Assessment of the relationship between rectus femoris cross-sectional area and knee extension strength in the prosthesis users with transtibial amputation: A case-control study.

Objectives: This study aims to investigate cross-sectional area of the amputated-limb rectus femoris compared to the intact-limb and controls and to determine its correlation with functional strength and walking tests in prosthesis users with transtibial amputation. Patients and methods: Between October 2018 and April 2019, a total of 14 prosthesis users (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) who met the inclusion criteria, and 14 age-, sex-, and dominancy-matched able-bodied controls (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) were included in this case-control study. Cross-sectional area of rectus femoris (CSA-RF) was evaluated bilaterally by two independent examiners. Knee extension strength was measured bilaterally by using a handheld dynamometer. Functional strength and walking were assessed by Step-Up-Over and Walk-Across tests of the NeuroCom Balance Master® device. Results: The CSA-RF was found to be reduced in amputated-limb compared to the intact-limb and able-bodied controls (p<0.01). In the prosthesis users, the cross-sectional area difference between both limbs rectus femoris muscles was shown to be correlated with actual and functional knee extension strength, step length, and walking speed (p<0.05). Intra- and inter-observer reliability of CSA-RF on both sides were found to be good to excellent (intraclass correlation coefficient: 0.856-0.936). Conclusion: Ultrasonographic measurement of CSA-RF is a valid and reliable tool to assess the functional strength and walking in the prosthesis users with unilateral transtibial amputation.

The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy.

Paravertebral muscles are affected in spondyloarthritis. Decreased mobility of spine may lead to atrophy and fatty degeneration of these muscles. The objective of this study was to compare the sonographic, electrophysiological and magnetic resonance imaging (MRI) features of paraspinal muscles between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). The patients who were diagnosed as AS with modified New York criteria and those as nr-axSpA with ASAS 2009 criteria were enrolled. Clinical evaluation, electrophysiological examination including nerve conduction studies and needle electromyography (EMG) for lower extremities and paraspinal mapping (PSM) were performed by the first examiner. The second examiner measured lumbar multifidus areas, graded the fatty degeneration of the muscle at different levels in T2 weighted axial MRI and also performed the ultrasonographic evaluation. A total of 19 patients with AS and 14 patients with nr-axSpA were evaluated. MRI of 2 patients with AS could not be obtained. Right lumbar multifidus area/vertebra area (MV ratio) was smaller in AS patients at L3 level (p 0,029); there were no significant differences in other levels. Fatty degeneration was also higher in AS patients in left multifidus at L5-S1 disc level (p 0,015). PSM scores that demonstrate the extent of denervation in paraspinal muscles were significantly higher in AS patients than in nr-axSpA patients (p < 0,001). Patients with AS have more fatty degeneration and denervation in paraspinal muscles. These processes may also contribute the severity of pain and disability. The relationship between paraspinal muscle denervation and progression of fatty degeneration should further be revealed.

Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?: Endorsed by the European Association of Preventive Cardiology.

AIMS: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries. METHODS: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using global burden of disease study ischaemic heart disease incidence estimates. Four high-income countries were selected for comparison (N = 790 programmes) to European data, and multilevel analyses were performed. RESULTS: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8% country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey. Programme volumes (median 300) were greatest in western European countries, but overall were higher than in other high-income countries (P < 0.001). Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programmes were funded by social security (n = 25, 59.5%; with significant regional variation, P < 0.001), but in 72 (16.0%) patients paid some or all of the programme costs (or ∼18.5% of the ∼€150.0/programme) out of pocket. Guideline-indicated conditions were accepted in 70% or more of programmes (lower for stable coronary disease), with no regional variation. Programmes had a multidisciplinary team of 6.5 ± 3.0 staff (number and type varied regionally; and European programmes had more staff than other high-income countries), offering 8.5 ± 1.5/10 core components (consistent with other high-income countries) over 24.8 ± 26.0 hours (regional differences, P < 0.05). CONCLUSION: European cardiac rehabilitation capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.

Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study.

OBJECTIVE: To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. METHODS: Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. RESULTS: Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. CONCLUSION: The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.