Regenerative injection therapy for osteoarthritis: fundamental concepts and evidence-based review.

Regenerative therapy involves the injection of a small volume of solution into multiple sites of painful ligament and tendon insertions (entheses) and adjacent joint spaces, with the goal of reducing pain and ostensibly promoting tissue repair and growth. Dextrose and platelet-rich plasma solutions have been shown to increase expression of growth factors in vivo and have shown promising clinical results in the treatment of tendinosus. In the treatment of osteoarthritis, small clinical trials and case series to date suggest safety, symptomatic improvement, and functional improvement at up to a year of follow-up; however, most of these studies are uncontrolled. Given the methodological limitations of clinical research on regenerative injections for osteoarthritis to date, this treatment should be considered only after execution of a comprehensive assessment and treatment plan, including optimization of biomechanics, weight loss, cardiovascular exercise, resistance training, and judicious use of more established topical, oral, and injectable medications.

Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach.

This article aims to provide a comprehensive review of the current literature that pertains to the therapeutic use of autologous platelet-rich plasma (PRP). The basic science literature regarding the role of growth factors in mediating the healing process and the laboratory data from in vitro and in vivo studies that evaluated PRP are reviewed. Subsequently, the current evidence regarding PRP efficacy from animal models, human surgical studies, and human clinical studies is presented. A critical analysis of the literature follows, and the article concludes with the authors' perspectives on the state of PRP as a potentially efficacious bioregenerative treatment option for musculoskeletal and sports medicine applications. The relevant articles in this review were obtained via PubMed literature searches for PRP publications that pertain to musculoskeletal and sports medicine conditions. This article is not intended to be a formal meta-analysis.

Changes in stroke rehabilitation outcomes after the implementation of Japan's long-term care insurance system: a hospital-based study.

OBJECTIVE: To explore the changes in stroke rehabilitation outcomes after the introduction of Japan's long-term care insurance (LTCI) system. DESIGN: Stroke patients discharged during a 3-yr period before and after the implementation of LTCI were compared (before-LTCI vs. after-LTCI). Outcome measures included onset to admission interval, length of stay, and correlation between discharge site and functional level at discharge. RESULTS: A total of 201 patients in the before-LTCI group and 252 patients in the after-LTCI group were eligible for the study. Shorter mean length of stay (P < 0.01) and higher rates of discharge to a rehabilitation facility (P < 0.01) were found in the after-LTCI group. Logistic regression analysis revealed that the patients with higher activities of daily living scores or ambulatory status at discharge were more likely to be discharged to home after inpatient rehabilitation in both groups (P < 0.01). The rate of discharge to home was similar in both groups. CONCLUSIONS: Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.