Inter and Intra Operator Reliability of Motor and Palpation Evaluation in Fascial Manipulation in individuals with coxarthrosis.

OBJECTIVE: An inter and intra rater reliability (INTERR and INTRAR) study was designed. METHODS: 71 subjects, with primary hip coxarthrosis, were included and randomly divided in a study group (SG= 36) and a control group (CG= 35) to assess the efficacy of the Fascial Manipulation® (FM®) method. The primary objective was the assessment of INTERR and INTRAR about movement verification (MV) and palpation verification (PV) of FM® performed by two physiotherapists (PtA and PtB). The secondary objective was evaluate the efficacy of FM® through MV, PV and pain score. Pain was assessed using the Numeric Rating Scale (NRS). SG received three weekly sessions of FM® byPtA. PtB re-evaluated all the subjects at the end of the study. RESULTS: Results of the INTERR analysis showed for SG: MV (ICC= 0.92, k= 72.7%); PV (ICC= 0.91, k= 75.7%). For CG : MV (ICC= 0.95, k= 84.2%); PV (ICC= 0.90, k= 75%). Results of the INTRAR analysis for SG reported: MV (ICC= 0.82, k= 74,8%); PV (ICC= 0.60, k= 46.8%); for CG: MV (ICC= 0.93, k= 78.7%); PV (ICC= 0.84, k= 53.3%). Statistical significance were reported in NRS (p = 0.001), MV (p = 0.0003) and PV (p < 0.0001) with better results for SG using "Intention To Treat" method. DISCUSSION: This study demonstrates that FM® assessment procedures have a high reliability even if applied by practitioners with basic experience. Furthermore FM® treatment can improve pain and ROM in individuals with primary coxarthrosis.

What Factors Are Associated With the Recovery of Autonomy After a Hip Fracture? A Prospective, Multicentric Cohort Study.

OBJECTIVE: To identify the factors associated with recovering autonomy in activities of daily living (ADL) in patients who have had a hip fracture. DESIGN: A prospective cohort study. SETTING: The orthopedic and orthogeriatric departments of 2 regional hospitals. PARTICIPANTS: Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture. MAIN OUTCOME MEASURES: The level of autonomy at 4 months was assessed using the ADL scale. RESULTS: The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014). CONCLUSIONS: Recovery of deambulation, treatment of disorientation and management of incontinence are modifiable factors significantly associated with the functional recovery of autonomy.

Which factors are independent predictors of early recovery of mobility in the older adults' population after hip fracture? A cohort prognostic study.

INTRODUCTION: The aim of the present study was to identify all factors that might influence the short-term recovery of mobility in older adults' patients after hip surgery. METHODS: A prospective cohort prognostic study was carried out. The study enrolled all consecutive patients aged 65 years or over admitted for hip fracture due to fragility. Patients were monitored from their admission into the emergency department of the hospital, until their discharge. The level of mobility was measured by the ILOA scale, administered during the 6th day of hospitalisation. The identified variables were divided into baseline patient variables, linked to the patient's characteristics, and, healthcare/hospital variables, linked to the program of care within post-surgery hospitalisation. RESULTS: The total number of patients enrolled and examined at discharge was 484. Six days after surgery, the level of mobility achieved by patients, as measured by ILOA Scale, was 42.4 (± 6.0). Increased age (B = 0.111; p = 0,042), pressure sore mattress with a motor used (B = 3.817; p < 0.0005), delay in achieving an upright position (B = 0.509; p < 0.0005), no recovery of walking (b = 2.339; p < 0.0005), prolonged use of diapers (B = 0.004; p < 0.0005) or catheter (B = 0.089; p < 0.0005), indication for no weight bearing (B = 2.023; p = 0.031), and temperature for fewer days (B = 0.040; p = 0.023) are factors able to affect negatively recovery of mobility in the initial post-operative period in patients surgically treated for hip fracture. CONCLUSION: Therapy and physiotherapy choices after surgery for hip fracture are significantly associated with early recovery of mobility of older adults' patients, regardless of their baseline conditions. Early removal of supporting devices promoting prolonged bed immobility, such as air mattress, catheter, and incontinence pad, together with achieving an early upright position, are elements to take into account when planning future trials to understand its efficacy in enabling better recovery of mobility.

Liver disease and dyslipidemia as a manifestation of lysosomal acid lipase deficiency (LAL-D). Clinical and diagnostic aspects, and a new treatment. An update. / Enfermedad hepática y dislipemia como manifestación de deficiencia de lipasa acida lisosomal (LAL-D). Aspectos clínicos, diagnósticos y nuevo tratamiento. Actualización.

Lysosomal acid lipase deficiency (LAL-D) is still a little recognized genetic disease with significant morbidity and mortality in children and adults. This document provides guidance on when to suspect LAL-D and how to diagnose it. It is recommended to add lysosomal acid lipase deficiency to the List of differential diagnoses of sepsis, oncological diseases, storage diseases, persistent diarrhea, chronic malnutrition, and hemophagocytic lymphohistiocytosis. It should also be considered in young patients with dyslipidemia and atherosclerosis as well as diseases associated with fatty liver and/or hepatomegaly. LAL-D should be suspected in patients with hepatomegaly, hyperlipidemia and /or elevated transaminases found during routine checks or testing for other conditions, and in patients with cryptogenic cirrhosis. At present, there is the option of a specific enzyme replacement treatment.

La deficiencia de lipasa ácida lisosomal es una enfermedad genética aún poco reconocida, con significativa morbimortalidad en niños y en adultos. Esta guía orienta sobre cuándo sospechar la enfermedady cómo diagnosticarla. Serecomienda agregar la deficiencia de lipasa ácida lisosomal a la lista de diagnósticos diferenciales de las sepsis, enfermedades oncológicas, enfermedades de depósito, diarrea prolongada y desnutrición crónica y linfohistiocitosis hemofagocítica. Asimismo, se sugiere considerarla en pacientes jóvenes con dislipemia y arterioesclerosis y en enfermedades que ocurran con hígado graso y/o hepatomegalia. La hepatomegalia, hiperlipidemia y/o elevación de las transaminasas en ocasión de controles de rutina o de otras afecciones deberían hacer sospechar la deficiencia de lipasa ácida lisosomal, al igual que en pacientes con cirrosis criptogénica. Hoy existe la opción de un tratamiento de remplazo enzimático específico.