Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study.

BACKGROUND: Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. OBJECTIVE: This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. METHODS: The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. RESULTS: A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group. CONCLUSIONS: The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources. TRIAL REGISTRATION: ClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252.

Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study.

BACKGROUND: The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. OBJECTIVE: The aim of this study was to assess the feasibility of a novel artificial intelligence-powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. METHODS: This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). RESULTS: A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of -4.79 seconds (95% CI -7.24 to -1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. CONCLUSIONS: This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. TRIAL REGISTRATION: ClinicalTrials.gov NCT03045549; https://clinicaltrials.gov/ct2/show/NCT03045549.

Home-based Rehabilitation With A Novel Digital Biofeedback System versus Conventional In-person Rehabilitation after Total Knee Replacement: a feasibility study.

In-person home-based rehabilitation and telerehabilitation can be as effective as clinic-based rehabilitation after total knee arthroplasty (TKA), but require heavy logistics and are highly dependent on human supervision. New technologies that allow independent home-based rehabilitation without constant human supervision may help solve this problem. This was a single-center, feasibility study comparing a digital biofeedback system that meets these needs against conventional in-person home-based rehabilitation after TKA over an 8-week program. Primary outcome was the change in the Timed Up and Go score between the end of the program and baseline. Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation). The study demonstrated a superiority of the experimental group for all outcomes. Adverse events were similar in both groups. This is the first study to demonstrate that a digital rehabilitation solution can achieve better outcomes than conventional in-person rehabilitation, while less demanding in terms of human resources.

Effects of prefrontal anodal transcranial direct current stimulation on working-memory and reaction time.

Transcranial direct current stimulation (tDCS) has proven to be a useful tool in the scientific research community, particularly for clinical investigation purposes. Neuroimaging studies indicate that there is a connection between the prefrontal cortex (PFC) and working memory (WM), as well as between the primary motor cortex and reaction time (RT). Thus, our goal was to evaluate the effect of anodal stimulation of the PFC, with respect to WM and RT. We tested 20 healthy subjects randomized into two groups - half received active stimulation and the other half sham stimulation. Participants underwent two stimulation sessions of 10 minutes each, separated by a 10-minute interval for rest. The task was performed during the stimulation periods, and consisted in the display of a list of words for the subject to read and memorize. Afterwards, a new list was shown and the subject was asked to to press a key when a repeated word appeared. A current of 1 mA was delivered via a foc.us gamer headset. After both stimulations, the participants answered an Adverse Effects Questionnaire. Statistical tests were performed to compare the accuracy, error rate, and reaction time values for active vs. sham and first vs. second stimulations. The results obtained led us to infer that there were no significant improvements in the performance of the active group in comparison with the sham group, in terms of WM and overall RT values. However, RT data analysis indicated that active simulation subjects showed significantly lower values when compared to the sham group, only for the first stimulation period. Due to emerging technological advances, the videogame industry has started to invest in the commercialization of products that promise to enhance neural functions and, thus, improve gamers' performance. The results obtained provide evidence of the importance of testing such commercial devices. The scientific community should have an active role in the validation of these claims.

Making the case for circumcision as a public health strategy: opening the dialogue.

Hispanics in the United States have lower rates of male circumcision and higher rates of HIV. Although MC has been demonstrated to reduce the risk of acquisition of several sexual transmitted diseases such as HIV, human papilloma virus infection, and herpes simplex virus type 2, MC is only medically reimbursable by insurance for adults or children following recurrent infection, injury, or malformation of the penis. We conducted two studies of attitudes regarding MC among health care providers to Hispanic clients at Miami, Florida STD and Prenatal Clinics. This study presents qualitative data drawn from intensive interviews with 21 providers, including a mohel. Qualitative data was analyzed for dominant themes and collapsed into overarching themes. Thirteen themes emerged; acceptability, appearance, circumcision and children, circumcision and HIV, cost, cultural differences, health benefits, knowledge and personal experiences, pain and injury to the penis, perceived HIV risk, religion, sexual performance, and sexual pleasure. Except for the mohel, Hispanic male providers related MC acceptability to American Pediatric Association guidelines, personal circumcision status, and were skeptical regarding health benefits for sexually transmitted disease (STD)/HIV risk reduction. Female providers focused on the financial burden to parents, lack of information, and low acceptability among Hispanic men. This study illustrates the differing attitudes on circumcision held by providers, and suggests that gender, culture, cost, and providers themselves may limit MC acceptability among Hispanic clients. Results suggest that promotion of MC as an HIV risk reduction strategy must begin with the support of medical practitioners to promote the endorsement of MC as a prevention strategy.

Lesiones por la danza en niños / Injuries for the children dance

Mediante un diseño de campo exploratorio descriptivo, utilizando la técnica de muestreo inencional, se realizó una entrevista semiestructurada con preguntas abiertas a 25 alumnos de la Escuela de Ballet "Teresa Carreño", durante el mes de Octubre de 1993. Se obtuvo una distribución por sexo de 92 por ciento hembras y 8 por ciento varones; con un rango de edad entre 9-22 años (prom.: 15,5); que iniciaron entrenamiento entre los 4-7 años de edad. En todos los niveles de entrenamiento predominó el sexo femenino. El mayor número y severidad de lesiones ocurrió en el grupo avanzado con 90 por ciento (principiantes: 0 por ciento; intermedios: 33 por ciento), siendo las lesiones más frecuentes: Esguinces (16 por ciento), Tendinitis (20 por ciento), se registró además 1 fractura por stress (10 por ciento). se estudió además el tratamiento recibido y el profesional consultado en primera instancia. El Ballet es una disciplina artística de altas exigencias físicas y mentales, en la que el médico debe estar familiarizado con las diferentes técnicas de danza y considerar la importancia de la prevención de lesiones