Clinical measurement of the dart throwing motion of the wrist: variability, accuracy and correction.

Despite being functionally important, the dart throwing motion is difficult to assess accurately through goniometry. The objectives of this study were to describe a method for reliably quantifying the dart throwing motion using goniometric measurements within a healthy population. Wrist kinematics of 24 healthy participants were assessed using goniometry and optical motion tracking. Three wrist angles were measured at the starting and ending points of the motion: flexion-extension, radial-ulnar deviation and dart throwing motion angle. The orientation of the dart throwing motion plane relative to the flexion-extension axis ranged between 28° and 57° among the tested population. Plane orientations derived from optical motion capture differed from those calculated through goniometry by 25°. An equation to correct the estimation of the plane from goniometry measurements was derived. This was applied and differences in the orientation of the plane were reduced to non-significant levels, enabling the dart throwing motion to be measured using goniometry alone.

Total hip arthroplasty with the MS-30 polished surface cemented stem: a single surgeon consecutive series study at 10 year follow-up.

The Morscher-Sportorno femoral stem is a stainless steel, straight, three-dimensionally tapered, collarless implant for cemented fixation in total hip replacement. The clinical and radiographic results of this implant at a minimum of 5-year follow-up have been extremely encouraging. However, the results at 10 years have yet to be reported. Therefore, we wished to establish the clinical performance and survival of the polished surface MS-30 femoral stem at a minimum of 10-year follow-up. We report the results at a minimum follow-up of 10 years of a single surgeon series of 55 total hip replacements with the polished surface MS-30 cemented femoral component in 48 consecutive patients aged between 50 and 64. The median period of observation was 12 years (inter-quartile range, 10-13). Six patients died with their implant in situ, and one patient was unable to attend for follow-up. All the remaining 41 patients with 47 total hip replacements were reviewed. All patients were assessed clinically with the use of the Oxford hip score, and radiographs taken at the latest follow-up were evaluated by an independent specialist hip surgeon. To date, none of the implants have been revised. The median Oxford hip score was 13 (inter-quartile range, 12-14). Radiologically, no stems had evidence of loosening on assessment by the Harris criteria, and only 4 hips (8.5 %) had osteolysis adjacent to the stem, mostly in Gruen zone 7. The results of the polished surface MS-30 femoral stem were satisfactory with survivorship at a minimum of 10 years of 100 %. These findings support the continued use of this femoral component.

Determinants of caregiving burden and quality of life in caregivers of stroke patients.

BACKGROUND AND PURPOSE: A large proportion of disabled stroke survivors live at home and are supported by informal caregivers. Identification of determinants of caregiver burden will help to target caregiver interventions. METHODS: Data on patient, caregiver, and health and social support characteristics were collected prospectively over 1 year in 232 stroke survivors in a randomized trial of caregiver training. The contribution of these variables to caregiver burden score (CBS) and quality of life (QOL) measures at 3 months and 1 year was analyzed using regression models. RESULTS: Stroke patients had a mean age of 74+/-11 years, and 120 (52%) were men. The mean age of caregivers was 65.7+/-12.5 years, 149 (64%) were females, and 116 (50%) had received caregiver training. The mean CBS was 48+/-13 and 38+/-11 (score range of bad to good 88 to 22) and QOL score was 75+/-16 and 75+/-15 (score range of bad to good 0 to 100) at 3 months and 1 year, respectively. CBS and QOL correlated with each other and with patient (age, dependency, and mood), caregiver (age, gender, mood, and training), and support (social services and family networks) variables. Of these, only patient and caregiver emotional status, caregiver age and gender, and participation in caregiver training were independent predictors of either outcome at 3 months. Patient dependency and family support were additional independent predictors at 1 year. Social services support predicted institutionalization but not caregiver outcomes. CONCLUSIONS: Advancing age and anxiety in patients and caregivers, high dependency, and poor family support identify caregivers at risk of adverse outcomes, which may be reduced by caregiver training.