: Due to slow patient inclusion, the trial was terminated prior to fulfilling the power calculation. Thirty-two patients were included in the trial from March 2011 to September 2012. Of these, 11 were randomized to the GSP intervention and 21 as controls. There was no difference in 30-day complication rates or 6-week abstinence rates between the two groups.

CONCLUSIONS: A trial assessing the effect of smoking cessation on postoperative complications on the day of soft tissue surgery is still needed. If another trial is to be planned it must be more pragmatic with less extended inclusion criteria and conducted nationally or internationally to ensure enough patients for the trial.

TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01469091 ). Registration date: 27 October 2011.

Originalsprog Engelsk
Tidsskrift Trials
Vol/bind 16
Udgave nummer 1
Sider (fra-til) 441
ISSN 1745-6215
DOI
Status Udgivet - 2015

Polymorphisms in the Toll-Like Receptor and the IL-23/IL-17 Pathways Were Associated with Susceptibility to Inflammatory Bowel Disease in a Danish Cohort

Bank, S., Andersen, P. S., Burisch, J., Pedersen, N., Roug, S., Galsgaard, J., Ydegaard Turino, S., Broder Brodersen, J., Rashid, S., Kaiser Rasmussen, B., Avlund, S., Bastholm Olesen, T., Hoffmann, H. J., Andersen Nexø, B., Sode, J., Vogel, U. & Andersen, V., 25 dec. 2015, I: P L o S One. 10, 12, s. e0145302

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), result from the combined effects of susceptibility genes and environmental factors. Previous studies have shown that polymorphisms in the Toll-like receptor (TLR), the apoptosis, the IL-23/IL-17 and the interferon gamma (IFNG) pathways are associated with risk of both CD and UC.

METHODS: Using a candidate gene approach, 21 functional single nucleotide polymorphisms (SNPs) in 15 genes were assessed in a clinical homogeneous group of severely diseased ethnic Danish patients consisting of 624 patients with CD, 411 patients with UC and 795 controls. The results were analysed using logistic regression.

RESULTS: The polymorphisms TLR5 (rs5744174) and IL12B (rs6887695) were associated with risk of CD, and TLR1 (rs4833095) and IL18 (rs187238) were associated with risk of both CD and UC (p<0.05). After Bonferroni correction for multiple testing, the homozygous variant genotype of TLR1 743 T>C (rs4833095) was associated with increased risk CD (OR: 3.15, 95% CI: 1.59-6.26, p = 0.02) and CD and UC combined (OR: 2.96, 95% CI: 1.64-5.32, p = 0.005).

CONCLUSION: Our results suggest that genetically determined high activity of TLR1 and TLR5 was associated with increased risk of both CD and UC and CD, respectively. This supports that the host microbial composition or environmental factors in the gut are involved in risk of IBD. Furthermore, genetically determined high activity of the IL-23/IL-17 pathway was associated with increased risk of CD and UC. Overall, our results support that genetically determined high inflammatory response was associated with increased risk of both CD and UC.

Originalsprog Engelsk
Tidsskrift P L o S One
Vol/bind 10
Udgave nummer 12
Sider (fra-til) e0145302
ISSN 1932-6203
DOI
Status Udgivet - 25 dec. 2015

Postprandial Plasma Concentrations of Individual Bile Acids and FGF19 in Patients with Type 2 Diabetes

Sonne, D. P., Van Nierop, S., Vaz, F. M., Soeters, M. R., Vilsboll, T. & Knop, F. K., jun. 2015, s. A530-A530. 1 s.

Publikation: KonferencebidragKonferenceabstrakt til konferenceForskningpeer review

Power and color Doppler settings for inflammatory flow - impact on scoring of disease activity in patients with rheumatoid arthritis

Torp-Pedersen, S. T., Christensen, R., Szkudlarek, M., Ellegaard, K., D'Agostino, M. A., Iagnocco, A., Naredo, E., Balint, P., Wakefield, R. J., Torp-Pedersen, A. & Terslev, L. 2015 I : Arthritis & Rheumatology. 67, 2, s. 386-95

Publikation: Forskning - peer reviewTidsskriftartikel

Objectives: To determine how settings for power and color Doppler sensitivity varies on different high and intermediate range ultrasound (US) machines and to evaluate the impact of these changes on Doppler scoring of inflammatory joints Methods: Six different types of ultrasound machine were used. On each machine, the factory setting (FS) for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity - study settings (SS). Eleven RA patients with wrist involvement were scanned on the 6 machines each with 4 settings generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity - color fraction (CF) - higher CF indicated higher sensitivity. Results: Power Doppler was more sensitive on half of the machines whereas color Doppler was more sensitive on the other half with both FS and SS. There was an average increase in Doppler sensitivity despite modality of 78% when SS were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, 7 patients varied between grades 0 and 3 with the other 4 patients between grades 0 and 2. Conclusion: The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation in RA patients and this must be taken into account in multi-centre studies. © 2014 American College of Rheumatology.

Originalsprog Engelsk
Tidsskrift Arthritis & Rheumatology
Udgivelsesdato 2015
Vol/bind 67
Tidsskriftsnummer 2
Sider 386-95
ISSN 1537-2960
DOI
Status Udgivet

Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis

Torp-Pedersen, S., Christensen, R., Szkudlarek, M., Ellegaard, K., D'Agostino, M. A., Iagnocco, A., Naredo, E., Balint, P., Wakefield, R. J., Torp-Pedersen, A. & Terslev, L., feb. 2015, I: Arthritis and Rheumatology. 67, 2, s. 386-95 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints.

METHODS: Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity.

RESULTS: Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2.

CONCLUSION: The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation by ultrasound in RA patients, and this must be taken into account in multicenter studies.

Originalsprog Engelsk
Tidsskrift Arthritis and Rheumatology
Vol/bind 67
Udgave nummer 2
Sider (fra-til) 386-95
Antal sider 10
ISSN 2326-5191
DOI
Status Udgivet - feb. 2015

BACKGROUND: Reports vary considerably concerning characteristics of patients who will respond to mobilizing exercises or manipulation. The objective of this prospective cohort study was to identify characteristics of patients with a changeable lumbar condition, i.e. presenting with centralization or peripheralization, that were likely to benefit the most from either the McKenzie method or spinal manipulation.

METHODS: 350 patients with chronic low back pain were randomized to either the McKenzie method or manipulation. The possible effect modifiers were age, severity of leg pain, pain-distribution, nerve root involvement, duration of symptoms, and centralization of symptoms. The primary outcome was the number of patients reporting success at two months follow-up. The values of the dichotomized predictors were tested according to the prespecified analysis plan.

RESULTS: No predictors were found to produce a statistically significant interaction effect. The McKenzie method was superior to manipulation across all subgroups, thus the probability of success was consistently in favor of this treatment independent of predictor observed. When the two strongest predictors, nerve root involvement and peripheralization, were combined, the chance of success was relative risk 10.5 (95% CI 0.71-155.43) for the McKenzie method and 1.23 (95% CI 1.03-1.46) for manipulation (P = 0.11 for interaction effect).

CONCLUSIONS: We did not find any baseline variables which were statistically significant effect modifiers in predicting different response to either McKenzie treatment or spinal manipulation when compared to each other. However, we did identify nerve root involvement and peripheralization to produce differences in response to McKenzie treatment compared to manipulation that appear to be clinically important. These findings need testing in larger studies.

TRIAL REGISTRATION: Clinicaltrials.gov: NCT00939107.

Originalsprog Engelsk
Tidsskrift B M C Musculoskeletal Disorders
Vol/bind 16
Sider (fra-til) 74
ISSN 1471-2474
DOI
Status Udgivet - 2015

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