New insights for statistical analysis of blood pressure response to resistance training in elderly hypertensive women / Novas perpectivas para a análise estatística da resposta da pressão arterial ao treinamento resistido em mulheres idosas hipertensas

ABSTRACT The main goal was to present statistical procedures for a better data interpretation of responsiveness, explain how to deal with RTM effect, and describe how to determine clinically important changes in BP from significant real difference (SRD). Twenty-seven hypertensive elderly women were included, and RT consisted of a periodized linear model. The RT lasted 10 weeks, with two sessions performed per week. Responders were classified on the basis of SBP differences between time-points T1 (first 3 weeks) and T4 (weeks 9-10). Statistical analyses were performed using One-Way Repeated Measures ANOVA, an analysis of covariance (ANCOVA), the linear mixed model (LMM) was used in the present study, and SRD was also calculated. In conclusion, when one-way repeated measure ANOVA was conducted to determine whether there was a statistically significant difference in SBP levels over the course of 10-week RT, results showed a non-significant reduction of -2.24 mmHg, while classifying subjects by responsiveness provides a different perspective of the results. Furthermore, initial SBP was the more powerful predictor of post-exercise SBP response, as analyzed by the regression to the mean effect. Finally, the reductions of -2.24 mmHg was not statistically significant nor clinically meaningful, but fell within the measurement error of the SBP measurements.

RESUMO O objetivo principal do estudo foi apresentar procedimentos estatísticos para uma melhor interpretação dos dados sobre a responsividade, explicar como lidar com o efeito da regressão a média (RM) e descrever como determinar alterações clinicamente importantes na pressão arterial (PA) pelo cálculo da diferença clínica (DC). Vinte e sete mulheres idosas hipertensas foram incluídas e o treinamento resistido (TR) consistiu em um modelo linear periodizado. O TR durou 10 semanas, com duas sessões realizadas por semana. Os responsivos foram classificados com base nas diferenças da pressão arterial sistólica (PAS) entre os momentos T1 (primeiras 3 semanas) e T4 (semanas 9-10). As análises estatísticas no presente estudo foram realizadas utilizando a ANOVA de medidas repetidas, análise de covariância (ANCOVA) e modelo linear misto (MLM). Conclui-se que quando uma ANOVA de medidas repetidas é aplicada, os resultados mostram uma redução não significativa de -2,24 mmHg, mas a classificação dos participantes por responsividade fornece uma interpretação diferente dos resultados. Além disso, a PAS inicial foi o preditor mais potente da resposta pós-exercício da PAS, conforme analisado pela RM. Finalmente, as reduções de -2,24 mmHg não foram estatisticamente significativas e nem clinicamente importantes, mas caíram dentro do erro de medida.

A Comparison of Clinical Outcomes between Decompressive Laminectomy Alone and with Arthrodesis in Lumbar Single Level Spinal Stenosis

OBJECTIVE: By comparing the data of patients with spinal stenosis who had undergone decompressive laminectomy alone or with arthrodesis, we retrospectively analysed the advantages and disadvantages of the subsequent surgical techniques. METHODS: We analyzed the radiological parameters, surgical techniques, and clinical outcomes of 35 patients, who had undergone operation for spinal stenosis. The patients were divided into two groups, laminectomy alone(15 patients) and laminectomy with arthrodesis(17 patients) and the patients' subjective outcomes and radiological results were compared. RESULTS: Subjective satisfaction was higher in patients who had received decompressive degrees laminectomy alone(80%) than patients who received degrees decompressive laminectomy with arthrodesis(70%). The mean preoperative spinal lordotic angle in the laminectomy alone groups improved from 32.3 degree to 33.9 degree, postoperatively, and 33.1 degree at the last follow up. The mean preoperative spinal lordotic angle in the laminectomy with arthrodesis groups improved from 33.5 degree to 37.8 degree postoperatively, and 37.4 degree at last follow up. The lamine- ctomy with arthordesis group showed better results regarding spinal lordotic angle correction but this was not directly related to the clinical outcomes CONCLUSION: There was no significant correlation in clinical outcome, correction of spinal lordosis angle and patients' subjective satisfaction between decompressive laminectomy alone and with arthrodesis. Therefore, we suggested that decompressive laminectomy alone was achived good outcomes in patients who has single level spinal stenosis with no proven spinal instability at preoperative stage.

Más allá del valor p

Introducción: En medicina se ha privilegiado el valor p y lo que éste aporta. No obstante, cada día se usan otros criterios, como el intervalo de confianza, y nuevas formulaciones de las pruebas de hipótesis que pueden proveer más profundidad en la identificación de resultados clínicamente relevantes. Objetivos: Exponer criterios y pruebas de hipótesis que vayan más allá del valor p. Resultados: Se da una explicación a los intervalos de confianza y a diferentes pruebas de hipótesis para identificar, en el análisis de los datos de la investigación, los valores clínicamente relevantes. Conclusión: El valor p, los intervalos de confianza y la identificación de diferencias clínicamente relevantes por medio del uso de hipótesis de superioridad, de no inferioridad y de equivalencia son fundamentales para la investigación clínica...

Introduction: In medicine the p value has had an important place because of its contribution. In addition the confidence intervals and new formulations of significant test are used every day as a way to identify clinically relevant results. Objective: To describe the criteria and the significant test beyond the p value. Results: Confidence intervals and significant tests are review to identify in data analysis clinically relevant findings. Conclusion: The p value, confidence intervals and the identification of clinically relevant findings by means of superiority, non-inferiority and equivalence hypothesis are fundamentals in clinical research...

Comparison of Postoperative Symptomatic Improvement between Simple Decompression and Fusion with Instrumentation in Lumbar Spinal Stenosis without Instability / 대한척추외과학회지

STUDY DESIGN: The difference between the improvement after operation depending on the surgical method on patients with a spinal canal stenosis without instability were examined retrospectively. OBJECTIVES: To determine the difference between the improvement after surgery depending on the operative method on patients with spinal canal stenosis without an instability by using a retrospective study. SUMMARY AND LITERATURE REVIEW: There is a The clinical difference between simple decompression and fusion using instrument after decompression. MATERIAL AND METHODS: Sixty-six patients, who were diagnosed with pure spinal canal stenosis without instability and treated with surgery from October 2002 to April 2004 and were available for a follow up at least for 1 year were examined. There were 22 examples of decompression only and 22 examples of fusion using instruments. The change in postoperative pain was scaled using a visual analogue scale (VAS), and the functional disability in everyday life was clinically compared with the Korean ODI (KODI) and Lower Back Outcome Score for back pain (LBOS). RESULTS: 20 male and 24 females were examined, and the mean age was 61(45~76) years. the Million Visual Analogue Scale (MVAS) showed improvement in 28.3% of group A with decompression, and the everyday life disability scale using the Korean ODI and Lower back outcome score for back pain (LBOS) showed a improvement of 16.1% (KODI) and 18.4% (LBOS). Group B each showed 18.0% improvement using the VAS. The Korean ODI and Lower Back Outcome Score for back pain each improved by 18.0% (KODI) and 17.3% (LBOS) in two groups showing no statistically significant difference. CONCLUSION: There was little difference in the level of improvement in spinal canal stenosis patients without instability, regardless of ehether they had been treated with simple decompression or fusion using instrument after decompression.