- Email: [email protected]
Poster 37 Obesity and Rehabilitation Outcomes After Orthopaedic Trauma
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scores were observed with onabotulinumtoxinA 200 U (25.9) and 300 U (29.2) versus placebo (11.2) (P⬍.001 for both comparisons versus placebo); results at week 12 were similar. OAB-PSTQ total scores at weeks 6 and 12 also were improved for both the 200 U and 300 U onabotulinumtoxinA groups versus placebo; 20.6%, 58.4%, and 56.6% of patients in the placebo, onabotulinumtoxinA 200 U and onabotulinumtoxinA 300 U groups, respectively, reported they were very satisfied with treatment at week 6 (P⬍.001 versus placebo). Conclusions: Patients with NDO treated with onabotulinumtoxinA 200 U or 300 U had significantly improved QOL and greater treatment satisfaction compared with patients treated with placebo, with no clinically relevant differences in efficacy between onabotulinumtoxinA doses.
Poster 35 Evaluation of Correlation Between the Modified Balance Error Scoring System and the Sensory Organization Test as Measures of Postural Stability. Elena J. Jelsing, MD (Mayo Clinic, Rochester, MN, United States); Jonathan Finnoff, DO, John H. Hollman, PT, PhD, Desiree J. Lanzino, PhD, Cara Prideaux, MD, Yusef A. Sayeed, MD, MPH, MEng, Neil T. Shepard. Disclosures: E. J. Jelsing, none. Objective: To evaluate the Modified Balance Error Scoring System (M-BESS) as a measure of postural stability by comparing the M-BESS to the criterion standard of balance testing, the Sensory Organization Test (SOT), in a normal population. Design: A prospective, crossover design. Setting: The vestibular/balance laboratory of a tertiary medical center. Participants: 30 healthy subjects between the ages of 18 and 45 without musculoskeletal injury or a medical diagnosis that affects balance. Interventions: Subjects completed, in a random order, both MBESS and SOT testing. Main Outcome Measures: Pearson correlation coefficient was used to correlate the composite scores of the M-BESS and the SOT. Results: There was no statistically significant correlation between the M-BESS and SOT composite scores (r⫽0.090; P⫽.636). Conclusions: Postural stability testing is frequently performed in healthy individuals before participating in sports that have a high risk for concussion, such as hockey or football. Postural stability tests are repeated after a concussion, and the postconcussion values are compared with the preconcussion values to determine whether a postural stability deficit exists and to assist with return-to-play decision making. Unfortunately, this study was unable to validate the M-BESS as a test for postural stability. Future studies may wish to include subjects with postural stability deficits, such as athletes with concussion, to determine whether the M-BESS is a valid postural stability measure in this population.
Poster 36 Monopolar Capacitive Coupled Radiofrequency and Platelet-rich Plasma for Treatment of Common Musculoskeletal Conditions. Joseph Cronkey, MD (Private Practice, Dunmore, PA, United States).
PRESENTATIONS
Disclosures: J. Cronkey, Alpha Orthopaedics, Inc, stock options or bond holdings. Objective: Emergent technologies, that is, monopolar capacitive coupled radiofrequency (mcRF) and platelet-rich plasma (PRP) are now available to treat conditions characterized by a failed healing response. PRP, in particular, is also indicated for the treatment of degenerative joint disease. Both mcRF and PRP positively influence the chemical and/or cellular inflammatory cascade to promote healing. The mcRF application results in temperature elevation at the targeted structure up to 50°C, which stimulates heat shock proteins and incites the wound healing response. Ultrasound-guided PRP injections result in an inflammatory-reparative reaction through cytokinin release. Design: A prospective, controlled trial. Setting: The study was conducted in an office setting. Participants: Eighty-nine patients who have failed previous conservative treatment for tendinopathies of the elbow, quadriceps, patellar, and Achilles tendon and plantar fasciopathy. Interventions: Study subjects were treated either with mcRF or PRP. PRP was the only treatment option for patients with osteoarthrosis and rotator cuff pathology, including tendinosis and partial tears. Treatments were delivered directly by the investigator, and the patients were followed-up prospectively for an average of 9 months (range, 3-15 months). Main Outcome Measures: Pain scores and patient satisfaction. Results: The average age for the mcRF cohort was 53 years (range, 17-88 years) and 58 years for the PRP group (range, 19-90 years). The male to female ratio was 1:1. Thirty-three of 42 patients treated with mcRF experienced marked improvement (78%), whereas, in the PRP group, 33 of 47 patients experienced marked improvement (70%) as self-assessed by the study subjects. Conclusions: The results of this study are in agreement with published data on the use of both technologies; however, this is the first time that a side-by-side comparison was established. PRP and mcRF represent a new approach to musculoskeletal pathology; both modalities aim at inducing a biologic response and are considered at the frontier of regenerative therapeutics. The risk-benefit ratio found suggests that these noninvasive, office-based alternatives for the management of musculoskeletal conditions are valuable tools and should be used based on a clear understanding of the underlying pathology.
Poster 37 Obesity and Rehabilitation Outcomes After Orthopaedic Trauma. Heather K. Vincent, PhD (University of Florida, Gainesville, FL, United States); James W. Atchison, DO, Kelley M. Lamb, BS, Kalia Sadasivan, MD, Amanda Seay, Kevin R. Vincent, MD, PhD. Disclosures: H. K. Vincent, none. Objective: Obesity is a risk factor for perisurgical complications after orthopedic trauma and is independently related with functional impairment. The purpose of this study was to determine whether rehabilitation outcomes differ based on body mass index (BMI) after surgical care for orthopedic trauma. Design: This was a retrospective study. Patients or Programs: 298 patients with orthopedic trauma (46.2 years).
PM&R
Setting: A tertiary care facility and an affiliated inpatient rehabilitation hospital. Interventions: NA. Main Outcome Measures: Main outcomes were Functional Independence Measure (FIM) ratings, musculoskeletal pain (numerical score from 0 [none] to 10 [worst]), length of stay (LOS), postsurgical complications, therapy participation, and discharge destination. Results: LOS was not different between groups (9.0 versus 9.9 days). The FIM rating at discharge was lower in patients who were obese than patients who were not obese (74.9 versus 82.6 points) and the change in FIM rating was 13% lower in the obese group. This FIM efficiency (points gained per day) was lower in the obese group (2.6 versus 3.0 FIM points gained per day; P⫽.031). Discharge pain scores were lower in the obese group (2.9 versus 3.9 points; P⫽.05).Common complications in the nonobese and obese groups were infections (13%, 17%), anemia (7%, 10%), and respiratory distress (5% for both). The percentage of days that the patients in the nonobese and the obese groups participated in therapies was 91% and 92%; therapy intensity (sessions per day) was 5.1 and 5.3 for these groups. Similar proportions of patients achieved independence or supervision only with tasks such as upper and lower body dressing, transfers, stair climbing, and walking after rehabilitation. Activities that the fewest patients in both groups were able to obtain complete independence or supervision only were walking (12.8%-14.8% of the groups) and stair climbing (1.8%-4.3% of the groups). However, 81% and 88% of the 2 groups were discharged home. Conclusions: Obesity does not preclude improvements in functional independence during rehabilitation after orthopedic trauma, which may be due to rigorous prescreening before acceptance of admission into rehabilitation. However, the rate and magnitude of improvement are less in persons with BMIⱖ30 kg/m2 and should be considered when making plans of care for recovery in the home.
Poster 38 The Neurological Impairment Scale: A Predictor of Functional Outcome in Patients With Severe Complex Disability. Lynne F. Turner-Stokes, DM, FRCP (King’s College London, London, United Kingdom); Richard Siegert, PhD, Aung Thu, FRCP, Heather Williams, MSc. Disclosures: L. F. Turner-Stokes, Ipsen Ltd, consulting fees or other remuneration; UK National Institute for Health Research, research grants; Allergan Ltd, consulting fees or other remuneration; Dunhill Medical Trust, research grants; Luff Foundation, research grants. Objective: To examine the relationship between the Neurological Impairment Scale (NIS) and the UK Functional Assessment Measure (UKFIM⫹FAM), and to assess the NIS as a predictor of (a) functional status at discharge and (b) change in function during rehabilitation. Design: An analysis of routinely collected data from a prospective cohort collected over 15 months, from September 1, 2009 to November 30, 2010. Setting: A tertiary specialist inpatient neurologic rehabilitation unit. Participants: 82 patients with severe complex disability (mean [SD] age, 42⫾14.6 years; mean [SD] length of stay, 117⫾61 days:
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35 (43%) had stroke, 35 (43%) other acquired brain injury, 12 (15%) spinal cord and/or peripheral neurologic or other conditions. Interventions: An inpatient rehabilitation program. Main Outcome Measures: The NIS is a scale of severity of impairment that comprises 13 items (each rated 0-4 and gives a total score range of 0-50) mapped onto the International Classification of Functioning (ICF). The UK FIM⫹FAM adds 12 items to the Functional Independence Measure (FIM) to form a 30-item functional status scale, which comprise 16 motor and 14 cognitive items. The scores were rated by the multidisciplinary team on admission and discharge. Results: Median (interquartile range [IQR]) NIS total scores were 19 (range, 14-30) on admission and 16 (range, 10-21) on discharge: a median change of –3 (0 to –7) (Wilcoxon z, – 4.8; P⬍.001). Total FIM⫹FAM scores were 127 (range, 55-158) admission, 167 (range, 120-185) discharge: median change 28 (range, 11-51) (z, – 6.7; P⬍.001). NIS admission scores correlated strongly with FAMMotor and FAM-Cognitive discharge scores (, 0.87 and 0.68; P⬍.001]). Two stepwise multiple regressions were conducted. Predictors of variance in discharge FAM score were the following: NIS-admission score, 83%; NIS-change score, 7%; FIM-admission, 1.6%. Predictors of variance in FAM change score were NIS-change, 29%; NIS-admission score, 6%; and FIM-admission score, 30%. Conclusions: Collected alongside the UKFIM⫹FAM, the NIS score on admission is a useful predictor of functional outcome. Functional gain is determined to a significant extent by change in impairment, but it also depends on functional status at baseline.
Poster 39 A Quantitative Assessment of Ipsilateral Knee Pain: Improvement After Hip Arthroplasty. Wenbao Wang, MD (Columbia University Medical Center, New York, NY, United States); Jung Keun Choi, MD, Jeffrey A. Geller, MD, William Macaulay, MD, Jonathan D. Nyce, BS. Disclosures: W. Wang, none. Objective: Ipsilateral knee pain (IKP) is commonly associated with many intra-articular hip pathologies and other sources of pain referred from the lumbar spine and pelvic area. The purpose of this study was to evaluate the pattern of IKP before and after hip arthroplasty. We hypothesized that hip pathology was one of the causes of preoperative IPK and that it would demonstrate significant improvement after hip arthroplasty. Design: A retrospective, self-controlled study. Setting: A center for hip and knee replacement. Participants: Prospectively collected complete patient data of 252 subjects were retrospectively reviewed. Interventions: We performed primary and revision total hip arthroplasty (THA), metal-on-metal hip resurfacing (MOMHR), or conversion THA. Main Outcome Measures: Western Ontario McMaster Osteoarthritis Index pain score of each joint before surgery, at 3 months, and 1 year after surgery. Results: 245 patients (96.1%) had at least 1 follow-up set of data at 3 months or 1 year. Before surgery, 141 of 255 (55.3%) had IKP, which was much higher than the contralateral side (45/255 [17.6%]), P⬍.0001. Also, the IKP score (79.7⫾26.5) was significantly lower than that of the contralateral side (94.8⫾14.9), P⬍.001. IKP showed marked improvement, to 95.7⫾11.8 and
scores were observed with onabotulinumtoxinA 200 U (25.9) and 300 U (29.2) versus placebo (11.2) (P⬍.001 for both comparisons versus placebo); results at week 12 were similar. OAB-PSTQ total scores at weeks 6 and 12 also were improved for both the 200 U and 300 U onabotulinumtoxinA groups versus placebo; 20.6%, 58.4%, and 56.6% of patients in the placebo, onabotulinumtoxinA 200 U and onabotulinumtoxinA 300 U groups, respectively, reported they were very satisfied with treatment at week 6 (P⬍.001 versus placebo). Conclusions: Patients with NDO treated with onabotulinumtoxinA 200 U or 300 U had significantly improved QOL and greater treatment satisfaction compared with patients treated with placebo, with no clinically relevant differences in efficacy between onabotulinumtoxinA doses.
Poster 35 Evaluation of Correlation Between the Modified Balance Error Scoring System and the Sensory Organization Test as Measures of Postural Stability. Elena J. Jelsing, MD (Mayo Clinic, Rochester, MN, United States); Jonathan Finnoff, DO, John H. Hollman, PT, PhD, Desiree J. Lanzino, PhD, Cara Prideaux, MD, Yusef A. Sayeed, MD, MPH, MEng, Neil T. Shepard. Disclosures: E. J. Jelsing, none. Objective: To evaluate the Modified Balance Error Scoring System (M-BESS) as a measure of postural stability by comparing the M-BESS to the criterion standard of balance testing, the Sensory Organization Test (SOT), in a normal population. Design: A prospective, crossover design. Setting: The vestibular/balance laboratory of a tertiary medical center. Participants: 30 healthy subjects between the ages of 18 and 45 without musculoskeletal injury or a medical diagnosis that affects balance. Interventions: Subjects completed, in a random order, both MBESS and SOT testing. Main Outcome Measures: Pearson correlation coefficient was used to correlate the composite scores of the M-BESS and the SOT. Results: There was no statistically significant correlation between the M-BESS and SOT composite scores (r⫽0.090; P⫽.636). Conclusions: Postural stability testing is frequently performed in healthy individuals before participating in sports that have a high risk for concussion, such as hockey or football. Postural stability tests are repeated after a concussion, and the postconcussion values are compared with the preconcussion values to determine whether a postural stability deficit exists and to assist with return-to-play decision making. Unfortunately, this study was unable to validate the M-BESS as a test for postural stability. Future studies may wish to include subjects with postural stability deficits, such as athletes with concussion, to determine whether the M-BESS is a valid postural stability measure in this population.
Poster 36 Monopolar Capacitive Coupled Radiofrequency and Platelet-rich Plasma for Treatment of Common Musculoskeletal Conditions. Joseph Cronkey, MD (Private Practice, Dunmore, PA, United States).
PRESENTATIONS
Disclosures: J. Cronkey, Alpha Orthopaedics, Inc, stock options or bond holdings. Objective: Emergent technologies, that is, monopolar capacitive coupled radiofrequency (mcRF) and platelet-rich plasma (PRP) are now available to treat conditions characterized by a failed healing response. PRP, in particular, is also indicated for the treatment of degenerative joint disease. Both mcRF and PRP positively influence the chemical and/or cellular inflammatory cascade to promote healing. The mcRF application results in temperature elevation at the targeted structure up to 50°C, which stimulates heat shock proteins and incites the wound healing response. Ultrasound-guided PRP injections result in an inflammatory-reparative reaction through cytokinin release. Design: A prospective, controlled trial. Setting: The study was conducted in an office setting. Participants: Eighty-nine patients who have failed previous conservative treatment for tendinopathies of the elbow, quadriceps, patellar, and Achilles tendon and plantar fasciopathy. Interventions: Study subjects were treated either with mcRF or PRP. PRP was the only treatment option for patients with osteoarthrosis and rotator cuff pathology, including tendinosis and partial tears. Treatments were delivered directly by the investigator, and the patients were followed-up prospectively for an average of 9 months (range, 3-15 months). Main Outcome Measures: Pain scores and patient satisfaction. Results: The average age for the mcRF cohort was 53 years (range, 17-88 years) and 58 years for the PRP group (range, 19-90 years). The male to female ratio was 1:1. Thirty-three of 42 patients treated with mcRF experienced marked improvement (78%), whereas, in the PRP group, 33 of 47 patients experienced marked improvement (70%) as self-assessed by the study subjects. Conclusions: The results of this study are in agreement with published data on the use of both technologies; however, this is the first time that a side-by-side comparison was established. PRP and mcRF represent a new approach to musculoskeletal pathology; both modalities aim at inducing a biologic response and are considered at the frontier of regenerative therapeutics. The risk-benefit ratio found suggests that these noninvasive, office-based alternatives for the management of musculoskeletal conditions are valuable tools and should be used based on a clear understanding of the underlying pathology.
Poster 37 Obesity and Rehabilitation Outcomes After Orthopaedic Trauma. Heather K. Vincent, PhD (University of Florida, Gainesville, FL, United States); James W. Atchison, DO, Kelley M. Lamb, BS, Kalia Sadasivan, MD, Amanda Seay, Kevin R. Vincent, MD, PhD. Disclosures: H. K. Vincent, none. Objective: Obesity is a risk factor for perisurgical complications after orthopedic trauma and is independently related with functional impairment. The purpose of this study was to determine whether rehabilitation outcomes differ based on body mass index (BMI) after surgical care for orthopedic trauma. Design: This was a retrospective study. Patients or Programs: 298 patients with orthopedic trauma (46.2 years).
PM&R
Setting: A tertiary care facility and an affiliated inpatient rehabilitation hospital. Interventions: NA. Main Outcome Measures: Main outcomes were Functional Independence Measure (FIM) ratings, musculoskeletal pain (numerical score from 0 [none] to 10 [worst]), length of stay (LOS), postsurgical complications, therapy participation, and discharge destination. Results: LOS was not different between groups (9.0 versus 9.9 days). The FIM rating at discharge was lower in patients who were obese than patients who were not obese (74.9 versus 82.6 points) and the change in FIM rating was 13% lower in the obese group. This FIM efficiency (points gained per day) was lower in the obese group (2.6 versus 3.0 FIM points gained per day; P⫽.031). Discharge pain scores were lower in the obese group (2.9 versus 3.9 points; P⫽.05).Common complications in the nonobese and obese groups were infections (13%, 17%), anemia (7%, 10%), and respiratory distress (5% for both). The percentage of days that the patients in the nonobese and the obese groups participated in therapies was 91% and 92%; therapy intensity (sessions per day) was 5.1 and 5.3 for these groups. Similar proportions of patients achieved independence or supervision only with tasks such as upper and lower body dressing, transfers, stair climbing, and walking after rehabilitation. Activities that the fewest patients in both groups were able to obtain complete independence or supervision only were walking (12.8%-14.8% of the groups) and stair climbing (1.8%-4.3% of the groups). However, 81% and 88% of the 2 groups were discharged home. Conclusions: Obesity does not preclude improvements in functional independence during rehabilitation after orthopedic trauma, which may be due to rigorous prescreening before acceptance of admission into rehabilitation. However, the rate and magnitude of improvement are less in persons with BMIⱖ30 kg/m2 and should be considered when making plans of care for recovery in the home.
Poster 38 The Neurological Impairment Scale: A Predictor of Functional Outcome in Patients With Severe Complex Disability. Lynne F. Turner-Stokes, DM, FRCP (King’s College London, London, United Kingdom); Richard Siegert, PhD, Aung Thu, FRCP, Heather Williams, MSc. Disclosures: L. F. Turner-Stokes, Ipsen Ltd, consulting fees or other remuneration; UK National Institute for Health Research, research grants; Allergan Ltd, consulting fees or other remuneration; Dunhill Medical Trust, research grants; Luff Foundation, research grants. Objective: To examine the relationship between the Neurological Impairment Scale (NIS) and the UK Functional Assessment Measure (UKFIM⫹FAM), and to assess the NIS as a predictor of (a) functional status at discharge and (b) change in function during rehabilitation. Design: An analysis of routinely collected data from a prospective cohort collected over 15 months, from September 1, 2009 to November 30, 2010. Setting: A tertiary specialist inpatient neurologic rehabilitation unit. Participants: 82 patients with severe complex disability (mean [SD] age, 42⫾14.6 years; mean [SD] length of stay, 117⫾61 days:
Vol. 3, Iss. 10S1, 2011
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35 (43%) had stroke, 35 (43%) other acquired brain injury, 12 (15%) spinal cord and/or peripheral neurologic or other conditions. Interventions: An inpatient rehabilitation program. Main Outcome Measures: The NIS is a scale of severity of impairment that comprises 13 items (each rated 0-4 and gives a total score range of 0-50) mapped onto the International Classification of Functioning (ICF). The UK FIM⫹FAM adds 12 items to the Functional Independence Measure (FIM) to form a 30-item functional status scale, which comprise 16 motor and 14 cognitive items. The scores were rated by the multidisciplinary team on admission and discharge. Results: Median (interquartile range [IQR]) NIS total scores were 19 (range, 14-30) on admission and 16 (range, 10-21) on discharge: a median change of –3 (0 to –7) (Wilcoxon z, – 4.8; P⬍.001). Total FIM⫹FAM scores were 127 (range, 55-158) admission, 167 (range, 120-185) discharge: median change 28 (range, 11-51) (z, – 6.7; P⬍.001). NIS admission scores correlated strongly with FAMMotor and FAM-Cognitive discharge scores (, 0.87 and 0.68; P⬍.001]). Two stepwise multiple regressions were conducted. Predictors of variance in discharge FAM score were the following: NIS-admission score, 83%; NIS-change score, 7%; FIM-admission, 1.6%. Predictors of variance in FAM change score were NIS-change, 29%; NIS-admission score, 6%; and FIM-admission score, 30%. Conclusions: Collected alongside the UKFIM⫹FAM, the NIS score on admission is a useful predictor of functional outcome. Functional gain is determined to a significant extent by change in impairment, but it also depends on functional status at baseline.
Poster 39 A Quantitative Assessment of Ipsilateral Knee Pain: Improvement After Hip Arthroplasty. Wenbao Wang, MD (Columbia University Medical Center, New York, NY, United States); Jung Keun Choi, MD, Jeffrey A. Geller, MD, William Macaulay, MD, Jonathan D. Nyce, BS. Disclosures: W. Wang, none. Objective: Ipsilateral knee pain (IKP) is commonly associated with many intra-articular hip pathologies and other sources of pain referred from the lumbar spine and pelvic area. The purpose of this study was to evaluate the pattern of IKP before and after hip arthroplasty. We hypothesized that hip pathology was one of the causes of preoperative IPK and that it would demonstrate significant improvement after hip arthroplasty. Design: A retrospective, self-controlled study. Setting: A center for hip and knee replacement. Participants: Prospectively collected complete patient data of 252 subjects were retrospectively reviewed. Interventions: We performed primary and revision total hip arthroplasty (THA), metal-on-metal hip resurfacing (MOMHR), or conversion THA. Main Outcome Measures: Western Ontario McMaster Osteoarthritis Index pain score of each joint before surgery, at 3 months, and 1 year after surgery. Results: 245 patients (96.1%) had at least 1 follow-up set of data at 3 months or 1 year. Before surgery, 141 of 255 (55.3%) had IKP, which was much higher than the contralateral side (45/255 [17.6%]), P⬍.0001. Also, the IKP score (79.7⫾26.5) was significantly lower than that of the contralateral side (94.8⫾14.9), P⬍.001. IKP showed marked improvement, to 95.7⫾11.8 and