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Journal articleBehan F, Bull A, Beck B, et al., 2024,
Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation: a Delphi study
, British Journal of Sports Medicine, Vol: 58, ISSN: 0306-3674Objective To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise hip bone mineral density (BMD) loss following traumatic lower limb amputation.Methods In three Delphi rounds, statements were presented to a panel of 13 experts from six countries. Experts were identified through publications or clinical expertise. Round 1 involved participants rating their agreement with 22 exercise prescription statements regarding BMD loss post amputation using a 5-point Likert scale. Agreement was deemed as 3–4 on the scale (agree/strongly agree). Statements of <50% agreement were excluded. Round 2 repeated remaining statements alongside round 1 feedback. Round 3 allowed reflection on round 2 responses considering group findings and the chance to change or maintain the resp onse. Round 3 statements reaching ≥70% agreement were defined as consensus.Results All 13 experts completed rounds 1, 2 and 3 (100% completion). Round 1 excluded 12 statements and added 1 statement (11 statements for rounds 2–3). Round 3 reached consensus on nine statements to guide future exercise interventions. Experts agreed that exercise interventions should be performed at least 2 days per week for a minimum of 6 months, including at least three different resistance exercises at an intensity of 8–12 repetitions. Interventions should include weight-bearing and multiplanar exercises, involve high-impact activities and be supervised initially.Conclusion This expert Delphi process achieved consensus on nine items related to exercise prescription to minimise hip BMD loss following traumatic lower limb amputation. These recommendations should be tested in future interventional trials.
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Journal articleYork TJ, Szyszka B, Brivio A, et al., 2024,
A radiographic artificial intelligence tool to identify candidates suitable for partial knee arthroplasty
, Archives of Orthopaedic and Trauma Surgery, Vol: 144, Pages: 4963-4968, ISSN: 0936-8051Introduction: Knee osteoarthritis is a prevalent condition frequently necessitating knee replacement surgery, with demand projected to rise substantially. Partial knee arthroplasty (PKA) offers advantages over total knee arthroplasty (TKA), yet its utilisation remains low despite guidance recommending consideration alongside TKA in shared decision making. Radiographic decision aids exist but are underutilised due to clinician time constraints.Materials and Methods: This research develops a novel radiographic artificial intelligence (AI) tool using a dataset of knee radiographs and a panel of expert orthopaedic surgeons' assessments. Six AI models were trained to identify PKA candidacy. Results: 4,967 labelled four-view radiograph series were included. Models achieved statistically significant accuracies above random assignment, with EfficientNet-ES demonstrating the highest performance (AUC 95%, F1 score 83% and accuracy 80%). Conclusions: The AI decision tool shows promise in identifying PKA candidates, potentially addressing underutilisation of this procedure. Its integration into clinical practice could enhance shared decision making and improve patient outcomes. Further validation and implementation studies are warranted to assess real-world utility and impact.
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Journal articleChang R, Campbell A, Kent P, et al., 2024,
Improvements in Forward Bending Are Related to Improvements in Pain and Disability During Cognitive Functional Therapy for People With Chronic Low Back Pain
, JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, Vol: 54, Pages: 721-731, ISSN: 0190-6011 -
Journal articleZhao Y, Coppola A, Karamchandani U, et al., 2025,
Correction: Artificial intelligence applied to magnetic resonance imaging reliably detects the presence, but not the location, of meniscus tears: a systematic review and meta-analysis
, EUROPEAN RADIOLOGY, ISSN: 0938-7994 -
Journal articleRiley N, Kasza I, Hermsmeyer IDK, et al., 2024,
Dietary lipid is largely deposited in skin and rapidly affects insulating properties.
, Res SqSkin has been shown to be a regulatory hub for energy expenditure and metabolism: mutations of skin lipid metabolism enzymes can change the rate of thermogenesis and susceptibility to diet-induced obesity. However, little is known about the physiological basis for this function. Here we show that the thermal properties of skin are highly reactive to diet: within three days, a high fat diet reduces heat transfer through skin. In contrast, a dietary manipulation that prevents obesity accelerates energy loss through skins. We found that skin was the largest target in a mouse body for dietary fat delivery, and that dietary triglyceride was assimilated both by epidermis and by dermal white adipose tissue. Skin from mice calorie-restricted for 3 weeks did not take up circulating lipids and showed a highly depleted stratum corneum. Dietary triglyceride acyl groups persist in skin for weeks after feeding. Using multi-modal lipid profiling, we have implicated both keratinocytes and sebocytes in the altered lipids which correlate with thermal function. In response to high fat feeding, wax diesters and ceramides accumulate, and triglycerides become more saturated. In contrast, in response to the dramatic loss of adipose tissue that accompanies restriction of the branched chain amino acid isoleucine, skin becomes more heat-permeable, resisting changes induced by Western diet feeding, with a signature of depleted signaling lipids. We propose that skin should be routinely included in physiological studies of lipid metabolism, given the size of the skin lipid reservoir and its adaptable functionality.
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Journal articleSugand K, Park C, Aframian A, et al., 2024,
Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises
, Frontiers in Pediatrics, Vol: 12, ISSN: 2296-2360Introduction: The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact.Methods: A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance.Results: The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care.Discussion: The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surg
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Journal articleHadjipanayi C, Yin M, Bannon A, et al., 2024,
Remote gait analysis using ultra-wideband radar technology based on joint range-Doppler-time representation
, IEEE Transactions on Biomedical Engineering, Vol: 71, Pages: 2854-2865, ISSN: 0018-9294Objective: In recent years, radar technology has been extensively utilized in contactless human behavior monitoring systems. The unique capabilities of ultra-wideband (UWB) radars compared to conventional radar technologies, due to time-of-flight measurements, present new untapped opportunities for in-depth monitoring of human movement during overground locomotion. This study aims to investigate the deployability of UWB radars in accurately capturing the gait patterns of healthy individuals with no known walking impairments.Methods: A novel algorithm was developed that can extract ten clinical spatiotemporal gait features using the Doppler information captured from three monostatic UWB radar sensors during a 6-meter walking task. Key gait events are detected from lower-extremity movements based on the joint range-Doppler-time representation of recorded radar data. The estimated gait parameters were validated against a gold-standard optical motion tracking system using 12 healthy volunteers.Results: On average, nine gait parameters can be consistently estimated with 90-98% accuracy, while capturing 94.5% of participants' gait variability and 90.8% of inter-limb symmetry. Correlation and Bland-Altman analysis revealed a strong correlation between radar-based parameters and the ground-truth values, with average discrepancies consistently close to 0.Conclusion: Results prove that radar sensing can provide accurate biomarkers to supplement clinical human gait assessment, with quality similar to gold standard assessment.Significance: Radars can potentially allow a transition from expensive and cumbersome lab-based gait analysis tools toward a completely unobtrusive and affordable solution for in-home deployment, enabling continuous long-term monitoring of individuals for research and healthcare applications.
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Journal articleJohnson M-C, McGregor AH, A'Hern R, et al., 2024,
'I presumed the pain would eventually get better by itself'; challenges with access to rehabilitation for upper limb dysfunction after breast cancer treatment - descriptive and qualitative findings from a cross-sectional survey
, European Journal of Surgical Oncology, Vol: 50, ISSN: 0748-7983PURPOSE: Sixty percent of breast cancer patients develop persistent upper limb pain and dysfunction, but only limited knowledge exists about how these symptoms relate to rehabilitation access. METHODS: A postal survey was sent to patients treated at a London University Teaching Hospital (2018-2020). Data were collected on pain (Pain Detect), shoulder function (Disability of Shoulder Arm and Hand (DASH)), quality-of-life (QoL) (EQ-5D-5L), and clinical characteristics, including treatment and access to rehabilitation. The free-text section invited patients' comments on upper limb symptoms and management strategies, which were analysed thematically. Quantitative data were analysed descriptively, and the medians were examined with Mann-Whitley U-Tests or Kruskal-Wallis Test. RESULTS: Of 511 patients surveyed, 162 (32 %) questionnaires were returned and analysed. Respondents' mean age was 62 years (SD 11.3). The majority had Sentinel Node Biopsy 71 % (116/162) and mastectomy 61 % (99/162). 73 % (119/162) reported pain. Mean (SD) Pain Detect and DASH Score were respectively 11.07 (7) and 21.7 (21.5), with 51 % recording significant shoulder dysfunction, and only 28 % reporting access to rehabilitation. Individuals with neuropathic pain had significantly higher median (range) DASH score 60.8 (35.8, 75.0) p = 0.000. Median DASH score for sedentary individuals was significantly higher 22.9 (7.9, 31.8) p = 0.0009. Free-text analysis revealed persistent, progressive symptoms, mixed attitudes towards exercise and variations in access to rehabilitation and support. CONCLUSION: Two years following surgery many patients reported significant upper limb symptoms which adversely impact on QoL. However, approximately two thirds did not access potentially beneficial rehabilitation treatments. There is a need to improve pathways of care.
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Journal articleHancock M, Smith A, O'Sullivan P, et al., 2024,
Patients with worse disability respond best to cognitive functional therapy for chronic low back pain: a pre-planned secondary analysis of a randomised trial
, Journal of Physiotherapy, Vol: 70, Pages: 294-301, ISSN: 1836-9553QuestionDo five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?DesignSecondary analysis of the RESTORE randomised controlled trial.ParticipantsA total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.InterventionParticipants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care.Outcome measuresThe outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising.ResultsBaseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks.ConclusionThe finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients.RegistrationACTRN12618001396213.
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Journal articleKhan AM, Gupte CM, 2024,
Paediatric Knee Injuries: A Narrative Review
, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 85, ISSN: 1750-8460 -
Conference paperSgambato BG, Hakami H, Yang X, et al., 2024,
Towards natural multi-DoF prosthetic control with distributed ultrasound
, 2024 IEEE Ultrasonics, Ferroelectrics, and Frequency Control Joint Symposium (UFFC-JS), Publisher: IEEE, Pages: 1-6Powered hand prostheses are essential to support limb-difference users living independently. However, prosthesis abandonment rates are high due to a mismatch between the user’s needs and the performance of current surface electromyography-powered prostheses. Ultrasound has been proposed as an alternative modality of interfacing, but current work has mainly investigated offline scenarios or virtual benchtop validations. To advance in this area, we designed a custom socket and prosthesis solution with 32 distributed single-element transducers to record line-scanning ultrasound across the stump of one participant. A machine learning model was trained, allowing the participant to voluntarily control simultaneous wrist rotation and hand aperture. Offline cross-validation showed a high performance with an r-square of 0.69 ± 0.26. An Online experiment demonstrated that the participant was able to complete the virtual target achievement control task, the box and blocks test, and the clothespin relocation test in an accurate way. This marks the first functional demonstration of A-mode ultrasound-based simultaneous and proportional control, demonstrating its potential for natural and flexible control of prosthetic hands.
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Journal articleAllen J, Clunie G, Newman H, et al., 2024,
Comment on Chatwin et al. Waves of precision: a practical guide for reviewing new tools to evaluate mechanical in-exsufflation efficacy in neuromuscular disorders. J. Clin. Med. 2024, 13, 2643
, Journal of Clinical Medicine, Vol: 13, ISSN: 2077-0383We read with interest the paper published by Chatwin et al. [1], Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders in the April 2024 edition of the Journal of Clinical Medicine. The ways in which the respiratory (physio)therapy profession is embracing new tools to refine the efficacy of mechanical in-exsufflation (MI-E) are both innovative and fascinating, and we would like to congratulate the authors for establishing such an informative review. We do, however, have a couple of issues to query. As members of a speech and language therapy (SLT) group with a special interest and expertise in upper airway assessment using ultrasound and other adjuvant tools, we believe that this review is missing reference to contemporary literature specific to two key upper airway assessment methods: (1) cervical auscultation and (2) ultrasound. We write this letter in the interest of drawing the reader’s attention to this work. In the absence of empirical evidence, expert opinion plays an important role in clinical decision-making and the development of practice guidelines [2]. However, where evidence does exist, a balanced critique of current literature is necessary. This includes recognising the limitations of emerging assessment tools to ensure that readers are well-informed and that risks of misapplication are mitigated [2,3,4]. We hope our contribution will encourage appropriate use of cervical auscultation and ultrasound in clinical practice and facilitate a well-balanced understanding of their potential and, more importantly, constraints as tools to evaluate the upper airway.
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Journal articleAbel R, 2024,
The ontogeny of human fetal trabecular bone architecture occurs in a limb-specific manner
, Scientific Reports, Vol: 14, ISSN: 2045-2322Gestational growth and development of bone is an understudied process compared to soft tissues and has implications for lifelong health. This study investigated growth and development of human fetal limb bone trabecular architecture using 3D digital histomorphometry of microcomputed tomography data from the femora and humeri of 35 skeletons (17 female and 18 male) with gestational ages between 4 and 9 months. Ontogenetic data revealed: (i) fetal trabecular architecture is similar between sexes; (ii) the proximal femoral metaphysis is physically larger, with thicker trabeculae and greater bone volume fraction relative to the humerus, but other aspects of trabecular architecture are similar between the bones; (iii) between 4 and 9 months gestation there is no apparent sexual or limb dimorphism in patterns of growth, but the size of the humerus and femur diverges early in development. Additionally, both bones exhibit significant increases in mean trabecular thickness (and for the femur alone, bone volume fraction) but minimal trabecular reorganisation (i.e., no significant changes in degree of anisotropy, connectivity density, or fractal dimension). Overall, these data suggest that in contrast to data from the axial skeleton, prenatal growth of long bones in the limbs is characterised by size increase, without major reorganizational changes in trabecular architecture.
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Conference paperSoteriou I, Hadjixenophontos S, Musbahi O, et al., 2024,
Artificial Intelligence Approach in Hip Prosthesis Identification and Assessing Radiographic Outcome Measures
, 48th Annual Conference of the Association-of-Surgeons-in-Training (ASiT), Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323 -
Journal articleKuder I, Rock M, Jones G, et al., 2024,
An optimization approach for creating application-specific ultrasound speckle tracking algorithms
, Ultrasound in Medicine and Biology, Vol: 50, Pages: 1108-1121, ISSN: 0301-5629Objective:Ultrasound speckle tracking enables in vivo measurement of soft tissue deformation or strain, providing a non-invasive diagnostic tool to quantify tissue health. However, adoption into new fields is challenging since algorithms need to be tuned with gold-standard reference data that are expensive or impractical to acquire. Here, we present a novel optimization approach that only requires repeated measurements, which can be acquired for new applications where reference data might not be readily available or difficult to get hold of.Methods:Soft tissue motion was captured using ultrasound for the medial collateral ligament (MCL) of three quasi-statically loaded porcine stifle joints, and medial ligamentous structures of a dynamically loaded human cadaveric knee joint. Using a training subset, custom speckle tracking algorithms were created for the porcine and human ligaments using surrogate optimization, which aimed to maximize repeatability by minimizing the normalized standard deviation of calculated strain maps for repeat measurements. An unseen test subset was then used to validate the tuned algorithms by comparing the ultrasound strains to digital image correlation (DIC) surface strains (porcine specimens) and length change values of the optically tracked ligament attachments (human specimens).Results:After 1500 iterations, the optimization routine based on the porcine and human training data converged to similar values of normalized standard deviations of repeat strain maps (porcine: 0.19, human: 0.26). Ultrasound strains calculated for the independent test sets using the tuned algorithms closely matched the DIC measurements for the porcine quasi-static measurements (R > 0.99, RMSE < 0.59%) and the length change between the tracked ligament attachments for the dynamic human dataset (RMSE < 6.28%). Furthermore, strains in the medial ligamentous structures of the human specimen during flexion showed a strong correlation with anterior/posterior p
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Journal articleNair A, Alagha MA, Cobb J, et al., 2024,
Assessing the value of imaging data in machine learning models to predict patient-reported outcome measures in knee osteoarthritis patients
, Bioengineering, Vol: 11, ISSN: 2306-5354Knee osteoarthritis (OA) affects over 650 million patients worldwide. Total knee replacement is aimed at end-stage OA to relieve symptoms of pain, stiffness and reduced mobility. However, the role of imaging modalities in monitoring symptomatic disease progression remains unclear. This study aimed to compare machine learning (ML) models, with and without imaging features, in predicting the two-year Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for knee OA patients. We included 2408 patients from the Osteoarthritis Initiative (OAI) database, with 629 patients from the Multicenter Osteoarthritis Study (MOST) database. The clinical dataset included 18 clinical features, while the imaging dataset contained an additional 10 imaging features. Minimal Clinically Important Difference (MCID) was set to 24, reflecting meaningful physical impairment. Clinical and imaging dataset models produced similar area under curve (AUC) scores, highlighting low differences in performance AUC < 0.025). For both clinical and imaging datasets, Gradient Boosting Machine (GBM) models performed the best in the external validation, with a clinically acceptable AUC of 0.734 (95% CI 0.687–0.781) and 0.747 (95% CI 0.701–0.792), respectively. The five features identified included educational background, family history of osteoarthritis, co-morbidities, use of osteoporosis medications and previous knee procedures. This is the first study to demonstrate that ML models achieve comparable performance with and without imaging features.
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Journal articleBartolo MK, Newman S, Dandridge O, et al., 2024,
An ovine knee simulator: description and proof of concept
, Frontiers in Bioengineering and Biotechnology, Vol: 12, ISSN: 2296-4185Aims: The ovine stifle is an established model for evaluation of knee treatments, such as meniscus replacement. This study introduces a novel ovine gait simulator for pre-testing of surgical treatments prior to in vivo animal trials. Furthermore, we describe a pilot study that assessed gait kinematics and contact pressures of native ovine stifle joints and those implanted with a novel fiber-matrix reinforced polyvinyl alcohol-polyethylene glycol (PVA-PEG) hydrogel meniscus to illustrate the efficacy of the simulator.Methods: The gait simulator controlled femoral flexion-extension and applied a 980N axial contact force to the distal tibia, whose movement was guided by the natural ligaments. Five right ovine stifle joints were implanted with a PVA-PEG total medial meniscus replacement, fixed to the tibia via transosseous tunnels and interference screws. Six intact and five implanted right ovine stifle joints were tested for 500 k gait cycles at 1.55 Hz. Implanted stifle joint contact pressures and kinematics in the simulator were compared to the intact group. Contact pressures were measured at 55° flexion using pressure sensitive film inserted sub-meniscally. 3D kinematics were measured optically across two 30-s captures.Results: Peak contact pressures in intact stifles were 3.6 ± 1.0 MPa and 6.0 ± 2.1 MPa in the medial and lateral condyles (p < 0.05) and did not differ significantly from previous studies (p > 0.4). Medial peak implanted pressures were 4.3 ± 2.2 MPa (p > 0.4 versus intact), while lateral peak pressures (9.4 ± 0.8 MPa) were raised post medial compartment implantation (p < 0.01). The range of motion for intact joints was flexion/extension 37° ± 1°, varus/valgus 1° ± 1°, external/internal rotation 5° ± 3°, lateral/medial translation 2 ± 1 mm, anterior/posterior translation 3 ± 1 mm and distraction/compression 1 ± 1 mm. Ovine joint kinematics in t
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Journal articleGoh EL, Boughton OR, Donnelly T, et al., 2024,
Do joint-preserving hip procedures compromise subsequent total hip arthroplasty? A meta-analysis of complications, functional outcome and survivorship
, SICOT-J, Vol: 10, ISSN: 2426-8887 -
Journal articleDavies A, Sabharwal S, Liddle AD, et al., 2024,
Corrigendum.
, Bone Joint J, Vol: 106-B -
Journal articleDavies A, Liddle AD, Talaya MBZ, et al., 2024,
Revision rate in metal compared to ceramic humeral head total shoulder arthroplasty and hemiarthroplasty (vol 106, pg 482, 2024)
, BONE & JOINT JOURNAL, Vol: 106B, Pages: 1-1, ISSN: 2049-4394
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