A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial.

OBJECTIVE: Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon. DESIGN: Prospective multi-centre randomised controlled trial. SETTING: Four hand surgery departments in Sweden. SUBJECTS: A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52). INTERVENTION: A smartphone application to facilitate rehabilitation. MAIN OUTCOME MEASURES: Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks. RESULTS: Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8-13.3), 11.8 (CI 11.0-12.8) for the intervention group, and 13.3 (CI 12.6-14.0), 12.8 (CI 12.0-13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9-99.5) compared to the controls 82.9 (CI 76.9-88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction. CONCLUSION: The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed. LEVEL OF EVIDENCE: I. Randomised controlled trial.

Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis.

DESIGN: Cross-sectional clinical measurements. INTRODUCTION: Activity limitation is often persistent after surgically treated carpometacarpal (CMC) joint osteoarthritis (OA). PURPOSE: To describe content and concurrent validity, test-retest reliability and internal consistency of the Swedish version of the Patient Specific Functional Scale (PSFS) in patients with surgically treated CMC joint OA. METHODS: Fifty-eight patients were assessed ten weeks after surgical treatment of CMC joint OA. PSFS, the shorter version of Disabilities of the Arm, Shoulder and Hand (Quick DASH), EuroQol-5Dimensions (EQ-5D), pain intensity, joint movement of CMC joint, grip and pinch strength were assessed. Classification of activities was done according to the International Classification of Functioning, Disability and Health (ICF). Spearman correlation, intra-class correlation coefficient (ICC) and Kappa were calculated to assess validity, test-retest reliability and internal consistency. The PSFS was administered twice, 2-3 days apart. RESULTS: All of the activity limitations stated in the PSFS could be classified according to the activity component in the ICF. Significant correlations for the PSFS were obtained with pain at rest (r(s) = -0.36) and the Quick DASH (r(s) = -0.28). Test-retest reliability was good, ICC (0.79) and the three items of the PSFS correlated 0.69-0.83 with the total score of PSFS. CONCLUSION: Content validity was excellent, concurrent validity was low-moderate, as in earlier studies. The PSFS could be a valuable supplement to existing measures in measuring activity limitations in individuals with surgically treated CMC joint OA. LEVEL OF EVIDENCE: Not applicable.

Dynavisc as an Adhesion Barrier in Finger Phalangeal Plate Fixation-a Prospective Case Series of 8 Patients.

Purpose: Adhesion problems are common after plate fixation of finger phalanges and often lead to stiffness and reoperations with plate removal and tenolysis. The aim of this prospective case series was to study the effect of the adhesion barrier gel Dynavisc on total active motion (TAM), postoperative pain, and grip strength after plate fixation of phalangeal fractures. Total active motion at 3 months after surgery was the primary outcome. Methods: Eight patients with a fracture of the proximal phalanx underwent surgery with open reduction and plate fixation. The adhesion barrier Dynavisc was applied between plate and extensor tendon and between tendon and skin. Results in terms of pain, grip strength, and TAM at 2 weeks, 3 months, and 1 year after surgery were collected. Results on TAM were classified according to Page and Stern. Results: After 3 months, only 2 patients had a result classified as excellent. After 1 year, 3 patients fulfilled the criteria for an excellent result. There were no adverse events. Patients with long-standing postoperative pain had a worse outcome on TAM. Conclusions: The antiadhesive effect of Dynavisc in this prospective case series was unconvincing. Only 2 patients had an excellent result on TAM at 3 months. Because the gel is resorbed within 30 days after application, it is questionable whether the gel had a role in improvement that occurred later in the postoperative course. Larger, randomized studies would be required to show any anti-adherent effect of Dynavisc definitively in finger fracture surgery. Type of study/level of evidence: Therapeutic IV.

Enantioselective synthetic thalidomide receptors based upon DNA binding motifs.

A series of molecularly imprinted polymer (MIP) synthetic receptors selective for the sedative thalidomide (5) have been designed and synthesized based upon the functional monomer 9-(2'-methacryloyloxyethyl)adenine (2). (1)H-NMR studies were used to establish the existence of DNA-like binding interactions between 2 and the template (5). A series of ethylene glycol dimethacrylate cross-linked copolymers was synthesized using either 2 or methacrylic acid, or a combination of these functional monomers. Zonal HPLC studies demonstrated enantioselectivity (alpha = 2.11) and ligand selectivity which could be attributed to the interaction of 2 with the imide moiety of 5. Compound 2 provided a more significant contribution to the binding of 5 than methacrylic acid, though a combination of these two functional monomers resulted in improved enantioselectivity. Frontal chromatographic and batch binding studies confirmed the observed differences in affinity of the imprinted and reference polymers for the template.

Silanized surfaces for in vitro studies of actomyosin function and nanotechnology applications.

We have previously shown that selective heavy meromyosin (HMM) adsorption to predefined regions of nanostructured polymer resist surfaces may be used to produce a nanostructured in vitro motility assay. However, actomyosin function was of lower quality than on conventional nitrocellulose films. We have therefore studied actomyosin function on differently derivatized glass surfaces with the aim to find a substitute for the polymer resists. We have found that surfaces derivatized with trimethylchlorosilane (TMCS) were superior to all other surfaces tested, including nitrocellulose. High-quality actin filament motility was observed up to 6 days after incubation with HMM and the fraction of motile actin filaments and the velocity of smooth sliding were generally higher on TMCS than on nitrocellulose. The actomyosin function on TMCS-derivatized glass and nitrocellulose is considered in relation to roughness and hydrophobicity of these surfaces. The results suggest that TMCS is an ideal substitute for polymer resists in the nanostructured in vitro motility assay. Furthermore, TMCS derivatized glass also seems to offer several advantages over nitrocellulose for HMM adsorption in the ordinary in vitro motility assay.