The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Lorimer G Moseley - One of the best experts on this subject based on the ideXlab platform.
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persistent pain after Wrist or hand Fracture development and validation of a prognostic model
Journal of Orthopaedic & Sports Physical Therapy, 2019Co-Authors: Aidan G Cashin, Adrian C Traeger, Markus Hubscher, Lorimer G Moseley, Flavia Di Pietro, Luke Parkitny, James H McauleyAbstract:Background Worldwide, the incidence of Wrist Fracture is increasing. There are currently no externally validated prognostic models to inform early decision making for these patients. Objectives To ...
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psychological distress mediates the relationship between pain and disability in hand or Wrist Fractures
The Journal of Pain, 2015Co-Authors: Lorimer G Moseley, Luke Parkitny, Cassie Ross, Ilona Juraskova, Hopin Lee, Tasha R StantonAbstract:Abstract Upper limb Fracture is a common musculoskeletal injury and can lead to marked pain-related disability. Unlike other common painful musculoskeletal conditions, such as low back pain, little consideration has been given to the role that psychological variables may play in explaining the relationship between pain and disability during early Fracture recovery. This cross-sectional study aimed to determine if psychological distress (symptoms of depression, anxiety, and/or stress) mediate the relationship between pain and disability in acute hand/Wrist Fractures. Self-reported data from a consecutive sample of 594 patients with acute hand/Wrist Fracture were used. Mediation analyses were conducted to determine the role of depression, anxiety, and stress in the relationship between pain and disability, controlling for relevant demographic and Fracture-related variables. Depression and stress, but not anxiety, significantly mediated the relationship between pain and disability. That is, although each psychological distress variable was associated with pain ( P 1 = 0.27, P = .03) and stress (b 3 = .23, P = .02) were significantly associated with disability and fulfilled recommended criteria for establishing a mediating variable. Increased depression and stress, but not anxiety, explain the relationship between pain and disability and may be novel targets for interventions designed to reduce pain-related disability after upper limb Fracture. Perspective This study presents the mediating effect of psychological distress on the relationship between pain and disability in acute upper limb Fracture. These factors may be novel targets for interventions designed to reduce pain-related disability after acute Fracture.
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intense pain soon after Wrist Fracture strongly predicts who will develop complex regional pain syndrome prospective cohort study
The Journal of Pain, 2014Co-Authors: Lorimer G Moseley, Robert D Herbert, Timothy Parsons, Samantha Lucas, Jacobus J Van Hilten, Johan MarinusAbstract:Complex regional pain syndrome (CRPS) is a distressing and difficult-to-treat complication of Wrist Fracture. Estimates of the incidence of CRPS after Wrist Fracture vary greatly. It is not currently possible to identify who will go on to develop CRPS after Wrist Fracture. In this prospective cohort study, a nearly consecutive sample of 1,549 patients presenting with Wrist Fracture to 1 of 3 hospital-based Fracture clinics and managed nonsurgically was assessed within 1 week of Fracture and followed up 4 months later. Established criteria were used to diagnose CRPS. The incidence of CRPS in the 4 months after Wrist Fracture was 3.8% (95% confidence interval = 2.9-4.8%). A prediction model based on 4 clinical assessments (pain, reaction time, dysynchiria, and swelling) discriminated well between patients who would and would not subsequently develop CRPS (c index .99). A simple assessment of pain intensity (0-10 numerical rating scale) provided nearly the same level of discrimina- tion (c index .98). One in 26 patients develops CRPS within 4 months of nonsurgically managed Wrist Fracture. A pain score of $5 in the first week after Fracture should be considered a ''red flag'' for CRPS. Perspective: This study shows that excessive baseline pain in the week after Wrist Fracture greatly elevates the risk of developing CRPS. Clinicians can consider a rating of greater than 5/10 to the ques- tion ''What is your average pain over the last 2 days?'' to be a ''red flag'' for CRPS.
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is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb a randomised clinical trial
Pain, 2005Co-Authors: Lorimer G MoseleyAbstract:In complex regional pain syndrome (CRPS1) initiated by Wrist Fracture, a motor imagery program (MIP), consisting of hand laterality recognition followed by imagined movements and then mirror movements, reduces pain and disability, but the mechanism of effect is unclear. Possibilities include sustained attention to the affected limb, in which case the order of MIP components would not alter the effect, and sequential activation of cortical motor networks, in which case it would. Twenty subjects with chronic CRPS1 initiated by Wrist Fracture and who satisfied stringent inclusion criteria, were randomly allocated to one of three groups: hand laterality recognition, imagined movements, mirror movements (RecImMir, MIP); imagined movements, recognition, imagined movements (ImRecIm); recognition, mirror movements, recognition (RecMirRec). At 6 and 18 weeks, reduced pain and disability were greater for the RecImMir group than for the other groups (P<0.05). Hand laterality recognition imparted a consistent reduction in pain and disability across groups, however, this effect was limited in magnitude. Imagined movements imparted a further reduction in pain and disability, but only if they followed hand laterality recognition. Mirror movements also imparted a reduction in pain and disability, but only when they followed imagined movements. The effect of the MIP seems to be dependent on the order of components, which suggests that it is not due to sustained attention to the affected limb, but is consistent with sequential activation of cortical motor networks.
W Illiame B Uckley - One of the best experts on this subject based on the ideXlab platform.
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systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation an evidence based practice approach
Journal of Manual & Manipulative Therapy, 2009Co-Authors: Giampietro L Vairo, Sayers John Miller, N Cb Icolem M Rier, W Illiame B UckleyAbstract:Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial Wrist Fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.
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systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation an evidence based practice approach
Journal of Manual & Manipulative Therapy, 2009Co-Authors: Giampietro L Vairo, Sayers John Miller, N Cb Icolem M Rier, W Illiame B UckleyAbstract:Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial Wrist Fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.
Julie P W Bynum - One of the best experts on this subject based on the ideXlab platform.
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second Fractures among older adults in the year following hip shoulder or Wrist Fracture
Osteoporosis International, 2016Co-Authors: Julie P W Bynum, Johnerik Bell, Robert V Cantu, Qianfei Wang, Christine M Mcdonough, Don Carmichael, Tor D Tosteson, Anna N A TostesonAbstract:We report on second Fracture occurrence in the year following a hip, shoulder or Wrist Fracture using insurance claims. Among 273,330 people, 4.3 % had a second Fracture; risk did not differ by first Fracture type. Estimated adjusted second Fracture probabilities may facilitate population-based evaluation of secondary Fracture prevention strategies. The purpose of this study was estimate second Fracture risk for the older US population in the year following a hip, shoulder, or Wrist Fracture. Observational cohort study of Medicare fee-for-service beneficiaries with an index hip, shoulder, or Wrist fragility Fracture in 2009. Time-to-event analyses using Cox proportional hazards models to characterize the relationship between index Fracture type (hip, shoulder, Wrist) and patient factors (age, gender, and comorbidity) on second Fracture risk in the year following the index Fracture. Among 273,330 individuals with Fracture, 11,885 (4.3 %) sustained a second hip, shoulder or Wrist Fracture within one year. Hip Fracture was most common, regardless of the index Fracture type. Comparing adjusted second Fracture risks across index Fracture types reveals that the magnitude of second Fracture risk within each age-comorbidity group is similar regardless of the index Fracture. Men and women face similar risks with frequently overlapping confidence intervals, except among women aged 85 years or older who are at greater risk. Regardless of index Fracture type, second Fractures are common in the year following hip, shoulder or Wrist Fracture. Secondary Fracture prevention strategies that take a population perspective should be informed by these estimates which take competing mortality risks into account.
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second Fractures among older adults in the year following hip shoulder or Wrist Fracture
Osteoporosis International, 2016Co-Authors: Julie P W Bynum, Johnerik Bell, Robert V Cantu, Qianfei Wang, Christine M Mcdonough, Don Carmichael, Tor D Tosteson, Anna N A TostesonAbstract:Summary We report on second Fracture occurrence in the year following a hip, shoulder or Wrist Fracture using insurance claims. Among 273,330 people, 4.3 % had a second Fracture; risk did not differ by first Fracture type. Estimated adjusted second Fracture probabilities may facilitate population-based evaluation of secondary Fracture prevention strategies.
Lorraine A Fitzpatrick - One of the best experts on this subject based on the ideXlab platform.
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correction to abaloparatide effect on forearm bone mineral density and Wrist Fracture risk in postmenopausal women with osteoporosis
Osteoporosis International, 2020Co-Authors: Nelson B Watts, Gary Hattersley, Paul D. Miller, Gregory C Williams, Lorraine A Fitzpatrick, Y Wang, Felicia CosmanAbstract:The original version of this article, published on 21 March 2019, unfortunately contained a mistake.
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abaloparatide for risk reduction of nonvertebral and vertebral Fractures in postmenopausal women with osteoporosis a network meta analysis
Osteoporosis International, 2019Co-Authors: Jeanyves Reginster, Setareh A. Williams, F Bianic, R Campbell, M Martin, Lorraine A FitzpatrickAbstract:This network meta-analysis assessed the efficacy of abaloparatide versus other treatment options to reduce the risk of Fractures in women with postmenopausal osteoporosis. The analysis indicates that abaloparatide reduces the risk of Fractures in women with postmenopausal osteoporosis versus placebo and compared with other treatment options. This network meta-analysis (NMA) assessed the relative efficacy of abaloparatide versus other treatments to reduce the risk of Fractures in women with postmenopausal osteoporosis (PMO). PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials published before December 20, 2017, that included women with PMO who were eligible to receive interventions for primary or secondary Fracture prevention. The NMA was conducted by Fracture site (vertebral [VF], nonvertebral [NVF], and Wrist), with the relative risk (RR) of Fracture versus placebo the main clinical endpoint. The NMA used fixed-effects and random-effects approaches. A total of 4978 articles were screened, of which 22 were included in the analysis. Compared with other treatments, abaloparatide demonstrated the greatest treatment effect relative to placebo in the VF network (RR = 0.13; 95% credible interval [CrI] 0.04–0.34), the NVF network (RR = 0.50; 95% CrI 0.28–0.85), and the Wrist Fracture network (RR = 0.39; CrI 0.15–0.90). Treatment ranking showed that abaloparatide had the highest estimated probability of preventing Fractures in each of the networks (79% for VF, 70% for NVF, and 53% for Wrist Fracture) compared with other treatments. Individual networks demonstrated a good level of agreement with direct trial evidence and direct pair-wise comparisons. This NMA indicates that abaloparatide reduces the RR of VF, NVF, and Wrist Fracture in women with PMO with or without prior Fracture versus placebo, compared with other treatment options. Limitations include that adverse events and drug costs were not considered, and that generalizability is limited to the trial populations and endpoints included in the NMA.
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abaloparatide effect on forearm bone mineral density and Wrist Fracture risk in postmenopausal women with osteoporosis
Osteoporosis International, 2019Co-Authors: Nelson B Watts, Gary Hattersley, Paul D. Miller, Gregory C Williams, Lorraine A Fitzpatrick, Y Wang, Felicia CosmanAbstract:Wrist Fractures are common, contribute significantly to morbidity in women with postmenopausal osteoporosis, and occur predominantly at the ultradistal radius, a site rich in trabecular bone. This exploratory analysis of the phase 3 ACTIVE study evaluated effects of abaloparatide versus placebo and teriparatide on forearm bone mineral density (BMD) and risk of Wrist Fracture. Forearm BMD was measured by dual energy X-ray absorptiometry in a subset of 982 women from ACTIVE, evenly distributed across the three treatment groups. Wrist Fractures were ascertained in the total cohort (N = 2463). After 18 months, ultradistal radius BMD changes from baseline were 2.25 percentage points greater for abaloparatide compared with placebo (95% confidence interval (CI) 1.38, 3.12, p < 0.001) and 1.54 percentage points greater for abaloparatide compared with teriparatide (95% CI 0.64, 2.45, p < 0.001). At 18 months, 1/3 radius BMD losses (versus baseline) were similar for abaloparatide compared with placebo (−0.42; 95% CI −1.03, 0.20; p = 0.19) but losses with teriparatide exceeded those of placebo (−1.66%; 95% CI −2.27, −1.06; p < 0.001). The decline with abaloparatide was less than that seen with teriparatide (group difference 1.22%; 95% CI 0.57, 1.87; p < 0.001). The radius BMD findings, at both ultradistal and 1/3 sites, are consistent with the numerically lower incidence of Wrist Fractures observed in women treated with abaloparatide compared with teriparatide (HR = 0.43; 95% CI 0.18, 1.03; p = 0.052) and placebo (HR = 0.49, 95% CI 0.20, 1.19, p = 0.11). Compared with teriparatide, abaloparatide increased BMD at the ultradistal radius (primarily trabecular bone) and decreased BMD to a lesser extent at the 1/3 radius (primarily cortical bone), likely contributing to the numerically lower Wrist Fracture incidence observed with abaloparatide.
Brian H Rowe - One of the best experts on this subject based on the ideXlab platform.
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critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility Fracture secondary analyses from two controlled trials
Osteoporosis International, 2014Co-Authors: Sumit R Majumdar, David A Hanley, Finlay A Mcalister, J A Johnson, Daniala L Weir, Debbie Bellerose, Anthony S Russell, Brian H RoweAbstract:Summary Most patients are not treated for osteoporosis after their fragility Fracture “teachable moment.” Among almost 400 consecutive Wrist Fracture patients, we determined that better-than-average osteoporosis knowledge (adjusted odds = 2.6) and BMD testing (adjusted odds = 6.5) were significant modifiable facilitators of bisphosphonate treatment while male sex, working outside the home, and depression were major barriers.
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cost effectiveness of a multifaceted intervention to improve quality of osteoporosis care after Wrist Fracture
Osteoporosis International, 2011Co-Authors: David A Hanley, Sumit R Majumdar, Finlay A Mcalister, Anthony S Russell, Brian H Rowe, Walter P Maksymowych, Donald W Morrish, Douglas A Lier, James A JohnsonAbstract:In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with Wrist Fracture. An economic analysis of the trial now demonstrates that the intervention tested “dominates” usual care: over a lifetime horizon, it reduces Fracture, increases quality-adjusted life years, and saves the healthcare system money. In a randomized trial (N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a Wrist Fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation. Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients’ remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted. Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three Fractures (one hip Fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations. For outpatients with Wrist Fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce Fractures, and gain quality-adjusted life expectancy.
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multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent Wrist Fracture a randomized controlled trial
Canadian Medical Association Journal, 2008Co-Authors: Sumit R Majumdar, David A Hanley, Finlay A Mcalister, Debbie Bellerose, Anthony S Russell, Jeffrey A Johnson, Walter P Maksymowych, Don W Morrish, Brian H RoweAbstract:Background: Older patients who experience a fragility Fracture are at high risk of future Fractures but are rarely tested or treated for osteoporosis. We developed a multifaceted intervention directed at older patients with Wrist Fractures (in the form of telephone-based education) and their physicians (in the form of guidelines endorsed by opinion leaders, supported by reminders) to improve the quality of osteoporosis care. Methods: In a randomized controlled trial with blinded ascertainment of outcomes, we compared our intervention with usual care (provision of printed educational materials to patients). Eligible patients were those older than 50 years of age who had experienced a Wrist Fracture and were seen in emergency departments and Fracture clinics; we excluded those who were already being treated for osteoporosis. The primary outcome was bisphosphonate treatment within 6 months after the Fracture. Secondary outcomes included bone mineral density testing, “appropriate care” (consisting of bone mineral density testing with treatment if bone mass was low) and quality of life. Results: We screened 795 patients for eligibility and randomly assigned 272 to the intervention (137 patients) or control (135 patients) group. The median age was 60 years; 210 (77%) of the subjects were women, and 130 (48%) reported a previous Fracture as an adult. Six months after the Fracture, 30 (22%) of the intervention patients, as compared with 10 (7%) of the control patients, were receiving bisphosphonate therapy for osteoporosis (adjusted relative risk [RR] 2.6, 95% confidence interval [CI] 1.3–5.1, p = 0.008). Intervention patients were more likely than control patients to undergo bone mineral density testing (71/137 [52%] v. 24/135 [18%]; adjusted RR 2.8, 95% CI 1.9–4.2, p p Interpretation: A multifaceted intervention directed at high-risk patients and their physicians substantially increased rates of testing and treatment for osteoporosis. Nevertheless, more than half of the patients in the intervention group were not receiving appropriate care 6 months after their Fracture, which suggests that additional strategies should be explored. (ClinicalTrials.gov trial register no. NCT00152321.)
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educational intervention to reduce falls and fear of falling in patients after fragility Fracture results of a controlled pilot study
Preventive Medicine, 2006Co-Authors: Diana Rucker, David A Hanley, Anthony S Russell, Brian H Rowe, Jeffrey A Johnson, Ivan P Steiner, Walter P Maksymowych, Brian R Holroyd, Charles H Harley, Donald W MorrishAbstract:OBJECTIVES.: Falls and fear of falling are a major health problem. We sought to determine the effectiveness of an educational intervention in reducing fear of falling and preventing recurrent falls in community-dwelling patients after a fragility Fracture. METHODS.: One hundred two community-dwelling patients aged 50 years or older who fell and sustained a Wrist Fracture and were treated at Emergency Departments in Edmonton, Alberta, Canada (2001-2002) were allocated to either standardized educational leaflets and post-discharge telephone counseling regarding fall prevention strategies ("intervention") or attention-controls ("controls"). Main outcomes were fear of falling and recurrent falls 3 months after Fracture. RESULTS.: Mean age was 67 years and most patients were female (80%). The majority of falls (76%) leading to Fracture occurred outdoors. Three months post-Fracture, almost half of patients (48%) reported increased fear of falling and 11 of 102 (11%) reported falling again. The intervention did not reduce the fear of falling (43% had increased fear vs. 53% of controls, adjusted P value = 0.55) or decrease recurrent falls (17% fell vs. 5% of controls, adjusted P value = 0.059) within 3 months of Fracture. CONCLUSIONS.: An educational intervention undertaken in the Emergency Department was no more effective than usual care in reducing fear of falling or recurrent falls in community-dwelling patients. Future strategies must address a number of dimensions beyond simple education.
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a controlled trial to increase detection and treatment of osteoporosis in older patients with a Wrist Fracture
Annals of Internal Medicine, 2004Co-Authors: Sumit R Majumdar, Brian H Rowe, Jeffrey A Johnson, Ivan P Steiner, Walter P Maksymowych, Charles H Harley, Donald W Morrish, Deb Folk, Brian H Holroyd, Brian J WirzbaAbstract:In a multifaceted intervention directed at patients and their physicians, the rates of testing and treatment for osteoporosis after emergency department care for a fragility Fracture were more than...
