Is It Safe to Prep the External Fixator In Situ During Second-Stage Pilon Surgical Treatment?

OBJECTIVE: To evaluate the infection rate of our protocol of prepping the external fixator in situ during definitive second-stage pilon fracture open reduction internal fixation. DESIGN: Retrospective clinical investigation. SETTING: Academic Level 1 Trauma Center. PATIENTS/PARTICIPANTS: Out of 229 patients with distal tibia fractures presenting to our institution from 1999 to 2014, 100 were treated in a 2-stage fashion utilizing this protocol. INTERVENTION: Prepping the external fixator into the surgical field during the second-stage/definitive open reduction internal fixation procedure. MAIN OUTCOME MEASUREMENT: The rates of deep and superficial infections after definitive fixation. RESULTS: The deep infection rate was 13%, and the superficial infection rate was 11%. CONCLUSIONS: Infection rates using this protocol are comparable to previously reported infection rates for two-stage surgical treatment of pilon fractures. This protocol provides the treating surgeon information about an alternative method to streamline definitive fixation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Meta-analysis of interventions to increase physical activity among cardiac subjects.

BACKGROUND: Extensive primary research has tested interventions to increase physical activity (PA) among adults with cardiovascular disease. This meta-analysis integrates the extant research about how to increase PA in cardiac samples. METHODS: Extensive literature searching located published and unpublished intervention studies that measured PA outcomes. Results were coded from primary studies. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS: Data were synthesized across 11,877 subjects from 79 eligible research reports. The overall mean PA effect size for 2-group comparisons was 0.35 (higher mean for treatment than control), which is consistent with a difference of 1984 kcal/week for treatment subjects versus 1615 for control subjects. The fitness effect size for 2-group comparisons was .17. Other statistically significantly positive 2-group effect sizes were .24 for quality of life and .23 for subsequent cardiac events. Effect sizes for anthropometric measures and blood pressure did not differ significantly from 0. Exploratory moderator analyses found large effect sizes for PA among studies that had (1) an exclusive focus on PA versus diverse health behaviors, (2) more contact between interventionists and subjects, (3) supervised exercise sessions, (4) fitness testing, (5) face-to-face encounters versus mediated intervention delivery, and (6) more minutes of activity per week. Effect sizes were unrelated to funding status, dissemination vehicle, gender distribution, or attrition rate. CONCLUSIONS: These findings document that interventions can be effective in increasing PA among patients with cardiovascular diseases. Primary research should compare interventions in randomized trials to confirm causal relationships.

Meta-analysis of health behavior change interventions in type 1 diabetes.

OBJECTIVES: To meta-analyze research testing interventions to improve health behaviors including exercise among adults with type 1 diabetes. METHODS: Multiple literature-searching strategies identified published and unpublished studies reporting glycated hemoglobin outcomes. Fixed- and random-effects meta-analyses included moderator effects. RESULTS: Data were synthesized across 1435 subjects. The overall effect size was 0.26. This translates into a reduction of 0.33 in mean HbA1c levels between treatment (8.47%) and control (8.80%) groups. Effect sizes were larger with more females, lower body mass index, higher baseline HbA1c, and interventions targeting multiple behaviors. CONCLUSIONS: Behavior change interventions improve metabolic control in type 1 diabetes.

Physical activity interventions among adults with arthritis: meta-analysis of outcomes.

OBJECTIVE: Due to reduced physical activity, adults with arthritis experience significant disability and comorbidities including cardiovascular disease. This meta-analytic review integrates results from primary research studies testing interventions to increase physical activity in arthritis patients. METHODS: Extensive literature searching strategies were employed to locate published and unpublished empirical studies testing physical activity interventions. Results were coded for studies that had at least 5 participants. Effect sizes (ESs) were calculated for measures of physical activity, pain, and objective and subjective measures of functional ability. RESULTS: Twenty-eight research studies with 4111 subjects were synthesized. The mean ES for 2-group comparisons (treatment versus control) was 0.69 for physical activity, 0.21 for pain, 0.49 for objectively measured function, and 0.14 for subjectively measured function. This average effect on subjective function is consistent with a Health Assessment Questionnaire mean of 0.64 for treatment subjects as compared with 0.70 for control subjects. For pain assessed using the 0 to 10 visual analog scale, the average effect amounts to a mean of 3.78 for treatment subjects versus 4.33 for control subjects. Control group subjects experienced statistically significant improvements in pain and, to a lesser extent, objectively measured functional ability during study participation. CONCLUSIONS: Physical activity interventions resulted in moderate positive effects on physical activity behavior and small positive effects on pain and physical function outcomes. Future research should examine specific intervention characteristics that result in optimal results, such as frequency, type, and intensity of exercise.

Meta-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes.

This review applied meta-analytic procedures to integrate primary research that examined exercise fitness outcomes among adults with type 1 or type 2 diabetes. We used extensive literature searching strategies to locate published and unpublished intervention studies that tested exercise interventions. We conducted meta-analytic procedures using both fixed- and random-effects models. Analyses were conducted separately for type 1 and type 2 diabetes and separately for two-group and single-group data under two assumptions about pre-post fitness outcomes association: no association and a strong positive association (0.80). Codable data were extracted from 35 reports with 1074 subjects. The type 1 diabetes overall weighted mean effect size for two-group comparisons was 0.65. For treatment group pretest versus post-test, the effect was 0.62. The effect size among adults with type 2 diabetes for two-group comparisons was 0.35. The treatment group pretest versus post-test comparison effect was 0.37. Effect sizes among control group participants were not statistically different from 0. For type 2 diabetes two-group comparisons, larger effect sizes were associated with exercise prescription, fitness testing, supervised exercise, group sessions, and recommendations for longer duration exercise sessions. HbA1c, age, body mass index, and gender distribution were unrelated to fitness outcomes.

A meta-analysis of exercise interventions among people treated for cancer.

GOAL: This review applied meta-analytic procedures to integrate primary research findings that tested exercise interventions among people treated for cancer. METHODS: Extensive literature searching strategies located published and unpublished intervention studies that tested exercise interventions with at least five participants (k = 30). Primary study results were coded. Meta-analytic procedures were conducted. MAIN RESULTS: The overall weighted mean effect size (ES) for two-group comparisons was 0.52 (higher mean for treatment than control) for physical function, 0.35 for symptoms other than fatigue, and 0.27 for body composition. More modest positive ESs were documented for mood (0.19), quality of life (0.14), fatigue (0.11), and exercise behavior (0.04). ESs were larger among single-group pre-post design studies. ESs among control group participants were typically negative and not (statistically) significantly different from 0. CONCLUSIONS: Exercise interventions resulted in small positive effects on health and well-being outcomes among existing studies. Future research should examine intervention-specific characteristics that result in optimal results, such as dose.