Development and Intertester Reliability of a Novel Device to Measure Nonweightbearing Ankle Joint Dorsiflexion Range of Motion.

BACKGROUND: Ankle joint dorsiflexion range of motion is essential to normal gait. Ankle equinus has been implicated in a number of foot and ankle pathologies included Achilles tendonitis, plantar fasciitis, ankle injury, forefoot pain, and foot ulceration. Reliable measurement of ankle joint dorsiflexion range of motion, both clinically and in a research setting, is important. METHODS: The primary aim of this study was to investigate the intertester reliability of an innovative device for measuring ankle joint dorsiflexion range of motion. A total of 31 (n = 31) participants volunteered to take part in this study. A paired t-test was performed to assess for systematic differences between the mean measures of each rater. Intertester reliability was evaluated using the intraclass correlation coefficient (ICC) and their 95% confidence intervals. RESULTS: A paired t-test demonstrated that the mean ankle joint dorsiflexion range of motion did not significantly differ between raters. The ankle joint ROM mean for rater 1 was 4.65 SD (3.71) and rater 2 was 4.67 SD (3.91). Intertester reliability for the use of the Dorsi-Meter was excellent and demonstrated a very narrow range of error. The ICC (95%CI) was 0.991 (0.980 to 0.995) the SEM (in degrees) was 0.07, the MDC95, in degrees was 0.19 and 95% LOA, degrees was -1.49 to 1.46. CONCLUSIONS: We found the intertester reliability of the Dorsi-Meter to demonstrate higher levels of intertester reliability compared to previous studies investigating other devices. We reported the MDC values to provide an estimate of the smallest amount of change in the ankle joint dorsiflexion range of motion that must be achieved to reflect a true change, outside the error of the test. The Dorsi-Meter has been established as an appropriate reliable device to measure ankle joint dorsiflexion for clinicians and researchers with very small minimal detectable change and limits of agreement.

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review.

BACKGROUND: Mobile clinics have been used to deliver primary health care to populations that otherwise experience difficulty in accessing services. Indigenous populations in Australia, Canada, New Zealand, and the United States experience greater health inequities than non-Indigenous populations. There is increasing support for Indigenous-governed and culturally accessible primary health care services which meet the needs of Indigenous populations. There is some support for primary health care mobile clinics implemented specifically for Indigenous populations to improve health service accessibility. The purpose of this review is to scope the literature for evidence of mobile primary health care clinics implemented specifically for Indigenous populations in Australia, Canada, New Zealand, and the United States. METHODS: This review was undertaken using the Joanna Brigg Institute (JBI) scoping review methodology. Review objectives, inclusion criteria and methods were specified in advance and documented in a published protocol. The search included five academic databases and an extensive search of the grey literature. RESULTS: The search resulted in 1350 unique citations, with 91 of these citations retrieved from the grey literature and targeted organisational websites. Title, abstract and full-text screening was conducted independently by two reviewers, with 123 citations undergoing full text review. Of these, 39 citations discussing 25 mobile clinics, met the inclusion criteria. An additional 14 citations were snowballed from a review of the reference lists of included citations. Of these 25 mobile clinics, the majority were implemented in Australia (n = 14), followed by United States (n = 6) and Canada (n = 5). No primary health mobile clinics specifically for Indigenous people in New Zealand were retrieved. There was a pattern of declining locations serviced by mobile clinics with an increasing population. Furthermore, only 13 mobile clinics had some form of evaluation. CONCLUSIONS: This review identifies geographical gaps in the implementation of primary health care mobile clinics for Indigenous populations in Australia, Canada, New Zealand, and the United States. There is a paucity of evaluations supporting the use of mobile clinics for Indigenous populations and a need for organisations implementing mobile clinics specifically for Indigenous populations to share their experiences. Engaging with the perspectives of Indigenous people accessing mobile clinic services is imperative to future evaluations. REGISTRATION: The protocol for this review has been peer-reviewed and published in JBI Evidence Synthesis (doi: 10.11124/JBISRIR-D-19-00057).

Reliability of a New Method to Determine Foot Arch Height for Clinicians.

BACKGROUND: Arch height is an important indicator of risk of foot pathology. The current non-invasive gold standard based on footprint information requires extensive pre-processing. Methods used to obtain arch height that are accurate and easier to use are required in routine clinical practice. METHODS: The proposed arch index diagonals (AId) method for determining the arch index (AI) reduces the complexity of the preprocessing steps. All footprints were first prepared as required by the Cavanagh and Rodgers method for determining the AI and then compared to the proposed diagonals method. Results were classified according to the Cavanagh and Rodgers cut-off values into three groups of low, normal and high AI. ANOVA and Tukey's post hoc tests were applied to identify significant differences between AI groups. Linear modeling was applied to determine the fit of the new AId method compared to the Cavanagh and Rodgers AI. RESULTS: One hundred and ninety-six footprints were analyzed. The ANOVA indicated significant differences between the groups for AId (F1,194=94.49, p<0.0001) and the Tukey post hoc tests indicated significant differences between the pair-wise comparisons (p<0.001). Linear modeling indicated that the AId ratio classified more footprints in the high arch group compared to Cavanagh and Rodgers results (R2=32%, p< 0.01). Intra- and inter-rater correspondence was above 90% and confirmed that the AId results provided a better indication of arch height. CONCLUSIONS: The proposed method simplifies current processing steps to derive the arch height.

Disease-modifying drugs for multiple sclerosis in pregnancy: a systematic review.

Based on fair quality Level 3 evidence, Lu et al.(1) note that glatiramer acetate (GA) exposure was not associated with lower mean birthweight, lower mean gestational age, preterm birth (37 weeks), congenital anomaly, or spontaneous abortion. However, GA was given an indeterminate recommendation because further research is needed. The results are not compelling: 3 of the 4 existing human studies of GA were small case series.(1.)

EMG/NCS in the evaluation of spine trauma with radicular symptoms.

In the management of spine trauma with radicular symptoms (STRS), EMG/nerve conduction studies (NCS) often have low combined sensitivity and specificity in confirming root injury. The anatomic level of injury may not correspond to the root level. Paraspinal studies are nonlocalizing and can be falsely positive and negative. Unlike MRI and CT imaging, EMG/NCS do not reveal the biological morphology of the lesion. There are no studies that confirm the efficacy of EMG/NCS in the management of STRS. EMG/NCS may be indicated if there is a differential diagnosis between a root and distal neuropathic/myopathic lesion. Otherwise, as shown in this series of cases typically referred for outpatient EMG/NCS testing, there is limited evidence to support the use of often uncomfortable and costly EMG/NCS in STRS.

Outpatient home-based continuous intravenous dihydroergotamine therapy for intractable migraine.

BACKGROUND: Established consecutive-day inpatient intravenous dihydroergotamine protocols administered by bolus intravenous injection or continuous infusion injection in the hospital have demonstrated efficacy and safety in modifying the course of daily intractable headache. We conducted a study to determine efficacy, tolerability, and feasibility to treat patients with daily intractable headache with continuous intravenous dihydroergotamine in an outpatient home-based setting. METHODS: A total of 31 patients fulfilling ICHD-II criteria for chronic daily headache, 25 with chronic migraine and 6 with medication overuse headache, were treated with outpatient home-based continuous intravenous dihydroergotamine for 3 days. Patients were pretreated with 10 mg intravenous metoclopramide prior to the first day of infusion and administered 3 mg dihydroergotamine given continuously at a rate of 42 mL/hour on day 1 and 2, and administered 1.5 mg on day 3 at the rate of 21 mL/hour. The primary end point was a change in pain intensity, as measured by an 11-point numeric pain intensity scale at the end of 3 days. The secondary end point was reduction in headache frequency at long-term follow-up. RESULTS: Patients reported an average of 63.4% reduction in the intensity of migraine pain by the end of the 3-day infusion. Side effects were minimal and no serious adverse effects occurred. Approximately one-third of patients became completely headache-free after day 3, and 1 patient had no improvement. Long-term follow-up data indicated an average 86% reduction in headache frequency and almost every patient converted from chronic daily headache to episodic migraine except for 1 patient. Patients with medication overuse headache were no longer consuming the daily offending medication. CONCLUSIONS: Efficacy and safety of our outpatient home-based intravenous dihydroergotamine program compared favorably to that of established inpatient intravenous pulse injection and continuous infusion protocols for the treatment of intractable migraine. The use of outpatient continuous intravenous dihydroergotamine is an effective and well-tolerated therapy for intractable migraine but without the added cost and inconvenience of hospitalization.

Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification.

There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease.