Chair based exercise in community settings: a cluster randomised feasibility study.

BACKGROUND: Some older people who find standard exercise programmes too strenuous may be encouraged to exercise while remaining seated - chair based exercises (CBE). We previously developed a consensus CBE programme (CCBE) following a modified Delphi process. We firstly needed to test the feasibility and acceptability of this treatment approach and explore how best to evaluate it before undertaking a definitive trial. METHODS: A feasibility study with a cluster randomised controlled trial component was undertaken to 1. Examine the acceptability, feasibility and tolerability of the intervention and 2. Assess the feasibility of running a trial across 12 community settings (4 day centres, 4 care homes, 4 community groups). Centres were randomised to either CCBE, group reminiscence or usual care. Outcomes were collected to assess the feasibility of the trial parameters: level of recruitment interest and eligibility, randomisation, adverse events, retention, completion of health outcomes, missing data and delivery of the CCBE. Semi- structured interviews were conducted with participants and care staff following the intervention to explore acceptability. RESULTS: 48% (89 out of 184 contacted) of eligible centres were interested in participating with 12 recruited purposively. 73% (94) of the 128 older people screened consented to take part with 83 older people then randomised following mobility testing. Recruitment required greater staffing levels and resources due to 49% of participants requiring a consultee declaration. There was a high dropout rate (40%) primarily due to participants no longer attending the centres. The CCBE intervention was delivered once a week in day centres and community groups and twice a week in care homes. Older people and care staff found the CCBE intervention largely acceptable. CONCLUSION: There was a good level of interest from centres and older people and the CCBE intervention was largely welcomed. The trial design and governance procedures would need to be revised to maximise recruitment and retention. If the motivation for a future trial is physical health then this study has identified that further work to develop the CCBE delivery model is warranted to ensure it can be delivered at a frequency to elicit physiological change. If the motivation for a future trial is psychological outcomes then this study has identified that the current delivery model is feasible. TRIAL REGISTRATION: ISRCTN27271501 . Date registered: 30/01/2018.

The centralization phenomenon. Its usefulness as a predictor or outcome in conservative treatment of chronic law back pain (a pilot study).

STUDY DESIGN: Two-hundred-forty-three patients with chronic low back pain were studied in a prospective comparative survey to determine whether the "centralization phenomenon" was associated with outcome after an interdisciplinary work-hardening program. OBJECTIVE: The hypothesis was that patients who demonstrated centralization during initial mechanical assessment would have better outcomes than noncentralizers. SUMMARY OF BACKGROUND DATA: Overall, subjects had decreased pain intensity ratings (mean 20%), increased lifting ability (6-8 kg), and a 59.2% return-to-work rate at a mean of 9.7 months follow-up. METHODS: Patients were classified as either centralizers or noncentralizers, based on results of their initial assessment. Changes in pain ratings, one-time maximal weights lifted, Oswestry scores, and return-to-work status were compared between groups. RESULTS: The centralizers reported significant decreases in their maximum pain ratings (centralizers, 16%; noncentralizers, 6%) and had a higher return-to-work rate (centralizers, 68%; noncentralizers, 52%) than the noncentralizers. CONCLUSION: Centralization can help identify sub-groups within the population with chronic low back pain and could be a useful goal setting and case management tool in the rehabilitation of low back pain.

Renal extracorporeal shock wave lithotripsy performed in patient with implantable cardioverter defibrillator.

The effect of extracorporeal shock wave lithotripsy on the automatic implantable cardioverter defibrillator is unknown. To evaluate what effect might occur, a non-implanted automatic implantable cardioverter defibrillator was subjected to a full course of extracorporeal shock wave lithotripsy while inactive. Bench testing by the manufacturer after lithotripsy demonstrated normal function of the device. A patient with an automatic implanted cardioverter defibrillator who required contralateral extracorporeal shock wave lithotripsy then underwent this procedure. The right renal calculus was destroyed successfully with no apparent damage to the automatic implantable cardioverter defibrillator. A test of the automatic implantable cardioverter defibrillator after lithotripsy demonstrated normal sensing and conversion of induced ventricular tachycardia.

Femoropopliteal stent placement: long-term results.

Twenty-one patients who underwent percutaneous transluminal angioplasty (PTA) followed by attempted insertion of a self-expandable vascular endoprosthesis for femoropopliteal lesions were prospectively followed up for an average of 17.6 months with angiographic, Doppler ultrasound, and clinical examinations. Stents were placed bilaterally in one patient. Of the 22 lesions, 18 were total occlusions and four, stenoses. Stent placement was successful in 21 of 22 lesions. Nine occlusions occurred: four in the first 30 days and five 1-5 months after PTA. Three patients developed intrastent intimal hyperplasia that necessitated an additional percutaneous procedure. At 12 months, the patency rate without other interventions (the primary patency rate) was 49%. In patients who underwent secondary intervention (fibrinolysis, atherectomy, or PTA), the secondary patency rate was 67%, which fell to 56% after 18 months. At the end of the study, the overall rate of reocclusion was 43%. It is concluded that use of the self-expandable vascular endoprosthesis in the femoropopliteal region likely does not decrease the reocclusion rate after PTA alone. Its use is indicated for treatment of acute closures after femoropopliteal PTA.

Outcome of percutaneous intervention in iliac artery stents.

PURPOSE: To assess the safety and efficacy of secondary procedures in iliac artery stents. MATERIALS AND METHODS: Thirty-four patients (36 limbs) underwent one or more interventional procedures in iliac artery stents to treat restenosis (n = 30) or occlusion (n = 6). All patients were followed up by means of clinical and angiographic examination. Primary and secondary patency were assessed with angiography, duplex ultrasound, or both. Primary patency was determined after one interventional procedure, and secondary patency was determined at the end of the study (mean +/- standard deviation, 20.1 months +/- 17.5; range, 1-58 months). RESULTS: Immediate angiographic success was achieved in all cases. Four complications were observed. The primary and secondary cumulative patency rates were 77.5% +/- 7.6 and 94% +/- 4.1 at 6 months, 73% +/- 8.4 and 89.3% +/- 6 at 12 months, and 51.4% +/- 10.9 and 78.8% +/- 8.8 at 2 years. At the end of the study, 80% of the arteries were still nominally patent. CONCLUSION: Restenosis and chronic occlusion in iliac artery stents can be treated with percutaneous interventional procedures; however, stenosis can still recur.

Strecker stent implantation in iliac arteries: patency and predictive factors for long-term success.

PURPOSE: To evaluate Strecker stent implantation in iliac arteries. MATERIALS AND METHODS: Sixty-four iliac arteries with Strecker stents were prospectively studied. Stents were placed for dissection (n = 31), total occlusion (n = 28), unsatisfactory results (n = 3) or restenosis (n = 1) after percutaneous transluminal angioplasty, and a calcified atherosclerotic lesion that bulged into the lumen (n = 1). RESULTS: Stent placement was successful in 63 arteries (98%). The overall complication rate was 12% (n = 8). During follow-up, three patients died. The stent was compromised in 18 cases because of hyperplasia (n = 10) or occlusion (n = 8). The primary patency rate was 84% at 1 year and 69% at 2 years; the secondary patency rate was 90% at 1 year and 81% at 2 years. Initial dissection (P = .046), a length of 60 mm or less for the stent region (P = .007), and total covering of the abnormal segment with the stent (P = .03) were significant predictive factors for good, long-term results. CONCLUSION: Use of the Strecker endoprosthesis appears useful but not ideal. Determination of predictive factors for long-term success may help identify indications for its use.

Self-expandable stents for the treatment of iliac artery obstructive lesions: long-term success and prognostic factors.

OBJECTIVE: The purpose of our study was to report long-term (more than 2 years of follow-up) angiographic patency after self-expandable stent implantation in the iliac artery and to identify patient- or procedure-related prognostic factors of angiographic patency. SUBJECTS AND METHODS: Ninety-five consecutive patients (101 arteries) underwent Wallstent implantation to treat claudication (n=95 limbs), rest pain (n=2), and nonhealing ulcer (n=3). Another patient was asymptomatic but was treated for acute occlusion of the iliac artery after coronary angioplasty. After implantation of self-expandable stents, we followed up by examining clinical and angiographic records at 6 months, 1 year, and annually thereafter. The Kaplan-Meier survival curve was used to determine primary and secondary patency rates. Primary patency was that achieved after the initial procedure only. Secondary patency was defined as that achieved after one or more successful additional percutaneous procedures within the stent or beyond the stent. Multivariate analysis using the Cox proportional hazard model was performed to identify predictive factors of angiographic failure, defined as restenosis of 50% or greater or occlusion. RESULTS: Four-year patency rates of 61% (primary) and 86% (secondary) were found (mean follow-up, 29 months). The following five factors were associated with long-term angiographic failure: occlusion of the superficial femoral artery (relative hazard = 5.21), absence of hypertension (relative hazard = 4.85), a stent diameter of less than 8 mm (relative hazard = 4.45), two or more stents implanted (relative hazard = 3.56), and current tobacco consumption (relative hazard = 2.46). CONCLUSION: Improved patency rates may be obtained by selecting patients for Wallstent implantation in the iliac artery based on five factors shown to be prognostically important.

Percutaneous iliac artery stent: angiographic long-term follow-up.

The authors conducted a prospective study of 49 consecutive patients with 53 lesions in 52 iliac arteries. All were treated between October 1987 and April 1990 with percutaneous transluminal angioplasty (PTA) and insertion of either a self-expandable or balloon-expandable stent. Lesions included total occlusion (28%), dissection (42%), post-PTA restenosis (21%), and unsatisfactory PTA (9%). Complications included one aortic protrusion, one acute thrombosis of the stent (resolved with urokinase), and three distal embolizations (5.7%) (resolved with urokinase and aspiration). During 15 months of follow-up, two patients died (one after occlusion). Three other occlusions occurred; one of these was resolved with local thrombolysis. Hyperplasia occurred in seven cases (13.5%), and stenosis occurred at the end of the stent because of incomplete covering of the lesion in three (5.8%); a complementary procedure was performed in six of these cases. Primary patency was 85.3% at 12 months and 80.9% at 18 months; secondary patency rate was 96.1% at 12 and at 18 months. At the end of the study, excluding data for the two patients who died, 27 limbs (54%) were asymptomatic and improvement was achieved in 19 (38%); the clinical success rate was 92%. No amputations were required.

Infrarenal aortic stents: initial clinical experience and angiographic follow-up.

From March 1990 to May 1991, arterial stents were placed in seven patients because of a tight stenosis (five patients) or a total chronic occlusion (two patients) located in the infrarenal aorta. In one case, the aortic occlusion extended to both common iliac arteries. After balloon dilatation, aortic stents were successfully positioned in all cases. Bilateral common iliac recanalization and stent placement were performed in one case. No complications occurred in any of the patients. No complications occurred in any of the patients. Follow-up data were derived from clinical assessments and angiographic results. After a 15.1-month mean follow-up period (range 12-24 months), the seven aortic stents remained patent. Three iliac artery procedures were performed in two of the patients as well. Claudication recurred in three of the seven patients which was related to a common iliac occlusion (one case) or distal progression of atherosclerosis (two cases). Aortic stents seem to be suitable for treating failed angioplasty of aortic lesions but the procedure remains technically difficult when there is associated severe atherosclerosis of the proximal common iliac arteries. Nevertheless, considering the morbidity rate (0%) and the patency rate in this series, this technique could become an alternative to surgical treatment for infrarenal aortic occlusive lesions.