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In recent years, human activity recognition (HAR) has gained significant interest from researchers in the sports and fitness industries. In this study, the authors have proposed a cascaded method including two classifying stages to classify fitness exercises, utilizing a decision tree as the first stage and a one-dimension convolutional neural network as the second stage. The data acquisition was carried out by five participants performing exercises while wearing an inertial measurement unit sensor attached to a wristband on their wrists. However, only data acquired along the z-axis of the IMU accelerator was used as input to train and test the proposed model, to simplify the model and optimize the training time while still achieving good performance. To examine the efficiency of the proposed method, the authors compared the performance of the cascaded model and the conventional 1D-CNN model. The obtained results showed an overall improvement in the accuracy of exercise classification by the proposed model, which was approximately 92%, compared to 82.4% for the 1D-CNN model. In addition, the authors suggested and evaluated two methods to optimize the clustering outcome of the first stage in the cascaded model. This research demonstrates that the proposed model, with advantages in terms of training time and computational cost, is able to classify fitness workouts with high performance. Therefore, with further development, it can be applied in various real-time HAR applications.
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Corpo Humano , Redes Neurais de Computação , Humanos , Exercício Físico , Atividades Humanas , Árvores de DecisõesRESUMO
Background: Persistent infection rate after 2-stage reimplantation complicating elbow arthroplasty has been reported to be as high as 25%. The purposes of this retrospective study were to determine the infection eradication rates, complications and outcomes in a cohort of patients treated with two-stage reimplantation for deep periprosthetic joint infection (PJI) following total elbow arthroplasty (TEA) and to determine possible associated risk factors for treatment failure. Methods: Between 2000 and 2017, 52 elbows underwent a two-stage reimplantation for PJI after TEA. There were 22 males and 30 females with a mean age of 61 (range, 25-82) years. The most common bacterium was Staphylococcus epidermidis (28 elbows). Mayo Elbow Performance Scores were calculated at the latest follow-up. Mean follow-up time was 6 years (range, 2-14 years). Results: PJI was eradicated in 36 elbows (69%). The remaining 16 elbows were considered treatment failures secondary to recurrent infection. The risk of persistent infection was 3.3 times higher in elbows with retained cement (p 0.04), and 3.5 times higher when the infecting organism was Staphylococcus epidermidis (p 0.06). Conclusion: Two-stage reimplantation for PJI after TEA was successful in eradicating deep infection in 69% of cases. The eradication of PJI after TEA still needs to be improved substantially.
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BACKGROUND: Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development. AIM: The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use. METHODS: Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO. RESULTS: A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory. CONCLUSION: Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young people's developmental opportunities and health outcomes.
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AIMS: The purpose of this study was to report bone adaptive changes after anatomical total shoulder arthroplasty (TSA) using a standard-length hydroxyapatite (HA)-coated humeral component, and to report on a computer-based analysis of radiographs to determine changes in peri-implant bone density objectively. METHODS: A total of 44 TSAs, performed between 2011 and 2014 using a cementless standard-length humeral component proximally coated with HA, were included. There were 23 males and 21 females with a mean age of 65 years (17 to 65). All shoulders had good quality radiographs at six weeks and five years postoperatively. Three observers graded bone adaptive changes. All radiographs were uploaded into a commercially available photographic software program. The grey value density of humeral radiological areas was corrected to the grey value density of the humeral component and compared over time. RESULTS: Stress shielding was graded as mild in 14 shoulders and moderate in three; the greater tuberosity was the predominant site for stress shielding. The mean metaphyseal and diaphyseal fill-fit ratios were 0.56 (SD 0.1) and 0.5 (SD 0.07), respectively. For shoulders with no radiologically visible stress shielding, the mean decrease in grey value in zones 1 and 7 was 20%, compared with 38% in shoulders with radiologically visible stress shielding. CONCLUSION: The rate of moderate stress shielding was 7%, five years after implantation of a cementless standard-length HA-coated humeral component. Clinical observation of stress shielding identified on radiographs seems to represent a decrease in grey value of 25% or more. Cite this article: Bone Joint J 2021;103-B(5):958-963.
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Artroplastia do Ombro/instrumentação , Úmero/cirurgia , Desenho de Prótese , Prótese de Ombro , Adolescente , Adulto , Idoso , Materiais Revestidos Biocompatíveis , Durapatita , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
BACKGROUND: Surgical management of shoulder instability in patients with Ehlers-Danlos syndrome (EDS) remains challenging secondary to the pathologic nature of their connective tissue. Allograft reconstruction of the shoulder capsule in EDS has the potential to increase stability by providing healthier connective tissue. The purpose of this study was to report the surgical technique and outcome of open capsulorraphy and augmentation of the anterior capsule with an Achilles tendon allograft in patients with shoulder instability in the setting of EDS. METHODS: Five shoulders (4 patients) with EDS and severe anteroinferior or multidirectional instability underwent open capsular shift combined with Achilles allograft augmentation of the anterior capsule. Patients were evaluated for pain, motion, recurrent instability, subjective shoulder value, American Shoulder and Elbow Surgeons score, complications, and reoperations. The mean follow-up time was 3.6 years (range, 2-5 years). RESULTS: Shoulder stability was restored in 4 of 5 (80%) shoulders. At the final follow-up, the mean subjective shoulder value and American Shoulder and Elbow Surgeons scores were 84 and 77.3, respectively. One shoulder developed recurrent posterior instability after an injury 1.6 years after the index procedure. The mean pain visual analog scale was 7 preoperatively and 2 at the most recent follow-up. Before surgery, all patients reported the use of narcotic pain medication, whereas at the most recent follow-up, only the one patient who had experienced recurrence reported moderate pain. Except for the shoulder that required revision surgery for posterior shoulder instability, there were no complications or other reoperations. CONCLUSION: Open capsulorraphy with Achilles allograft augmentation improved stability and pain in 4 of 5 shoulders with instability in the setting of EDS. In this small case series of patients with EDS, Achilles tendon allograft augmentation was safe and effective as a primary or revision surgical procedure for anterior shoulder instability. A larger patient cohort with longer follow-up is needed to confirm these findings.
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Tendão do Calcâneo , Síndrome de Ehlers-Danlos , Instabilidade Articular , Articulação do Ombro , Tendão do Calcâneo/cirurgia , Aloenxertos , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/cirurgia , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Estudos Retrospectivos , Ombro , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Progressive glenoid bone loss and humeral head subluxation occur in primary glenohumeral osteoarthritis (GHOA), but less is known about the rate and pattern by which this occurs. The purpose of this study was to determine how glenohumeral subluxation and glenoid bone loss changed over time in shoulders that underwent arthroplasty and had been evaluated with radiographs at 1 or more time points over the 5-15 years before arthroplasty. METHODS: We retrospectively identified 48 shoulders that had been evaluated with high-quality radiographs both before arthroplasty and at least once 5-15 years earlier. Axillary radiographs were used to classify glenoid morphology using the modified Walch classification on the oldest, most recent, and all intervening radiographs. The mean interval time between the oldest and most recent radiographs was 8.9 years (range 5-15 years). Nineteen patients had a single intervening radiograph (mean, 6.7 years from most recent radiograph; range 4.4-8.9 years), 6 patients had 2 (mean, 5.6 years; range 0.2-13.9 years), 3 had 3 (mean, 5 years; range 2.4-8.3 years), 2 had 5 (mean, 3.4 years; range 1.1-5.7 years), and 1 had 6 (0.5 years). RESULTS: Glenoid morphology on the earliest radiograph was classified as A1 in 22, A2 in 13, B1 in 1, B2 in 9, B3 in 1, and D in 2 shoulders. Walch A patterns identified on early radiographs most commonly maintained an A pattern over time, but 20% developed eccentric wear with 5 of 35 becoming B type and 2 of 35 becoming a D type before arthroplasty. All B-type glenoids remained B type. Classic progression of bone loss along the same concentric or eccentric "track" occurred 41% of the time, with 9 of 22 A1 glenoids becoming A2 glenoids, the only B1 glenoid becoming a B2 glenoid, and 56% (5/9) of B2 glenoids becoming B3 glenoids before arthroplasty. Only 15% (2/13) of A2 glenoids developed eccentric wear compared with 32% (7/22) of A1 glenoids. CONCLUSION: In primary GHOA, humeral head subluxation and glenoid bone loss do progress over time, but not universally and not always through the same pathway. Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed. Shoulders presenting with concentric arthritis developed an eccentric pattern 20% of the time. For concentric arthritis, progression of bone loss from A1 to A2 occurred 41% of the time. For eccentric arthritis, progression of bone loss from B2 to B3 occurred 56% of the time.
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Cavidade Glenoide , Osteoartrite , Articulação do Ombro , Cavidade Glenoide/diagnóstico por imagem , Humanos , Cabeça do Úmero/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Estudos Retrospectivos , Escápula , Articulação do Ombro/diagnóstico por imagemRESUMO
INTRODUCTION: Upper extremity lymphedema can complicate mastectomy, lymph node dissection, and radiation. The purpose of this study is to present the outcomes of shoulder arthroplasty in patients with lymphedema. METHODS: The 19 shoulders with a shoulder arthroplasty and lymphedema on the surgical side (6 anatomic, 12 reverse, 1 hemiarthroplasty) were followed for four years (1-10 years). There were 2 males and 17 females; average age was 67.8 (48-86) years. Breast carcinoma was the most common reason for lymphedema (75%). A dedicated lymphedema questionnaire could be completed for 14 shoulders. RESULTS: Pain improved from moderate or severe preoperatively to no or mild in 18 shoulders. Motion improved in elevation (55° preoperatively, 107° at last follow-up), external rotation (14°, 43°), and internal rotation (sacrum, L5). Complications included an acromion stress fracture with a deep infection (1), deep infection (1), superficial infection (1), and glenoid loosening (1). Lymphedema worsened in nine cases, but worsening was permanent in only four. Currently, lymphedema treatment is being performed by 93% of survey respondents. No patients reported lymphangitis or lymphangiosarcoma. CONCLUSION: Shoulder arthroplasty for an upper extremity with lymphedema provides substantial improvements in pain and motion; however, infection is a concerning complication. Fifty percent of the patients will experience worsening of their lymphedema and in 20% worsening may be permanent.
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BACKGROUND: When revision elbow arthroplasty is required in the presence of structural proximal ulnar bone loss and triceps insufficiency, structural ulnar bone-grafting and triceps reconstruction are both required to reconstruct the skeleton and to restore active extension. We have developed a technique utilizing a structural proximal ulnar allograft with its attached triceps as an allograft-prosthetic composite (APC) to provide reconstruction of the proximal ulnar bone and deficient extensor mechanism with the same allograft. METHODS: Between 2010 and 2017, the senior author performed 10 revision elbow arthroplasties using a proximal ulnar allograft with its intact triceps tendon allograft. The allograft ulna was combined with an ulnar component in an APC fashion, whereas the remaining triceps was repaired to the triceps allograft. Indications for a revision surgical procedure included aseptic loosening in 4 elbows, periprosthetic ulnar fracture with component loosening in 2 elbows, and the second stage of a 2-stage reimplantation in 4 elbows. Two elbows also required humeral APCs due to associated structural humeral bone loss. Postoperatively, all elbows were immobilized in extension for 6 weeks. The mean follow-up time was 45 months (range, 24 to 76 months). RESULTS: Revision elbow arthroplasty resulted in pain improvement in all elbows in a 10-point visual analog scale. The mean flexion-extension arc was 95°, the mean Mayo Elbow Performance Score was 76 points (range, 45 to 95 points), and the mean triceps strength score was 4. There were 6 reoperations: 3 for humeral loosening, 1 for deep infection, 1 for fracture of the ulnar allograft, and 1 for wound debridement and closure. For the 8 elbows with an intact ulnar reconstruction, no ulnar components were radiographically loose, and the ulnar graft was considered radiographically intact and healed in 8 elbows. CONCLUSIONS: Reconstruction of the proximal part of the ulna and triceps in failed elbow arthroplasties with structural ulnar bone loss can be effectively accomplished using a structural proximal ulnar allograft as an APC with the preserved triceps tendon for the extensor mechanism reconstruction, but the procedure is associated with an expected high reoperation rate, as is the case in complex revision elbow arthroplasty. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Artroplastia de Substituição do Cotovelo/métodos , Reoperação/métodos , Ulna/transplante , Idoso , Aloenxertos/cirurgia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Despite recent improvements in surgical implants and techniques, distal humerus nonunion does occur between 8% and 25% of the time.Careful identification and improvement of any modifiable risk factors such as smoking, metabolic disorders, immunosuppressant medications, poor nutritional status and infection is mandatory.A recent computed tomography scan is paramount to determine the nonunion pattern, assess residual bone stock, identify previously placed hardware, and determine whether there is evidence of osteoarthritis or malunion of the articular surface.Internal fixation is the treatment of choice in the majority of patients presenting with reasonable bone stock and preserved articular cartilage; total elbow arthroplasty is an appealing alternative for elbows with severe destruction of the articular cartilage or severe bone loss at the articular segment, especially in older, female patients. Internal fixation requires not only achieving a stable fixation, but also releasing associated elbow contractures and the liberal use of bone graft or substitutes.Although reported union rates after internal fixation of distal humerus nonunions are excellent (over 95%), the complication rate remains very high, and unsatisfactory results do occur. Cite this article: EFORT Open Rev 2020;5:289-298. DOI: 10.1302/2058-5241.5.190050.
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BACKGROUND: Glenoid baseplate and glenosphere positioning may affect scapular notching rates. The purpose of this study was to assess various radiographic parameters and correlate them with scapular notching after primary reverse total shoulder arthroplasty (RTSA) at a minimum follow-up time of 5 years. METHODS: The study sample included 147 primary RTSA with good-quality postoperative radiographs at least 5 years after implantation (mean follow-up 6.1 years, range 5-12 years). The center of rotation (COR) of the glenosphere in reference to the bone-baseplate interface was medialized in 71 and lateralized in 76 shoulders, with a varus polyethylene opening angle in 134 shoulders. Preoperative and immediate postoperative radiographs were measured to determine (1) glenoid baseplate inclination: α, ß, and the reverse shoulder arthroplasty (RSA) angles; (2) glenoid component inferiorization-peg glenoid rim distance (PGRD); and (3) sphere bone overhang distance (SBOD). Scapular notching was graded according to the Sirveaux classification. RESULTS: Scapular notching was noted in 98 shoulders (67%) and classified as grade 1 in 46, grade 2 in 25, grade 3 in 20, and grade 4 in 7. There were statistically significant associations between notching and both medialized glenospheres (91% vs. 45%, P = .001) and varus polyethylene angle (P = .0001). The mean postoperative RSA angle, PGRD, and SBOD were 6.6 degrees, 23.8 mm, and +2.6 mm, respectively. Preoperative α and postoperative ß, RSA, PGRD, and SBOD were all associated with notching (P < .05). The rate of reoperation was 2.7% at a minimum of 5 years, with reasons for reoperation related to component failure in only one shoulder. CONCLUSION: Scapular notching correlates with glenoid and baseplate inclination, baseplate inferiorization, inferior glenosphere overhang, glenosphere COR, humeral polyethylene angle, and longer clinical follow-up. SBOD is a clinically useful measurement with decreased values associated with notching. It is the superior measurement in implants with eccentric glenospheres. Moderate or severe notching was seen in only approximately 15% of the shoulders. Revision surgery was extremely low in this cohort, and it was not related to notching or instability.
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BACKGROUND: Preoperative planning software has been developed to measure glenoid version, glenoid inclination, and humeral head subluxation on computed tomography (CT) for shoulder arthroplasty. However, most studies analyzing the effect of glenoid positioning on outcome were done prior to the introduction of planning software. Thus, measurements obtained from the software can only be extrapolated to predict failure provided they are similar to classic measurements. The purpose of this study was to compare measurements obtained using classic manual measuring techniques and measurements generated from automated image analysis software. METHODS: Ninety-five two-dimensional computed tomography scans of shoulders with primary glenohumeral osteoarthritis were measured for version according to Friedman method, inclination according to Maurer method, and subluxation according to Walch method. DICOM files were loaded into an image analysis software (Blueprint, Wright Medical) and the output was compared with values obtained manually using a paired sample t-test. RESULTS: Average manual measurements included 13.8° version, 13.2° inclination, and 56.2% subluxation. Average image analysis software values included 17.4° version (3.5° difference, p < 0.0001), 9.2° inclination (3.9° difference, p < 0.001), and 74.2% for subluxation (18% difference, p < 0.0001). CONCLUSIONS: Glenoid version and inclination values from the software and manual measurement on two-dimensional computed tomography were relatively similar, within approximately 4°. However, subluxation measurements differed by approximately 20%.
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Cells have evolved complex mechanisms to maintain protein homeostasis, such as the UPRER, which are strongly associated with several diseases and the aging process. We performed a whole-genome CRISPR-based knockout (KO) screen to identify genes important for cells to survive ER-based protein misfolding stress. We identified the cell-surface hyaluronidase (HAase), Transmembrane Protein 2 (TMEM2), as a potent modulator of ER stress resistance. The breakdown of the glycosaminoglycan, hyaluronan (HA), by TMEM2 within the extracellular matrix (ECM) altered ER stress resistance independent of canonical UPRER pathways but dependent upon the cell-surface receptor, CD44, a putative HA receptor, and the MAPK cell-signaling components, ERK and p38. Last, and most surprisingly, ectopic expression of human TMEM2 in C. elegans protected animals from ER stress and increased both longevity and pathogen resistance independent of canonical UPRER activation but dependent on the ERK ortholog mpk-1 and the p38 ortholog pmk-1.
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Caenorhabditis elegans/fisiologia , Retículo Endoplasmático/metabolismo , Hialuronoglucosaminidase/metabolismo , Longevidade/fisiologia , Proteínas de Membrana/metabolismo , Resposta a Proteínas não Dobradas , Animais , Caenorhabditis elegans/imunologia , Linhagem Celular , Proliferação de Células , Resistência à Doença , Estresse do Retículo Endoplasmático , Fibroblastos/metabolismo , Humanos , Imunidade Inata , Modelos Biológicos , Peso Molecular , Transdução de SinaisRESUMO
BACKGROUND: The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia. METHODS: This single-center, parallel, unblinded, randomized clinical trial evaluated 129 adults undergoing primary TSA. Patients were allocated to single-injection ISB, continuous ISB, or local infiltration analgesia. The primary outcome was the Overall Benefit of Analgesia Score (range, 0 [best] to 28 [worst]) on postoperative day 1. Additional outcomes included pain scores, opioid consumption, quality of life, and postoperative complications in the first 24 hours, at 3 months, and at 1 year. RESULTS: We analyzed 125 patients (42 with single-injection ISB, 41 with continuous ISB, and 42 with local infiltration analgesia). The Overall Benefit of Analgesia Score was significantly improved in the continuous group (median [25th percentile, 75th percentile], 0 [0, 2]) compared with the single-injection group (2 [1, 4]; P = .002) and local infiltration analgesia group (3 [2, 4]; P < .001). Pain scores were significantly lower in the continuous group compared with the local infiltration analgesia group (P < .001 for all time points) and after 12 hours from ward arrival compared with the single-injection group (median [25th percentile, 75th percentile], 1.0 [0.0, 2.8] vs. 2.5 [0.0, 4.0]; P = .016). After postanesthesia recovery discharge, opioid consumption (oral morphine equivalents) was significantly lower in the continuous group (median [25th percentile, 75th percentile], 7.5 mg [0.0, 25.0 mg]) than in the local infiltration analgesia group (30 mg [15.0, 52.5 mg]; P < .001) and single-injection group (17.6 mg [7.5, 45.5 mg]; P = .010). No differences were found across groups for complications, 3-month outcomes, and 1-year outcomes. CONCLUSION: Continuous ISB provides superior analgesia compared with single-injection ISB and local infiltration analgesia in the first 24 hours after TSA.
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Analgesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Ombro , Bloqueio do Plexo Braquial/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos Opioides/uso terapêutico , Artroplastia do Ombro/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Qualidade de Vida , Fatores de TempoAssuntos
Analgésicos Opioides/uso terapêutico , Anestesia/métodos , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Crônica , Humanos , Estudos Multicêntricos como Assunto , Seleção de Pacientes , Saúde Pública , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Projetos de PesquisaRESUMO
Molecular mechanisms regulating aging at the post-transcriptional level are not clear. In this issue of Molecular Cell,D'Amico et al. (2019) demonstrate that the translational inhibition of mitochondrial fission factor (MFF) regulates cellular homeostasis and aging.
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Dinâmica Mitocondrial , Mitofagia , Longevidade , Proteínas de Membrana , Proteínas Mitocondriais , Proteínas de Ligação a RNARESUMO
BACKGROUND: The sternoclavicular joint may become unstable as a result of trauma or medial clavicle resection for arthritis. Allograft reconstruction with the figure-of-8 configuration is commonly used. This study was conducted to determine the outcome of sternoclavicular joint reconstruction using an alternative graft configuration. METHODS: Between 2005 and 2013, 19 sternoclavicular joint reconstructions were performed using a semitendinous allograft in a sternal docking configuration. The median age at surgery was 44 years (range, 15-79 years). Indications included instability in 16 (anterior, 13; posterior, 3) or medial clavicle resection for osteoarthritis in 3. The median follow-up time was 3 years (range, 1-9 years). RESULTS: Two reconstructions (10.5%) underwent revision surgery, 1 additional patient had occasional subjective instability, and the remaining 16 (84%) were considered stable. Sternoclavicular joint reconstruction led to improved pain (visual analog scale for pain subsided from 5 to 1 point, P < .01), with pain being rated as mild or none for 15 shoulders. At the most recent follow-up, the median 11-item version of the Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 11 (interquartile range [IQR], 0-41) and 88 (IQR, 62-100) respectively. The cosmetic aspect of the shoulder was satisfactory in 16 reconstructions (84%), with a median of 10 points (IQR, 9-10 points) on the visual analog scale for overall satisfaction. CONCLUSION: Reconstruction of the sternoclavicular joint with a semitendinous allograft in a sternal docking fashion restores stability in most patients requiring surgery for instability of the sternoclavicular joint or medial clavicle resection for osteoarthritis.
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INTRODUCTION: Work reintegration constitutes a major milestone in the rehabilitation process of adults who have sustained a burn. Research studies with other conditions demonstrated that open, explicit communication about the worker's condition and potential limitations may facilitate this transition. However, the best approach to enable this discussion to occur has yet to be described. The aim of this exploratory qualitative study was to investigate burn survivors' and clinicians' perspectives of the barriers and facilitators to work reintegration that could be addressed through education of work colleagues, which information to communicate to the workplace and the most effective method to disseminate this knowledge. METHODS: Five semi-structured focus groups were conducted with three groups of informants including: (1) 13 burn survivors who had already returned to work; (2) 7 who were planning on returning; and (3) 9 burn care professionals. Qualitative data were inductively analyzed employing constant comparative techniques. RESULTS: Key barriers and facilitators that were identified included residual impairments, individual characteristics, support from the social environment, work accommodations and resources from the healthcare and compensation systems. Burn survivors agreed that return to work efforts were not adequately supported and that education should be provided to work colleagues about the burn and rehabilitation process, but that information on residual impairments should be communicated judiciously as it may be used prejudiciously against those seeking new employment. In the latter case, it is preferable to inform the workplace of their strengths and abilities. CONCLUSIONS: Extensive literature demonstrating the benefits of educational programs for the peers and teachers of pediatric burn survivors when they return to school already exists. This study provides evidence that there is a need for a similar process for adult burn survivors returning to work. The educational material must be versatile enough so that it can be customized to individual burn survivor's needs and the environments in which they work.