Selection process for botulinum toxin injections in patients with chronic-stage hemiplegic stroke: a qualitative study.

BACKGROUND: Botulinum toxin (BT) injection is a new treatment for spasticity with hemiplegia after stroke. How a patient decides to receive BT injections after becoming aware of the treatment remains unclear. In this exploratory qualitative study, we aimed to investigate patients' decision-making about treatment strategies in collaboration with family and health professionals and to identify conflicts in patients' feelings about BT treatment. METHODS: The study included six patients with stroke sequelae. Data were collected using comprehensive interviews and were analyzed using the grounded theory approach and trajectory equifinality modeling. RESULTS: After patients learned about BT treatment, they clearly exhibited the following two concurrent perceptions: "the restriction of one's life due to disabilities" and "the ability to do certain things despite one's disabilities." Some patients reported a "fear of not being able to maintain the status quo owing to the side effects of BT." To alleviate this fear, timely support from family members was offered, and patients overcame anxiety through creative thinking. However, there were also expressions that revealed patients' difficulties dealing with negative events. These factors influenced the patients' development of "expectations of BT" or "hesitations about BT." CONCLUSIONS: To establish treatment strategies in collaboration with patients, healthcare professionals should show supportive attitudes and have discussions with patients and their family members to help patients resolve their conflicts and should establish treatment strategies that maintain the positive aspects of patients' lives.

[Effectiveness of Postoperative Physical Therapy for Upper-Limb Impairments after Breast Cancer Treatment].

Previous studies have reported the benefits of beginning rehabilitation immediately after breast cancer surgery for improving motor function. However, most studies have not evaluated the long-term struggles patients face after hospital discharge in resuming their previous activities and socialparticipation. Furthermore, the intervention methods and effects of rehabilitation for such activities have not been evaluated. We investigated the effectiveness of postoperative physical therapy for upperlimb impairments after breast cancer treatment. Fifty-four women in the postoperative period of surgery for breast cancer participated in the study. Range of motion in the ipsilateral shoulder was initially limited after surgery and recovered during the study period: shoulder flexion range of motion reached a mean value from 110 to 155 degrees, mean abduction was from 70 to 110 degrees, and mean externalshoul der rotation was from 69 to 85 degrees. Lymphedema was present in 5 women. In conclusion, physical functional disabilities were present in the late postoperative period for breast cancer survivors, and limited range of motion in their shoulders negatively affected their functional capacity and quality of life. Therefore, we need to increase rehabilitation care after breast cancer surgery immediately.

Conversion to Extension Contracture as a Means of Correction of Severe Flexion Contracture of the PIP Joint Using a Modified Dynamic External Fixator.

Background: This is a retrospective case series investigating the outcomes using a dynamic external fixator (DEF) for treatment on severe flexion contractures at the proximal interphalangeal (PIP) joint. Severe flexion contractures of the PIP joint occurring after multiple operations and neglected over a long period of time are difficult to treat. The recurrence of contracture, even after successful treatment, is inevitable in patients with severe cases. In this study, we defined the severity of PIP joint contracture based on the active range of motion (ROM), soft tissue condition, and duration of the contracture. We also illustrated the strategy, results, and complications of using a DEF with rubber bands in these severe cases. Methods: We studied 11 fingers of 10 patients with PIP joint contracture treated by DEF. These were fixed at a small arc and neglected for an average 4.1 years (range, 1-9 years). The temporal Kirshner wire (K-wire) fixation after achieving an extension via DEF was maintained for 9.1 weeks on average. We retrospectively reviewed the results of these patients with an average 2-year follow-up. Results: Our method yielded favorable results upon retrospective evaluation. The average active ROM of the affected PIP joint improved from 90/96° to 34/83° with a functional arc and good patient satisfaction. The elastic force induced by strong rubber bands was safe and effective. The first step of joint space widening was the key to obtaining a successful joint extension afterwards. Serious progression of osteoarthritis at the PIP joint and pin-site fracture were a complication in each one case. Conclusions: In this study, we evaluate the surgical strategy of using DEFs powered by elastic torque from rubber bands to treat severe cases of flexion contractures of fingers. We first created extension contracture intentionally, followed by promoting flexion movement during follow-up in this group of patients.

Effect of Exercise Training on Body Temperature in the Elderly: A Retrospective Cohort Study.

BACKGROUND: This study evaluated the effect of exercise training on body temperature and clarified the relationship between body temperature and body composition in the elderly. METHODS: In this retrospective cohort study, a total of 91 elderly participants performed aerobic and anaerobic exercise training twice a week for 2 years. Non-contact infrared thermometer and bioelectrical impedance analysis were performed at baseline and at 2 years. RESULTS: Mean age of study participants was 81.0 years. The participants were divided into two groups by baseline body temperature of 36.3 °C; lower body temperature group (n = 67) and normal body temperature group (n = 24). Body temperature rose significantly after exercise training in the lower body temperature group (36.04 ± 0.11 °C to 36.30 ± 0.13 °C, p < 0.0001), whereas there was no significant difference in the normal body temperature group (36.35 ± 0.07 °C to 36.36 ± 0.13 °C, p = 0.39). A positive correlation was observed between the amount of change in body temperature and baseline body temperature (r = -0.68, p < 0.0001). Increase in skeletal muscle mass was an independent variable related to the rise in body temperature by the multivariate logistic regression analysis (odds ratio: 4.77, 95% confidence interval: 1.29-17.70, p = 0.02). CONCLUSIONS: Exercise training raised body temperature in the elderly, especially those with lower baseline body temperature.

Contributors to newly developed coronary artery disease in patients with a previous history of percutaneous coronary intervention beyond the early phase of restenosis.

OBJECTIVE: The low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio is considered to be a sensitive marker of the risk of atherosclerotic cardiovascular disease; however, in patients with a previous history of percutaneous coronary intervention (PCI), there is little information regarding the predictive value of this parameter beyond the period of early restenosis. The aim of this study was to investigate contributing factors to newly developed coronary artery disease in patients with a previous history of PCI after stabilization. METHODS: The clinical characteristics of 238 patients with a previous history of PCI who underwent coronary angiography following recurrent cardiac ischemia beyond the period of early restenosis were examined. RESULTS: Overall, 64% of the patients underwent late revascularization, while 31% and 50% underwent late target lesion revascularization and new lesion revascularization, respectively. A multivariate analysis identified the LDL-C/HDL-C ratio to be an independent contributor to late revascularization (hazard ratio (HR), 1.37; p<0.001). Similarly, the independent contributors to late target lesion revascularization and new lesion revascularization were the non-HDL-C level and LDL-C/HDL-C ratio, respectively. Based on the median value of the LDL-C/HDL-C ratio, the patients were classified into high and low LDL-C/HDL-C ratio groups. The log-rank test revealed a significantly higher incidence of late revascularization in the high-LDL-C/HDL-C ratio group than in the low-LDL-C/HDL-C ratio group among the patients with an LDL-C level of ≥ 100 mg/dL (p=0.011). However, the difference between the two groups was diminished among the patients with an LDL-C level of <100 mg/dL (p=0.047), and only diabetes mellitus (HR, 2.239; p=0.009) was found to be an independent contributor to late coronary revascularization in these patients. CONCLUSION: The LDL-C/HDL-C ratio is an important contributor to the development of new coronary artery disease in patients with a previous history of PCI beyond the period of early restenosis, particularly among patients with an LDL-C level of ≥ 100 mg/dL.

True or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty?

BACKGROUND AND PURPOSE: The associations between leg length discrepancy (LLD) and patient-perceived inequality and functional outcomes after total hip arthroplasty (THA) are unclear in the literature. The aim of this study was to determine the types of LLD after THA and to identify the best predictor of patient-perceived LLD and functional outcome in the short term after THA. METHODS: We subdivided LLD into true and apparent types and prospectively studied 53 consecutive patients undergoing unilateral primary THA to determine whether there is an association between the type of LLD and functional outcome 2 months after the operation. Apparent LLD was measured by the block test and true LLD was measured by hip radiography. We classified the patients into 4 groups: true, apparent, mixed, and no-LLD groups. The questionnaire included a visual analog scale of pain, the Western Ontario and McMaster Universities Osteoarthritis Index, and patient-perceived inequality. Physical performance was measured using walking speed and the Timed Up and Go test. RESULTS: The apparent and mixed LLD groups had a higher prevalence of patient-perceived inequality than the true and no-LLD groups. The results of physical performance showed that the walking speed of the mixed LLD group and the results of the Timed Up and Go Test of the apparent LLD group were significantly slower than those of the true LLD group. DISCUSSION: We suggested that the true LLD group may have a weak relationship with functional outcome after THA while the apparent LLD resulting from pelvic obliquity due to hip contracture or scoliosis is correlated with the short-term functional outcome after THA. CONCLUSION: Apparent LLD can be a better predictor of patient-perceived inequality and physical performance than true LLD.