Exploration of Content and Reach of Physical Therapy-Related Discussion on Twitter.

BACKGROUND: Many individuals access and share health information on social networking sites. Previous studies have analyzed the social media site Twitter to discern public opinion related to health phenomena such as antibiotics, concussions, and flu. Physical therapy-related online discussions have not been studied. OBJECTIVE: The aim of this study was to explore content, participants, and structure of physical therapy-related discussions on Twitter. DESIGN: This study was observational. METHODS: Over 12 weeks, more than 30,000 physical therapy-related tweets were collected. A random sample of 100 tweets underwent preliminary analysis to determine broad categories including tweet author, tone, and theme. A second random sample of 100 tweets was analyzed to confirm categories. Once categories were established, a new sample of 1000 tweets was randomly selected for analysis and categorization. All study investigators categorized a shared collection of tweets to establish inter- and intrarater agreement. Twitter conversations were visualized using NodeXL. RESULTS: Intrarater and interrater agreement for tweet categorization was 95% and 89%, respectively. The distribution of the intended audience was 35.5% professional, 35.5% broad reach, and 29% public. The gross distribution of tweet tone was 63.1% neutral, 31.4% positive, and 5.6% negative. Twenty-eight percent of tweets were authored by physical therapists/physical therapist assistants and nearly one-half were categorized as "marketing." Tweets tended to be "isolated," not within a conversation, or consist of conversation within "tight crowds." LIMITATIONS: This study was purely observational. Social media content can be highly influenced by temporal events, which limits the generalization of specific findings. CONCLUSIONS: Study results indicate that the reach of physical therapy-related tweets may not be as broad as intended by the author. Physical therapy professionals and the hospitals/clinics that employ them may need to implement strategies to be more intentional in reaching a broader audience with online messages.

Impact of degree of stenosis in May-Thurner syndrome on iliac vein stenting.

OBJECTIVE: May-Thurner syndrome (MTS) patients with lifestyle-limiting symptoms undergo stenting of the iliac vein for relief of compressive disease. The impact of degree of stenosis on clinical symptoms and outcomes after stenting is unknown and examined in our study. METHODS: Retrospective review of contemporaneously entered data of 202 patients who underwent stenting for MTS between 2005 and 2011 was performed. Classification into three groups based on luminal area obtained by intraoperative intravascular ultrasound interrogation of the involved femoroiliocaval segments was carried out. Normal luminal diameters and areas were defined as 12 mm and 125 mm2, 14 mm and 150 mm2, and 16 mm and 200 mm2 in the common femoral, external iliac, and common iliac veins, respectively. Mild (<60%), moderate (60%-89%), and severe (>90%) compression groups were defined using the normal values noted previously and observed after stenting to evaluate outcomes. Kaplan-Meier analysis was done to assess primary, primary assisted, and secondary patencies. Visual analog scale for pain scores, grade of swelling, and Venous Clinical Severity Score (VCSS) before and after stenting at 6, 24, and 48 months were analyzed using paired t-test and Tukey test. Logistic regression was used to gauge the impact of multiple variables including degree of stenosis on stent reintervention. RESULTS: There were 55 patients who had mild, 87 patients who had moderate, and 60 patients who had severe iliac vein compression. Baseline demographic characteristics and comorbidities were similar across all groups. In addition, there was no statistically significant difference in median baseline visual analog scale score, grade of swelling, and VCSS among the groups. Compression was treated with angioplasty and stenting encompassing all areas of disease as determined by intravascular ultrasound. Stent technique involved use of Wallstent (Boston Scientific, Marlborough, Mass) only in 183 patients and Wallstent-Z stent (Cook Medical, Bloomington, Ind) combination in the remainder. No difference in median stent patency was noted on follow-up. Clinically, at 48 months, a statistically significant recurrence of pain, swelling, and worsening of VCSS were noted in the severe stenosis group but not in the other two groups. No variable was noted to have an impact on stent reintervention. CONCLUSIONS: Severity of MTS stenosis is not a predictor of initial clinical symptoms. Long term, patients with ≥90% initial MTS stenosis experience recurrence of symptoms. The degree of iliac venous stenosis does not appear to affect stent patency. Such information will help counsel patients before intervention.

Endovascular management of chronic total occlusions of the inferior vena cava and iliac veins.

OBJECTIVE: Percutaneous recanalization and stenting is currently the standard of care for symptomatic chronic total occlusions (CTOs) of the iliofemoral veins. CTO lesions involving the inferior vena cava (IVC) present a more complex patient subset. In this series we describe our single-center experience with endovascular recanalization of symptomatic occlusions of the IVC. METHODS: Patients were evaluated with duplex ultrasound imaging, venous function tests, and venography before intervention. Occluded segments were recanalized, balloon dilated, and stented. The basic stent technique modified over time to accommodate the iliocaval junction, presence of IVC filters, and lesions extending to the renal veins and atrium. RESULTS: Between November 2000 and August 2015, 71 patients (41 men [58%]) underwent IVC endovascular recanalization procedures for symptomatic chronic IVC occlusions. Patients were an average age of 51 years (range, 23-77 years). Underlying contributing factors for venous occlusion included IVC filter occlusion in 38 (54%), caval ligation/clipping in 4 (6%), and hypercoagulable disorder in 27 (38%). The technical success rate was 85% (n = 60). The proximal extent of the stents were infrarenal in 40 (67%), suprarenal in 11 (18%), or intrathoracic in 9 (15%). There was minimal perioperative morbidity (2 hematomas, 1 renal failure) and no postoperative mortality. Average follow-up was 48.0 ± 43.3 months (range, 6-172 months). Primary, primary assisted, and secondary patency rates at 60 months were 52%, 85%, and 93%, respectively. Significant improvement in pain and swelling was seen in 91% and 83%, respectively; and complete cumulative relief of pain and swelling was 66% and 41% respectively. Ulcers were present in 18 patients and healed completely without recurrence in 14 (78%) after recanalization. The Venous Clinical Severity Score was 8.4 ± 5.1 (range, 4-27) before the intervention and 3.9 ± 3.2 (range, 0-14) after the intervention (P < .001). CONCLUSIONS: Endovascular recanalization of chronic total IVC occlusions can be performed with minimal morbidity and mortality. When successful, symptoms can be substantially improved, with excellent patency.

Deep venous thrombosis associated with caval extension of iliac stents.

BACKGROUND: It is generally difficult to place an iliac vein stent precisely at the iliocaval junction with venographic control or even with intravascular ultrasound guidance. Furthermore, mechanical properties of the Wallstent (Boston Scientific, Marlborough, Mass) can predispose precisely placed stents to distal displacement or stent collapse. Our center has thus advocated extending Wallstents 3 to 5 cm into the inferior vena cava to prevent complications of missed proximal lesions or stent migration. This technique has gradually been accepted, and concerns of jailing of contralateral flow were not initially recognized. We analyzed deep venous thrombosis (DVT) incidence following iliocaval stenting with two alternative techniques: (1) Wallstents with 3- to 5-cm extension into the inferior vena cava; and (2) a modified Z-stent (Cook Medical, Bloomington, Ind) technique, in which overlapping Wallstents end at the iliac confluence and caval extension is performed with a Z-stent placed at the top of the stack. The function of the Z-stent is to provide improved radial force at the iliocaval confluence and to prevent jailing of contralateral flow with larger stent interstices. METHODS: There were 755 limbs with consecutive Wallstent caval extensions (2006-2010) and 982 limbs with Z-stent extensions (2011-2015) analyzed for DVT incidence postoperatively. RESULTS: Demographics were similar for both groups. Mean age was 56 and 58 years in the Wallstent and Z-stent groups, respectively. There was a female predominance (Wallstent, 69%; Z-stent, 67%) and a higher incidence of left-sided disease (Wallstent, 66%; Z-stent, 56%) in both groups. There was a slightly higher incidence of post-thrombotic disease in the Z-stent subgroup (Wallstent, 53%; Z-stent, 68%). Cumulative freedom from contralateral DVT was 99% and 90% in the Z-stent and Wallstent groups, respectively (P < .001) during the 5 years following stent placement. However, all three patients with DVT contralateral to a Z-stent actually had high placement of the Wallstent across the confluence. Thus, no patients with proper Z-stent technique had a contralateral DVT. Cumulative freedom from ipsilateral DVT was 97% and 82% in the Z-stent and Wallstent groups, respectively (P < .001) during the 5 years following stent placement. The decrease in incidence of ipsilateral DVT appeared to be attributable to decreased missed distal lesions with increased operator experience and not attributable to the Z-stent itself. CONCLUSIONS: Contralateral DVT incidence was significantly lower with the Z-stent modification. In addition, the Z-stent modification provides greater radial strength at the iliac-caval confluence and simplifies simultaneous or sequential bilateral stenting. Use of proper technique and intravascular ultrasound is essential to limit the incidence of ipsilateral DVT.