Is there a difference in physical activity levels in patients before and up to one year after unilateral total hip replacement? A systematic review and meta-analysis.

OBJECTIVE: To determine the difference in physical activity levels before and up to one year after unilateral primary total hip replacement. DATA SOURCES: A search was performed on 13 July 2016. Studies were eligible for inclusion if they presented preoperative and up to one year postoperative measures of physical activity for patients who had undergone unilateral primary total hip replacement. REVIEW METHODS: Any article that used a measure of physical activity pre and up to one year post-unilateral primary total hip replacement. Data was synthesised using a meta-analysis with 95% confidence intervals (CI), if appropriate. The Critical Appraisal Skills Programme cohort study checklist was used to assess the quality of evidence. RESULTS: From 6024 citations, 17 studies were selected: Nine studies were analysed in a meta-analysis and eight studies were analysed qualitatively. The quality of the evidence was 'low' to 'moderate'. There was no statistically significant difference in physical activity pre- to post-total hip replacement when assessed using: movement-related activity (mean difference (MD): -0.08; 95% CI: 1.60, 1.44; I2 = 0%; n = 77), percentage of 24-hours spent walking (MD: -0.21; 95% CI: -1.36, 0.93; I2 = 12%; n = 65), 6-minute walk test (MD: -60.85; 95% CI: -122.41, 0.72; I2 = 84%; n = 113) or the cardiopulmonary exercise test (MD: -0.24; 95% CI: -1.36, 0.87; I2 = 0%; n = 76). CONCLUSION: There is no statistically significant difference in physical activity levels before and up to one year after unilateral primary total hip replacement. However, the low to moderate methodological quality of the included articles should be taken into consideration when drawing conclusions.

Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography.

This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies. A systematic review of the published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases (WHO International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, NIHR Clinical Research Portfolio Database) searched from their inception to July 2013. Eligible studies included those which presented the attitudes or perceptions of people with osteoarthritis towards non-operative management strategies. Study quality was appraised using the CASP and the Gough's weight of evidence appraisal tools. Data were analysed through a meta-ethnography approach. Thirty-three studies including 1,314 people with osteoarthritis were sampled; the majority diagnosed with knee osteoarthritis. The overarching themes indicated people with osteoarthritis delay their diagnosis, opting for self-management and informal information gathering. This informal rather than health professional-led guidance is sought and maintained as an important resource throughout the care of this population and is valued. Diagnosis is sought at a 'critical point'. Healthcare interventions largely provided are poorly perceived. The period of subsequent self-management is an expectation before the inevitable requirement for joint replacement. There remains uncertainty regarding when this is required, but the expected failure of conservative treatment to manage pain and symptoms is common. In conclusion, patients should be enthused towards the principles of self-management and clinicians should not trivialise osteoarthritis. This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis.

Effectiveness of caregiver interventions for people with cancer and non-cancer-related chronic pain: a systematic review and meta-analysis.

BACKGROUND: People with chronic pain frequently have difficulties in completing everyday tasks to maintain independence and quality of life. Informal caregivers may provide support to these individuals. However, the effectiveness of interventions to train and support these individuals in caregiving remains unclear. The purpose of this study was to systematically review the evidence to determine the effectiveness of caregiver interventions to support informal caregivers of people with chronic pain. METHODS: A systematic review of published and unpublished literature databases was undertaken (9 April 2021). Trials reporting clinical outcomes of caregiver interventions to train informal caregivers to support community-dwelling people with chronic pain were included. Meta-analysis was undertaken and each outcome was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: Twenty-seven studies were eligible (N = 3427 patients). Twenty-four studies assessed patients with cancer pain and three with musculoskeletal pain. No other patient groups were identified. There was very low-quality evidence that caregiver interventions were beneficial for caregiver health-related quality of life (standardised mean difference = 0.26, 95% confidence interval = 0.01 to 0.52; N = 231). There was moderate-quality evidence that caregiving interventions were effective in reducing pain in the short-term (standardised mean difference = 0.16, 95% confidence interval = -0.29 to -0.03). There was low-quality evidence that caregiving interventions had no beneficial effect over usual care for psychological outcomes, fatigue, coping or physical function in the long-term. CONCLUSION: Caregiving interventions may be effective for patients and caregivers but only in the shorter-term and for a limited number of outcomes. There is insufficient evidence examining the effectiveness of caregiver interventions for people with non-cancer-related pain.

Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography.

BACKGROUND: People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain. METHODS: A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool. RESULTS: From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad. CONCLUSION: The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.

Structures and phase transitions in (MoO2)2P2O7.

We report structural investigations into (MoO(2))(2)P(2)O(7) using a combination of X-ray, neutron and electron diffraction, and solid-state NMR supported by first principles quantum chemical calculations. These reveal a series of phase transitions on cooling at temperatures of 377 and 325 K. The high temperature gamma-phase has connectivity consistent with that proposed by Kierkegaard at room temperature (but with improved bond length distribution), and contains 13 unique atoms in space group Pnma with lattice parameters a = 12.6577(1) A, b = 6.3095(1) A, c = 10.4161(1) A, and volume 831.87(1) A(3) from synchrotron data at 423 K. The low temperature alpha-structure was indexed from electron diffraction data and contains 60 unique atoms in space group P2(1)/c with cell parameters a = 17.8161(3) A, b = 10.3672(1) A, c = 17.8089(3) A, beta = 90.2009(2) degrees, and volume 3289.34(7) A(3) at 250 K. First principles calculations of (31)P chemical shift and J couplings were used to establish correlation between local structure and observed NMR parameters, and 1D and 2D (31)P solid-state NMR used to validate the proposed crystal structures. The intermediate beta-phase is believed to adopt an incommensurately modulated structure; (31)P NMR suggests a smooth structural evolution in this region.

Direct synthesis of cubic ZrMo2O8 followed by ultrafast in situ powder diffraction.

There has been a considerable amount of interest in negative thermal expansion (NTE) phases which are of importance, for example, in the manufacture of low or zero expansion composite materials. Cubic gamma-ZrMo(2)O(8) is of importance since it shows smooth NTE (alpha = -8 x 10(-6) K(-1) at 100 K) over a wide temperature range with no significant discontinuities as a function of temperature. The material has long been thought to be metastable at all temperatures and has previously only been produced under kinetic control by routes such as the careful dehydration of ZrMo(2)O(7)(OH)(2).2H(2)O. High-speed, high-temperature in situ diffraction studies carried out at beamline ID11 at the European Synchrotron Radiation Facility (ESRF) have shown that it is in fact possible to prepare gamma-ZrMo(2)O(8) directly from the constituent oxides in a narrow temperature window around 1400 K where it appears to be entropically stabilized. Under these conditions gamma-ZrMo(2)O(8) forms in a matter of seconds and can be quenched to room temperature. Full quantitative Rietveld analysis of diffraction patterns collected in as little as 0.25 s during the synthesis has allowed the reaction pathway to be followed.

Complex superstructures of Mo2P4O15.

We report structural studies on Mo(2)P(4)O(15) over the temperature range 16-731 K, which show that it is considerably more complex than revealed by earlier work. Its low-temperature structure has lattice parameters a = 24.1134(6) A, b = 19.5324(5) A, c = 25.0854(6) A, beta = 100.015(1) degrees, and V = 11635.0(5) A(3) at 120 K, containing 441 unique atoms in space group Pn, a remarkably high number for a material with such a simple composition. Mo(2)P(4)O(15) undergoes a structural phase transition at approximately 520 K to a high-temperature phase in space group P1, with lattice parameters a = 17.947(3) A, b = 19.864(3) A, c = 21.899(3) A, alpha = 72.421(3) degrees, beta = 78.174(4) degrees, gamma = 68.315(4) degrees, and V = 6877.2(19) A(3) at 573 K. The high-temperature structure, with 253 unique atoms, retains much of the low-temperature complexity.

Mo2P4O15--the most complex oxide structure solved by single crystal methods?

We report the crystal structure and phase transitions of Mo2P4O15 which, despite a simple chemical formula, has 441 crystallographically unique atoms in its asymmetric unit and thus has the most complex structure of any extended oxide reported to date.

' Scaling-up' in emergencies : British NGOs after Hurricane Mitch

This article examines research on NGO 'scaling-up' in a disaster context and links it to a broader discussion on whether scaling-up is a useful concept for understanding NGO processes in an emergency. Using concepts of scaling-up from development literature, research findings from a study of the responses of British NGOs to Hurricane Mitch in Central America are presented. The article assesses the extent and type of scaling-up on support to partners. Broader issues relating to scaling-up is useful, the tendency for its use to refer to organisatinal growth has limited a wider understanding and evaluation of the role of Northern NGOs in humanitarian crises. (AU)