Exploring use of activity monitors for patients with obesity during weight-loss treatment - a qualitative study.

BACKGROUND: Obesity is a major health concern in western countries. In Norway, patients with obesity can attend weight-loss programmes, which focus on changes in dietary and physical activity habits. Use of self-monitoring is advocated when changing dietary and physical activity habits for adults with obesity. This study aimed to explore the experiences of patients with obesity who used activity monitors while attending a weight-loss programme. METHODS: Patients with body mass index (BMI) > 35 kg/m2 with weight related comorbidities or a BMI > 40 kg/m2 referred to an intermittent weight-loss programme were recruited into this study. They were introduced to one of three different activity monitors, Fitbit Zip™, Mio Fuse™, or Mio Slice™. Semi-structured interviews were performed with patients six months into the weight-loss programme. Thematic analysis was applied when analysing the data. RESULTS: Of the 29 informants (aged 21 to 66 years) interviewed, 59% were female. Their experience with activity monitors was related to their adherence to the weight-loss programme. Two main themes emerged from the informants stories: 1. "Activity monitors visualize proof of effort or failure to change health habits". 2. "Activity monitors act as a positive or negative enforcer when incorporating change". CONCLUSIONS: Using activity monitors either strengthens or undermines patients' attempts to change health habits when attending a weight-loss program. Our findings suggest a need for more individualized weight-loss programmes for patients with obesity.

Atypical hip pain origin in a young athletic woman: a case report of giant cell carcinoma.

Primary bone tumors are infrequently encountered in a sports medicine practice. We describe a case in which a young athletic woman with a medical history significant for ulcerative colitis initially presented to our clinic with chronic hip pain. Her initial roentograms were negative for boney pathology and her history and examination were consistent with trochanteric bursitis. However, follow-up radiographs performed 9 months later showed a radiolucent mass that eventually, after open biopsy and histologic evaluation, was determined to be giant cell tumor. This case shows the importance of repeat radiographic studies in patients whose joint pain does not respond or responds slowly to conservative therapy, despite initial normal findings. It also establishes that radiographic findings do not always correlate with actual disease process, for this lesion was found to be giant cell carcinoma--a diagnosis contrary to the original diagnosis of clear cell chondrosarcoma that was suggested by radiology.

Persistent hiccup associated with thoracic epidural injection.

Epidural steroid injections are commonly used to treat lumbosacral radicular and discogenic pain. When used in this manner, these agents can cause minor, transient systemic side effects and rarely result in any serious complications. Because adverse reactions are uncommon and transient, epidural injections are considered a safe therapeutic intervention. We describe the first case of persistent hiccups as a consequence of a thoracic epidural steroid injection in a patient with thoracic discogenic pain.

Nonoperative treatment of an interosseous ganglion cyst.

Ganglion cysts of the knee are being reported more frequently secondary to an increased rate of magnetic resonance imaging studies. Although knee pain is the impetus for imaging, ganglion cysts are often incidental findings. Nonoperative treatment is a successful therapeutic option. We report a patient with variable pain presentations over the course of her treatment. The pattern of complaints pointed to different primary etiologies about the knee, but all were common to an interosseous ganglion cyst. A stepwise assessment and expansion of the differential diagnosis allowed for appropriate utilization of modalities and limited morbidity with nonoperative therapy.

Scapular instability. The scapulothoracic joint.

Scapular instability may be the result of a variety of casues of which the clinician should be made aware. Work-up should include an initial radiographic evaluation and may require more in-depth investigation. Treatment should be prescribed dependent on the underlying diagnosis. In most cases, instability about the scapula can be treated with a careful plan of exercises to strengthen the involved musculature. It may take upwards of 12 to 18 months to achieve adequate results. Nonoperative failures may need to be treated with surgical techniques including nerve dissection and reconstruction with muscle flaps.

An unusual case of shoulder pain.

Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain.

Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome.

The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations.

Musculoskeletal rehabilitation and sports medicine. 2. Shoulder and upper extremity injuries.

This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of shoulder and upper extremity injuries commonly occurring from athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.

Musculoskeletal rehabilitation and sports medicine. 3. Knee and lower extremity injuries.

This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of knee and lower extremity injuries that commonly occur during athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.