Assessing functional mobility after lower limb reconstruction: a psychometric evaluation of a sensor-based mobility score.

OBJECTIVE: To develop and validate a robust, objective mobility assessment tool, Hamlyn Mobility Score (HMS), using a wearable motion sensor. BACKGROUND: Advances in reconstructive techniques allow more limbs to be salvaged. However, evidence demonstrating superior long-term outcomes compared with amputation is unavailable. Lack of access to quality regular functional mobility status may be preventing patients and health care staff from optimizing rehabilitation programs and evaluating the reconstructive services. METHODS: In this prospective cohort study, 20 patients undergoing lower limb reconstruction and 10 age-matched controls were recruited. All subjects completed the HMS activity protocol twice under different instructors at 3 months postoperatively, and again at 6 months, while wearing an ear-worn accelerometer. Demographic and clinical data were also collected including a short-form health survey (SF-36). HMS parameters included standard test metrics and additional kinematic features extracted from accelerometer data. A psychometric evaluation was conducted to ascertain reliability and validity. RESULTS: The HMS demonstrated excellent reliability (intraclass correlation coefficient >0.90, P < 0.001) and internal consistency (Cronbach α = 0.897). Concurrent validity was demonstrated by correlation between HMS and SF-36 scores (Spearman ρ = 0.666, P = 0.005). Significant HMS differences between healthy subjects and patients, stratified according to fracture severity, were shown (Kruskal-Wallis nonparametric 1-way analysis of variance, χ = 21.5, P < 0.001). The HMS was 50% more responsive to change than SF-36 (effect size: 1.49 vs 0.99). CONCLUSIONS: The HMS shows satisfactory reliability and validity and may provide a platform to support adaptable, personalized rehabilitation and enhanced service evaluation to facilitate optimal patient outcomes.

Sports medicine, confidentiality and the press.

OBJECTIVE: To analyse athletes' medical information disclosed by English newspapers. METHODS: Ten daily national newspapers, nine Sunday newspapers and one local newspaper were studied during March 2010 for media releases relating to the medical conditions of athletes. RESULTS: Three hundred and thirty-three newspapers were reviewed revealing 5640 specific bulletins regarding athletes' health. Daily national newspapers averaged 18.72 daily bulletins, Sunday newspapers 11.86 and one local newspaper reviewed 6.07. The frequency with which various sports had their athletes' medical details published was analysed. Football accounted for 83.78%. The information source in 77.32% of articles is not clearly stated. The patient was only responsible in 6.10% of cases, where the source of attribution is clear. CONCLUSIONS: English newspapers are replete with athletes' medical details, with football dominant. A significant risk to clinicians' professional status exists if they collude to release the un-consented confidential medical information to those with no direct involvement in athletes' medical care. Athletes' education as to their rights as patients and to sports medicine professionals as to their obligations are urgently required.

Climate change and pavement burns in the United Kingdom: a case report of two patients.

Pavement burns are more common in locations familiarised with high temperatures and a dry climate zone, but have not previously been reported in temperate climates. We present two cases of patients who suffered pavement burns in the United Kingdom during an unprecedentedly hot day in July 2022. The first case involved a 66-year-old male who suffered partial and full thickness burns requiring excision and skin grafting. The second case involved a 58-year-old female with partial thickness burns also requiring excision and skin grafting. Both patients had pre-existing co-morbidities and their pavement burns were precipitated by heat stroke. Pavement burns represent a mechanism of injury that necessitates increased operative management, length of hospital stay and cost per surface area burned when compared to flame or scald burns (Silver et al., 2015). As a result of global warming, we anticipate extreme heat events, and subsequently pavement burns, to increase in incidence in the United Kingdom. There is opportunity for education of the public and health professionals for prevention.

A method of assessing the severity of cam type femoro-acetabular impingement in three dimensions.

Femoroacetabular impingement is caused by abnormal morphology of either the femur or acetabulum or both. Diagnostic criteria currently include an alpha angle of over 50° on a lateral radiograph. In this study, CT scans of symptomatic hips (n = 37) were compared with normal hips (n = 34) obtained from CT colonoscopy procedures. The femoral head described in terms of a three dimensional (3D) alpha angle and a 3D head neck margin (epiphysis) angle '3Dµ' using a semi-automated algorithm. In normal hips 70% have a maximum 3Dα angle of more than 50° at some point around their femoral head (mean 53° ± 5°, range 42° - 64°), while in cam hips, it was significantly larger (mean 69° ± 10°, range 54° - 94°, p<0.001). The 3Dµ also varied significantly and had a reverse relationship to that of the alpha angle: cam hips have an articular extent that crossed over spherical limit of the hip joint (mean minimum 41° ± 7°) while the articular margin of normal hips always remained within the spherical limit (mean minimum 49° ± 6°). This semi-automated algorithm provides an objective measure of the femoral head in health and disease. It can reliably distinguish cam hips from normal, enabling cam hips to have their cam quantified and their surgery planned objectively.